Quality Assurance

On an annual basis, the Department of Health and Mental Hygiene evaluates Managed Care Organization quality. For CY 2010, Jai Medical Systems became the first Managed Care Organization in the history of the Maryland Medicaid program to achieve a perfect score by exceeding the incentive targets in all 10 Value Based Purchasing Initiative measures. Jai Medical Systems repeated this feat achieving 10 out of 10 Incentives in the Value Based Purchasing Initiative measures for CY 2012. Jai Medical Systems’ performance distinguishes the company not only in Maryland, but ranks the company among the best in the nation. In fact, Jai Medical Systems is the highest-rated Medicaid Health Plan in Maryland and one of the highest-rated Medicaid health plans in the nation with a rating of 4.5 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2015-2016*. In addition, Jai Medical Systems has received a rating of Excellent (the highest rating possible) for 2015/2016 from NCQA for our overall quality.

For more information on Jai Medical Systems’ quality initiatives, please check out our Quality Reports.

HEDIS Criteria

Access to HEDIS Criteria is available for our participating providers. Please contact our Quality Assurance Department if you require assistance in accessing our HEDIS Criteria.

*National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s Web site (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

Provider Incentive Program

In an effort to support our network providers and their continued efforts with our quality metrics, we are pleased to share the launch of the Jai Medical Systems’ Provider Incentive Program (PIP).  Our PIP program is designed to reward our network providers with assisting us in meeting our quality goals and objectives by providing immediate financial rewards when appropriate CPT II codes are submitted with medical claims, as appropriate.  Please see below for more information regarding the current HEDIS measures under the PIP program:

Please check back as we will be updating this page with additional HEDIS measures that will be a part of the PIP program.