Effective Date: Oct. 28, 2026

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

Type of Change: Billed Charges Process
 
Explanation of Change:

Previously, Johns Hopkins Health Plans communicated that all facility claims with billed charges exceeding $75,000 submitted through Availity without the required itemized bill and medical records attachments would not be forwarded to Johns Hopkins Health Plans for adjudication.

Johns Hopkins Health Plans is not implementing this change in Availity.

• High-cost claims will be processed as usual in Availity.
• Claims without the required supporting documentation will not be rejected.

However, Johns Hopkins Health Plans still requires that 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.

The above request for itemized bills and medical records to accompany high-dollar claims remains in effect.

NOTE: High-cost claims will advance to Johns Hopkins Health Plans for adjudication but may subsequently be denied if the supporting documentation required to finalize the claim is not included with the submission. If a claim is denied due to missing supporting documentation, the remittance advice will include information about the documentation required by Johns Hopkins Health Plans to process and finalize the claim.