Forms

Johns Hopkins HealthCare provides immediate access to required forms and documents to assist our providers in expediting claims processing for all three of our lines of business.

All Health Plans

EHP Forms

• Behavioral Health Services Referral
• Care Management Services Request
• Group Disability Claim
• Medical Review Medical Injectable Prior Authorization Request
• Newborn Notification and Authorization Request
• Newborn Notification and Authorization Request Instructions
• Pharmacy Compound Prior Authorization
• Pharmacy Formulary Exception Request (This applies to select EHP employer groups using the Prescribing Guide Formulary only.)
• Pharmacy Prior Authorization (This applies to all EHP employer groups using either the Managed Formulary or Prescribing Guide.)
• Sub W-9
• Synagis Prior Authorization Request

Priority Partners Forms

• Hepatitis C Therapy Prior Authorization Request
• Medical Review Medical Injectable Prior Authorization Request
• Member Referral
• Member Response
• Newborn Notification and Authorization Request
• Newborn Notification and Authorization Request Instructions
• Pharmacy Compound Prior Authorization
• Pharmacy Prior Authorization Request (non-opioid medications only)
• Pharmacy Opioid Prior Authorization Request
• Primary Care Provider Change
• Same Day Preauthorization Request
• Synagis Prior Authorization Request

USFHP Forms

• Acknowledgement and Financial Responsibility Statement
• Care Management Services Request 
• Medical Review Medical Injectable Prior Authorization Request
• Newborn Notification and Authorization Request
• Newborn Notification and Authorization Request Instructions
• Pharmacy Compound Prior Authorization Request
• Pharmacy Prior Authorization Request
• Uniform Treatment Plan
• Synagis Prior Authorization Request

Advantage MD Forms

• Maryland Uniform Consultation Referral
• Maryland Uniform Credentialing
• Medical Review Medical Injectable Prior Authorization Request
• Offshoring of PHI Attestation
• Provider Update
• Psychological and Neuropsychological Testing Request
• Sub W-9
• Synagis Prior Authorization Request
• View all forms for the PPO and HMO plans

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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.

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