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Johns Hopkins Health Plans

Division of Health Services

The Johns Hopkins Health Plans Division of Health Services is committed to quality health care, and partnership with our dedicated providers is key to achieving this goal.

The Division of Health Services departments include:

Appeals

To request an appeal of denied services, refer to the provider appeal rights on the denial letter.

Fax appeals to:
410-762-5304

Mail to:
Johns Hopkins Health Plans
Attn: Appeals Department
7231 Parkway Drive, Suite 100
Hanover, MD 21076

Expedited appeals:
Pre-service and medication expedited appeals only may be called in to the expedited verbal appeals phone line: 410-762-5383.

Care Management

The Johns Hopkins Health Plans Care Management team offers a variety of services to help members manage chronic health conditions, recover from serious illness, and make healthy lifestyle changes. Our care management services are voluntary and are provided at no cost to the member. Members identified with certain needs may be automatically enrolled, but are under no obligation to participate in these programs.

The Care Management team collaborates with members, their family or caregivers and their providers to assist members in learning about their health conditions, navigating their treatment, removing barriers to care and linking members to resources. The Care Management team assists members in developing condition specific self-management skills to stabilize their health. We are here to support all members wherever they are on the health continuum. The Care Management team also provides assistance to all members as they transition from an emergency department visit or inpatient hospitalization to the community (home).

Care Management Services

We can collaborate with you to help your members access a variety of services.

Care Management works with the following vendors:

For Advantage MD and Priority Partners members, we work with Evicore to assist members with transitional care after discharge from a skilled nursing facility.

For EHP and Priority Partners members, we work with Progeny Health, LLC. to assist members with utilization management for infants born and admitted to neonatal intensive care units (NICU). Progeny Health, LLC. also offers care management to NICU graduates through their first year of life.

For Priority Partners members, we work with Optum Maryland to manage mental health needs.

Please send us your referrals by contacting us at:

Phone: 800-557-6916
Monday through Friday: 8 a.m. to 5 p.m.
Voicemail messages received after normal business hours will be addressed the following business day.

Email: [email protected]

Utilization Management

The aim of the Johns Hopkins Health Plans Utilization Management (UM) program is to achieve the mission of providing access to high quality, cost-effective, member-centered care. Johns Hopkins Health Plans' utilization management decisions are based on appropriate care and existence of coverage.

Johns Hopkins Health Plans does not give financial incentives to staff that reward denials or promote under-utilization of services. Johns Hopkins Health Plans does not make decisions about hiring, promoting, or terminating practitioners or Johns Hopkins Health Plans staff based on the likelihood that the practitioner or Johns Hopkins Health Plans staff member supports denials of benefits. You may request a copy of the UM criteria or benefit guidelines used in the decision of any case. For concurrent inpatient admissions, a UM RN is on-call after hours, including weekends and holidays to assist with urgent admissions and discharge planning.

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