GlobalHealth has partnered with Zelis to provide electronic claims remittance and payments for our Medicare business. Electronic remittance advice and payments are available for our providers submitting claims for our Medicare business starting with dates of service January 1, 2022. To learn more and enroll for electronic payments and remittance, please click here.
WORKING WITH GLOBALHEALTH
GlobalHealth has been a provider- and member-centric organization since its beginning in the state of Oklahoma. The health plan was started by a group of primary care physicians who were passionate about improving patient outcomes and controlling healthcare spend by focusing on patient service and quality outcomes.
GlobalHealth plans are designed to encourage members to receive proper healthcare while reducing out-of-pocket expenses. We align our plans with strong benefits, including $0 unlimited primary care physician visits, and most plans have no medical or drug deductibles.
We are driven by our passion to deliver the best healthcare coverage in the industry. We are committed to continuous innovation and comprehensive member engagement to earn the satisfaction and confidence of those we serve.
We aspire to earn and retain provider confidence and trust in us.
We believe in developing and maintain valued relationships with our partners.
We believe managing and navigating healthcare should be easier. This starts by developing and maintaining valued relationships with our members and network provider partners.
At GlobalHealth, we:
- Listen to the needs of outreach managers and clinicians and share information that allows them to refine their services.
- Deliver insights that allow nurses to coordinate and facilitate available healthcare services to support our members.
- Give our providers solutions that go beyond standard healthcare options.
- Serve members using a proactive outreach strategy that includes finding community resources, scheduling appointments and coordinating healthcare services to navigate a complex healthcare system.
Specialist Authorization – Medicare Advantage Plans Only
GlobalHealth does not require prior authorizations for network specialist office visits. Members have direct access to set up an office visit appointment with a network specialist physician.
Certain services rendered or referred by specialist physicians require prior authorizations. Services include, but are not limited to: outpatient surgery, physical therapy, cardiac rehabilitation, Part B drugs, and specialized diagnostic tests such as MRIs. These are only examples. Please refer to the plan Evidence of Coverage or call Customer Care if you have any questions about whether a service requires prior authorization.
Please note that this only applies to Medicare Advantage plans.
GlobalHealth Generations Classic Choice offers a Point-of-Service Plan
Members will have access to some out-of-network services:
- Inpatient admissions
- Some outpatient hospital services
- Specialist office visits
- Eye exams
- Skilled nursing facility care
All out-of-network services require referral and prior authorization. Other care must be through in-network providers.
Find all the resources you need as a provider right here. Click here for forms and other resources.
Healthcare services, such as for specialty care, hospitalizations, and outpatient surgery require preauthorization from GlobalHealth. Authorization requests are processed through the Provider Portal which is an online tool available to all contracted providers.
Commercial Prescription Referral Information
To request a prescription referral, click here. You may contact the Pharmacy Department at (918) 878-7361, 8 am - 5 pm CST, Monday - Friday, to speak to a representative from the Pharmacy Department. If no one is available, please leave a message and your call will be returned as soon as possible. You may also fax the information to us at (405) 280-5613.
Medicare Coverage Determinations Information
To request a coverage decision for Part D Prescription Drugs, contact GlobalHealth's Pharmacy Benefit Manager, CVS Caremark, by calling (866)-494-3927 (TTY users call 711), 24 hours a day, 7 days a week, or by writing to:
CVS Caremark Part D Services
C/O:Coverage Determination & Appeals
PO Box 52000
Phoenix, AZ 85072-2000
Or via Fax: 855-633-7673
Need to request a Part D Coverage Determination? Click here.