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School of Medicine
Johns Hopkins Employer Health Programs (EHP) provides immediate access to required forms and documents to assist our providers in expediting claims processing.
- Behavioral Health Services Referral Form
- Care Management Services Request Form
- Group Disability Claim Form
- Maryland Uniform Consultation Referral Form
- Maryland Uniform Credentialing Form
- Maryland Uniform Treatment Plan Form
- Medical Injectable Prior Authorization Form
- Pharmacy Compound Prior Authorization Form
- Pharmacy Formulary Exception Request Form (This applies to select EHP Employer Groups using the Prescribing Guide Formulary only.)
- Pharmacy Prior Authorization Form (This applies to all EHP Employer Groups using either the Managed Formulary or Prescribing Guide.)
- Provider Update Form
- Rejection Review Appeals Form
- Sub W-9 Form
- Synagis Prior Authorization Form
PLEASE NOTE: All Forms will need to be faxed to Employer Health Programs (EHP) in order to be processed. See the appropriate fax number on the top of the form for submission. If you have any questions please contact Customer Service at 410-424-4450 or 1-800-261-2393.