MARYLAND PHYSICIANS CARE November 16, 2012 Introduction Thank you Erika Berg and AAHAM for inviting me to this session. I hope you find the next few minute helpful

Who We Are Maryland Physicians Care (“MPC”) is a Statewide Maryland Medicaid MCO owned by Western Maryland Health System Meritus Health Maryland General Health System St. Agnes HealthCare

Who We Are MPC serves enrollees in Maryland's HealthChoice (HC) Program Primary Adult Care (PAC) Program

Enrollment and Market Share Health Choice Statewide 153K Members 20.1% Market share Allegany and Garrett Counties 17K Members 94% Market share PAC Enrollment 13K Members 23% Market share 1,013 Members 67% Market share As of March 2012

HEDIS Measures (Healthcare Effectiveness Data Information Set) HEDIS measures are reported annually on: Effectiveness of Care Access/Availability of Care Satisfaction with the Experience of Care Healthcare Plan Stability Use of Service Healthcare Plan Description Information Cost of Care Informed Healthcare Choices HEDIS is directed by NCQA (National Commission for Quality Assurance)

2012 HEDIS Target Measures Well Child Visit 3-6 Postpartum Care SSI Adults SSI Children Appropriate MEDS for Asthma (Combined) Cervical Cancer Screen 21-64 Lead Screening 12 and 23 Months Diabetic Eye Exams Immunizations (Combo3) Adolescent Well Care Visit If you have any questions you can contact our HEDIS coordinator – Roger Yates who’s contact information is listed in the back of the presentation.

Pay for Performance The P4P measurement criteria is Maryland Physicians Care (“MPC”) has a Pay-for- Performance Program (“P4P”) which pays out annually to PCP groups that demonstrate high clinical quality The P4P measurement criteria is Compatible with MPC’s core mission Consistent with HEDIS and Department of Health and Mental Hygiene Measurement criteria Seeks to align incentives.

CY 2012 Pay for Performance Criteria Adolescent Well Care (Pediatrics, Family Practice) Well Child 3-6 (Pediatrics, Family Practice) Lead Screening* (Pediatrics, Family Practice) Immunizations (Combo 3) (Pediatrics, Family Practice) Appropriate Meds for Asthma (Internal Medicine, Family Practice & Pediatrics) Diabetic Eye (Internal Medicine, Family Practice) Cervical Cancer Screening (Internal Medicine, Family Practice) Postpartum Care (Obstetrics, Family Practice) Timeliness of Prenatal Care (Obstetrics, Family Practice) *State of MD specifications instead of NCQA HEDIS specifications

My MPC Source HIPAA Compliant Website

Prior Authorization Search Tool

Overview Healthy Groove – Take Steps To Live Well is a program brought to you by Maryland Physicians Care (MPC) that helps Marylanders take control of their health and well-being by encouraging healthy habits. Through grassroots outreach and community advocacy across Maryland, we show simple steps for adults and children ways to: Eat smarter Be more active Schedule and keep regular checkups and screening appointments This is a program that is starting into it’s fourth year with MPC. We use Healthy Groove at local community health fairs to raise awareness of the benefits of living a healthy lifestyle. 18

About the Events Events in communities across western, central and capital regions of Maryland Communities are encouraged to get their healthy groove on with: Free food, music, giveaways and health screenings* Free healthy and fun activities such as Nintendo Wii™, jump rope and hula hoop contests *Activities and screenings will vary by event. 19

Healthy Groove RV

The following information can be found on our website: www.MarylandPhysiciansCare.com The following information can be found on our website: Various Forms Provider Manual Current Drug Formulary Search the directory of participating providers Access to our Secure HIPAA Compliant Website Our website will soon be changing. You will still be able to access all of this information we are changing the format to make it more user friendly

Member Eligibility Member eligibility can be checked several ways: Call EVS @ 866-710-1447 Log onto EVS at: https://encrypt.emdhealthchoice.org/emedicaid/_Portal/provWelcome.jsp Log on to MPC’s Secure HIPAA compliant web portal at: https://MarylandPhysiciansCare.abovehealth.com

Maryland Physicians Care Claims Tips Fill out claim form completely including NPI # Timely filing limit for original submissions is 180 days from the date of service Use valid codes Send claim to proper address: Maryland Physicians Care Attn:Claims PO Box 61778 Phoenix, AZ 85082-1778

Provide the following: Prior Auth Tips Provide the following: Member information Clinical note/explanation of medical necessity Diagnosis and procedure codes Date(s) of Service When faxing use a cover sheet with correct phone & fax numbers for your practice Fax to MPC at 800-953-8856 For unscheduled admits fax to: 800-385-4169 Jenny Please contact MPC’s Prior Authorization Department by TELEPHONE for INPATIENT EMERGENCY, URGENT or DIRECT ADMISSIONS. Fax numbers are listed to use for non emergent requests. The website can also be used to submit non emergent requests. Turn around time for non emergent requests are 2 days for complete requests and 7 days for incomplete requests. For tertiary care referrals the following academic medical centers participate with MPC – WVU, UMMS, JHH

Contact Information Provider Relations 1-800-953-8854 Prior Authorization Monday – Friday 8:00am – 5:00pm 1-800-953-8856 (fax) Secure HIPAA Compliant Website Link: https://MarylandPhysiciansCare.abovehealth.com/

Contact Information Claims Inquiry 1-800-953-8854 Secure HIPAA Compliant Website Link: https://MarylandPhysiciansCare.abovehealth.com/ Appeals Inquiry Fax: 1-866-831-0790 Email: mpc.appeals@marylandphysicianscare.com Basic appeals status should be checked by calling the claims inquiry number listed above

Contact Information Claims Resubmission Address: Maryland Physicians Care Attn: Claims Resubmission P.O. Box 61778 Phoenix, AZ 85082-1778 Appeals Address: Attn: Appeals 509 Progress Dr. Linthicum, MD 21090 Corrected Claims need to be submitted as Resubmissions not as appeals.

Contact Information Special Needs Coordinator for Case Management Services 1-800-953-8854 HEDIS Coordinator Roger Yates 410-401-9493 – Direct line

Questions? Questions?