Delivering quality medical services to our members is the hallmark of Johns Hopkins Health Plans, and we rely on our network providers to do this.
Recent Announcements
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A new issue of 'Provider Pulse' is now available online. The issue contains important information on policies and procedures, quality care, plan changes and other materials pertinent to providers in the Advantage MD, Employer Health Programs, Priority Partners and US Family Health Plan networks.
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Providers and facilities interested in joining Johns Hopkins Health Plans provider network can fill out the LOI form online.
Letter of Interest Request to Join Network Form:
Once completed, the LOI form will be submitted directly to Johns Hopkins Health Plans Contracting Team.
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Johns Hopkins Health Plans Provider Relations team announces the 2023 annual provider training session schedule for Johns Hopkins Advantage MD D-SNP (HMO). D-SNP plan members have special needs that make them eligible for both Medicare and Medicaid (dual eligible). The training describes Special Needs Plans (SNPs), define the Model of Care, as well as explain provider responsibilities and member benefits. All D-SNP providers are required to complete this training annually, especially providers on the care teams of D-SNP members. Please note: Providers only need to attend one training per year.
Presenters: Connie Bradford, Kathy Budacz, Dawn Griffin
Presenters: Michael Randall, Nicole Kreamer, Estella Blanche Deshong
After registering for the session, you will receive a confirmation email containing information about joining the meeting and the ability to add the invitation to your calendar.
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The federal government enacted The No Surprises Act in December 2020, which became effective on January 1, 2022. The No Surprises Act rules allow patients to give consent to waive surprise billing protections in certain circumstances. If a non-par provider obtains consent from a Johns Hopkins Employer Health Programs (EHP) member or authorized representative to waive surprise billing protections, the Member Consent Form (see below for link to form template) must be submitted with the claim.
Member Consent Form Submission Methods:
- Paper claim, with paper Member Consent Form attached
- Electronic claim, with paper Member Consent Form mailed separately
- If submitting a paper Member Consent Form that matches up to an electronic claim, please include the following information to ensure the form will be received and processed correctly:
- Member Full Name
- Member DOB
- Member ID
- Date of Service
- List of Services -OR- Copy of electronic claim, if possible.
- If submitting a paper Member Consent Form that matches up to an electronic claim, please include the following information to ensure the form will be received and processed correctly:
Provider Relations
The Provider Relations Department is dedicated to the partnerships we've established within our provider network. Provider Relations Network Managers and Coordinators work closely with providers and facilities to satisfy the needs of our program enrollees. These include but aren't limited to:
- Rate negotiation and services coordination for non-par providers/vendors
- Needs analyses for network expansions
- Orientation for new providers
- Routine office visits for ongoing training and assurance of contractual compliance
- Annual seminars on general and specific topics of interest
- Updated policies and procedure information
- Network management/monitoring for adequacy, access, appointment and availability
- Immediate response to inquiries, requests and/or issues
- Routine correspondence and communication
Frequently Asked Questions
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We would be honored to include your practice within our provider network. Contact our Provider Relations Department at 888-895-4998 or 410-762-5385, or review our list of Network Managers, and contact your area representative.
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Approximately 30 days from the time we receive your claim. Want to get paid even faster? Did you know that Johns Hopkins Health Plans now offers electronic payments to its providers? Electronic Funds Transfer (EFT) is easy to set up and once complete guarantees a quicker reimbursement. For more information e-mail [email protected] or call 888-895-4998 today.
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Certain medications require prior authorization before coverage is approved to ensure medical necessity, clinical appropriateness and/ or cost effectiveness. Coverage of these drugs is subject to specific criteria approved by physicians and pharmacists on the Johns Hopkins Health Plans Pharmacy and Therapeutics Committee. To see a list of drugs that require prior authorization, visit the pharmacy sections for EHP, Priority Partners or US Family Health Plan.
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HealthLINK is a secure, online web portal for Johns Hopkins Employer Health Plan (EHP), John Hopkins US Family Health Plan (USFHP) and Priority Partners MCO members and their in network providers. As a provider, you can check patient eligibility, claims status, submit and check the status of referrals and authorizations, run patient reports, send secure messages to Customer Service and more. To sign up for an account, contact Provider Relations at 1-888-895-4998.