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.
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. Now that the rates have been published DHMH has authorized the MCOs to take back any overpayments. Priority Partners has decided to absorb that additional cost and will not be taking back any of the overpayments made to our providers between January 1 and May 20, 2014.
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.