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At Jai Medical Systems, keeping our providers informed is our top priority.
Important: Network Adequacy Verification
On an annual basis, the Maryland Department of Health conducts a Network Adequacy Validation (NAV) analysis of our provider network. This analysis is performed through an independent telephone survey in which a sample of the providers listed in our Provider Directory are contacted to verify the information listed in our Provider Directory is accurate.
Based on feedback from the 2025 survey, one of the issues identified involved discrepancies in providers “accepting new patients” status. In certain circumstances, these discrepancies may have resulted from updates not being communicated to us in a timely manner or from front office staff being unaware of the provider’s participation status or current acceptance status.
To help ensure the accuracy of information available to our members, we respectfully request your assistance and attention to the following:
- Network Participation Awareness: Please ensure that all staff members, particularly frontline staff, are informed of your participation status with Jai Medical Systems. If your office would like to receive a Jai Medical Systems Participating Provider sticker, please contact our Provider Relations Department at 1-888-JAI-1999.
- Accurate Provider Directory Listings: Please verify that your directory listing is current and accurate. Any changes to your practice information, such as address, phone number, or office hours, should be reported to us promptly.
Updates to your provider directory listing may be submitted online by visiting www.jaimedicalsystems.com or via email to providerrelations@jaimedical.com.
We appreciate your cooperation in this important matter and your continued commitment to maintaining accurate provider information. If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999 or providerrelations@jaimedical.com.
Cell and Gene Therapy Access Model for Sickle Cell Disease
The Maryland Medicaid Cell and Gene Therapy Access Model for sickle cell disease was implemented effective January 1, 2026. The model is designed to facilitate Medicaid beneficiary access to high-cost gene therapies through outcomesbased agreements with manufacturers.
The model includes coverage for CASGEVY and LYFGENIA, which may only be administered at authorized treatment centers. At this time, authorized centers include Children’s National Medical Center and the University of Maryland Medical Center. Providers must ensure that administration occurs only at approved sites. The model applies to HealthChoice Managed Care Organizations and Medicaid fee for service participants. No step therapy requirements apply under this model.
The treatment course is approximately 12 months through infusion, followed by required longterm clinical monitoring. Eligible participants may qualify for additional support services, including travel, lodging, and childcare, as applicable. Gene therapies are reimbursed based on invoice at actual acquisition cost and must be billed using UB-04 claims in accordance with established billing guidelines. All treatment services require preauthorization. Providers and Medicaid beneficiaries retain appeal rights, and the State maintains oversight to ensure adherence to model criteria.
For questions regarding this model, please contact mdh.cgtmodel@maryland.gov.
2026 QUALITY INITIATIVES
NEW: 90-Day Prescription Fills
The following medications are eligible for dispensing in quantities of up to a 90-day supply:
- Asthma Controller Medications (excluding rescue medications)
- Statins (maximum cost of $200 per 90-day supply)
- Antihypertensive medications* (maximum cost of $300 per 90-day supply)
*Clonidine is limited to a 30-day supply
Please note: An initial prescription fill of up to 30 days is required to initiate therapy.
Cancer Screening Recommendations
The U.S. Preventive Services Task Force recommends a colorectal cancer screening for adults aged 45 to 75 years and breast cancer screening for women ages 40 to 74 years. Network providers are encouraged to discuss these recommendations with patients, and initiate referrals, as clinically appropriate. Eligible Jai Medical Systems members who complete these screenings may qualify for a Healthy Reward.
Preventative Care Panels
To support the delivery of evidence-based preventative services, Jai Medical Systems provides Preventative Care Panels to our Primary Care Providers. February’s panel was recently sent via US mail. This panel report will identify your assigned patients and indicate any preventative services that may be due. We hope that this report is helpful to you in your outreach efforts.
For additional information regarding these initiatives, please contact the Quality Assurance Department at quality@jaimedical.com.
Prescriber Reminder & Quick Reference Guide
Jai Medical Systems would like to remind providers that any duly licensed provider may prescribe medication for our members regardless of participation status.
In addition, we recently developed a Prescriber Quick Reference Guide which shares important information about access to our formulary, prior authorization forms, and copayment information. To access our new Prescriber Quick Reference Guide, please visit: https://www.jaimedicalsystems.com/providers/pharmacy/.