Effective Date: Oct. 15, 2026

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

Type of Change: Billed Charges Process

Explanation of Change:

Claims submitted through Availity without the required itemized bill and medical records attachments will not be forwarded to Johns Hopkins Health Plans for adjudication. This process change, as previously communicated, goes into effect Oct. 15, 2026.

All facility claims with billed charges exceeding $75,000 require the itemized bill and medical records to be submitted with the claim electronic medical records and itemized bills through Availity, our secure provider portal.

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.