HEALTH Claim COST CONTAINMENT SOLUTIONS for Tpa’s

1. HEALTH ClaimCOST CONTAINMENT SOLUTIONS for Tpa’s Presented by London Medical Management, Inc.

2. DISCUSSION • Health Claim Cost Containment Solutions • Unique combination of Health Claim Negotiations with PatientPALTM advocacy services

3. In-network Claims: • PHCS • Multi-plan • Three Rivers • InterPlan • Beech Street HEALTH CLAIM NEGOTIATIONS 2 Buckets of Claims • Out-of-network Claims: • No network affiliation • No discounts

4. HOSPITAL STOP LOSS PROVISION Protects the Hospital, NOT the Client ***Once Billed Charges reach the Stop Loss amount ($50,000 in this case), hospital Reimbursement reverts from Per Diem to a Percentage of Billed Charges (usually 40% discount) ***Example above: Average Daily Reimbursement is $7,200

5. In-network Claims: • PHCS • Multi-plan • Three Rivers • InterPlan • Beech Street HEALTH CLAIM NEGOTIATIONS 2 Buckets of Claims • Out-of-network Claims: • No network affiliation • No discounts

6. Pend: • ALL in-network claims that reach $10,000*** level • ALL out-of-network claims • All Claims must be pended BEFORE they are paid • ***Threshold levels may be adjusted to maximize client savings HEALTH CLAIM NEGOTIATIONS Process

7. CLAIM from TPA • UB 92/HCFA 1500 • ASC II File Format • In/Out of network • indication • Provider Contact • agreements are negotiated one • claim at a time HEALTH CLAIM NEGOTIATIONS Process • Provider Charges (Research) • based on geographic • location of the facility/provider • - Historical negotiations data • LMM Claim Fact Sheet • claim details extracted • from info provided by • TPA

8. HEALTH CLAIM NEGOTIATIONS PROVIDER DATABASE

9. HEALTH CLAIM NEGOTIATIONS Claim Fact Sheet

10. HEALTH CLAIM NEGOTIATIONS Claim Fact Sheet

11. In-network Claims: • Claims < $10,000*** should be processed according to • the network contract • Claims > $10,000*** will be sent to LMM for review • Out-of-Network Claims (include “wrap” networks): • ALL out-of-network claims will be sent to LMM for review • ***Threshold levels may be adjusted to maximize client savings Claim Negotiations Protocol

12. *Negotiations for a Fortune 500 company working with a nation’s leading health plan **PLAN Allowable includes discounts available through associated networks

13. Nationally recognized advocacy service for your clients

14. Patient PAL is an advocacy service available to employees and their covered family members when faced with: • Chronic health conditions • Emergencies • Major surgeries • High-risk critical illnesses • Catastrophic health events PATIENT PALTM

15. Well Patient Entry • Patient PAL - 24/365 • Physician Referral • 2nd opinion • Emergency transportation • COE/Hospital Admission Assistance • Pricing Negotiation Acute Patient HRA Patient PAL Care Continuum At Risk Patient Identification Large Claim Assistance • Outreach & Coaching • Comprehensive • Physical Exam • Physician Referral • Disease Management • Engagement Pre-Admission Post Discharge

16. Patient Record Face Sheet Electronic Medical Record (EMR)

17. Patient Referral Source

18. Health Claim Cost Reduction: • Percentage of documented savings • Patient PAL services available to all covered • members on as needed basis London Medical Management Contingency Fee

19. WHAT WE HELP YOU ACHIEVE • Decrease the total cost of health care through direct negotiations of individual patient claims • Enhanced service by accessing Patient PAL for employees makes TPA’s more competitive against carriers

20. Our Value Proposition • We assist TPA’s and employers to reduce the cost impact of large claims through direct negotiations with providers. We utilize the savings from these negotiations to help employees and their dependents navigate the complexities of the healthcare system through our Patient PAL program.

21. Our Clients Include:

22. SUMMARY • Health Claim Cost Containment Solutions • Unique combination of Health Claim Negotiations with Patient PALTM advocacy services

23. NEXT STEPS • Implementation: • Business Associate Agreement between TPA and LMM • Claims negotiation protocol implementation with the Health Plan • Non-disclosure Agreements

24. Frequently Asked Questions Q: How are negotiations done? A: Knowledge-based negotiations with information available through internal negotiation database. Q: Is existing discount negated? A: Existing discount is never negated. That’s why allowable amount is critical to have so that LMM negotiates an additional discount. Q: Who pays LMM fees? A: Client pays LMM fees. Q: What is the provider payment monitoring system? A: Once negotiations are complete LOA is sent to client TPA for payment; LMM reaches out to provider to verify receipt of payment. Q: How is the claim information exchanged? A: Excel format, usually exchanged through client’s FTP/secured server. Q: How often is client invoiced? A: Monthly

25. Frequently Asked Questions Q: What is included in the invoice? A: All negotiated claims showing Billed Charges, Allowable, Final Payment and Savings. Q: How long is the set-up process? A: Usually two weeks from signature of all agreements. Q: Is Allowable or Payment negotiated? A: Negotiations are based on Allowable amounts. Q: What happens to patient responsibility, deductible and/or co-insurance upon successful completion of negotiations? A: Patient responsibility still applies. Q: What are the next steps? A: Health Plan LOI; BAA; Contract with LMM; analysis of health claims retrospectively to show potential savings had LMM been involved. Q: How does Patient PAL work with Case Management or does it replace it? A: Patient PAL does not replace but rather enhances Case Management, where Case Management serves as authorization entity and Patient PAL serves as facilitator of prompt and best medical care.

26. LMM Contact Info Corporate Headquarters Contact: Jack G. London, President/CEO Phone: 702-737-7555 Fax: 702-737-7504 Address: 11920 Southern Highlands Pkwy Suite 103 Las Vegas, NV 89141 www.LondonMedicalManagement.com www.PatientPAL.org