Resources & Guidelines

The Johns Hopkins US Family Health Plan provider manual has been recently updated by the Provider Relations Department, Johns Hopkins HealthCare LLC. It is a guide for network providers regarding benefit eligibility, referral and pre-authorization requirements, claim 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.

Download the Provider Manual

• Anesthesia Guidelines
• Appeals Grid
• Care Managment
• Medical Policies
• Medical Guidelines and Behaioral Health Clinical Practice Guidelines
• *Medical Record Standards
• Physician Assistant Reimbursement Policy
• Policies
• Quick Reference Guide
• Outpatient Referral Guidelines 
• Urgent Care Centers
• Sudden and Serious Criteria List

*Note on Medical Record Documentation Standards: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.