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Johns Hopkins Employer Health Programs (EHP) provides immediate access to required forms and documents to assist our providers in expediting claims processing.
- ABA Prior Authorization Request
- Care Management Services Request
- Group Disability Claim Form (Broadway Services Inc)
- Group Disability Claim Form (JH Bayview Medical Center, JHH/JHHSC)
- Medical Admission or Procedure Authorization Request (not for medical injectable requests)
- Medical Review Medical Injectable Prior Authorization Request
- Newborn Notification and Authorization Request
- Newborn Notification and Authorization Request Instructions
- Provider Appeal Submission Form
- Provider Claims/Payment Dispute and Correspondence Submission Form
- Request for Medical Appropriateness Determination for Psychological Testing
- Substitute Form W-9
PLEASE NOTE: All Forms will need to be faxed to Employer Health Programs (EHP) in order to be processed. See the appropriate fax number on the top of the form for submission. If you have any questions please contact Customer Service at 410-424-4450 or 800-261-2393.