1. 03-23-05 October 2006 Who, What, Where, and When Presentation Presented by EDS Provider Field Consultants

2. Who, What, Where, and When Presentation October 2006 page 2 Agenda IHCP Information Eligibility Verification Systems Division of Family Resources Health Care Excel Pharmacy Services Third Party Liability Managed Care EDS Member and Provider Relations Questions Welcome and Announcements

3. Who, What, Where, and When Presentation October 2006 page 3 IHCP Information The main sources for information about the Indiana Health Coverage Programs (IHCP) is available in the following locations: IHCP Web site at www.indianamedicaid.com IHCP Provider Manual IHCP provider monthly newsletters IHCP provider bulletins IHCP provider banner pages Note: These reference tools apply to fee-for- service/Traditional Medicaid, not the risk based managed care delivery system

4. Who, What, Where, and When Presentation October 2006 page 4 IHCP Information Member-focused information about specific IHCP Programs: Hoosier Healthwise –www.healthcareforhoosiers.com Medicaid Select –www.medicaidselect.com

5. Who, What, Where, and When Presentation October 2006 page 5 Web InterChange Functions Web interChange provides access to the following: Member eligibility Benefit limits Claim status Check inquiry Claim submission Prior authorization Prior authorization inquiry Provider profile update Third party liability update Web interChange

6. Who, What, Where, and When Presentation October 2006 page 6 Access Web interChange to verify member eligibility using: Member ID number Social Security Number Name and date of birth Medicare ID number Eligibility Verification Systems Web interChange

7. Who, What, Where, and When Presentation October 2006 page 7 Eligibility Verification Systems The automated voice-response (AVR) provides access to the following: Member eligibility verification Benefit limits Prior authorization Claim status Check write Available 24 hours, seven days a week at (317) 692-0819 in the Indianapolis local area or 1-800-738-6770 Automated Voice-Response

8. Who, What, Where, and When Presentation October 2006 page 8 Eligibility Verification Systems The OMNI 380 terminal is a swipe card system. Support is available by dialing: 1-800-284-3548 or (317) 488-5051 To purchase new equipment contact: MedData a Division of AGDATA, Inc. 1010 Hurley Way, Suite 180 Sacramento, CA 95825 (916) 648-7440 OMNI

9. Who, What, Where, and When Presentation October 2006 page 9 Division of Family Resources Consists of 92 county offices Uses the Indiana Client Eligibility System (ICES) Determines member eligibility Determines spend-down monthly obligations Determines Qualified Medicare Beneficiary (QMB) eligibility

10. Who, What, Where, and When Presentation October 2006 page 10 Contact the HCE Prior Authorization Department to make PA requests –By telephone at (317) 347-4511 in the Indianapolis local area or 1-800-457-4518 –By mail at: HCE Prior Authorization Department P.O. Box 531520 Indianapolis, IN 46253-1520 Health Care Excel Prior Authorization

11. Who, What, Where, and When Presentation October 2006 page 11 Contact the Provider and Member Concern Line to report fraud and abuse –Call (317) 347-4527 in the Indianapolis local area or 1-800-216-5938 –Report member misuse of medical benefits –Report provider misconduct Health Care Excel Fraud and Abuse

12. Who, What, Where, and When Presentation October 2006 page 12 Contact the HCE Medical Policy Department: By telephone at (317) 347-4500 By mail at: HCE Medical Policy Department P.O. Box 53380 Indianapolis, IN 46253-0380 Health Care Excel Medical Policy

13. Who, What, Where, and When Presentation October 2006 page 13 Pharmacy Services Contact the EDS Pharmacy/POS Helpdesk By telephone at (317) 655-3240 in the Indianapolis local area or 1-800-577-1278 On the Web at www.indianamedicaid.comwww.indianamedicaid.com Obtain pharmacy prior authorizations from ACS By telephone at 1-866-879-0106 By fax at 1-866-780-2198

14. Who, What, Where, and When Presentation October 2006 page 14 Third Party Liability Report and correct third party liability (TPL): By telephone at (317) 488-5046 or 1-800-457-4510 By fax at (317) 488-5127 Online through Web interChange TPL updates may include the following: TPL no longer effective for member TPL not on file for member

15. Who, What, Where, and When Presentation October 2006 page 15 Managed Care Contact AmeriChoice for PMP enrollment and education: Medicaid Select – 1-877-633-7353 or www.medicaidselect.com

16. Who, What, Where, and When Presentation October 2006 page 16 Managed Care The following are the five Managed Care Organizations (MCOs) in risk-based managed care (RBMC) through December 31, 2006: CareSource –1-866-930-0017 or www.caresource-indiana.comwww.caresource-indiana.com Harmony –1-800-504-2766 or www.harmonyhmi.comwww.harmonyhmi.com MDwise –1-800-356-1204 or www.mdwise.orgwww.mdwise.org Managed Health Services –1-800-414-9475 or www.managedhealthservices.comwww.managedhealthservices.com Molina –1-800-642-4509 or www.molinahealthcare.comwww.molinahealthcare.com Managed Care Organizations

17. Who, What, Where, and When Presentation October 2006 page 17 Contact Customer Assistance for answers to general program questions: Call (317) 655-3240 in the Indianapolis local area or 1-800-577-1278 Telephone lines are open from 8 a.m. to noon and 1 p.m. to 5 p.m., Monday through Friday Analysts are cross-trained on all facets of the program Analysts do not provide eligibility information. EDS Member and Provider Relations Customer Assistance

18. Who, What, Where, and When Presentation October 2006 page 18 Contact Provider Enrollment for answers to questions about enrollments and provider file information Call 1-877-707-5750 Telephone lines are open from 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday EDS Member and Provider Relations Provider Enrollment

19. Who, What, Where, and When Presentation October 2006 page 19 Send issues requiring extensive research to the Written Correspondence Unit at the following address: EDS Written Correspondence P.O. Box 7263 Indianapolis, IN 46207-7263 EDS Member and Provider Relations Written Correspondence

20. Who, What, Where, and When Presentation October 2006 page 20 Provider field consultants perform the following tasks: Educate providers Serve as provider association liaisons Manage projects EDS Member and Provider Relations Provider Field Consultants

21. Who, What, Where, and When Presentation October 2006 page 21 Questions

22. 03-23-05 October 2006 page 22 EDS 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204 Presentation by EDS Provider Field Representatives EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. EDS is an equal opportunity employer and values the diversity of its people. © 2005 Electronic Data Systems Corporation. All rights reserved.