Johns Hopkins HealthCare LLC Payer Day May 11, 2018 Presented by: - - PowerPoint PPT Presentation

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Johns Hopkins HealthCare LLC Payer Day May 11, 2018 Presented by: - - PowerPoint PPT Presentation

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Johns Hopkins HealthCare LLC Payer Day May 11, 2018 Presented by: Johns Hopkins HealthCare Provider Relations Department May, 2018 5/11/2018 Agenda Introduction JHHC Advantage MD Product Overview HMO (new) JHHC Updates

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5/11/2018

Johns Hopkins HealthCare LLC

Payer Day May 11, 2018

May, 2018

Presented by: Johns Hopkins HealthCare Provider Relations Department

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5/11/2018

Agenda

  • Introduction
  • JHHC Advantage MD Product Overview – HMO (new)
  • JHHC Updates
  • Priority Partners MCO: Don’t Lose Your Coverage
  • JHHC Website and Contact Information
  • JHHC HealthLink@Hopkins
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Johns Hopkins Advantage MD

  • Johns Hopkins Advantage MD Plans

– PPO, PPO Plus, Group – HMO – Effective 1/1/2018

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Johns Hopkins Advantage MD Service Area

Service Area is defined as a geographic area where a health plan can accept

  • members. In 2018 JHHC is adding Frederick County.

– Anne Arundel County – Baltimore City – Baltimore County – Calvert County – Carroll County – Howard County – Montgomery County – Somerset County – Washington County – Wicomico County – Worcester County – Frederick County-new as of 1/1/18

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Advantage MD HMO Plan-New 2018

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MEMBER ID CARD HMO

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Differentiation HMO/PPO

HMO

  • Primary care physician coordinates all care for the member
  • All care must be within the plan network (no out-of-network

coverage)

  • Lower out-of-pocket costs
  • Monthly premiums are lower than PPO plans
  • Referrals are required for specialty care; please provide a

copy to the patient and submit to JHHC

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HMO Referral Requirements

  • Referrals are required for specialty services
  • Referrals should be to in-network specialty providers only –

there is no out-of-network coverage for the HMO

  • PCPs should complete referrals in HealthLINK and provide

the member with a copy. Or, complete the Maryland Uniform Consultation Referral Form, provide member a copy, and fax to JHHC at 410-424-4036.

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Johns Hopkins HealthCare Updates

  • Effective 1/1/2018, USFHP members no longer need

a referral for urgent care visits.

  • This applies to participating and non-participating

providers.

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Johns Hopkins HealthCare Updates

  • USFHP Pharmacy Fax Number

– The JHHC Pharmacy Department has launched a new fax number that will serve as the single fax number for all USFHP Pharmacy request.

  • Fax: 410-424-4037
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Johns Hopkins HealthCare Updates

  • Outpatient Referral & Pre-authorization Guidelines Update
  • Procedures in ASCs Prior Authorization Initiative
  • Urology Outpatient Prior Authorization Initiative
  • Gastroenterology Outpatient Prior Authorization Initiative
  • Ophthalmology Outpatient Prior Authorization Initiative
  • Infusion Services Outpatient Prior Authorization Initiative
  • Prenatal Obstetrical Ultrasound Policy Clarifications
  • MRI of the Cervical & Lumbar Spine Prior Authorization

Initiative

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Priority Partners MCO: Don’t Lose Your Coverage The Maryland Department of Health is now dis-enrolling members who do not have a correct address in the system.

  • Call Maryland Health Connection at:

– 1-855-642-8572 (TTY 1-855-642-8573)

  • Go online to: MarylandHealthConnection.gov
  • Download the free Enroll MHC mobile app.
  • Get free in-person help from a local connector entity, health

department, or department of Social Services.

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Johns Hopkins HealthCare Website

Provider website includes:

– Provider Manuals – Forms – HealthLINK@Hopkins portal access – Online Provider Directory

  • Find participating providers on www.jhhc.com

– Policies & Procedures – Compliance Guidance – Prior-authorization Tool

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HealthLINK@Hopkins

Registered providers are able to access the following information using HealthLINK:

  • Eligibility
  • Claims
  • Authorizations & Referrals
  • PCP member rosters
  • Care coordination reports
  • Advantage MD HMO – Referral submission

NOTE: Quick Reference Guide on HealthLINK@Hopkins at www.jhhc.com

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Updating Your Information

  • If there are any changes in your practice, you are required

to notify Johns Hopkins HealthCare Provider Relations Department by:

  • Update information on CAQH
  • Calling 1-888-895-4998, and/or
  • Faxing the documentation to 410-424-4604

CMS requires the Health Plan to validate provider information on a quarterly basis.

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Contact Information

  • Provider Relations Department: 1-888-895-4998 (provider

education, credentialing & contract inquiries)

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THANK YOU

Presented by:

5/11/2018

Presented by: Johns Hopkins HealthCare Provider Relations Department

May, 2018

QUESTIONS?