Resources & Guidelines

This page contains helpful information such as:

Provider Manuals
Resources and Guidelines for EHP, Priority Partners & USFHP

Provider Manuals

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!

Resources & Guidelines

For all health plan providers

Anesthesia Guidelines
Appeals Form- Rejection Review
Care Management

Care Management Services Referral Form

Claims Retraction
Clinical Practice Guidelines
Emergency Department Review Process
*Medical Record Standards
DME-No Pre-Authorization Coding Document

Outreach Referral

Physician Assistant Reimbursement Policy

Pre-Authorization Coding document

Pre-Authorization Criteria for Outpatient Speciality Services at Kennedy Krieger Institute

Preventive Health Guidelines

Maryland Uniform Consultation Referral

Maryland Uniform Credentialing

Maryland Uniform Treatment Plan

Sudden and Serious Criteria List
Utilization Management Medical Polices
Substance Abuse Assessment Tool (CAGE)**

Find a Lab

Forms

Sub W-9 Form

EHP

Appeals Response Grid
Outpatient Referral Guidelines

Quick Reference Guide
Urgent Care Centers

EHP Schedule of Benefits

EHP Forms

Group Disablility Claim

Provider Update Form

Rejection Review Appeals

Synagis Prior Authorization

Pharmacy Prior Authorization Request

Priority Partners

Appeals Response Grid
Emergency Prescription Procedures
Maryland Health Kids Preventive Health Screening Resources
Member Benefits (HealthChoice)
Member Benefits (PAC)
MRI of Breast Policy
Laboratory Policy
Newborn Enrollment Notice for Hospitals
Outpatient Referral Guidelines
Outreach Services
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)
Radiology Policy
Self Referral Protocols
Urgent Care Centers

Priority Partners Forms

Behavioral Health Referral Assessment

Health Educator Referral

Maternity & Newborn Authorization

Newborn Enrollment Notification

Outreach Referral
Pharmacy Pre-Authorization

Primary Care Provider Change

Provider Update Form

Rejection Review – Appeals

Same Day Pre-Authorization

Special Needs Referral

Suboxone/Subutex Pre-Authorization

Synagis Pre-Authorization

USFHP

Appeals Grid
Quick Reference Guide
Outpatient Referral Guidelines
Urgent Care Centers

USFHP Forms

Provider Update Form

Rejection Review - Appeals Form

Synagis Prior Authorization Form

Pharmacy Prior Authorization 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.

**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.

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