Find helpful resources and guidelines for all of our health plans.

For all health plan providers

Join the Johns Hopkins Health Plans Network or Make Demographic Changes

• I’m interested in a NEW contract with Johns Hopkins Health Plans or I want to add another health plan to my contract
  • Complete the online request form
    • Do NOT fill out this form if you are adding a new provider to an already contracted provider group or requesting a change to the demographics (address, phone number, NPI, individual name change) of an already contracted provider.
• I’m already contracted and need to make demographic updates or add a provider to my group
  • Please complete the online request form or send your request to [email protected]. Ensure you provide accurate information regarding the changes needed.
  • If you have any questions or need assistance contact our Provider Relations Customer Service at 888-895-4998 (option 4) or 410-762-5385.

Resources & Guidelines

• Anesthesia Guidelines
• Care Management Programs
• CareLink
• Claims Retraction
• Clinical Practice Guidelines Policy
• Emergency Department Review Process
• Medical Record Documentation Standards
• Quality Measures Tip Sheet
• Ongoing Monitoring State Fed Exclusion Debarment Sanctions Policy
• Preauthorization Criteria for Outpatient Specialty Services at Kennedy Krieger Institute
• Preventive Health Guidelines Policy
• Standard of Conduct
• Substance Abuse Assessment Tool (CAGE)**
• Sudden and Serious Diagnosis Codes
• Utilization Management Medical Polices

Forms

• New Network Request Form
• Home Care Authorization Request Form
• Maryland Uniform Consultation Referral
• Maryland Uniform Credentialing
• Practitioner Office Site Evaluation Form
• Prospective Review
• Provider Update Form
• Provider Update Form (Online)
• Uniform Treatment Plan

Advantage MD

Resources & Guidelines

• Criteria for Practitioner Participation
• HMO Quick Reference Guide
• HMO Select Quick Reference Guide
• Mail Order Best Practices
• Medical Injectables Requiring NovoLogix Preauthorization
• PPO Quick Reference Guide
• Practitioner Discipline & Appeals
• Termination of Network Participation, Reporting Terminations, Fraud & Abuse
• Yearly Wellness Checklist
• Offshore Attestation
  • Memo - Offshore Subcontracting
  • Memo - Offshore Subcontractor Data Module in HPMS
  • Memo - Offshore Subcontracting Questions & Answers
  • Form - Offshore Subcontracting Attestation
• eviCore Laboratory Management Program

Benefit Information

• Plan Benefits Overview
• HMO Quick Reference Guide
• Coverage Brochure
• Yearly Wellness Checklist

Pharmacy Information

• Pharmacy & Formulary Overview
• Medical Injectables Requiring NovoLogix Preauthorization
• Medical Injectable Drug Criteria

Forms

• Advantage MD Forms

EHP

Resources & Guidelines

• Provider Appeals Policy
• Quick Reference Guide

Benefit Information

• Plan Benefits Overview
• Schedule of Benefits

Pharmacy Information

• Pharmacy & Formulary Overview
• Pharmacy Drug Preauthorization Forms and Policies
• Medical Injectables Requiring NovoLogix Preauthorization
• Medical Injectable Drug Criteria

Forms

• EHP Forms

Priority Partners

Resources & Guidelines

• Outpatient Code Editor - Medicaid
• Radiology and Advanced Cardiac Imaging Codes Requiring Preauthorization by eviCore
• Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
• Molecular and Genetic Testing Codes Requiring Preauthorization by eviCore
• Get Vaccinated Flyer
• Laboratory Policy
• Maryland Healthy Kids Preventive Health Screening Resources
• Medical Injectables Requiring Preauthorization
• Primary Care Quality & Efficiency Standards for Healthcare Quality Improvement
• Provider Appeals Policy
• Quick Reference Guide

Benefit Information

• Plan Benefits Overview

Pharmacy Information

• Pharmacy & Formulary Overview
• Pharmacy Formulary Changes
• Pharmacy Drugs Preauthorization Forms
• Pharmacy Drugs Preauthorization Policies
• Medical Injectables Requiring Preauthorization
• Medical Injectable Drug Preauthorization Forms
• Medical Injectable Drug Forms and Criteria
• Medical Injectables Requiring Preauthorization

Forms

• Priority Partners Forms

USFHP

Resources & Guidelines

• Outpatient Code Editor - Tricare
• Medline Plus®
• Provider Appeals Policy
• Quick Reference Guide
• Quick Reference Guide (Sentara)

Benefit Information

• Plan Information Overview

Pharmacy Information

• Pharmacy & Formulary Overview
• Pharmacy Drugs Preauthorization Forms
• Pharmacy Drugs Preauthorization Policies
• Medical Injectables Requiring Preauthorization
• Medical Injectable Drug Preauthorization Form
• Medical Injectable Drug Policies

Forms

• USFHP Forms

Note on Medical Record Standards Documentation: Johns Hopkins Health Plans has established standards for primary care medical record documentation. Records must be maintained in a manner that is current, detailed and organized to facilitated communication, coordination and continuity of care. The standards address confidentiality, the availability of the medical record, and required content of the record. To ensure confidential care for members, the Johns Hopkins Health Plans standards state that medical records are stored securely. Records must be easy to retrieve, but only authorized personnel should have access to them. In addition, staff is expected to receive training in member confidentiality. Compliance with these new standards will be monitored as part of our Quality Improvement Program.

Drug and alcohol abuse or dependence are common issues but are often under recognized in primary care settings. Utilizing a simple screening tool, such as the four question CAGE substance abuse assessment, is an easy yet effective way for the primary care provider to determine if substance abuse exists and needs to be addressed.