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PROVIDER FORMS AND RESOURCES

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  • The 2023 Provider Manual is now available.
  • Opioid- Related Educational Resources (Free CME)
    • The National Committee for Quality Assurance (NCQA) and Boston University School of Medicine have developed two new opioid related CME opportunities that address how to treat opioid misuse disorder in the primary care setting. The CME are provided free of charge.

    • GlobalHealth supports safe, effective treatment with various activities, such as provider and member education, Provider Behavioral Health toolkits and behavioral health and substance abuse treatment. GlobalHealth collects and reports annual data on two HEDIS opioid related measures. Our pharmacy team monitors opioid prescriptions for high dosages, multiple fills, multiple providers and/or pharmacies. When these are identified, we work with the provider(s) and member to ensure clear communication and coordination of care.  

    • While the programs are developed for Primary Care, GlobalHealth encourages all of our network providers to review the information.

    • Additional resources:
  • Prescribing Biosimilars
    • With the increasingly complex usage of biologic medications and biosimilars it is important to provide provider based education and methods for encouraging the use of biosimilars.
    • Additional Resources: Biosimilar Product Regulatory Review and Approval

On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available machine-readable files that include in-network negotiated payment rates and historical out - of network charges for covered items and services, including prescriptions drugs. The requirements in this rule will give consumers the tools needed to access pricing information through their health plans.

For more information about the Transparency in Coverage rule, please click here to access CMS final rule.

Insurers and Plans are required to publish Machine Readable Files and make available to public by 07/01/2022. Data in machine readable files must be updated monthly.

To access GlobalHealth MRF file please click below.