Provider News & Notices

At Jai Medical Systems, keeping our providers informed is our top priority.

At Jai Medical Systems, keeping our providers informed is our top priority.

Please review the information below for our newsletters, latest healthcare updates, and special announcements.

Jai Medical Systems Managed Care Organization, Inc. Provider Newsletter

Winter 2017 – VOLUME LXII

Alert! In CY 2018, people will lose Medicaid coverage if they have a bad address

Beginning in January of 2018, the Maryland Department of Health will automatically
disenroll Medicaid members whose mail is returned because of an invalid mailing address.
Unfortunately, this new process could result in thousands of people losing Medicaid coverage.

Please help us educate all people covered by Medicaid about the importance of maintaining a
valid address with Maryland Medicaid. We also ask that our providers encourage Medicaid
recipients to report any address changes as soon as possible directly to Maryland Health
Connection. There are many ways to update an address with the Maryland Health Connection:

  • Online at (Use the “Change My Information” button on the account homepage to update the application.)
  • By phone. Call the Maryland Health Connection at 1-855-642-8572 (TTY: 1-855-642-8573)
  • In person. Receive free, in person help from a local connector entity, certified application counselor, health department or department of social services.

We appreciate your assistance with getting the word out regarding this important issue.

Tell us what you think! Complete our Provider Satisfaction Survey

In order to deliver the absolute best provider experience, it is important that we receive your feedback. Please complete the attached provider satisfaction survey as soon as possible. Completed surveys may be returned via fax to 410-433-4615.

Formulary Updates

Please visit for our most current formulary as well as formulary updates and changes. In addition to formulary updates, our pharmacy page contains important documents available for download regarding our prescription prior authorization process.

Lab Services Requiring Prior Authorization

Jai Medical Systems requires prior authorization for certain lab services. For a complete listing of lab services that require prior authorization, please visit:

Health Education Classes

Did you know that Jai Medical Systems offers free Health Education classes to our members?
We do! Topics include diabetes education, asthma education, hypertension education, weight
management, smoking cessation, and women’s health. Currently, our health education classes
are offered on Thursdays at 1235 E. Monument Street, Baltimore, MD 21202 and 4340 Park
Heights Ave, Baltimore, MD 21215.

If you would like to refer one of our members for health education, please contact our
Customer Service Department today at 1-888-524-1999.

Provider Network Expansion

In order to accommodate the growing needs of our members, Jai Medical Systems is
expanding its provider network throughout the State of Maryland. Applications are now
being accepted from primary care providers, specialty care providers, hospitals, specialty
care networks, and ancillary care providers throughout the State of Maryland who are
interested in joining our network. If you know any providers who may be interested in
joining our network, please have them contact our Provider Relations Department at
1-888-JAI-1999 or e-mail

Secret Shopper Program Update

As part of the federal managed care regulation update, the State of Maryland is continuing its Secret Shopper program, and will be surveying our participating providers. Survey questions will focus on ensuring that the information that we have presented in our print and online directory, including your name, location, phone number, and office hours are correct. They will also be surveying providers regarding the earliest availability for an appointment as well as after-hours coverage. We are requesting that you please remind your staff about the Secret Shopper program and ensure that they are all aware of your participation status with Jai Medical Systems. Please also be sure to inform our Provider Relations Department about any changes to your practice, including your office hours, phone number, fax number, etc. By informing us of changes as soon as they occur, we can ensure that our print and online provider directories reflect accurate information about your practice. Please note that demographic changes may be made at any time by calling our Provider Relations Department at 1-888-JAI-1999.

Case Management & Disease Management Programs

Complex Case Management and Case Management programs are available for Jai Medical
Systems’ members, who have serious medical conditions or have complex and/or special
needs. These services provide support and guidance to those members that need or would
like extra assistance with their health care. Our Case Managers can also assist with care
coordination. Below are some examples of medical conditions or circumstances where
Case Management or Complex Case Management may be helpful:

  • Individuals with Hepatitis C
  • People who use the Emergency Room (ER) frequently
  • People with HIV or AIDS
  • Pregnant women and women who have recently had a baby
  • Special Needs Children
  • Individuals with Developmental Disabilities
  • Individuals with Physical Disabilities
  • People with behavior health issues along with medical conditions
  • People with Substance Abuse problems
  • People who need an Organ Transplant
  • People with Asthma/COPD
  • People with Cancer
  • People who need dialysis or who are receiving dialysis
  • People with Diabetes
  • People who need special durable medical equipment

In addition, Jai Medical Systems has developed Disease Management Programs to assist
your patients suffering with hypertension and asthma. These programs have been designed
to reinforce your treatment plan for the patient. Aspects of the programs include assisting
patients with understanding their condition, updating them regarding new information about
hypertension and asthma, and providing them with assistance from our staff to help them
manage their disease.

For more information about Case Management services, Complex Case Management
services, and/or Disease Management programs offered by Jai Medical Systems, or to refer
a patient of yours who is a Jai Medical Systems member, please contact our the Customer
Service Department at 1-888-JAI-1999. You may also find additional information about
our Case Management and Disease Management programs online at:

Updates and Reminders:
  • Provider Portal: Participating providers are encouraged to utilize our Provider Portal to inquire about member eligibility, claim status, appeal status, and much more. To begin using our Provider Portal, please visit our website:
  • Health Risk Assessment: Please encourage members to utilize our online wellness portal, located at Our portal features wellness tips, health education videos, and a health assessment that members can complete.
  • 24 Hour Nurse Advice Line: Please inform members about our 24 Hour Nurse Advice Line. To access our 24 Hour Nurse Advice Line, members should call 1-844-259-8613.
  • Electronic Claims Submission: To submit claims electronically, please register by visiting ClaimsNet website at

    Prior to submitting your claims, please fax the appropriate authorization Attn: Authorizations, Fax Number 1-866-381-7200.

    Prior to submitting your claims, please fax the appropriate referral to Attn: Referrals, Fax Number 1-866-381-7200.

  • Provider Relations Contacts:
    Mrs. Helena Manu
    Director of Provider Relations

    Mrs. Maggie Dembo
    Provider Relations Representative

    Mr. Karl Maple
    Provider Relations Representative

    Ms. Katie Brintzenhofe
    Provider Relations Representative