Delivering quality medical services to our members is the hallmark of Johns Hopkins Health Plans, and we rely on our network providers to do this.
News and Announcements
-
In the wake of the collapse of Baltimore’s Francis Scott Key Bridge on March 26, 2024, we at Johns Hopkins Health Plans offer our support to all who are affected by this disastrous event. We would like to remind our providers of resources in place at Johns Hopkins Health Plans that may be helpful during this time. View resources.
-
Johns Hopkins Health Plans provides free tools and services to people with disabilities to communicate effectively. Johns Hopkins Health Plans also provides free language services to people whose primary language isn’t English (e.g. qualified interpreters and information written in other languages). These services can be obtained by calling the Customer Service number on their member ID card.
You may also contact Johns Hopkins Medicine International for assistance or submit a member referral to Priority Partners. -
Due to an issue impacting Optum/Change Healthcare and its network, Johns Hopkins Health Plans has removed connectivity with Change Healthcare out of precaution until their situation can be investigated and resolved. As a result, you may experience issues with submitting electronic claims and delays in receiving payment from Johns Hopkins Health Plans beginning on or after February 22, 2024. Read our FAQ for updated information.
-
Johns Hopkins Health Plans’ Provider Relations team welcomes you to the 2024 provider training sessions for Johns Hopkins Advantage MD D-SNP (HMO). D-SNP plan members have special needs that make them eligible for both Medicare and Medicaid (dual eligible).
-
A new issue of 'Provider Pulse' is now available online. The issue contains important information on policies and procedures, quality care, plan changes and other materials pertinent to providers in the Advantage MD, Employer Health Programs, Priority Partners and US Family Health Plan networks.
-
Providers and facilities interested in joining Johns Hopkins Health Plans provider network can fill out the LOI form online.
Letter of Interest Request to Join Network Form:
Once completed, the LOI form will be submitted directly to Johns Hopkins Health Plans Contracting Team.
-
The federal government enacted The No Surprises Act in December 2020, which became effective on January 1, 2022. The No Surprises Act rules allow patients to give consent to waive surprise billing protections in certain circumstances. If a non-par provider obtains consent from a Johns Hopkins Employer Health Programs (EHP) member or authorized representative to waive surprise billing protections, the Member Consent Form (see below for link to form template) must be submitted with the claim.
Member Consent Form Submission Methods:
- Paper claim, with paper Member Consent Form attached
- Electronic claim, with paper Member Consent Form mailed separately
- If submitting a paper Member Consent Form that matches up to an electronic claim, please include the following information to ensure the form will be received and processed correctly:
- Member Full Name
- Member DOB
- Member ID
- Date of Service
- List of Services -OR- Copy of electronic claim, if possible.
- If submitting a paper Member Consent Form that matches up to an electronic claim, please include the following information to ensure the form will be received and processed correctly:
Provider Relations
The Provider Relations Department is dedicated to the partnerships we've established within our provider network. Provider Relations Network Managers and Coordinators work closely with providers and facilities to satisfy the needs of our program enrollees. These include but aren't limited to:
- Rate negotiation and services coordination for non-par providers/vendors
- Needs analyses for network expansions
- Orientation for new providers
- Routine office visits for ongoing training and assurance of contractual compliance
- Annual seminars on general and specific topics of interest
- Updated policies and procedure information
- Network management/monitoring for adequacy, access, appointment and availability
- Immediate response to inquiries, requests and/or issues
- Routine correspondence and communication
Frequently Asked Questions
-
We would be honored to include your practice within our provider network. Contact our Provider Relations Department at 888-895-4998 or 410-762-5385, or review our list of Network Managers, and contact your area representative.
-
Approximately 30 days from the time we receive your claim. Want to get paid even faster? Did you know that Johns Hopkins Health Plans now offers electronic payments to its providers? Electronic Funds Transfer (EFT) is easy to set up and once complete guarantees a quicker reimbursement. For more information e-mail [email protected] or call 888-895-4998 today.
-
Certain medications require prior authorization before coverage is approved to ensure medical necessity, clinical appropriateness and/ or cost effectiveness. Coverage of these drugs is subject to specific criteria approved by physicians and pharmacists on the Johns Hopkins Health Plans Pharmacy and Therapeutics Committee. To see a list of drugs that require prior authorization, visit the pharmacy sections for EHP, Priority Partners or US Family Health Plan.
-
HealthLINK is a secure, online web portal for Johns Hopkins Employer Health Plan (EHP), John Hopkins US Family Health Plan (USFHP) and Priority Partners MCO members and their in network providers. As a provider, you can check patient eligibility, claims status, submit and check the status of referrals and authorizations, run patient reports, send secure messages to Customer Service and more. To sign up for an account, contact Provider Relations at 1-888-895-4998.