2015 Outpatient Referral Guidelines
Per the Provider Notice letter you should have received, the 2015 Outpatient Referral & Pre-Authorization Guidelines for EHP, Priority Partners, and USFHP are now up on the JHHC website. To view these guidelines, please click the links below:
Use the Alternative Drug Guide for EHP Members
The Alternative Drug Guide for EHP Members is a tool that displays drug brands by category and offers less expensive, generic alternatives to consider for each brand. Please do your part and save your patients money by prescribing cost-effective medications. Click here to view the Alternative Drug Guide.
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.
Upgrade to How We Keep You Informed
Under your Participating Provider Agreement with JHHC, you are entitled to notices regarding the policies and procedures and the Provider Manual, and modifications thereto, applicable under your agreement. Moving forward, notice of policies and procedures and the Provider Manual, together with medications thereto, will be posted on the JHHC website so that you can remain up-to-date on policies and procedures applicable under the Agreement. We will also send a notification of updates via email and fax 30 days prior to policy effective dates. You should have received a letter in the mail as your official notification of this change.
EHP Benefits Explorer Launches
EHP recently launched the EHP Benefits Explorer, an interactive tool designed to help EHP patients quickly and easily find coverage information related to specific services. Visit benefits.ehp.org today to see what each individual employer offers your patients.
Important Information for Providers Receiving Electronic Fund Transfer and Electronic Remittance Advice Transactions
Johns Hopkins HealthCare (JHHC) is working to implement the mandates of the Affordable Care Act (ACA). Effective immediately, all Providers must register with our trading partner Emdeon to continue receiving EFTs and ERAs (835s). Enroll now, at www.emdeon.com/eft, to ensure uninterrupted EFT payments. The financial verification process can take up to 10 days. Please start as soon as possible! Effective October 1, 2014, we are moving our payment cycle. All payments will be deposited one business day later. If you need help with the Emdeon platform, contact the Emdeon Support Team at: 866-506-2830, option 1. For additional information regarding this notice, contact the JHHC Provider Relations at 888-895-4998.
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. Johns Hopkins US Family Health Plan received a NCQA rating of Excellent as a Commercial HMO, its highest ranking. Johns Hopkins EHP received a NCQA rating of Accredited as a Commercial POS. Priority Partners received a NCQA rating of Commendable as a Medicaid HMO. NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.
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.
Looking for the Pharmacy Prior Authorization form?
Access the Pharmacy Prior Authorization form for EHP, Priority Partners and USFHP.
New Mailing Address for USFHP Claims Only
Effective immediately, please send USFHP claims only to:
PO Box 830479
Birmingham, AL 35283
Please note that this PO BOX is for USFHP claims only. Do not send Priority Partners or EHP claims to this address. For USFHP appeals, complaints, and all other correspondence, please use
6704 Curtis Court
Glen Burnie, MD 21060
Important information for Maryland Medicaid providers in prep for January 1, 2014. Please read our Message to Maryland Medicaid providers to learn what you can expect as we launch the Medicaid expansion on January 1, 2014.
Primary Adult Care (PAC) Program update. Primary Adult Care (PAC) members have full HealthChoice benefits effective January 1, 2014. New member ID cards have been processed and should be received by members the week of January 6, 2014. If services are needed prior to receiving the ID card, providers can verify eligibility using EVS using the patient’s name or Medical Assistance number. When using EVS, providers will see two entries (one for the PAC program and one for the HealthChoice program). Be sure the correct HealthChoice ID number is used to ensure proper billing and payment. Providers can also log into HealthLINK to look up members by name and/or date of birth.