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Resources & Guidelines
Find helpful resources and guidelines for all of our health plans.
For all health plan providers
- Anesthesia Guidelines
- Care Management Programs
- CareLink
- Claims Retraction
- Clinical Practice Guidelines Policy
- Emergency Department Review Process
- Medical Record Documentation Standards
- Quality Measures Tip Sheet
- Ongoing Monitoring State Fed Exclusion Debarment Sanctions Policy
- Pre-Authorization Criteria for Outpatient Specialty Services at Kennedy Krieger Institute
- Preventive Health Guidelines Policy
- Standard of Conduct
- Substance Abuse Assessment Tool (CAGE)**
- Sudden and Serious Diagnosis Codes
- Utilization Management Medical Polices
Advantage MD
- CPT Codes Requiring Prior Authorization By JHHC-eviCore
- Criteria for Practitioner Participation
- Durable Medical Equipment (DME) Provider Directory
- Practitioner Discipline & Appeals
- Pre-Authorization Guidelines
- HMO Benefits Chart
- HMO Frequently Asked Questions
- HMO Quick Reference Guide
- Coverage Brochure
- PPO Comparison Benefit Chart
- PPO Quick Reference Guide
- Termination of Network Participation, Reporting Terminations, Fraud & Abuse
- Yearly Wellness Checklist
- Offshore Attestation
EHP
- 2019 Preauthorization Procedure Code Update
- Durable Medical Equipment (DME) Provider Directory
- EHP Schedule of Benefits
- Outpatient Referral Guidelines
- Pharmacy Advanced Control Formulary Changes
- Provider Appeals Policy
- Quick Reference Guide
Priority Partners
- 2019 Preauthorization Procedure Code Update
- CPT Codes Requiring Prior Authorization By JHHC-eviCore
- Durable Medical Equipment (DME) Provider Directory
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
- Laboratory Policy
- Maryland Healthy Kids Preventive Health Screening Resources
- Newborn Enrollment Notice for Hospitals
- Outpatient Referral Guidelines
- Partners with Mom Program for High Risk Pregnant Women
- Pharmacy Formulary Changes
- Primary Care Quality & Efficiency Standards for Healthcare Quality Improvement
- Provider Appeals Policy
- Quick Reference Guide
- Self Referral Protocols
USFHP
- 2019 Breast Pump Device Policy Update
- 2019 Preauthorization Procedure Code Update
- Durable Medical Equipment (DME) Provider Directory
- Laboratory Developed Tests (LDT) Codes
- Pharmacy Formulary Changes
- Medline Plus®
- Outpatient Referral Guidelines
- Provider Appeals Policy
- Quick Reference Guide
Note on Medical Record Standards Documentation: Johns Hopkins HealthCare has established standards for primary care medical record documentation. Records must be maintained in a manner that is current, detailed and organized to facilitated communication, coordination and continuity of care. The standards address confidentiality, the availability of the medical record, and required content of the record. To ensure confidential care for members, the JHHC standards state that medical records are stored securely. Records must be easy to retrieve, but only authorized personnel should have access to them. In addition, staff is expected to receive training in member confidentiality. Compliance with these new standards will be monitored as part of our Quality Improvement Program.
Drug and alcohol abuse or dependence are common issues but are often under recognized in primary care settings. Utilizing a simple screening tool, such as the four question CAGE substance abuse assessment, is an easy yet effective way for the primary care provider to determine if substance abuse exists and needs to be addressed.