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Provider – A person, group, or facility that provides health care services and/or products.
(e.g. doctor, nurse practitioner, specialist, hospital, or pharmacy, etc.).
Primary Care Provider (PCP): A PCP is the person or provider that you select (or that has been selected for you) to be the medical professional who takes care of your healthcare needs or problems and helps you get any needed specialty services.
Gender – The sex of the provider; male or female.
Office Location – The physical address for the provider.
Office Phone Number –The telephone number at which the provider can be contacted.
Specialty – The area of medicine in which the provider specializes. Examples of types of specialty include Internal Medicine, Pediatric Medicine, and Obstetrics and Gynecology. The provider self-reports their specialty on their credentialing application. Providers are requested to validate their specialty annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least and this information is verified by the provider at least annually and by Jai Medical Systems Managed Care Organization every three years.
Board Certification – An official provider certification in an area of specialty by the American Board of Medical Specialties or other certifying board. For the most up-to-date information regarding a provider’s Board Certification, please visit the American Board of Medical Specialties website at www.ABMS.org. To verify a provider’s current Board Certification status, please visit http://www.certificationmatters.org/ and you can enter the provider’s information or search by location and specialty. Providers are requested to validate their board certification annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least Board Certification is verified by the provider at least annually and by Jai Medical Systems Managed Care Organization every three years.
Group Name – The name of the group practice for the provider. The Group Name is verified by the provider at least annually.
Medical Group Affiliation – The directory lists medical groups in the organization’s network with which the physicians’ providers are affiliated. Providers are requested to validate their medical group affiliation annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years.
Hospital Affiliation – These are the hospitals for which the provider has admitting privileges. The provider must apply for privileges to each hospital individually and meet the hospital’s admitting privileges standards. Providers are requested to validate their hospital affiliation annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years.
Hospital Affiliation(s) is self-reported by the provider annually and verified by Jai Medical Systems Managed Care Organization every three years.
Hospital Accreditation – There are specific organizations that accredit hospitals. This section includes the name of the accrediting body and the status of accreditation. Hospital Accreditation is self-reported by each hospital annually and verified through the accreditation organization’s website.
Accepting New Patients – This explains whether a provider is currently accepting new patients. Providers are requested to validate if they accept new patients annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years. This information is only identified for Primary Care Providers, Obstetricians and Gynecologists, and Substance Abuse Providers. This information is verified by the provider at least annually.
Languages – These are the language(s) that are spoken by providers participating in our network. Providers are requested to validate their language(s) spoken annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years. Provider language is verified by the provider at least annually.
Hospital Name – The name for an institution providing medical and surgical treatment and nursing care for sick or injured people. Hospitals are requested to validate their name annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years.
Hospital Location – The physical address for the hospital. Hospitals are requested to validate their location annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years.
Hospital Phone Number – The telephone number at which the hospital can be contacted. Hospitals are requested to validate their telephone numbers annually and immediately upon change. Jai Medical Systems Managed Care Organization verifies this at least every three years.
Hospital Accreditation – There are specific organizations that accredit hospitals which evaluate and accredit hospitals based on a set of standards. This section includes the name of the accrediting body and the status of accreditation. Hospital Accreditation is self-reported by each hospital annually and verified through the accreditation organization’s website.
Hospital Quality Data – Quality data that is from a recognized national source. This source lists quality data about each hospital, including but not limited to, general information, patient experience, timely and effective care, complications, readmissions, deaths, use of medical imaging, payment, and value of care. Please visit Hospital Compare’s website https://www.medicare.gov/hospitalcompare/search.html to find a hospital.