Kansas Medical Society

1. Kansas Medical Society Welcome to Sunflower State Health Plan September 6, 2012 Confidential and Proprietary

2. Presenter Contact Info • Kent Cerneka – Vice-President, Network Development • Phone: 314-505-6340 or kcerneka@centene.com • Lacee Allen– Manager Provider Relations • Phone: 601-874-1874 or lacallen@centene.com • Monica Arter – Sr. Director of Medical Management • Phone: 314-505-6011 or marter@centene.com • Teresa Dodd – Manager, Payment Excellence Team • Phone: 314-445-0108 or tdodd@centene.com Confidential and Proprietary

3. Parent Organization Overview • Headquartered in St. Louis, MO • Fortune 500 company • Employ over 6,000 individuals • Contract with over 130,000 providers • Serve over 2.1 million members / 18 states • 4 LTC programs/ 12 ABD programs Confidential and Proprietary

4. Core Functions Network Development • Since 2006, Sunflower’s parent company has built provider networks from scratch in eight states totaling ~ 50,000 providers: Georgia – 15, 957 providers (116 Hospitals) Illinois – 5,390 providers (54 Hospitals) South Carolina – 7,380 providers (29 Hospitals) Kentucky – 12,552 providers (54 Hospitals) Mississippi – 4,232 providers (74 Hospitals) Louisiana – 3,987 providers (31 Hospitals) Washington – 8,600 providers (66 Hospitals) Missouri – 7,782 providers (72 Hospitals) • Targeting 8,000 to 10,000 Provider Network in KS which includes Hospitals, Physicians, FQHC/RHC’s, and Ancillary Providers Critical Success Factors: • Flexible, consultative, relationship-based, partner focused • Dedicated resources for Kansas • On-the-ground experienced Network Development leaders building collaborative relationships (hospitals, physicians, CMHCs, CDDOs FQHCs, trade associations) • Complemented by a dedicated telephonic Network Development team • Educate, listen and engage; Collaborate rather than mandate Confidential and Proprietary

5. Core Functions Provider Relations • Dedicated, local Provider Relations Representatives • Initial Training and Orientation within 30 days of contract effective date • Train on Sunflower Policy and Procedures • Train on Website and Secure Portal Functions – including registration process for Secure Portal • Registration and Training on EFT/ERA process, EDI submission, etc. • Orientations conducted as individual meetings, group meetings, and webinars • Provider Summit Calls – begin approximately 30 days prior to “Go-Live” and continue as long as there is interest • Ongoing education Confidential and Proprietary

6. Web Portal • Through the Secure Web Portal, Providers can: • Check Member Eligibility • Check by CPT or HCPCs code whether prior authorization is needed for par providers • Submit Prior Authorization Requests • View Patient Lists • Submit, view and adjust claims • View Payment History • Member Health Record • Through the unsecure website, Providers can access: • Provider/Billing Manual • Quick Reference Guides • Prior Auth and Notification of Pregnancy Forms • Clinical Guidelines • Provider Newsletters and announcements Confidential and Proprietary Confidential and

7. Core Functions Medical Management • Care Management Teams • Identify and engage high-risk and non-compliant members • Identify barriers to compliance with treatment plans and goals • Facilitate communication across medical and behavioral specialties • Coordinate services, including transportation and referrals • Disease Management Teams - NCQA/URAC Accredited Programs • Onsite Discharge Planning at high-volume facilities Confidential and Proprietary

8. Core Functions Utilization Management • Goal is to ensure services are appropriate for the condition, provided in an appropriate setting and meet or exceed professionally recognized standards of care. • Program is based on nationally recognized, evidence-based clinical decision support criteria • InterQual is used to determine medical necessity review of most services • Program is overseen by a Medical Director. Only MDs can make adverse decisions (denial or reduction of service.) MDs are available for peer to peer discussions. Confidential and Proprietary

9. Core Functions Programs and Incentives: • Start Smart for Your Baby – education and case management program starts during pregnancy through child’s first year of life • Start Smart for Your Health– educational materials printed and on website. • CentAccount – monetary awards loaded to a pre-paid debit card for healthy behaviors. Based on claims with specific CPT Codes. • MemberConnections and Connections Plus – community events, home visits. Phones for members at highest risk with unreliable phone access. Confidential and Proprietary

10. Core Functions Claims Payment and Remittance • Payer ID – 68069 • Clearinghouses: • SSI, Emdeon, Gateway, Availity, Smart Data Solutions • EFT/ERA through PaySpan Health • Free Service and fast online enrollment • Register for Webinars • Payment Excellence Team (PET) • Strongly encourages and participates in Claims Testing prior to Go-Live Confidential and Proprietary

11. Claims Processing Centers • Farmington, Missouri Claims Center • Centralized mail room • Vertexing, OCR validation and data entry • High Dollar Review • Quality Review Team • Claims Processing Center • Provider Claims Call Center • Great Falls, Montana Claims Center • Claims Processing Center • Kansas claims to be processed here • Provider Claims Call Center • Kansas claims calls to be answered here Confidential and Proprietary

12. PET/Payment Excellence Team Goals of the Payment Excellence Team • Ensure claims are received, processed timely and processed correctly for all new markets • Assist in research of benefits, payment methodology, billing requirements, etc. • Write all new work processes for claims and answer all claims related questions immediately after go-live • Write the health plan’ provider billing manual • Partner with IT to test all aspects of claims receipt and processing 45 days prior to go-live • Monitor pend volume and aging in efforts to identify ways to avoid pends and increase auto-adjudication rate • Partner with provider relations to help resolve key provider issues and provide claims related education to providers and provider relations staff • Partner with health plan and Internal Audit to review check run and increase payment accuracy • Manage all claims related issues for a period of 3-6 months post go-live Confidential and Proprietary

13. Sunflower State’s relationship with local PPO Network • A PPO serving the State of Kansas and surrounding areas • The only physician owned and operated PPO in Kansas • Providers in the ProviDRS Care network may participate with Sunflower • by executing a Sunflower/Medicaid addendum to their ProviDRS Care • agreement • Benefits of contracting with Sunflower State Health Plan through ProviDRS Care: • Simple Sunflower/Medicaid addendum to ProviDRs Care contract in lieu of • review and execution of a full participation agreement • Since you are already credentialed through ProviDRs Care, there is no • additional credentialing paperwork Confidential and Proprietary

14. What to expect prior to January 1, 2013 • Sunflower is emphasizing the need to complete contracts by end of September!!! • Member enrollment packets (including provider directory information) is targeted for distribution at the end of October • Ensure that we have ample time to review your contract packet, complete the credentialing process, and upload your information into our directory systems • Signed an LOI? You will still need to complete contracting and credentialing paperwork. • Behavioral Health Providers already contracted with Cenpatico – addendum process Next two weeks – Contracts approved and distributed to providers • Provider Contract • CAQH Credentialing documents or KS Standardized Credentialing App • Disclosure of Ownership form (Federal requirement) Next two months – types of communication from our contracting team • Personal visits • Phone calls • Fax and/or Email Confidential and Proprietary

15. Network Subcontractors Vision: To join our vision provider network, OptiCare, email OptiCare at networkmanagement@opticare.netor go to this link:http://www.opticare.com/joinus.aspx Pharmacy: For contact information or to join US Script’s provider network please visit us at http://www.usscript.com/contact.php Behavioral Health: To join our behavioral health provider network, Cenpatico, go to this link: http://www.cenpatico.com/providers/join-our-network/ or call 800-989-1655 Or you can contact: Deb Burnham Network Manager 800.989.1655, ext. 1 office | 785.633.5746 cell Non Emergency Transportation Amy Mueller Manager, Network Operations Medical Transportation Management, Inc. Direct: (636) 695-5589 Fax: (800) 459-6224 amueller@mtm-inc.net Sunflower State Provider Contracting1-877-644-4623http://www.sunflowerstatehealth.com Confidential and Proprietary

16. Questions? Confidential and Proprietary