Provider News & Notices

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

Important Notice: Electronic Claims Submissions (October 2025)

Jai Medical Systems has been made aware of an issue with our clearinghouse, SSI Group, that may have impacted some EDI claims submissions.  If you submitted electronic claims to Jai Medical Systems on or after October 6, 2025, please closely monitor all claims submissions to ensure that they have been appropriately received by our organization.  For providers who may have experienced any claim submission rejections, as a general reminder, you may drop these impacted claims to paper claim forms and submit to our organization via mail for processing.  If you have any questions related to this matter, please feel free to contact our Provider Relations Department at providerrelations@jaimedical.com.

A Message from the Director of Provider Relations

On behalf of Jai Medical Systems, I would like to wish you a joyous holiday season and a happy, healthy New Year! Thank you for your service and dedication to our members throughout 2025. As we prepare for the new year, we are excited to share an important update with you. The Maryland Department of Health has approved Jai Medical Systems’ request to expand our service area to include Caroline, Charles, Dorchester, Kent, Queen Anne’s St. Mary’s, Talbot, Wicomico, and Calvert Counties, effective January 1, 2026. We are very excited about this service area expansion and if you are a provider in these areas, we look forward to you serving our new members!

In order to accommodate the growing needs of our members, Jai Medical Systems is continuing to expand our provider network, and we are accepting applications from primary care providers, specialty care providers, hospitals, primary care networks, specialty care networks, and ancillary care providers throughout the State of Maryland. If you know of any providers who may be interested in joining our network, please have them contact the Provider Relations Department directly via email at providerrelations@jaimedical.com.

Thank you for your continued support and we look forward to a productive and impactful new year ahead.

Happy New Year,

Hennrietta Dodoo
Director of Provider Relations

Satisfaction Survey Results

Each year, Jai Medical Systems receives feedback from our members through two surveys. The first is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The goal of this survey is to find out what our members think of our health plan and our network providers, and compares our scores against other health plans throughout the State and Nation. Our highest performing areas for adults surveyed included “How Well Doctors Communicate” at 92.19% and “Customer Service” at 91.10%. For the 2024 Child CAHPS survey, we received an “Overall Health Plan Rating” of 65.40% and the highest performing area was “How Well Doctors Communicate” at 94.02%

The second survey is an internal survey that Jai Medical Systems sends out to give all our members an opportunity to provide us feedback on how we are doing. In 2024, based on responses from 100 members, our overall satisfaction rate was 86%. Our 2025 internal survey was recently sent to our members, and the results will be shared in our next newsletter.

Primary Care Provider Survey Feedback

On an annual basis, Jai Medical Systems is assessed by the Maryland Department of Health through a survey that allows our network Primary Care Providers to rate our health plan, and it also gives us the opportunity to compare our results against other MCOs in Maryland. The survey asks PCPs to rate their satisfaction with Jai Medical Systems on various topics such as claims processing, preauthorization, customer service, and provider relations. Jai Medical Systems is excited to share that compared to the HealthChoice aggregate scores of all other Managed Care Organizations throughout the State, our MCO received higher ratings in nearly all categories. Please see the below for a complete snapshot of the 2024 HealthChoice PCP Satisfaction survey results:

HEDIS Reminder: Adult Immunizations

HEDIS Guidelines recommend adults receive the Hepatitis B, Tdap, and Zoster vaccine as follows:

• Hepatitis B: Adults under the age of 60 who do not have a history of the Hepatitis B illness should receive the two or three dose Hepatitis B vaccine, if not received as a child. Lab results showing immunity also satisfy this requirement.
• Tdap: Adults, age 18 and over, should receive at least one Td or Tdap vaccine every 10 years.
• Zoster: Adults, age 50 and over, should receive 2 doses of the herpes zoster recombinant vaccine.

Vaccines are available to Jai Medical Systems members both through their medical and pharmacy benefit, so please ensure that any members that you may be seeing are up to date with the recommended vaccines for their age.

Access and Availability Standards

To ensure members receive timely care, Jai Medical Systems has established access standards for routine and urgent appointments, as well as availability requirements for all in-network Primary Care Providers (PCPs) and Specialists.

For Specialists, routine and preventive care appointments must be scheduled within 30 days of a PCP referral, while urgent care requests should be scheduled as soon as possible but within 30 days of the member’s PCP request.

For PCPs, urgent care appointments must be scheduled within 48 hours, and routine or preventive care appointments must be scheduled within 30 days of the request. Additionally, PCPs are required to provide on-call availability to ensure members have access to after-hours care. These standards are designed to promote timely access to care, improve health outcomes and reduce inappropriate ER utilization. If you have any questions about access and availability standards, please reach out to our Provider Relations team directly at providerrelations@jaimedical.com.

Lab Service Reminders

Jai Medical Systems is contracted with LabCorp for all laboratory services. Please ensure that our members receive laboratory services from LabCorp, and that their Medicaid ID number is included on all lab requests submitted. LabCorp maintains drawing stations throughout Maryland and provider drop boxes are available from LabCorp, upon request.

Labs requiring Prior Authorization
Providers should be aware that certain lab tests require prior authorization. For the most up-to date listing of lab services that require prior authorization, please visit our website at www.jaimedicalsystems.com.

Translation Services

Jai Medical Systems offers culturally and linguistically appropriate translation and interpreter services to our network providers for our members who speak a language other than English. While 87% of our patient population speak English, our membership’s next most common languages include Spanish (4.03%), French (0.11%), and Arabic (0.09%).

For more information about language accessibility resources available, including translation assistance, please visit us at www.jaimedicalsystems.com or contact our Customer Service Department today at 1-888-JAI-1999.

Formulary Updates

Effective immediately, the prior authorization criteria for the following medications has been updated:

• Releuko (Filgrastim-ayow, a Neupogen biosimilar)
• Fylnetra (Pegfilgrastim-pbbk, a Neulasta biosimilar)
• Eligard (leuprolide)

For more information about this notice and all other Formulary Change notices, please visit us online at https://www.jaimedicalsystems.com/ providers/pharmacy/.

Important Billing Tips for the New Year

Active ePREP Registration
All providers rendering care to Maryland Medicaid beneficiaries must enroll, and remain in an active status, with Maryland Medicaid through their electronic Provider Revalidation and Enrollment Portal (ePREP). Failure to properly enroll or remain in an active status with Maryland Medicaid’s ePREP system may result in claim denials. To check your current ePREP status, please visit https://eprep.health.maryland.gov/.

NPI Uncollapsing and You
Providers participating in Maryland Medicaid’s NPI Uncollapsing Initiative must ensure that all new NPIs have been fully enrolled in ePREP. Please review your information carefully to confirm that your new NPI, Tax Identification Number (TIN), billing practices, and service location details are up to date.

If you have recently taken part in the NPI Uncollapsing process, please notify Jai Medical Systems immediately of any updates to your billing information. Jai Medical Systems will acknowledge receipt of your requested billing changes within 30 calendar days. Once we have confirmed that our system has been updated, your practice will then be able to bill utilizing the new information. Please note, if you begin to bill with new NPIs prior to notifying Jai Medical Systems or confirming our systems have been configured with the update, you may see claim denials and/or rejections.

Participating Provider Patient Advocacy

Jai Medical Systems does not prohibit, or otherwise restrict, a provider acting within the lawful scope of practice, from advising or advocating on behalf of a member who is his or her patient.