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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 approach the end of the year, I want to take a moment to express my sincere gratitude for your continued partnership with Jai Medical Systems. Looking to the year ahead, I would like to also take this time to share a few important reminders:
NPI Location Specific Changes and Billing Information Updates
We understand that over the next year, there are many changes coming to Maryland Medicaid with regards to requirements for location specific NPIs. We want to remind all providers of your responsibility to keep Jai Medical Systems informed of any changes with regard to your billing practices and billing information such as your tax identification number, billing NPI and address, as well as any NPI specific location information. Please be sure to send any changes to your billing information to our attention as soon as possible to ensure that there are no delays in the processing of your claims. We will acknowledge receipt of your requested billing changes within 30 calendar days.
Social Determinants of Health
If you are conducting social determinants of health screenings, or gaining information about our members social issues, please ensure that you are including Z codes on your claims submissions and referring our members to support services, as appropriate.
Behavioral Health ASO Change
Maryland’s Behavioral Health Administrative Services Organization is changing from Optum to Carelon, beginning January 1, 2025. To contact Carelon for behavioral health care coordination and assistance, please call 1-800-888-1965.
Wishing you a Merry Christmas, a joyful holiday season, and a happy New Year!,
Hennrietta Dodoo
CAHPS and Satisfaction Survey Results
Each year, Jai Medical Systems receives feedback from our members through two surveys. The first is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The goal of this survey is to find out what our members think of our health plan and our network providers. The CAHPS survey results are compared against other health plans throughout the State and Nation. The 2023 Adult CAHPS results showed that our “Overall Health Plan Rating” was 47.64%. Our highest performing areas for adults included “How Well Doctors Communicate” at 91.42% and “Customer Service” at 92.98%. For the 2023 Child CAHPS survey, we received an “Overall Health Plan Rating” of 59.43% and the highest performing area was “How Well Doctors Communicate” at 93.22%.
The second survey is an internal survey that Jai Medical Systems sends out to give all our members an opportunity to provide us feedback on how we are doing. In 2023, based on responses from 1000 members, our overall satisfaction rate was 99%. Our 2024 internal survey was recently sent to our members and the results will be shared with our providers next year
Provider Satisfaction Feedback
In November 2023, Jai Medical Systems requested providers to participate in our Internal Provider Satisfaction Survey. We are pleased to report an overall satisfaction rate of 88% from our providers. Providers expressed particularly high levels of satisfaction with our Customer Service, Provider Relations, Utilization Management staff, and Quality Assurance initiatives and programs.
One area identified for improvement was the expansion of our provider network. Specifically, providers noted the need for more specialists in Pain Management, Podiatry, Dermatology, and other specialties. In response, the Provider Relations Department is actively working to grow our network and include additional providers across the state. We greatly value your feedback and encourage you to share any additional suggestions by email at providerrelations@jaimedical.com.
Translation Services
Jai Medical Systems offers culturally and linguistically appropriate translation and interpreter services to our network providers for our members who speak a language other than English. While 53.71% of our patient population speak English, our membership’s next most common languages include Spanish (0.74%), Haitian Creole (0.06%), and Chinese (0.02%). To request a translator, simply call the our Customer Service Department at 1-888-JAI-1999. For more information about language accessibility resources available, please visit us at www.jaimedicalsystems.com.
Updates and Reminders
Health Education
Jai Medical Systems offers Health Education classes for our members. Health Education topics include diabetes education, controlling hypertension, and weight management. These classes are offered both in person as well as virtual through Zoom. Members interested in joining us for a health education class can sign up by calling us at 1-888-JAI-1999, or online at http://3.22.111.192/members/referral-interest-form/.
Access and Availability Standards
To ensure members receive timely care, Jai Medical Systems has established access standards for routine and urgent appointments, as well as availability requirements for all in-network Primary Care Providers (PCPs) and Specialists. For Specialists, routine and preventive care appointments must be scheduled within 30 days of a PCP referral, while urgent care requests should be scheduled as soon as possible but within 30 days of the member’s PCP request.
For PCPs, urgent care appointments must be scheduled within 48 hours, and routine or preventive care appointments must be scheduled within 30 days of the request. Additionally, PCPs are required to provide oncall availability to ensure members have access to after-hours care. These standards are designed to promote timely access to care, improve health outcomes and reduce inappropriate ER utilization. If you have any questions, please reach out to our Provider Relations team at 1-888-524-1999, or at providerrelations@jaimedical.com.
Formulary Updates
Jai Medical Systems formulary updates can be found on our website at: http://3.22.111.192/providers/pharmacy.
ePREP
Did you recently renew your Professional Licenses? If the answer is yes, you may need to update your ePREP profile. Maryland Medicaid requires that provider ePREP accounts be up to date with the most accurate information for a provider, including professional license and registration renewals, such as one’s DEA or CDS. As a reminder, failure to ensure your ePREP account is up-to-date and active may result in claim denials from Jai Medical Systems.
Coordination of Care: Substance Abuse and Behavioral Health
SBIRT Process
SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based, comprehensive, and integrated public health approach to the delivery of early intervention and treatment services to patients who have risky alcohol or drug use. Maryland SBIRT aims to address drug overdose deaths and health disparity outcomes among minorities, while reducing healthcare costs in Maryland. PCPs are encouraged to perform this important screening for their patients. This care is covered by Jai Medical Systems. For patients who are interested in substance abuse and/or behavioral treatment, please refer them to the State’s ASO vendor, Optum, by calling 1-800-888-1965 for assistance with linking the member to care. For more information on SBIRT, please visit https://bha.health.maryland.gov/Pages/SBIRT.aspx. Please note, effective January 1, 2025, Carelon will be the new Behavioral Health Administrative Service Organization for Maryland Medicaid.
Release of Information (ROI): Substance Abuse
As a reminder, in order to share substance abuse diagnosis data with your patient’s health insurance plan, please ensure that you are 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 at https://mmcp.health.maryland.gov.
False Claims, Policies and You
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, 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 by their efforts to stop a violation. We welcome and encourage you to report anything suspicious. To report fraud and abuse or if you have any questions regarding our policies and procedures, please contact our Fraud 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 and abuse, please visit our website: www.jaimedicalsystems.com.