1. Blue Cross & Blue Shield of Kansas 2012

2.  Denny Hartman, CPC BCBSKS Provider Representative, Hospitals in Southern KS  Connie Winkley BCBSKS Institutional Relations Education/Communication Coordinator  Cindy Garrison, CPC BCBSKS Provider Representative, Hospitals in Northern KS  Marie Burdiek Electronic Data Interchange (EDI) Account Representative Presented by:

3. Agenda Connecting with Providers Other Party Liability (OPL) Quality Based Reimbursement Program (QBRP) Electronic Data Interchange (EDI)

4. Connected to our Providers Institutional Provider Representative Training eNews BCBSKS Website (www.bcbsks.com)www.bcbsks.com Blue Access

5. Connected to our Providers Availity Webinars KHA Convention All Payers Workshop BCBSKS Contact Information on the Web

6. Other Party Liability (OPL) Focus on Cost Containment by coordinating payments between carriers Non-Duplication of Benefits Provision Exclusions

7. Other Party Liability (OPL) Duplicate Coverage Maintenance of Benefits (MOB) Accidents Worker's Compensation Auto No-Fault The OPL Web Questionnaire

8. OPL - Patient Information Form

9. Submit OPL Information Electronically

10. Other Party Liability The Remittance Advice (RA) for secondary payers: ◦ Shows total amount paid by primary carrier ◦ Shows total amount of patient responsibility ◦ Shows the total provider write-off ◦ Eliminates the need to retrieve the primary carrier EOB

11. Other Party Liability To identify an OPL claim on the RA the CNTR column will state OP. The OPL Adjustment Reason Code (ARC) and Remarks on the RA for OPL claims are listed in the table below with the code defined. ARCRemarksCode Definition 19MA04This service is due to a job-related illness or injury covered by Worker's Compensation 21MA04The services are Motor Vehicle relate 22MA04The Primary Carrier must process first and an Explanation of Benefits from the Primary Carrier is required. 22N48The Explanation of Benefits (EOB) from the Primary Carrier does not match this claim. 23Paid as secondary carrier 23MA04The patient has accepted a financial settlement from another insurance company for this claim. 23M43The Primary Carrier's payment exceeds the amount payable under the patient's contract. No Secondary Carrier payment is available on this claim. 227N179Awaiting a response to an OPL Questionnaire sent to the patient.

12. Explanation of Benefits COB: Duplicate coverage secondary payment formula Provider's Contractual Obligation Worker's Compensation

13. Quality Based Reimbursement Program (QBRP) Background ◦ Patient Protection and Affordable Care Act ◦ Reimbursement arrangement that incentivizes quality ◦ Requirement for a health plan to be eligible to participate on the Exchange

14. Exchange Timeline ◦ 2014 ◦ BCBSKS quality incentive programs will be evaluated for approval in 2013. QBRP Criteria for 2013 ◦ Collaborative effort to develop our QBRP ◦ The goal: provider's quality, safety and affordability continually improve Quality Based Reimbursement Program (QBRP)

15. Quality Measures ◦ 3 Prerequisites 1.File claims electronically 2.Accept electronic remittance advices through the ANS1835 transaction or retrieve remittance advices from the BCBSKS website. 3.Use the BCBSKS electronic portal for inpatient hospital precertification and continued stay reviews. Quality Based Reimbursement Program (QBRP)

16. 7 Quality Measures ◦ 3 measures require a signed attestation form only and 4 measures require reporting. ◦ Process oriented vs. outcome based ◦ Incentive payment is not based on the scores submitted. Quality Based Reimbursement Program (QBRP)

17. Timeline ◦ A one-time attestation form and information required for quality measures were due December 1, 2012. ◦ Updated information must be received no later than May 15, 2013. ◦ Failure to report information by May 15, 2013 will result in the reduction of the incentive previously given. Quality Based Reimbursement Program (QBRP)

18. TriWest Transition FAQs Web Services

19. 2012 BCBSKS All Payers Workshop