Presented on this page are helpful resources for providers.
If there is a resource that you do not see listed on this page, please feel free to contact our Provider Relations Department today for assistance.
ICD10 Claims Processing
In efforts to ensure proper claims processing for inpatient claims and outpatient claims for dates of service beginning October 1st, 2015, all providers must provide a valid ICD-10 diagnosis code to the Jai Medical Systems Utilization Management Department upon notification of all Inpatient admissions and request for all outpatient services. Failure to provide the UM department a valid ICD-10 code could result in a delay or denial in payment. For all questions or inquiries regarding this matter please contact Chardae Buchanan at 410-433-5600 option 7 or Barbara Younger at 410-433-5600 option 4. Thank you.
Frequently Asked Questions
Please refer to our FAQ document for additional information about the transition to ICD-10.
Clearinghouse Trading Partners
Jai Medical Systems currently partners with SSI Claimsnet to provide electronic billing services for professional and institutional claims. Electronic claims submission improves billing and collection by reducing lag time between claims submission and payer processing. Utilizing a clearinghouse can also reduce the cost of paper transactions and postage costs.
Visit this page for more information about registering with SSI Claimsnet to start sending electronic claims data.
Jai Medical Systems Provider Manual 2021
Access to our Provider Manual and Provider Portal is available for our participating providers. Please contact our Provider Relations Department if you require assistance in accessing our Provider Manual and/or Provider Portal.
General Medicaid Provider Information
For general Medicaid provider information, including forms, updates, fee schedules, and billing instructions, please visit the Maryland Department of Health and Mental Hygiene’s website.
All services requiring prior authorization, as outlined in the ‘Prior Authorization Guidelines’ below, require a Standard Authorization Request Form to be completed by the member’s Primary Care Provider and submitted to the Utilization Review and Case Management Department for review and approval. This form does not replace the Jai Medical Systems Referral Form and is not a valid document for claim submission purposes.
Non-Invasive Prenatal Testing (NIPTs) Clinical Criteria
As recently shared by the Maryland Department of Health regarding the NIPTs Clinical Criteria, Jai Medical Systems has added CPT 81420 and 81507 as covered services without the need for a Prior Authorization. We do require providers to utilize our preferred lab vendor, LabCorp, for this testing.
Utilization management decisions made by Jai Medical Systems Managed Care Organization, Inc. staff are based on the appropriateness of care and the availability of benefit coverage. There are no financial incentives or rewards provided to Jai Medical Systems Managed Care Organization, Inc. staff for utilization management decisions, including for denials of coverage or underutilization of coverage benefits.
The clinical criteria used for making utilization management decisions is available for review in the Jai Medical Systems Managed Care Organization, Inc. administrative offices. Practitioners may request a copy of the criteria that is used in making utilization management decisions by calling our Utilization Management Department at 1-888-JAI-1999.
Important Tools for Primary Care Providers regarding HPV Vaccination Rates
Please review the resources provided by both the Department of Health and Mental Hygiene as well as the CDC to assist in your HPV vaccination efforts.
Cultural Competency Education for Providers
We encourage you to check out the links below for information regarding the competencies for providers when it comes to treating a diverse population.