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Resources & Guidelines

Below you will find helpful resources and guidelines for all three of our health plans:

For all health plan providers


Advantage MD


Priority Partners

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Hepatitis C Clinical Criteria
Hepatitis C Therapy Prior Authorization
Laboratory Policy
Maryland Healthy Kids Preventive Health Screening Resources
Newborn Enrollment Notice for Hospitals
Outpatient Referral Guidelines (2017)
Outpatient Referral Guidelines (2016)
Partners with Mom Program for High Risk Pregnant Women
Pharmacy Formulary Changes
Primary Care Quality & Efficiency Standards for Healthcare Quality Improvement
Provider Appeals Policy
Quick Reference Guide
Radiology Policy
Self Referral Protocols
Transplant Network Policy


Outpatient Referral Guidelines (2017)
Provider Appeals Policy
Quick Reference Guide


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.