IN-P-0002B Indiana 2017 Health Partner Orientation

WORKING with CareSource Health Partner Orientation1 How to use this PRESENTATION This presentation is an orientation training for all of CareSource’sIndiana health partners, including those serving members of: • Hoosier Healthwise (HHW) HHW • Healthy Indiana Plan (HIP) • Marketplace Plans (MP) • CareSource Medicare Advantage/CareSource Dual Advantage(D-SNP) HIP We will indicate what plan(s) each slide’s information applies to with MP the tabs on the slide. MA/D - SNP 2 About CareSource PART 1 3 Our MISSION To make a lasting difference inour members' lives by improving their health and well-being. OUR PLEDGE Make it easier for you to work with us Partner with providers to help members make healthy choices Direct communication Timely and low-hassle medical reviews Accurate and efficient claims payment 4 Health Care with HEART MISSION FOCUSED Comprehensive, member- 31 centric health and life services. EXPERIENCED With over 31 years of service, CareSource is a leading non-profit health insurance company. 93% DEDICATED MEDICAL COST RATIO We serve over 1.8 million members through our Medicaid, Marketplace and Medicare Advantage/CareSource Dual Advantage plans and our Veterans Choice A-Z partnership with TriWest Healthcare $14.5 M Alliance. IN FOUNDATIONGRANTS 5 Our PLANS LOW-INCOME LOW-INCOME, HEALTH MEDICARE ADULTS & UNINSURED INSURANCE ADVANTAGE CHILDREN AND ADULTS ADOLESCENTS DUAL AGES 19-64 MARKETPLACE UP TO AGE19 ELIGIBLE HOOSIER HEALTHY INDIANA MARKETPLACE MEDICARE ADVANTAGE/ HEALTHWISE PLAN DUAL ADVANTAGE(D-SNP) Details: HHW Details: Details: Details: • For uninsured • Qualified health • Combines • Risk-based Hoosiers up to 138% managed care plan benefits of of federal poverty • Individual and Medicare and • Children up to age level Family health Medicaid into HIP 19 • Members are insurance plans single plan • Pregnant women responsible for cost • All plans include • Adds additional sharing by making a POWER account Pediatric Dental & benefits contribution (PAC) or Vision outside of MP by copayments. • Optional Adult Medicare and Members who make Dental, Vision & Medicaid plans a PAC receive Fitness coverage MA/D enhanced benefits - 6 SNP Our PLANS ST. JOSEPH ELKHART LAGRANGE STEUBEN LAPORTE LAKE PORTER NOBLE DEKALB HIGHLIGHTS MARSALL STARKE KOSCIUSKO WHITLEY ALLEN We provide services for Hoosier JASPER PULASKI FULTON and in NEWTON Healthwise Healthy Indiana Plan WABASH ALL of Indiana WHITE CASS MIAMI WELLS ADAMS BENTON CARROLL HOWARD GRANT We offer our Marketplace plans in ALL of WARREN TIPPECANOE JAY CLINTON TIPTON Indiana DELAWARE HHW FOUNTAIN MADISON RANDOLPH MONTGOMERY BOONE HAMILTON We offer our MA/D-SNP plan in 18 HENRY HANCOCK WAYNE counties in Indiana (See counties PARKE HENDRICKS MARION PUTNAM VERMILLION RUSH FAYETTE UNION where MA/D-SNP is offered on map) HIP JOHNSON SHELBY VIGO MORGAN CLAY FRANKLIN OWEN DECATUR MONROE BROWN SULLIVAN RIPLEY GREENE JENNINGS OHIO JACKSON LAWRENCE SWITZERLAND MP JEFFERSON KNOX DAVIESS MARTIN SCOTT WASHINGTON ORANGE CLARK PIKE FLOYD DUBOIS MA/D GIBSON CRAWFORD WARRICK PERRY HARRISON - POSEY SPENCER SNP 7 Working with CareSource PART 2 8 Provider Network & ELIGIBILITY CareSource members choose or are assigned a primary care provider (PCP) “DO YOU TAKE upon enrollment. CARESOURCE?” Be sure to ask to see each patient’s member When referring patients, ensure other ID card to ensure you take their plan. Be sure providers are in-network to ensure coverage. to confirm which CareSource plan the member is asking that you accept. Use our Find A Doc tool at CareSource.com to help you locate a participating CareSource NOTE: For Marketplace and HHW provider by plan. MA/D-SNP, routine Vision and Hearing services are covered through EyeMed and OUT-OF-NETWORK TruHearing network providers. HIP For HHW/HIP, routine Vision SERVICES services are covered through Out-of-network services are NOT covered Superior Vision. MP unless they are emergency services, self- NOTE: Provider eligibility to accept referral services or prior authorized by CareSource members can be CareSource (not applicable to Marketplace confirmed in the CareSource Provider MA/D Plans). Portal. - 9 SNP Notification of Pregnancy Indiana Health Coverage Programs (IHCP) recognizes that timely identification of risk factors improves birth outcomes. The Notification of Pregnancy (NOP) form pinpoints risk factors in the earliest stages of pregnancy for women enrolled in HIP andHHW. The NOP form may be accessed through the Provider Healthcare Portal (https://portal.indianamedicaid.com/hcp/) REIMBURSEMENT A qualified provider is eligible for a $60 reimbursement for one NOP per pregnancy completed and successfully submitted using the Provider Healthcare Portal. The submitted information is used by CareSource to determine the risk level associated with the pregnancy and establish areas of follow-up care: • Submit claim 99354-TH if you completed the NOP, but not in the 1st trimester • Submit claim 99354-TH for $70 if you completed the NOP within the 1st trimester HHW • The NOP must be submitted via the Provider Portal no more than five calendar days from the date of the the office visit on which the NOP is based • The member’s pregnancy must be less than 30 weeks’ gestation at the time of the HIP office visit on which the NOP is based. 10 ID CARDS: Medicaid Member HOOSIER HEALTHWISE HEALTHY INDIANA PLAN 11 ID CARDS: Marketplace Member Make sure the state matches your contracted region Marketplace dependents are indicated by the Member ID + dependent suffix (portion after the “-”) Example: 14800000000-01 (JaneDoe) 12 ID CARDS: Medicare Member MEDICARE ADVANTAGE CARESOURCE DUAL ADVANTAGE 13 Claim SUBMISSIONS SUBMISSION PROCESS Providers can submit claims through our secure, online Provider Portal at CareSource.com > Provider Log In. Here, providers can submit claims along with any documentation, track claim payments and more. WE ENCOURAGE ELECTRONIC CLAIM SUBMISSION • We will be partnering with ECHO Health for electronic funds transfer (EFT).* HHW • You must enroll with ECHO Health to participate. • Find the enrollment form online at www.echohealthinc.com. For questions, call ECHO Support at 1-888-485-6233. HIP EDI CLEARINGHOUSES CareSource currently accepts electronic claims through our clearinghouse, Availity. Providers can find a list of EDI vendors online at MP www.availity.com/caresourceedivendors. NOTES M A / • Please list your National Provider Identifier (NPI) on all claims. D - S N • Please ensure you list the correct billing taxonomy code. P 14 Access and AVAILABILITY As a CareSource health partner, you must ensure your practice complies with the following minimum access standards: • Provide 24-hour availability to your CareSource patients by telephone. – Whether through an answering machine or a taped message after hours, patients should have the means to contact their PMP or back-up health partner to be triaged for care. – It is not acceptable to use a phone message that doesn’t provide access to you or your back- HHW up health partner and only recommends an emergency room after hours. • Be available to see members at least three days per week for a minimum of 20 hours per week. • Provide members telephonic access to the PCP (or appropriate designee) HIP in English and Spanish 24/7. Please refer to our Provider Manual at CareSource.com for a complete MP listing of Access and Availability standards. MA/D 15 - SNP Access and AVAILABILITY Primary Care Providers (PCP’s) Medicaid Members Marketplace Members Type of Visit Should be seen… Should be seen… Emergency needs Immediately upon Immediately upon presentation presentation Urgent care* Not to exceed 48 hours Not to exceed 48 hours HHW Regular and routine care Not to exceed 14 calendar Not to exceed 6 weeks days HIP *For primary medical providers (PMPs) only: Provide 24-hour availability to your CareSource patients by telephone. Whether through an answering machine or a taped message used after hours, patients should be given the means to contact their PMP or a back-up provider to be triaged for care. It is not acceptable to use a phone MP message that does not provide access to you or your back-up provider, and only recommends emergency room use for after hours. MA/D - SNP 16 Access and AVAILABILITY Non-PCP Specialists Medicaid Members Marketplace Members Type of Visit Should be seen… Should be seen… Emergency needs Immediately upon Immediately upon presentation presentation Urgent care* Not to exceed 48 hours Not to exceed 48 hours HHW Regular and routine care Not to exceed 14 calendar Not to exceed 6 weeks days HIP *Providers should see members as expeditiously as their condition and severity of symptoms warrant. It is expected that if a provider is unable to see the member within the designated timeframe, CareSource will facilitate an appointment with another participating provider, or a non-participating provider, when necessary. MP MA/D - SNP 17 Access and AVAILABILITY Behavioral Health Providers Medicaid Members Marketplace Members Type of Visit: Should be seen… Should be seen… Emergency needs Immediately upon Immediately upon presentation presentation Non-life threatening Not to exceed 6 hours Not to exceed 6 hours emergency* HHW Urgent care* Not to exceed 48 hours Not to exceed 48 hours Initial visit for routine care Not to exceed 10 business Not to exceed 10 business days days HIP Follow-up routine care Not to exceed 30 calendar Not to exceed 30 calendar days (based on condition) days (based on condition MP For the best interest of our members, and to promote their positive health care outcomes, CareSource supports and encourages continuity of care and coordination of care between medical care providers, as well as between physical health providers MA/D and behavioral health providers. - SNP 18 Hospice COVERAGE Healthy Indiana Plan (HIP) members receive hospice coverage with the exception of institutional hospice which is only covered inFFS. Hoosier Healthwise (HHW) members must be disenrolled from managed care in order to receive hospice services. The state of Indiana administers this benefit.The member must be enrolled in traditional Medicaid.

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