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 2020 – VOLUME LXVI

COVID-19 Updates

Jai Medical Systems continues to monitor the COVID-19 pandemic, and wants to ensure that our providers have the most up-to-date information related to COVID-19. For your reference, please see below for a few important updates.

Expanded COVID-19 Testing

Healthcare providers are encouraged to order, refer, and/or perform a COVID-19 tests for individuals as appropriate. For all Jai Medical Systems members, providers are reminded to use LabCorp. To find a list of testing sites, please visit:

Contact Tracing

People who test positive for COVID-19 may be contacted by one of Maryland’s contact tracers. For more information about Maryland’s contact tracing efforts and what a patient may expect from a Contact Tracing call, please visit:

For additional provider updates from the Maryland Medicaid Program, please visit or

Seasonal Flu Vaccine:

Due to the COVID-19 pandemic, now more than ever, the flu vaccine is critically important. As we approach the cold and flu season, please encourage all your patients to get the flu shot as soon as possible. As a reminder, the State of Maryland mandates that all vaccines be reported to ImmuNet. For more information, visit

Value Based Purchasing Initiative

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. Preventive care services are critically important to the health of your patients. Please continue to bring your patients, our members, in for needed care especially when they are missing one or more of the important services listed in the VBPI chart below.

Provider Demographic Information Notice

It is important that we provide our members with the most accurate and up-to-date directory information related to our network providers and their locations. Providers can make updates to their demographic information in two ways:

Utilizing the “update provider information” link on our website:


Submitting a formal notification letter via fax at 410-403-1816 or 410-433-4615, or email us at

If you have modified hours of operation, and/or limited services during the COVID-19 pandemic, please notify Provider Relations of these temporary changes, so that members can be properly informed.

Hepatitis C Treatment Updates

Effective August 1, 2020, the following changes have been made by Maryland Medicaid to the prior authorization criteria for Hepatitis C:

  • For non-cirrhotic patients, the baseline viral load labs and the treatment consult note may now be within 180 days of the request date.
  • For cirrhotic patients, the baseline labs and the treatment consult note still need to be within 90 days of the request date.

The Hepatitis C Treatment Prior Authorization Form has been updated to reflect this change. Updated versions of the form and criteria are available on our website at Contact Jai Medical Systems at 1-888-524-1999 if you need a copy faxed to you.

Providers can contact ProCare Rx’s Prior-Authorization Department at 1-800-555-8513 for assistance with PA requests or questions regarding clinical guidelines. The PA Department is available Monday through Friday from 8:30 am-5:30 pm. For assistance with PA requests during non-business hours please contact ProCare Rx’s 24 hour customer service department at 1-800-213-5640.

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

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.

Provider Network Expansion

Effective March 1, 2020, Jai Medical Systems has its expanded service area to include Howard County, Harford County, and Carroll County . In order to accommodate the growing needs of our members, Jai Medical Systems is currently 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 the Provider Relations Department at 1-888-JAI-1999 or e-mail:

Eligibility Verification System (EVS)

Please ensure that you verify the eligibility of all Medicaid recipients on the date of service for which they present. Providers can verify Medicaid eligibility using the Medicaid Eligibility Verification System (EVS) The system offers both a telephonic and online eligibility verification. The EVS system can be accessed as follows:

EVS Phone Number: 1-866-710-1447

EVS Website:

Referrals to Specialists

Each member’s Primary Care Provider (PCP) is responsible for issuing referrals for specialty care. In addition to properly completing the referral form, please make certain that any relevant medical records are sent to the specialists in a timely fashion. To ensure proper claims adjudication, please make sure to follow these simple guidelines regarding referrals:

Primary Care Providers

  • Please ensure that all referrals are completely filled out and written legibly.
  • Please make sure that the information is written legibly on any copies of the referral.
  • Please ensure that the member’s information is correct and all provider information is filled out in its entirety including appropriate NPIs.
  • Once the referral has been completed, please fax it to 1-866-381-7200.


  • Verify that a valid referral was obtained prior to rendering services.
  • If you are unaware of referral information (date the referral was issued, service location, services desired, etc.), please contact the member’s PCP to verify what is being requested.
  • When submitting a paper claim, attach a copy of the valid referral with the claim to ensure that the claim is processed with the correct referral

Formulary Changes

Effective immediately, the following products have been added to Jai Medical Systems’ formulary:

  • Admelog
  • Insulin Lispro (generic Humalog)
  • Abacavir Oral Solution 20 mg/ml
  • Atazanavir Sulfate 150 mg cap, QL 60/30
  • Fosamprenavir 700 mg Tablet, QL 60/30
  • Nevirapine 200 mg Tablet, QL 60/30
  • Nevirapine 50 mg/5 ml Susp
  • Nevirapine ER 100 mg Tablet, QL 30/30
  • Nevirapine ER 400 mg Tablet, QL 30/30
  • Ritonavir Oral Tablet 100 mg, QL 30/30
  • Stavudine Oral Capsule 15 mg, QL 60/30
  • Stavudine Oral Capsule 20 mg, QL 60/30
  • Stavudine Oral Capsule 30 mg, QL 60/30
  • Stavudine Oral Capsule 40 mg, QL 60/30
  • Zidovudine Oral Capsule 100 mg, QL 60/30
  • Zidovudine Oral Tablet 300 mg, QL 60/30

Effective August 1, 2020, the following products will be removed from the formulary:

  • Avandia, Avandaryl and Avandamet

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 WILL result in claim denials effective September 1, 2020 for dates of service beginning January 1, 2020.

To enroll or revalidate with Maryland Medicaid today, please visit the ePREP website at 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

Claim Submission Guidelines

To ensure that your claims are processed quickly and accurately, please make sure to follow these simple guidelines regarding billing practices, referrals, and authorizations. When submitting the following type of claim, please ensure that you are following Jai Medical Systems’ Billing Instructions in addition to the listed items below:

  • Timely submit all claims, either electronically or on paper, within 180 days of the date of service.
  • Attach or Fax one copy of a valid completely filled out, legibly written referral, outpatient authorization, or inpatient authorization, where applicable, to Jai Medical Systems’ Claims Processing Center (fax number 1-866-381-7200) prior to claim submission.
  • Include the appropriate authorization number that is valid for the claim being billed. Authorizations include referrals, outpatient authorization, or inpatient authorization to be billed in the appropriate field. This field is located in block 23 for the CMS1500 form and block 63 for the UB-04.
  • Indicate or attach a copy of the member’s primary insurance Explanation of Payment (EOP) or Remittance advice any information regarding the member’s primary insurance and any payment made from the third party payor (TPP), if applicable.

Updates and Reminders:
  • Electronic Claims Submission: To submit claims electronically, providers must register with ClaimsNet website at When applicable, prior to submitting your claims, please fax the appropriate authorization or referral to Fax Number: 1-866-381-7200.
  • 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 at
  • 24 Hour Nurse Advice Line: Please inform members about our 24 Hour Nurse Advice Line. To access, members should call 1-844-259-8613.
  • Health Risk Assessment: Please encourage members to utilize our new online wellness portal, located at Our wellness portal features wellness tips, health education videos, and a health assessment that members can complete.
  • Online Health Education: Health Education materials are available to Jai Medical Systems members online. Members can access these materials by registering on the member portal located at
  • Claims Appeal Timeframes: Please note that providers have 180 calendar days to submit a first level appeal from the date of Explanation of Payment for the claim in question. Providers have 30 calendar days to submit a second level appeal from the date of the first level appeal’s determination letter. Providers have 85 business days to submit a third level appeal from the date that the first level appeal was received.
  • E-Blast! At Jai Medical Systems, we are continually striving to reduce our impact on the environment and improve provider satisfaction. Providers are automatically enrolled to receive emails from Jai Medical Systems. If you would like to opt out, please select the unsubscribe button at the bottom of the email. To sign-up today, please visit our website at

Contact Us
301 International Circle Hunt Valley, MD 21030
Phone: 1-888-JAI-1999
Hours of Operation: Monday – Friday