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

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 • Priority Partners MCO: Don’t Lose Your Coverage • JHHC Website and Contact Information • JHHC HealthLink@Hopkins 5/11/2018

Johns Hopkins Advantage MD • Johns Hopkins Advantage MD Plans – PPO, PPO Plus, Group – HMO – Effective 1/1/2018

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

Advantage MD HMO Plan-New 2018

MEMBER ID CARD HMO

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

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.

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.

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

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

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.

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

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

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.

Contact Information • Provider Relations Department: 1-888-895-4998 (provider education, credentialing & contract inquiries)

QUESTIONS? THANK YOU Presented by: Presented by: Johns Hopkins HealthCare Provider Relations Department 5/11/2018 May, 2018