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Welcome to Johns Hopkins HealthCare LLC
Johns Hopkins HealthCare LLC (JHHC) provides health care services for four health plans: Priority Partners Managed Care Organization, Johns Hopkins Employer Health Programs (EHP), Johns Hopkins US Family Health Plan (USFHP) and Johns Hopkins Advantage MD (Advantage MD).This site provides our medical health providers with general plan information, current news, and plan updates.
Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients.
Log in to your HealthLINK account to view information on your USFHP patients.
Search health topics in the Health Library.
Priority Partners Expanding Partnership with eviCore healthcare
Priority Partners is pleased to announce we will be expanding our partnership with eviCore healthcare to include prior authorization management for molecular and genomic testing for dates of service December 1, 2021 and beyond. More details to come.
HealthLINK and Provider Directory Portals
Due to connectivity issues, the HealthLINK and Provider Directory portals are down and currently there is no access to these resources. We will let you know when connectivity is restored. Thank you for your patience.
The Summer 2021 issue of "Provider Pulse" is now available online. The issue contains updates on policies and procedures, claims and billing, pharmacy and more.
Reminder: Updated Addresses for Remitting Overpayments for Claims Related to Priority Partners, EHP and USFHP
Providers remitting overpayments for claims paid by JHHC, including Priority Partners, Johns Hopkins Employer Health Programs (EHP), and Johns Hopkins US Family Health Plan (USFHP), must remit overpayments to the addresses below. This change went into effect May 15, 2021. NOTE: This change does not apply to Johns Hopkins Advantage MD.
Post Office Remittance Address:
Johns Hopkins HealthCare, LLC
P.O. Box 412856
Boston, MA 02241-2856
Overnight Mail Address:
Bank of America Lockbox Services
Johns Hopkins Healthcare, LLC 412856
2 Morrissey Blvd.
Dorchester, MA 02125
Failure to send checks to the addresses noted above may result in delays in application of the payment(s) against your account(s).
NOTE: Please include the claim # (s), applicable Dates of Service, and applicable EOB, if possible, with the check when submitting a refund.
Phillips Announces Voluntary Recall of Devices
Philips, a health technology company, issued a voluntary recall notification for certain sleep and respiratory care devices. The recall is to mitigate potential health risks related to the sound abatement foam component, which may degrade into particles which may enter the device’s air pathway and be ingested or inhaled by the user, and the foam may off-gas certain chemicals. The recall pertains to specific Philips Bi-Level Positive Airway Pressure (Bi-Level PAP), Continuous Positive Airway Pressure (CPAP), and mechanical ventilator devices. View all affected devices. If you have a patient that uses one of the affected devices, please discuss their continued treatment options with them.
JHHC Announces New Partnership with CVS-NovoLogix for Preauthorization for Medical Injectables
Effective July 1, 2021 Johns Hopkins HealthCare LLC (JHHC) will require prior authorization for certain provider-administered medications to determine medical necessity. This new requirement will impact the Employer Health Programs (EHP) as well as Johns Hopkins Advantage MD. The new prior authorization program will be managed through collaboration with CVS Health–NovoLogix.
Additionally, Priority Partners will be transitioning to the CVS-NovoLogix platform to continue direct preauthorization services for provider-administered medications.
Through CVS Health-NovoLogix, providers will gain access to a new prior-authorization authorization system that offers the following:
- An efficient intake process through a web-based application
- A self-service experience with access to real-time status updates
More details and training opportunities will be communicated by 5/1/2021.
Reminder: Behavioral Health Preauthorization Process
JHHC would like to remind our providers that preauthorization requests for Behavioral Health (BH) services should not be submitted through the iExchange system. Preauthorization requests to Utilization Management (UM) for Behavioral Health Services must be made via the following numbers (Note: Priority Partners Behavioral Health requests should be submitted through the vendor Optum Maryland only):
- Advantage MD: 844-340-2217 (BH UM Intake); 844-363-6772 (BH UM fax)
- EHP: 800-261-2429 (BH UM Intake)
- Priority Partners: 800-888-1965 (Optum Maryland customer service)
- USFHP: 888-281-3186 (BH UM Intake)
During the current COVID-19 pandemic we are experiencing higher than normal call volumes and requests for authorizations. As a result, you may experience delays in the processing time for your authorization requests. Please allow time for COVID-19 testing results, along with your authorization request, to be returned prior to scheduling patients for care.
To ensure you have the information you need for planning, we are available to assist with authorization status inquiries Monday through Friday, 8 a.m. to 4:30 p.m. for Johns Hopkins USFHP and for Johns Hopkins Advantage MD. For Priority Partners or EHP coverage, we are available Monday through Friday 8 a.m. to 5 p.m. We truly understand the urgency that each case presents and are processing based off of current industry guidelines and regulations to prevent jeopardizing the health and wellbeing of our members. We appreciate your time as we work through the COVID-19 pandemic.
Contact the Customer Service/UM Intake team at:
- PPMCO, EHP, & USFHP: 410-424-4480
- Johns Hopkins Advantage MD: 844-560-2856
EHP Administration Telemedicine Policy
The Telemedicine Policy for Johns Hopkins Employer Health Programs (EHP) has been updated to contain guidelines, conditions and requirements pertaining to the COVID-19 epidemic. Please review the updated policy for more information.
Coronavirus (COVID-19) Prevention and Coverage Information for Plan Members
To address concerns about coronavirus (COVID-19), Johns Hopkins HealthCare posted important information on member websites. This messaging covers the COVID-19 virus, how the virus is spread, and actions members can take to protect themselves and their families. We have also assured them that any COVID-19 testing or treatment they need will be covered by their health plans and that they would pay their usual cost shares. We reminded members about these steps they can take to prevent infection:
- Wash your hands often with soap and water for at least 20 seconds, especially:
- Before eating
- After going to the bathroom
- After blowing your nose, coughing, or sneezing
- When you can’t get to soap and water, use a hand sanitizer with at least 60% alcohol.
- Stay home when you are sick.
- Avoid close contact with people who are sick. If someone is sick at home, wash your hands before and after caring for them.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
We directed members to the CDC’s COVID-2019 website to keep up with the latest updates. We also instructed them to call their providers if they develop coronavirus symptoms—fever, cough, or trouble breathing—if they have been in close contact with someone who has COVID-19, or believe they may have been exposed to the virus.
The CDC and Johns Hopkins Medicine are sources for the latest information about the virus.
2021 Provider Manuals
The 2021 Provider Manuals for Johns Hopkins Advantage MD, Johns Hopkins Employer Health Programs (EHP), Priority Partners, and Johns Hopkins US Family Health Plan (USFHP) are available for your reference. If you have any questions about the Provider Manuals, please contact your network manager.
Preauthorization is No Longer Required for Observation
Effectively immediately, preauthorization is no longer required for observation after the first 24 hours. This applies to Johns Hopkins Employer Health Programs (EHP), Johns Hopkins US Family Health Plan, Priority Partners, and Johns Hopkins Advantage MD. It is expected that for the vast majority of patients, disposition will occur within 24 hours of placement in observation status. Up to 48 hours of outpatient observation care may be required in certain circumstances.
Observation hours exceeding 48 hours (24 hours for Priority Partners members) will be denied.
Please refer to Policy Number CMS11.03 for more information on this medical policy.
Recommendations for Vaccines in Light of Measles Outbreaks in the U.S.
Recent outbreaks of the measles, including cases in Maryland, have brought more attention to the MMR vaccine. Based on guidelines from the Centers for Disease Control and Prevention and the Maryland Department of Health, Johns Hopkins HealthCare is issuing a recommendation to protect patients who may have an increased risk of measles exposure. Please review this communication and consider its impact on your patients.
Revised Procedure for Criminal Background Checks for Prospective USFHP Providers
JHHC is required to initiate criminal background checks, per TRICARE regulations, on initial providers that request to participate with the Johns Hopkins US Family Health Plan (USFHP). Learn more about this update.