Provider News & Notices

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

Dear Provider,
Thank you for your continued participation with Jai Medical Systems. We need your assistance! On an basis, the Maryland Department of Health conducts a annual Network Adequacy Validation (NAV) analysis of our provider network.

As part of this analysis, an independent telephone survey of providers listed in our Provider Directory is conducted to confirm the accuracy of their practice information. Your participation in this survey is important and helps ensure that both providers and members have access to accurate and up-to-date information.

WAYS TO HELP:

Network Participation Awareness
Please ensure that your staff, especially front-line staff, are aware of your participation status with Jai Medical Systems. If your office would like a Jai Medical Systems Participating Provider window cling, please contact our Provider Relations Department at 1-888-JAI-1999.

Accurate Directory Listings
Please review your practice listing in our provider directory to ensure it is accurate. If there have been any changes to your practice; such as address, phone number, or office hours; please notify us promptly.

Provider Directory updates can be submitted online at www.jaimedicalsystems.com or by emailing providerrelations@jaimedical.com.

We appreciate your assistance with this important effort. If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999.

Sincerely,
Hennriet a Dodoo
DIRECTOR OF PROVIDER RELATIONS

FACT OR FICTION:
CLARIFYING COMMONLY ASKED QUESTIONS

Fiction: Jai Medical Systems only accepts Jai Medical Systems referral forms issued by the member’s PCP.
FACT: Jai Medical Systems accepts both Jai Medical Systems referral forms and the Maryland Uniform Consultation Referral Form.

Fiction: Pharmacy Prior Authorization Forms must be completed by the member’s PCP only.
FACT: The prescriber is responsible for completing the Pharmacy Prior Authorization Form for medications they prescribe which require prior authorization. Members should not be referred back to a PCP for a medication a Specialist is prescribing.

Fiction: Family planning services, including IUDs, are covered under the pharmacy benefit only.
FACT: Jai Medical Systems covers family planning services, including IUDs, under the member’s medical benefit. These are considered self-referral services and do not require a PCP referral. More information can be found in our provider manual at https://jaimedicalsystems.com/wp-content/uploads/2025/02/JMS_Provider-Manual-1.25.pdf

Fiction: Providers cannot view claim information in the provider portal.
FACT: Providers can access claim details in the provider portal, including but not limited to adjudication dates, check numbers, and denial reasons.

Fiction: Providers are allowed to bill members for denied services or balance bill (the difference between the amount charged and the amount paid by Medicaid).
FACT: Medicaid providers are prohibited from balance billing. Members should never be charged for a covered service, including services that are denied by Medicaid.

If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999.

H.R. 1 – Maryland Medicaid Update

We wanted to share an important update with our providers regarding H.R. 1 and its anticipated impact on Maryland Medicaid. This legislation introduces significant changes that may affect coverage, funding, and program requirements across the state. Maryland Medicaid currently serves over 1.5 million individuals, including more than 320,000 adults covered under the ACA expansion. Under H.R. 1, approximately 130,000 Marylanders are projected to lose Medicaid coverage, and the state could face up to $2.7 billion in annual federal funding reductions once the law is fully implemented.

The legislation also introduces new requirements such as work and community engagement requirements for certain adult Medicaid enrollees, more frequent eligibility redeterminations, and limits on retroactive coverage. Notably, Maryland must exempt individuals considered “medically frail” from the monthly 80-hour work requirement. These changes are expected to increase administrative complexity and may impact enrollment stability.

The implementation of these changes is occurring in phases between late 2025 and 2027. Key milestones include federal guidance on eligibility redeterminations, which was released by December 31, 2025; changes to qualified immigrant eligibility effective October 1, 2026; required implementation of work requirements by December 31, 2026; and mandatory six-month eligibility redeterminations and retroactive coverage limitations beginning January 1, 2027.

Providers can play an important role in supporting our members through these transitions by educating them on the new eligibility and reporting requirements, assisting them with redeterminations, and directing them to official state resources to help prevent gaps in coverage.

Implementation will continue to evolve, and additional guidance will be shared as more information becomes available. For more information, providers are encouraged to visit the Maryland Medicaid website at https://health.maryland.gov/mmcp/Pages/workrequirements.aspx.

PROVIDER ENROLLMENT PORTAL TRANSITION

Maryland Medicaid is transitioning from the ePREP enrollment system to a new platform called MPRIME. The MPRIME system is scheduled to launch in October of 2026. To prepare for this transition, a phased hold on ePREP applications will begin this summer. Starting July 1, 2026: high and moderate-risk provider types will no longer be able to submit applications, followed by limited-risk provider types on August 1, 2026. During this period, no new enrollments, revalidations, or updates can be submitted until MPRIME is live. Providers due for revalidation between July and the October go-live will be asked to complete revalidation earlier in the year, with at least 90 days provided to complete the process. Failure to complete revalidation within this timeframe may result in suspension. Maryland Medicaid has released a Frequently Asked Questions (FAQ) resource available at https://health.maryland.gov/mmcp/provider/Pages/mprime.aspx and will continue to provide additional guidance, training, and updates ahead of the transition. Providers are encouraged to review available resources and stay alert for future communications to ensure readiness. If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999.

REMOTE ULTRASOUND & FETAL NONSTRESS TESTING UPDATE

Expanded coverage is now available for remote ultrasound procedures and remote fetal nonstress testing for eligible pregnant members. These services are covered when performed in accordance with Maryland Medicaid requirements, including maintaining the same standard of care as in-person services, ensuring HIPAA compliance, and using appropriate technology to securely transmit patient data for provider interpretation. Remote services must be billed using the appropriate place of service codes and meet all program participation requirements. Reimbursement for these services is aligned with in-person rates. If you have any questions regarding this update, or if your organization offers these services, please contact our Provider Relations Department at 1-888-JAI-1999.

2025 HEALTHCHOICE PCP STATISFACTION SURVEY

On an annual basis, Jai Medical Systems is assessed by the Maryland Department of Health by a survey that allows our network Primary Care Providers to rate our health plan. This survey 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 2025 HealthChoice PCP Satisfaction survey results:

UPDATES ON ADULT IMMUNIZATIONS

Immunizations are not just for children; adult members should also be assessed and offered appropriate vaccines to help prevent serious illness.

KEY VACCINES TO REVIEW WITH YOUR PATIENTS

Flu: Recommended annually for all adults (September–June).
Tdap: Adults 19+ should receive a booster if it has been more than 10 years since their last dose.
Zoster: Adults 50+ should receive the 2-dose series, spaced 2–6 months apart.
Hepatitis B: Adults 19–59 should be assessed for completion of the vaccine series. Consider titer testing if status is unclear, especially for those born before the mid-1990s.

Taking a few moments to review immunization status during visits can significantly improve patient outcomes and prevent disease.

PROFESSIONAL SERVICES & MEDICAL LABORATORY INFO

Maryland Medicaid has updated their website link for Fee-For-Service medical laboratory and professional services. Providers are encouraged to visit this new page to access the most current fee schedules, billing guidance, and service information from Maryland Medicaid.

For more information, please visit: https://health.maryland.gov/mmcp/provider/Pages/professional-services.aspx

LABCORP, AUTHORIZATIONS & REPORT SUBMISSIONS

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 a prior authorization. For the most up-to date listing of lab services that require prior authorization, please visit our website at www.jaimedicalsystems.com.

RELEASE OF INFORMATION (ROI) SUBSTANCE ABUSE

As a reminder, in order to share substance abuse diagnostic information with your patient’s health insurance plan, please ensure that your patient is completing a Release of Information (ROI) form annually. In order to enhance our ability to coordinate care, please encourage your patients to complete the ROIs if they are in substance abuse treatment. The ROI form can be found online for download by visiting https://mmcp.health.maryland.gov.

PARTICIPATING PROVIDER PATIENT ADVOCACY

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

SCREENING, BRIEF INTERVENTION & REFERRAL TO TREATMENT

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence based, comprehensive, public health screening tool intended to deliver early intervention and treatment services to patients who are at risk for alcohol or drug misuse. SBIRT aims to reduce drug overdose deaths and health disparity outcomes among minorities, while reducing healthcare cost in Maryland. PCPs are encouraged to perform this important screening for their patients. The SBIRT screening is a covered MCO service when billed by a PCP. To bill the SBIRT screening, please include the appropriate SBIRT HCPCS on your claim. The SBIRT HCPCS codes and reimbursement information can be found at http://www.samhsa.gov/sbirt/coding-reimbursement.

For patients interested in treatment for substance use disorder or behavioral health, please refer and coordinate treatment care with Carelon, Maryland Medicaid’s behavioral health administrative services vendor. For behavioral health patient referrals and assistance, please contact Carelon by phone at 1-800-888-1965. For general information on the SBIRT, please visit https://bha.health.maryland.gov/pages/SBIRT.aspx.

PRIOR AUTHORIZATION PROCESS – MEDICAL ONLY

Effective January 1, 2026, Jai Medical Systems has implemented updated prior authorization decision timeframes, issuing determinations within 72 hours for expedited (urgent) requests and within seven calendar days for standard (non-urgent) requests. These timeframes are aligned with applicable federal and state requirements. To support timely determinations, providers are encouraged to submit a complete request including all supporting clinical information. Please note that all services requiring prior authorization must include a completed Prior Authorization Request Form. Complete requests should be sent to the Utilization Management Department for review and consideration. For more information regarding our prior authorization guidelines, please visit us online at https://jaimedicalsystems.com/providers/provider-resources/.

FORMULARY UPDATES

JAI MEDICAL SYSTEMS HAS MADE RECENT CHANGES TO ITS FORMULARY FOR THE FOLLOWING MEDICATIONS :

For more information about these formulary, and to view current Formulary Change notices, please visit us online at https://www.jaimedicalsystems.com/providers/pharmacy/.

VISIT US ONLINE

Jai Medical Systems offers many services to our providers through our website and provider portal, which we have outlined below. This information is also available in print or by telephone. You may request this information by calling us at 1-888-JAI-1999.

HOURS: Monday – Friday 9AM to 6PM
LOCATION: 301 International Circle Hunt Valley, MD 21030