These guidelines are updated every quarter and posted to the Johns Hopkins HealthCare website. Mail Referrals Forms: CarePartners of Connecticut P.O. Pharmacy Compound Drug Prior Authorization Form: If your doctor is not able to substitute an ingredient in a medication or prescribe a different drug to you,they will need to fill out this form to request prior authorization for a compound drug. Representation of Responsibility for Minor Child: If you are over 18 years old, filling out this form will give you theright to represent and make health care information-related decisions about a minor child who is 17 years old or younger. 4\"o$*XPRj+ Elective inpatient admissions and all outpatient hospital-based service requests require pre-service Prior Authorization, as do requests for: Inpatient Hospice Admissions. Authorization for Release of Health Information Standing: This form lets you choose someone you trust to have access to yourhealth records. Please note: PPO and EPO members can see specialists without obtaining a referral from AllWays Health Partners. Remember, a request for prior authorization is not a guarantee of payment. These guidelines are updated quarterly and posted to the Johns Hopkins HealthCare website. Prior Authorization. h21V0P61A Any request that was submitted to the fax number 410-767-6034 on or after December 5, 2021 must be resubmitted to the email address provided above. Priority Partners Coronavirus (COVID-19) - Hopkins Health (4 days ago) Priority Partners Coronavirus (COVID-19) In accordance with the Governor's Order Terminating Various Emergency Orders issued on June 15, 2021, most of the guidance issued by the Maryland Department of Health (MDH) in response to COVID-19 expired on July 1, 2021, and Aug. 15, 2021. Tell us about your health, and well see what services may be able to help. However, with our preconfigured online templates, things get simpler. Records must be easy to retrieve, but only authorized personnel should have access to them. Search health topics in theHealth Library. To ensure that the most up-to-date referral and preauthorization guidelines for outpatient services are being followed, visit www.jhhc.com > For Provid- Printing and scanning is no longer the best way to manage documents. &`$` ML To request a paper copy, please call Customer Service at 800-654-9728 (TTY for the hearing impaired: 888-232-0488). 4/6/2020 : Yes . Pre-authorization is required for select procedures when performed in an outpatient hospital setting. Outpatient Referral and Preauthorization Guidelines at www.jhhc.com. All rights reserved. You can search for participating health partners using the "Find a Provider" tool. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's . To request a paper copy, please call Customer Service at 800-654-9728 (TTY for the hearing impaired: 888-232-0488 ). T$ Priority Partners can help you. endstream endobj 415 0 obj <>stream EZ-Net is the preferred and most efficient way to submit a Prior Authorization (PA). This means that your PCP does not need to arrange or approve these services for you. Effective January 1, 2021, providers may begin contacting CVS Caremark to obtain prior authorizations for ProMedica Employee Health Plan members receiving specialty drugs. HCP's Preferred Specialists. If you have any questions, please contact Customer Service at 1-800-654-9728. Contact us or find a patient care location. Below is a summary of the changes to the Outpatient Referral and Preauthorization Guidelines that go into effect May 1, 2020: *For related medical policies, please go to www.jhhc.com > For Providers > Policies. For more details on the benefits, download the summary of coverage and benefits. HealthLINK@Hopkins. The Outpatient Referral and Preauthorization Guidelines (OPRGs) clearly outline the referral and preauthorization requirements for many outpatient services for our Johns Hopkins Advantage MD, Johns Hopkins Employer Health Programs (EHP), Priority Partners and Johns Hopkins US Family Health Plan (USFHP) members. To request a paper copy, please call Customer Service at 800-654-9728 (TTY for the hearing impaired: 888-232-0488). All documents are available in paper form without charge. h\ Priority Partners will review the service, drug or equipment for medical necessity. Some of these medical drugs may require prior authorization. Find more COVID-19 testing locations on Maryland.gov. The adult representative can only be the minor's parent, step-parent, legal guardian, or kinship caregiver. You will get reimbursed in part or in whole once the classes are over. Enter the last name, specialty or keyword for your search below. Unauthorized services will not be reimbursed. You can also download the Member Handbook. To see information details on prior authorization and other explanation of benefits, review our Outpatient Referral and Pre-Authorization Guidelines. Referring patients for office-based Specialty Care has never been easier when using HCP's Preferred Specialist Physicians which include thousands of experts across New York City and Long Island. Log in to eviCore's Provider Portal at. WDkj^_8 uzmi7%Kidc=GM}@w93F_0a"pT5[Z n0Vtr'E w@. PLEASE NOTE: All forms are required to be faxed to Priority Partners for processing. You can also decide how much of your personal health information you want that person to know. Pre-service requests for the following . Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Please note: PPO and EPO members can see specialists without obtaining a referral from AllWays Health Partners. To request a paper copy, please call Customer Service at 800-654-9728 (TTY for the hearing impaired: 888-232-0488 ). Referral Guidelines vary by plan; please refer to your plan materials. Self Referral Services Priority Partners requires notification from your provider at the beginning of your pregnancy. There are two steps in the prior authorization process: Your health care provider submits the request for pre-approval to Priority Health. We require prior authorizations to be submitted at least 7 calendar days before the date of service. We are vaccinating all eligible patients. Your regional contractor sends you an authorization letter with specific instructions. All documents are available in paper form without charge. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Authorization for Release of Health Information - Specific Request, Hepatitis C Therapy Prior Authorization Request, Medical Admission or Procedure Authorization Request, Medical Injectable Prior Authorization Forms, Newborn Notification and Authorization Request, Newborn Notification and Authorization Request Instructions, Pharmacy Compound Drug Prior Authorization Form, Pharmacy Quantity Limit Exception Prior Authorization Form, Pharmacy Step Therapy Exception Prior Authorization Form, Provider Claims/Payment Dispute and Correspondence Submission Form, EHP/Priority Partners/Advantage MD patients. Effective May 1, 2020 The Outpatient Referral and Preauthorization Guidelines (OPRGs) clearly outline the referral and preauthorization requirements for many outpatient services for our Johns Hopkins Advantage MD, Johns Hopkins Employer Health Programs (EHP), Priority Partners and Johns Hopkins US Family Health Plan (USFHP) members. Contact us or find a patient care location. Follow the simple instructions below: The prep of lawful documents can be high-priced and time-consuming. p} Outpatient Medical Review . Send a completed Authorization Request form to (888) 746-6433 or (516) 746-6433. Prior authorization also frequently referred to as preauthorization is a utilization management practice used by health insurance companies that requires certain procedures, tests and medications prescribed by healthcare clinicians to first be evaluated to assess the medical necessity and cost-of-care ramifications before they are . Mason Provider Forms Requisition form. If preauthorization is not given, then coverage for care, services or supplies may be limited or denied. %PDF-1.7 % Your doctor can request a prior authorization by filling out a prior authorization request and sending it to Priority Partners. Location Authorizations Prior authorization may be needed before getting outpatient services in a hospital or hospital-affiliated facility. Your plan may contract with a pharmacy benefits management company to process prior authorization requests for certain prescription drugs or specialty drugs. Requirement All medication preauthorization requirements and related prior authorization forms are available here. w%Eo6#Pu5Gho Medication Preauthorization Requirement All medication preauthorization requirements and related prior authorization forms are available here. Update 5/13/2021: CMS is temporarily removing CPT codes 63685 and 63688 from the list of OPD services that require prior authorization. As a Priority Partners HealthChoice member, your benefits include: Pregnant women receive all of the benefits above, plus: See our pregnancy page for more information on tips and services. The priority referral was inadequate in 57% of cases. If you have any questions, please contact Customer Service at 1-800-654-9728. Prior Authorization and Pre-Claim Review Initiatives. Your doctor can request this drug by filling out a prior authorization request. You can work with a care manager to help improve a health condition. Referral- Outpatient Surgery and Procedures Other OON: 15120: Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) See Comment: See Comment: Non-Covered Benefit See our Prior Authorization List, which will be posted soon, or use our Prior Authorization Prescreen tool. Referral & Preauthorization Process. Referral Guidelines Specialist Outpatient referral guidelines and Queensland Health clinical prioritisation criteria Title Alcohol and Other Drugs Service (PDF 128 kB) Antenatal (PDF 165 kB) Cancer Care (PDF 258 kB) Cardiology and Respiratory (PDF 129 kB) Endoscopy Colonoscopy Gastroenterology Referral Form (PDF 405 kB) . This "place of service" authorization may help guide providers and customers to a more cost-efficient location, while ensuring quality of care, when use of an outpatient hospital is not medically necessary. Notice of Privacy Practices(Patients & Health Plan Members). Look up plan benefits During the COVID-19 public health emergency, some of our authorization guidelines may be superseded by the information on our COVID-19 FAQ. Note: Your request will be reviewed, and reimbursement is not guaranteed. The adult representative can only be the minors parent, step-parent, legal guardian, or kinship caregiver. h21T0PM,NMQ()*M.-.HM. Prior authorization requirement effective October 1, 2017. Prior authorization should help avoid incorrect cosmetic payments and assure patients' insurance benefits for functional procedures are covered. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Dont worry, if you dont fill out this form, Priority Partners will continue to keep your health information protected and private. However, if you wish to begin the preauthorization process, please have your doctor call the HPP Preauthorization Department at 215-991-4350 or 888-991-9023 (toll free). All services requiring prior authorization, as outlined in the 'Prior Authorization Guidelines' below, require a Standard Authorization Request Form to be completed by the member's Primary Care Provider and submitted to the Utilization Review and Case Management Department for review and approval. Retrospective authorizations Humana MA private fee-for-service (PFFS): Preauthorization is not required for MA PFFS plans; notification is requested, as it helps coordinate care for Humana-covered . 0EA2w6Y)};9K/hP2[/2UewJ(di&m^Zngwz|Es ( Pharmacy Prescription Reimbursement Secondary Claim Form:This form should be used ONLY if you are submitting claims for secondary prescription coverage. Pre-authorization Your provider must ask for and receive approval before you receive certain care. Enter the last name, specialty or keyword for your search below. CMS runs a variety of programs that support efforts to safeguard beneficiaries' access to medically necessary items and services while reducing improper Medicare billing and payments. Authorization ( also referred to as pre-approval, pre-authorization and pre-certification ) MA for. Or equipment for medical necessity @ Hopkins is a secure, online web Portal where providers can check eligibility. 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