1. Credentialing, Enrollment and Creating a Partnership Nancy Marotta, Sr. Manager, Provider Operations, BCBSMA, April 27, 2016

2. 2 Blue Cross Blue Shield of Massachusetts Provider Operations Credential and Recredential Physicians, Clinicians and Facilities Execute Provider Contracts Enroll Providers into our Claims processing systems Maintain Provider Data Provider Data is fed to BCBSMA Member directories

3. 3 Blue Cross Blue Shield of Massachusetts We heard you and we agree with you! 2015 was met with many challenges Provider Operations underperformed We heard you; Lost Inventory Long turnaround times Have to submit transactions multiple times Had to call or query us multiple times

4. 4 Blue Cross Blue Shield of Massachusetts What we have done We listened We made changes We instituted controls We want to partner with you

5. 5 Blue Cross Blue Shield of Massachusetts What we have done Imaging, Index, automate inventory control Email Box for all receipts Auto Response (confirmation of receipt) ‘Close the loop’ campaign, Email responses Early Credentialing Process Hire additional resources Single Credentials committee; April 2016

6. 6 Blue Cross Blue Shield of Massachusetts How we can Partner Better Submit your requests to us in Email Provider-Enrollment@bcbsma.com You will receive an auto confirmation response from BCBSMA —Tip: include in the subject line what is in the email Start the Credentialing Process early Email the form listing key data elements for your new physician(s)/clinician(s) being added CAQH just has to be started, don’t wait for contracts to be ready Complete CAQH – Avoid delays Hospital Affiliation Confirmations MCSR (state DEA where applicable)-especially on Optometrist Advanced nurses-collaborating physician, admitting arrangements and Certificates (ANCC or NCC) PA’s-supervising physician and NCCPA # so that we can verify Any work history gaps over 6 months need to be in writing

7. 7 Blue Cross Blue Shield of Massachusetts How we can Partner Better Take the Guess work out of your Request Send a Contract Update form with every request Email the Contract We no longer return paper executed contracts ‘Closing the Loop’ On your contract update form be sure to include the email address(s) you want the response to be emailed too. If it is not on your contract update form we will look for another on your request Lastly we will email our response to the practice address we have on file Member Directories Important to let us know if a provider leaves your organization and or if phone numbers or addresses change. For changes not involving a contract use the ‘standard demographic form’ found on our portal at Bluecrossma.com CMS, NCQA and ACA all have come out with strict requirements on healthplans to ensure that directories are accurate for member usage.

8. 8 Blue Cross Blue Shield of Massachusetts Other Updates Single Credentials committee structure, April 2016 3 committees to one CPR and Credentialing are aligned Instituted weekly subcommittee meetings Credentialing Policy Board Certification/DEA/Reference letter Revisiting Foreign Trained Policy Credentialing Guidelines are on Bluecrossma.com

9. 9 Blue Cross Blue Shield of Massachusetts For more information Business Operations Analyst – K Grade Contact Nancy Marotta@bcbsma.com