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
Special Message: An Important COVID-19 Vaccination Update
I have some exciting news to share with you. As you may have heard recently in the news and from Governor Hogan, the FDA has granted Emergency Use Authorization to both Pfizer’s and Moderna’s COVID-19 vaccines. While vaccine distribution is currently limited; we have been notified that there is current vaccine allocation for those individuals in Phase 1A.
Phase 1A includes Frontline HealthCare Workers, Nursing Home Residents, Law Enforcement, Correctional Health Care Staff, and Front-Line Judiciary Staff. Providers who are interested in receiving the COVID-19 vaccine should contact their local health department for COVID-19 vaccine availability for providers and other frontline healthcare staff.
If you are a provider who lives or works in Baltimore City, please visit: https://coronavirus.baltimorecity.gov/covid-19-vaccine-information
If you are a provider who lives or works in Baltimore County, please visit: https://www.baltimorecountymd.gov/covid-19/vaccines
If you are a provider who lives or works in Anne Arundel County, please visit: https://aahealth.org/vaccine-allocation/
For more information related to the vaccines available, please visit the CDC’s website at COVID-19 Vaccination | CDC.
Winter 2020 – VOLUME LXVII
A Message from the Director of Provider Relations
On behalf of Jai Medical Systems, I would like to thank each and everyone of you for your hard work and dedication during what has been the most challenging public health crisis in our lives. We truly appreciate your care and sacrifice with assisting our members in 2020 and consider you all true healthcare heroes. Thank you!
We believe the New Year brings great hope for turning the tide on the COVID-19 pandemic. Currently, the FDA has granted Emergency Use Authorization to both Pfizer’s and Moderna’s COVID-19 vaccines. While vaccine distribution is currently in process in accordance with Maryland’s COVID-19 vaccine distribution plan; we want to make sure all of our participating providers are aware of the importance of registering with Maryland’s Immunet system.
Recently, you may have received correspondence from your Local Health Department and/or the Maryland Department of Health regarding the importance of registering with Immunet. Immunet is Maryland’s Immunization Information System (IIS), a confidential and secure database that is HIPAA compliant that is used to store vaccination information. Immunet stores an individual’s vaccination records and offers a web-based tool for healthcare providers and schools to understand the vaccination status of their patients and students.
In the past, Immunet was predominantly used to store and source information related to pediatric vaccinations. However, with the passage of HB 316 in the 2019 Maryland Legislative session, Maryland Law now requires any and all vaccinating providers to report any immunization given to a patient to Immunet for dates of service beginning October 1, 2019. Further, we believe Immunet will play an important role in identifying providers that will receive the COVID-19 vaccine for their patients.
Please Register with Immunet! We strongly encourage all providers who provide vaccination services to their patients to register with Maryland’s Immunet system. If you are not currently registered with Immunet, please register today by visiting the following website: https://phpa.health.maryland.gov/OIDEOR/IMMUN/Pages/providerenrollmentform.aspx.
The Immunet registration process should take no more than 10 minutes to complete. Some of the important information that you will need to complete the registration process includes the following: Basic Contact Information, Organization Name, Address, and VFC PIN (For Pediatric Providers only). Once you have completed the registration process, you should receive an email from Immunet within three to five business days with your log-in information.
Lastly, we have received correspondence from the Maryland Department of Health (MDH) about the new COVID-19 vaccine and vaccine administration codes. In accordance with MDH Transmittal #141, we will be reimbursing providers at the rates established by Fee-For Service for the administration of the COVID-19 vaccine which are as follows:
COVID-19 Vaccine Products
CPT 91300 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) $0.00* CPT 91301 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) $0.00*
*Vaccination products will be made available to providers at no cost by the federal government for the foreseeable future; therefore, only the cost of administration will be reimbursed.
COVID-19 Vaccine Administration
CPT 0001A – Immunization administration by intramuscular injection of SARS-CoV2, 30 mcg (first dose): $16.94
CPT 0002A – Immunization administration by intramuscular injection of SARS-CoV2, 30 mcg (second dose): $28.39
CPT 0011A – Immunization administration by intramuscular injection of SARS-CoV2, 100 mcg (first dose): $16.94
CPT 0012A – Immunization administration by intramuscular injection of SARS-CoV2, 100 mcg (second dose): $28.39
This information is subject to change. For the most up-to-date information related to COVID-19 vaccine codes and pricing,
please refer to MDH’s webpage: https://mmcp.health.maryland.gov/Documents/COVID-19%20Reimbursable%20Vaccine%20and%20Infusion%20Codes%20Fee%20Schedule%2012-21-20.pdf.
Thank you for your support and dedication. From all the staff at Jai Medical Systems, we wish you a Merry Christmas and a
Happy New Year!
Director of Provider Relations
Coordination of Care- Substance Abuse/Behavioral Health
SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based, comprehensive, and integrated public health approach to the delivery of early intervention and treatment services to patients who have risky alcohol or drug use. Maryland SBIRT aims to address drug overdose deaths, health disparity outcomes among minorities, and healthcare costs in Maryland. PCPs are encouraged to perform this important service for their patients. This care is covered by Jai Medical Systems.
Please refer patients who are in need of behavioral health treatment to Optum, who will also assist them with finding a provider. Please call 1-800-888-1965 for patient referrals.
For additional information on SBIRT, please visit: https://bha.health.maryland.gov/Pages/SBIRT.aspx.
Release of Information (ROI)- Substance Abuse
Effective January 1, 2020, Optum Maryland became the new Administrative Service Organization (ASO) for Maryland’s Public Behavioral Health System. An Release of Information (ROI) is required in order to share substance abuse diagnosis data with your patient’s health insurance plan. Please note, a new ROI is required every year. In order to enhance our ability to coordinate care, please encourage your patients to complete the ROIs if they are in substance abuse treatment.
Please review the attached document for authorization for ROI: https://mmcp.health.maryland.gov/SiteAssets/pages/Administrative-Service-Organization-Transition-Information-/ROI%20for%20sharing%20data%20with%20MCOs%20Optum%20Updated.11.7.19.pdf
For additional information regarding SBIRT, referrals to the ASO or core service agencies for behavioral health services, please visit https://mmcp.health.maryland.gov/Pages/Administrative-Service-Organization-Transition-Information-.aspx.
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.
Provider Satisfaction Survey
In order to ensure that we are consistently delivering the best provider experience, it is important that we receive your feedback. We kindly request that you complete our Annual Provider Satisfaction Survey, which is enclosed. Completed surveys may be returned by fax to 410.433.4615 or by email to firstname.lastname@example.org.
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: http://www.jaimedicalsystems.com/members/case-management/.
Important Formulary Updates
Effective immediately, the following product has been added to Jai Medical Systems’ formulary:
- No prior authorization required –> Pantoprazole
- Prior authorization required –> Trulicity
Effective November 1, 2020, Rabeprazole has been amended to require a prior authorization on Jai Medical Systems’ formulary.
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.
For other information related to our formulary and formulary updates, please visit our website at www.jaimedicalsystems.com.
Have you enrolled with ePREP?
Maryland Medicaid requires all providers rendering care to Medicaid beneficiaries enroll with Medicaid’s 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 for dates of service beginning January 1, 2020.
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.
Claim Submission Guidelines
To ensure that your claims are processed quickly and accurately, please be 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 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
- 24 Hour Nurse Advice Line: Please inform members about our 24 Hour Nurse Advice Line. To access, members should call 1-844-259-8613.
- 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 www.jaimedicalsystems.com
- 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 www.jaimedicalsystems.com
301 International Circle Hunt Valley, MD 21030
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