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At Jai Medical Systems, keeping our providers informed is our top priority.
Alert: Provider Notice regarding Change Healthcare Cybersecurity Incident
Due to the ongoing cybersecurity incident with Change Healthcare/Optum, our claims clearinghouse, SSI Group, has temporarily disabled direct claim interfaces with Change Healthcare/Optum Clearinghouse as a precautionary measure. To learn more about alternative ways in which you can submit claims to Jai Medical Systems, please review our Provider Notice regarding the Change Healthcare/Optum Cybersecurity Incident and Claims Submissions.
A Message from the Director of Provider Relations
Dear Provider,
Jai Medical Systems is closely following the cybersecurity incident that has impacted Change Healthcare/Optum. Further, we are aware of the concerns the associated disruptions have caused for our provider community. We share these concerns. However, Jai Medical Systems wants to assure the provider community that our systems are ready and available to process claims as we were not directly impacted by this cybersecurity incident. As a result, we want to make sure providers are aware of the variety of ways in
which they can submit their claims to Jai Medical Systems.
Electronic Claims Submissions
Jai Medical Systems utilizes SSI Group as our clearinghouse for direct electronic claims submissions. To sign-up and submit electronic claims directly to Jai Medical Systems through SSI Group, please follow the steps outlined below:
- Visit: https://products3.ssigroup.com/ProviderRegistration/register
- Click “Register”
- Follow the step-by-step instructions to complete the registration process. Payor ID: JAI01. If you have any technical problems, please contact helpdesk@claimsnet.com.
Signing up with SSI Group for electronic claims submission to Jai Medical Systems will also provide you with an Electronic Remittance Advice (ERA) (835). No separate 835 enrollment is required. The 835 will automatically generate when Jai Medical Systems receives EDI claims. Alternatively, you may use a clearinghouse other than Change Healthcare/Optum to pass electronic claims to Jai Medical Systems as an intermediary as long as they are capable of submitting electronic claims to SSI Group.
Paper Claims Submissions
Jai Medical Systems also accepts paper claims. Paper Claims may be mailed directly to our organization at:
Jai Medical Systems
Attn: Claims Department
301 International Circle
Hunt Valley, MD 21030
If you have any questions regarding this matter, please feel free to contact the Provider Relations Department at 1-888-JAI-1999.
Sincerely,
Hennrietta Dodoo
Director of Provider Relations
HIV/AIDS Education
To ensure that Primary Care Providers (PCPs) treating our members with HIV/AIDS stay informed about important 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 MidAtlantic AIDS Education and Training Center (AETC), the Baltimore City Health Department, and Simply Speaking HIV Management. For more information or for assistance with signing up for an HIV/AIDS training course, please contact our Provider Relations Department at providerrelations@jaimedical.com.
New Prescription Drug Co-Payment Requirement
Beginning on May 1, 2024, all Maryland HealthChoice Managed Care Organizations will be required to charge a Pharmacy Prescription Co-Payment.
In accordance with directives from the Maryland Department of Health regarding pharmacy co-payments for individuals in the Maryland HealthChoice Program, and in order to comply with the Mental Health Parity and Addiction Equity Act, beginning on May 1, 2024, Jai Medical Systems will be required to charge the following co-payments for prescription drugs:
- $1.00 co-payment on new and refilled
preferred brand name and generic drugs,
and HIV/AIDS drugs. - $3.00 co-payment on new and refilled
non-preferred brand name drugs.
Please note, in accordance with applicable federal and state statutory requirements, individuals under the age of 21, pregnant women, and Native Americans are not required to pay co-payments. Co-payments also do not apply to family planning drugs.
Referrals and Prior Authorizations
In our managed care model, Primary Care Providers (PCPs) are responsible for overseeing the health care and care plan for our members. PCPs are considered the gatekeepers to care, which is why services requiring a referral or prior authorization must be coordinated with a member’s PCP.
Referrals
Jai Medical Systems accepts the Jai Medical Systems referral form and the Maryland Uniform Consultation Referral Form . To ensure payment of claims, please fax all completed and legible referrals to 1-866-381-7200 prior to submitting claims.
Prior Authorizations
Jai Medical Systems requires prior authorization (PA) for specific services and procedures. A PA request form must be completed by the member’s Primary Care Provider and submitted to Utilization Management (UM) for review and approval. Failure to obtain a PA form for services requiring prior authorization may result in claims denial. For the most up-to-date information regarding services requiring a PA or our PA process, please visit www.jaimedicalsystems.com or contact our UM Department at 410-433-5600.
Network Expansion
In order to accommodate the growing needs of our members, Jai Medical Systems is expanding its provider network throughout the State of Maryland. We are now accepting applications for network consideration from primary care providers, specialty care providers, hospitals and specialty care networks, and ancillary care providers.