Arkansas Payment Improvement Initiative (APII) April Statewide Webinar April 17, 2013

1. Arkansas Payment Improvement Initiative (APII) April Statewide Webinar April 17, 2013 0

2. Contents • Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative • Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update • Sheena Olson,Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update • Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder • Paula Miller, HP Enterprises Analyst - PAP Report Update

3. Overview Arkansas aims to create a sustainable patient-centered health system Focus of presentation Objective • Accountability for the Triple Aim • Improving the health of the population • Enhancing the patient experience of care • Reducing or controlling the cost of care Care delivery strategies • Population-based care delivery • Risk stratified, tailored care delivery • Enhanced access • Evidence-based, shared decision making • Team-based care coordination • Performance transparency • Episode-based care delivery • Common definition of the patient journey • Evidence-based, shared decision making • Team-based care coordination • Performance transparency Enablinginitiatives Payment improvement initiative Health care workforce development Consumer engagement and personal responsibility Health information technology adoption SOURCE: State Innovation Plan

4. Payers recognize the value of working together to improve our system, with close involvement from other stakeholders… Coordinated multi-payer leadership… • Creates consistent incentives and standardized reporting rules and tools • Enables change in practice patterns as program applies to many patients • Generates enough scale to justify investments in new infrastructure and operational models • Helps motivate patients to play a larger role in their health and health care 1 Center for Medicare and Medicaid Services

5. Providers, patients, family members, and other stakeholders who helped shape the new model in public workgroups Public workgroup meetings connected to 6-8 sites across the state through videoconference Months of research,data analysis, expert interviews and infrastructure developmentto design and launch episode-based payments Updates with many Arkansas provider associations (e.g., AHA, AMS, Arkansas Waiver Association, Developmental Disabilities Provider Association) 1,000+ 29 26 Monthly Key Design Elements We have worked closely with providers and patients across Arkansas to shape an approach and set of initiatives to achieve this goal

6. Health Homes Episodes: Assess-ment based Episode-based models PCMH Episodes: Retros-pective risk-based • A Population & episode-based delivery systems roll-out: next 3-4 years Approach Timing Wave (description) 1 2Q 2012 –- 3Q 2012 3Q 2013 –- 3Q 2014 3Q 2014 –- 3Q 2015 • 69 CPC enrolled practices, ~230 providers, 100k+ Arkansans1 • Target voluntary enrollment up to 30% of practices (including “virtual practices,” 2), focusing initially on Pediatrics • Target enrollment of remaining primary care practices 2 3 Population-based models 1 1H 2013 –- 1H 2014 2H 2013 –- 2H 2014 • All adult DD providers (children follow 6-12 months)Voluntary enrollment for eligible BH providers 2 1 3Q 2012 –- 4Q 2012 4Q 2012 –- 4Q 2013 4Q 2013 –- 2Q 2016 • Multi-payer launch of first 5 episodes (ADHD, URI, CHF, Joint replacement, Perinatal) • Transition to scale while maintaining momentum: 1-2 sub-waves of 5-10 episodes • Accelerate scale up: quarterly launch of 5-10 episodes 2 3 2H 2013 –- 2H 2014 • All adult DD and LTSS services (DD kids phase-in 6-12 months behind adult) 1 1 CPC practice participation as of March, 2013 2 Virtual aggregation of patient panels to meet scale of 5,000 persons Source: State Innovation Model Application

7. Contents • Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative • Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update • Sheena Olson,Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update • Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder • Paula Miller, HP Enterprises Analyst - PAP Report Update

8. Episodes Update For Medicaid, work has occurred on 15 Episodes, with 5 having gone live Live Pending legislative review In Development • Wave 1 Wave 1a Seeking clinical input Wave 1b • Wave 2 Wave 2a Wave 2b Wave 2c (not started) 1 Participation includes development and rollout of episode

9. Contents • Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative • Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update • Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update • Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder • Paula Miller, HP Enterprises Analyst– PAP Report Update

10. PCMH town hall schedule Date Location Address April 16 4 – 6 pm Little Rock UAMS at I. Dodd Wilson Education Building -- Rooms 126 & 226 4301 W. Markham Little Rock, AR  72205 April 18 4 – 6 pm Mountain Home Arkansas State University-Mountain Home – McMullin Hall 1600 South College Street Mountain Home, AR 72653 April 22 4 – 6 pm Fort Smith Golden Living Building – Rogers Taylor Conference Room 1000 Fianna Way Fort Smith, AR 72919 April 25 4 – 6 pm El Dorado South Arkansas Community College – Library Auditorium 300 S. West Avenue El Dorado, AR 71730 May 7 4 – 6 pm Hot Springs National Park Community College – Auditorium 101 College Drive Hot Springs, AR 71913 May 9 4 – 6 pm Bentonville Northwest Arkansas Community College – Wal-Mart Auditorium 1 College Drive Bentonville, AR 72712 May 15 4 – 6 pm Paragould Arkansas Methodist Medical Center – Auditorium 900 West Kings Highway Paragould, AR 72451

11. Contents • Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative • Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update • Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update • Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder • Paula Miller, HP Enterprises Analyst - PAP Report Update

12. Treatment Outcomes Assessment & Diagnosis • Effectiveness of treatment • Reasons necessitating second treatment plan • Continuing care • Initial treatment plan1: 2 visits per week2 for 12 weeks (based on evidence based programs) • ~40% improve3 • Re-assess those that do not improve • Second treatment plan1: 2 visits per week2 for 12 weeks (based on evidence based programs) • ~30% improve3 • Re-assess those that do not improve • Medication may be a useful adjunct (primarily with comorbidities) • For comorbid ADHD/ODD, treatment should address ADHD symptoms first • Thorough assessment is performed • Licensed clinician confirms diagnosis and is responsible for care • Parent/caregiver notification Guideline-concordant treatment pathway for clients diagnosed with ODD PRELIMINARY 1 Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; 2 Visits may include client or parent/caregiver therapy; 3 Expert Interviews SOURCE: Expert Interviews, Journal of Clinical Child and Adolescent Psychiatry and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry

13. Distribution of number of non-comorbid ODD clients treated by individual providers PRELIMINARY Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only Number of clients treated by individual providers (clients aged 6 – 17, no comorbid conditions)1 # clients Provider count 240 50 40 30 20 10 0  1-5  6-10  11-20  21-50  51-100 101+ Clients treated % of Providers 54% 9% 12% 13% 7% 5% % of Episodes 0.8% 2.4% 6.1% 18.1% 26.5% 46.0% Average episodes per client1 1.2 1.6 2.0 2.3 2.6 2.5 1 Episode defined as one 90 day program SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)

14. Concordant with evidence-based programs, the most frequent services provided are non-medical interventions PRELIMINARY Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477) Cost breakdown by service type for ODD episodes (clients aged 6 – 17, no comorbid conditions) Total cost, ($ millions) $19 M $1 M $1 M $2 M $13 M $2 M Total Assessment1 Testing2 Office visits Non-medication interventions3 Medication % total cost 5% 6% 11% 68% 9% % episodes with occurrence 69% 17% 78% 92% 39% 1 Represents assessments billed to Medicaid. 58% of spend is from 90885 9 ZZZ, Psychiatric evaluation of hospital records; 42% of spend from 90801 9 ZZZ Psychiatric diagnostic interview exam 2 90% of spend from uncoded claims (no CPT code); 5% of spend from 90801 9 AR1, Psychological testing; 4% of spend from 96101 9 ZZZ, Psychological testing (includes psychodiagnostic tests of emotion); 1% other 3 Non-medication interventions includes all psychotherapy, counseling, community support, and therapeutic activities SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy)

15. Behavioral Health Providers provide the vast majority of ODD care in Arkansas PRELIMINARY Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477) Cost breakdown by provider for ODD episodes (clients aged 6 – 17, no comorbid conditions) Total cost, ($ millions) $19M $0.4M $18.5M $0.1M Total Physician (PCP or Psychiatrist) Behavioral health provider organization Other1 Episode count 190 10,225 62 % total episodes 1.8% 98% 0.5% Average cost / episode $1,311 $1,782 $731 1 Other includes FQHC providers, non-behavioral health provider school-based providers, and non-standard providers of care SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy)

16. A third of clients (32%) are receiving care above and beyond what is recommended in guidelines and evidence-based treatments PRELIMINARY Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only Episode cost distribution for episodes (clients aged 6 – 17, no comorbid conditions) Average cost / episode ($) Episode count These clients represent 63% of spend Estimated cost of effective evidence based programs1 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000 13,000 14,000 More Average cost / episode Dollars 1 Evidence Based programs suggest 1-2 treatments per week for 12-14 weeks = ~30 treatments; Medicaid data shows median cost/treatment = $72; 30 treatments x $72/treatment = $2160 per episode. SOURCE: Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; Journal of Clinical Child and Adolescent Psychology and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry; Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)

17. Contents • Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative • Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update • Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update • Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder • Paula Miller, HP Enterprises Analyst - PAP Report Update

18. Medicaid Little Rock Clinic 123456789 April 2013 Arkansas Health Care Payment Improvement Initiative Provider Report Medicaid Report date: April 2013 Historical performance: April 1, 2012 – March 31, 2013 DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.org

19. Division of Medical Services P.O. Box 1437, Slot S-415 · Little Rock, AR 72203-1437 501-683-4120 · Fax: 501-683-4124 Dear Medicaid provider, This is an update on the Arkansas Health Care Payment Improvement Initiative – a payment system developed with input from hundreds of health care providers, patients and family members. Our goal is to support and reward providers who consistently deliver high-quality, coordinated, and cost-effective care. As a reminder, a core component of this multi-payer initiative is episodes of care. An episode is the collection of care provided to treat a particular condition over a given length of time. Since July, Arkansas Medicaid introduced five episodes: Upper Respiratory Infection (URI), Perinatal, Attention Deficit/Hyperactivity Disorder (ADHD), Total Joint Replacement (TJR), and Congestive Heart Failure (CHF), with many more episodes to be added over time. For each episode, the provider that holds the main responsibility for ensuring that care is delivered at appropriate cost and quality will be designated as the Principal Accountable Provider (PAPs). For some episodes in the period covered in the attached report (Jul 2011 to Jun 2012), you were identified as the PAP. After appropriate risk-adjustments and exclusions, your average quality and cost was compared with previously announced thresholds. This determines any potential sharing of savings or excess cost indicated in the report. Note that all information described throughout your report is based on retrospective claims and all providers should continue to submit and receive reimbursement for claims as they do today. The TJR and CHF episodes are currently in the preparatory phase and this current report is historical only, covering episodes completed between Jul 2011 and Jun 2012. The ‘performance period’ for these episodes will start February 1, 2013, and reports reflecting episodes eligible for risk and gain sharing will follow beginning in July 2013, due to time needed for appropriate claims to be received. To aid you in your role as a PAP for future episodes, we have been working hard with providers and other payers to design a set of reports that give you detailed data about the quality and cost of your care as well as how this compares with the range of performance of other providers. As each payer will send a report covering their patients, you may receive similar reports from Arkansas Blue Cross Blue Shield or QualChoice. We encourage you to log onto the provider portal at www.paymentinitiative.org to access your current and previous ‘preparatory period’ reports. As a PAP for either the CHF or TJR episodes, you should begin using this portal to enter selected quality metrics for each patient with an episode of care starting after February 1, 2013. We have been working diligently to solicit feedback from the provider community and will continue in our efforts to respond to all questions, comments and concerns raised in a timely and consistent manner. For answers to frequently asked questions regarding the initiative and episodes, please refer to the payment initiative website (www.paymentinitiaitve.org). You can also call us at 1-866-322-4696 or locally at 501-301-8311 with questions or email ARKPII@hp.com. Additionally, be sure to check the website regularly for updates on upcoming informational WebEx sessions, other resources, or to sign up for alerts. Sincerely, Andy Allison, PhD Medicaid Director DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.org 18

20. Medicaid Little Rock Clinic 123456789 April 2013 Table of contents Performance summary Attention Deficit/Hyperactivity Disorder (ADHD) – Level I Attention Deficit/Hyperactivity Disorder (ADHD) – Level II Cholecystectomy Colonoscopy Congestive Heart Failure Oppositional Defiant Disorder Perinatal Tonsillectomy Total Joint Replacement Upper Respiratory Infection – Non-specific URI Upper Respiratory Infection – Pharyngitis Upper Respiratory Infection – Sinusitis Glossary Appendix: Episode level detail

21. Medicaid Little Rock Clinic 123456789 April 2013 Attention Deficit / Hyperactivity Disorder (ADHD) – Level II Not eligible for gain sharing Upper Respiratory Infection – Sinusitis Will receive gain sharing Met Acceptable $0.00 N/A Commendable $349.50 Not eligible for gain sharing Not eligible for gain sharing Cholecystectomy Congestive Heart Failure Met Not met Acceptable Acceptable $0.00 $0.00 Not eligible for gain sharing Not eligible for gain sharing Perinatal Colonoscopy Met Met Acceptable Acceptable $0.00 $0.00 Not eligible for gain sharing Met Acceptable $0.00 Oppositional Defiant Disorder Not eligible for gain sharing Total Joint Replacement N/A Acceptable $0.00 Not eligible for gain sharing Tonsillectomy Met Acceptable $0.00 Upper Respiratory Infection – Non-specific URI Subject to risk sharing -$3,844.50 N/A Not acceptable Upper Respiratory Infection – Pharyngitis Not eligible for gain sharing Not met Acceptable $0.00 Performance summary Quality of services and cost summary 1 Quality of Service Average Episode Cost Share Amount Episode of Care Your Gain/Risk Share Not eligible for gain sharing Attention Deficit / Hyperactivity Disorder (ADHD) – Level I Met Acceptable $0.00 Across these Episodes of Care You are Subject to Risk Sharing: Stop-loss was applied -$3,000.00

22. Medicaid Little Rock Clinic 123456789 April 2013 $1,547 to $2,223 < $1,547 > $2,223 Completed certification % Level I episodes Avg. physician visits/episode ü ü Acceptable Not acceptable You Commendable Summary – ADHD: Level I closed episodes 1 Overview Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29 2 Cost of care compared to other providers Gain/Risk share $0 Commendable Acceptable Not acceptable You > $4000 All providers You are not eligible for gain sharing • Selected quality metrics: Met • Average episode cost: Acceptable 3 Quality summary 4 Cost summary You achieved selected quality metrics Your average cost is acceptable Linked to gain sharing Your total cost overview, $ Average cost overview, $ % episodes with medication 512,000 2,000 466,000 1,750 100% 100% Standard for gain sharing You (non-adjusted) You (adjusted) You All providers 50% 50% 0% 0% Your episode cost distribution You Avg You Avg 100 # episodes 100% 50 >$10157 <$700 $700- $1547 $1547- $1772 $1772- $1998 $1998- -$2223 $2223- $10157 50% 0% Distribution of provider average episode cost You Avg 7500 Cost, $ 20 5000 2500 10 Percentile 0 You Avg 5 Key utilization metrics All providers You Average number of psychosocial visits per episode Average number of visits per episode 4.1 62 3.9 38

23. Medicaid Little Rock Clinic 123456789 April 2013 Quality and utilization detail – ADHD: Level I closed Metric linked to gain sharing Minimum standard for gain sharing You 1 Quality metrics: Performance compared to provider distribution Percentile Percentile Metric You 25th 50th 75th 0 25 50 75 100 - % with completed certification 92% 50% 75% 85% % of episodes with medication 48% 40% 52% 67% % of episodes that are Level I 25% 20% 30% 40% Avg. physician visits per episode 4.1 2.3 3.9 4.3 - % non-guideline concordant 28% 10% 30% 50% - % non-guideline no rationale 15% 5% 15% 25% You achieved selected quality metrics û 2 Utilization metrics: Performance compared to provider distribution Percentile Percentile Metric You 25th 50th 75th 0 25 50 75 100 Average number of visits per episode 4.1 2.3 3.9 4.3 Average number of psychosocial visits per episode 62 15 38 74

24. Medicaid Little Rock Clinic 123456789 April 2013 Cost detail – ADHD: Level I closed Total episode included = 233 You All providers # and % of episodes with claims in care category Total vs. expected cost in care category, $ Average cost per episode when care category utilized, $ Care category 233 100% 550 128,150 Inpatient – PAP 100% 500 116,500 230 99% 2,415 555,450 Outpatient – PAP 99% 2,400 552,000 221 Ancillary professional 95% 76 16,796 97% 76 16,796 Inpatient readmission or transfer 184 79% 81 14,904 77% 81 14,904 21 75% 117 2,457 Primary inpatient admission 80% 95 1,995 16 78% 70 1,120 Outpatient facility 75% 75 1,200 12 5% 69 828 Pharmacy 3% 62 744 1 Emergency department <1% 97 97 <1% 84 84 7 3% 25 175 Other 4% 27 189

25. Medicaid Little Rock Clinic 123456789 April 2013 $5,403 to $7,112 < $5,403 > $7,112 Completed certification Avg. physician visits/episode % Level II episodes ü ü Acceptable Not acceptable You Commendable Summary – ADHD: Level II closed episodes 1 Overview Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29 2 Cost of care compared to other providers Gain/Risk share $0 Commendable Acceptable Not acceptable You > $4000 All providers You are not eligible for gain sharing • Selected quality metrics: Met • Average episode cost: Acceptable 3 Quality summary 4 Cost summary You achieved selected quality metrics Your average cost is acceptable Linked to gain sharing Your total cost overview, $ Average cost overview, $ % episodes with medication 512,000 2,000 466,000 1,750 100% 100% Standard for gain sharing You (non-adjusted) You (adjusted) You All providers 50% 50% 0% 0% Your episode cost distribution You Avg You Avg 100 # episodes 100% 50 >$12601 <$2223 $2223- $5403 $5403- $5973 $5973- $6543 $6543- $7112 $7112- $12601 50% 0% Distribution of provider average episode cost You Avg 7500 Cost, $ 20 5000 2500 10 Percentile 0 You Avg 5 Key utilization metrics All providers You Average number of psychosocial visits per episode Average number of visits per episode 4.1 62 3.9 38

26. Medicaid Little Rock Clinic 123456789 April 2013 $3,394 to $3,906 < $3,394 > $3,906 You are not eligible for gain sharing • Selected quality metrics: Met • Average episode cost: Acceptable ü ü C-section rate Avg. number of ED visits per episode Acceptable Not acceptable You Commendable Summary – Perinatal 1 Overview Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29 2 Cost of care compared to other providers Gain/Risk share $0 Commendable Acceptable Not acceptable You > $4000 All providers 3 Quality summary 4 Cost summary You achieved selected quality metrics Your average cost is acceptable Linked to gain sharing Your total cost overview, $ Average cost overview, $ HIV screening Gestational DM screening 850,000 3500 815,500 3400 100% 100% Standard for gain sharing You (non-adjusted) You (adjusted) You All providers 50% 50% 0% 0% Your episode cost distribution You Avg You Avg Group B Strep screening Bacteriuria screening 100 # episodes 50 100% 100% Standard for gain sharing <$2000 $2000- $3394 $3394– $3565 $3565– $3735 $3735- $3906 $3906- $5399 >$5399 50% 50% Distribution of provider average episode cost 0% 0% You Avg You Avg 12000 Chlamydia screening Hepatitis B screening Cost, $ 100% 100% 8000 Standard for gain sharing 4000 50% 50% Percentile 0% 0% You Avg You Avg 5 Key utilization metrics All providers You 2.1 30% 1.3 17%

27. Medicaid Little Rock Clinic 123456789 April 2013 Quality and utilization detail – Perinatal You Metric linked to gain sharing Minimum standard for gain sharing 1 Quality metrics: Performance compared to provider distribution Percentile Percentile Metric You 25th 50th 75th 0 25 50 75 100 - HIV screening rate 97% 50% 66% 99% - Group B strep screening rate 87% 60% 83% 93% - Chlamydia screening rate 90% 63% 84% 87% - Gestational diabetes screening rate 56% 42% 50% 65% - Asymptomatic bacteriuria screening rate 90% 43% 62% 73% - Hepatitis B screening rate 58% 41% 55% 69% You achieved selected quality metrics û 2 Utilization metrics: Performance compared to provider distribution Percentile Percentile Metric You 25th 50th 75th 0 25 50 75 100 C-section rate 17% 23% 30% 40% % episodes with an ultrasound 78% 71% 75% 81% Avg number of ED visits per episode 1.3 1.7 2.1 5.1

28. Questions

29. For more information talk with provider support representatives… Online • More information on the Payment Improvement Initiative can be found atwww.paymentinitiative.org • Further detail on the initiative, PAP and portal • Printable flyers for bulletin boards, staff offices, etc. • Specific details on all episodes • Contact information for each payer’s support staff • All previous workgroup materials Phone/ email • Medicaid: 1-866-322-4696 (in-state) or 1-501-301-8311 (local and out-of state) orARKPII@hp.com • Blue Cross Blue Shield: Providers 1-800-827- 4814, direct to EBI 1-888-800-3283, APIICustomerSupport@arkbluecross.com • QualChoice: 1-501-228-7111, providerrelations@qualchoice.com