Find helpful resources and guidelines for all of our health plans.
For all health plan providers
- Facets Important Information
- 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
- Preauthorization 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
- Criteria for Practitioner Participation
- Durable Medical Equipment (DME) Provider Directory
- HMO Quick Reference Guide
- Mail Order Best Practices
- Medical Injectables Requiring NovoLogix Preauthorization
- PPO Quick Reference Guide
- Practitioner Discipline & Appeals
- Termination of Network Participation, Reporting Terminations, Fraud & Abuse
- Yearly Wellness Checklist
- Offshore Attestation
- eviCore Laboratory Management Program
- eviCore: Comprehensive Interventional Pain Management Prior Authorization CPT Code List
- eviCore: Comprehensive Joint Surgery Prior Authorization CPT Code List
- eviCore: Comprehensive Physical Therapy & Occupational Therapy Prior Authorization CPT Code List
- eviCore: Comprehensive Spine Surgery Prior Authorization CPT Code List
- Radiology and Advanced Cardiac Imaging Codes Requiring Preauthorization by eviCore
EHP
Priority Partners
- Outpatient Code Editor - Medicaid
- Radiology and Advanced Cardiac Imaging Codes Requiring Preauthorization by eviCore
- Durable Medical Equipment (DME) Provider Directory
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
- Molecular and Genetic Testing Codes Requiring Preauthorization by eviCore
- Get Vaccinated Flyer
- Laboratory Policy
- Maryland Healthy Kids Preventive Health Screening Resources
- Medical Injectables Requiring Preauthorization
- Newborn Enrollment Notice for Hospitals
- Pregnancy Support - Program for High Risk Pregnant Women
- Primary Care Quality & Efficiency Standards for Healthcare Quality Improvement
- Provider Appeals Policy
- Quick Reference Guide
- Self Referral Protocols
- eviCore: Comprehensive Interventional Pain Management Prior Authorization CPT Code List
- eviCore: Comprehensive Joint Surgery Prior Authorization CPT Code List
- eviCore: Comprehensive Physical Therapy & Occupational Therapy Prior Authorization CPT Code List
- eviCore: Comprehensive Spine Surgery Prior Authorization CPT Code List
- Pharmacy & Formulary Overview
- Pharmacy Formulary Changes
- Pharmacy Drugs Preauthorization Forms
- Pharmacy Drugs Preauthorization Policies
- Medical Injectables Requiring Preauthorization
- Medical Injectable Drug Preauthorization Forms
- Medical Injectable Drug Forms and Criteria
- Medical Injectables Requiring Preauthorization
USFHP
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.