Priority Partners Resources & Guidelines

Our Priority Partners provider manuals are guides for network providers regarding benefit eligibility, referral and pre-authorization requirements, claims and appeals information, and much more. If your office needs a manual, or any additional information, please contact your Network Manager at 888-895-4998 or 410-762-5385.  This section also contains helpful quick reference guides and access to downloadable policies and procedures.  For forms, click here.

Provider Manuals:

• Priority Partners Provider Manual 
• Priority Partners PAC Provider Manual 

Resources:

• Anesthesia Guidelines
• Claims Retraction
• Emergency Department Review Process 
• Emergency Prescription Procedures
• Laboratory Policy 
• Medical Policies
• Medical Guidelines and Behavioral Health Clinical Practice Guidelines
• *Medical Record Standards
• Member Summary of Benefits (HealthChoice)
• Member Summary of Benefits (PAC)
• MRI of the Breast Policy 
• Outpatient Referral Guidelines
• Physician Assistant Reimbursement Policy
• Preventative Health Guidelines
• Provider Quality & Efficiency Standards for HealthCare Quality Improvement
• Self Referral Handbook for Providers
• Radiology Policy 
• Urgent Care Centers

Quick Reference Guides:

• Priority Partners PAC Quick Reference Guide 
• Priority Partners Quick Reference Guide 
• Read our Health Preventive Guidelines 

Appeals Process:

• Priority Partners Appeals Response Grid
• Rejection Review – Appeals Form

* Note on Medical  Record Standards Documentation: Johns Hopkins HealthCare 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 JHHC 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.