Provider News & Notices

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

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

Alert: Provider Notice

 

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. If you submit claims to Jai Medical Systems via the ChangeHealthcare/Optum clearinghouse, please work with ChangeHealthcare/Optum to ensure they can provide an alternate clearinghouse pathway to get your claims to us via SSI Group for processing. Alternatively, you are welcome to submit claims directly to Jai Medical Systems through SSI Group. You can sign up to submit claims directly to Jai Medical Systems through SSI Group at the following website: https://products3.ssigroup.com/ProviderRegistration/register 

 


A Message from the Director of Provider Relations

Dear Provider,

On behalf of Jai Medical Systems, I would like to wish you a Merry Christmas and a happy, healthy New Year!  Thank you for your service and dedication to our members throughout 2023.  We look forward to working with each and every one of you as we face the challenges that lie ahead in 2024.  These challenges include helping our members maintain their eligibility as the Medicaid redetermination process continues, improving the health and well-being of our members while we improve our performance on quality measures such as HEDIS, and expanding our network as we improve provider communication and integration.  We sincerely appreciate your assistance as we face these challenges and look forward to working with you in 2024.  Please note, this will be the last issue of our provider newsletter that we distribute on paper.  Future publications of the Jai Medical Systems provider newsletter will be distributed via email while remaining available online as always.

Season’s Greetings,

Hennrietta Dodoo
Director of Provider Relations


Network Adequacy Validation (NAV)

On an annual basis, the Maryland Department of Health conducts a Network Adequacy Validation (NAV) analysis of our network.  This NAV includes an independent telephone survey in which a sample of the providers listed in our Provider Directory are called to validate the information listed in our Provider Directory for their practice.  The NAV report for this past year indicates that there are areas that need improvement such as whether or not a provider is participating with Jai Medical Systems and whether or not a provider is accepting new patients.

Please ensure that all of your staff are aware of your participation status with Jai Medical Systems.  In the next few weeks, all primary care providers in our network will be receiving a special mailer requesting them to validate the information we have listed in our Provider Directory for their practice.  Please review the directory listing in this mailer and contact us with any changes related to the directory listing.  In addition, this mailer will include a Jai Medical Systems participating provider sticker.  Please ensure that this sticker is prominently displayed at your practice location.  If you require additional stickers, please contact us.  Primary Care Providers that need to make updates to their demographic and directory information may do so in two ways:


     Provider Toolkit for Redetermination Efforts

In an effort to reduce any lapse in coverage, we are requesting that our network providers encourage and share messaging with Medicaid recipients about the importance of completing their redetermination application.  The Maryland Department of Health, in collaboration with MCOs, has created a Provider Toolkit to assist with redetermination efforts for the Medicaid population.  The outreach toolkit contains important messaging and flyers that can be shared with your patients to educate them about the redetermination process.  This toolkit can be found online at https://health.maryland.gov/mmcp/Pages/MedicaidCheckIn-Providers.aspxPlease take a few moments to print out some of the available flyers.


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, while reducing 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 substance abuse and/or behavioral treatment to Optum and assist them with finding a provider.  Please call 1-800-888-1965 for behavioral health patient referrals and assistance.

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 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.


Updates and Reminders

Visit Us Online: Jai Medical Systems offers many online services to our providers through our website and provider portal. To view a list of these services, please visit us at: www.jaimedicalsystems.com. If you prefer, this information is also available in print or by telephone. You may request this information by calling us at 1-888-524-1999.

Depression Screening for: As a reminder, as of January 1, 2023, the Maryland Department of Health has revalidated the 2016 requirement of an annual screening for Depression beginning at the age of 11 utilizing the PHQ-9, modified for teens. This tool can be found in the Maryland Healthy Kids Provider Manual. If you have any questions, please contact the EPSDT/Healthy Kids program at 410-767-1836.

24 Hour Nurse Advice Line: Jai Medical Systems offers all of our members access to a 24-Hour Nurse Advice Line. Our 24-Hour Nurse Advice Line can assist members with nonemergent medical advice and resource guidance. Members can access our Nurse Advice Line and speak with a nurse today by calling 1-833-359-0170.

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.

Online Health Education

Health Education materials are available to Jai Medical Systems members online.  Members can access these materials by registering on the member portal located at www.jaimedicalsystems.com.