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At Jai Medical Systems, keeping our providers informed is our top priority.
A Message from the Director of Provider Relations
Dear Provider,
As we enter Fall and the leaves change, we are reminded that there are many things to be thankful for including your continued participation with Jai Medical Systems. Thank you for being a valued member of our provider network; we truly appreciate your participation and value your contributions to the health of our members. I am pleased to share with you that Jai Medical Systems recently achieved Health Equity Accreditation from the National Committee for Quality Assurance. We are proud of this achievement, and appreciate your contributions to helping us earn this Accreditation. Thank you! As you read this newsletter, you will find important information and updates regarding the Maryland Medicaid NPI Uncollapsing project and how to update your billing information with Jai Medical Systems, HEDIS updates, as well as information on SBIRT and how to bill for this important screening. If you have any questions regarding any of the topics in this newsletter, please do not hesitate to contact our Provider Relations Department today at 1-888-JAI-1999.
Sincerely,
Hennrietta Dodoo
Director of Provider Relations
ALERT: NPI Uncollapsing Project
If you are participating in the NPI Uncollapsing Initiative with Maryland Medicaid, it is your responsibility to keep us informed of any changes regarding your billing practices and billing information such as: Tax Identification Number (TIN), Billing NPI and Address, as well as any NPI Specific Location information. Please be sure to send any changes regarding your practice’s billing information to our attention as soon as possible to ensure that there are no delays in the processing of your claims. Updates to your billing information can be sent to us via email at ProviderRelations@jaimedical.com. Jai Medical Systems will acknowledge receipt of your requested billing changes within 30 calendar days. Once we have confirmed that our system has been updated, your practice will then be able to bill utilizing the new information. Please note, if you begin to bill with new NPIs prior to notifying Jai Medical Systems, or confirming our systems have been configured with the update, you may see claim denials and/or rejections. For information and questions related to the NPI Uncollapsing from Maryland Medicaid, please visit here. For information from Jai Medical Systems on the NPI Uncollapsing Initiative, including frequently asked questions, please visit us online at https://jaimedicalsystems.com/providers/provider-billing/
Satisfaction SURVEY
On an annual basis, to ensure that we provide the best possible experience to our network providers, Jai Medical Systems requests feedback from our network providers through our internal satisfaction survey. We kindly invite you to share your experience with Jai Medical Systems by completing our online Provider Satisfaction Survey by visiting https://www.surveymonkey.com/r/ TVK2RVF.
Providers who complete our survey will be entered into a raffle drawing for a $100 gift card.
Primary Care Corner:
Important Updates and Reminders
Formulary
Jai Medical Systems has a comprehensive formulary of medications available to our members. To search our formulary, or find formulary change updates, please visit our website.
Health Education
Jai Medical Systems offers Health Education classes for our members on topics such as diabetes management, weight management, and smoking cessation. Classes are offered both in-person and via Zoom. Interested members can sign-up for a health education class by phone at 1-888-JAI-1999.
Patient Advocacy
Jai Medical Systems does not prohibit, or otherwise restrict, a provider acting within the lawful scope of practice, from advising or advocating on behalf of a member who is his or her patient.
HEDIS Update: Mammograms
In preparation for Breast Cancer Awareness month, we would like to take this opportunity to share with our network providers that HEDIS has recently changed the age requirement for mammograms in an effort to align with the new U.S. Preventive Services Task Force guidelines. Women, ages 40-74, should receive a mammogram every two years in order to meet the HEDIS requirement. We encourage our network providers to talk with your patients, and refer them, as appropriate, for their mammogram screening. Please be advised that Jai Medical Systems members who receive their mammogram are eligible to receive a Healthy Reward! For more information about our Healthy Rewards program, and how it may be able to encourage your patients to seek important preventative healthcare, please contact our Quality Department at quality@jaimedical.com.
Meet our Quality Ambassador, Mirren!
Jai Medical Systems is proud to share that we have designated Mirren, Quality Assurance Specialist, as our Quality Ambassador. Mirren will be reaching out to our Primary Care Providers in the near future about important quality programs, HEDIS updates, and continuing education events hosted by Jai Medical Systems. If you have any questions regarding quality and how you can make an impact to our members health outcomes, please feel free to reach out to Mirren by email at quality@jaimedical.com.
Find A SPECIALIST
Jai Medical Systems has a comprehensive network of specialty and ancillary care providers throughout Maryland. To locate a specialty care or ancillary care provider for your Jai Medical Systems patients, please use our online searchable Provider Directory located at: https://jaimedicalsystems.com/members/find-provider/. If you need assistance finding a specialty care provider, please contact our Provider Relations Department at 1-888-JAI-1999.
HIV/AIDS TRAINING
To ensure that our network Primary Care Providers stay informed about important HIV/AIDS treatment updates, Jai Medical Systems recommends PCPs attend an HIV/AIDS Treatment and Management training every two years. HIV/AIDS training courses are available for free through various organizations, such as the Mid-Atlantic AIDS education and Training Center (AETC), the Baltimore City Health Department or Simply Speaking HIV Management. For more information about available HIV/AIDS training courses or for assistance with registering for an upcoming training session, please contact our Provider Relations Department at ProviderRelations@jaimedical.com.
SBIRT
SBIRT (Screening, Brief Intervention, and Referral to Treatment) is evidence based, comprehensive and integrates a public health approach to deliver early intervention and treatment services to patients who are at risk for alcohol or drug misuse. Maryland SBIRT aims to address drug overdose deaths, health disparity outcomes among minorities, while reducing healthcare cost in Maryland. PCPs are encouraged to perform this important screening for their patients. The SBIRT screening is a covered MCO service when billed by a PCP. To bill the SBIRT screening, please include the appropriate SBIRT HCPCS on your claim. For patients interested in treatment for substance use disorder or behavioral health, please refer and coordinate treatment care with Carelon, Maryland Medicaid’s behavioral health administrative services vendor. For behavioral health patient referrals and assistance, please contact Carelon by phone at 1-800-888-1965. For additional information on the SBIRT, please visit https://bha.health.maryland.gov/pages/SBIRT.aspx. Release of Information (ROI) Substance Abuse As a reminder, in order to share substance abuse diagnostic information with your patient’s health insurance plan, please ensure that your patient is completing a Release of Information (ROI) form annually. In order to enhance our ability to coordinate care, please encourage your patients to complete the ROIs if they are in substance abuse treatment. The ROI form can be found online for download by visiting https://mmcp.health.maryland.gov.
False Claims Policies
The Federal and State False Claims Acts makes it a crime for any person or organization to knowingly present or conceal a false or fraudulent claim for payment to the United States government or to a government contractor, including claims submitted to Medicaid. To comply with the Federal Deficit Reduction Act, we would like to make you aware of your rights and responsibilities under the Federal and State False Claims Acts, administrative remedies, civil penalties, and the protections for whistleblowers under such laws. As an agent, contractor or vendor of Jai Medical Systems Managed Care Organization, Inc., our policies and procedures regarding this legislation not only apply to our employees, but they also apply to you.
The criminal penalties for knowingly submitting fraudulent claims could include fines and/or imprisonment. In addition to criminal penalties, administrative remedies can include monetary penalties, costs of the civil action brought to recover any such penalty or damages, plus 3 times the amount of damages which are incurred by the government. These penalties are detailed in 18 U.S.C. Section 287 and 31 U.S.C. Section 3730 of the False Claims Act.
Also, according to the False Claims Act, federal law prohibits retaliation, and as a whistleblower, any employee, contractor, or agent is entitled to all relief necessary to be made whole if they are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against due to their efforts to stop a violation. We welcome and encourage you to report anything suspicious. To report fraud, waste, and abuse or if you have any questions regarding our policies and procedures, please contact our Fraud, Waste and Abuse Compliance Officer at 1-888-JAI-1999. You can also write to: Jai Medical Systems, 301 International Circle, Hunt Valley, MD 21030. For more information regarding fraud, waste, and abuse, please visit our website: www.jaimedicalsystems.com.