CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved. ePayments: Cracking the Code

AGENDA Who is Pay-Plus Solutions? The Problem The Solution How Does My Organization Benefit? Questions & Answers

COMPANY OVERVIEW Industry Expertise Built from the ground up for the healthcare industry by seasoned healthcare executives Locations Clearwater, FL Operations Bedminster, NJ IT Data Center Press Release March 2014: Pay-Plus Named Winner of the "Killer Technology" award category for their Virtual Healthcare Claim Payment Technology

STRATEGIC ALLIANCES Healthcare Services Bank, NA Financial Partners

MISSION

December 16, Pay-Plus® Solutions (PPS) receives CAQH® (CORE®) Phase III Certification PAY-PLUS® SOLUTIONS SUCCESSFULLY COMPLETES CAQH PHASE III CORE CERTIFICATION

Explosive Client Growth

DAY 3 Average Time Funds Available The Problem: Patient Visits Provider & Provider Submits Invoice Payor Creates Check File DAY 13 Average Time Check Funds Available Providers want a STANDARDIZED clean 835 Traditional lockbox services: 30-40% error correction PPS services: 0% error DAY 1 Traditional Check Process PPS ePayment Process

ACA SECTION 1104 Compliance Timeline – Adopted by Payors not later than July 1, 2012 – Operating rules effective no later than January 1, 2014 January 1, 2014 healthcare Payors must implement a solution for: – Electronic Funds Transfer (EFT) – Prompt delivery of ’s

ACA SECTION 1104 December 31, 2013: HHS issued Notice of Proposed Rule Making (NPRM) on ACA-mandated health plan certification – Possible extension of certification deadline: Dec. 31, 2015 – Accreditation (Plan vs. Payor vs. use 3 rd Party Vendor) – Certification Options: – Option 1: HIPAA Credential (Coming Soon) – Option 2: Voluntary CORE Certification (Require Phase I & II) NOTE: Most Payors are contracting with Phase I, II and III vendors to meet compliance.

January 1, 2014: Effective Date by which HIPAA-covered entities must comply with the Federally Mandated Operating Rules. April 1, 2014: Penalty Date by which CMS will begin assessing penalties against health plans that have failed to meet certification and compliance requirements. (may be delayed until January 1, 2016 but will know ~July 2014) PENALTY FOR NON-COMPLIANCE $1 per covered life for each day not in compliance Maximum of $20 per life annually 25,000 EMPLOYEE LIVESx 2.5= 62,500 Covered Livesx $1.00/ DAY (MAX $20/ YEAR ) = $1,250,000 + Potential Interest & Additional Fines DEADLINES AND PENALTIES

CORE COMPLIANT 835 A CORE 835 is … Re-Association back to the 837 claim lines Using the proper adjustment code sets (CARC, RARC, CAGC) in the appropriate combinations An adjustment dollar amount for each adjustment Re-association number to the payment (ACH) While much of the above is available within the traditional 835, CORE is very specific in how the 835 is constructed and code set combinations

AdjustmentCAGCCARCRARCDescription A. $50PR1 Deductible B. $60OA23 Other Adjustments NON-CORE COMPLIANT

AdjustmentCAGCCARCRARCDescription A. $25PR1 Deductible $25PRA2B2 Non-PPO Deductible B. $30PI40 Charges do not meet qualifications for emergent/urgent care. Note: refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. $30PI14 The date of birth follows the date of service NON-CORE COMPLIANT 835CORE COMPLIANT

CORE COMPLIANT ePAYMENT A CORE ACH is … CCD+ Format: not your standard ACH Re-association number back to the 835 Matches the 835 to the penny: separate ACH for each 2100 loop

THE SOLUTION: PAY-PLUS PRODUCT SUITE

PROVIDER PRODUCT OVERVIEW Virtual credit card is faxed to Provider EOP information is always available for download as 835, PDF or Excel (CSV) PAYOR VIA FAX QUICKPAY SYSTEM DATA LOAD Workflow:

DISCUSSIONS WITH HHS AMA complaining about cost of cards HHS concerned about excessiveness of fees Healthcare Industry does not understand Credit Card Industry Shared with HHS a solution to excessive card interchange by using a process we are developing with MasterCard.

Product Overview PROVIDER DATA Payments pushed to Merchant Settlement Account via MasterCard Payments aggregated from multiple Payors EOP information is available for download as 835, PDF, Excel (CSV) or by Fax, or FTP QUICKPAY SYSTEM DATA LOAD PAYOR Workflow:

Product Overview PROVIDER DATA Payments pushed via ACH to corporate account Payments aggregated from multiple Payors EOP information is available for download as 835, PDF, Excel (CSV) or by Fax, or FTP PROVIDER BANK ACCOUNT QUICKPAY SYSTEM DATA LOAD PAYOR PPPS BANK Workflow:

STEP 1 – PAYMENT EXTRACTION Integrated Workflow N Y PAY-PLUS PAYMENT SELECT PAYOR’S SYSTEM INITIATES PAYMENT CYCLE PAYOR’S SYSTEM INITIATES PAYMENT CYCLE APPROVE CYCLE? TOTAL PAYMENT FILE CHECK RELEASE CHECK PRINT VENDOR PROVIDERS PAY-PLUS PAYMENT PROCESSING Payor PAY-PLUS CHECK PRINT VENDOR PROVIDER THE PROCESS:

NACHA FUNDS TRANSFER FILE PAY-PLUS QUICKPAY SYSTEM STEP 2 – FUNDS TRANSFER THE PROCESS:

PAY-PLUS QUICKPAY SYSTEM STEP 3 – PROVIDER NOTIFICATION THE PROCESS:

STEP 4 – PAYOR NOTIFICATION PAY-PLUS QUICKPAY SYSTEM PAYOR’S STSTEM THE PROCESS:

PAYOR/PROVIDER PORTAL

PROVIDER PORTAL PROVIDER SIGN UP

PROVIDER PORTAL PROVIDER HOMEPAGE

PAYOR PORTAL PAYOR HOMEPAGE

PAYOR PORTAL FUNDS MANAGEMENT

HOW DOES MY ORGANIZATION BENEFIT? PAYOR BENEFITS BOTTOM LINE Revenue Generation Reduce Expenses No Start-Up Fees OPERATIONS No Workflow Disruption ACA Compliance Complex Reporting + 24/7 Access High Touch Provider Customer Service PROVIDER BENEFITS BOTTOM LINE Improve Cash Flow Pursue Secondary Billings Faster OPERATIONS Aggregation of Payments Eliminate Re-Keying of Remittance Data Historical Information Available Match Payments to Advices Quickly

PAY-PLUS DIFFERENTIATORS HIGH TOUCH PROVIDER SERVICE PPS IMPLEMENTATIONLIVE WITH PPS Verify Provider TIN, Address, etc. Introduce PPS Payment Process VERIFY NETWORK EVOLVEMENT Responsible for all ePayment provider questions, A-Z MEMBER SERVICES PAYMENT FOLLOW UP Follow up every 6-7 days when a payment is not completed Pay-Plus Solutions Completion Average With PPS hands-on customer centric approach Fax Only Completion Average Without follow-up calls: competitors’ “fax and pray” HIGH TOUCH PROVIDER SERVICE RESULTS: Higher Dollar Completion Average Continual Provider recruitment to PPS Membership Network

Questions and Answers

FOR MORE INFORMATION: ART HOATH, EVP OF PAY-PLUS