Plan Benefits

EHP offers programs and services to help members better manage their health. EHP recently launched the EHP Benefits Explorer, an interactive tool designed to help EHP members quickly and easily find coverage information related to specific services. For detailed information on what each individual employer offers, visit benefits.ehp.org or see the schedule of benefits . As EHP members, your patients can take advantage of the following:

• Prescription coverage: Prescription drug benefits vary among EHP employer groups. The EHP pharmacy and formulary can be viewed here.
• Dental care: The EHP dental benefit, offered by some EHP plans, is administered by Delta Dental. Members can call Delta Dental customer service at 1-800-932-0783.
• Visits to urgent care: Members can find urgent care centers by accessing the Provider directory or calling EHP customer service at 1-800-261-2393.
• Care management program: Members are placed in one of three levels and, depending on their level, are given a variety of support, tools, and services that are specifically designed to help them better understand and manage their medical conditions. Members can call 1-800-557-6916 for more information.
• Pregnancy resources: Various programs for expectant moms including a high risk prenatal case management program. Members can call 1-800-261-2396 Ext. 5355 for more information.
• HealthLink@Hopkins: This is the secure web portal for members' personal health information. Members can login and register at ehp.org.
• Members also have access to the nationwide Cigna PPO network, a supplemental provider network. EHP covers all provider health care services in the Cigna PPO network at the in-network benefit level. Members may use a Cigna PPO network provider as their primary care provider.

Appointment Access Standards

Behavioral health providers must:

• Refer patients to the ER within six hours for non-life-threatening emergencies
• Initial visits for routine care within ten business days
• Provide urgent care within 48 hours
• Follow up routine care within 30 days for new or existing patients

EHP Administration Telemedicine Policy

Policy Number: RPC.030
Effective Date: 06/01/2022

POLICY

Johns Hopkins Health Plans will reimburse Telehealth/Telemedicine and virtual health services when covered under plan benefits and when technical requirements and billing guidelines are met. The appropriate modifiers and/or Place of Service (POS) must be used when the telehealth or telemedicine claims are submitted. Claim(s) that do not follow correct coding and billing guidelines may be denied. For the purpose of this policy, the terms “telehealth” and “telemedicine” are used interchangeably and encompass virtual health care services.

SCOPE

This payment policy applies to telehealth/telemedicine and virtual health services reported on CMS-1500 claim forms or their electronic equivalent, to a Johns Hopkins Health Plans product, from network and non-network physicians, providers and suppliers.

BILLING GUIDELINES

Johns Hopkins Health Plans may reimburse for services recognized by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA). Providers may find a list of these services on the CMS website: Telehealth Services List.

Note: EHP will follow CMS Claims Processing guidelines.

GENERAL CONSIDERATIONS FOR TELEHEALTH

Covered services rendered as a telehealth service follow the same prior authorization requirements as if the service was rendered face-to-face.

1. Covered services rendered as a telehealth service follow the same prior authorization requirements as if the service was rendered face-to-face.
2. When using a telemedicine procedure code, a modifier is not necessary. Only codes that are not traditional telemedicine procedure codes require the modifier.
3. Per CMS, the originating site facility fee, HCPCS code Q3014, is only billable with POS 11 (an office visit).
4. Johns Hopkins Health Plans do not reimburse for the technical fees or costs for the provision of telemedicine services.