Dear Provider,
Fall is here! As we welcome the new season, I would like to take a moment to thank you for your continued partnership and the exceptional care you provide to our members every day. Your dedication and commitment help ensure that individuals and families across Maryland receive the quality healthcare they deserve.
As Maryland prepares for upcoming federal Medicaid changes under H.R. 1, we want to share important information that may affect some Maryland Medicaid members over the next several years. Maryland Medicaid currently covers more than 1.5 million residents. Under H.R. 1, certain Medicaid eligibility and renewal requirements will change beginning in October 2026 and January 2027. The Maryland Department of Health is working with health plans, providers, and community partners to help members understand these changes and maintain their coverage.
KEY CHANGES INCLUDE
- New eligibility rules for certain non-citizens beginning October 1, 2026.
- Work and community engagement requirements for certain adults enrolled through the ACA Medicaid expansion beginning January 1, 2027. Members subject to the requirement will need to complete at least 80 hours per month of qualifying activities such as employment, education, job training, or volunteer service.
- More frequent eligibility renewals for certain adults, who will be required to renew coverage every six months rather than annually.
- Changes to retroactive coverage rules beginning January 1, 2027.
Providers play an important role in helping members prepare for these changes. We encourage providers to remind patients to keep their contact information current, respond promptly to Medicaid renewal requests, and watch for communications from Maryland Medicaid regarding any new requirements that may apply to them.
For more information, providers are encouraged to visit the Maryland Medicaid website at https://health.maryland.gov/mmcp/Pages/workrequirements.aspx.
Thank you for your continued partnership and commitment to serving Maryland Medicaid members.
Sincerely,
Hennrietta Dodoo
DIRECTOR OF PROVIDER RELATIONS
VACCINE BILLING REMINDER FOR PEDIATRIC PROVIDERS
As we continue to support accurate claims processing, we would like to remind providers of the appropriate billing requirements for vaccines covered under the Vaccines for Children (VFC) Program.
PATIENTS AGES 18 AND YOUNGER
Vaccines supplied through the VFC Program are provided to VFC providers at no cost. When administering a vaccine to a VFC eligible patient, providers should bill the vaccine code with modifier SE. The SE modifier allows reimbursement for the administration of the vaccine, currently $23.28 per vaccine administered.
PATIENTS AGES 19 AND OLDER
The SE modifier should not be used when billing vaccines administered to adults. For these members, the vaccine itself is covered and reimbursed according to the provider’s contracted fee schedule
FINDING A SPECIALIST HAS NEVER BEEN EASIER!
When your patients need specialty care, finding a participating provider quickly is essential. Our online Provider Directory makes it easy to identify in-network specialists, verify participation, and locate providers based on specialty, location, and other search criteria.
WHY USE THE PROVIDER DIRECTORY?
The searchable directory is designed to help providers:
- Find participating specialists within our network.
- Search by specialty, provider name, practice location, or ZIP code.
- Identify providers who are accepting new patients.
- Access current provider contact information, including phone numbers and office addresses.
- Support timely referrals and care coordination for your patients.
HOW TO SEARCH FOR A SPECIALIST?
Access the online Provider Directory using the link below:
https://jaimedicalsystems.com/members/find-provider/
- Enter the provider’s specialty, name, city, or ZIP code.
- Review the search results to identify participating providers that meet your patient’s needs.
- Contact the specialist’s office directly to confirm appointment availability and any specific scheduling requirements.
IMPORTANT REMINDER
Maryland Medicaid and Jai Medical Systems do not reimburse a separate vaccine administration fee for adults. For members age 19 and older, reimbursement for the vaccine includes the administration of the vaccine.
CPT codes 90471, 90472, 90473, and 90474 are not reimbursed by Maryland Medicaid for adult vaccine administration services.
Proper use of the SE modifier helps ensure accurate claims payment and reduces unnecessary claim denials or adjustments. We encourage all providers who administer vaccines to review their billing practices and share this information with appropriate clinical and billing staff. If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999.
SUPPORTING QUALITY PATIENT CARE
Using the Provider Directory helps ensure that members are referred to participating network providers, reducing delays in care and helping patients access covered services more efficiently. The directory is regularly updated to provide the most current provider participation information available. We encourage all providers and office staff responsible for referrals to bookmark the directory and use it as a resource whenever specialty services are needed.
NEED ASSISTANCE?
If you have questions about provider participation or need help locating a specialist, please contact our Provider Relations Department at 1-888-JAI-1999.
QUALITY CORNER: Immunizations
With flu season approaching, providers are encouraged to remind patients that the influenza vaccine is recommended annually for everyone 6 months of age and older. In addition, adults 19 years and older should receive a Tdap vaccine at least once every 10 years, and adults 50 years and older should receive the Zoster (shingles) vaccine.
As a reminder, Jai Medical Systems members may receive covered immunizations through our pharmacy benefit at participating innetwork pharmacies or local health departments that offer vaccines. Encouraging patients to stay current on recommended vaccinations can help prevent serious illness and promote healthier outcomes.
PREVENTATIVE HIV/AIDS CARE
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 [email protected].
LANGUAGE & ACCESSIBILITY UPDATE
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 87.7% of our patient population speak English, our membership’s next most common languages include: Spanish (4.8%), French (0.2%) and Chinese (0.1%).
New this quarter: Jai Medical Systems is pleased to now offer print materials in Braille and Large Print. To request a translator or a copy of a document in Braille or Large Print, simply call our Customer Service Department at 1-888-JAI-1999.
For more information about language accessibility resources available, please visit us at www.jaimedicalsystems.com.
PARTICIPATING PROVIDER 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.
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 by phone at 1-888-JAI-1999 or visit our website at www.jaimedicalsystems.com.
ACCESS & 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 on-call 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 about access and availability standards, please reach out to our Provider Relations team directly at [email protected].
MARYLAND MEDICAID TRANSITION TO
MPRIME
The Maryland Department of Health (MDH) transition from the ePREP provider enrollment system to the Maryland Provider Registration and Information Management Enterprise (MPRIME) went live on October 13, 2026.
As part of this transition, we ask that participating providers ensure that the billing National Provider Identifier (NPI) submitted on claims exactly match the billing NPI registered in MPRIME. Providers should verify that their billing NPI information is accurate and up to date in MPRIME to avoid claim denials and payment delays. The MPRIME System can be accessed by visiting: https://www.mprime.health.maryland.gov/mprime/login.
Existing providers should log into MPRIME and associate their user accounts with all active provider records, as historical information from ePREP has been preloaded but requires account linkage to restore full administrative access. Providers must also ensure they are properly enrolled in MPRIME for claims to process appropriately.
If you have any questions, please contact our Provider Relations Department at 1-888-JAI-1999. For any questions or assistance with the MPRIME system, please contact Provider Services at the Maryland Department of Health at 410-767-5503 or 1-800-445-1159.