Medical ProvidersSubmit 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
What you will need
- Patient full name and Globalwide Health membership number
- Treatment dates and diagnosis / procedure codes
- Itemised invoice with your facility letterhead
- Copy of the patient's Globalwide 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.
Need help with your claim?