2. 2 Who is Maryland Physicians Care –Provider sponsored statewide MCO –Incorporated in 1996 –A Maryland hospital owned MCO; owners include: Holy Cross Health Meritus Medical Center ( formerly Washington County Health System) Western Maryland Health System Maryland General Health Systems Saint Agnes Healthcare –Provides managed care services to over 196,000 HealthChoice members

3. 3 Maryland Physicians Care Vision, Mission, Values Maryland Physicians Care Vision, Mission, Values Our Vision We seek to be a dominant, financially stable, and socially responsible managed care organization of choice for members, providers and health care purchasers in the markets we serve. Our Mission We are a value-driven, community-focused managed care organization that improves the health status of its members through effective care management systems. Our vision and values as a provider-sponsored organization enhance the missions of the owners’ health systems. Our Values Quality: Emphasize continuous efforts to improve health status and quality of life for those individuals and communities we serve. Respect: Promote dignity and integrity in all aspects of plan governance and management. Collaboration: Achieve corporate goals and objectives through effective partnerships with key health care stakeholders. Financial Strength: Maintain long term financial viability through sound plan governance and management.

4. 4 No Pharmacy Copays Free prescription and over-the-counter medications Free vision care for adults (21 and older) One eye exam every year One set of glasses OR contact lenses every two years One pair of lenses every year (when needed) Free vision care for children (20 and under) One eye exam and set of glasses every year One set of contact lenses (when medically necessary) Low-cost dental care for adults (21 and older) Free exams and cleanings two times a year Limited X-rays once a year Limited cavity fillings (with some cost to you) Simple and medically necessary emergent extraction (with some cost to you) 20% discount on non-covered dental services Added Value Benefits Free SafeLink Cell Phone: Free cell phone 250 free monthly minutes Unlimited text messaging Click hereClick here to download the SafeLink application More benefits at NO COST to our members: Routine primary care provider visits and physical exams Urgent and emergency care Immunizations for children Primary mental health services Substance abuse treatment and counseling Mammograms Small Miracles Program (incentives for pregnant women) Case managers for health conditions like asthma, diabetes and high blood pressure Disease management educational programs Transportation assistance

5. 5 Enhanced HIPPA Compliant Web Portal, My MPC Source Our new, faster web portal is now available for all providers to use. We encourage all providers to register in the upgraded system now and start enjoying some of our new and enhanced benefits. What can you expect? Simply put, you should experience faster processing and better access. The benefits include: Convenient, safe access Single sign-on – One log-in and password allows you to move smoothly through various systems. Mobile interface – Enjoy the additional convenience of access through your mobile device. Personalized content and services – After log-in, you will find a landing page customized for you. Real-time data access – View updates as soon as they are posted. Better tracking –Know immediately the status of each claim submission and PA request. Auto-Auths – Depending on the auth type and service location, it is possible to receive an auto-approval on your request. Detailed summaries – Find easy access to details about denied PA requests or claims. Enhanced information to analyze, track and improve services and processes.

6. 1 MAIN LOGIN PAGE Enter User Name and Password Select Sign In

7. 7 Universal User Landing Page Top Bar Navigation Health Information Messages & Notification Health Plan Contacts Useful Links

8. 8 Universal User Landing Page Quick Link Footers for easy access to all sections of the portal

9. 9 MY ACCOUNT My Profile – Modify email and phone information Messaging – Send and receive email messages from the health plan along with important updates found under post and notification Health Tools – Check PA requirements and submit authorizations

10. 10 TASKS Search Authorizations Search Claims Search Remittance Panel Roster Search Providers Health Tools – Check PA requirements and submit authorizations

11. 11 ADMINISTRATION User List – Identify all of the users for your practice by name or provider ID Add Users – The administrator for the plan has the ability to add additional users

12. QUESTIONS ABOUT THE PORTAL SECTION?

13. 13 CAREWEB-AUTHORIZATION SYSTEM – REQUEST QUEUE The Auth Queue tab displays a list of your prior authorizations. You can filter the list based on various criteria including two elements of submission status: Draft and Submitted. The list may comprise multiple pages of authorization records and you can advance to the next page by selecting the page number or by selecting ‘more’. You can also sort on any of the headers. To review the details of a specific authorization merely select the authorization number (e.g. EPS00078767) to open the view and see the detail.

14. 14 CAREWEB-REQUEST DETAIL A message may be attached to the authorization by the health plan staff OR by you. The ‘Message’ button will indicate with a number if there are any messages. Select the ‘Message’ button to create a new message. NOTE: Requests can be cancelled using ‘Cancel Request’. However, you are advised to only cancel requests that are not submitted (requests in Draft). If you need to cancel a request that is already submitted, please contact the health plan.

15. 15 CAREWEB-NEW PA REQUEST Fields marked with an asterisk (*) must be filled out. The Requesting Provider can be searched by last name or MPC provider ID or a portion of either. Request Types include: Outpatient Procedure, Inpatient – Medical, Inpatient – Surgical or Inpatient – Behavioral Health. For MPC, our providers should only use Outpatient Procedure (OP services), Inpatient-Surgical (scheduled IP services). Unscheduled admissions must be faxed to the health plan and behavioral health is a carve out. The Patient/Member can be searched by last name or MPC member ID or a portion of either. Note: The member’s eligibility dates are displayed. The patient’s diagnosis code may be searched by code or description or a portion of either. More than one code may be added OR deleted.

16. 16 CAREWEB-REVIEW REQUEST Review the request for accuracy and add any file attachments (clinical) as support. Note that the Request Status is ‘NoDecisionYet’ – the request may be corrected or canceled if necessary. If the request is ready to be advanced, select the DOCUMENT button to apply a guideline/clinical criteria to the requested procedure (s). Each procedure code is subject to being ‘documented’ if a guideline exist. Example: If a request has (2) procedures, each one will be evaluated.

17. 17 CAREWEB-DOCUMENT PROCEDURES Complete the statements by selecting all that apply. Depending upon the procedure and/or diagnosis additional statements will be presented for completion. After completing each statement, select NEXT or BACK to revisit previous pages.

18. 18 CAREWEB-FINAL REVIEW The request summary is presented again for final review and it now includes the guidelines and clinical indications as declared. Note that the request is still in a status of ‘NoDecisionYet’. You have the option to ‘Re- Document’ the procedure. There are three actions that can be taken: 1) Select the SUBMIT button 2) Select the BACK button to review or correct previous work or 3) Select CANCEL REQUEST. Select SUBMIT. Note the disclaimer at the bottom of the page.

19. 19 CAREWEB-SUBMITTED AND AUTO APPROVED In this example, based upon RULES previously defined, the prior authorization request is automatically approved. Authorizations can be auto-approved or pended for medical review. Note that the Request Status is: Completed – Approved. The requester’s next step is to return to the Auth Queue or select Cancel. We recommend that the requester contact the health plan if they desire to cancel a request that has been submitted.

20. Q & A