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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.
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)
The Fall 2020 issue of "Provider Pulse" is now available online. The issue contains updates on policies and procedures, claims and billing, pharmacy and more.
HealthLINK Maintenance Scheduled for November 21
Monthly maintenance for HealthLINK has been scheduled for November 21, 2020, from 8 p.m. to 9 p.m. EST. During this time, HealthLINK functions will not be available. Thank you for your patience.
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.
2020 Provider Manuals
The 2020 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.
Medical Policy Update
JHHC issued an email to providers regarding the medical policies that are effective on 02/03/2020. For questions about the updates, contact Provider Relations at 1-888-895-4998 or visit our medical policies page to see the latest updates.
ePREP Enrollment Date Extended to January 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 January 1, 2020. 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.
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.
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.