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

Fall 2017 – VOLUME LX

Jai Medical Systems is the Highest Rated Medicaid Health Insurance Plan in Maryland and the United States!

Dear Provider,

I am pleased to inform you that Jai Medical Systems is the Highest Rated Medicaid Health Insurance Plan in Maryland and the United States, having earned a rating of 5 out of 5 in the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2017-2018.

In addition, for the third year in a row, Jai Medical Systems has also earned NCQA’s highest accreditation status of Excellent. NCQA’s Excellent Accreditation status is reserved for the best health plans in the nation. It is only awarded to those plans that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care.

We would like to thank all of our providers for their continued loyalty, support, and service to our members. We are very proud to have earned this distinction. Ensuring our members receive high quality health care is what matters most to our company. That is why we are continually evaluating and evolving our systems and population management strategies to ensure they are efficient, effective, and scalable. By working closely with our business partners, vendors, and especially our providers, we are able to collectively focus and achieve clinical objectives, while ultimately improving clinical outcomes and long term health status.

The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS is the most widely used performance tool in health care. NCQA’s website ( contains information to help consumers, employers and others make informed health care choices.

Once again, thank you for being a participating provider with Jai Medical Systems.


Jai Seunarine
Chief Executive Officer

Diabetes Prevention Program

Jai Medical Systems is currently accepting member referrals for our Diabetes Prevention Program. For more information regarding our Diabetes Prevention Program, or to see if one of your patients may qualify, please visit us online at or contact our Customer Service Department at 1-888-JAI-1999.

Visit Us Online

There are many online services available for our members and providers. Many of the resources listed in this chart are available at

If you prefer, all of these resources are also available in print and by telephone. You may request these printed materials by calling Jai Medical Systems at 1-888-JAI-1999.

HEDIS® 2017 Results

HEDIS® is a set of standardized performance measures sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). The performance measures in HEDIS® are related to many significant public health issues such as cancer, heart disease, asthma, diabetes, and timely immunizations. HEDIS® evaluates the quality of care received by our members utilizing administrative data obtained through diagnostic codes and procedure codes that are submitted when medical services are billed. When necessary, this data is supplemented by medical record reviews to obtain information regarding services that may not have been reported.

The HEDIS® 2017 results are in! Jai Medical Systems achieved exceptionally well in CY 2016. Thanks to the hard work of our participating providers, Jai Medical Systems scored the highest score in the State of Maryland in childhood immunizations, vaccinations for adolescents, well-child visits for both kids aged 3-6 and adolescents, lead screening in children, asthma medication management, adolescent access to primary care ages 12-19, chlamydia screening in women, HbA1c testing for diabetics, HbA1c control <8.0% for diabetics, and monitoring on persistent medications. Jai Medical Systems also exceeded the National HEDIS mean scores for 2016 in 54 of the 59 measures.

In CY 2017, Jai Medical Systems continues to focus on HEDIS® measures related to the treatment of asthma and hypertension by ensuring that qualifying members are offered the opportunity to enroll in our Disease Management Programs and our Health Education Programs. Jai Medical Systems also continues to offer a prevention program for patients at risk of developing type 2 diabetes. So far, we have over 110 patients enrolled in this program. We greatly appreciate your efforts in ensuring that our members continue to receive the highest quality health care possible. Your commitment and dedication to serving the health care needs of Jai Medical Systems’ members is commendable and we appreciate all that you do. Please contact the Quality Assurance Department at 1-888-JAI-1999 with any questions or concerns you may have regarding HEDIS® or our Diabetes Prevention Program.

Human Papilloma Virus (HPV) Vaccine

Jai Medical Systems needs your help. Please ensure that all eligible members receive the HPV vaccine as appropriate. The HPV vaccine can prevent HPV infections that are most likely to cause HPV related cancers. Improving HPV vaccination rates is a primary focus for the State of Maryland and Jai Medical Systems. For additional tools and resources, please visit the Maryland Department of Health website at

Opioid Prior Authorization Update

A new prior authorization requirement for certain types, strengths, and combinations of pain medications went into effect June 1, 2017. Please visit our website at for additional information regarding the Opioid Prescription Policy changes, CDC guidelines for prescribing opioids, and to obtain a copy of the required Prescription Prior Authorization Forms.

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.
  • Pharmacy Update: Please visit for our most current formulary as well as all formulary updates and changes.
  • 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.