©2013 Premier Healthcare Exchange, Inc. Y OU ’ VE G OT THE P OWER : H OW TO M ANAGE YOUR H IGH D OLLAR C LAIMS

©2013 Premier Healthcare Exchange, Inc.©2014 Premier Healthcare Exchange, Inc. W HO IS PHX  A customer ‘first’ healthcare cost management company headquartered in Bedminster, NJ with a staff size of 225+  Our objective is to provide the most innovative, comprehensive and effective cost management solutions at one destination  Our expertise includes network management and customization, claims editing, bill review & audit, out-of-network services and customer support  In 2014 our savings are expected to exceed $300 million from PHX core services to 250+ clients

©2013 Premier Healthcare Exchange, Inc. Network Management > ProPoint Primary > ProPoint National Access > Custom Network Solutions Network Management > ProPoint Primary > ProPoint National Access > Custom Network Solutions Payment Management > Select > Select Plus > Direct > RedPlus Payment Management > Select > Select Plus > Direct > RedPlus Claims Integrity > Claims Editing > Bill Review & Audit (post and pre payment) > Out-of-Network Services Claims Integrity > Claims Editing > Bill Review & Audit (post and pre payment) > Out-of-Network Services Trust in AccuracyTrust in SavingsTrust in Access ©2014 Premier Healthcare Exchange, Inc. C OST M ANAGEMENT S OLUTION

©2013 Premier Healthcare Exchange, Inc.©2014 Premier Healthcare Exchange, Inc. America’s Health Insurance Plans (AHIP), found that from 2008 to 2010 inpatient hospital prices increased 8.2% per year with wide variation in price levels and growth rates across states and localities.* *March 2013 issue of the American Journal of Managed Care (AJMC) I NDUSTRY G ROWTH

©2013 Premier Healthcare Exchange, Inc.©2014 Premier Healthcare Exchange, Inc. M OST C OMMON B ILLING E RRORS  Incorrect Unit/Quantity Billed  Duplicate Line Item Charge  Level of Care Assignment  Unsupported or Undocumented Service  Operating Room and Recovery Room Time Units  Billing Compliance/Unbundling

©2013 Premier Healthcare Exchange, Inc. Pre-Payment Process

©2013 Premier Healthcare Exchange, Inc.  Pre-payment, line-by-line, desktop review of in & out-of–network claims billed with % off discounts and DRG Carve Outs  Expert team staffed with registered nurses, certified coders, pharmacist, Medical Director, and panel of physicians Secured Savings = Letter of Agreement (LOA)  Dedicated staff to retrieve pertinent medical records at no cost  Compliment case management/utilization review initiatives  Compliance with state mandates + Provider limitations  Hands on manual audit = greater results ©2014 Premier Healthcare Exchange, Inc. B ILL R EVIEW AND A UDIT

©2013 Premier Healthcare Exchange, Inc. THREE TIER APPROACH Line by line clinical audit of medical records; Review for billing discrepancies, duplicate charges, waste & quality of care and risk management issues Financial Review Experimental/ Investigational & Medical Necessity Review Cost vs. charge review; Utilize tools such as AWP, Implant invoice/pricing database & PPO network analysis Concrete recommendations based on groups plan language exclusion definitions of E/I and MN supported by industry recognizes guidelines FDA, Medicare, standard of care compendiums and specialty peer review physicians Clinical Review B ILL R EVIEW AND A UDIT

©2013 Premier Healthcare Exchange, Inc. B ILL R EVIEW AND A UDIT F OCUS  Revenue Code 278 – Implants > Orthopedic > Spinal > Cardiac  Revenue Code 636 – J Codes/Drugs > Chemotherapy > IVIG > Factor VII  Level of Care (NICU, ICU)  Respiratory (Nitric Oxide, ECMO, Vent)  Experimental/Investigational (All therapies)  Hospital Acquired Conditions  Ambulatory Surgical Center

©2013 Premier Healthcare Exchange, Inc. Leukemia with Clofarabine Intervention Total billed: $262,386 Revenue code high dollar specialty drug review  J Code 9027-Clofarabine 1 mg  Single use vial/20 mg per vial  Units billed did not correspond to MD order  Revised UB secured reflecting appropriate unit count Revised UB-04 $38,812 $223,574 (85%) In Savings $223,574 (85%) In Savings C ASE S TUDY #1

©2013 Premier Healthcare Exchange, Inc. Placement of Endurant Abdominal Aortic Aneurism Total billed: $106,734 Revenue code implant review  Line by line review of detailed bill against medical record  Based on historical information and implant cost benchmarks, charge appeared to be atypical for device.  Charge addressed with Provider  Provider confirmed charge capture for this device was not correct as billed. Revised UB-04 $38,870 $67,864 (64%) In Savings $67,864 (64%) In Savings C ASE S TUDY #2

©2013 Premier Healthcare Exchange, Inc. Code EditsR&C Benchmarks Medicare Benchmarks PHX Historical Provider Database Clinical Expertise PHX Network Affiliates PHX Export PHX Out-of-Network Service ©2014 Premier Healthcare Exchange, Inc. PHX Claim Negotiations PHX Choice Network = Import/Export of files = PHX Net Cost of Claim Tools = PHX Savings Channels 3 O UT - OF -N ETWORK /N ET C OST OF A C LAIM

©2013 Premier Healthcare Exchange, Inc. Post Payment Process

©2013 Premier Healthcare Exchange, Inc.  Post payment audits of Institutional claims with a focus on claims with DRG carve outs, revenue code outliers & % off discounts  Data Mining functionality to identify clinical areas of focus based on post payment claim data + Past audit results B ILL R EVIEW AND A UDIT S ERVICES Analysis of Contracts Clinical Audit In depth clinical audit based on detailed itemization & clinical documentation conducted by a licensed clinician Analysis & audit in conjunction with payor contracts, medical & payment policies to uncover recoverable opportunities & savings  Compliance with state mandates + Provider limitations  Hands-on manual audit  delivers greater results  Two Tier Approach of Audit to identify overpayments & recoverable savings

©2013 Premier Healthcare Exchange, Inc. Client Case Study

©2013 Premier Healthcare Exchange, Inc.©2014 Premier Healthcare Exchange, Inc. C ASE S TUDY P AYOR F ACTS  National Market Payor  Current Member enrollment over 400,000  Developed a proprietary Managed Care Network and access’s multiple leased networks  Current Cost Containment Strategy includes: Post payment audit vendor SIU Division Staff of Nurse Auditors to review certain claim types

©2013 Premier Healthcare Exchange, Inc. ANNUAL SAVINGS $16,792,598 Savings per Claim Successful Claims = 1,174 $14,303 ©2014 Premier Healthcare Exchange, Inc. N ATIONAL C ARRIER C ASE S TUDY

©2013 Premier Healthcare Exchange, Inc. P OWER OF P ARTNERSHIP

©2013 Premier Healthcare Exchange, Inc.©2014 Premier Healthcare Exchange, Inc.

©2013 Premier Healthcare Exchange, Inc. ©2014 Premier Healthcare Exchange, Inc. C ONTACT I NFORMATION Bryan Russo Director of Sales x361 Ingrid Crowley Director, Bill Review and Audit x250