GlobalLink™ Access Request

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GLOBALLINK ACCESS REQUEST

Please complete the form below to request access to GlobalLink™. Note that GlobalLink™ is only available to contracted providers. Please allow 7 business days to process your request.

To request multiple users, please submit a separate form for each user. Alternatively you may contact Provider Relations (globallink.access@globalhealth.com) to request a Bulk User Access Request Form.

Enter office locations, tax-IDs, and NPIs below. The first row is required. More rows are provided if your access request is for multiple offices / locations or tax IDs.

Office Location

Office / Location Name *

9-Digit Tax ID *

Organization NPIs *

Additional Office Location 1

Office / Location Name

9-Digit Tax ID

Organization NPIs

Additional Office Location 2

Office / Location Name 2

9-Digit Tax ID 2

Organization NPIs 2

Additional Office Location 3

Office / Location Name 3

9-Digit Tax ID 3

Organization NPIs 3

Additional Office Location 4

Office / Location Name 4

9-Digit Tax ID 4

Organization NPIs 4

Contact Information

What do you need access to for the provided office locations? *

Claims
Referrals

Enter the contact information for the user requesting access to GlobalLink.

First Name *

Last Name *

Contact Work Phone Number * XXX-XXX-XXXX

Work Email Address *

Office Manager First Name *

Office Manager Last Name *

Office Manager Work Phone Number *

By checking this box, you acknowledge that a GlobalHealth representative may contact your office manager to validate the information provided. *

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