Unicare Health Plan of WV Inc A true

Unicare Health Plan of WV, Inc A true partnership with our provider community Uni. Care is an Anthem Company. UWVPEC-0244 -15

Welcome! We would like to thank everyone for taking time out of their busy schedule to be here today! Thank you for the dedicated care and time you provide our Uni. Care Health Plan of West Virginia, Inc. (Uni. Care) members each day. 2

Today’s Objectives Our goal today is to share with you some of the following information you need to know about Uni. Care as a valued health care provider: Ø Ø Who we are Our role in ensuring quality health care for Uni. Care Medicaid recipients The specific resources that are available to you and your patients The processes we have in place that affect you 3

Uni. Care Plan History • Operational November 2003 • Four counties, 700 Members Marketplace • Statewide • Enrollment 130, 000+ • 1 of 4 managed care organizations (MCO) • Largest Medicaid MCO Products • Mountain Health Trust • Vendor relationships for dental (adult emergency/children), pharmacy and vision • Behavioral Health • West Virginia Health Bridge (ACA expansion) Membership • 80% of membership < 19 years of age • Approximately 5, 000 deliveries annually • High rates of emergency room (ER) utilization, substance abuse and NICU cases Provider Network • More than 5, 100 providers • 68 hospitals • 957 ancillary locations • 20 Rural Health Centers (RHC) and 28 Federally Qualified Health Centers (FQHC) >150 sites Network Dynamics • No commercial product Demographics of Uni. Care members • 10% pregnant women • 10% adults with children • 80% under 19 years of age • ¼ of the state’s population receive Medicaid benefits • Ethnicity of West Virginia population: 95% non-Hispanic white 4

HANCOCK BROOKE OHIO UNICARE Contracted Counties MARSHALL MONONGALIA WETZEL MORGAN PRESTON MARION TYLER BERKELEY HARRISON PLEASANTS MINERAL TAYLOR WOOD HAMPSHIRE JEFFERSON DODDRIDGE RITCHIE BARBOUR GRANT WIRT LEWIS CALHOUN JACKSON MASON UPSHUR GILMER ROANE TUCKER HARDY RANDOLPH BRAXTON PENDLETON PUTNAM WEBSTER CLAY CABELL KANAWHA POCAHONTAS NICHOLAS WAYNE LINCOLN FAYETTE BOONE GREENBRIER MINGO LOGAN RALEIGH Contracted SUMMERS MONROE WYOMING MERCER Not Contracted MCDOWELL 5

Medicaid Managed Care Benefits Covered and Carved Out Services

Services Covered by Uni. Care • • • Office visit and physician services Specialty services Hospital services Prenatal services Initial evaluation for mental health diagnosis by primary care physician (PCP) Family planning services Ø Members may use any Medicaid qualified provider • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Ø • • Limited to children under 21 Pharmacy Dental (pediatric) Diagnostic service (e. g. , lab and radiology) Behavioral Health Services 7

Services Covered by Uni. Care • Vision Service: Ø Ø Ø Vision Service Plan Adults limited to medical treatment only Children’s benefits include exam, lenses, frames and needed repair every 12 months • Pharmacy Services: Ø Express Scripts, Inc. ® • Dental Services for Children: Ø Ø Scion Under 21 years old • Dental Services for Adults: Ø Ø Scion Emergency extractions only Express Scripts, Inc. is a separate company that provides pharmacy services and pharmacy benefit management services on behalf of health plan members. 8

Carved Out Services • Covered by Bureau for Medical Services (BMS) • Carved out services include*: Ø Ø Intellectual and Developmental Disabilities (I/DD) waiver Long-term care Non-emergency/Non-ambulance medical transportation Transplants *Medicaid beneficiaries have coverage for these services; however, Uni. Care does not pay for them. 9

Provider Education Resources Available

Provider Changes • Uni. Care requires all providers, including hospitals, to send any administrative change requests to us so that we have correct information in our system. Ø This includes changes in your practice or facility name, address, fax and email information, tax identification number (TIN) and other similar changes Ø Provide specific instructions for your change request Ø Submit this information • Fax: 1 -877 -608 -6752 • Email: ssbdatamanagementservices@anthem. com 11

Appointment Availability Requirements 12

After Hours Care • Members will have access to a quality comprehensive health care services 24/7 • Emergency calls • System in place to ensure that members can reach the PCP or an on-call provider • Members also can call Med. Call® • Suggested text for answering machines: Ø “Hello, you have reached [physician/office name]. If this is an emergency, hang up and dial 911 or go to the nearest hospital emergency room. If this is not an emergency and you have a medical concern or question, please call[insert contact phone or pager number]. You will receive a return call from the on-call physician within [time frame]. 13

Clinic Days • Uni. Care is launching a quality initiative designed to improve our compliance rates for preventive services. Our HEDIS results indicate a significant number of members are not receiving timely preventive services. • Clinic Day is an initiative that brings members and providers together to improve access to care and patient compliance. In partnership with our network providers, we will host a series of Clinic Days for Uni. Care members who have not received wellchild visits or immunizations. • Clinic Day can also target members who are due for diabetes care or postpartum care. Members will be directed to the office of the provider identified as their PCP. • Uni. Care will coordinate appointment scheduling with the provider and member. 14

Uni. Care Disease Management Clinical and Non-clinical Wellness & Health Promotion • Weight management, smoking cessation, low acuity outreach, seasonal outreach, homeless outreach, Healthcare Effectiveness Data and Information Set (HEDIS®)/quality improvement initiatives Member health education materials and newsletters • Development and approval process in support of all health plan and corporate partners Call 1 -888 -830 -4300 for member referral to Disease Management Conditions Covered: • Asthma • Diabetes • Congestive heart failure • COPD • Hypertension • Coronary artery disease • HIV/AIDS • Major depressive disorder • Schizophrenia • Bipolar disorder • Substance abuse *HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 15

Uni. Care Case Management • • • Complex case management Stabilization case management Discharge planning Facility/field visits High-risk obstetric case management Social worker intervention Case Management Referral 1 -866 -655 -7423(option 1) 16

Uni. Care Utilization Review Resources Pharmacy Prior Authorizations • Phone: 1 -877 -375 -6185 • Phone: 1 -866 -655 -7423 • Fax: 1 -855 -875 -3627 • Fax : 1 -855 -402 -6983(Medical) • Fax: 1 -855 -325 -5556 (Behavioral Health Inpatient) • Fax: 1 -855 -325 -5557 (Behavioral Health outpatient) Continued Stay Review • Phone: 1 -866 -655 -7423 • Fax: 1 -855 -402 -6985 Customer Service • Phone: 1 -800 -782 -0095 Peer-to-Peer Line • Phone: 1 -877 -496 -0071 Grievance/Appeal fax • Fax: 1 -866 -387 -2968 17

Customer Care Center Services • Dedicated to Uni. Care’s Medicaid Managed Care Program • Phone: 1 -800 -782 -0095 1 -866 -368 -1634 (TTY) • Assistance for providers Ø Ø Ø Eligibility verifications Claims inquiries PCP assignment and changes Benefit information Interpreter services Provider website navigation 18

UNICARE HEALTH PLAN of WV, Inc. TERRITORY MAP Terri Roush Network Relations Manager (304) 989 -5471 Terri. Roush@anthem. com HANCOCK BROOKE As of 9/12/16 OHIO Carrie Blankenship MARSHALL 304) 533 -4086 Carrie. Blankenship@anthem. com MONONGALIA WETZEL Chris Bates (304) 539 -1746 Chris. Bates@anthem. com HARRISON PLEASANTS Beth Roach MORGAN MARION TYLER PRESTON BERKELEY MINERAL TAYLOR HAMPSHIRE JEFFERSON DODDRIDGE WOOD Cell: (304)590 -5929 RITCHIE BARBOUR TUCKER Office: (804)772 -0103 WIRT Beth. Roach@anthem. com LEWIS HARDY UPSHUR GILMER CALHOUN JACKSON GRANT RANDOLPH MASON ROANE PUTNAM BRAXTON PENDLETON (304) 539 -2845 WEBSTER CLAY Angela. Richards@anthem. com CABELL KANAWHA WAYNE Angie Richards NICHOLAS POCAHONTAS Jill Miller (304) 410 -2618 LINCOLN Jill. Miller@anthem. com BOONE Mary Straface FAYETTE GREENBRIER MINGO (304) 622 -6505 Mary. Straface@anthem. com LOGAN RALEIGH Beth Daniel SUMMERS MONROE WYOMING MERCER MCDOWELL (304) 410 -9395 Elizabeth. Daniel 2@anthem. com

Uni. Care ID Card 20

Uni. Care ID Card • • • Members receive their Uni. Care ID card upon enrollment The Uni. Care ID number has a “W” prefix The member will not receive a Uni. Care ID card each month BMS will still issue a Medicaid eligibility card ID cards will only be reissued to the member for the following reasons: Ø Member change of address Ø Change of PCP Ø Upon member request 21

Submitting Claims • • • 365 days from the date of service Ø Paper Ø Electronic Submit paper claims: Ø Uni. Care Health Plan of West Virginia, Inc. , P. O. Box 91, Charleston, WV 25321 -0091 Electronic Data Interchange (EDI) Ø Fast, inexpensive and secure Ø Shorter Claims turn around Ø Expedited payment EDI Payer ID # 80314 Technical Support: Ø Phone: 1 -800 -470 -9630 Ø Email: E-Solutions. Support@Uni. Care. com Ø Live Chat: www. unicare. com/edi 22

Provider Updates- Availity • Expansion of our provider portal services through Availity Ø Availity Web Portal, a multi-payer portal (website) at availity. com that gives physicians, hospitals and other health care professionals access to multiple payer information with a secure single sign-on Ø Availity’s Web Portal offers a variety of online functions to help providers reduce administrative costs by eliminating paperwork and phone calls. Ø Target date for Access Point retirement ü end of 1 st quarter 2017 Ø Ø The services are free to providers! Provider Bulletin Updates To register for the Availity Web Portal go to availity. com If you have questions or need additional registration assistance, contact Availity Client Services at 1 -800 -Availity(1 -800 -282 -4548) 23

FQHC/RHC Reminders • • • Services included in the FQHC and RHC Encounter Rate must be billed using the UB-04 claim form Providers must bill all encounters using the encounter code T 1015 along with the appropriate modifier Claims must list the actual CPT/HCPCS procedure codes and appropriate revenue codes, as defined by Medicare, to identify services included during the encounter visit. The FQHC and RHC may indicate the actual charge or a zero for the CPT/HCPCS codes listed on the claim for encounter data purposes, but MUST include the encounter rate for the T 1015 encounter code for payment. Indicate the appropriate type of bill when submitting corrected claims to ensure properly processing. The third digit of “ 7” in the three digit type of bill defines a replacement/corrected claim. Behavioral Health group therapy reimbursed at the fee-for-service rates Ø 90853 -AJ 24

Questions? 17

THANK YOU FOR YOUR PARTICIPATION TODAY!