Globily
Medical ProvidersSubmit a Payment Request

Provider Portal

Submit a Payment Request

Use the secure form below to submit your invoice and supporting documents. Our finance team processes approved claims within 5–10 business days.

Complete the Form

Fill in patient details, treatment dates, and invoice amount.

Attach Documents

Upload your itemised invoice, medical report, and patient Smart Health Card copy.

Receive Payment

Finance team reviews and pays approved claims within 5–10 business days.

Provider Payment Request Form

Hosted securely on Zoho Forms

OPEN PAYMENT FORM

What you will need

  • Patient full name and Globily membership number
  • Treatment dates and diagnosis / procedure codes
  • Itemised invoice with your facility letterhead
  • Copy of the patient's Globily Smart Health Card
  • Your bank account details for payment transfer
  • Any pre-authorisation reference number (if applicable)

Processing Time

Claims are reviewed within 2 business days of receipt. Payment is issued within 5–10 business days of approval. You will receive an email confirmation at each stage.

SUBMIT PAYMENT REQUEST

Need help with your claim?

Globily

Contact Us

  • Inside USA 1 877 200 3066
  • International +719 266 2835
  • WhatsApp +719 203 7797
  • 102 South Tejon Street
  • Colorado Springs, CO 80903
  • USA
  • Mon - Fri, 9am - 5pm | Sat, 9am - 12pm

Globily is the brand name for customizable medical travel protection plans offered by Globalwide and its subsidiaries including Globalwide International LLC, Colorado license #966872. Plans consist of travel medical insurance underwritten by an authorized insurance carrier, as identified in the insurance policy if purchased. Other non-insurance assistance services are provided directly by Globalwide International LLC, and Globalwide Mediassist. The information on this website is provided for informational purposes only and does not include all terms, conditions, and exclusions of the travel insurance coverage. Some or all coverage may not be available in your state. Globily is a registered trademark in the U.S. Patent & Trademark Office, owned by Globalwide International LLC.

© Globily © Smart Health Card © Globalwide International Copyright 2026. All Rights Reserved. · Privacy Policy · Terms of Use · Cookie Policy · Legal Disclaimer