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 2019 – VOLUME LXIII
On behalf of Jai Medical Systems, we would like to wish you all a safe and happy holiday season. We appreciate your participation with our organization and would like to thank you for your continued service to our members. 2019 has been a tremendous year, to say the least, as we have added over 3,000 new providers to our network. We look forward to our continued provider network expansion in 2020, as well as working with you in the New Year!
The Provider Relations Team
Is Your Staff Aware Of Their Participation with the Highest Rated MCO In Maryland?
As a participating provider with Jai Medical Systems, please remember the following:
- Providers must ensure that Jai Medical Systems is included as an accepted insurance health plan.
- Providers should display participating provider signage as provided by Jai Medical Systems. If your organization does not have a participating provider sign please contact the Provider Relations Department at 1-888-JAI-1999; and
- Providers should ensure that all providers and staff are appropriately educated and aware of their participating provider status with Jai Medical Systems at all times.
Jai Medical Systems would like to remind all providers that Maryland Medicaid requires ePREP registration. According to the Maryland Department of Health, all providers submitting claims for HealthChoice members must complete registration with ePREP by January 1, 2020. Failure to properly enroll and maintain an active status in ePREP may result in claim denials for dates of service beginning January 1, 2020.
To enroll with ePREP, please visit https://eprep.health.maryland.gov/ or for more information, please contact the Medicaid program at 1-844-4MD-PROV (1-844-463-7768) or visit health.maryland.gov/ePREP.
If you have any questions about how to enroll with ePREP, 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. We are here to help.
Provider Network Expansion
In order to accommodate the growing needs of our members, Jai Medical Systems is 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 who are interested in joining our network. If you know any providers who may be interested in joining our network, please have them contact our Provider Relations Department at 1-888-JAI-1999 or via e-mail at firstname.lastname@example.org.
Effective January 1, 2020, Maryland MCOs are responsible for covering HIV medications. Maryland Medicaid is no longer covering these medications directly under Fee for Service. Current patients will be able to continue their current treatment, but will be subject to each MCO’s formulary starting July 1, 2020. Beginning January 1, 2020, new patients will be required to follow the MCO’s formulary or obtain prior authorization. For more information regarding Jai Medical Systems coverage of HIV medications, please visit our website.
Effective January 1, 2020, Maryland Medicaid is changing their prior authorization guidelines for Hepatitis C treatment. The minimum fibrosis score threshold required for treatment will now be F0. Fibrosis test results will still be required in order to meet Maryland Medicaid medical necessity requirements, however there will no longer be a minimum fibrosis score of F1.
Effective September 1, 2019, Jai Medical Systems will no longer reimburse enteral/parenteral formula such as Ensure, for members over the age of 21, as this is not a Mary-land Medicaid covered benefit. Jai Medical Systems will cover these products for mem-bers under the age of 21 only when such services are medically necessary and appropri-ate. All requests for enteral/parenteral formula require a Standard Prior Authorization Request Form to be completed by the member’s Primary Care Provider. To download this form, please visit https://www.jaimedicalsystems.com/providers/provider-resources/
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.
After Hours Coverage & Appointments
All Primary Care Providers are required to provide after hours coverage to members during hours when their medical office is closed. In addition, all PCPs are required to maintain compliance with the following appointment availability:
- Urgent care appointments should be available within 48 hours
- Routine and preventative care appointments should be available within 30 days
Please ensure that after hours coverage is available and that appointments are available to your patients within the time requirements listed above.
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
- Individuals who qualify for REM
- 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
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.
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 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
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