At Jai Medical Systems, keeping our providers informed is our top priority.
A Message from the Director of Provider Relations: Medicaid Redeterminations
Starting in May, Maryland began the redetermination process for Medicaid eligibility for the 1.8 million people enrolled in Maryland Medicaid. The redetermination process will proceed for the next 12 months. This is the first time that this process has taken place since the start of the federal public health emergency more than 3 years ago. In order to stay covered, it is critical for people enrolled in Medicaid to complete the redetermination process when it is their turn.
Please be advised that recipients will be notified when it is their turn to complete the redetermination process. Jai Medical Systems will be reaching out to our members through a variety of means including phone, text, email, and mail.
While it is our hope and expectation that our various means of outreach will get the message out to our members regarding the redetermination process, we hope that our network providers can also assist in these outreach efforts. Please ensure that you and your
staff are alerting all Medicaid patients of the need to complete the redetermination process. For your reference, the redetermination date for Medicaid recipients is available through the Maryland Medicaid EVS system; both online and by phone. In addition, there are many resources available to assist and support providers in helping their Medicaid patients complete the redetermination process. Please see below.
For those Jai Medical Systems members who need to redetermine, there are a variety of ways that they can renew their benefits including by phone at 1-855-642-8572 or online at marylandhealthconnection.gov. For any Jai Medical Systems members with questions related to the redetermination process, or who may need assistance when it is their turn to redetermine, please have them contact our Customer Service team at 1-888-524-1999.
Director of Provider Relations
Important Resources for Redetermination
Provider Outreach Toolkit: https://health.maryland.gov/mmcp/Pages/MedicaidCheckIn-providers.aspx
Maryland Health Connection: https://www.marylandhealthconnection.gov/
Jai Medical Systems: https://jaimedicalsystems.com/members/become-member/
CAHPS and Member Satisfaction Survey
Annually, Jai Medical Systems receives results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey and an internal Member Satisfaction Survey. The CAHPS® Survey is a national survey that allows our members to rate our services and then gives us the opportunity to compare our results against other MCOs in Maryland. In addition, we annually send our members a Satisfaction Survey to assess the quality, availability, and accessibility of care within our network.
Based on the results we received from the 2022 CAHPS® surveys and our Member Satisfaction Survey, we wanted to share with network providers two areas that we believe member satisfaction could be improved:
• Member education on how to schedule an appointment with a specialist, and
• Ensuring members receive a copy of all specialist referrals.
When educating members on scheduling appointments with specialists, there are few key points to remember. First, explain the importance and benefits of the Specialist referral, ensuring that members understand why it is necessary. Please note, it is important to provide a copy of the referral to the member, fax a copy to the Specialist and fax a copy of the referral to the Referral Fax line at 1-866-381-7200. Next, provide clear contact information for the Specialist’s Office, including phone numbers. Please emphasize the importance of prompt scheduling to avoid delays in receiving care. Lastly, encourage open communication and offer support if members encounter difficulties or have questions about scheduling an appointment or the referral process. By following these steps, you can empower members to navigate the referral and appointment process effectively and ensure they receive the specialized care they need while improving overall satisfaction.
HPV: Don’t Wait – Vaccinate!
As we emerge from the COVID-19 pandemic, it is clear that certain care, such as important immunizations, have dropped in utilization. One vaccine with a drop in utilization in Maryland is the Human Papillomavirus (HPV) vaccine series. Please ensure that you are discussing the importance of the HPV vaccine with all eligibles populations, including pre-teens and adults up to the age of 45. For more resources on HPV vaccination uptake, please visit https://health.maryland.gov/phpa/cancer/Pages/HPV.aspx. For outreach assistance to eligible populations in need of the HPV vaccine, please contact our Provider Relations Department and we will connect you with resources.
Jai Medical Systems made changes to its formulary effective July 1, 2023. For a complete summary of our formulary changes, please visit our website at www.jaimedicalsystems.com/providers/pharmacy. This page also contains important information regarding prior authorization forms, and other criteria.
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.