Provider Billing Guidelines (UB-04 & CMS1500)
To ensure timely and accurate claims processing, please follow these simple guidelines regarding billing practices, referrals, and authorizations.
Jai Medical Systems Managed Care Organization, Inc. follows the Maryland Medicaid billing guidelines for claims billing. You may find a copy of the most recent Maryland Medicaid Billing Instructions at https://mmcp.health.maryland.gov/Pages/Provider-Information.aspx.
Claim Submission Requirements
When submitting the following type of claim, please ensure that you have appropriately followed the Maryland Medicaid Billing Instructions. Please also ensure that the following items are included, as applicable:
Paper Claims
- A valid, complete, legibly written referral, outpatient authorization, or inpatient authorization, where applicable.
- The valid authorization number should be included in the appropriate field:
- CMS1500: Block 23
- UB-04: Block 63
- Authorization formats include: HR-prefix (JMS Referral Forms), U-prefix (Maryland Uniform Consultation Referral), OA-prefix (Outpatient authorizations), and IA (Inpatient authorizations)
- A copy of the member’s primary insurance Explanation of Payment (EOP) or Remittance advice, if applicable.
Electronic Claims
- Fax one copy of a valid, complete, legibly written referral, outpatient authorization, or inpatient authorization, where applicable, to Jai Medical Systems’ Claims Processing Center prior to claim submission. Fax Number: 1-866-381-7200
- Enter the valid authorization number in the Authorization field specific to the billing software program that you utilize
- Include any information regarding the member’s primary insurance and any payment made from the third-party payor (TPP), if applicable.
Electronic Claims Submission
Jai Medical Systems strongly encourages all participating providers to submit claims electronically.
There are many benefits to submitting claims electronically to Jai Medical Systems including:
- Faster claims payment
- Faster claim adjudication
- Elimination of postage costs
- Receipt of Electronic Remittance Advice (ERA) (835)
Participating providers can begin to submit claims electronically by registering here.
Electronic Claims Submission Registration
Registration is easy and free for participating providers. To complete the simple registration process, please follow these steps:
- Visit the SSI Group website
- Follow the step-by-step instructions to complete the registration process
- Once registered, you may open a ticket with ClaimsNet/SSI Group, if needed.
For technical support with registration, please contact ClaimsNet/SSI Group at 1-800-820-4774.
Important Notice: Electronic Claims Submissions (October 2025)
Jai Medical Systems has been made aware of an issue with our clearinghouse, SSI Group, that may have impacted some EDI claims submissions. If you submitted electronic claims to Jai Medical Systems on or after October 6, 2025, please closely monitor all claims submissions to ensure that they have been appropriately received by our organization.
Paper Claims Submission
Jai Medical Systems encourages all participating providers to submit claims electronically. However, paper claims may be mailed to:
Jai Medical Systems
Attn: Claims Department
301 International Circle
Hunt Valley, MD 21030
For an initial submission of an ER claim with medical records, please mail to:
Jai Medical Systems
Attn: ER Medical Record Claims
PO Box 747
Hunt Valley, MD 21030
Claims Appeals
Jai Medical Systems encourages providers to use our Claims Payment Appeal Submission Form when submitting a claim being appealed. Please submit a separate form for each claim number being appealed.
Appeal Timeframes
- First Level Appeal: Providers have one hundred and eighty (180) calendar days to submit a first level appeal from the date of Explanation of Payment (EOP) for the claim in question.
- Second Level Appeal: Providers have thirty (30) calendar days to submit a second level appeal from the date of the first level appeal’s determination letter.
- Third Level Appeal: Providers have eighty-five (85) business days to submit a third level appeal from the date that the first level appeal was received. If a provider is submitting a third level medical record review appeal, they must attach the second level appeal determination letter and all applicable medical records.
Required Appeal Documentation
All appeals submitted to Jai Medical Systems must include the following information:
- Cover letter explaining the reason for the appeal including:
- Member name and date of birth
- Claim number and date(s) of service being appealed
- Contact phone number, and
- Mailing address for where the determination letter should be mailed
- Copy of the claim being appealed and/or copy of the EOP; and
- Supporting relevant documentation.
Please note, any appeals received that do not meet the requirements outlined above may be returned to the submitting party and may not be reviewed.
Appeal Submission Mailing Addresses
All appeals for Medical Record Review should be addressed and mailed to:
Jai Medical Systems
Attn: Medical Record Review
P.O. Box 1650
Hunt Valley, MD 21030
All appeals for Out of State Claims Review should be addressed and mailed to:
Jai Medical Systems
Attn: OUT OF STATE CLAIMS
P.O. Box 39659
Baltimore, MD 21212
All other appeals should be addressed and mailed to:
Jai Medical Systems
Attn: Appeals Department
301 International Circle
Hunt Valley, MD 21030
Special Billing Notices
Observation Services
Please be advised that Jai Medical Systems follows the Maryland Medicaid Fee-for-Service Observation Billing Guidelines. For more information regarding these guidelines, please refer to the following Maryland Medicaid Transmittals:
NCCI Edits
In accordance with CMS regulations and requirements, Jai Medical Systems applies National Correct Coding Initiative edits when processing claims.
Maryland Medicaid Transition from ePREP to MPRIME – Coming Soon
Maryland Medicaid will be transitioning from ePREP, Maryland Medicaid’s online Electronic Provider Revalidation and Enrollment Portal, to the Maryland Provider Registration and Information Management Enterprise (MPRIME) portal in October 2026. For more information about this transition, please review the following materials from the Maryland Department of Health:
- MPRIME Transition: Provider Enrollment Portal Transition
- MPRIME FAQs: Provider Enrollment Portal Transition – Frequently Asked Questions
NPI Location Specific Changes and Billing Information Updates
Jai Medical Systems understands that over the next year, there are many changes coming to Maryland Medicaid with regards to requirements for location specific NPIs.
We want to remind all providers of their responsibility to keep Jai Medical Systems informed of any changes with regard to their billing practices and billing information such as tax identification number(s), billing NPI and address, as well as any NPI specific location information.
Please be sure to send any changes regarding your practice’s billing information to our attention as soon as possible to ensure that there are no delays in the processing of your claims. We will acknowledge receipt of your requested billing changes within 30 calendar days. Once we have confirmed that our system has been updated, your practice will then be able to bill utilizing the new information.
For general information about the NPI Uncollapsing from the Maryland Department of Health, please review their FAQs here. You may also review Jai Medical Systems’ FAQs here.
Fee Schedule Updates and Reimbursement Corrections
Jai Medical Systems predicates its Fee Schedule on the Maryland Medicaid Fee-For-Service fee schedule. The Maryland Department of Health (the Department) updates its Medicaid Fee-For-Service fee schedules on a periodic basis. For the most up-to-date Maryland Medicaid fee schedule information, please visit the following link to the Department’s Medicaid Fee Schedule page: https://health.maryland.gov/mmcp/Pages/Provider-Information.aspx.
Please be aware that the Department does not always provide MCOs advance notice of fee schedule changes, nor are fee schedule updates made on a scheduled basis by the Department. Due to the nature of these fee schedule updates, please be advised that Jai Medical Systems uses its best efforts to implement any modifications to the Medicaid Fee-For-Service fee schedule as of the effective date of the rate change established and published by the Department on its website.
In the event that Jai Medical Systems receives notification from the Department about a retrospective Medicaid Fee-For-Service fee schedule update, Jai Medical Systems will retrospectively adjust payments to providers for previously submitted claims for qualifying dates of service for covered services provided to members back to the effective date of the rate change or a maximum of ninety (90) calendar days prior to our receipt of the rate change, whichever is shorter.
If you discover that the Department has updated a Medicaid Fee-For-Service fee schedule, and Jai Medical Systems has incorrectly paid a claim at the prior or incorrect Medicaid Fee Schedule rate, it is important to notify Jai Medical Systems promptly. In these instances, we recommend providers submit an appeal. In addition, if you believe Jai Medical Systems has made a fee schedule or provider reimbursement error, Jai Medical Systems will adjust payments to providers for previously submitted claims for qualifying dates of service for covered services provided to members for a maximum of ninety (90) calendar days from date that Jai Medical Systems is notified of the fee schedule or reimbursement error.
If you have any questions regarding our current fee schedule, please feel free to contact our Provider Relations Department at 1-888-JAI-1999 or via email at providerrelations@jaimedical.com.