MDwise Provider Portal 2018 IHCP Annual Workshop Good Afternoon, my name is David hoover. I am the provider representative for Region 5, which includes Kokomo, Logansport, Muncie, Decatur and Portland, Indiana. Today we will briefly go over MDwise as a whole and I will give some updates on things happening in the new year. MDwise Provider Portal HHW-HIPP0583 (9/18)

Agenda MDwise History Updates Provider Page Accessing the Portal Eligibility Claim Status Member Health Profile Quality Reports Portal Registration Helpful Hints Resources Questions

2007: MDwise selected to provide care through the Healthy Indiana Plan MDwise History 1994: MDwise founded as Indiana-based nonprofit health care company Central Indiana Managed Care Organization, Inc. (CIMCO), utilizing a delivery system model 2001: CIMCO teamed up with IU Health Plan and formed into MDwise, Inc., serving more than 55,000 Hoosier Healthwise members. 2007: MDwise begins service Care Select (now Hoosier Care Connect) members 2007: MDwise selected to provide care through the Healthy Indiana Plan 2018: MDwise acquired by Michigan-based McLaren Health Care; one of Michigan’s largest integrated health systems MDwise’s history began back in 1994 when we were founded as CIMCO. From 2001 to 2014, MDwise offered medical coverage to Indiana residents through the Hoosier Healthwise, Hoosier Care Connect, formerly Care Select, HIP and Marketplace programs. Our focus shifted over the last couple of years from all 4 medical programs to just Hoosier Healthwise and HIP. And in 2017, MDwise was purchased by McLaren Health Care, a Michigan-based health system with a significant health plan operation across the state of Michigan.

Who Is McLaren Health Care? Is one of the largest integrated health care systems in Michigan Owns 15 hospitals, including Barbara Ann Karmanos, nationally renowned for their cancer care and outcomes Employs over 500 physicians Trains over 550 residents annually Has a workforce of over 20,000 Owns McLaren Health Plan, who covers over 265,000 members in Medicaid, commercial, and Medicare Supplemental markets.

MDwise – McLaren Synergies Sharing Best Practices between MDwise and McLaren Health Plan, such as: Care Management Opioid Crisis Management Effectively managing inappropriate ER utilization Streamlining Prior Authorizations Pay for Value Physician Incentive programs Claims adjudication Results are Demonstrating: Improvement in health care outcomes for our members Enhanced access for members Greater administrative efficiencies, which allow more health care dollars to be spent on the actual delivery of medical care

Updates Effective 1/1/19: MDwise is restructuring it’s Delivery System model to: Improve claim payment timeliness and accuracy Streamline and reduce administrative redundancy for providers Provide greater access for our members One standard authorization list One point of contact for all authorization requests One claim submission address Non-Excel Delivery System contracts Providers not contracted with MDwise Excel must contract to stay in network. Effective January 1, 2019, MDwise will begin operating as a single network, MDwise Excel. This will show when checking eligibility in the MDwise Portal as well as the state systems. Along with this change, MDwise delivery system contracts will expire December 31, 2018. If you are not currently contracted as a MDwise Excel provider and want to be able to see MDwise members, you will need to contract as a MDwise excel provider. Please reach out to your dedicate provider representative to begin this process. Also changing will be out claims processing, our prior authorization process and requirements, and our MDwise portal access. All of these items are covered in this presentation, so lets get started!

Effective 1/1/19: Eligibility: Updates When determining eligibility, verify: Is the member eligible for services today? Which Indiana Health Coverage Program plan are they enrolled? If the member is in Hoosier Healthwise or Healthy Indiana Plan, are they assigned to MDwise? Who is the member’s Primary Medical Provider (PMP)? Beginning in January, you will be able to utilize the state website for the members Program and MCE. The assigned network or delivery system will always be MDwise Excel. To verify a PMP, you will use the MDwise provider portal, as you do now. Provider Healthcare Portal MDwise Provider Portal IHCP Program Delivery System: MDwise Excel MCE Assigned PMP History Assigned PMP

Effective 1/1/19 Prior Authorization One standard authorization list One point of contact for all authorization requests Submission timelines and process will not change Go to MDwise.org for most up-to-date version of PA lists MDwise.org For Providers Forms Prior Authorization Effective January 1st, our PA guides will update. There will be one PA list per program. The PA lists will still be housed on the Prior Authorization page. The current 2017 and prior PA lists will remain on this page to allow for review after the new year. Be sure you are reviewing the correct PA guides in the new year.

Provider Page

Provider Page

Provider Page Features: Provider Manuals Department Forms Pharmacy Resources Quality Education Materials Contact Guides New and Announcements Provider Portal Access ProviderLink Newsletter How to Become a MDwise Provider Prior Authorization Lists Continuing Education Materials

Why use the Provider Page? Updated versions of forms Updated contact guides Access to archived materials Learn how to earn incentives through Quality Print resources for your office to educate members on: Smoking Cessation Behavioral Health Diabetes Pregnancy

How to access the Provider Portal Accessing the Portal How to access the Provider Portal

Accessing the Portal

Accessing the Portal Access your Portal Profile Request an Account View Sign-up Guide for Questions

Features of the MDwise Portal Accessing the Portal Features of the MDwise Portal Claim Status Claim Payment Information Member Eligibility Quality Reports PMP Member Rosters Member Health Profile Care Management/Disease Management (CM/DM) Request Form Secure Messages for Provider Relations

Accessing the Portal

Eligibility Verifying Eligibility Search by member RID or SSN Original effective date Eligibility Status PMP History Claim history for last 150 days

Claim Status Tip: Search claims by member RID and date of service to see status on all claims submitted for this date (paid, denied, duplicate, pended)

MDwise Provider Portal Claim Status MDwise Provider Portal

The information is displayed in one interface and can be printed. Member Health Profile The Member Health Profile (MHP) is an online tool to help registered in-network PMP’s and specific Behavioral Health providers with coordination of care. Allows the primary medical provider (PMP) and behavioral health (BH) provider to view their members medical and pharmacy claims for all of doctors that see the member. The information is displayed in one interface and can be printed. PMP’s can use this information to identify the gaps in care and better manage the members overall care plan.

How to Request Access to Member Health Profile: Complete our online request form Only PMP NPI’s should be used, Specialists/non-PMP’s will not be able to lookup users in the Member Health Profile. Allow 5-7 business days for processing If providers have technical issues getting registered or accessing the profile, please send an email to healthprofile@mdwise.org. Please note: This is not for claims questions. Do not send any PHI

Member Health Profile

Member Health Profile

Member Health Profile

Quality Online Reports Quality Reports Members in need of services PMP Panels

Missed Opportunities Report Quality Comparison Report Compares individual provider office performance to all of MDwise. Missed Opportunities Report Shows opportunities at member appointments that were missed. Example: An acute visit that can also count toward a well visit. Year to Date Report Shows where your office is compared to the previous year. The comparison report shows where your office is compared to the rest of the MDwise providers

Quality Request Access Complete required fields and submit Access granted within 2-3 business days

Resources 1 2 5 3 4 9 If you have questions on these forms or on the contracting process for MDwise Excel, be sure to contact your dedicated Provider Relations representative for your region, as shown here. 6 8 7

Resources Representative Territory Phone Email Paulette Means Region 1 317-822-7490 pmeans@mdwise.org Garrett Walker Region 2 317-983-6088 gwalker@mdwise.org Michelle Phillips Region 3, Hospice, Home Health 317-983-7819 mphillips@mdwise.org Jamaal Wade Region 4 317-822-7276 jwade@mdwise.org David Hoover Region 5 317-983-7823 dhoover@mdwise.org Tonya Trout Region 6 317-308-7329 ttrout@mdwise.org Rebecca Church Region 7 317-308-7371 rchurch@mdwise.org Sean O’Brien Region 8 317-308-7344 sobrien@mdwise.org Whitney Burnes Region 9 317-308-7345 wburnes@mdwise.org Nichole Young Behavioral Health (CMHC, OTP, IMD or Residential) 317-822-7509 nyoung@mdwise.org Michelle Phillips, our dedicate Home Health and Hospice rep is now covering region 3 as well. If you are a DME provider, please reach out to the Representative in you respective region. Also, territory reps are now covering ABA providers as well. For behavioral health, Nichole young covers CMHC’s, OTP’s, IMD’s and residential providers. All other BH providers should contact their territory reps.

MDwise Customer Service Resources MDwise Customer Service 1-800-356-1204 MDwise Provider Relations 317-822-7300 ext. 5800 Enrollment submissions & updates go to prenrollment@mdwise.org Provider Relations Territory Map http://www.MDwise.org/for-providers/contact-information/ MDwise Website www.MDwise.org

Questions