1. HFMA ANNUAL PAYOR PANEL 2016 “With you when it matters…” Coventry Health Care of Missouri, Inc. Provider Relations April 12, 2016

2. Living the Aetna Way will allow us to achieve our strategic goals “With you when it matters…” We put the people we serve at the center of everything we do

3. What is an Exchange? The Exchange is an online market place where individual consumers and small group employers can purchase insurance coverage. Exchanges may be offered at the State or the Federal level Illinois has chosen a state partnership exchange Missouri has opted for Federal Exchange On the exchange, consumers are able to: View Subsidy eligibility Review and compare all the plans available on the exchange Enroll in health coverage “With you when it matters…”

4. Coventry’s Marketplace/Exchange Overview “With you when it matters…” Coventry Healthcare offers Individual coverage for the Illinois and Missouri exchanges for 2016 Three options for the marketplace: 1.Federal (FFM) – Federally-facilitated exchange where the state has no role in operation or management – Missouri 2.State Partnership (SPM) – Federal government builds infrastructure but states retain authority (network adequacy, licensure, etc.) – Illinois 3.State Base – The states create, operationalize, and maintain their own exchange All other group sales remain the same for Coventry Healthcare’s off- exchange markets

5. Coventry’s Marketplace/Exchange Products Missouri “With you when it matters…” 1.Coventry One PPO – Eastern Missouri and Southwestern Illinois 2. Coventry One Carelink from Coventry is a narrow network PPO product Missouri and Illinois counties Hospital affiliated providers: Mercy, SSM, St. Elizabeth’s, St. Anthony’s-Alton, HSHS 3. Coventry One FocusedCare is a narrow network PPO product Missouri and Illinois counties Hospital affiliated providers: BJC Healthcare(all facilities) St. Elizabeth Hospital-Belleville, IL. (HSHS) St. Anthony’s Medical Center, St. Louis, MO.

6. “With you when it matters…” Radiation therapy Prior authorization managed by MedSolutions dba eviCore healthcare. They can be reached at: Phone: 1-888-693-3211 Fax: 1-888-693-3210, Monday-Friday, normal business hours or as required by federal or state regulations Online at www.evicore.com Pain management, hip and knee arthroplasties Prior authorization managed by Triad dba eviCore healthcare. Phone: 1-888-584-8742 Fax: 1-888-229-5680, Monday-Friday, normal business hours or as required by federal or state regulations. Online at www.triadhealthcareinc.com/cvty Heart catheterization and/or high tech radiology Prior authorization managed by National Imaging Associates. Phone: 1-800-642-7835 (Illinois) and 1-800-642-7339 (Missouri) Online at www.RADMD.com Chemotherapy Prior authorization managed by New Century Health. They can be reached at: Phone: 1-877-624-8601, option 5, Monday through Friday, 8:00 a.m. to 8:00 p.m. EST Fax: 1-877-624-8602 Online at my.newcenturyhealth.com (login required)

7. “With you when it matters…” Lab Services/Providers In-Office Lab Policy Lab specimens for CHC of Missouri’s Commercial and Medicare Advantage should be sent to Quest Diagnostics in the St. Louis Metro area, or one of the approved outpatient labs for those outside of the metro area. The metro area is defined as: –In Missouri: Franklin, Jefferson, Lincoln, St. Charles, St. Francis, St. Genevieve, St. Louis City, St. Louis, Warren, Washington counties –In Illinois: Madison, Monroe, St. Clair counties Coventry Health Care reimburses in-network providers for specific lab procedures when they are preformed in office on a STAT basis only. Please refer to our provider manual for a detailed list of these labs. The provider manual is available under the provider section on www.chcmisssouri.com.

8. “With you when it matters…” Valuable Information Available Online at www.chcmissouri.com Comprehensive provider search Drug formulary (prescription coverage) Prior authorization information Medical injectable list Authorization form Prior authorization list CPT codes requiring prior authorization Network participation details Credentialing policies, criteria and provider rights related to credentialing Click “Providers” on the home page for immediate access to these valuable resources:

9. “With you when it matters…” Visit the “Provider Document Library” to access: Provider Manual – Includes information about claims processing, member rights and responsibilities, and other helpful resources. Complex Case Management – Informs providers about our complex case management program and how to refer patients to the program. Network News – Holds current and past issues of Network Connection, our provider newsletter. Quality Improvement Policies and Procedures – Notes quality improvement annual evaluations and medical record documentation standards. Utilization Management Policies – Displays summaries of our evaluation of new medical technology, utilization management criteria and financial incentives policy. Wellness – Highlights preventive health guidelines, clinical practice guidelines and disease management programs.

10. “With you when it matters…”

11. Update on our integration—what you need to know As you may know, Coventry and Aetna are now one company. Although we’re one company, we’ll continue to operate separate Coventry and Aetna networks in Illinois and Missouri. In January 2016, Coventry members began to transition to Aetna claim systems. As part of this change, we’ll gave members new ID cards. Your current Coventry participation agreement still applies The terms in your agreement still apply to members with these new ID cards. This doesn’t impact your participation in the Coventry or Aetna networks. We’ll process claims based on Aetna’s policies, not Coventry’s For Coventry members administered on Aetna claim systems, we’ll process claims based on Aetna clinical and claim payment policies, which may vary from Coventry’s. Where you should send claims Please send claims to the address listed on the back of the ID card.

12. “With you when it matters…” 2016 Sample ID Card- Coventry members migrated to Aetna

13. “With you when it matters…” www.DirectProvider.com Services & Information Available: Claim Adjustment Requests Remittance Advices Eligibility/Benefit Inquiry Resource Library Secure Messaging Member ID cards Enhanced News Authorization Request/Inquiry/Update/Appeal

14. “With you when it matters…” www.DirectProvider.com Select a Health Plan:  Coventry Health Care of Missouri  Carpenters’ Health and Welfare Trust Fund  Coventry of Missouri (MODOT)  University of Missouri  Coventry Health Care of Illinois  Coventry Health Care of Kansas and Preferred Health System  Coventry Health Care National Network  CoventryOne National  Mail Handlers Benefit Plan  Rural Carrier Benefit Plan

15. “With you when it matters…” Workers Comp on DirectProvider.com Workers Comp link added to provide access to Coventry’s Workers Comp (WC) business information Includes access to WC Bills, Pricing Sheets, Explanations of Review/ EOR’s CMS 1500 & UB-04 Bill Images If you are currently registered with DirectProvider.com for Coventry Health Plans access, just click the WORKERS’ COMP link in the left navigation bar on the home page and follow the instructions

16. Here are a few tips on navigating the authorization submission process: “With you when it matters…” Authorizations on DirectProvider.com Made Easy Submit the same type of clinical information that is needed when requesting the authorization via phone. Either document the information in the comment section of the authorization or attach clinical information to the authorization. Without clinical information, the authorization may be denied for lack of information. It is recommended to check member eligibility and current authorizations prior to entering a new authorization. Online help is available on DirectProvider.com for authorization as well as other key functions. If you have any questions or require technical support Coventry’s Net Support Team is available 9am-5pm Monday through Friday at (866) 629- 3975.

17. “With you when it matters…” 2016 DirectProvider.com Training Authorizations & Referrals Claims/Remittance Advices Administrator Registration Interactive Webinars To register your provider office staff for DirectProvider.com training sessions please go to Directprovider.com and view the NEWS section on Directprovider.com and choose the link Direct Provider Training Announcement for any of the trainings listed above.

18. “With you when it matters…” Aetna Tools and Training

19. “With you when it matters…” Precertification Training

20. “With you when it matters…” NaviNet Training

21. “With you when it matters…”