AzAHP Credentialing Alliance May 2012

1. AzAHP Credentialing Alliance May 2012

2. Goal: To reduce the burden of credentialing currently placed on Arizona providers.

3. P A R T I C I P A T I N G P L A N S • Care1st Health Plan Arizona • CMDP • Health Choice Arizona • Maricopa Health Plan • Mercy Care Plan • Phoenix Health Plan • SCAN Health Plan Arizona • United Community and State (APIPA) • University of Arizona Health Plan ALL Arizona business lines (AHCCCS Acute/ALTCS, MA PD, D-SNP, Commercial). Together we represent over 1,115,000 members and over 15,000 unique providers. Plans DO NOT need to be a member of AzAHP to participate in the alliance.

4. S T R U C T U R E HEALTH PLAN HEALTH PLAN HEALTH PLAN

5. O P T U M I N S I G H T • Nation’s largest CVO • Approximately 550,000 credentialing events/year • Alliance experience • Certified by NCQA, accredited by URAC, compliant with JCAHO standards

6. S H A R E D C O M P O N E N T S • Initial Credentialing • Site visits (PCPs & OBGYN) • Re-credentialing • Both practitioners (includes dental) and facilities/organizations • Utilizing CAQH for practitioner applications • Plans retain control over network decisions and their credentialing committee

7. I N I T I A L C R E D E N T I A L I N G • Practitioners joining existing groups • New practitioner/practitioner group

8. R E - C R E D E N T I A L I N G • Plan specific re-cred date • Dr. John Smith • PLAN A: 4/17/2014 • PLAN B: 7/10/2013 • PLAN C: 1/20/2014 Alliance re-cred date: 7/10/2013

9. C U R R E N T A C T I V I T I E S • Contracts • OptumInsight • CAQH • Plan Participation Agreements • Workflow definition/Statement of Work • Network extracts from Plans to Optum due May 17 • Provider communication campaign • Delegated oversight process & pre-delegation review • Expecting the implementation to begin in June and LIVE September 2012

10. Questions

11. AzAHP Credentialing Alliance May 2012 Scott Cummings scummings@care1st.com 602.778.1860