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
Winter 2018 – VOLUME LXVI
A Message from the Director of Provider Relations
On behalf of Jai Medical Systems, I would like to thank each of our participating providers for their service and dedication to our members. This holiday season, we are excited to share with you that we are continuing to expand our provider network in order to accommodate the growing needs of our members. In fact, we recently just added Doctor’s Community Hospital, located in Lanham, MD, to our provider network.
If you know any providers who may be interested in joining our network, please have them contact our Provider Relations Department at email@example.com.
Thank you for your support. Have a Terrific Holiday and a Happy New Year!
Director of Provider Relations
New Member Identification Card
We recently updated the look of our Member Identification (ID) Cards. Please see the sample image to the right. This new card will be issued only to newly enrolled Jai Medical Systems members as well as members who may request a replacement ID card. Members may still use the older version of our ID card. As always, our members should present their member ID cards at the time of service, and providers should confirm eligibility with Jai Medical Systems prior to rendering services.
New Claims Appeal Submission Form
Jai Medical Systems encourages providers to use our new optional Claims Payment Appeals Submission Form when submitting an appeal for a claim. Using our Claims Payment Appeals Submission Form will ensure we are able to process your appeal in the most timely and efficient manner possible. When using our Claims Payment Appeals Submission Form, please submit a separate form for each claim being appealed. You may download the form online at https://www.jaimedicalsystems.com/providers/provider-billing/.
Please note, any appeals received that do not meet the requirements outlined below may be returned to the submitting party and may not be reviewed. All appeals submitted to Jai Medical Systems must include the following information:
- Cover letter and/or a Claims Payment Appeals Submission Form,
- Copy of claim and/or EOP, and
- Supporting relevant documentation.
Vaccinating Maryland’s Adolescents against HPV
We are asking for your help in addressing the State of Maryland’s public health initiative in immunizing Maryland’s adolescents against Human Papillomavirus (HPV). As you are aware, the HPV vaccine is very important because it protects against cancers caused by human papillomavirus infection. During this time of the year, many adolescents will be checking in with their Primary Care Providers for important well child checks and immunizations, such as the flu shot. If age-appropriate, please educate the parent and/or guardian about the importance of initiating and/or completing the HPV vaccination series. Recent studies have shown that a patient who receives a strong provider recommendation is four to five times more likely to receive the HPV vaccine.
Case Management and 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 who 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 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 DME
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 medication reminders to increase compliance.
For more information about the Case Management services and/or the 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 these programs online at www.jaimedicalsystems.com.
Are you Culturally Competent?
Cultural competency is an important component of improving the quality of care delivered to our diverse member population. To learn more about culturally competency in healthcare, we encourage providers to visit our website at https://www.jaimedicalsystems.com/providers/provider-resources/.
Our webpage features links to resource sites that offer guides and online training focused on defining cultural needs in managed care. Some of the guides even offer providers CME/CE credits.
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.
In order to deliver the best provider experience, it is important that we receive your feedback. Please complete the enclosed Provider Satisfaction Survey. Completed surveys may be returned by fax to 410.433.4615 or by email to firstname.lastname@example.org.
Visit Us Online
There are many online services available for our members and providers. Many of the resources listed in the chart on the left are available on our website at www.jaimedicalsystems.com.
If you prefer, all of this information is also available in print and by telephone. You may request this information by calling Jai Medical Systems at 1-888-JAI-1999.
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.
Prior Authorization Guidelines: Jai Medical Systems requires a prior authorization (PA) be obtained for certain services and procedures. Prior to submission of a PA request, approval for the applicable procedure must be received from the Primary Care Provider. For a listing of procedures and services requiring a PA, please visit our web-site at www.jaimedicalsystems.com/providers/provider-resources/. If you do not see a procedure or service listed or would like to see if a PA may be required, please feel free to contact our Utilization Management Department at 1-888-JAI-1999.
24 Hour Nurse Advice Line: Please help us educate our members about our 24 Hour Nurse Advice Line. Our 24 Hour Nurse Advice Line can help assist our members with their afterhours, non-emergent, healthcare needs and questions. The phone number for our 24 Hour Nurse Advice line is 1-844-259-8613.
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 by Jai Medical Systems.