Caring for our customers

1. Caring for our customers Fall 2017 Updates

2. Websites • Websites for health care professionals • www.aetna.com • Information on how to work with us, products & programs, resources for health care professionals and helpful links. • www.navinet.net • Information on member eligibility, claim status, EOBs, claim reconsiderations, secure emails to provider services, claim payment policies, claims reimbursement tool, claims payment estimator and much more!

3. Aetna OfficeLink Updates – News you can use • Aetna OfficeLink Updates delivers timely information for your practice or facility. • The online newsletter is published in March, June, September and December. • Inside each issue providers will find: • Updates to our precertification list • Clinical payment, coding and policy updates • Medicare information • Pharmacy information • Plan and product information • State specific news • Providers may also chose to sign up to receive the electronic communication via email located in the OfficeLink section of Aetna’s website. • Newsletters can be found by going to www.aetna.com, Health Care Professionals, Newsletters & News, Read OfficeLink newsletters and then Mid-America OfficeLink Update newsletter. • All previous copies are stored online as a reference.

4. Aetna at a Glance • A quick reference guide for health care professionals • The quick reference is a great tool to find: • Secure website (NaviNet) resources & information • Secure website (NaviNet) tools and transactions • Claims submission information & claims addresses • Provider Service Center contact information • Contact information specific to the Mid-America Region • This guide can be found by going to www.aetna.com, Health Care Professionals, Education & Manuals, Explore provider manuals, Read our quick-reference guide.

5. Provider Manuals • Provider manuals about our policies and programs You can view and download these manuals: • Office Manual for Health Care Professionals • Behavioral Health Provider Manual • Women’s Health Programs and Policies Manual • Aetna Benefits Product Guide Provider manuals can be found by going to www.aetna.com, Health Care Professionals, Education & Manuals, Explore provider manuals Coventry Health Care provider office manuals are located on www.chcnebraska.com, Services & Support, Providers, Document Library, Provider Manual

6. Educational webinars • Learn how to work with us electronically • We offer interactive, 45-minute webinars that walk you through how to use our online tools. How to register for webinars • Register online at www.aetna.com, Health Care Professionals, Provider Education & Manuals, Educational Webinars and click the Complete the online webinar registration form link. • Sent an email to eSolutionsTraining@aetna.com with the name and date of the webinar in the subject line.

7. Claims, Payment & Reimbursement • Convenient tools and guidelines to help you get paid faster • ERA, EFT and Electronic EOB information • Coordination of benefits & claims submission information • Electronic transaction tools • Payment estimator & fee schedule information • Aetna Signature Administrators (ASA) information • Overpayment information • This information can be found by going to www.aetna.com, Health Care Professionals, Claims, Payment & Reimbursement

8. Disputes & Appeals Process • Our process for disputes and appeals • Log onto www.aetna.com, Health Care Professionals, Disputes & Appeals to learn more about Aetna’s Dispute & Appeals process • Reconsiderations and Disputes can be submitted online through NaviNet. • The denial determines whether the review requested is a dispute/reconsideration or an appeal. • All appeals require the Practitioner and Provider Complaint and Appeal form or the Member Complaint and Appeal form. • Please see the FAQs for additional information on what is considered an appeal vs reconsideration. Mailing address for reconsiderations: Aetna Provider Resolution TeamPO Box 981106El Paso, TX 79998-1106

9. Precertification • Precertification occurs before inpatient admissions and select ambulatory procedures and services. • Check the precertification lists by going to www.aetna.com, Health Care Professionals, Precertification, Check our precertification lists • New updates were made 9/1/17 • Search by an individual CPT code • You can submit a precertification request through our secure provider website (NaviNet) or by phone using the number on the member’s ID card

10. Clinical Policy Bulletins • Clinical Policy Bulletins (CPBs) are used to determine medical coverage • CPBs detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. • Search our CPBs using • CPT Codes • Key words • CPB number These bulletins can be found by going to • www.aetna.com, Health Care Professionals, Clinical Policy Bulletins. Then you can select Medical Clinical Policy Bulletin • www.navinet.net, claims, code editing, clinical & payment policy look up. There is a look up tool that will show you which CPB is linked to a denial on your claim.

11. Management and Network Services LLC (MNS) Effective January 1, 2018, MNS won’t be a contracted provider. • MNS will no longer coordinate the skilled nursing services for credentialing or manage authorizations or claims payment. • This change impacts all patients enrolled in Aetna and/or Coventry Medicare, Commercial or network access business (First Health, auto or workers’ compensation) lines of business. • For dates of service on or after 1/1/18, please submit all patient claims directly to Aetna and/or Coventry. Check the back of the member’s ID card for the correct address or claim-payer ID number. • Aetna is currently in the process of contracting directly with all of the skilled nursing facilities. • Effective 1/1/18 Providers will work directly with Aetna for precertification.

12. Keep your information up to date • To update your office’s demographic information, go to NaviNet and sign in. • You should notify us whenever you have: • New email or mailing addresses • New phone or fax numbers • Name changes due to marrige or another life event • A new policy regarding accepting new patients • A new hospital or group affiliation • Make sure your CAQH is up to date and accurate • Aetna uses CAQH data to match up and compare to demographic information in our provider systems • Mismatches fall out onto a report for research • If you use CAQH for your credentialing, please make sure that only addresses you are practicing at are listed

13. Aetna plans offered • What plans will be available in 2018? • Aetna Plans will include • Commercial HMO, PPO, POS, Open Access plans • Performance network commercial plans offered with the CHI Health ACO, Nebraska Health Network high performance network and MIPPAhigh performance network • Aetna’s CHI Health ACO product is currently sold in Douglas, Sarpy and Pottawattamie counties 2018 additional counties will include: Buffalo, Dawson, Hall, Howard, Lancaster, Phelps and Saline • Medicare plans (Aetna Medicare in Nebraska is only offered as a retiree program for employers at this time) • Aetna Signature Administrators (ASA) contracts directly with TPA’s to access Aetna’s PPO network • For additional information on ASA, please visit www.aetna.com • Meritain Health is an Aetna Company that offers the use of Aetna’s national networks

14. Coventry plans offered • What plans will be available in 2018? • Coventry Plans will include • Commercial HMO, PPO, POS, Open Access plans • Performance network commercial plans offered with the CHI Health, Nebraska Health Network and MIPPAhigh performance networks ** No new employer groups will be offered these plans for 2018. These plans will only be offered to employers currently on them in 2017 through the KWYH legislation. • Medicare plans – Coventry Medicare Advantage Plans will remain Coventry until at least 2020 • Medicare Advantage HMO & PPO • Coventry Total Care – High performance Medicare network that only includes CHI providers. This product is only sold in Douglas, Sarpy and Pottawattamie counties. • First Health is the rental network for TPA clients to access as payers. For a current listing of First Health clients, please log into www.directprovider.com ** Due to the KWYH (keep what you have) legislation, Coventry is required to offer employer groups currently on a Coventry plan that same plan for 2018. Unless other legislation requires Coventry to change something, all Coventry groups except for Medicare will be offered an Aetna plan for 1/1/19.

15. Aetna Leap • Aetna Leap is Aetna’s individual member plans • Aetna Leap plans will not be offered on or off the exchange for 2018 • Aetna Leap began 1/1/17 and members will be honored who have paid premiums through 12/31/17 • Aetna Leap members only have digital ID cards unless the member has requested a plastic copy be mailed to them • Aetna Leap member eligibility and claims processing are housed on a different claims platform than traditional Aetna • Aetna Leap eligibility checks, claims status, reconsiderations and other electronic tools are available through NaviNet

16. Aetna Leap Issues & Corrections • Aetna Leap Identified Issues • Not all Provider contract information transferred over to the Aetna Leap systems • Providers were not showing all of the correct networks as participating • Providers may still be told they are out of network by Customer Service, we continue to do education when necessary. • If you are told you are out of network and you believe this is not correct, please ask to speak to a supervisor. Please make sure to provide a reference number, name of representative and member information. This assists us with all education and tracking. • Aetna Leap Corrections • We continue to update systems when errors are found or identified • We continue to monitor open projects waiting for reprocessing by meeting weekly with the Leap projects team on status updates • Projects are very back logged but we continue to ask for weekly updates to track progress

17. Questions?