Kristen Edsall R.N., B.S.N., M.S.N. Manager, Payer Relations Ensuring Appropriate Reimbursement: Commercial Insurance Tips and Tools Kristen Edsall R.N., B.S.N., M.S.N. Manager, Payer Relations If you are trying to connect to this webinar and are having technical difficulties, please call:   1-800-374-1852 – select option 2 The event code for this event is – 590 341 471

Attendance If you have multiple attendees on one phone line/viewing on one computer, please type the number of additional attendees in the ‘Chat’ window. Access the toolbar at the top of your screen. Click on the icon. I have just a few logistical announcements before we get started. All phones lines have been muted and will remain muted for the entire call. If you are viewing this presentation with colleagues at one computer please use the chat feature on the tool bar to enter the number in attendance in your room. We are interested in knowing how many people have joined us today.

To ask a question If you have a question, please type your question in the ‘Chat’ window. You may type in questions during the webinar. Questions will be answered in a Q&A document which will be sent out after the webinar To ask a question to the speakers or for technical assistance , please use the chat box. Simply click on the chat box icon on the top toolbar & type your question/comment in the box and select ‘send’. The chat box will be monitored throughout the session and speaker questions will answered at the end of the presentation. Technical questions will be responded to as quickly as possible.

Instructions on How to Answer Poll 9/18/2019 Instructions on How to Answer Poll Please use the question pop-up box on the right side of your screen Make your selection by clicking the radio button next to the answer that best fits your situation Click the “Submit” button Once the poll is closed it will take 20 seconds for results to display We have 3 poll questions at various spots in today’s presentation – here is how the polling works.

Reimbursement Support Center Project Goals 9/18/2019 Reimbursement Support Center Project Goals Create new tools to help transplant center staff work with payers in order to: Decrease reimbursement barriers by providing quick and easy-to-use information and tools Communicate effectively and work directly with payers on reimbursement issues and access challenges Here at NMDP we get a lot of questions from transplant centers that relate to insurance and reimbursement. Our goal with the expansion of our web resources is to help provide key information and resources so that every transplant center has access to this information and has one place to find the information. The content on the site is designed to help decrease barriers to getting timely and accurate reimbursement. We also want to foster and encourage your centers to develop great relationships with your payers as this will go a long way when things don’t go right.

New Reimbursement Support Center 9/18/2019 Network.BeTheMatchClinical.org Transplant Centers/Access to Transplant OR Network.BeTheMatchClinical.org/reimbursement The reimbursement resource center can be found on the network site and it is not password protected, anyone can access this area.

New Features Payer-specific content Checklists Letter templates 9/18/2019 Payer-specific content Checklists Letter templates Appeals process charts Payer organizational structure chart Links to learn more Important tips Glossary of definitions Here is a brief summary of the new tools on the site.

Resource Center Homepage Features Access to recorded webinars such as this one Support advocacy efforts! Find answers to questions we have received from transplant centers Find out how to contact us here

Commercial Insurance: Deep Dive Learn about Commercial Insurance A to Z & access tools to increase efficiency Understand different types of insurance products Learn how the Medical Policy process works and how you can get involved Access letter templates and other tools

Decode the language and acronyms of the payer/insurance world

Learn about payers clinical departments and what they do

Understand how payers are organized so you know how to navigate when you need to

How well do you understand how different insurance types (fully insured vs employer based) impact HCT coverage: I am knowledgeable and comfortable with the differences I know there are differences in coverage, but could benefit from more information I don’t really understand the difference

Commercial Insurance Overview 9/18/2019 Commercial Insurance Overview Page Tool

Commercial Products Better understand how insurance plan type impacts coverage and requirements

Commercial Policies

Commercial Medical Policy Process Get involved with your payer’s medical policy committee

Commercial Coverage 9/18/2019 Make sure you are very familiar with your payers policies and how they relate to coverage for your patients!

Commercial Authorizations

Commercial Authorizations 9/18/2019  If you received authorization for care from one payer and the patient changes payers you must get a new prior authorization from the new payer Request the urgency that fits with the patient situation

How familiar is your center with changes to the appeals process as a result of reform? Very familiar – we have updated our processes We know about the changes but not in detail Changes? What changes?

Due to reform appeals processes are more standardized! Page Tools: Step-by-step guide for standard appeals Step-by-step guide for urgent appeals Appeal Letter templates

Post ACA appeals have standardized process

Appeal letter templates Standard Appeal Level 1 appeal letter Standard Urgent Level 2 appeal letter Appeal letter templates For each type and stage of appeal

Many coding tools and content available HCT Coding Many coding tools and content available Page Tools

General Coding Tools Code Crosswalks

Clinical Trial Coverage Patients must be enrolled in an *approved* clinical trial in order to get coverage Page Tools

FAQ’s Don’t forget to check here for specific coding direction

Webinar Announcements & Recordings Check back to see what is coming up and catch up on what you missed!

Can I Download and Print Tools? Materials Catalog Access and download all available materials and tools via the Materials Catalog Filter on Reimbursement under Clinical Topics

Your Feedback is Valued Can you easily find what you need? Is the information easy to understand? Are the tools helpful? Are there additional tools you would find beneficial? Are there tools you have that you would be willing to share?

9/18/2019 Register for Our Next Webinar Reimbursement Support Center: Health Policy & Advocacy in the HCT Community: Get Involved! August 18th, 1-2pm CDT We will be hosting a monthly series to deep dive into sections of the resource center.

Stay Connected Subscribe to our e-news Join the BMT Financial Forum Learn about upcoming webinars Stay current on new tools Receive notifications about advocacy efforts and how you can help Join the BMT Financial Forum Connect with peers from other transplant centers for knowledge sharing Communicate with NMDP about advocacy efforts and learn how you can help

Evaluation When the webex ends please look at your browser to see a new window with the evaluation – you can complete the evaluation right now If you close out of that screen accidentally don’t worry we will send you a link via email Within a week you will get an email with a link to the eval

NMDP/Be the Match Contact Kristen Edsall Manager, Payer Relations 763-406-5837 PayerPolicy@nmdp.org

THANK YOU!!