MyCare Ohio Skilled Nursing Facility Orientation

1. MyCare Ohio Skilled Nursing Facility Orientation

2. Demonstration/Pilot Area 2

3. Health Plan Options 3

4. Implementation Timeline 4

5. 114,000 members in 29 counties are eligible for the MyCare Ohio program. This includes: • Individuals 18 years and older • Members residing in the MyCare Ohio service area • Individuals entitled to benefits under Medicare Part A enrolled under Medicare Parts B and D, and receive full Medicaid benefits. • Adults with disabilities and persons 65 years and older • Persons with serious mental illness

6. Program Exclusions Those who are not eligible for MyCare Ohio enrollment: • Individuals under age 18 years • Individuals with an ICF/IDD level of care served either in an ICF/ID facility or on a waiver • Individuals who are eligible for Medicaid through a delayed spend-down • Individuals with third party insurance

7. Opt IN Enrollees Full duals with Buckeye • Medicare and Medicaid benefits through Buckeye • Medicare – option to change plans monthly • If member selects another MyCare MCP will be enrolled as a full dual with the new plan • If member selects a plan outside the MyCare network, member retains Medicaid benefits with Buckeye. • One claim submitted to Buckeye. • Will be adjudicated for both Medicare and Medicaid with one submission. • Will generate two payments

8. Opt IN ID Card (Medicare & Medicaid)

9. Opt OUT Enrollees Medicaid as Secondary Coverage with Buckeye • Medicaid benefits only through Buckeye • Option to change Managed Care Plans during initial 90 days of enrollment • Locked in for remainder of benefit year until annual open enrollment • Medicare benefits through other non MyCarepayor including Fee for Service • Secondary claims to be submitted to Buckeye. • Will be adjudicated as secondary payor

10. Opt OUT ID Card (Medicaid Only)

11. Service Packages • Services included: • Medical benefits • Behavioral health benefits • Home & Community Based Services • Long Term Care • Pharmacy • Dental • Vision

12. e Services • MyCare Ohio Waiver includes: • Ohio Home Care Waiver • Transitions II Carve-Out Waiver • Passport Waiver • Choices Waiver • Assisted Living Waiver • Enrollees who are eligible for waiver will have access to all of the services included in the MyCare Ohio Waiver.

13. Determining Eligibility • Waiver Eligibility will be determined by government agencies • Department on Aging • CareStar or other vendor • Level of care assessment evaluates the member’s: • Ability to perform the activities of daily living • Mental acuity • Level of impairment • Level of need • Member’s level of care determination will determine which services the member is eligible to receive. • Skilled, Intermediate, Intermediate/Mental Retardation-Developmental Disabilities / Protective or None • Member has choice to receive services

14. Transitions of Care – Nursing Facility • NF services: • Provider will be retained at current rate for the life of Demonstration(42 months).

15. Transitions of Care - Exceptions During the transition period, change from the existing services or provider can occur in any of the following circumstances: • Consumer requests a change • Significant change in consumer’s status • Provider gives appropriate notice of intent to discontinue services to a consumer • Provider performance issues are identified that affect an individual’s health & welfare Plan-initiated change in service provider can only occur after an in-home assessment and development of a plan for the transition to a new provider

16. The Integrated Care Team Works Together with the Member to Find the Best Health Solutions for Members • Care Manager (Accountable Point of Contact) • Accountable point of contact for the Integrated Care Team • Registered Nurses, Social Workers and Counselor’s. • Program Coordinator • Mixture of licensed/certification professionals. Focused on the physical, psychological and social welfare of the member. • Community Health Worker • Provides team support, and reaches out to members with health and preventive care information • Waiver Service Coordinator • Focuses on Buckeye members that receive services through a home and community-based services waiver. • Partnership with the Area Agency on Aging (AAA) for member age 60+.

17. Provider Value

18. Value That Centene Brings to Providers • Timely and accurate claims payment (clean claims) processed within 7-8 days of receipt • 75% of claims are paid within 7-10 days of receipt • 99% of claims are paid within 30 days • Local dedicated resources: Care coordinators serve as an extension of physician offices • Education of providers and support staff through orientations • Provider participation on health plan committees and boards • Minimal referral requirements for physician services • Electronic and web-based claims submission • Web based tools for administrative functions

19. Provider Portal @ www.bchpohio.com • Through our main website, providers can access: • Provider Newsletters • Provider and Billing Manuals • Provider Directory • Announcements • Quick Reference Guides • Benefit Summaries for Consumers • Online Forms • Logon to www.bchpohio.comand become a registered provider

20. On our secure portal, providers can: • Verify eligibility and benefits • View provider eligibility list • Submit and check status of claims • Review payment history • Secure Contact Us Registration is free and easy. These services can also be handled by Buckeye Provider Services @ 866-296-8731

21. Submitting Claims to Buckeye

22. What Requires Prior Authorization? ALL SNF and LTC services require prior authorization • New Services: • Services will be based on the member’s care plan. • Care Coordinator will be in contact with both the member and provider. • Once services are approved, prior authorization will be entered into the system by Care Coordinator. • Care Coordinator will contact service providers with a prior authorization number, confirming service can now take place. • Existing Services: • Services that are currently in place for member will remain for 365 days. • HCBS Care Coordinator will enter prior authorizations for each service into the system. • Providers will receive a notice from Buckeye explaining transition process, and members identified as currently in facility or LTC. • If you have questions if a service is authorized for the member, contact the HCBS care coordination team at 866-549-8289. All out of network non-emergent services and providers require prior authorization.

23. Claim Services Timely Filing Guidelines • 365 Days from the date of service • 180 Days if retro eligibility is an issue • 180 Days to submit a corrected claim, request a reconsideration of payment, or to file a claim dispute *Please refer to our provider or billing manual online for more detailed information* Paper Claims • Providers may submit to the following addresses: Buckeye Community Health Plan Attn: Claims P.O. Box 3060 Farmington, MO 63640 (866)-329-4701 Corrected Claims, and Requests for Payment Reconsideration • Providers may submit to the following addresses: Buckeye Community Health Plan MyCare Ohio Claim Reconsideration P.O. Box 4000 Farmington, MO 63640

24. Claim Submission and Reimbursement • Authorization is required for all services including bed hold days • Buckeye will accept standard Medicare and Medicaid billing codes RUGS etc. No payor specific codes required • Buckeye will reimburse based upon current Medicare & Medicaid fee schedules including bed hold days • Bed hold days policy will be consistent with current regulatory policies and rates (Buckeye has current rates including occupancy variances) • Inpatient hospice – Buckeye will reimburse hospice provider who will in turn reimburse SNF for room & board. Program Exclusions

25. Bad Debt Policy • Bad Debt – applies to member liability for skilled level of care days 21-100 of single stay • Buckeye will not require SNF to file annual bad debt report • Buckeye will aggregate bad debt detail from adjudicated claims by facility • Buckeye will review and determine liability using the following methodology • Services 5/1/14 through 9/30/14 – 76% of bad debt • Services 10/1/4 through 12/31/14 – 65% of bad debt • Reimbursement will be paid as a lump sum payment in the 2nd quarter of each year. Program Exclusions

26. Claim Services CLAIM SUBMISSION OPTIONS Electronic Claims Submission – EDI • More efficient, fewer errors • Faster reimbursement 5-7 days from submission • Requires EDI vendor or clearinghouse agreement Buckeye Provider Portal • Requires registration and username/password • Very efficient; fewer errors • No cost to provider • Faster reimbursement 5-7 days from submission Paper Claim Submission • Less efficient • Requires original claim forms • Average reimbursement 10-14 days from submission of clean claim

27. Via the Provider Portal we can also: • Receive an ANSI X12N 837 professional, institution or encounter transaction. Portal allows batch\individual claim submissions • Generate an ANSI X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). • Please contact: Buckeye Community Health Plan c/o Centene EDI Department 1-800-225-2573, extension 25525 or by e-mail at: EDIBA@centene.com

28. Paper Claim format • All services must be billed to Buckeye using a CMS 1500 form. • Forms cannot be filled out by hand. • Must be completed using computer software or a typewriter. • All claims must be submitted within 180 days from the date of service. • Claims must be submitted to the following address: • Buckeye Community Health Plan • ATTN: Claims 3060 • Farmington, MO 63640 Program Exclusions

29. Billing – Dos and Don’ts • Billing – Dos • Submit your claim within 90 days of the date of service • Submit on a proper original form – CMS 1500 • Mail to the correct PO Box number • Submit all claims in a 9” x 12” or larger envelope • Type all fields completely and correctly • Use typed black or blue info only at 9-point font or larger • Include all other insurance information (policy holder, carrier name, ID number and address) when applicable • Billing – Don’ts • Submit handwritten claims • Use red ink on claim forms • Don’t circle data on claim forms • Don’t add extraneous information to any claim form field • Don’t use highlighter on any claim for field • Don’t submit photocopied claim forms (no black and white claim forms) • Don’t submit carbon copied claim forms • Don’t submit claim forms via fax Program Exclusions

30. EFT and ERA • Buckeye partners with PaySpan Health delivering electronic payments (EFTs) and remittance advices (ERAs). • FREE to Buckeye Providers • Electronic deposits for your claim payments • Electronic remittance advice presented online. • HIPAA Compliant Provider Benefits with PaySpan Health • Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems • Improve cash flow – Electronic payments for faster payments • Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds. Multiple practices and accounts are supported. • Match payments to advice quickly – You can associate electronic payments with electronic remittance advices quickly and easily. • Manage multiple Payers – Reuse enrollment information to connect with multiple Payers. Assign different Payers to different bank accounts, as desired. For more information visit www.payspanhealth.com or contact them directly at (877) 331-7154 to obtain a registration code and PIN number.

31. Thank you!