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A.

PROVIDER RELATIONS

HealthAmerica maintains a strong commitment to meeting the needs of our providers. In order to accomplish this, each Provider Relations Representative is individually assigned to both primary and specialty care physicians in certain geographic areas. In this way, each office becomes familiar with their representative and is able to form a solid working relationship.

Your Provider Relations Representative will visit or phone you to ensure that your day to day experience with HealthAmerica and our members is a smooth one. We are always available to meet with office staff or physicians at your request. Office Manager's Meetings are held each year, along with various training seminars held throughout the year. A quarterly provider news letter is mailed to providers along with specialized mailings. Also, available via the web is our informational website at www.cvty.com

The Provider Relations Department is responsible for the field service and ongoing education and training of HealthAmerica's provider community. Each provider representative has a thorough understanding of HealthAmerica's operations and is well versed on all product lines. Refresher office training is always available.

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B. PROVIDER RELATIONS MISSION STATEMENT

The Provider Relations Department and the Provider Relations Representatives pledge to provide superior customer service for providers. We will: ... Develop strong relationships with providers and staff and community ... Proactively communicate accurate information in a timely manner in order to assist the providers in delivering high quality healthcare to our members ... Be a reliable resource in supporting and assisting providers in the smooth operation of their practice ... Provide excellent service to both internal and external customers ... Commit to being leaders of positive change and to HealthAmerica being known as the best managed care organization ... Involve all HealthAmerica employees in providing excellent provider service.

HealthAmerica Provider Relations

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C. TOP 10 REASONS

1. Any change to your practice i.e, Practice Tax ID, Name, Phone Numbers, Address or Patient Acceptance. *Please Utilize Provider Notification form on Page 5 Initiate Credentialing of New Providers. Schedule an in-service for new staff. On-going education for existing staff Clarification of HealthAmerica and HealthAssurance policies & procedures. Order supplies: provider manual, provider directory, drug formulary, authorization guidelines, chart stickers, claim envelopes & pregnancy assessment forms. Clarification of contract. Request fee schedule information. Membership list questions. ... and the BIGGEST REASON of all ... 10. E-Business. Find out how you can use WebMD to submit authorizations, check eligibility and/or claims status at YOUR convenience, sign up for Electronic Fund Transfers (EFT) & Electronic Remittance Advice (ERA) Note: please continue to call the Customer Service Organization for claims, eligibility & benefit questions at Harrisburg 1-800-788-5448

2. 3. 4. 5. 6.

7. 8. 9.

* Please use attached Provider Notification Form

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HEALTHAMERICA AND HEALTHASSURANCE PROVIDER NOTIFICATION FORM

The following information is required if one or more of the following occurs. incomplete information, will result in delay of claims process or denial. Failure to complete, or

THIS SECTION MUST BE COMPLETED TO SUBMIT THIS FORM:

Submitted by (please print clearly): _____________________________________________ Provider Zip Code: ______________ Phone Number: ____________________

SECTION I ­ Must have a 60 day notification Tax ID # or Name Change ­ Copy of W9 is required Effective Date of Change: __________________________ Original Tax ID#: _____________________ New Tax ID#: ________________________ Original Legal Name: _________________________________________________________ New Legal Name: ______________________________________________________________ Original Group Name: ___________________________________________________________ New Group Name: ______________________________________________________________ Check Payable to: ______________________________________________________________ Practice Ownership (i.e. Hospital Owned, Managed Care Organization etc.): Yes No

If Yes, state owner: __________________________________________________ Please attach a list of physicians within the group (letterhead listing all physicians will be sufficient).

SECTION II Address change/ Site addition Site Termination

Effective Date: __________________________________ Original Address: ________________________________________________________ New Address: ___________________________________________________________ Provider Notification Form

Billing Address:_______________________________________________________________________ 5

County: ________________________________ Administrative Phone #: ___________________ Appointment Phone #: ___________________ Phone #: _________________________ Fax #: _______________________

Office Contract: __________________________

Please attach a list of physicians within the group (letterhead listing all physicians will be sufficient).

SECTION III ­ Must have a 90 day notification Physician leaving an existing Group Termination/Effective Date:______________________________________________ Physician Name: ______________________________________________________ Group Name: __________________________________________________________ Tax ID#: ______________________________________________________________ Reason for leaving: __________________________________________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________

SECTION IV ­ Physician cannot see patients until physician is credentialed. New Associate joining Group ­ Must notify HealthAmerica immediately Was physician a previous provider for HealthAmerica? Yes No

Effective Date (date physician joined/will join Practice): __________________________ Physician Name: __________________________________________________________ Group Name: _____________________________________________________________ Original Group (if applicable): _______________________________________________ Provider Notification Form New Tax ID#: ____________________ Original Tax ID#: (if applicable)____________________ Administrative Phone #: _________________ Fax #: _________________________ Appointment Phone #: _________________

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Specialty: ______________________________________________________________ License #: ___________________________ Hospital Affiliations: ___________________________________________________________________ Signature: ___________________________________________________________ **Please return/fax the form to the attention of your Provider Relations Representative** Plymouth Meeting HealthAmerica 401 Plymouth Road Suite 350 Plymouth Meeting, PA 19462 (610) 729-7530 (FAX) UPIN #: _________________________

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D. PRODUCT OVERVIEW This manual is designed to assist physicians and their office staff in understanding the various managed health care products administered by HealthAmerica, HealthAssurance, and Advantra. A capsule definition of each program is described within. This guide has been assembled to serve as a comprehensive resource for information. Please feel free to contact us at anytime should you have any questions. Note: Benefits and copayments may vary according to specific employer plan description. HealthAmerica Health Maintenance Organization (HMO) A medical delivery system in which a participating Primary Care Physician (PCP) provides most medical services for a member who has signed up for his/her practice. The PCP can now refer members directly to a participating specialist with no authorization necessary. Should a procedure or hospitalization be necessary (see Section IV), the ordering physician will obtain the necessary prior precertification. HealthAssurance Preferred Provider Organization (PPO) A plan that contracts with providers at an agreed upon fee schedule. Members do not select a Primary Care Physician to manage their care, and may self-refer to a participating or non-participating provider. However, when members see participating physicians, they receive a higher level of coverage and have lower or no deductibles. Some services, such as preventive care may be covered only when a Rider is included in the member's benefit plan. HealthAssurance Coordinated Care Preferred Provider Organization (CCPPO) (also known as Point-Of-Service (POS) A combination of the HMO and PPO delivery systems which allows the member to decide at the "Point" or "Time" of service whether to use Coordinated Care (member utilizes Primary Care Physician who then provides most medical care) or Self-Referred Care (member bypasses their Primary Care Physician and self-refers to a participating or non-participating provider). If the member uses the Coordinated Care option, benefits are covered at a higher level, but if the member wishes to use the Self-Referred Care choice, benefits are paid at a lower level with more out-of-pocket expense for the member. Some services, such as preventive care, may be covered only when provided by the member's Primary Care Physician. HealthPass PPO HealthPass is the Pennsylvania State University self-funded PPO plan for retired employees only. No Primary Care Physician selection is required. Members can choose to use contracted participating specialists and hospitals at a higher benefit level, or utilize services outside of the network with a non-contracted, nonparticipating provider at a reduced benefit level for higher levels of co-insurance and deductibles.

Plan A

Plan A is the Pennsylvania State University self-funded managed indemnity plan. No Primary Care Physician selection is required. Members have unrestricted choice of providers and hospitals.

Penn State Choice

Penn State Choice is a self-funded PPO for active employees only. No Primary Care Physician selection is required. Members can choose to use contracted participating specialists and hospitals at a higher benefit level, or utilize services outside of the network with a non-contracted, non-participating provider at a reduced benefit level for higher levels of co-insurance and deductibles.

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HealthAmerica One HealthAmerica One is a high deductible PPO product, offered to individuals and families. Advantra (Medicare+Choice HMO): See Advantra section for product information

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E. PARTICIPATING HOSPITALS * The preceding list of participating hospitals is subject to change. Please visit our website or call your provider representative for any updates. Abington Memorial Hospital Albert Einstein Medical Center Brandywine Hospital Bryn Mawr Hospital Bryn Mawr Rehabilitation Hospital Chester County Hospital Chestnut Hill Hospital Chestnut Hill Rehabilitation Hospital Children Seashore House of the Children's Hospital Children's Hospital of Philadelphia Crozer Chester Medical Center Crozer Chester Medical Center Springfield Hospital Crozer Chester Medical Center Taylor Hospital Delaware County Memorial Hospital Doylestown Hospital Frankford Hospital ­ Bucks Campus Frankford Hospital ­ Frankford Frankford Hospital ­ Torresdale Graduate Hospital Grand View Hospital Hahnemann University Hospital Holy Redeemer Hospital and Medical Center Hospital of The University of Pennsylvania Jennersville Regional Hospital Lankenau Hospital Magee Rehabilitation Hospital Mercy Fitzgerald Hospital Mercy Hospital of Philadelphia Paoli Memorial Hospital Pennsylvania Hospital Phoenixville Hospital Pottstown Memorial Medical Center Presbyterian Medical Center Riddle Memorial Hospital Roxborough Memorial Hospital St. Christopher's Hospital for Children St. Luke's Quakertown Hospital Thomas Jefferson University Hospital Thomas Jefferson University Hospital ­ Methodist Division Warminster Hospital Wills Eye Hospital

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F. IMPORTANT ADDRESSES/TELEPHONE NUMBERS HealthPass/Plan A

HealthAmerica HealthAssurance Advantra 1-800-290-0190 HealthAmerica Advantra PO Box 7087 London KY 40742-7087 HealthPass Plan A

Coventry Health Care of DE

Coventry Health Care of Delaware, Inc.

Advantra Claims Filing

N/A

N/A 1-800-833-7423 or 1-302-283-6500

Authorizations

1-800-755-1135

Fax: 1-717-541-5764

1-800-755-1135 Fax: 1-717-541-5764

ValueOptions Behavioral Health

1-866-834-1717 (TDD 1-800-334-1987) Hours: M-F 8:00 am ­ 5:00 pm (available 24 hours for emergency situations) HealthAmerica PO Box 54182 Philadelphia PA 19178-4182 Attention: Recoveries Dept 1-877-588-0405 HealthAmerica 120 East Kensinger Drive Cranberry Twp PA 16066 Attention: Recoveries Dept 1-877-588-0405 1-800-788-8445 HealthAmerica/HealthAssurance PO Box 7089 London KY 40742-7089 HealthAmerica/HealthAssurance Interactive Voice Response (IVR) 1-800-788-8445 Option 2 ,#2 Payor Number 25126 (includes HealthAmerica Advantra)

ValueOptions

1-866-834-1717 (TDD 1-800-334-1987) Hours: M-F 8:00 am ­ 5:00 pm

United Behavioral Health 1-866-808-2808 Hours: M-F 8:00am - 5:30pm

(available 24 hours for emergency situations)

HealthAmerica PO Box 8088 State College, PA 16803 Attention: Recoveries Dept 1-800-366-6433 HealthAmerica 120 East Kensinger Drive Cranberry Twp PA 16066 Attention: Recoveries Dept 1-877-588-0405 1-800-366-6433 PSU-HealthPass/PSU-Plan A PO Box 7132 London, KY 40742 1-800-366-6433 First Union Bank PO Box 8500-54328 Philadelphia, PA 19178

Check Refunds

Check Returns

Coventry Health Care, Inc. 120 East Kensinger Drive Cranberry Twp PA 16066 Attention: Recoveries Dept 1-877-588-0405 1-800-845-6592 Coventry Health Care of Delaware, Inc. PO Box 7713 London, KY 40742 1-800-833-7423 1-302-283-6500 Payor Number 25130

Claims Filing

Claim Status Check

EDI Claim Submission

N/A

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Formal Appeals

HealthAmerica HealthAssurance Advantra HealthAmerica/HealthAssurance 3721 TecPort Drive PO Box 67103 Harrisburg, PA 17106-7103 Attention: Appeals Dept

HealthPass Plan A HealthAmerica PO Box 8088 State College, PA 16803 Attention: Appeals Dept

Coventry Health Care of Delaware, Inc. CLINICAL APPEALS Coventry HealthCare, Inc. Little Falls Center II 2751 Centerville Rd. Ste 400 Wilmington, DE 19808-1627 ADMINISTRATIVE APPEALS Coventry Health Care, Inc, 211 Lake Drive Newark, DE 19702 1-800-833-7423 or 1-302-283-6500

Member Services

1-800-788-8445

Advantra 1-800-290-0190

1-800-366-6433

Office Locations

HealthAmerica ­ Plymouth Meeting 401 Plymouth Road Suite 350 Plymouth Meeting, PA 19462

HealthAmerica ­ State College

1965 Waddle Road Suite 200 State College, PA 16803 814-231-8700 (800) 366-6674 1-888-362-4648 Hours: M-F 9:00am - p:00pm Saturday: 9:00am - 5:00pm Automated system available 24 hours a day

Coventry Health Care, Inc. Little Falls Center II 2751 Centerville Road, Suite 400 Wilmington, DE 19808 (302) 995-6100

Cole Managed Vision

1-888-362-4648 Hours: M-F 9:00am - p:00pm Saturday: 9:00am - 5:00pm Automated system available 24 hours a day

N/A

Caremark 1-800-378-7040

Pharmacy Department

1-800-755-1135 Option 1

Fax 866-738-9682 or 717-541-5909 Hours: M-F 8:30 am ­ 5pm HealthAmerica/HealthAssurance PO Box 7107 London KY 40742-7107 HealthAmerica Advantra PO Box 7106 London KY 40742-7106

1-800-755-1135 Option 1

Fax 866-738-9682 or 717-541-5909

Hours: M-F 8:30 am ­ 5pm Resubmission of Corrected Claims

HealthAmerica PO Box 7103 London, KY 40742-7103 Coventry Health Care of Delaware, Inc. PO Box 7713 London, KY 40742

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HealthAmerica HealthAssurance Advantra

HealthPass Plan A www.healthamerica.cvty.com www.ohr.psu.edu/benefits/benefits. htm

Coventry Health Care of Delaware, Inc. Www.chcde.com

Website

www.healthamerica.cvty.com

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G. MEMBER LITERATURE AND PUBLICATIONS Member Guide HealthAmerica and HealthAssurance Member Guides are written and designed for our members in a memberfriendly format to take the member through the process of accessing benefits. Major emphasis is placed on readability and understanding of benefits. HealthAmerica and HealthAssurance have member publications, Living Well for commercial members and Good Times for Medicare members. These publications follow a magazine format and emphasizes wellness and early intervention. Our Plan customizes the specific pages and related topics in addition to Plan updates and policies.

Member Newsletters

Upon enrolling in HealthAmerica and HealthAssurance, all members receive a copy of their product specific Member Guide and applicable legal documents outlining benefits. Identification cards are mailed separately. The member newsletters are mailed directly to the policyholder's home. Surveys ... Routine surveys are mailed to members periodically throughout the year. ... A member satisfaction survey is conducted annually. ... PCP-specific member satisfaction surveys are conducted to assess appointment availability and access to care. This is done by HealthAmerica's Quality Improvement Department.

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