Provider News & Notices

At Jai Medical Systems, keeping our providers informed is our top priority.

A Message from the Director of Provider Relations

On behalf of Jai Medical Systems, we would like to wish you all a safe and happy holiday season. We appreciate your participation with our organization and would like to thank you for your continued service to our members. 2022 has been a tremendous year, to say the least, and we are pleased to announce that the Maryland Department of Health has approved our request to expand our service area to include Prince George’s County effective January 1, 2023.  We are very excited about this expansion and look forward to providing high quality healthcare benefits and services to the people of Prince George’s County. Please help us      welcome our new members. We request that participating providers become familiar with this new service area as well as our benefit offerings.  To locate a provider please utilize our online provider directory by visiting:

jaimedicalsystems.com → Providers → Find a Provider

We look forward to our continued provider network expansion in 2023, as well as working with you all in the New Year!

Special Notice regarding Dental Benefits for Adult Medicaid Recipients

Beginning January 1, 2023, Maryland Medicaid will provide coverage of dental services to adults under the Maryland Healthy Smiles Dental Program (MHSDP). As a result, all adults who have Medicaid will receive benefits that are similar to the benefits pregnant women and adults in the Rare and Expensive Case Management program receive.  The MHSDP program will provide comprehensive dental services which include diagnostic, preventative, restorative, endodontic, periodontic, and certain prosthodontic services; oral maxillofacial surgery; and sedation.

To ensure the continuation of care, we encourage all dental providers to enroll with Maryland Medicaid to participate in MHSDP.  To enroll as a Medicaid provider:

• Visit the Electronic Provider Enrollment and Revalidation Portal (ePREP) at ePREP.health.maryland.gov.
• Step-by-step enrollment instructions with tutorial videos can be found under the prospective provider section of the MHSDP website: https://health.maryland.gov/mmcp/Pages/maryland-healthy-smiles-dental-program.aspx.

If you are already enrolled in Medicaid, there is NOTHING additional you need to do.  For more information about Medicaid enrollment, call the ePREP help desk at
1-844-463-7768.  If you have questions about the adult dental coverage expansion, please call MHSDP at 1-844-275-8753.

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, health disparity outcomes among minorities, and healthcare costs in Maryland. PCPs are encouraged to perform this important service for their patients. This care is covered by Jai Medical Systems. Please refer all patients who are interested in treatment to Optum and assist them with finding a provider. Please call 1-800-888-1965 for patient referrals.

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, Optum is the Administrative Service Organization (ASO) for Maryland’s Public Behavioral Health System. Therefore, 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 by visiting https://mmcp.health.maryland.gov.

Formulary Updates / Changes

Effective 10/1/2022, the following products have been added to the formulary:

• Trelegy Ellipta (fluticasone furoate/ umeclidinium/ vilanterol) with a prior authorization requirement.
• Optichamber with a quantity limit of 1 per 180 days.
• Diclegis (doxylamine Succinate/ pyridoxine hydrochloride) with a quantity limit of 40 per 10 day supply.

Effective 11/1/2022, the following products will have a change made to their coverage status – Brand products will be removed, though the generic
counterparts will remain on the formulary:

• Flovent
• Advair
• Advair HFA
• Symbicort – For Symbicort generic version will be added to the formulary with the updated PA criteria.

Effective 11/1/2022, the following products will have a change made to their coverage status – PA criteria for Fluticasone-Salmeterol (Wixela, generic Advair), Budesonide-Formoterol (generic Symbicort), Striverdi, Serevent, and Anoro Ellipta.  For more information on the criteria changes for these products, please visit us online at jaimedicalsystems.com/pharmacy.

Updates and Reminders

Holiday Closures

Our office will be closed on January 2, 2023, in observance of the New Year, and on January 16, 2023, for Martin Luther King Jr. Day.

COVID19 Vaccines

The COVID19 Bivalent Booster is now available for individuals ages 6 months and older who have completed their primary series of the vaccine.  Please ensure that you are offering this vaccine and/or referring interested members for the vaccine if they qualify.

Eligibility Verification

Please ensure that you are verifying the eligibility of all members of Jai Medical Systems.  Eligibility verification can be completed by phone at 1-866-710-1447 or online at www.emdhealthchoice.org.

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 results in claims denials from Jai Medical Systems.

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.

Satisfaction Survey Results

The member ratings are in!  Jai Medical Systems receives member ratings through two surveys.  One is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.  This survey is designed to find out what patients think of their health plan, Jai Medical Systems. The CAHPS survey results are compared against other Managed Care Organizations throughout the State and Nation. For the 2022 Adult CAHPS, we received 174 responses and for the Pediatric CAHPS we received 189 responses. The Adult CAHPS results showed that our “Overall Health Plan Rating” is 56.80%. Our highest performing areas for adults included “How Well Doctors Communicate” at 93.90% and “Customer Service” at 93.15%. For the 2022 Pediatric
CAHPS, we received an “Overall Health Plan Rating” of 71.20% and the highest performing area was “How Well Doctors Communicate” at 96.83%. Jai Medical Systems also gives members an opportunity to provide feedback on an annual internal survey. For 2021, the overall satisfaction rate was 91% from this survey.  The 2022 survey was sent out to members recently.

Primary Care Providers, too, are given the opportunity to provide feedback.  On the State’s 2022 HealthChoice PCP Satisfaction Survey, 51 PCPs responded.  The overall satisfaction rate with Jai Medical Systems was 85.51%.  This rate is down from previous years but higher than the overall satisfaction rate for the HealthChoice aggregate.  Jai Medical Systems also gives PCPs an opportunity to provide feedback on an annual internal survey. Only 15 PCPs responded.  For 2022, the overall satisfaction rate was 69% from this survey.

Visit Us Online

There are many services available online to both our members and providers. The resources listed in the chart below are available on our provider portal or on our website at jaimedicalsystems.com. If you prefer, all of this information is also available in print and/or by telephone. You may request this information by calling the Provider Relations Department today at 1-888-JAI-1999.