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Announcements

New Resource for EPSDT Requirements
The Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) features many required health care services for children on Medicaid. To help you stay informed about the requirements of EPSDT, we have created a webpage with helpful information and links to periodicity schedules, immunization recommendations, and additional resources. Visit the EPSDT webpage for more information.
 

Thank you for providing great health care to our Priority Partners child members, and we hope this information helps you to continue this great care.

277CA Provider Web Announcement
Johns Hopkins HealthCare has begun sending the 277CA EDI transaction to providers for EDI claims errors for Employer Health Programs (EHP) and Priority Partners members.
 

What is the 277CA?
A 277CA is an acknowledgement back from the Payer to the provider indicating that a claim was received by Payer, but was unable to be accepted for processing. A common example of a claim unable to be accepted is a claim with an invalid member ID number.

The 277CA will be sent to the various EDI claim trading partners who submit claims to Johns Hopkins HealthCare on behalf of providers. The EDI trading partners will in turn send those transactions to the provider or their EDI contractor or vendor. 

Providers who use outside contractors or vendors for their EDI claims transactions will need to contact their EDI vendor to setup the receipt of the 277CA from Johns Hopkins HealthCare.

The 277CA will use both the CARC’s and RARC’s to explain what needs to be corrected on the claim and then resubmit them back to Johns Hopkins HealthCare for processing as a new claim.

The purpose of the 277CA is to better serve our provider network and reduce the need for providers to make a phone call to check on a claim status.  

Join Us for Seminar II of the Medicare Advantage Informational Coding Seminar Series
This follow-up to Seminar I presents additional tools and tactics to close gaps in care and optimize Medicare Advantage Hierarchical Conditional Coding and is designed for practice administrators, office managers and appropriate clinical staff. 

Seminar II is offered:
Thursday, September 15, 1 p.m. – 4 p.m.
Thursday, December 8, 9 a.m. – 12 p.m. or 1 p.m. – 4 p.m.

Location:
Johns Hopkins HealthCare
Suite D Conference Room
6701 Baymeadow Drive
Glen Burnie, MD 21060

Please RSVP to one of the offerings to seminars@jhhc.com or 888-895-4998.
If a representative from the provider entity attends two seminars, the provider entity will receive a $100 incentive.
Please note that CME and CEU credit is not offered. Please call Provider Relations with questions about the seminar at 888-895-4998.

2016 Outpatient Referral Guidelines
Per the Provider Notice letter you should have received, the 2016 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:

Advantage MD Outpatient Referral Guidelines
EHP Outpatient Referral Guidelines
Priority Partners Outpatient Referral Guidelines
USFHP Outpatient Referral Guidelines

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.

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.