Johns Hopkins Advantage MD provides immediate access to required forms and documents to assist our providers in expediting claims processing.

• Procedure Authorization Request (not for medical injectable requests)
• Medication Formulary Exception Request (HMO and D-SNP)
• Medication Formulary Exception Request (PPO)
• Medication Step Therapy Exception Request (HMO and D-SNP)
• Medication Step Therapy Exception Request (PPO)
• Medication Tier Exception Request (HMO and D-SNP)
• Medication Tier Exception Request (PPO)
• Medication Quantity Limit Exception Request (HMO and D-SNP)
• Medication Quantity Limit Exception Request (PPO)
  
• Model of Care Provider Training Attestation Form (D-SNP)
• Model of Care Provider Training Attestation Form (D-SNP) - online
• Offshoring of PHI Attestation
• Participating Provider Post-Service Payment Dispute Submission Form 
• Prescription Drug Coverage Determination Request (HMO and D-SNP) 
• Prescription Drug Coverage Determination Request (PPO)
• Prescription Drug Coverage Redetermination Request (HMO and D-SNP)
• Prescription Drug Coverage Redetermination Request (PPO) 
• Primary Care Provider Change
• Psychological and Neuropsychological Testing Request
• Substitute Form W-9
• Waiver of Liability Statement
• Whole Health Assessment Form
• Whole Health Assessment (Online Form)

PLEASE NOTE: All forms will need to be faxed to Johns Hopkins Advantage MD in order to be processed. See the appropriate fax number on the top of the form for submission. If you have any questions, please contact Customer Service at 877-293-5325.