Provider Forms and Resources
Provider Forms and Resources
Important Notices for Providers
Providers
- 2017 Provider Manual (Revised Dec 2017)
- Frequently Asked Questions from Providers
- Provider Update Form
- Provider Training
- GlobalLink Training
- Preventive Care Recommendations and Clinical Practice Guidelines (Update 2017)
- Certification of Treating Health Care Provider
- Physician Treatment Request Form
- Physician Certification - Experimental or Investigational Denials
Quality
- 2018 Affirmation Statement about Incentives
- Quality Improvement Program Summary
- Quality Improvement Program Update/HEDIS Measure Summary
- Medicare Stars Program Overview
- Patient Care and Utilization Management
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
- Home Delivery Order Form (ESI mail order form)
- Prescription Drug Claim Form (ESI Commercial Claim Form)
- Prescription Drug Transition of Care Form (Rx_TOC)
- Prior Authorization Forms