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 2019 – VOLUME LXII

Jai Medical Systems Receives Highest National Rating For Fourth Year In A Row

We are pleased to announce that Jai Medical Systems is once again one of the Highest Rated Medicaid Health Insurance Plans in the United States for 2019-2020, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings. For 2019-2020, Jai Medical Systems earned a rating of 5 out of 5 in the NCQA Medicaid Health Insurance Plan Ratings for the fourth consecutive year. No other Medicaid Health Plan has earned a rating of 5 out of 5 four years in a row. In addition, for the fifth year in a row, Jai Medical Systems has also earned NCQA’s highest Accreditation status of Excellent. We cannot achieve such high ratings without the hard work and assistance of our participating providers. Thank you for your participation and service to our members. For more information about our NCQA Accreditation and Health Plan Ratings, please check out our press release at www.jaimedicalsystems.com/blog/.


Have you enrolled with ePREP?

Maryland Medicaid requires all providers rendering care to Medicaid beneficiaries enroll with Medicaid’s new electronic Provider Revalidation and Enrollment Portal (ePREP). Maryland’s ePREP system is Medicaid’s one stop shop for provider enrollment, re-enrollment, revalidation, information updates and demographic changes. According to the Maryland Department of Health, all providers submitting claims for HealthChoice members must enroll with ePREP as soon as possible. Failure to properly enroll or remain in an active status with Maryland Medicaid’s ePREP system may result in claim denials.

To enroll or revalidate with Maryland Medicaid today, please visit the ePREP website at www.ePREP.health.maryland.gov or contact the ePREP call center at 1.844.463.7768. If you have any questions about the ePREP enrollment process, please feel free to contact our Provider Relations Department today at 1-888-JAI-1999 or the Maryland Department of Health via email at MDProviderRelations@automatedhealth.com.


VBPI 2019: We need your help!

On an annual basis, Maryland Medicaid selects specific HEDIS® and encounter based quality indicators for its Value Based Purchasing Initiative (VBPI). VBPI is one of the methods used by the HealthChoice program to gauge the performance of participating Managed Care Organizations. Currently, there are only about three months left in the year and we have a lot of work to do in terms of making sure we meet our targets for the CY 2019 VBPI. The measures in the chart to the right are of critical importance to our organization. Please continue to work to bring into care our members, your patients, who may be failing one or more of these quality measures.


Alert: HIV/AIDS Medications Carve-In

Beginning January 1, 2020, HIV/AIDS medications will no longer be covered under the Maryland Fee for Service program. Instead, these important medications will be covered by Jai Medical Systems’ pharmacy benefit. For the first six months of this transition, there will be a smoothing period for members who have already been prescribed HIV/AIDS medications. We recommend that providers who are prescribing HIV/AIDS medications, including Truvada, check our website for updates regarding our formulary options as well as any criteria such prior authorization for individuals receiving these medications.


Diabetes Prevention Program

Effective September 1, 2019, Jai Medical Systems is offering a Diabetes Prevention Program to provide you with support and tools for your members to lose weight and reduce their risk of getting diabetes. This program is offered at NO COST to our members. To learn more about our Diabetes Prevention program or to refer a patient to this program, please call our Customer Service Department today at 1-888-JAI-1999.


Hepatitis C Treatment Update

Maryland Medicaid has updated the prior authorization (PA) criteria for the treatment of Hepatitis C, effective July 1, 2019. The most significant change to the criteria is that the minimum qualifying fibrosis score for treatment is now F1 (previously it was F2). Also, members under age 21 do not have to meet the fibrosis score threshold in order to be approved for treatment, though a fibrosis score is still needed in order to determine the correct treatment and duration. Beginning, January 1, 2020, Maryland Medicaid will modify its criteria standards to include a minimum qualifying fibrosis score of F0 or higher for treatment.

Jai Medical Systems will continue to use the clinical criteria from Maryland Medicaid when approving all treatments, but patients must be ineligible for a preferred treatment before a non-preferred treatment will be approved. The current list of preferred treatments for Hepatitis C remains:

  • Generic Harvoni (ledipasvir-sofosbuvir): Genotypes 1,4,5,6
  • Generic Epclusa (sofosbuvir-velpatasvir): All Genotypes
  • Zepatier: Genotypes 1 and 4
  • Mavyret: All Genotypes

Visit Us Online

There are many services available online to both our members and providers. The resources listed in the chart to the right are available on our provider portal or on our website at www.jaimedicalsystems.com.

If you prefer, all of this information is also available in print and/or by telephone. You may request this information by calling the Provider Relations Department at today 1-888-JAI-1999.


Updates and Reminders:
    • E-Blast! At Jai Medical Systems, we are continually striving to reduce our impact on the environment and improve provider satisfaction. To sign-up today, please visit our website at www.jaimedicalsystems.com.

    • Health Education Classes: Did you know that Jai Medical Systems offers free Health Education classes to our members? We do! We offer a variety of classes on topics such as diabetes, asthma, controlling hypertension, weight management, smoking cessation, men’s health, and women’s health. Our health education classes are held on Thursdays at Jai Medical Center, located at 1235 East Monument Street, Baltimore, MD 21202. Transportation to our health education classes is available. For more information, please contact our Customer Service Department at 1-888-JAI-1999.

      Contact Us
      Providerrelations@jaimedical.com
      301 International Circle Hunt Valley, MD 21030
      Phone: 1-888-JAI-1999
      Hours of Operation: Monday – Friday
      9am-6pm