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U K HUMANA OVERVIEW OF ADMINISTRATIVE SERVICES OCTOBER 3, 2001.

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Presentation on theme: "U K HUMANA OVERVIEW OF ADMINISTRATIVE SERVICES OCTOBER 3, 2001."— Presentation transcript:

1 U K HUMANA OVERVIEW OF ADMINISTRATIVE SERVICES OCTOBER 3, 2001

2 HUMANA PARTICIPANTS Cindy Wise, Director of Large Group Sales Ninette Gaither, Director Large Account Executives Terri Lacefield, Director Operations, Self-Funded Solutions Reno Altschul, Account Manager, Lexington Market Debbie Griffith, Manager Self-Funded KY Market Carla Whaley, VP Commercial Sales Betsy Warren, Clinical Manager, Outcomes Analysis Kevin Zurlage, Director Provider Operations, Lexington Market

3 Agenda Reno AltschulIntroduction Cindy WiseHumana Today Terri LacefieldOperations Kevin ZurlageNetwork Betsy WarrenPharmacy Cindy WiseAdministrative Services Humana in the Future

4 University of Kentucky/Humana Network Strategy Goals Maximize member access to participating providers in a PPO network Access best provider discounts to lessen costs to University/Employees Strategy Utilize Humana’s cost effective network wherever member access is adequate Supplement with Choice Care Network for wider coverage and more provider choice Fill gaps with Healthstar/PPO Next network to offer maximum number of members access to PPO plan

5 Warren 17 Logan 6 Fulton Hickman Carlisle Ballard Graves 20 McCracken Calloway 11 24 Marshall Livingston Lyon 12 Trigg 9 Crittenden 3 Caldwell 48 Christian 58 Todd 5 Hopkins 93 Muhlen- burg 7 Union 6 Webster 12 Henderson McLean 4 Ohio 13 Daviess 70 Grayson 15 Hancock Brecken- ridge 5 Hardin 133 Meade 9 Larue 10 Marion 6 Bullitt 11 Nelson 10 Wash- ington 14 4 Spencer Shelby 26 Oldham Henry 3 Trimble Carroll Butler 6 Simpson 6 Allen 6 Monroe 5 Edmon- son 5 Barren 3 Hart 6 Met- calfe 4 Adair 4 Taylor 2 Russell 8 Wayne 21 Casey 6 Whitley 21 Bell 23 Knox 11 Lincoln 23 Rock- castle 17 Clay 7 Leslie 19 Boyle 67 Jackson 19 Garrard 74 Mercer 91 Perry 133 Knott 17 Pike 24 Harlan 98 Letcher 43 Laurel 24 Owsley 7 Lee 12 Estill 20 Breathitt 77 Floyd 92 Wolfe 14 27 Powell Magoffin 9 Madison 275 Cumber- land 2 Jefferson 338 Pulaski 170 13 Mccreary Green 4 Clinton 5 Martin 8 Johnson 36 Morgan 4 Menifee 8 Clark 244 66 Montgomery Lawrence 5 Greenup 19 Elliott 4 Carter 13 Boyd 95 Lewis 9 Rowan 21 Fleming 14 Bath 23 30 Nicholas Bourbon 181 Mason 60 3 Bracken Harrison 51 Pendleton 2 Scott 244 Fayette 9941 Jessa- mine 744 Owen 15 Grant 21 Franklin 112 Wood- ford 325 80 Anderson Gallatin BooneKenton Campbell Robertson 5 6 4 4 128 15 101 4 3 13 24 13 4 4 4 Humana/Choice Care Network - 88 counties Humana & Healthstar (PPO Network) - 11 counties UK Actives and Retirees Choice Care & Healthstar (PPO Network) - 12 counties Humana (Indemnity) - 9 counties

6 Fayette & Surrounding Counties Humana &Choice Care Network Participation Area Penetration Hospital - 90% Area Penetration Physician - 90% Statewide Penetration Hospital - 79% Statewide Penetration Physician - 76%

7 Network Status/Next Steps Expand Choice Care Network –124/214 targeted physicians completed –4/12 targeted hospitals completed Pulaski County Humana/Choice Care Networks

8 Humana Today Health Benefits Company - 40 years old Kentucky Corporate Office with National Presence 15 Years of Experience in Self Funding Presence in all 50 States Disease Management –Disease Management News Ranked Humana Best in Nation –Disease Management Purchasing Consortium Recognition Internet Abilities –Top 10 Ranking by Web Criteria for User Experience & Accessibility –Ranked 29th of 500 in PC Week Web Site Link to Healtheon/MD Onsite Claims Summary for Individuals

9 Humana Today Technology –On-Line Enrollment and Eligibility Verification –Automated Enrollment –Secure, Convenient Access to Health Records –Information Management Software for Claims Payment and Customer Service –ID Card Requests On-Line –Member Benefit Information –SPD On-Line Requests

10 UK Administrative Services Claims Administration Network Access Utilization Review (Personal Nurse) HumanaFirst HumanaBeginnings Interface with Stoploss Carrier Reports (Monthly, Quarterly, Annually) On-Site Representation - Local Representatives - Monthly On-Site Claims Processor ID Cards Production of Summary Plan Descriptions (SPD’s)

11 Humana in the Future Testing New Products on Ourselves Emphysis Provider Directory Printing on Demand E-Mail Access to Customer Service Notification of Doctor’s Appointment Smart Card Technology Constant Evolution Making it Easier to do Business with Us: Lexmark, GE, Dell Computers @ Humana: Revolutionizing the Health Care Experience for our Large Group Customers


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