MMBA Mid-Michigan Chapter April 3, 2013

1. MMBA Mid-Michigan Chapter April 3, 2013 Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org

2. McLaren Health Plan Medicaid McLaren Health Plan Commercial Service Area

3. Increased Reimbursement! • Opportunities • Did you know that you can easily turn a sick visit into a well child visit? • When you have a MHP member in your office for a sick visit who is also due for a well child visit, simply incorporate the elements of a well child exam into the visit, and bill MHP for both the sick and well child services performed • You can do this by adding modifier 25 to the sick visit and you will be reimbursed for both services • As another way of ensuring that our members receive this important well child exam, MHP will reimburse you for one well child visit each calendar year. You don’t have to wait a full calendar year to perform a well child visit

4. Club 101 • Well Child Visits for Medicaid Members • McLaren Health Plan reimburses Providers higher than the Medicaid fee schedule • Well child visit codes are now reimbursed at $101.00 per visit • Includes CPT Codes 99392, 99393, 99382, and 99383 • Well child visits must include: • Physical exam • Mental and Developmental screening • Hearing and Vision components • Other tests to detect potential problems

5. Expanded Access Award • Expanded Access for Commercial and Medicaid Members • Provide service to a McLaren Health Plan member in the office during hours other than normal business hours and receive an additional $17.38 in reimbursement • Includes CPT Codes 99050 and 99051 • Medicaid does not currently reimburse providers for either of these codes. This is additional reimbursement offered by McLaren Health Plan.

6. Lead Testing Incentive • Lead Testing for Medicaid Members • This lead screening program is easily achievable and recognizes McLaren Health Plan’s Primary Care Physicians who meet MDCH requirements of lead testing children before their second birthday • CPT 36416 – Collection of capillary blood specimen for lead - $15.00 • CPT 83655 – Perform the lead testing in office - $25.00

7. Customer Service • Provider Questions • Call Toll Free (888) 327-0671 • Answered by a Specialized Customer Service Representative • Choose Benefit/Eligibility Question Option for Member Eligibility and Benefit Verification or Referral Assistance • Choose Claim Status/Question for Claims Inquiries • Office Support • Each Office is Provided a: • Network Development Coordinator • Contract Questions • Office Orientations • Education • Requests for Materials • Nurse Case Manager (PCP Offices) • Each Office has an Assigned Nurse • Medical/Clinical Issues Support • Member Issues Requiring Follow-Up

8. Website Information • McLarenHealthPlan.org • McLarenHealthAdvantage.org • Key Information • Provider Directories • Formularies • Disease and Health Management Programs • Clinical/Preventive Practice Guidelines • Provider Manual • Provider Newsletters • FACTSWeb • Real-time, on-line access to insured and dependent eligibility, plan summary information, claims history and status, and payment reports • Requires completion of password application for access to this program

9. Key Contacts (Hours of Operation: Mon. – Fri., 8:30 AM – 5:00 PM) • Customer Service: (888) 327-0671 • Network Development: (888) 327-0671 • Medical Management: (888) 327-0671 • Mailing Addresses: AdministrativeClaimsEDI Claims G-3245 Beecher Rd PO Box 1511 Optum ENS Flint, MI 48532 Flint, MI 48501-1511 Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org

10. Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org MHP41061043