WORKING WITH GLOBALHEALTH

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.

Relationships

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.

Important Notices to Providers

Provider Manual Update

Click here to view the 2020 Provider Manual or the 2021 Provider Manual. It includes valuable information about working with GlobalHealth and our policies. Please become familiar with it as it is an extension of your provider contract.

For a deep dive into the Provider Manual with a Q&A session, register for a training session. Click here.

Specialist Authorization Changes – Medicare Advantage Plans Only

GlobalHealth no longer require prior authorizations for specialist office visits. Members have direct access to set up an office visit appointment with a specialist physician.

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 – Generations Classic (HMO), Generations Select (HMO), Generations Value (HMO), Generations Classic Choice (HMO-POS), and Generations State of Oklahoma Group Retirees (HMO). All other plans will continue to have the same prior authorization process as is in place today. There are no changes to the specialist authorization requirements for GlobalHealth’s commercial products.

Point-of-Service Plan

GlobalHealth is introducing a new HMO-POS plan type in 2021, Generations Classic Choice.

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.

COVID-19 for Medicare Advantage

GlobalHealth will be waiving cost share through the end of 2021 when treatment is for COVID-19 regardless of when the public health emergency declaration ends.  Services with waived cost sharing include:

• Emergency services
• Inpatient hospital care
• Medicare Part B prescription drugs
• Observation services
• Specialist visits
• Skilled nursing facility
• Urgently needed services

COVID-19 Vaccine Coverage

Resources

Find all the resources you need as a provider right here. Click here for forms and other resources. Get answers to many questions on the FAQ page or contact Provider Relations.

GlobalHealth Products

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.

• Plan for State, Education and Local Government Employees
• Plan options for Federal Employees
• Plans for Medicare-eligible beneficiaries – Generations Medicare Advantage Plans
• Plan for Medicare-eligible State of Oklahoma Retirees – Generations State of Oklahoma Group Retirees Medicare Advantage Plan
• Plans for Large Groups

Important Changes Effective November 3, 2016: GlobalHealth implements new claims editing system. Click here to read full details.

Medical Authorizations

Healthcare services, such as for specialty care, hospitalizations, and outpatient surgery require preauthorization from GlobalHealth. Authorization requests are processed through GlobalLink™, an online tool available to all contracted providers.

Need to process a medical referral? Click here.

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 Coverage Appeals and Exceptions
Department MC 109
P.O. Box 52000
Phoenix, AZ 85072-2000

Or via Fax: 855-633-7673
 

Need to request a Part D Coverage Determination? Click here.