Billing Training Updated March 2018

Great Plains Medicare Advantage Plan is a Medicare Advantage Plan offering a product designed to improve care for residents. The product offered by Great Plains Medicare Advantage Plan is: Institutional/Institutional Equivalent Special Needs Plan (ISNP)– designed for residents who functionally and medically meet a nursing facility level of care We are a plan with strong local roots and a commitment to the residents, families, and communities we serve. 2

Capitation Rates – Per Member Per Month Plan Per State Part A SNF Cap Part B Therapy Cap Skill in Place Per Diem GPMA - Nebraska $ 334.00 $ 137.00 $ 290.00 GPMA - South Dakota GPMA - North Dakota (Bismarck Area) $ 350.00 GPMA - North Dakota (Grand Forks Area) Capitation Checks cut last business day of the month and mailed directly to participating facilities. Member Count based on 15th of the month membership.

Supplemental Benefits 6 routine foot care visits per year 1 Routine Eye Exam and glaucoma test (annually) with Plan paying up to $275 annually for eyewear Hearing Exams – 1 routine exam and hearing aid fitting annually. Hearing Aids up to $2,000 every 2 years Dental -- Preventative services such as oral exam, cleaning and x-rays. Plan also pays up to $1,500 every 2 years Non-Emergency Transportation – 24 one-way trips annually Claims submitted by performing provider to the Plan using paper claims, Provider Portal via EZNet or EDI.

Non-Emergency Transportation Plan covers 24 one-way non-emergency transports per year under following 3 categories: Non-Emergency - No Wheelchair/Ambulatory (A0120): $35.00 + $2.00 per mile (A0380) (each way) Non-Emergency - Wheelchair: (A0130) $55.00 + $2.00 per mile (A0380) (each way) Non-Emergency - Stretcher: T2005 @ $112.50 + $2.00 per mile (A0380) (each way) Claims submitted by performing provider to the Plan using paper claims, EZNet or EDI.

Cannot bill future dates of service Great Plains Medicare Advantage Plan follows all Medicare guidelines in regard to timely filing requirement (12 months from date of service) Cannot bill future dates of service Bill Great Plains Medicare Advantage Plan as you would bill Medicare in 30 day increments Acceptable claim forms: CMS 1500 for Professional Claims UB04 for Facility Claims Claims can be submitted via paper, Provider Portal via EZNet or EDI Paper Claims Mailing Address: Great Plains Medicare Advantage Plan PO Box 908 Addison, TX 75001-0908 6

Provider Portal Access and Training EZNet Functionality: Member Eligibility Lookup Authorization/Referral Submittal & Inquiry Claims Submittal & Inquiry User Guide & Training Video available on home page: https://planprovportal.align- 360.com/EZ-NET60/ConfigFiles/EZ- NET%20User%20Guide.docx Monthly provider trainings offered on the last Friday of each month at 12:30 PM EST

Reduce the cost of sharing information— reduced faxes, voicemail, and telephone tag Improve the accuracy of information presentation—eliminate the incidence of human error Provide secure, controlled access to information 24 hours a day, 7 days a week Enhance communication between us and our network providers Compatible with the popular Microsoft® Internet Explorer 9.0 and > 8

EZ-NET Benefits to Business Partners Search for network providers Submit authorizations requests and claims into the EZ-CAP system Inquire on authorization status Verify health plan eligibility View member authorization history Check status of claim/encounter information PCPs can access and print assigned member lists Look up procedure codes, diagnosis codes, and other general reference information Provide a contact list of key office personnel for problem resolution

Payment Schedule Claims can be submitted directly through our clearinghouse or through your current system. You can also receive payments electronically, but you need to sign up! Here is how: EDI Customer Support: 1-888-635-0009, Option 2 Website: http://exchangeedi.com/quick-links Obtain Companion Guide from the Great Plains Medicare Advantage website EDI Routing Great Plains Medicare Advantage ND – GPND1 Great Plains Medicare Advantage SD – GPSD1 Great Plains Medicare Advantage NE – GPNE1 10

Claims Require the Authorization UM Department can be reached at: Phone: 1-844-637-4760 (Option 3) Fax: 800-541-9048 Email: UMInquiryRequest@GreatPlainsMedicareAdvantage.com For help, Great Plains Medicare Advantage Provider Services Representatives can be reached at: 1-844-637-4760 Helpful provider information is always available on the Great Plains Medicare Advantage website: www.greatplainsmedicareadvantage.com 11

Authorization Quick Guide Optometry- No preauthorization required. No preauthorization required for glasses ($275 benefit every year) but encourage provider to verify benefits with provider services (844-637-4760) to ensure that benefit has not been used. Audiologist- Requires preauthorization. Plan does cover hearing aids up to $2000 every 2 years. Dental- Requires preauthorization. Plan does cover dentures up to $1500 every 2 years. Podiatry- No preauthorization is required as long as visit is done at facility. If member has to go to an office visit, referral from PCP/NP is required and Request for Authorization form needs to be submitted. Psychiatrist-Requires PCP/NP referral and copy of order must be included with Request for Authorization form. Psychologist/LCSW visits-Requires PCP/NP referral and copy of order must be included in the Request for Authorization form. 12

Authorization Quick Guide Specialist- Requires PCP/NP referral and preauthorization. Please check provider directory for in network physicians or contact your Member Advocate for assistance. Examples include cardiologist, orthopedic, ENT, etc. Wound Management/DME-Requires preauthorization and PCP/NP referral along with clinical documentation. Labs-No preauthorization is required. If member has to go out of facility, PCP/NP referral is required along with Request for Authorization form. If services are emergent, no preauthorization is required. X-rays-No preauthorization is required. If member has to go out of facility, PCP/NP referral is required along with Request for Authorization form. If services are emergent, no preauthorization is required. Transportation-Requires preauthorization for Ambulance. This can be included on the same Request for Authorization form as the Hospitalization. The transport for the supplemental benefit for non- emergency transport does not require an authorization. 13

Thank You!

Billing Training Updated: March 2018