Johns Hopkins Health Plans policies are developed to assist in administering plan benefits and do not constitute medical advice.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

• Medical Policies
• Reimbursement Policies
• Priority Partners Pharmacy Management Drug Policies

Medical Management Drug Policies

• Advantage MD Medical Injectable Drug Criteria
• EHP Medical Injectable Drug Criteria
• Priority Partners Medical Injectable Drug Criteria
• USFHP Medical Injectable Drug Policies

Utilization Management Policies

Johns Hopkins Health Plans utilization management policies are available for providers. Please see the list below for a selection of policies.

• MAPD UM008 – Inpatient Concurrent Review
• UM58 – Concurrent Review for Inpatient Stays
• UM71 – Administrative Days Review
• UM62 – Lack of Clinical Review Criteria/Criteria Supplement

If you have questions, please contact Provider Relations at 888-895-4998.