Provider Billing

Provider Billing (UB-04 & CMS1500)

To ensure that your claims are processed quickly and accurately, please make sure to follow these simple guidelines regarding billing practices, referrals, and authorizations.  Jai Medical Systems Managed Care Organization, Inc. follows the Maryland Medicaid billing guidelines for claims billing.  You may find a copy of the most recent Maryland Medicaid Billing Instructions at https://mmcp.health.maryland.gov/Pages/Provider-Information.aspx. Please note that there have been significant, meaningful changes in the UB04 Hospital Billing instructions, effective June 2019.

When submitting the following type of claim, please ensure that you have appropriately followed the Maryland Medicaid  Billing Instructions in addition to the below listed items:

Paper Claim

• Attach a valid completely filled out, legibly written referral, outpatient authorization, or inpatient authorization, where applicable.
• Include the authorization number that is valid for the claim being billed HRXXXXXXX(referral), OAXXXXXFXXX (outpatient authorization), IAXXXXXFXXX or IAXXXXXIXXX (inpatient authorization) in the appropriate field. This field is located in block 23 for the CMS1500 form and block 63 for the UB-04).
• Attach a copy of the member’s primary insurance Explanation of Payment (EOP) or Remittance advice, if applicable.

Electronic Claim

• Fax one copy of a valid completely filled out, legibly written referral, outpatient authorization, or inpatient authorization, where applicable, to Jai Medical Systems’ Claims Processing Center (fax number 1-866-381-7200) prior to claim submission.
• Indicate the authorization number that is valid for the claim being billed HRXXXXXXX(referral), OAXXXXXFXXX (outpatient authorization), IAXXXXXFXXX or IAXXXXXIXXX (inpatient authorization) in the Authorization field specific to the billing software program that you utilize.
• Indicate any information regarding the member’s primary insurance and any payment made from the third party payor (TPP).

Jai Medical Systems encourages all participating providers to submit claims electronically.

Participating providers can begin to submit claims electronically by registering here.
Registration is easy and free for participating providers.

There are many benefits to submitting claims electronically to Jai Medical Systems including:

• Faster claims payment
• Faster claim adjudication
• Elimination of postage costs
• Receipt of Electronic Remittance Advice (ERA) (835)

To complete the simple registration process, please follow these steps:

1. Visit the ClaimsNet website
2. Click on “Register”
3. Follow the step by step instructions to complete the registration process

If you have any technical problems, please contact helpdesk@claimsnet.com.

Paper Claims

Jai Medical Systems encourages all participating providers to submit claims electronically, however, providers wishing to submit paper claims can mail them to:

Jai Medical Systems
301 International Circle
Hunt Valley, MD 21030
Attn: Claims Department

For an initial submission of an ER claim with medical records, please mail to:

Jai Medical Systems
PO Box 747
Hunt Valley, MD 21030
Attn: ER Medical Record Claims

Claims Appeals

Claims Payment Appeal Submission Form

Jai Medical Systems encourages providers to use our Claims Payment Appeal Submission Form when submitting a claim being appealed. Please submit a separate form for each claim number being appealed.

Providers have one hundred and eighty (180) calendar days to submit a first level appeal from the date of Explanation of Payment (EOP) for the claim in question. Providers have thirty (30) calendar days to submit a second level appeal from the date of the first level appeal’s determination letter. Providers have eighty-five (85) business days to submit a third level appeal from the date that the first level appeal was received. If a provider is submitting a third level medical record review appeal, they must attach the second level appeal determination letter and all applicable medical records.

Please note, any appeals received that do not meet the requirements outlined below may be returned to the submitting party and may not be reviewed. All appeals submitted to Jai Medical Systems must include the following information:

• Cover letter explaining the reason for the appeal including the name and date of birth of the patient, claim number being appealed, date of service of the claim, contact phone number, and return mail address where the determination letter should be mailed
• Copy of the claim being appealed and/or copy of the EOP; and
• Supporting relevant documentation.

All appeals for Medical Record Review should be addressed and mailed to:

Jai Medical Systems
Attn: Medical Record Review
P.O. Box 1650
Hunt Valley, MD 21030

All other appeals should be addressed and mailed to:

Jai Medical Systems
Attn: Appeals Department
301 International Circle
Hunt Valley, MD 21030

Special Notices

Enhanced COVID-19 Vaccine Administration Fee for Primary Care Providers

Effective November 1, 2021, Jai Medical Systems will reimburse Primary Care Providers who are administering COVID-19 vaccines an enhanced administration fee of $70.  Currently, Medicare and Medicaid pay COVID-19 vaccine administering providers $40.00 per vaccine administration.  We have enhanced our rate in an effort to incentivize those Primary Care Providers who we know may be spending additional time with patients counseling them on the vaccine that may not be captured within your visit, as well as to assist with the administrative load that comes with the vaccine management, storage, handling, and reporting of COVID-19 vaccines.  This enhanced COVID-19 vaccine administration rate will be applicable through March 31, 2022.  Please ensure that when billing our organization for COVID-19 vaccines that you are billing at the new, enhanced rate in order to receive this reimbursement rate.

For any Primary Care Provider who is not currently administering COVID-19 vaccines and is interested in doing so, please contact our Provider Relations Department today at providerrelations@jaimedicalsystems.com.

Special Notice – Paper Claims Submitted the Week of July 14 

This is an important notice for providers that may have sent paper claims to Jai Medical Systems the week of July 12th.  We have been notified by our courier that a mailing of claims that were processed by our organization on July 14th have yet to make it to their scheduled destination.   We suggest that providers who may have submitted paper claims the week of July 12th  check their EOPs for any potential missing claims payments.  If you believe that you sent a claim that may have been in this mailing, please re-send the paper claim to our attention for processing.

Important Information regarding Observation

Please be advised that Jai Medical Systems follows the Maryland Medicaid Fee for Service Observation Billing Guidelines.  For more information regarding these guidelines, please review the following Maryland Medicaid Transmittals.

Hospital Transmittal # 246 / MCO Transmittal # 114

Hospital Transmittal # 249

Special Notice: COVID-19 Lab Testing Information

Jai Medical Systems uses LabCorp for laboratory services.  LabCorp offers testing for COVID-19.  The specimen must be collected by the healthcare provider and sent to LabCorp for processing.  Please visit www.labcorp.com/coronavirus-disease-covid-19 for additional information.

Jai Medical Systems will reimburse for COVID-19 testing in accordance with Maryland Medicaid directives for Managed Care Organizations.  Jai Medical Systems will reimburse CLIA certified laboratories at 100% of the Medicaid fee schedule for the procedure codes below.

NCCI Edits

In accordance with CMS regulations, Jai Medical Systems uses the National Correct Coding Initiative edits when processing claims.

Fee Schedule Notice

Jai Medical Systems predicates its Fee Schedule on the Maryland Medicaid Fee For Service fee schedule.  The Maryland Department of Health (the Department) updates its Medicaid Fee For Service fee schedules on a periodic basis.  Please visit the following link for the most up-to-date fee schedule information: https://mmcp.health.maryland.gov/Pages/Provider-Information.aspx.

In the event that the Department publishes a new Medicaid Fee For Service fee schedule, our organization will retroactively adjust payments to Provider for previously submitted claims for qualifying dates of service for Covered Services provided to Enrollees back to the effective date of the rate change or ninety (90) days prior to our receipt of notice of the rate change, whichever is shorter.

If you discover that the Department has updated a Medicaid Fee For Service fee schedule, but that our organization has paid a claim at the old Medicaid Fee Schedule, it is important that you notify our organization promptly.  In these instances, we recommend that the provider submit an appeal.

Please be aware that the Department does not provide MCOs advance notice of fee schedule changes nor are fee schedule updates made on a consistent basis by the Department.  Due to the nature of these fee schedule updates, please be advised that Jai Medical Systems’ uses its best efforts to implement any modifications to the Medicaid Fee For Service fee schedule as of the effective date of the rate change established and published by the Department on its website or ninety (90) days prior to our receipt of notification of the rate change, whichever is shorter.

If you have any questions regarding our current fee schedule, please feel free to contact our Provider Relations Department at 1-888-JAI-1999 or via email atproviderrelations@jaimedicalsystems.com.