1. Health Plan Industry Provider Domain Overview

2. 2 Company Confidential | For Internal Use Only | Do Not Copy Health Plan And Provider Data Health plans have functions for collecting provider data either via internal processes or through industry collaborations such as CAQH Health plans use provider data for a wide variety of purposes such as credentialing, claims processing, quality assurance, emergency response, member services (directories and referrals), and more. Strategies to streamline data collection electronically is a win-win proposition with reduced duplicative paperwork and millions of dollars of annual administrative costs. Health plans use services via industry collaborations such as CAQH; the Council on Affordable, Quality Health Care. CAQH is supported by America’s Health Insurance Plans, the American Academy of Family Physicians, the American College of Physicians, the American Health Information Management Association, the American Medical Association, the Healthcare Administrative Simplification Coalition, the Medical Group Management Association and other provider organizations. Other entities also are sources of provider data such as informatics companies (IMS Health) and other commercial vendors (Enclarity).

3. 3 Company Confidential | For Internal Use Only | Do Not Copy CAQH Industry Collaboration CAQH-an industry collaboration- collects data for more than 800,000 physicians and other health professionals, as well as over 550 participating health plans, hospitals and healthcare organizations. A single, standard online form is the centerpiece of the service. Providers in all 50 states and the District of Columbia are able to enter their information free of charge through an interview-style process. CAQH meets the data-collection requirements of URAC, the National Committee for Quality Assurance (NCQA) and the Joint Commission standards. Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, New Jersey, New Mexico, Ohio, Rhode Island, Tennessee, Vermont and the District of Columbia have adopted the CAQH standard form as their mandated or designated provider credentialing application.

4. 4 Company Confidential | For Internal Use Only | Do Not Copy Health Plan Provider Data Requirements Typical data collected by health plans during provider database functions include: A List of all previous and current practice locations Identification numbers, such as UPIN, Medicare, Medicaid, and National Provider Identifier (NPI) Malpractice insurance face sheet Summary of any pending or settled malpractice cases Curriculum Vitae Medical license number DEA certificate and number CDS certificate IRS Form W-9 Health plans have not traditionally collected electronic addresses such as email addresses or URLs of websites

5. 5 Company Confidential | For Internal Use Only | Do Not Copy Health Plan Provider Data Overview Health plans have a variety of systems that support provider management systems. There is significant variation in the level of modernization, the quality of data, and the use of these systems Health plan provider systems vary significantly in basic definitions, functionality, and configuration Health plans have variable levels of data quality housed within these systems. Improving data quality and operational processes is important to health plans as the cost of bad data is high and creates customer abrasion points Health plans face substantial costs for remediating legacy systems for ICD 10 support Fixing Provider Databases have the potential to lower operating costs, may lower cost of care, and may enable health plans to better deploy payment innovation, improved analytics, and new products and service offerings

6. 6 Company Confidential | For Internal Use Only | Do Not Copy Sources of Value from Accurate Provider Directories Activity Enhancement DefinitionSummary Auto Adjudication Claims which do not require manual interventions Poor provider data can cause claims to enter a pended status which require re-work, returned mail, and service Provider Contracting Contracts must be represented in claim processing systems to enable payment Improved provider data allows more accurate and timely payment and payments more consistent with contract requirements Accurate provider data is an enabler of Medicare Ambulatory Payment Classification system Non-Par. Payments Non Participating physicians are paid at a different; often high rates Accurate provider data allows better determination of what contract to apply to a particular claim Accurate claim payment can reduce total claim costs Staff & Vendor Activities Health plans spend significant amounts of personnel and vendor resources keeping files accurate Opportunities to reduce manual processes Opportunities to pool costs of accurate provider data acquisition Previous industry activities via CAQH Reduced system maintenance costs and SSCRs Begins second half of 2010 with full run-rate by 2014

7. 7 Company Confidential | For Internal Use Only | Do Not Copy Current Health Plan Industry Activities America’s Health Insurance Plan’s (AHIP) has been working with it’s members exploring a related “registry” concept for payers to advance the use of secure data exchange technology solutions focused on driving out unnecessary administrative costs and expanding the use of business to business (B2B), direct communication links. To expand such capabilities three things are needed: Standard Communications Protocols: Improve existing framework for real-time transactions and peer to peer exchange using generally accepted communications protocols such as:  Secure Multipurpose Internet Mail Extensions (MIME)/ Simple Mail Transfer Protocol (SMTP) /X.509 Digital Certificates  Simple Object Access Protocol (SOAP), Web Services Description Language (WSDL)/X.509 Digital Certificates3  Secure File Transfer Protocol (FTP) Digital Certificates: Adopt commercial approaches to certificates and authentication to enable machine to machine secure transaction exchange Industry Directory (routing registry): “white pages” of internet routing addresses and digital certificate locations for healthcare

8. 8 Company Confidential | For Internal Use Only | Do Not Copy Current Health Plan Industry Activities AHIP Registry Goals: The development of service architecture for access to payer routing information through a multiparty registry; The portal would also serve as the main “white pages” for providers /others to seek information about all payers; Manage Unique Payer Identifiers – e.g. HPIDs A standards based registry solution that adopts current best practices (SOAP, X.509, SMTP, SFTP, NIST Requirements, HIPAA, CORE Phase I and II, etc.) while allowing for future industry innovation; Application Program Interface (API) publication to web portal that would allow for system queries/updates from an end node to the registry; Administrative portal that would allow payers to control the configuration of the routing; Automated service to check certificate status for enrolled payers; Secured registry information residing in a secured data center. This project is in the concept stage but seems to align with the “provider directory” projects under consideration.