The Michigan Primary Care Transformation (MiPCT) Project

1. The Michigan Primary Care Transformation (MiPCT) Project Addition of Priority Health to MiPCT: An Overview and Your Questions Answered!

2. Agenda • Welcome and Overview of Priority Health’s Addition • MiPCTTouchpoints for Priority’s Inclusion • Dashboard and Member List implications • Care Management (staffing, etc.) implications • Priority Health: The Specifics! • Lines of business included • Billing guidelines • Etc • Q and A

3. Overview: Priority Health Addition • Adds approximately 150,000 members • All Priority MiPCTeligibles will be in fully-insured Priority POS, PPO and HMO products • Reimbursement for care management services builds other commercial payers • Allowing first dollar coverage (without patient financial obligation for satisfying a deductible) for care management servicesdelivered to high deductible plan members with Health Savings Accounts.

4. Member List and Dashboard Implications • Fully insured HMO and POS members to be included on MiPCT multipayer member lists in August • MiPCT eligible PPO members to follow (interim solution discussed later in webinar) • Priority members to be included on dashboard after historical claims data are available and processed (December 2013)

5. Care Management Implications • No change immediately in Care Management staffing sufficiency requirements • Staffing needs to be revisited at beginning of 2014 to determine if existing staff are sufficient to service the needs of patients

6. Priority Health: The Specifics • Laura Stuursma (Lead of Priority Implementation Team) • G-codes • CPT-codes • Covered membership

7. Priority Health G-codes • Interpretation and documentation • Coverage • Reimbursement • Unique payment process

8. Priority Health CPT codes • Interpretation and documentation • Coverage • Reimbursement • Claims payment and processing

9. Priority Health membership • G-codes – MiPCT practices only (FF-HMO, FF-POS and FF-PPO) • CPT codes • TCM codes covered by Medicare and Medicaid plans • Payable to all network practices • Benefit coverage for any member in applicable plans • Members do not need to be assigned or attributed to the practice • Members do not need to be included in a MiPCT monthly list

10. Q and A