Claims & Appeals
Claims
At Johns Hopkins Health Plans, we are committed to making it easy for providers to work with us. With a dedicated claims department, you can be assured that your claims will be handled quickly and accurately. Our objective is to process your claim in less than 30 days of receipt and 100% correctly. Timely filing of claims is 180 days from the date of service, unless otherwise specified in your provider agreement. The exception to this timely filing rule pertains to USFHP: The timely filing of claims for USFHP is 90 days from the date on the COB EOB.
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For EHP paper claims, mail to:
EHP
P.O. Box 4227
Scranton, PA 18505 -
For Priority Partners paper claims, mail to:
Priority Partners
P.O. Box 4228
Scranton, PA 18505 (date of service 9/1/22 or after) -
For Advantage MD paper claims, mail to:
Johns Hopkins Advantage MD
P.O. Box 3537
Scranton, PA 18505 -
For USFHP paper claims, mail to:
Johns Hopkins Health Plans
P.O. Box 219960
Kansas City, MO 64121-9960
Attn: USFHP Claims Submission -
Please complete the Provider Claims/Payment Dispute and Correspondence Submission Form and fax to 410-424-2800 or mail to:
Johns Hopkins Health Plans
Adjustments Department
7231 Parkway Dr, Ste.100
Hanover, MD 21076
You can submit and check the status of claims for Advantage MD, Priority Partners, and EHP, through Availity, our secure, real-time platform that connects providers with payers to help providers manage medical benefits and insurance claims.
Please submit and check the status of USFHP claims through HealthLINK@Hopkins, the secure, online web portal for Johns Hopkins Health Plans providers and members.
Contact Provider Relations at 1-888-895-4998 to learn more.
Appeals
Appeals Process
Johns Hopkins Health Plans will reconsider denial decisions in accordance with the provider manual and contract. All appeal requests should be submitted in writing. For information about the appeals process for Advantage MD, Johns Hopkins EHP, Priority Partners MCO, and Johns Hopkins US Family Health Plan, please refer to the provider manuals or contact your network manager.
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Appeals letters and other clinical information should be mailed or faxed to Johns Hopkins Health Plans.
Please complete the Priority Partners, USFHP. EHP Participating Provider Appeal Submission Form and fax 410-762-5304 or mail to:
Johns Hopkins Health Plans
Appeals Department
7231 Parkway Drive, Suite 100
Hanover, MD 21076Fax Number: 410-762-5304
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Please complete the Advantage MD Provider Payment Dispute Form and and fax to 855-206-9206 or mail to:
Johns Hopkins Advantage MD Payment Disputes
P.O. Box 3537
Scranton, PA 18505Phone: PPO: 877-293-5325, HMO: 877-293-4998; TTY users may call 711
Fax: 1-855-206-9206 -
Effective March 21, 2022, the P.O. Box to send Advantage MD non-participating provider appeals requests is changing to:
Mail to:
Johns Hopkins Advantage MD Appeals
P.O. Box 8777
Elkridge, MD 21075
NEW Fax: 1-410-424-2806Phone: PPO: 877-293-5325, HMO: 877-293-4998; TTY users may call 711
Appeal must be received within 60 days of the denial date. All appeals requests must include a completed and signed Waiver of Liability Statement.
NOTE: There is no change to the JH Advantage MD participating provider payment dispute process, address, phone or fax number.
For a Fast Appeal (Advantage MD)
Phone: PPO: 877-293-5325; TTY users may call 711
Fax: 1-855-206-9206