Effective Date: July 18, 2026

Health Plans Affected: Advantage MD, Employer Health Programs (EHP), Priority Partners, USFHP

Type of Change: Process Change

Explanation of Change: 

Starting July 18, 2026, claims submitted through Availity without the required itemized bill and medical records attachments will not be forwarded to Johns Hopkins Health Plans for adjudication.

• All facility claims with billed charges exceeding $75,000 will require itemized bill and medical records.
• Failure to submit itemized bills and supporting medical records for billed charges exceeding $75,000 will result in rejected claims.

Providers may attach a medical record and/or an itemized bill for any claim, regardless of billed amount, as additional information. Additionally, Johns Hopkins Health Plans may also occasionally ask for an itemized bill and/or medical record to help clarify or pay a claim more accurately.