1. Provider Refresher Training Program 2011

2. Provider Training Program Agenda Welcome and Opening Remarks Program Components Facility Selection Support Program How the Program Works: Authorization Process Algorithms Guidelines Radiation Awareness Provider Self-Service Tools (RadMD and IVR) NIA Provider Relations and Contact Information Questions and Answers NIA—A Magellan Health Company 2

3. Program Components Utilization Management/Authorizations: NIA's proprietary, evidence-based decision algorithms support scripting for call center representatives or online, leading to quick procedure approval or consultation with our radiology experts. Information and Transaction Tools: Our online resource, www.RadMD.com, gives ordering providers the ability to request and obtain authorizations, reference lists of nearby imaging facilities, locate authorizations and submit rapid authorization requests. Providers report a high level of satisfaction with their use of RadMD, finding it a simple tool to use and a time-saver for staff. www.RadMD.com Ordering Provider Program: Analyze referral patterns with the Health Plan and develop additional education and outreach opportunities to the provider community to review various facility options based upon convenience factors for members (i.e., free parking, on a public transportation line, weekend hours, etc.) Provider Privileging: The program includes privileging of the Health Plan’s freestanding facilities and the Health Plan’s in-office providers for advanced and cardiac imaging. The program promotes continuous quality improvement, provides scope of practice limitations and enables consumers to make educated health care decisions. Hospitals are excluded from the privileging program. NIA—A Magellan Health Company 3

4. Facility Selection Support Program

5. Facility Selection Support Goals The facility selection process is based on patient support and cost effectiveness Primary consideration is always the clinical aspect of the patient when making facility recommendations. Helps ensure that patients go to quality imaging facilities that are conveniently located. Supports the education of both the provider and patient about cost-effective facility alternatives. Facilitates the delivery of tests at free-standing, outpatient facilities (when appropriate) to support lower costs NIA—A Magellan Health Company 5

6. How Facilities are Selected During prior authorization, the authorization representative will help the ordering provider select a facility based on: Facilities meeting NIA’s quality requirements and patient’s clinical need Location and cost differential Convenience items important to patient Prior Authorization for a high cost facility will be confirmed with the consumer if there is no clinical justification Facilities located in or close to required zip code. Preference given to lower cost facilities Facilities with requested convenience items Facility Selected All facilities meeting NIA’s approved facility requirements for the indicated test. Facilities also meet the patient’s clinical requirements NIA—A Magellan Health Company 6

7. Convenience Services that can be Selected Transportation and parking Public transportation accessibility Free parking Language assistance Languages spoken by office staff Telecommunication equipment for deaf patients Weekend or evening hours Extended evening hours Weekend hours NIA—A Magellan Health Company 7

8. The Authorization Process

9. NIA Prior Authorization is required for: Non-emergent outpatient, short stay and urgent care CT/CTA Scan CCTA MRI/MRA PET Scan Diagnostic Nuclear Medicine Nuclear Cardiology/MPI Echocardiography Stress Echo Any code specifically cited in the Health Plan/NIA Billable CPT ® Code Claims Resolution Matrix. All other procedures will be adjudicated and paid by the Health Plan per their guidelines. Authorizations are valid for sixty (60) days from date of initial request. NIA—A Magellan Health Company 9

10. NIA Prior Authorization is not required for: Inpatient, Observation or Emergency Room: CT/CTA CCTA MRI/MRA PET Scan Diagnostic Nuclear Medicine Nuclear Cardiology/MPI Echocardiography Stress Echo NIA—A Magellan Health Company 10

11. Physicians’ office contacts NIA for prior authorization of study  RADMD.COM  Telephone Clinical information complete – procedure approved Clinical information not complete – additional information needed System evaluates request based on physician entered information Request for specific clinical information needed Additional clinical information complete –procedure approved Additional clinical not complete or inconclusive Initial Clinical Specialty Team Review  Physician Approves Case Without Peer-to- Peer  Physician Approves Case With Peer-to-Peer  Physician Denies Case Physician Review  Ordering Physician Withdraws Case W 92% of all cases receive final determinations in 24 – 48 hours.   ? ? NIA Clinical UM Authorization Process NIA— A Magellan Health Company | 11

12. Algorithms/Guidelines

13. NIA Clinical Expertise and Provider Engagement  NIA reviews more than 450,000 advanced imaging provider requests each month.  Algorithms and guidelines are reviewed and mutually approved by Geisinger Health Plan and NIA chief medical officers.  Many NIA algorithms recommend substituting more costly but more effective imaging technology. Our goal–the most appropriate test early in an episode of care for “Client” members.  Clinical consultation is a hallmark of NIA– we have 86 board-certified physicians representing radiology and a host of other specialties available for physician-to-physician (peer-to-peer) discussion. NIA— A Magellan Health Company | 13

14. Access Clinical Guidelines on RadMD Home Page NIA—A Magellan Health Company 14 This screen allows you to select: Health Plan Type of Study Exam

15. Clinical Guidelines Search NIA—A Magellan Health Company 15

16. From a drop down list on the NIA Clinical Guideline page, Select the appropriate Health Plan and Study NIA—A Magellan Health Company 16

17. Select the exam you want to review. A PDF document will open the guideline selected. NIA—A Magellan Health Company 17

18. NIA—A Magellan Health Company 18 Lumbar Spine CT Example of Clinical Information Needed

19. Algorithms can recommend Substituting More Costly but More Effective Imaging Technology NIA—A Magellan Health Company 19

20. Prior Authorization Checklist Information needed to make Medical Necessity Determination NIA—A Magellan Health Company 20

21. Requests Pended for Clinical Review Upload Clinical Documentation or use Fax Coversheet NIA—A Magellan Health Company 21

22. Radiation Awareness

23. Radiation Awareness Program NIA, in partnership with the Health Plan, has implemented a Radiation Awareness Program to educate the provider community as well as the members on radiation exposure. Goals of the Program Inform ordering providers of past exposure Offer provider education and consultation NIA—A Magellan Health Company 23

24. Radiation Awareness Program Distinguishing Features Claims-based, member-specific radiation accumulator NIA will advise ordering providers of patients with high level exposure (=>50 mSv cumulatively while with the Health Plan) to radiation during authorization requests and offer peer-to-peer consultation. Provider/member educational content is available Medical necessity decisions are not impacted by the patient’s radiation exposure - information is intended to assist the provider with the member’s care. More information on radiation awareness is available on our website, www.RadMD.com. www.RadMD.com NIA—A Magellan Health Company 24

25. Radiation Awareness NIA—A Magellan Health Company 25

26. Radiation Exposure Adds Up Over Time NIA—A Magellan Health Company 26

27. Self Service Tools and Usage

28. Interactive Voice Response (IVR) Use tracking number to check status of cases Web site: www.RadMD.comwww.RadMD.com Use tracking number to review an exam request NIA—A Magellan Health Company 28

29. NIA Web Site www.RadMD.com The NIA web site gives providers access to: Information concerning approved authorizations. Go to www.RadMD.com and login with username and password.www.RadMD.com Search the site using the patient’s ID number, name or authorization number. NIA—A Magellan Health Company 29

30. Initiate an Authorization Request on RadMD NIA—A Magellan Health Company 30 Available Sunday-Friday, 5:00 a.m. to 12:00 am Saturday 8:00 a.m. to 1:00 p.m. EST

31. Imaging Facilities View all Requests Entered by Ordering Provider NIA—A Magellan Health Company 31

32. Search Authorization by Name, Member ID Number or view All Requests NIA—A Magellan Health Company 32

33. NIA RadMD Website  User-friendly, near-real-time Internet tool offered by NIA o Sign in at www.RadMD.com  RadMD website offers access to: o Member preauthorization's o Date initiated o Exam requested o Valid billing codes (CPT)  Helpful resources including: o Evidence-based Clinical Guidelines (by diagnosis) o Outpatient Radiology Billable CPT® Codes Claim Resolution Matrix o Radiology Utilization Management Quick Reference Guide o NIA Frequently Asked Questions (FAQs) NIA—A Magellan Health Company 33

34. Magellan Health Services, Inc. | 34 Login and click the new user button on the right side of the home page. Fill out the application and click the submit button. You must include your e-mail address in order for our webmaster to respond to you with your NIA-approved username and password. HIPAA regulations require everyone in your organization to have his or her own username and password. On subsequent visits to the site, click the login button to proceed. To get started, visit www.RadMD.com

35. RadMD Demonstration

36. NIA Provider Relations

37. NIA Contact Information NIA Provider Relations Manager Charmaine Gaymon Phone: (410) 953-2615 Email: csgaymon@magellanhealth.comcsgaymon@magellanhealth.com Provides educational tools to ordering and rendering providers on imaging processes and procedures. Liaison between Geisinger Health Plan Provider Relations and NIA. NIA—A Magellan Health Company 37

38. Questions and Answers