DMGMA Payor Workshop 2012 Agenda ICD9 to ICD10

DMGMA Payor Workshop 2012

Agenda • • ICD-9 to ICD-10 Update Direct. Provider. com Appeals Process Provider Satisfaction Survey Credentialing Authorizations Provider Relations Staff

ICD-9 to ICD-10 Update • • ICD 10 is to be effective October 1, 2013 HIPAA Compliant 5010 standards are necessary to accept ICD codes. Coventry is on target for October 1 , 2013. Provider Inquires regarding 5010 or ICD 10 readiness can be sent to: 5010 ICD 10 Inq@cvty. com. Government announced the possibility of postponing the October 1, 2013 effective date. No change for Coventry in preparation. Coventry remains on target for October 1, 2013 effective date.

Direct. Provider. com Coventry Health Care - Directprovider. com Training Please send an e-mail with Directprovider. com Training in the subject line. The e-mail address is: Traing. Network. Management@cvty. com Section 1 Registration Process Manage Accounts Resource Library News e. Prescribing Section 2 Claims Inquiry Remittance Advice Message Center PPO Fee Schedule Client Listings Worker’s Comp Section 1 – Tuesday March 26 th - 3: 00 – 4: 30 Section 2 - Wednesday March 28 th - 3: 00 – 4: 30 Section 3 - Thursday March 29 th - 3: 00 – 4: 30 Section 3 Eligibility ID Cards Authorizations HEDIS® Reports Fl State Reports

Appeals Process Filing an Administrative or Clinical Appeal/Grievance Process should be sent to the address below: Coventry Health Care of Delaware, Inc. Attn: Appeals Coordinator 750 Prides Crossing Suite 300 Newark, DE 19702 All Claim Payments Disputes for denial of services, which may include, but are not limited to, claim check edits, the use of modifiers, duplicate claims, assistant surgeon billing, global or incidental codes, etc. should be sent to the address listed below: Coventry Health Care of Delaware, Inc. P. O. Box 7713 London, KY 40742

Provider Satisfaction Survey • The purpose of this survey was to monitor overall provider satisfaction with Coventry. This years survey was conducted telephonically by an independent firm, The Meyers Group. • The survey is inclusive of both participating primary care and specialist physicians. • Coventry received an overall score of 81% satisfaction. The specialists noted higher levels of satisfaction compared to the primary care physicians. • 90. 5% of the providers would recommend Coventry to other provider practices and 88% would recommend Coventry to other patients.

Credentialing • Re-attesting and updating the CAQH application. • In 2 nd Quarter 2012, credentialing verification will be transitioned to Optum Insight. • Credentialing notification will be sent via mail and on letterhead from Optum Insight. • Providers are Re-credentialed with Coventry every 3 years and site visits are a requirement for Primary Care and OB/GYN Offices.

Authorizations • PCP’s are responsible for: – Coordination of care for their members; and – Verifying member eligibility • Referrals are not required for any Coventry plans. • Members can go out-of-network for selfreferral services without an authorization. • Some services that require authorizations are: – Elective inpatient admission; – Emergency admission; and - Self Injectibles

Provider Relations Support Staff • Nedenia Leech – New Castle County Office phone number: 302 -995 -6100 ext. 1163 Cell number: 302 -354 -5135 E-mail: nxleech@cvty. com • Clarence Hanley – Kent and Sussex Counties Office phone number: 302 -995 -6100 ext. 1142 Cell phone no number: 302 -256 -8248 E-mail: chhanley@cvty. com

Thank you for joining us today.