Claims payment

GlobalHealth has partnered with Zelis to provide electronic claims remittance and payments for our Medicare business. Electronic remittance advice and payments are available for our providers submitting claims for our Medicare business starting with dates of service January 1, 2022. To learn more and enroll for electronic payments and remittance, please click here.

For additional support, please call 844-200-8167, TTY 711.

WORKING WITH GLOBALHEALTH

GlobalHealth has been a provider- and member-centric organization since its beginning in the state of Oklahoma. The health plan was started by a group of primary care physicians who were passionate about improving patient outcomes and controlling healthcare spend by focusing on patient service and quality outcomes.

GlobalHealth plans are designed to encourage members to receive proper healthcare while reducing out-of-pocket expenses. We align our plans with strong benefits, including $0 unlimited primary care physician visits, and most plans have no medical or drug deductibles.

We are driven by our passion to deliver the best healthcare coverage in the industry. We are committed to continuous innovation and comprehensive member engagement to earn the satisfaction and confidence of those we serve.

We aspire to earn and retain provider confidence and trust in us.

We believe in developing and maintain valued relationships with our partners.

Relationships

We believe managing and navigating healthcare should be easier. This starts by developing and maintaining valued relationships with our members and network provider partners.

At GlobalHealth, we:

• Listen to the needs of case managers and clinicians and share information that allows them to refine their services.
• Deliver insights that allow nurses to coordinate and facilitate available healthcare services to support our members.
• Give our providers solutions that go beyond standard healthcare options.
• Serve members using a proactive outreach strategy that includes finding community resources, scheduling appointments and coordinating healthcare services to navigate a complex healthcare system.

Eligibility and Benefits (270/271)

GlobalHealth has partnered with Change Healthcare to provide real-time solution to our providers to request information like eligibility, benefits and remaining out of pocket amount for our members.
To take advantage, please contact your Practice Management System Vendor or Change Healthcare Customer Support to update your systems.

GlobalHealth’s Payer ID for requesting Eligibility and Benefits inquiry is GLOBH.
If you are a Participating provider, you can also login to our Provider Portal to review member’s eligibility, benefits, claim status and member’s current out of pocket amount. Find out more here: https://ghprovider.prod.healthaxis.net/login/

Specialist Authorization

GlobalHealth does not require prior authorizations for network specialist office visits. Members have direct access to set up an office visit appointment with a network specialist physician.

Services rendered or referred by specialist physicians require prior authorizations. Services include, but are not limited to: outpatient surgery, physical therapy, cardiac rehabilitation, Part B drugs, and specialized diagnostic tests such as MRIs. These are only examples. Please refer to the plan Evidence of Coverage or call Provider Services if you have any questions about whether a service requires prior authorization.

All out-of-network services require prior authorizations.

Medical Authorizations

Healthcare services, such as for specialty care, hospitalizations, and outpatient surgery require
preauthorization from GlobalHealth. Authorization requests are processed through our Provider Portal, an online tool available to all contracted providers.

Medicare Coverage Determinations Information

To request a coverage decision for Part D Prescription Drugs, contact GlobalHealth's Pharmacy Benefit Manager, CVS Caremark, by calling (844)-449-0360 (TTY users call 711), 24 hours a day, 7 days a week, or by writing to:

CVS Caremark
Part D Coverage Appeals and Exceptions
Department MC 109
P.O. Box 52000
Phoenix, AZ 85072-2000
Or via Fax: 855-633-7673

Need to request a Part D Coverage Determination?  Click here.