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.

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.