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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.
Change to AIDS/HIV Prescription Drug Benefit for Priority Partners
Effective Jan. 1, 2020, AIDS/HIV prescription drug benefit coverage will be available under Priority Partners. Previously, Priority Partners members had these drugs covered through the Maryland Department of Health. The 2020 Formulary will be available soon, and will include a listing of preferred products in the HIV therapeutic class. Please be aware: this change may result in the members going from no copay to a $1 or $3 copay.
Epic (New CRM Application) Rollout
We are excited to announce the launch of JHHC's Epic CRM (Customer Relationship Management) application on Monday, October 14th. Starting Monday, Customer Service will be the first department to begin using this new system. This implementation represents a significant and long term investment by JHHC to better service our members and providers.
It is likely that our providers and members may experience longer wait times and talk time as the Customer Service Representatives work to master the new CRM system during implementation. Thank you in advance for your patience.
ePREP Enrollment Date Extended to December 1
New federal rules require that all Priority Partners providers enroll with the state’s Medicaid agency. To continue receiving Medicaid reimbursable funds, providers must submit an electronic application through the online online electronic Provider Revalidation and Enrollment Portal (ePREP). Enrollment is mandatory even if you do not participate with fee-for-service Medicaid.
All providers must register with ePREP by December 1, 2019. After that date, claims payments from unregistered providers will not be reimbursed by the state, therefore claims from unregistered providers will not be paid by Priority Partners.
NOTE: Providers contracted with multiple MCOs only need to enroll one time with the state’s ePREP system.
For additional information and to complete your application, please visit health.maryland.gov/ePREP or call 844-4MD-PROV.
Medical Policy Update
JHHC issued an email to providers regarding the medical policies that are effective on 10/01/19. For questions about the updates, contact Provider Relations at 1-888-895-4998 or visit our medical policies page to see the latest updates.
The Summer 2019 issue of "Provider Pulse" is now available online. The issue contains updates on policies and procedures, quality care, plan changes, events and more.
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.
The Winter 2019 issue of "Provider Pulse" is now available online. The issue contains updates on claims and billing, reimbursement reminders and updates, benefits and plan changes and more.