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

Spring 2020 – VOLUME LXIV

COVID-19 Update

At Jai Medical Systems, we have formed our own Response Team in order to appropriately respond to the novel coronavirus (COVID19). Our COVID19 Response Team has developed a response plan with the following goals and objectives:

    1. To ensure the health and well-being of our patients, providers, members, and staff.
    2. To maintain continuity of operations in order to perform core functions as an essential component of Maryland’s public and private health system.
    3. To cooperate and coordinate with local, state, and federal health agencies

We will make every effort to keep our providers and other interested parties up to date as this dynamic situation unfolds. For the most up to date information regarding Jai Medical Systems’ Response Plan, please visit us online at www.jaimedicalsystems.com. For general information related to COVID19, please visit the CDC’s website at

https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html


Highest scoring MCO on the HealthChoice Report Card for 2020!

On an annual basis, the Maryland Medicaid HealthChoice Health Plan Program provides a Report Card to show how the health plans in HealthChoice compare to each other in key areas. There are six Performance Areas that are measured, ranging from 1-star (Below HealthChoice average), 2-stars (HealthChoice Average), to 3-stars (Above HealthChoice Average). These scores are based on the medical care provided, thanks to great providers like you, and the annual member satisfaction CAHPS® survey sent to members in each Health Plan. Jai Medical Systems scored well above all other MCOs, earning a 3-star rating 6 times, which is the highest rating available! Every day Jai Medical Systems strives to provide compassionate, quality care, and to help make a positive difference in the lives of our members. Please see below for the full comparison chart from the 2020 HealthChoice Report Card:


State Vendor Change for Behavioral Health Services

Effective December 30, 2019, the state’s vendor for behavioral health services has changed from Beacon Health to Optum.

  • Filing claims: Providers must submit claims to Optum as of December 30, 2019. Claims submitted to Beacon after December 29, 2019 will be given a denial code and providers will need to resubmit these claims to Optum.
  • Authorization for Services: Providers must submit new and concurrent authorization requests to Optum as of January 1, 2020.

All providers (individual, group, programs, and institutions) MUST log into the Optum portal and register in order to request authorizations, file claims, and receive payments.

For further information, please call the provider question hotline at 1-800-888-1965 from Monday-Friday 8 am-6 pm or visit the links below:

https://maryland.optum.com/content/ops-maryland/maryland/en/participants-families/crisis-resources.html

https://maryland.optum.com/content/ops-maryland/maryland/en.html


New Service Area Locations!

Jai Medical Systems is pleased to announce that the Maryland Department of Health has approved our request to expand our service area to include Howard County, Harford County, and Carroll County effective March 1, 2020. We are very excited about this expansion and look forward to providing high quality healthcare benefits and services to the people of Howard, Harford, and Carroll Counties.

Jai Medical Systems has begun to receive new members in Howard County, Harford County and Carroll County. Please help us welcome our new members. We request that participating providers become familiar with these service areas as well as our benefit offerings. To locate a provider please utilize our online provider directory by visiting:

www.jaimedicalsystems.com → Providers → Find a Provider

If you have any questions or would like additional information regarding this matter, please feel free to contact the Provider Relations Department at 1-888-JAI-1999 or via email at providerrelations@jaimedical.com.


Hepatitis C Treatment Update

Effective January 1, 2020, Maryland Medicaid has modified its criteria standards to include a minimum qualifying fibrosis score of F0 or higher for treatment (previously it was F1). Even though a fibrosis score no longer needs to be met in order to be approved for treatment, a fibrosis score is still needed in order to determine the correct treatment and duration.

Jai Medical Systems will continue to use the clinical criteria from Maryland Medicaid when approving all treatments, but patients must be ineligible for a preferred treatment before a non-preferred treatment will be approved. The current list of preferred treatments for Hepatitis C remains:

Generic Harvoni (ledipasvir-sofosbuvir): Genotypes 1,4,5,6

Generic Epclusa (sofosbuvir-velpatasvir): All Genotypes

Zepatier: Genotypes 1 and 4

Mavyret: All Genotypes


Diabetes Prevention Program

Jai Medical Systems is now offering a Diabetes Prevention Program (DPP) to provide you with support and tools for your members to lose weight and help reduce their risk of developing diabetes. This program is offered at NO COST to our members through our in-person provider Continuum Wellness Center, LLC. To learn more about our Diabetes

Prevention program or to refer a patient to this program, please contact our Customer Service Department today at 1-888-JAI-1999.


Secret Shopper Survey

The State of Maryland has engaged a vendor to conduct phone call surveys to determine the accuracy of the provider directory listings of the participating providers in our net-work. 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. 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.

In the near future, you will receive a Provider Demographic Verification Letter. Please review this letter carefully to ensure that the information listed is accurate. For your convenience, demographic changes may be made online at any time at www.jaimedicalsystems.com.


Reduce Hospital Admission Rates

Preventative care and regular physician check-ups are essential to monitoring a member’s health, improving patient care, and reducing hospital admission rates. In effort to reduce hospital admission rates, we ask that all Primary Care Providers follow up with your members on your panels following any hospitalization. In addition, all Specialty Care Providers should make certain to send all applicable medical notes and information back to the member’s Primary Care Provider as they are the gate keepers of medical care.


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
  • HIV/AIDS Medications Formulary Update: Effective January 1, 2020, AIDS medications are no longer covered under Maryland Fee for Service. Instead, these important medications will be covered by Jai Medical Systems’ pharmacy benefit. For the first six months of this transition, there will be a smoothing period for members who have already been prescribed HIV/AIDS medications. We recommend that providers who are prescribing HIV/AIDS medications, including Truvada, check our website for updates regarding our formulary options as well as any criteria such prior authorization for individuals receiving these medications. Contact Jai Medical Systems for further assistance if your patient is having trouble filling their medication or if you have questions about whether a medication is covered under Jai Medical Systems.
  • 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.

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