Provider Education
At Johns Hopkins Health Plans, provider education plays a core role in our collaborative relationship with the facilities and practices in our network. The training presentations below supply relevant and timely information to providers and staff about the health plans we offer at Johns Hopkins Health Plans.
The training presentations give an overview of Johns Hopkins Health Plans and our individual product lines as well as providing updated information on changes and additions to our plans. The presentations also outline the claims, referral, and appeals processes, and lists important numbers and resources for provider inquiries and support.
Training Materials
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- EviCore Lab Management Program Orientation Advantage MD
- EviCore Lab Management FAQs Advantage MD & Priority Partners
- EviCore Lab Management Provider Orientation Presentation Priority Partners
- EviCore Lab Management Provider FAQs Priority Partners
- EviCore Lab Management Program Expansion Advantage MD & Priority Partners
- EviCore Radiology and Advanced Cardiac Imaging FAQs Advantage MD & Priority Partners
- EviCore Radiology and Cardiac Imaging Provider Orientation Presentation Advantage MD & Priority Partners
- EviCore Post-Acute Care QRG Advantage MD & Priority Partners
- EviCore Post-Acute Care FAQ Advantage MD & Priority Partners
- EviCore Post-Acute Care Utilization Management Program Advantage MD & Priority Partners
- EviCore Specialized Musculoskeletal Therapies PT OT FAQ Advantage MD & Priority Partners
- EviCore Provider Orientation Musculoskeletal Management Advantage MD & Priority Partners
- EviCore Physical Therapy & Occupational Therapy Advantage MD & Priority Partners
- EviCore Pain Joint Spine FAQ Advantage MD & Priority Partners
- EviCore Pre-Cert form SNF LTAC IRF
- EviCore Concurrent Review Authorization Form
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- Monthly Provider Orientation - All Product Lines
- NovoLogix Prior Authorization Training for Providers
- Provider Education Presentation - All Product Lines
- Advantage MD Provider Education Presentation
- Advantage MD Provider Education Presentation - D-SNP (HMO)
- EHP Provider Education Presentation
- EHP Provider Education Presentation - All Children's Hospital (Florida)
- Priority Partners Provider Education Presentation
- USFHP Provider Education Presentation
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Cultural competency training is a requirement for participating providers in the Johns Hopkins Health Plans network: Advantage MD, Employer Health Programs (EHP), Priority Partners, and US Family Health Plan (USFHP).
As a health care provider contracted by Johns Hopkins Health Plans, our expectation is for you and your staff to gain and continually deepen your knowledge of, and ability to support, the values, beliefs and needs of diverse cultures.
This results in effective care and services for all people by taking into account each person’s values, experiences and linguistic needs.
By enhancing the cultural competency of your workforce, together, we can:
- Improve the quality of patient-care delivery and health outcomes
- Increase member satisfaction
- Provide greater access to services
HHS offers A Physician's Practical Guide to Culturally Competent Care, a free, online educational program accredited for physicians, physician assistants, and nurse practitioners. This guide is available at the HHS website. The HHS website offers CME/CE credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
After completing the training, please complete the Cultural Competency Training Attestation Form.
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Johns Hopkins Health Plans uses Risk Adjustment to assess the health status of members in its Medicare Advantage plan, Advantage MD. Regulated by CMS, this process calculates a risk score based on medical conditions identified through ICD-10 diagnosis codes linked to Hierarchical Condition Categories (HCCs). Accurate coding and complete clinical documentation are essential to reflect a member’s true disease burden and ensure appropriate care.
To support accurate reporting, the Risk Adjustment team collaborates with providers and offers programs such as the Whole Health Assessment (WHA), Chart Review/Retrieval, and Coding Documentation Improvement (CDI). Capturing member conditions annually, as required by CMS, helps the plan better understand and manage members’ health needs.
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The provider education training includes: Autism Care Demonstration requirements (to include ABA provider requirements, correct billing practices/claims filing, authorizations, exclusions, medical records documentation, provider responsibilities, and program requirements), basic TRICARE rules, and 32 CFR 199.
This is an annual requirement for all ABA providers in the US Family Health Plan (USFHP) network in accordance with the TRICARE® Operations Manual Chapter 18 Section 3:8.3.10.
Job Aids
- Process for Authorization Requests to a Skilled Nursing Facility (SNF)
- Optum Claim Edit System (CES)
Availity Job Aids for Priority Partners, EHP and Advantage MD
- Accessing JPAL Prior Authorization Tool
- Accessing OnBase for Payment Disputes
- Accessing Novologix and EviCore in Availity
- Attaching Clinical Documentation/Concurrent Review in Availity
- Submitting an Eligibility & Benefits Request in Availity
- Submitting a Prior Authorization Request in Availity
- Submitting Claims in Availity
- Navigating the Availity Authorization/Referral Dashboard
- Online Appeals Form: Non-ER and ER Appeals