Welcome to Johns Hopkins HealthCare LLC
Johns Hopkins HealthCare LLC (JHHC) provides health care services for three health plans: Priority Partners Managed Care Organization, Johns Hopkins Employer Health Programs (EHP), and Johns Hopkins US Family Health Plan (USFHP). This site provides our medical health providers with general plan information, current news, and plan updates.�
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Priority Partners Redetermination Update
The state is now prepared to process redetermination forms. They will begin contacting everyone who was up to re-enroll since last October. Priority Partners will be contacting members who are up for redetermination giving them information on where they can get a redetermination form, what they need to complete the form, and where to send the forms. Be sure to EVS patients to ensure eligibility.
Outpatient Referral Guidelines Updated
The 2014 Outpatient Referral Guidelines for EHP, Priority Partners and USFHP have been updated. They can be accessed on the Resources & Guidelines page.
InterQual 2014 Summary of Clinical Revisions
The JH Scientific Evidence Evaluation and Policy Advisory Committee (SEEPAC) and JH Medical Policy Committee (MPC) have approved the change to the most recent InterQual 2014 for Utilization Management and policy decisions. Read the InterQual 2014 Summary of Clinical Revisions.
National Committee for Quality Assurance (NCQA) Accreditation
Johns Hopkins HealthCare is committed to the health and wellbeing of each and every one of its members. In fact, all three of our health plans have been awarded NCQA Accreditation. Read more.
Priority Partners Will Not Claw Back Overpayments
In January DHMH announced they would be reducing reimbursement rates for some of the E&M codes by 2-4%. There was a delay in receiving these new rates from DHMH so Priority Partners continued to pay those codes based on higher 2013 rates. Read more.
New Mailing Address for USFHP Claims Only
Effective immediately, please send USFHP claims only to:
PO Box 830479
Birmingham, AL 35283
Change From ICD-9 to ICD-10 Codes Delayed
The ICD-9 to ICD-10 transition has been delayed. No definitive date has been set for this change but it will be no earlier than 10/1/2015. We will update you when a date is set, but will continue to work with providers on testing. Read more.