PROVIDER FORMS AND RESOURCES
Important Notices for Providers
- The 2020 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
- 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 provide 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
- 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
Provider Policies and Training
- Medical Policies
- 2020 Provider Manual
- 2019 Provider Manual (Revised Jan 2019)
- Provider Training
- GlobalLink Training
- Site of Care Form
- Physician Treatment Request Form (Medical Prior Authorization)
- Commercial Pharmacy
- 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
- 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)
- EDI Claims Submitter Request Form
Behavioral Health Coordination of Care
- Provider Toolkit
- 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