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At Jai Medical Systems, keeping our providers informed is our top priority.
A Message from the Director of Provider
Dear Provider,
We need your help! Currently, the Maryland Department of Health is conducting a Network Adequacy Validation (NAV) analysis of our network. This analysis is conducted through an independent telephone survey in which a sample of the providers listed in our Provider Directory will be called to validate that the information listed in our Provider Directory for you or your practice is correct. Your participation in this survey is important and will help us improve the information that we share with both providers and members.
How Can I Help?
- Please ensure that your staff, especially frontline staff, are aware of your participation status with Jai Medical Systems.
- Please ensure that your directory listing us up-to-date. To verify your current listing, please feel free to visit us online at www.jaimedicalsystems.com. You can also submit changes to your provider directory listing online, or by contacting us at providerrelations@jaimedical.com.
We appreciate your assistance and cooperation with this important matter.
Sincerely,
Hennrietta Dodoo
Director of Provider Relations
Population Health Improvement Program
On an annual basis, the State of Maryland Healthcare Program selects specific HEDIS® and encounter based quality indicators for its Population Health Improvement Program (PHIP). PHIP is one of the methods used by the HealthChoice program to gauge the performance of participating Managed Care Organizations.
We would like to ensure that all of our participating providers are aware of the CY 2024 PHIP measures selected by the State of Maryland, which we have outlined below. On a periodic basis, we will be sending you more specific information concerning these measures, including strategies for success. To learn more about Jai Medical Systems quality initiatives, please visit
www.jaimedicalsystems.com/providers/quality-assurance/.
Prenatal and Postpartum Care
Timely prenatal care is essential, and this measure is to ensure that all pregnant women have an outpatient visit within their first trimester (before week 13). Intake assessment visits with Registered Nurses do not qualify as timely prenatal care per HEDIS standards. For postpartum care, women should have a postpartum-related visit within twelve weeks after delivery.
Lead Tests
Pediatric patients should be tested for lead before or soon after their first birthday and again before they turn 2 years of age.
SSI Annual Visit for Adults and Children
Patients with a disability should receive outpatient care annually.
Asthma Medication Ratio
Patients with Asthma should fill their controller more often than their rescue inhaler.
Risk of Continued Opioid Use
Patients should not stay on an opioid for more than 15 days if they are opioid naive.
HbA1c for Diabetics
Patients with diabetes have a controlled HbA1c of <8
Important Update: New Pharmacy Prior Authorization Form
Please be advised that we recently updated our Pharmacy Authorization (PA) form. Effective immediately, providers must submit requests using our new Pharmacy PA form. The new form is available for download on website at https://jaimedicalsystems.com/providers/pharmacy/.
Please note, requests submitted using older versions of the Pharmacy PA form will no longer be accepted. Please ensure you are using the most up-to-date form to avoid any delays in the processing of Pharmacy PA requests.
Reminder: Prescription Drug Co-Payment Requirement
As a reminder, beginning on May 1, 2024, all Maryland HealthChoice Managed Care Organizations were required to charge a pharmacy prescription co-pay.
In accordance with directives from the Maryland Department of Health regarding the imposition of pharmacy co-payments for individuals in the Maryland HealthChoice Program and 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 pharmacy prescription co-payments:
- $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.
Medicaid Redetermination
While the public health emergency unwinding period is over, Medicaid recipients must continue to renew their eligibility on a annual basis. Please ensure that any patients who have lost their eligibility or those who may have an upcoming redetermination date are notified of their need to renew their benefits.
How can my patient renew their Medicaid eligibility?
There are many ways an individual can renew their Medicaid benefits, including:
- Online at www.marylandhealthconnection.gov
- By phone at 1-855-642-8572
- By requesting a paper application by calling1-855-642-8572, or
- Through their local Department of Social Services, if applicable.
We appreciate your assistance with educating and encouraging our members to renew their benefits to maintain their healthcare coverage. For any questions regarding this matter, please contact our Customer Service team at 1-888-JAI1999.
Visit Us Online
Jai Medical Systems offers many services to our providers through our website and provider portal, which we have outlined below. This information is also available in print or by telephone. You may request this information by calling us at 1-888-524-1999.
