Montgomery County Medical Society Rockville Hilton October 25

Montgomery County Medical Society Rockville Hilton October 25, 2012 Care. First Blue. Cross Blue. Shield is the shared business name of Care. First of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®′ Registered trademark of Care. First of Maryland, Inc. PROPRIETARY AND CONFIDENTIAL

Current Initiatives Care. First Blue. Cross Blue. Shield is the shared business name of Care. First of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®′ Registered trademark of Care. First of Maryland, Inc. PROPRIETARY AND CONFIDENTIAL

Patient Centered Medical Home (PCMH) Care. First launched its PCMH program in January 2011. The Program has grown to its current size quickly and now involves nearly 1, 000 Care. First subscribers, making it the largest program of its type in the nation. PCP participants now represent approximately 80 percent of all eligible primary care physicians in Care. First physician networks. In the first 18 months of the program, Care. First has significantly enhanced the tools, resources, and supports available to PCMH participants. These enhancements include: – A detailed online member health record and online care plan development tool available 24/7 via the internet. – Comprehensive data on their Care. First patient population to identify opportunities for care improvement and cost savings. – Teams of registered nurses, community-based Local Care Coordinators and Care. First Regional Care Coordinators, aligned with individual practices to help coordinate care for the sickest patients. – A team of PCMH Program Consultants to help participants understand utilize the tools and data available through the program. – Free access to the American College of Physicians Medical Home Builder 2. 0 tool to assist practices in transforming to a medical home model. – Dedicated member service resources for Care. First PCMH members. 3 PROPRIETARY AND CONFIDENTIAL

Choose Electronic Claim Submission Electronic Submission (EDI): • Consistent data requirements versus completing a paper claim. • Decreases claim returns for additional information. • Faster payment • Enhances your record keeping abilities. • Electronic Fund Transfer (EFT) is available through Real Med, Emdeon and Allscripts. • Medicare secondary claims can now be submitted electronically- see the news item in carefirst. com. >provider& physician>news section. 4 PROPRIETARY AND CONFIDENTIAL

On-line Eligibility and Claim Status Tools Using Care. First Direct and the Voice Response Unit ( VRU): • Saves time waiting for a Customer Service Representative. • When you must call, Provider Service will focus on your more complicated claim inquiries. • Consistent Eligibility and Claim Information is found in the on-line tools. • Care. First is constantly enhancing Care. First Direct and the VRU. • Make sure that your agents/vendors, that do your billing and follow-up, have access to Care. First Direct. • We have several instructional webinars a month to train your staff or agents. 5 PROPRIETARY AND CONFIDENTIAL

Care. First’s Website “One-Stop” shopping for Care. First information – www. carefirst. com. providers and physicians. • • • Product and General Information manuals Access to Care. First’s Medical Policy Access to Care. First’s bi-monthly newsletter- Blue. Link Credentialing information in the “Quick Links” section of the website Job Aids Forms Critical news blasts Access to Care. First Direct Register for instructional Seminars and Webinars Companion Guide for the 5010 transaction sets ICD 10 updates 6 PROPRIETARY AND CONFIDENTIAL

Enhanced Provider Curriculum Care. First Blue. Cross Blue. Shield is the shared business name of Care. First of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®′ Registered trademark of Care. First of Maryland, Inc. PROPRIETARY AND CONFIDENTIAL

New Learning Curriculum for Providers Suggested Curriculum for new providers or providers that would like a refresher: • Session 1 - New Provider Introduction- overview of the expectations and training available for providers • Session 2 - Specialty Specific Contract Information (Institutional Ancillary Providers only) • Session 3 – Programs and Products – overview of Care. First Products and corresponding membership cards • Session 4 - Claims Submission Requirements- overview of how to file claims to Care. First • Session 5 – Corrected Claims Submission, Inquiry and Appeal Procedures- a “how to” for electronic claim correction. Also includes how to file an inquiry or an Appeal. • Session 6 – Self-Service Tools - Care. First Direct – Eligibility and Benefits • Session 7 – Self-Service Tools – Care. First Direct – Claims Status and Inquiry • Session 8 - Voice Response Unit (VRU) • Additional topic specific webinars we encourage you to take: – Blue Card , Blue Choice, Healthy. Blue, Physical, Occupational and Speech Therapy, OB/GYN Care 8 PROPRIETARY AND CONFIDENTIAL

General Updates Care. First Blue. Cross Blue. Shield is the shared business name of Care. First of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®′ Registered trademark of Care. First of Maryland, Inc. PROPRIETARY AND CONFIDENTIAL

Email from Care. First • Crucial Information is being shared via email. • Care. First typically only sends email updates once a week. • Please sign-up to receive emails at www. carefirst. com>providers and physicians>news. • Care. First only uses your email address for notification purposes. 10 PROPRIETARY AND CONFIDENTIAL

Fee Schedule • Fee Schedule letters dated 10/1/2012 were mailed or delivered to groups with a 12/1/2012 effective date. • Top 100 fees we included in the mailing, and there is an email address to request additional codes (feescheduleinfo@carefirst. com). • For more information please refer to the letter dated 10/1/2012. 11 PROPRIETARY AND CONFIDENTIAL

Voucher Enhancements Care. First is making changes to the Facets voucher format. • These enhancements to the format will aid in understanding the information on the voucher. • We anticipate these enhancements to be in the near future. • We will post the effective date and training webinars available for these changes on carefirst. com, and in the Blue. Link. 12 PROPRIETARY AND CONFIDENTIAL

NPI Reminder • The National Provider Identifier (NPI) must be used on all claims submissions. • This includes electronic and paper claims. 13 PROPRIETARY AND CONFIDENTIAL