AAHAM April 24, 2015

Member Access Member access to any PCP/Specialist in network –No referral necessary –Don’t have to see PCP on card –Member can call Member Services to update their card No copays –Arbor Health Plan does not charge copays for any service 2

Additional member benefits Arbor Health Plan provides additional benefits to members: Adult Preventive Visits and Vaccinations 24/7/365 Nurse Call Line Rapid Response and Outreach Team Diaper Reward Program Parenting and Lamaze Classes Breast Pump Purchases YMCA 90 Day Membership (select locations) Community Baby Shower 3

Prenatal Care MCOs responsible for newborns effective 2/1/14. –Once DHHS is notified of birth, newborn is retroactively enrolled in Managed Care the first of the month of the notification Obstetrical Needs Assessment Form (ONAF) –Receive $100 for completing form –Receive additional $300 if certain criteria are met –Available on our website 4

Enhanced Obstetrical Care Payments Additional payment of $300 ($100 for each measure) is automatically issued if an ONAF is received: –First visit occurs in first trimester or within 42 days of member’s Arbor membership –Infant is term (37 weeks) and not an elective delivery prior to 39 weeks gestation –Post-partum visit within 21 to 56 days after delivery Submit even if global code was billed. Payments for deliveries in July through December 2014 issued in May or June. 5

Recent Changes/Updates continued Enhanced PCP payments to continue Fee schedule updates will match Nebraska Medicaid effective dates. –Individual provider and facility rate updates will still be delayed 30 days Electronic Communications effective 7/1/15. – –Fax –Mouse 6

Recent Changes/Updates continued HIPAA 5010 X12 effective 4/1/15. –Incorrectly formatted claims will be rejected. ICD-10 has been delayed until 10/1/15. –Providers will be able to test ICD-10 claims with us, when the time comes. July and August is the projected timeframe. 7

Reminders Timely filing is 365 days from DOS Appeals/Resubmissions/Corrections within 90 days of original remit –DO NOT send claims or corrections to Omaha office COB claims must be submitted within 365 days of DOS or 60 days from primary EOB generation, whichever is longer. When submitting with an invoice, item must be easily identifiable by code on the invoice. Routine and medical vision claims submitted to Avesis (anesthesia and facility fees for vision services submitted to Arbor). 8

Credentialing Provider must be enrolled with Nebraska Medicaid at practice location –Enrollment Center – – Credential via: –CAQH –Arbor Health Plan’s Full Credentialing Application Contact your Account Executive with questions 9

NaviNet NaviNet Web Portal: Phone: –View Member Eligibility –Member Rosters –View Third Party Liability Information (TPL) –Claims Status & Updates –View/Print Remittance Advices –Prior Authorization Requests –Gaps in Care Report 10

Provider Network Management Adam Steffen, Director Provider Network Management Jessica Wykert, PNM, Account Executive – Western Nebraska Cathy Bojanski, PNM Account Executive – Northeast Nebraska Kami Hudson, PNM Account Executive – Southeast Nebraska 11