PROVIDER FORMS AND RESOURCES

Important Notices for Providers

• The 2019 Provider Manual is now available.
• Avoidance of Antibiotics in Adults with Acute Bronchitis
• Cervical Cancer Screening
• Important Information on Coordination of Care
• Use of Imaging Studies for Low Back Pain

Providers

• Medical Policies
• 2019 Provider Manual (Revised Jan 2019)
• Frequently Asked Questions from Providers
• Provider Update Form
• Provider Training
• GlobalLink Training
• Preventive Care Recommendations and Clinical Practice Guidelines (Update 2018)
• Certification of Treating Health Care Provider (English) (en Espanol)
• Physician Treatment Request Form (Medical Prior Authorization)
• Physician Certification - Experimental or Investigational Denials (English) (en Espanol)
• Site of Care Form
• 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

Quality

• 2018 Affirmation Statement about Incentives
• Quality Improvement Program
• Quality Improvement Program Update/HEDIS Measure Summary
• Medicare Stars Program Overview
• Care Management and Preauthorization Requirements

Claims

• GlobalHealth Commercial Plans Claim Reconsideration Request Form
• Generations Medicare Advantage Plans Reconsideration Request Form
• EDI Claims Submitter Request Form

Behavioral Health

• Oklahoma Standard Authorization to Use or Share Protected Health information
• Mental Health, Chemical Dependency & Substance Abuse Coordination of Care Screening and Referral Form Instructions
• Mental Health, Chemical Dependency & Substance Abuse Coordination of Care Screening and Referral Form

Pharmacy

Commercial

2019 Forms

• Home Delivery Order Form
• Specialty Drug Enrollment Form
• Prescription Drug Claim Form
• Prescription Drug Pricing Tool
• Prescription Drug Transition of Care Form
• Prior Authorization Form
  • Use the above Prior Authorization Form for Prescription Drug Prior Authorizations and Formulary Exceptions.

2018 Forms

• Home Delivery Order Form
• Specialty Drug Enrollment Form
• Prescription Drug Claim Form
• Prescription Drug Transition of Care Form
• Prior Authorization Forms

Medicare

• Medicare Part D Prescription Claim Form (CVS Direct Claims Form)
• Prescription Drug Mail Order Form (CVS Mail Order Form)
• 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.