Transcript Johns Hopkins HealthCare LLC

Johns Hopkins HealthCare LLC
AAHAM Presentation
Presented
by:Lee Phipps & Kathy Budacz
Presented by:
6/21/13
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Who We Are
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Today’s Topics
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HealthLINK@Hopkins
DHMH Reminders
Admissions, Urgent/Emergent Transfers
Johns Hopkins LIFELINE
ICD-10
CRISP
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HealthLINK@Hopkins Website
Priority Partners, PAC, EHP & US Family
Health Plan
 Website features include:
◦ Provider Manuals
◦ Forms
◦ Policies and Procedures
◦ Provider Search Tool
◦ HealthLINK (Log-In)
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HealthLINK@Hopkins
Secure Interactive Web Portal
Verify eligibility
 Submit claims and check claim status
 Review electronic remittance advice and download onto a PC
 Receive reports such as member rosters
 Review all outpatient Referral/Authorization requests
 Directly enter referrals and authorizations that do not require
medical review.
 Send secure messages to Customer Service
 Contact Michelle Mayer (410) 424-4928
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Rejection Review-Appeals Form
For Priority Partners,
EHP and
US Family Health Plan
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DHMH Reminders
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Administrative Day Rates (as of July 1, 2012)
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1184 Newborn Report – for Enrollment
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Dental – Maryland Healthy Smiles
DentaQuest Dental Program
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Admissions
Urgent / Emergent Transfers
JHHC Utilization Management should be
contacted and involved with any inpatient
admission/transfers, as soon as possible.
 JHHC Care/Utilization Management may be
able to assist in identifying as well as
coordinating with the most appropriate
facility.
 410-424-4480 or 800-261-2421, or after
hours at 800-307-9730.
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Johns Hopkins LIFELINE
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Lifeline Critical Care Transport Team
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Phone: (410) 614-7777
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Urgent / Emergent Transfers
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For Emergent and Urgent Physician
Consultation and Patient Transfer / Transport:
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Hopkins Access Line (HAL) 1-800-765-5447
or (410-955-9444 (Baltimore area) or
1-410-955-8032
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For example NICU
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NICU / PICU complications
Maryland Regional Neonatal Transport
Program (888-540-6767)
 In Maryland coordinates with Johns Hopkins
Hospital, University of Maryland Medical
Center and Howard County General (Level III
B Perinatal)
 Will arrange transportation
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Admission/Review
ELECTIVE – PRE-AUTHORIZED
REPORT ADMISSION ON DAY OF
ADMISSION
800-261-2421 OR 410-424-4480
URGENT / EMERGENT
REPORT ADMISSION ON DAY OF
ADMISSION OR NEXT BUSINESS DAY
800-261-2421 OR 410-424-4480
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ICD-10
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JHHC is currently on target for
implementation date of October 1, 2014
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Testing to begin shortly
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CRISP
Johns Hopkins HealthCare has signed a
contract with CRISP (Chesapeake Regional
Information System for Our Patients)
 JHHC receives daily files from CRISP for
admissions, ER, discharges and transfers.
 Allows JHHC to send real time CRISP data
(I/P discharge date and discharge summary
reports, etc.) to the members Primary Care
providers.
 EHP and Priority Partners only.
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COMBO 3
Complete immunizations on or before child’s
2nd birthday:
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4 doses – DTaP/DT
3 doses – IPV
3 doses – Hep B (Initial dose given in Hospital)
3 doses – Hib
4 doses – PCV
1 dose – MMR
1 dose – VZV
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Questions?
PROVIDER RELATIONS
1-888-895-4998
FAX 410-424-4604
Lee Phipps – Sr. Contracting Manager
(410) 762-5338
Kathy Budacz – Servicing Manager
(410) 762-5360
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