A AHAM

1. AAHAM April 24, 2014

2. Member Identification Card

3. 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 • 866-935-6760 • No copays • Arbor Health Plan does not charge copays for any service

4. Additional member benefits • Arbor Health Plan provides additional benefits to members: Adult Preventive Visits 24/7/365 Nurse Call Line Rapid Response and Outreach Team Diaper Reward Program Parenting and Lamaze Classes Breast Pump Purchases – effective November, 2013 YMCA 90 Day Membership (select locations) Community Baby Shower

5. 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 • OB Billing Guide • Prenatal care billed on separate lines for each DOS • Progesterone (J1725 & J1725TH) covered.

6. Recent Changes/Updates Enhanced Obstetrical Needs Assessment Form (ONAF) Payments Effective 4/1/2014: Additional payment of $300 is automatically issued for meeting ALL following requirements: • Completed ONAF submitted to Arbor within two weeks of Arbor member’s first visit • First visit occurs in first trimester or within 42 days of member’s Arbor membership • Infant is term and not an elective delivery prior to 39 weeks gestation • Post-partum visit within 21 to 56 days after delivery

7. Recent Changes/Updates continued • Early Periodic Screening , Diagnosis, & Treatment (EPSDT) • DX Code V20.0 – V20.3 are allowed for CPT’s 99381-99384 and 99391 - 99394.  • DX Codes V70.0 – V70.3 and V72.31 are allowed when billing CPT’s 99381-99384 and 99391 – 99394 • Referral indicator codes MUST be included on claims using CPT well-child preventive codes 99381-99395 with the required EP modifier. (Electronic 837P or CMS 1500 box 24H).

8. Recent Changes/Updates continued • Enhanced PCP payments currently being made • Fee schedule updates will match Nebraska Medicaid effective dates. • Individual provider and facility rate updates will still be delayed 30 days • PT/OT/ST no longer require authorization effective 1/1/14. • Held to visit count limitation observed by Nebraska Medicaid • Quad screen (81511) added as a covered service.

9. Recent Changes/Updates continued • New CMS 1500 Form must be submitted. • Complete transition to new form effective 4/1/14. • ICD-10 has been delayed until 10/1/15. • Providers will be able to test ICD-10 claims with us, when the time comes.

10. 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).

11. Credentialing • Provider must be enrolled with Nebraska Medicaid at practice location • Enrollment Center – 877-255-3092 • http://dhhs.ne.gov/medicaid/Pages/med_providerenrollment.aspx • Credential via: • CAQH • Arbor Health Plan’s Full Credentialing Application • Providers credentialed with Blue Cross Blue Shield of Nebraska are granted automatic approval • Contact your Account Executive with questions

12. NaviNet • NaviNet Web Portal: www.navinet.net • Phone: 888.482.8057 • 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

13. Provider Updates • Arbor Website www.arborhealthplan.com • Provider Handbook – available online • Annual Provider Newsletter • Arbor Webkey Mouse • List-serve in development • Watch website for updates

14. Electronic Data Interchange (EDI) • To transmit claims electronically, contact your EDI software vendor and provide Arbor Health Plan payer ID # 52312 • Arrange electronic claims submission through your EDI vendor or through Emdeon at 877-363-3666 • Electronic Funds Transfer (EFT) 866-506-2830 • Simplifies the payment process by providing fast, easy and secure payments • Reducing paper • Eliminating checks lost in the mail • Not requiring a change to your preferred banking partner • Enroll through our EFT partner, Emdeon Business Services or sign up via our fast and easy links on www.arborhealthplan.com • Electronic Remittance Advice (ERA) 877-363-3666

15. Provider Network Management • Adam Steffen, Director Provider Network Management • asteffen@arborhealthplan.com • Jessica Wykert, PNM, Account Executive – Western Nebraska • jwykert@arborhealthplan.com • Cathy Bojanski, PNM Account Executive – Northeast Nebraska • cbojanski@arborhealthplan.com • Kami Hudson, PNM Account Executive – Southeast Nebraska • khudson@arborhealthplan.com