March 28, 2013 CareCore National Overview

CareCore National utilizes research based clinical expertise to improve quality and reduce inappropriate utilization.  Nation’s largest Specialty Benefit Management company  Utilizing Innovative Data and Information Technology  Client Driven and Clinically Focused  Certified to provide Utilization Management (UM) services in all 50 states 2 CareCore National Overview

Experience ClinicalExpertise Infrastructure  Comprehensive appropriateness criteria based on evidence-based guidelines and peer reviewed literature  Advisory panels of both academic and private physicians  Unparalleled clinical resources –Team of 55+ full-time board-certified physicians representing all major specialties –All clinical questions conducted by nurses  Over 17 years of managing evidence-based outpatient health care services  First to market with Specialty Benefit Management programs  Clients include Commercial, Medicare, Medicaid and FEP members  Manage over 75 million lives, 35 million radiology lives  Fully integrated operational centers in:  South Carolina - Colorado - Remote Employees in over a dozen states  All utilizing next-in-queue technology to ensure operational continuity  45,000 Reviews Daily. Supported by a dedicated, in-house IT team  Over 1,200 employees nationwide CareCore National Infrastructure © 2012 CareCore National, LLC. All Rights Reserved. 3

© 2013 CareCore National, LLC. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. 4 CareCore National Clients

Network & Telephony Call Center Operations  All facilities, including remote agents, act as a single call center utilizing next-in-queue technology protecting against regional effects to operations System Volumes Over 40,000 calls daily. Exceeding 7M clinical reviews annually. Adjudicating over 6M imaging claims annually. Network & Telephony  Multiple full function data centers  Redundant (full load) data center connectivity  Geographically distributed redundant telephonic core switching including hardware and trunking capacity Applications & Data Storage  Core application processing capability carried out via dual ‘on line’ data centers.  100% of critical platforms are replicated in real time.  Utility based Compute, Storage and Network platforms (private cloud deployed)  ATMOS policy based storage for unstructured data components. CareCore National IT Infrastructure © 2012 CareCore National, LLC. All Rights Reserved. 5

  Secure, single sign-on capability  Real-time online authorizations  24/7 online capability to initiate authorizations, verify real-time authorization status, and eligibility look up  Online guidelines, quick reference guides, and program documents  Health Plan link to reporting mechanisms for real-time data regarding employer group and/or provider activity Web-Based Solutions and Access 6

7© 2013 CareCore National, LLC. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information.7  Physicians can review the CareCore evidence-based guidelines at any time at

The Importance of Evidence-Based Care PROGRAM OBJECTIVES PROGRAM OVERVIEWS NJ HEALTH PLAN PROGRAM SUMMARIES © 2012 CareCore National, LLC. All Rights Reserved.8

UM Program Objectives 1.Ensure Quality of Care 2.Maximize Member Benefit Options 3.Ensure Appropriate Use of Services 9

Meets Clinical Criteria APPROVED Advanced Imaging ▪ Cardiac Imaging ▪ Radiation Therapy ▪ Musculoskeletal (Pain Mgt) ▪ Oncology ▪ Sleep Studies © 2013 CareCore National, LLC. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information.10 Clinical Review Workflow Licensed Nurse Review Physician Review Peer-to-Peer Available Approved Medical Service

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12 Advanced Imaging Services  CAT Scan  MRI/MRA  PET  Nuclear Medicine  Outpatient Services  Approval valid 45 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours Radiology Benefit Management Tools  Prior authorization/MND  Scheduling  Education  Comprehensive reporting  Peer to Peer Consultation Radiology Program Compone nts

13 Radiology Member Scheduling CareCore National offers a “Concierge Service” to assist health plan members in scheduling their approved advanced imaging procedure to the imaging facility which best meets the member’s needs. Member Benefits Member education of the available facilities based on highest quality, convenient location, continuity of care and cost-effectiveness A live warm hand off to the facility to assist in scheduling an approved procedure at convenient time and location of the member’s preference Over 98% member satisfaction Members schedule appointments for Advanced Imaging Services:  CT/CTA  MRI/MRA  PET  PET/CT 13

14  Call CareCore National or go to to obtain a prior authorization or medical necessity determination (PA/MND)  At the end of the review the provider is given a case number  Upon approval CCN will contact the member by telephone and schedule the procedure at a participating facility  Members can contact CCN directly for scheduling assistance (Telephone number is health plan specific) Radiology Scheduling Process Overview

Essential to appropriately diagnose patients Appropriate to their training Coding & Bundling Rules Disallows up coding and limits technical fees CPT Code DRG Specific Claim logic “Limiting the scope of imaging procedures that a physician, site or specialty will be authorized for payment when self-referred.” Self-Referral & Payment Policies © 2012 CareCore National, LLC, All Rights Reserved Self-Referral Policy Payment Policies 15

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17 Diagnostic Studies  Nuclear stress test  Echo stress test  Cardiac PET  Cardiac MRI  Coronary CT angiography (CCTA)  Diagnostic left heart catheterization  Outpatient Services  Approval valid 45 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours Cardiac Benefit Management Tools  Prior authorization/MND  Comprehensive reporting  Education  Quality equipment and accreditation requirements  Peer to Peer Consultation Cardiology Program Components Cardiology Management

18  Online Prior Authorization Submission & Processing  Patient Prior Authorization History  Patient & Site Eligibility Verification  Authorization Status Look-up  Case Status Availability 18 Online Cardiology Prior Authorization Program

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20 Cancer Types: Bone Metastases, Brain metastases, Breast Cancer, Prostate Adenocarcinoma, Lung Cancer (SCLC/NSCLC), Cervical Cancer, Pancreatic Cancer, Rectal Adenocarcinoma, Head/Neck Carcinoma, Endometrial Cancer, Gastric Cancer, Primary CNS Lymphoma, Primary CNS Neoplasms Other Cancer Diagnoses that require Radiation Treatment  Outpatient Services  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours RT Benefit Management Tools  Medical Necessity Determination  Education  Comprehensive reporting  Peer to Peer Consultation Radiation Therapy Program Components

21  CareCore National’s extensive evidence-based criteria are written based on national Advisory Committee review of evidence based literature in alignment with existing American College of Radiology (ACR) and American Society for Therapeutic Radiology and Oncology (ASTRO) guidelines  The criteria is listed on the CareCore website: 1. Go to 2. Click on CareCore Solutions 3. Click on Radiation Therapy, Radiation Therapy Tools & Criteria Radiation Therapy

22  To initiate a Radiation Therapy request, the physician providing the radiation treatment plan will be required to complete all questions on the specific worksheet.  The Worksheets are located on the CareCore National Website.  The requests are to be submitted by WEB or by Telephone only  No requests may be faxed  A medical necessity determination number will be issued when medical necessity is finalized including the description of the approved treatment plan including technique, treatment sessions and gantry angles Radiation Therapy

23 A finalized medical necessity determination will result in one of three decisions: 1.FULL approval - the treatment plan requested is approved 2.FULL denial - the treatment plan requested in non-certified 3.PARTIAL approval - the treatment plan requested including treatment sessions and gantry angles is partially approved, allowing only a portion of the requested quantities and non- certifying the remainder Radiation Therapy

24  The provider and member are notified in writing of the decision  Authorization status can also be verified on the CareCore website  CareCore National Radiation Oncologists are available to speak with a referring or rendering physician at any time during the course of treatment  If a modification is required for an authorized treatment plan, the ordering provider’s office should contact CareCore National to request an update to an existing treatment plan Radiation Therapy

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26 Oncology & Injectable Drug Management  Chemotherapeutic Agents  Adjunctive Therapies  Supportive Therapies  ESA Agents  Anti-Angiogenesis Drugs  TNF Inhibitors  IVIG Products  Other Biotherapeutics  Outpatient Services  Approval valid 56 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours Oncology Benefit Management Tools  Medical Necessity Determination  Education  Comprehensive reporting  Peer to Peer Consultation Oncology Program Components Oncology Management

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 Comprehensive multidisciplinary treatment plans that include conservative care  Proven and unproven interventional techniques  Imaging guidance of procedures  The use of approved oral and injectable medications  Outpatient Services  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours Benefit Management Tools  Medical Necessity Determination  Education  Comprehensive reporting  Peer to Peer Consultation Program Components 28 Musculoskeletal Management

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 Sleep Diagnostics  Sleep Therapy Devices and Supplies  PAP Therapy Compliance Benefit Management Tools  Prior Authorization for Sleep Diagnostics & Therapy  Facility and Home Testing management  Compliance Monitoring & Reporting  Network Management & Development  Sleep Medical Management Policies  Peer to Peer Consultation Program Components 30 Sleep Management

In New Jersey  Post Service Medical Necessity Review Effective 1/1/2013 New Jersey Small group and Individual plans New Jersey Municipality plans New Jersey School Board plans In New York  Radiology Management Program Effective 2/1/2002  Member Scheduling Program Effective 4/1/2006  Cardiology Management Program MPI -Effective 9/1/2006  Radiation Therapy Program Effective 12/1/09 Oxford Program Overview 31

Aetna HMO Plans Covered: Commercial, ASO, Medicare Counties Covered: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren  Radiology Management Program Effective 8/1/2002  Member Scheduling Program Effective 9/1/2005  Claims Payment (Commercial, ASO, Medicare) Effective 9/1/2006  Cardiology Management Program MPI -Effective 9/1/2006 Stress Echo, Left Heart Cath – Effective 8/1/2009 Right Heart Cath – Effective 5/15/2010 Cardiac Implantables, Cardiac MRI, Cardiac PET, Cardiac CT CCTA- Effective 6/1/2012  Sleep Management Program Effective 11/1/2009  Radiation Therapy Program Effective 6/1/2010 Aetna PPO Plans Covered: Commercial, Medicare Counties Covered: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren  Radiology Management Program Effective 5/1/2007  Member Scheduling Program (Home Depot members only) Effective 1/1/2010  Member Scheduling Program (Aetna, Inc. PPO employees ) Effective 5/1/2010  Cardiology Program: Effective 5/1/2010 Aetna Northern New Jersey Program Overview 32

33  Radiology (Effective Date: 1/1/2005)  Horizon Radiology Program Prior Authorization/Medical Necessity Determination  Member Scheduling  Payment Policies  Privileging  Comprehensive Reporting  Quality Assurance/Management  Payment Policies  Peer to Peer Consults  Outpatient Services  Approval valid 45 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours  Cardiology (Effective Date: 3/1/2008)  Horizon Cardiology Management Prior Authorization/Medical Necessity Determination  Echocardiogram (Effective 7/1/2009)  Credentialing & Privileging (Effective 11/30/2009)  Transthoracic and Stress Echocardiogram ( Effective 11/30/2009)  Education  Privileging  Comprehensive Reporting  Quality Assurance/Management  Outpatient Services  Approval valid 45 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours Horizon Blue Cross Blue Shield NJ Program Overview

Horizon Blue Cross Blue Shield NJ Program Overview Continued  Oncology (Effective Date: 4/1/2007)  Oncology UM Program -Medical Necessity Determination  Epoge/Procrit  Aranesp  Education  Comprehensive Reporting  Peer to Peer Consultation  Outpatient Services  Approval valid 56 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours  Radiation Therapy (Effective Date: 3/1/2009)  Radiation Therapy Utilization Management Program -Medical Necessity Determination  Education  Comprehensive Reporting  Peer to Peer Consultation  Outpatient Services  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours  Musculoskeletal Utilization Management ( Effective Date: 4/26/2010)  MSM Utilization Management -Program Medical Necessity Determination  Education  Comprehensive Reporting  Peer to Peer Consultation  Outpatient Services  Approval valid 45 days  TAT Standard 2 BD upon receipt of completed clinical documentation  Urgent up to 3 hours 34

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