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
Summer 2019 – VOLUME LXI
Thanks to you, Jai Medical Systems is the highest performing MCO on the 2019 HealthChoice Report Card.
Jai Medical Systems would like to thank all of our participating providers for their support and their excellent delivery of healthcare services to our members. The HealthChoice Report Card above compares MCOs in several key areas related to patient care. Thanks to you, Jai Medical Systems earned 16 out of 18 stars. No other health plan came close to this performance.
Hepatitis C Treatment Update
Effective July 1, 2019, the State of Maryland will be implementing a new treatment criteria change for Hepatitis C. The new Metavir (fibrosis) score to receive treatment has been moved from F2 to F1.
For more information regarding the Hepatitis C elimination plan, please visit the Maryland Department of Health website at https://phpa.health.maryland.gov/OIDPCS/AVHPP/pages/Home.aspx .
We appreciate your dedication in ensuring that members who are at risk are receiving routine screenings and are being referred for treatment accordingly.
Register with ePREP Today!
Maryland Medicaid’s new electronic Provider Revalidation and Enrollment Portal (ePREP) is live! ePREP is the 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 complete registration with ePREP by October 1, 2019. Failure to properly register with Maryland Medicaid using ePREP may result in claim denials.
To enroll in ePREP webinars or to access additional resource materials regarding ePREP, please visit the Maryland Department of Health website at https://mmcp.health.maryland.gov/Pages/ePREP.aspx.
To enroll or revalidate with Maryland Medicaid today, please contact the ePrep call center at 1.844.4MD.PROV (1.844.463.7768) or visit the ePREP website at www.ePREP.health.maryland.gov.
If you have any questions about how to register with ePREP, please feel free to contact our Provider Relations Department today at 1-888-JAI-1999. We are here to help.
Reduce Hospital Admission Rates
In an effort to reduce hospital admission rates, we ask that all Primary Care Providers follow up with your members on your panels following any hospitalization. Preventative care and regular physician check-ups are essential to monitoring a member’s health, improving patient care, and reducing hospital admission rates.
Diabetes Prevention Program
Effective September 1, 2019: Jai Medical Systems is offering a Diabetes Prevention Program to provide you with support and tools to lose weight and reduce the risk of getting diabetes. This program is offered at NO COST to our members. Call our Customer Service Department at 410-433-2200 to learn more about this program and if you would like to refer your patients to the program.
Formulary Change Notice
- Eliquis (Apixaban) and Entresto (Sacubitril/Valsartan) have been added to the Jai Medical Systems formulary. Eliquis is a blood clot medication. Entresto is a medication for members with heart failure.
- Generic Harvoni (ledipasvir-sofosbuvir) and generic Epclusa (sofosbuvir-velpatasvir) have been added to the list of preferred treatments (with prior authorization) for Hepatitis C. The list of preferred treatments (prior authorization required) for Hepatitis C will now be generic Harvoni (ledipasvir-sofosbuvir), generic Epclusa (sofosbuvir-velpatasvir), Mavyret, and Zepatier.
The following topical analgesics have been added to the formulary:
- Lidocaine 3% cream with a Quantity Limit of 60gm/month and a high dollar limit of $70
- Lidocaine 5% ointment with a Quantity Limit of 50gm/month and a high dollar limit of $200
- Lidocaine/prilocaine 2.5/2.5% cream with a Quantity Limit of 60gm/month and a high dollar limit of $100
- Diclofenac 1% gel with a quantity limit of 100gm/month and a high dollar limit of $60 (with no prior authorization required)
- Lidocaine 4% has been removed from the formulary.
- Any fills for the initial2 fill of an opioid are limited to no more than a 7 day supply. Exceptions to this rule would be made for members who obtained a prior authorization for longer than a 7 day supply before they filled.
1This rule will not affect members who are already being treated with opioids.
2Initial fill is defined as there being no fills for an opioid in the previous 90 calendar days.
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.
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 authoriza-tions. When submitting the following type of claim, please ensure that you have appropriately followed the Maryland Medicaid Billing Instructions in addition to the below listed items:
- Attach or Fax one copy of a valid completely filled out, legibly written referral, out-patient 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 authorization number that is valid for the claim being billed HRXXXXXXX(referral), OAXXXXXFXXX (outpatient authorization), IAXXXXXFXXX or IAXXXXXIXXX (inpatient authorization) 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 Pay-ment (EOP) or Remittance advice any information regarding the member’s primary insurance and any payment made from the third party payor (TPP), if applicable.
Case Management & Disease Management Programs
Complex Case Management and Case Management programs are available for Jai Medical Systems’ members, who have serious medical conditions or have complex and/or special needs. These services provide support and guidance to those members that need or would like extra assistance with their health care. Our Case Managers can also assist with care coordination. Below are some examples of medical conditions or circumstances where Case Management or Complex Case Management may be helpful:
- Individuals with Hepatitis C
- People who use the Emergency Room (ER) frequently
- People with HIV or AIDS
- Pregnant women and women who have recently had a baby
- Special Needs Children
- Individuals with Developmental Disabilities
- Individuals with Physical Disabilities
- People with behavior health issues along with medical conditions
- People with Substance Abuse problems
- People who need an Organ Transplant
- People with Asthma/COPD
- People with Cancer
- People who need dialysis or who are receiving dialysis
- People with Diabetes
- People who need special durable medical equipment
In addition, Jai Medical Systems has developed Disease Management Programs to assist your patients suffering with hypertension and asthma. These programs have been designed to reinforce your treatment plan for the patient. Aspects of the programs include assisting patients with understanding their condition, updating them regarding new information about hypertension and asthma, and providing them with assistance from our staff to help them manage their disease.
For more information about Case Management services, Complex Case Management services, and/or Disease Management programs offered by Jai Medical Systems, or to refer a patient of yours who is a Jai Medical Systems member, please contact our the Customer Service Department at 1-888-JAI-1999. You may also find additional information about our Case Management and Disease Management programs online at:
It is against the law to commit Fraud and/or Abuse!
Examples of Fraud and Abuse:
- Anyone who forges a physician’s signature on a prescription medication or uses a phy-sician’s name to call a false prescription in to the pharmacy.
- Anyone who lies about having lost prescription medication.
- Anyone who gets prescription medication when they are not ill.
- Someone who used or is currently using a medical ID card that does not belong to them.
- Any member who excessively overutilizes emergency services when not necessary.
- A Provider who bills for services not rendered.
If you are suspected of committing fraud and/or abuse by Jai Medical Systems Managed Care Organization, Inc., you will be submitted to the Department of Health and Mental Hygiene – Office of Inspector General (DHMH-OIG) for further investigation.
How Do I Stop Fraud and Abuse?
We welcome and encourage you to report anything suspicious you may have seen. You can report suspected fraud and/or abuse without fear of reprisal.
To Report Fraud and Abuse
You can call the Fraud and Abuse Compliance Officer: 1-888-JAI-1999
Or write to:
Fraud and Abuse Compliance Officer
Jai Medical Systems
301 International Circle
Hunt Valley, MD 21030
Updates and Reminders:
Electronic Claims Submission: To submit claims electronically, providers must register with ClaimsNet website at www.claimsnet.com/jai.
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 www.jaimedicalsystems.com
Health Risk Assessment: Please encourage members to utilize our new online wellness portal, located at www.jmslivelifewell.com. Our wellness portal features wellness tips, health education videos, and a health assessment that members can complete.
24 Hour Nurse Advice Line: Please inform members about our 24 Hour Nurse Advice Line. To access, members should call 1-844-259-8613.
E-Blast! At Jai Medical Systems, we are continually striving to reduce our impact on the environ-ment and improve provider satisfaction. 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 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.
301 International Circle Hunt Valley, MD 21030
Hours of Operation: Monday – Friday
Nutritional Supplements – Not Covered Medicaid Benefit
Effective September 1, 2019, Jai Medical Systems Managed Care Organization, Inc. will no longer reimburse enteral/parenteral formula, such as Ensure, as this is not a Maryland Medicaid covered benefit. Claims billed prior to this date, with a valid referral from the member’s PCP and/or authorization from the Jai Medical Systems Utilization Management Department, will be processed. Where necessary, please submit invoices for pricing of B-codes billed when submitting an appeal. To review the current Maryland Medicaid DME/DMS/Oxygen approved list of items, list of eligible B-codes and other DME related services, please visit the following link:https://mmcp.health.maryland.gov/communitysupport/Pages/approvedlist.aspx.
If you have any questions or concerns regarding this matter, please contact the Provider Relations Department at 1.888.JAI.1999. Our representatives are available to assist you Monday through Friday, 9:00am and 6:00pm.