This page contains helpful information such as:
Our 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.
- EHP Provider Manual New Interactive Manual!
- Priority Partners Provider Manual New Interactive Manual!
- Priority Partners PAC Provider Manual New Interactive Manual!
- USFHP Provider Manual New Interactive Manual!
- Elder Plus Provider Manual New Interactive Manual!
Clinical Practice Guidelines
Emergency Department Review Process
*Medical Record Standards
DME-No Pre-Authorization Coding Document
Utilization Management Medical Polices
Substance Abuse Assessment Tool (CAGE)**
Appeals Response Grid
Emergency Prescription Procedures
Maryland Health Kids Preventive Health Screening Resources
Member Benefits (HealthChoice)
Member Benefits (PAC)
MRI of Breast Policy
Newborn Enrollment Notice for Hospitals
Outpatient Referral Guidelines
Partners with Mom Program for High Risk Pregnant Women
Provider Quality & Efficiency Standards for HealthCare Quality Improvement
Quick Reference Guide (HealthChoice)
Quick Reference Guide (PAC)
Self Referral Protocols
Urgent Care Centers
* 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.
**Drug and alcohol abuse or dependence are common issues but are often under recognized in primary care settings. Utilizing a simple screening tool, such as the four question CAGE substance abuse assessment, is an easy yet effective way for the primary care provider to determine if substance abuse exists and needs to be addressed.