• Provider Toolkit

• GlobalHealth Commercial Plans Claim Reconsideration Request Form
• Generations Medicare Advantage Plans Reconsideration Request Form
• Certification of Treating Health Care Provider (English) (en Espanol)
• Physician Certification - Experimental or Investigational Denials (English) (en Espanol)
• Waiver of Liability Form

GlobalHealth has partnered with Change Healthcare to provide real-time solution to our providers to request information like eligibility, benefits and remaining out of pocket amount for our members.
To take advantage, please contact your Practice Management System Vendor or Change Healthcare Customer Support to update your systems.

GlobalHealth’s Payer ID for requesting Eligibility and Benefits inquiry is GLOBH.
If you are a Participating provider, you can also login to our Provider Portal to review member’s eligibility, benefits, claim status and member’s current out of pocket amount. Find out more here: https://globalhealth.com/oklahoma/providers/globallink/

• Medicare Advantage Provider Portal User Guide
• Medicare Advantage Provider Portal Quick Reference Guide

• 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:

    • SCOPE of Pain

    • Expanding Access to Medications for Opioid Use Disorder in the Primary Care Setting

• 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

• Updated Vaccination Information Sheets (VIS)

  • The CDC routinely reviews and updates the Vaccine Information Sheets (VIS) that you are required by law to give patients when you give a vaccine. Please check here for current VIS. VIS are also available in many languages at http://www.immunize.org/vis/. The website provides additional resources about immunization  for providers, staff and patients.

• CDC Epidemiology and Prevention of Vaccine-Preventable Diseases ("Pink Book" - 13th ed.)
   
  • The 13th Edition Epidemiology and Prevention of Vaccine-Preventable Diseases, a.k.a. the “Pink Book,” provides physicians, nurses, nurse practitioners, physician assistants, pharmacists, and others with the most comprehensive information on routinely used vaccines and the diseases they prevent. Six appendices contain a wealth of reference materials including: vaccine minimum ages and intervals, current and discontinued vaccines, vaccine contents, foreign vaccine terms, and more. Also available at: https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

• Commercial Pharmacy
  • Prescription Drug Transition of Care Form
  • Prior Authorization Form
    • Use the above Prior Authorization Form for Prescription Drug Prior Authorizations and Formulary Exceptions.
• Medicare Advantage Pharmacy
  • Request for Medicare Prescription Drug Coverage Determination Form
  • Request for Medicare Prescription Drug Appeal (Redetermination) Form
    • Use the above Coverage Determination Form for Exceptions, Prescription Drug Prior Authorization, Quantity Limits, Step Therapy, and Reimbursements.
• Prescription Drug Cost Calculators

• Medical Policies
• 2023 Provider Manual
• Provider Training
• GlobalLink Training
• Site of Care Form

• 2018 Affirmation Statement about Incentives
• Quality Improvement Program
• Medicare Stars Program Overview
• Care Management and Preauthorization Requirements
• Preventive Care Recommendations and Clinical Practice Guidelines (Updated 2020)

• Quality Portal How To Guide (PDF)
• Quality Portal Reporting Guide (PDF)
• Quality Portal Frequently Asked Questions (PDF)
• Quality Portal Registration Guide (PDF)
• 5-STAR Guide (PDF)