Professional Provider Back to Basics Seminar

1. Professional Provider Back to Basics Seminar CareFirst BlueCross BlueShield Updates AAHAM Third Party Payer Meeting November 16, 2012

2. Agenda Electronic Services- Updates and Coming Attractions Federal Employee Program (FEP) Changes 2013 CareFirst General Updates

3. EDI Information Electronic Claim Submission (837) Electronic Remittance Advice (835/ERA)

4. Electronic Claims Submission • Who should submit claims electronically? • All Acute Care facilities • ASC, Skilled Nursing Facility, • Lithotripsy, ESRD, Birthing • Centers, DME, HIT, Home • Health, Hospice & Substance • Abuse • Any facility that submits • electronically will benefit Don’t get buried in paper

5. EDI On the CareFirst Website • Refer to the CareFirst website for information on: • CareFirst preferred clearinghouses and contact information • EDI manuals and reference guides • Hints for successful submission • Frequently asked questions • News & Updates

6. Helpful Hints - Critical to Success of EDI • Submit claims using your NPI number • Include patient’s entire prefix & membership number • Verify patient name and birth date • Use HIPAA standard data code sets • Review all reports daily • Correct all claims with errors and resubmit electronically • Review website regularly for news and updates • Refer to the website or BlueLink for a list of the preferred vendors that can be used to submit claims to CareFirst

7. EDI Support • Difficulties with submissions? • Contact your vendor/clearinghouse first. • CareFirst: • EDI Service Line • 1-877-526-8390 • edidirectsubmission@carefirst.com • For better assistance, use one of the following terms when • placing your call: • 835 ERA's/enrollment • NPI • 837 claim status for NCOF (no claim on file) or front end rejections from CareFirst

8. Electronic Fund Transfer (EFT) Information

9. Get Your Payment Fast Though Electronic Fund Transfer (EFT) • Get paid faster through electronic delivery of your payments • Reduce paperwork • Receive secure payment distribution • Avoid mail delay • To be eligible for EFT you must: • Submit claims electronically • Receive an 835/ERA (Electronic Remittance Advice)

10. Enroll Today for Electronic Fund Transfer (EFT)* • The following clearinghouses also offer electronic fund transfer (EFT) enrollment services: • Emdeon (formerly known as Webmd) at 866-369-8805 • Allscripts (formerly known as Payerpath) at 877-623-5706, ext. 1 or ext. 2 • RealMed at 877-927-8000, ext. 1201 Contact your clearinghouse with all questions regarding EFT capabilities and enrollment For more information refer to the CareFirst website at www.carefirst.com/providers>QuickLink>Ancillary&ElectronicClaims (EDI/EFT) *Note: If you currently receive automated payments from CareFirst there are no changes and no need to re-enroll

11. New Look to the Website

12. Quick Links

13. Coming Soon! CareFirst Direct 835 Remittance Advice

14. 835 Remittance Enhancements Log into CareFirst Direct

15. 835 Remittance Enhancements Click on Medical Claim Status

16. 835 Remittance Enhancements Click on Provider Remittances

17. 835 Remittance Enhancements Complete the Information below

18. 835 Remittance Enhancements

19. 835 Remittance Enhancements

20. CareFirst Direct 835 Webinars We are currently testing, and getting feedback from the provider community on the changes. Instructional webinars will be available when we get closer to the “go live” date. We will let you know when the Notice of Payment (NOP) is available on CareFirst Direct. It could be active as early as December.

21. Facets Vouchers for both professional and institutional providers will be changing during the 1st Quarter, 2013. A firm date has not yet been determined however training will be conducted via webinar sessions. Advise them to check the website periodically to see when these sessions are scheduled and to register to attend Facets Vouchers for both professional and institutional providers will be changing during the 1st Quarter, 2013. A firm date has not yet been determined however training will be conducted via webinar sessions. Advise them to check the website periodically to see when these sessions are scheduled and to register to attend Facet Voucher Changes The Facets Voucher/Notice of payment(NOP) for both professional and institutional providers will be changing during the 1stquarter of 2013. This change was done to make the voucher easier to interpret, and to make sure all of the necessary information is available. A firm date has not yet been determined, however training will be conducted via webinar sessions. Please check the website periodically and register when these sessions are listed.

22. CareFirst.com “One-Stop” shopping for CareFirst information –www.carefirst.com.providers and physicians. • Product and General Information manuals • Access to CareFirst’s Medical Policy • Access to CareFirst’s bi-monthly newsletter- BlueLink • Credentialing information in the “Quick Links” section of the website • Job Aids • Forms • Critical News blasts • Access to CareFirst Direct • Register for instructional Seminars and Webinars • Companion Guide for the 5010 Transaction sets • ICD10 updates

23. New Series of Webinars Suggested Curriculum for new providers or providers that would like a refresher: • Session 1- New Provider Introduction- overview of the expectations and training available for providers • Session 2 - Specialty Specific Contract Information (Institutional Ancillary Providers only) • Session 3 – Programs and Products – overview of CareFirst Products and corresponding membership cards • Session 4 - Claims Submission Requirements- overview of how to file claims to CareFirst • Session 5 – Corrected Claims Submission, Inquiry and Appeal Procedures- a “how to” for electronic claim correction. Also includes how to file an inquiry or an Appeal. • Session 6 – Self-Service Tools - CareFirst Direct – Eligibility and Benefits • Session 7 – Self-Service Tools – CareFirst Direct – Claims Status and Inquiry • Session 8 - Voice Response Unit (VRU) • Additional topic specific webinars we encourage you to take: • Blue Card , Blue Choice, HealthyBlue,

24. Federal Employee 2013 Changes

25. Changes to both Standard and Basic Option Plans Standard Option • 104 Standard Option – Self Only • 105 Standard Option - Self and Family Basic Option • 111 Basic Option – Self Only • 112 Basic Option – Self and Family

26. Residential Treatment Centers Benefits are not available for services performed or billed by Residential Treatment Centers. *More details can be found on page 91 in the Service Benefit Plan Brochure. (As soon as the web page opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)

27. Inpatient Hospice

28. Changes to the Basic Option Plan Basic Option • 111 Basic Option – Self Only • 112 Basic Option – Self and Family

29. Therapy The copayment for outpatient physical, occupational, and speech therapy billed for by a preferred hospital is now $25 per day, per facility; limited to a total of 50 visits per person, per calendar year. *More details can be found on page 78 of the Service Benefit Plan Brochure. (As soon as the web page opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)

30. Rehabilitation The copayment for outpatient cardiac rehabilitation, cognitive rehabilitation, and pulmonary rehabilitation billed for by a preferred hospital is now $25 per day, per facility. *More details can be found on page 78 of the Service Benefit Plan Brochure. (As soon as the web page opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)

31. Outpatient Services Copays for some outpatient diagnostic studies and radiological services are now $100 per day, per facility when those services are received at a Member or Non-member facility. Outpatient surgical, diagnostic, and treatment services performed and billed by a hospital or freestanding ambulatory facility, such as*: Operating, recovery, and other treatment rooms Anesthetics and anesthesia services Diagnostic bone density tests CT scans/MRIs/PET scans Diagnostic angiography Nuclear medicine Sleep studies Chemotherapy and radiation therapy Renal dialysis *This list is not all-inclusive. A more detailed list can be found on page 77 of the Service Benefit Plan Brochure. (As soon as the web page opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)

32. Change to the Standard Option Plan Standard Option • 104 Standard Option – Self Only • 105 Standard Option - Self and Family

33. Home Hospice • The copayment for continuous home hospice care performed by a preferred provider is now $250 per episode. *More details can be found on page 82 of the Service Benefit Plan Brochure. (As soon as the web page opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)

34. FEP Contact Information • CareFirst Direct provides free on-line look up of benefits, eligibility, claim status, authorizations, referrals and submission of administrative appeals. • Go to CareFirst.com>Providers & Physicians then click on Need Claim Status or Eligibility in the Solution Center. • FirstLine Voice Response Unit provides eligibility, benefits and claim status. This number will also connect you to FEP Provider Service. • 800-854-5256

35. CareFirst General Updates

36. Split Claims Please submit: 2012 claims separately from 2013 claims. Example: An admission date of 12.28.2012 and a discharge date of 1.4.2013 should be filed on two separate submissions. The charges for 2012 on one submission and the 2013 on another submission. Note: This process does not apply to the Federal Employee Program (FEP)claims. The years can be combined on one claim.

37. iEXCHANGE FYI CareFirst will be replacing iEXCHANGE during the 2nd quarter of 2013. Plan on attending the Institutional Quarterly Seminar in March 2013 for Training on the replacement for iEXCHANGE. Register for this or any of the CareFirst webinars and seminars at www.carefirst.com>provider & physicians>seminars and training tab.

38. CareFirst Administrators Providers can obtain claim status information for CareFirst Administrators accounts by accessing this website: www.cfablue.com

39. NCAS Providers can obtain claim status information for NCAS network lease accounts by accessing the NCAS website at www.ncas.com. This website can be used for memberships with the prefixes A11, A46 and A51. All other NCAS prefixes call the numbers on the back of the card.

40. Termination of the BlueWorldWide Expat Product • The last date of coverage for the Expat product offered to employees working and living abroad will be November 30. 2012 • As a result, effective Dec. 1, 2012, the Blue System will provide three separate offerings for international travelers and expatriates (members living overseas): • BlueCard Worldwide—Out of the country travel portion of the policy for local and National Account members. • FEP Overseas—Out of the country travel portion of the policy for government employees. • GeoBlue—A Blue-branded Licensee administering benefits for expatriates. This replaces the BlueWorldWide Expat product ending November 30, 2012. • Providers should not accept Blue ID cards with the alpha prefix EXF after November 30, 2012. Claims for dates of service after this date will not be reimbursed. • File claims for services on or before November 30, 2012 by April 1, 2013 • For eligibility and benefits for the products listed above as well as BlueCard call 1-800-676-BLUE. • Termination of the BlueWorldWide Expat Product • The last date of coverage for the Expat product offered to employees working and living abroad will be November 30. 2012 • As a result, effective Dec. 1, 2012, the Blue System will provide three separate offerings for international travelers and expatriates (members living overseas): • BlueCard Worldwide—Out of the country travel portion of the policy for local and National Account members. • FEP Overseas—Out of the country travel portion of the policy for government employees. • GeoBlue—A Blue-branded Licensee administering benefits for expatriates. This replaces the BlueWorldWide Expat product ending November 30, 2012. • Providers should not accept Blue ID cards with the alpha prefix EXF after November 30, 2012. Claims for dates of service after this date will not be reimbursed. • File claims for services on or before November 30, 2012 by April 1, 2013 • For eligibility and benefits for the products listed above as well as BlueCard call 1-800-676-BLUE. You should not accept ID cards with Alpha Prefix EXF after Nov. 30, 2012. Claims for services rendered after this date will not be reimbursed. • For services rendered on or before Nov. 30, 2012, submit all claims to CareFirstby April 1, 2013. • Original claims and adjustments submitted after April 1, 2013, for services provided on or before Nov. 30, 2012, will not be reimbursed through BlueCard. If you have any questions, please contact CareFirst. • Termination of the BlueWorldWide Expat Product You should not accept ID cards with Alpha Prefix EXF after Nov. 30, 2012. Claims for services rendered after this date will not be reimbursed. For services rendered on or before Nov. 30, 2012, submit all claims to CareFirstby April 1, 2013. Original claims and adjustments submitted after April 1, 2013, for services provided on or before Nov. 30, 2012, will not be reimbursed through BlueCard.

41. Termination of the BlueWorldWide Expat Product cont’ As a result, effective Dec. 1, 2012, the Blue System will provide three separate offerings for international travelers and expatriates: • BlueCard Worldwide—Part of domestic coverage for local and National Account business. • FEP Overseas—Coverage extended to government employees overseas. • GeoBlue—A Blue-branded Licensee administering the International Solutions Licensee (ISL) products Please verify eligibility and benefits through 1-800-810-Blue, or CareFirst Direct.

42. Self Service Tools Reminder for CareFirst Direct and the Voice Response Unit (VRU): CareFirst expects providers to use the self-service channels to obtain eligibility, benefits or claims status information.. We are moving our support for these simple, direct and factual queries to electronic channels and discouraging calls for these purposes. Ensure that your billing agency (this would not be your EDI vendor) has access to CareFirst Direct. CareFirst has scheduled webinars for billing agencies. Have your billing agency/vendor sign up for one of the CareFirst Direct webinars.

43. Questions Thank you for your attention