Provider Forms and Resources

Important Notices for Providers

•  Notice - 09/29/2017 - 2017 Provider Manual

Providers

• Medical Policies
• 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 2018)
• Certification of Treating Health Care Provider
• Physician Treatment Request Form
• Physician Certification - Experimental or Investigational Denials
  
  
• 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

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

• 2018 Forms

  • Home Delivery Order Form
  • Specialty Drug Enrollment Form
  • Prescription Drug Claim Form
  • Prescription Drug Transition of Care Form
  • Prior Authorization Forms

  2017 Forms

  • Prescription Drug Claim Form
  • Prior Authorization Forms

Medicare

• Medicare Part D Prescription Claim Form (CVS Direct Claims Form)
• Prescription Drug Mail Order Form (CVS Mail Order Form)