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November 14,2014 Introduction for Health Care Providers and Administrators to Humana Medicare Advantage Plans

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Humana is one of nations largest publicly traded health benefits companies with 11.2 million medical members 7.3 million specialty-product members Offers a wide array of plans for employer groups, government programs and individuals Offers a range of specialty products, including dental and vision plans Operates more than 300 medical centers Operates more than 240 worksite medical facilities About Humana

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Humana works diligently and is dedicated to staying in step with health care reform Humana follows guidance and mandates from the Centers for Medicare & Medicaid Services (CMS) Providers can go to the following website for updates on Health Care Reform: www.HealthCare.govwww.HealthCare.gov Humana and Health Care Reform

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One plan, one plan premium, one company Medicare Coverage Options Includes all the benefits of Original Medicare (Part A Hospital) (Part B Medical) Medicare Advantage health plan only (MA only) Stand-alone Part D (outpatient pharmacy) MAPD MA health plan with Part D included

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About Humanas Medicare Plans

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Humana Gold Plus Health Maintenance Organization (HMO) Medicare supplement (Medigap) plans Humana Gold Choice Private-Fee-for-Service (PFFS) HumanaChoicePPO Preferred Provider Organization (PPO) Humana Gold Plus HMO Point-of-Service (HMO-POS) Medicare Advantage Special Needs Plans (SNP) Please note: Plans offered vary by area/region. Humana Medicare Health Plans

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RightSource Rx

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Prescription Home-Delivery Service RightSourceRx is safe, accurate and convenient Developed for Humana members who: Are concerned about their prescription drug costs Have physical difficulty getting prescriptions filled Are interested in a new pharmacy solution

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How to Prescribe with RightSourceRx To submit new RightSourceRx prescriptions Transmit directly to RightSourceRx via electronic prescribing capabilities Call 1-800-379-0092, or Fax a physician prescription fax form to 1-800-379-7617 (Fax forms are available online at RightSourceRx.com)

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Additional Member Benefits

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Vision Dental Complimentary Alternative Medicine (CAM) Network network offering discounts at alternative health care providers Hearing Aid benefits for SNP only Additional Member Benefits

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Interacting with Humana Via the Internet

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Public section Health and wellness information Clinical practice guidelines Provider publications Provider network directories (corrections to your demographic information can be provided to us electronically) Secure section (Provider Self-Service Center) Patient eligibility and benefits Preauthorization requests Referral and claims submissions Referral and claims status Fee schedules Delegation of work to a contracted billing services More information Humana e-business consultant at:1-877-260-7360 Provider Website: Humana.com/providers

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Providers should do the following: Go to Humana.com/providers Select Register for Self-Service Choose Provider Select provider type: Physician Group Affiliated Provider Third-Party Administrator (TPA) or Billing Service Choose Register/Create a New Application Complete and submit the application Accessing the Provider Self-Service Center

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Help is available from Providers own tech support A Humana e-business consultant at deployment@humana.comdeployment@humana.com 1-877-260-7360 Training information is available from An e-business consultant at deployment@humana.com.deployment@humana.com Humanas provider website at http://www.humana.com/providers/explore/interactive.asp http://www.humana.com/providers/explore/interactive.asp Help with the Provider Self-Service Center

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Claims and Related Issues

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Claims clearinghouses: Availity www.availity.comwww.availity.com ZirMed www.zirmed.comwww.zirmed.com Athenahealthwww.athenahealth.comwww.athenahealth.com Gateway EDIwww.gatewayedi.comwww.gatewayedi.com McKessonwww.mckesson.comwww.mckesson.com Capariowww.capario.comwww.capario.com SSI Groupwww.ssigroup.comwww.ssigroup.com Details at: www.humana.com/providers/tools/claims/ electronic_submission.asp www.humana.com/providers/tools/claims/ electronic_submission.asp Submitting Claims

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Health care providers can submit Humana claims at no cost through the Humana Provider Self-Service Center at Humana.com/providers In some cases you can have a claim adjudicated while the member is still in your office. For more information, providers can contact a Humana e- business consultant The Claim Management Center

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See the members ID card for correct claim or encounter mailing address Find addresses at www.humana.com/providers/tools/claims/ claims_encounter.aspwww.humana.com/providers/tools/claims/ claims_encounter.asp Submitting Paper Claims

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Edits support Humana's continuing efforts to process claims fairly, accurately and appropriately. Edits relate to The American Medical Associations Current Procedural Terminology (CPT) code set The Healthcare Common Procedure Coding System (HCPCS) code set International Classification of Diseases code set, 9th Edition/Revision (ICD-9) Details can be found at: www.humana.com/providers/tools/claims/ processing_edits.asp www.humana.com/providers/tools/claims/ processing_edits.asp Claims Processing Edits

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Check the status of a claim by: Visiting the Provider Self-Service Center Using Humanas automated system (1-866-4-ASSIST) Speaking with a customer care specialist (1-866-4-ASSIST) The claims research team will review any claims that need further research and contact the appropriate health care provider Claims Issues

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The Provider Payment Integrity Department handles overpayments System-generated letters notify providers of overpayments Providers have 45 days to respond. Options include: Calling the PPI department at 1-800-438-7885 Disputing the letter in writing Mailing a refund check Financial Recovery

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To send a refund: Humana Health Care Plans P.O. Box 931655 Atlanta, GA 31193-1655 To dispute an overpayment letter: Humana Health Care Plans Attn: Financial Recovery Correspondence P.O. Box 14601 Lexington, KY 40512-4601 Financial Recovery Addresses

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Electronic remittance advices (ERAs) Remittance advices post automatically, reducing administrative time and improving posting accuracy Electronic fund transfers (EFTs) Payments are deposited directly to health care providers bank account ERAs and EFTs

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To access the ERA/EFT Setup-Change Request Application, providers should: Click the ERA/EFT Setup-Change Request link from the secure section of the Provider Self-Service Center Choose Tools and Resources from the public section of the provider website and then click on Electronic Remittance Providers should enter the required information: Name Email Phone number Tax identification number Details of two checks from Humana Getting Started with ERAs and EFTs

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Add ERAs and EFTs separately Add ERAs and EFTs together Change file delivery method Change bank information Check the status of transactions Cancel ERAs or EFTs that have been enabled ERA and EFT Capabilities

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Referral, Preauthorization, and Utilization Management

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The PCP initiates a referral by submitting a request to Humana using any one of the following processes: Humana.com/providers 1-800-523-0023 [Interactive Voice Response (IVR)] The PCP receives a referral number from Humana if the request is: Complete and the service is covered The service is medically necessary Please Note: The referral status can be verified by accessing the sources listed above Humana Gold Plus (HMO) PCP Referral Process for out of network providers

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Preauthorization and notification allows Humana to Provide members information on benefits Refer members to appropriate clinical programs Humana requests preauthorization or notification for several services and medications See the Quick Refer View details at: www.humana.com/providers/tools/claims/ pre_authorization.asp www.humana.com/providers/tools/claims/ pre_authorization.asp Preauthorization and Notification

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HealthHelp for radiation therapy diagnostic imaging and specific cardiac services OrthoNet for pain management and outpatient therapy Utilization Management Vendors

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Radiology services are administered by HealthHelp, a national recognized radiology benefit management organization Preauthorizations and notifications are handled through HealthHelps RadConsult service Radiology

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Requirements apply to CT scans, MRAs, MRIs, nuclear stress tests, PET and SPECT scans and radiation therapy Requests are handled through the RadConsult call center Online, visit portal.healthhelp.com/humanaportal.healthhelp.com/humana By phone o Call the call center at 1-866-825-1550 o Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday, and from 10 a.m. to 5 p.m. Eastern time, on Saturday Radiology Exclusions and Pre Authorization

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Education on-Demand: www.humana.com/providers/tools/ provider_tools/education_on_demand.aspwww.humana.com/providers/tools/ provider_tools/education_on_demand.asp RadConsult program support team 1-800-546-7092 Available 8 a.m. to 8p.m. Eastern time, Monday through Friday; 10 a.m. to 5 p.m., Saturday Email: rcsupport@healthhelp.com For More Information on Radiology

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Select pain management services are administered by OrthoNet, a utilization management company Services for which preauthorization is required include: Pain infusion pumps (back and neck pain only) Spinal cord stimulator devices Spinal fusion Other decompression surgeries Facet injection Epidural injections (outpatient only) Kyphoplasty Vertebroplasty Pain Management

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Request prior authorization by one of the methods below: Online Log into the Provider Self-Service Center or the secure provider area at www.availity.com www.availity.com By phone Call OrthoNet at 1-888-605-5344 Representatives are available from 8:30 a.m. to 8:30 p.m. Eastern time, Monday through Friday. By Fax Fax OrthoNet at 1-888-605-5345 Pain Management Exclusions and Preauthorization

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OrthoNet also administers outpatient therapy services Covered services include: Physical therapy Occupational therapy Speech therapy Outpatient Therapy

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Fax preauthorization requests to OrthoNet at 1-800-863-4061 Call 1-800-862-4006 for other inquiries Contacting OrthoNet about Therapy Services

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Clinical Management Programs

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Case Management Identifies high-risk members who may benefit from case management (HRA or post- discharge assessment) Is based on telephonic case management model Is episodic, typically within 30 to 90 days Objectives: Follow-up after inpatient admissions to confirm medication and provider appointment compliance Make post-discharge calls to help lower readmission rates, more appropriate post-acute care rehab, and improved medication compliance Focus on outpatient management and member guidance, including o Preventive health education o Disease management referral o Pharmacy/benefit maximization o Community resource coordination o Identification of special status members (e.g., institutional, end-stage renal disease and hospice) o Benefit education and guidance Episodic Case Management

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Provides chronically ill and frail members with holistic care Provides a long-term relationship Provides telephonic and in-person consultation by RNs and social workers to improve members well-being Is a multidisciplinary approach Optimizes health benefits, improves self-care management skills and prevents unnecessary hospital stays and emergency room visits HumanaCares Complex Care Management

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Bariatric management program Behavioral health Medication therapy management (MTM) Transplant management HumanaFirst Nurse Advice Line Humana Clinical Programs

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PPO Medicare Advantage plans require preauthorizations for post- acute care for: Skilled nursing facilities, (SNF) Long-term acute care hospitals (LTACH) Inpatient rehabilitation facilities (IRF) Humana nurses review admission requests using InterQual criteria Regional medical directors review 100% of LTACH and IRF admissions Clinical associates review SNF cases for admission and continued stay review UM helps facilitate the right care for right member in the right setting UM helps prevent unnecessary long lengths-of-stay Utilization Management (UM) Post-Acute Care

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Connecting with Clinical Management Physicians can refer members Members can self-refer 1-800-322-2758 The Clinical & Healthcare Resources Web page can be found at: www.humana.com/providers/clinical/

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Medicare customer service:See back of members ID card Authorization/IVR1-800-523-0023 Provider relations 1-800-626-2741 Provider Payment Integrity 1-800-438-7885 Medicare general case management 1-800-322-2758 Concurrent review1-800-322-2758 Disease management program Information:1-800-620-9529 RightSourceRx pharmacy:1-800-379-0092 Availity customer service/tech support:1-800-282-4548 Financial Recovery1-800-438-7885 Helpful Phone Numbers

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Questions? For follow-up questions