Humana Alabama Hospital Association Presentation July 15th, 2019

1. Humana Alabama Hospital Association Presentation July 15th, 2019

2. ATTENDEES • David Annand, M.D., VP, Health Services • Kerri Warkins, RN, Health Services Director • Shawn Kent, MBA, Director of Contracting • Scott Johnson • Network Executive Vickie Markhardt, Market Management Consultant Melinda Hulon Regional Manager Southeast Humana Mid South Region Region covers Alabama, Tennessee, Southwest Virginia Regional Headquarters: Knoxville, TN Regional Leadership Douglas Haaland, President David Annand, M.D., VP, Health Services Kerri Warkins, RN, Health Services Director Shawn Kent, Director of Contracting Current Membership in the Region is 220,000 members Alabama is a targeted growth market for Humana Medicare Advantage products

3. Vickie Markhardt Market Management Consultant Humana Claim Issue Resolution June 2019

4. PCC # 1-800-448-6262 Link to Provider information https://www.humana.com/provider/ Provider Call Center Claims Payment & General Inquiries • Claim specific questions • Check Copies • Eligibility & Member Benefit information • General Questions • Authorization Status & Outcome Letter copies • Current dispute status information • Inquiry Escalation & Routing • Grievance & Appeal Status • Making it Easy • Enhanced Service Initiatives • Webinars for coding online • Including modifiers 25/59 • Clearly defined escalation process • Improved training documents • Updated process guides

5. The primary focus of the Provider Concierge Unity (PCU) is researching and resolving complex Underpayment claim issues for providers, Markets, and other internal partners . Humana Claim Payment Inquiry Resolution Responsibilities and Work Flow Provider disagrees with response or resolution from the Provider Call Center (PCC) • Provider sends an e-mail to humanaproviderservices@humana.com with information regarding their dispute or question

6. Items you will receive in email from this presentation: Claim Payment Resolution Guide Provider Submission Spreadsheet form PCU Humana Claim Payment Inquiry Resolution Guide:http://apps.humana.com/marketing/documents.asp?file=3287934 Code Edit Information & Resources Link to the Code Edit information on Humana.com: https://www.humana.com/provider/support/claims/processing-edits/ The Code Edit Simulator is an app on the Availity Web Portal. When the claim information is entered in the simulator, it instantly displays potential code edits that Humana may apply. This feedback allows the provider to address issues that can delay the adjudication of the claim. A user ID and password is required for the portal and the site administrator must grant access to the simulator. Healthcare providers can submit specific questions about code editing through the Code Editing Questions tool (registration required) on Availity. Claim processing edits: https://www.humana.com/provider/medical-resources/claims-payments/processing-edits Making It Easier Series: On-demand presentations designed to help physicians and other healthcare providers understand Humana’s claims process. http://teams.humana.com/sites/ppno/providereducation/SiteAssets/home.aspx Claim coding & inquiry process guidelines:https://www.humana.com/provider/medical-resources/claims-payments/claims-coding

7. Melinda Hulon Regional Manager | Southeast CCM Service Experience & Quality Provider Payment Integrity June 2019

8. PPI has an enhanced Provider Service Model to improve the overall service experience. New and improved First Touch Issue Resolution process, including seamless escalation & transition of responsibilities. Provider Payment Integrity Claims Payment & General Inquiries • Claim specific overpayment questions • Refund Request Letter copies • PPI Correspondence Address verification • Refund disputes & questions • Recoupment extensions • Medical Record Review process navigation • Current dispute status information • Inquiry Escalation & Routing “I was very surprised to receive a live person. Overall the call was smooth, easy and I was provided the information I needed “ Voice of the Customer February 2018 Results • Making it Easy • Enhanced Service Initiatives • Re-Opened Live Line, 2018 • Enhanced E-mail option • Concise & seamless First Touch Resolution • Clearly defined escalation process • Improved training documents • Updated process guides • Voice of the Customer Survey

9. January 2019 Results Making it Easier! Claims Cost Management Service Model Transformation 86% 3.2 43% • Customer Satisfaction • Health Insurance Benchmark: 73% • Customer Effort Score • Service Industry Benchmark: 3.6 • Critical Inquiry decrease in PPI related Complaints • 2017 to 2018

10. The primary focus of the PPI Issue Resolution team is researching and resolving complex overpayment claim issues for providers, Markets, and other internal partners . Provider Payment Integrity Issue Resolution Responsibilities and Work Flow

11. Items you will receive in email from this presentation: Overpayment Tool Flyer PPI Issue Resolution team spreadsheet template Medical Records Management Flyer Claim Payment Inquiry Resolution guide What’s coming….. New overpayment tool through Availity in pilot state Multi-payor Record requests and review process remains the same Roll out to all providers in June/July All overpayments will be available to the groups, as well as their closed items for the past 18 months from set up. Self-serve option for our physician/hospital partners on overpayments. Have the capability to agree, inquire on, and dispute on all overpayments within the tool. Able to see the Medical Record Request letters and Findings letters directly linked from the MRM tool. Working to adjudicate claims more accurately upon receipt Decrease in overpayment requests Decrease in recoupments as a result of less overpayments Record requests will have Prepay on the request where applicable Looking to work with providers on better Electronic Submissions of medical records Working with industry leaders on new tools for electronic record submission Piloting those tools with small groups of providers before rolling out Recording best practices

12. Humana was awarded the PEEHIP account for Medicare eligible members beginning January 1, 2020. This will be a Three Year Agreement between Humana and PEEHIP Public Education Employee Health Insurance Plan (PEEHIP) Plan Benefits and Formulary mirror what PEEHIP members have under the current plan administrator. The plan is a passive preferred provider organization (PPO) plan, meaning providers can continue to see current patients because they will have the same copays and coinsurance levels for both in- and out-of-network. This plan will reimburse in-network health care providers at their current contracted rate. The plan will reimburse out-of-network providers who accept Medicare at the current Medicare Fee Schedule. PEEHIP members will have the same benefits whether they see in-network or out-of-network providers as long as the out-of-network provider: Participates in Medicare, and Agrees to bill Humana for services No referrals are required Members do not have to select a Primary Care Physician (PCP)

13. Questions? Humana Alabama Hospital Association Presentation July 15th, 2019