The Johns Hopkins Health Plans Division of Health Services is committed to quality health care, and partnership with our dedicated providers is key to achieving this goal. The Division of Health Services includes: Appeals, Care Management, Medical Policy, Quality Improvement, and Utilization Management departments.

Appeals

To request an appeal of denied services, refer to the provider appeal rights on the denial letter.

Fax appeals to:

410-762-5304

Mail to:

Johns Hopkins Health Plans
Attn: Appeals Department
7231 Parkway Drive, Suite 100
Hanover, MD 21076

Expedited appeals:

Pre-service and medication expedited appeals only may be called in to the expedited verbal appeals phone line: 410-762-5383.

Care Management

Johns Hopkins Health Plans Care Management team offers a variety of services to help members manage chronic health conditions, recover from serious illness, and make healthy lifestyle changes. Our care management services are voluntary and are provided at no cost to the member. Members identified with certain needs may be automatically enrolled, but are under no obligation to participate in these programs. Details regarding specific services areas are located on our websites.

Phone:

800-557-6916
Monday through Friday: 8:00 a.m. to 5:00 p.m.
Voicemail messages received after normal business hours will be addressed the following business day.

Email:

[email protected]

Medical Policy

For your convenience, refer to the Johns Hopkins Health Plans medical policies page.

Utilization Management

The aim of the Johns Hopkins Health Plans Utilization Management (UM) program is to achieve the mission of providing access to high quality, cost-effective, member-centered care. Johns Hopkins Health Plans' utilization management decisions are based on appropriate care and existence of coverage. Johns Hopkins Health Plans does not give financial incentives to staff that reward denials or promote under-utilization of services. Johns Hopkins Health Plans does not make decisions about hiring, promoting, or terminating practitioners or Johns Hopkins Health Plans staff based on the likelihood that the practitioner or Johns Hopkins Health Plans staff member supports denials of benefits. You may request a copy of the UM criteria or benefit guidelines used in the decision of any case. For concurrent inpatient admissions, a UM RN is on-call after hours, including weekends and holidays to assist with urgent admissions and discharge planning.

EHP, PPMCO, and USFHP

Phone numbers:

410-424-4480 or 800-261-2421 (toll-free) Monday through Friday, 8 a.m. to 5 p.m.

Fax #’s for EHP, PPMCO and USFHP

• Inpatient Medical: 410-424-4894
• Outpatient Medical: 410-762-5205
• Initial Inpatient: 410-424-2770
• Transplant/Bariatric: 410-424-4046
• SNF/LTAC/ACIR/AMBO Requests: 410-424-2703
• EHP & PPMCO NICU Admissions or Prior Pediatric Readmission (within 1 year of NICU discharge): fax notification and/or clinical to ProgenyHealth: 888-400-4636
• EHP & PPMCO Outpatient Urgent: 410-424-2707
• EHP & PPMCO Durable Medical Equipment (DME): 410-762-5250

EHP DME Provider Directory
PPMCO DME Provider Directory
 

• EHP Behavioral Health: 410-424-4891
• EHP Behavioral Health- Secured: 410-424-4765
• USFHP DME: 410-424-2603

USFHP DME Provider Directory

•  USFHP Inpatient: 410-424-2602
• USFHP Outpatient: 410-424-2603
• USFHP Behavioral Health: 410-424-4839
• eviCore Healthcare: 866-220-3071

Advantage MD

Phone numbers:

Advantage MD: 844-560-2856

Advantage MD Behavioral Health, Inpatient & Outpatient: 844-340-2217

Fax #’s for Advantage MD

• Outpatient Medical: 855-704-5296
• Inpatient Medical: 844-240-1864
• Outpatient Behavioral Health: 844-363-6772
• Inpatient Behavioral Health: 844-699-7762
• Post-Acute Facility (SSNF/ACIR/LTAC): 410-424-2703

Advantage MD DME Provider Directory