AETNA BETTER HEALTH OF NEBRASKA 2015 AAHAM CONFERENCE

AETNA BETTER HEALTH® OF NEBRASKA 2015 AAHAM CONFERENCE

Welcome and Introductions Provider Relations • Jeff Nelson- Provider Relations AETNA BETTER HEALTH Aetna Inc. 2

Our Core Values Behave ethically and act with integrity Be accountable and honor commitments Be passionate about the people we serve Listen to customers, prioritize and deliver value Communicate with candor Anticipate the future and make a difference Coach, mentor and continuously learn Be courageous, try new things and innovate AETNA BETTER HEALTH Set high expectations, be decisive and execute Trust and respect each other Be open to all voices and ideas Be collaborative, caring and optimistic Aetna Inc. 3

Our Members – The Center of What We Do Quality Management Provider Relations & Provider Network Member Services & Member Advocates Operations & Enrollment AETNA BETTER HEALTH Appeals & Grievances Medical Management Member Collaborative Services Aetna Inc. 4

Provider Relations • Aetna Better Health of Nebraska has dedicated Provider Relations staff • Provider Relations staff will visit provider offices regularly throughout the year to ensure Aetna is meeting their needs and addressing concerns • Provider Relations will: ─ Provide education to provider offices on a variety of topics ─ Provide support on Medicaid policies and procedures ─ Provide contract clarification ─ Assist with demographic changes, terminations, and initiation of credentialing ─ Monitor compliance with applicable State and Federal agencies ─ Conduct annual Provider Satisfaction Survey ─ Conduct member complaint investigation ─ Maintain the provider directory ─ Be a point of contact for provider concerns Provider Relations can be reached at (888) 784 -2693 AETNA BETTER HEALTH Aetna Inc. 5

Claims Inquiry/Claims Research (CICR) • Claims Inquiry/Claims Research (CICR) will: ─ Be the first point of contact for providers with any claims questions ─ Assist with claims questions, inquiries and reconsiderations ─ Review claims or remittance advice Claims Inquiry/Claims Research can be reached at (888) 784 -2693 AETNA BETTER HEALTH Aetna Inc. 6

Member Services • Member Services will: ─ Provide information on eligibility and benefits ─ Assist providers with non-compliant members and/or discharges ─ Assist members with available programs and resources ─ Assist member in finding providers ─ Assist members in filing grievances or appeals Member Services can be reached at (888) 784 -2693 AETNA BETTER HEALTH Aetna Inc. 7

Member ID Cards • New ID cards were issued on 8/25/14. All Coventry. Cares members should have new Aetna Better Health of Nebraska ID cards. ─ If the member does not have his/her new ID card, you can obtain enrollment verification at http: //aetnabetterhealth-nebraska. aetna. com. • Aetna Better Health will use the existing Medicaid ID number issued by the State of Nebraska AETNA BETTER HEALTH Aetna Inc. 8

Member Eligibility • Aetna Better Health of Nebraska member eligibility can be verified through ─ Provider portal (http: //aetnabetterhealth-nebraska. aetna. com), or ─ Member Services (888) 784 -2693 ─ NMES Line (402) 471 -9580 or (800) 642 -6092 AETNA BETTER HEALTH Aetna Inc. 9

Prior Authorization • Please review the new authorization requirements that went into effect August 25, 2014 • Request new prior authorizations ─ Online: Care. Web. QI , access through the provider portal ─ Phone: (888) 784 -2693 ─ Fax: (844) 213 -9659 AETNA BETTER HEALTH Aetna Inc. 10

Claims Submission • NEW Aetna Better Health of Nebraska EDI payer ID: 42130 • NEW claims mailing address: Aetna Better Health of Nebraska P. O. Box 63188 Phoenix, AZ 85082 -3188 • All claims should be submitted on the most current claim forms AETNA BETTER HEALTH Aetna Inc. 11

Claim Timely Filing • Timely filing for Aetna Better Health of Nebraska for initial claims submission follows your Coventry Health Care of Nebraska HMO contract • Providers will have 180 days from the date of an initial claim denial to submit corrected claims or requested information AETNA BETTER HEALTH Aetna Inc. 12

Provider Website • http: //aetnabetterhealth. com/Nebraska • Our provider website contains resources to assist provider interactions with Aetna Better Health of Nebraska: ─ View and download our provider manual, communications and newsletters ─ Searchable provider directory ─ Reconsideration and appeal forms ─ Clinical practice guidelines ─ Member materials ─ Fraud & abuse information and reporting ─ Gateway to our secure provider web portal ─ Information on resubmission and provider appeals ─ Review the member and provider handbooks AETNA BETTER HEALTH Aetna Inc. 13

Provider Portal • Please visit: http: //aetnabetterhealth-nebraska. aetna. com • Providers will be able to ─ Search member eligibility and verify enrollment ─ Search and initiate authorizations (Care. Web. QI) ─ Search claims status ─ View claim detail, explanation of benefits and remittance advice ─ View provider lists and panel roster ─ Contact the health plan via secure messaging AETNA BETTER HEALTH Aetna Inc. 14

Provider Portal • http: //aetnabetterhealth-nebraska. aetna. com • All providers must register for the provider web portal prior ─ Submit web portal e-registration forms online ─ See our provider web portal navigation guide to learn more about the provider web portal available on the provider website • Each TIN will have one account, with a primary representative ─ The primary representative can add authorized representatives within their office to their account • Contact Provider Relations for help registering AETNA BETTER HEALTH Aetna Inc. 15

Electronic Tools • Electronic claims submission ─ Payor ID 42130 ─ Less paperwork, less wasted time, and a more efficient office ─ Lower claims rejection rates ─ Faster claim delivery than by traditional mail – clean claims mean less money wasted for reprocessing ─ Faster claim payment to your office ─ Ability to easily identify and resubmit claims with missing or invalid data AETNA BETTER HEALTH Aetna Inc. 16

Electronic Tools • Electronic funds transfer (EFT) - Electronic funds transfer (EFT) will be our standard payment method for provider reimbursement as of August 1, 2014 • Electronic remittance advice (ERA - 835 files) - RAs will no longer be mailed to your office effective August 1, 2014, or 30 days after you sign up for EFT • Please work with your clearinghouse to ensure you can receive ERA & have the correct file paths • Enroll in EFT/ERA electronically by visiting our Secure Web Portal http: //aetnabetterhealth-nebraska. aetna. com • Paper forms can be found on the provider website Sign up for EFT/ERA Please contact Provider Relations at (888) 784 -2693 or e-mail MBU-NE-Finance-EFT@aetna. com with questions or to check EFT enrollment status. AETNA BETTER HEALTH Aetna Inc. 17

Claim Resubmissions & Reconsiderations • Resubmission claims may be sent electronically • Label all corrected claims as “Corrected Claim” on the claim form ─ Send all claim lines again, not just the line being corrected • Send paper reconsideration claims with attached documentation to: Aetna Better Health of Nebraska Attn: Claims Resubmission/Reconsideration P. O. Box 63188 Phoenix, AZ 85082 -3188 • Please use the Reconsideration Form found on the provider website http: //aetnabetterhealth. com/Nebraska AETNA BETTER HEALTH Aetna Inc. 18

Appeals • Our provider appeals process is utilized to dispute an adverse action of a denial, reduction or termination of a requested service ─ Post-service appeals are initiated in writing by mail ─ The appeal must specifically state the factual and legal basis for the appeal and the relief requested ─ Documents to support the appeal should be provided, such as a copy of the claim, remittance advice, medical review sheet, medical records, correspondence, etc. ─ Appeals on issues other than claims denials, such as authorization denials, must be filed no later than 90 days after the date of the adverse action • Appeals are reviewed within 90 days ─ Once you receive a notice of resolution, this will conclude your appeal process AETNA BETTER HEALTH Aetna Inc. 19

Grievances • A grievance is any written or verbal expression of dissatisfaction over a matter other than an action by a member or provider authorized in writing to act on the member's behalf. • Examples: Quality of care, quality of service, provider behavior, office environment, potential fraud and abuse • Grievance process ─ Acknowledged within 5 calendar days ─ Investigated by provider relations, quality management and/or by the State’s Ombudsman ─ May involve office site visits and assessments ─ Egregious grievances may warrant peer review and/or trigger an off-cycle credentialing review ─ Resolution and response to the member within 90 calendar days AETNA BETTER HEALTH Aetna Inc. 20

Quality Programs • EPSDT ─ Monthly post card mailing & reminder calls • Well Woman ─ Monthly birthday card mailing • Case Management ─ Pediatric, adult, perinatal • Disease Management ─ Diabetes, congestive heart failure, asthma, COPD • Member Advocates • Prevention and Wellness • Patient Centered Medical Homes • Readmission Prevention • ED utilization, inpatient admission & readmission reports • HEDIS AETNA BETTER HEALTH Aetna Inc. 21

Provider Credentialing • The Aetna Better Health of Nebraska credentialing process will be monitored by a Aetna Better Health of Nebraska dedicated Credentialing Coordinator • Contact your Provider Relations representative to initiate credentialing of a new provider ─ Please remember to contact the Coventry Commercial plan ─ Aetna utilizes the CAQH online, universal application • Aetna Better Health of Nebraska will not be able to assign retroactive effective dates for new providers AETNA BETTER HEALTH Aetna Inc. 22

Provider Manual • The provider manual is a resource for policies and procedures for Aetna Better Health of Nebraska ─ Access it online at: http: //aetnabetterhealth. com/Nebraska • Please review this manual for additional information about Aetna Better Health of Nebraska including: ─ Contacts ─ Provider rights and responsibilities ─ Credentialing ─ Member eligibility and enrollment ─ Billing and claims ─ Reconsiderations, appeals and grievances AETNA BETTER HEALTH Aetna Inc. 23

NDC Validation • The State of Nebraska determines which codes are required to be billed with NDC information. • If a CPT/HCPCS code which requires an NDC is billed, but no NDC information is present, the claim line will be denied. • NDC information submitted on a claim is validated against a standard NDC dataset (Medi. Span is the source of this dataset) to validate that the NDC number, unit of measure, and quantity is valid. • Deactivated or terminated NDCs cannot be accepted. • The approved unit of measure (F 2, GR, ML, UN, or ME) must be billed. AETNA BETTER HEALTH Aetna Inc. 24

NDC Validation (Continued) If a NDC is submitted when not required by the State of Nebraska for drug rebate submission, it will still be validated for accuracy. AETNA BETTER HEALTH Aetna Inc. 25

NDC Continued Effective December 22, 2014, Aetna Better Health will begin reviewing NDC dosage information. When an NDC is required, a dosage is required to be sent with the NDC information. If the dosage is over or under the standard dosage limits, medical records will be required to process the claim. If records are not sent, the claim line will be denied. If a claim is denied, please resubmit the claim with medical records and a reconsideration form AETNA BETTER HEALTH Aetna Inc.

EPSDT Modifier and Referral Indicator Codes • For Early and Periodic Screening, Diagnostic, and Treatment (EPSDT or Health Check) services, it is essential to bill these codes with an EP modifier. EPSDT services not billed with the EP modifier will result in a claim line denial. • In addition, one of the following referral indicator codes must be included on claims using CPT well-child preventive codes 99381 -99395 with the required EP modifier. (Electronic 837 P or CMS 1500 box 24 H). AETNA BETTER HEALTH Aetna Inc. 27

EPSDT Modifier and Referral Indicator Codes (Continued) AV - Patient refused referral S 2 - Patient is currently under treatment for diagnostic or corrective health problem NU - No referral given ST - Referral to another provider for diagnostic or corrective treatment AETNA BETTER HEALTH Aetna Inc. 28

VFC (Vaccines for Children) VFCs are not required to be billed with NDC information. The following codes are excluded from NDC validation: 90471, 90472, 90473, 90474, 90633, 90649, 90658, 90707, 90710, 90716, 90734, 90664, 90666, 90667, 90668, 90648, 90669, 90681, 90713, 90721, 90748, 90650, 90718, 90685, 90660, 90686, 90655, 90656, 90657, 90670, 90714, 90715, 90744, 90746, 90647, 90672, 90680, 90696, 90698, 90700, 90723 Additional information for UB Billing NDC information is required for specific revenue codes (0250, 0251, 0252, 0254, 0631, 0632, 0634, 0636, 0637) and bill type combinations (130 -149, 710 -749, or 830 -839). AETNA BETTER HEALTH Aetna Inc.

Web Portal Demo Aetna Better Health of Nebraska is hosting webinar sessions to assist providers with functions of the secure provider web portal: Any provider who wishes to participate will need to register. Please email us with your name, email address, date & time preferred. All registered providers will receive an email invitation to the webinar with further instructions the day prior to the scheduled webinar. Please check provider news for dates and times. AETNA BETTER HEALTH Aetna Inc. 30

Thank you Please sign up to receive Aetna Better Health of Nebraska news and updates at http: //tinyurl. com/mnnu 5 cn. AETNA BETTER HEALTH Aetna Inc.