PROVIDER FORMS AND RESOURCES

Important Notices for Providers

• The 2021 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

Important Resources

• 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:

    • 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

Provider Policies and Training

• Medical Policies
• 2021 Provider Manual
• 2020 Provider Manual
• Provider Training
• GlobalLink Training
• Site of Care Form

Prior Authorization

• Physician Treatment Request Form (Medical Prior Authorization)
• 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

Claims

• 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

Quality

• 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)