Provider News & Notices

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

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

Summer 2020 – VOLUME LXV

A Message To Our Providers

Dear Provider,

Jai Medical Systems wants you to know that we are open and ready to assist you during the COVID-19 pandemic. We are closely monitoring this dynamic situation and have developed a COVID-19 Response Team in order to best respond to the needs of both our member and provider communities. For the most up-to-date information related to our COVID-19 response, please visit us online at www.jaimedicalsystems.com.

In conjunction with the Maryland Department of Health’s response to COVID -19, Jai Medical Systems will be educating all of our members regarding the availability of COVID-19 testing. As a participating provider with Jai Medical Systems, we request that you and your staff ensure that you are familiar with the most up-to-date information related to COVID-19, such as the priorities for testing and testing locations near your patients. For your reference, please see below for a few important links to review:

As our member engagement and education activities progress, we do expect that some of your patients may contact your office directly for guidance. Please ensure that your staff is prepared to assist these patients as necessary. If you have any questions related to COVID-19 testing, please feel free to contact our Customer Service Department at 1-888-524-1999. We are here to help.

Sincerely,
Helena Manu
Director of Provider Relations


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 throughout the State of Maryland 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 e-mail providerrelations@jaimedical.com.


Telehealth Services

In response to COVID-19, Governor Hogan issued Executive Order No. 20-03-20-01 to authorize the reimbursement of audio-only health care services and HIPAA-compliant telehealth technology. Effective March 21, 2020, providers who are not able to meet in-person with a participant should make every effort to use traditional telehealth technology or audio only phones. Please note: These measures are restricted to use during the emergency declared by Governor Hogan to deal with the threat of COVID-19 and will expire immediately at the end of the declared emergency. This executive order is for medical assistance (HealthChoice and Fee-for-Service) programs and the Public Behavioral Health System.

For AUDIO-ONLY visits, providers should only use the following CPT codes: 99211, 99212, and 99213 and should use a UB modifier. For telemedicine visits in which audio and video two-way is being utilized, please bill the appropriate CPT code with a GT modifier. Also, providers should bill using the location the rendering provider would typically bill, such as service code 11 for “Office.” Please note that Place of Service Code 02 (Telehealth) is not recognized for Maryland Medicaid Participants.

For additional information regarding telehealth services and billing please visit https://mmcp.health.maryland.gov/Pages/telehealth.aspx.


Secret Shopper Program CY 2020

In the next few months, the State of Maryland will be engaging an external vendor to begin conducting phone call surveys to determine the accuracy of the provider directory listings of the participating providers in our network. To ensure that we are providing our members accurate information about the providers in our network, we need your help!

1. Please ensure that ALL of your staff members are aware that you participate with Jai Medical Systems! If you would like a Jai Medical Systems Participating Provider sticker, please contact our Provider Relations Department today at 1-888-JAI-1999.

2. One of the most important aspects of the survey will be the surveyor being able to get ahold of you or your office. Inaccurate demographic information in our directory will prohibit the surveyor from reaching you. Please ensure that you keep us informed of the most up-to-date demographic information regarding you and your practice. If there are any updates to your practice, including a change of your hours of operation, phone number, fax number, address, etc., please let us know as soon as possible! By informing us of changes as soon as they occur, we can ensure that our printed and online provider directories reflect the most accurate information about your practice.


Case Management & Disease Management Programs

Case Management, Complex Case Management, the Complex Care Program, and Disease 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 can be helpful:

  • Individuals with Hepatitis C
  • People who have frequent hospital stays or 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 Hypertension
  • People who need an Organ Transplant

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 Customer Service Department at 1-888-JAI-1999. You may also find additional information about our Case Management and Disease Management programs online at: www.jaimedicalsystems.com/members/case-management/.


Provider Demographic Information Notice

It is important that we provide our members with the most accurate and up-to-date information related to our network providers and their locations. Providers can make updates to their demographic information in two ways:

Utilizing the “update provider information” link on our website:

https://www.jaimedicalsystems.com/providers/update-provider-information/

OR

Submitting a formal notification letter via fax (410-403-1816 or 410-433-1615) or email (providerrelations@jaimedical.com)

* If you have modified hours of operation, and/or limited services during the COVID-19 pandemic, please notify Provider Relations of these temporary changes.


CAHPS Survey Results

On an annual basis, many Jai Medical Systems’ HealthChoice members have the opportunity to complete a national satisfaction survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The member satisfaction survey results are compared against other MCOs throughout the state and nation. The 2019 CAHPS survey showed that Jai Medical Systems mem-bers were very satisfied with How Well their Doctor Communicates. Both adult and child members gave us high marks in this composite. We thank all of our participating providers for listening to your patients so well! The adult surveys also showed our members were very happy with our Customer Service and Co-ordination of Care.

With the COVID-19 pandemic, we have been informed that the 2020 CAHPS surveys for members were mailed, but no follow up phone surveys were per-formed. We thank you for your continued service to our members.


Satisfaction Surveys

We have been notified by the Maryland Department of Health that the Primary Care Provider (PCP) Annual Satisfaction Surveys that were previously on hold due to COVID-19 will begin soon. This survey is important as it helps us understand how our managed care organization rates with you when compared to your experience with other MCO payors.

If you are a participating PCP, please be on the lookout for this survey from the Center for Study of Services (CSS). CSS is planning to outreach to PCPs via phone, mail, and fax beginning July 6, 2020. We request that you please complete this survey if you receive one, and submit it no later than August 10, 2020.


Credentialing and ReCredentialing

In order to join and maintain participation status with the Jai Medical Systems network, each provider must comply with our Credentialing and Recredentialing requirements. This includes keeping your credentialing documents, such as certifications, licenses, and medical malpractice insurance up-to-date with Jai Medical Systems. This helps us to avoid any discrepancies with services rendered to patients, as well as to avoid any confusion.

If any changes in this information have occurred, it is important that you notify Jai Medical Systems of these changes as soon as possible.


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.
  • 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.
  • Formulary Update: Effective April 20, 2020, HIV medications Truvada and Descovy no longer require a prior authorization. Prescriptions for 30 tablets a month can be written by the PCP. For more information regarding Jai Medical Systems coverage of medications, please visit our formulary on our website at: www.jaimedicalsystems.com/providers/pharmacy/.
  • Prior Authorization: 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 website. If you do not see a procedure or service listed, or would like to see if a PA may be required for a particular service or procedure, please contact our Utilization Management Department at 1-888-JAI-1999.
  • 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

Contact Us
Providerrelations@jaimedical.com
301 International Circle Hunt Valley, MD 21030
Phone: 1-888-JAI-1999
Hours of Operation: Monday – Friday
9am-6pm