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Medicare Online Portal For Providers

Medicare Online Portal For Providers

Medicare Online Portal For Providers – MedStar will only serve the following counties in MD in CY2018: Baltimore City MedStar of Harford Howard Prince George will continue to serve the District of Columbia in 2018.

9/9: UPMC Call Center Training 9/20-9/21: Assessed CMS Contact to Compliance Officer 10/1: ANOC in member’s home; affected members removed from distribution 9/22-9/26: Send SAR letter 10/1: SAR letter to new Age-ins 10/13-20: Q4 Newsletter to take SAR a -in, major changes 9/ 13: Broker annual conferences August September October November NOTE: The reduction of the service area should not be considered until recommended by Evolent. Once the reduction is in order, to discuss additional discussion points will be published 10/1: Notify network providers and staff about SAR

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Medicare Online Portal For Providers

Members will no longer have MedStar Medicare Choice as of 1/1/18 if they live in a reduced service area County MedStar Medicare Choice will no longer serve Anne Arundel, Baltimore, Charles, Calvert, St. Mary’s members have to choose a new one. A Medicare Advantage plan offered in their area or back to Original Medicare Members may continue to file claims and appeals during the timely filing period Providers may continue to file claims and disputes during the timely filing period Expect to continue receiving call from them. nominated members and providers serving those members as exhausted from their previous plan year.

Healthsun Health Plans

Maryland Hospitals MedStar Franklin Square Medical Center MedStar Good Samaritan Hospital MedStar Harbor Hospital MedStar Montgomery Medical Center MedStar Southern Maryland Hospital Center MedStar St. Mary’s Hospital MedStar Doctors Memorial Hospital Community Hospital Holy Cross Hospital Holy Cross Hospital Germantown Washington Hospital Adventist Hospital Prince Hospital George Calvert Memorial Shady Grove Hospital Medical Center Washington, D.C. MedStar Hospitals Georgetown University Hospital MedStar National Rehabilitation Network MedStar Washington Hospital Center 7/6/17 Contributed by K.Fisher * Image is at MedStar Health at Federal Hill

MedStar Health Research Institute MedStar Rehabilitation Network NRH MedStar Pharmacy MedStar Physician Partner PromptCare MedStar Surgery Center MedStar Visiting Nurse Association RadAmerica Multispecialty Care Centers

MedStar Medicare Choice will continue to offer three Medicare Advantage products for 2018 for a total of 6 plans (3 plans for the District of Columbia and 3 plans in Maryland). Cost sharing may vary for certain benefits between District of Columbia plans and Maryland plans. See benefits grid for details. Product Name Product Name Medicare Advantage HMO MedStar Medicare Choice (HMO) Medicare Advantage D-SNP (Special Needs Eligible Plan) Medicare and Medicaid Enrollees MedStar Medicare Choice Dual Advantage (HMO SNP) Medicare Advantage C-SNP (Special Needs Eligible Plan advanced special needs) Diabetes mellitus and chronic heart failure MedStar Medicare Choice Care Advantage (HMO SNP)

HMO Plan 2017 Premium HMO Plan 2018 Premium District of Columbia $17.00 $36.00 Maryland $27.00 DSNP Plan 2017 Premium DSNP Plan 2018 Premium District of Columbia $33.20 $30.70 Maryland 2017 CSNP Plan Premium 2018 CSNP Plan $30.70 Columbia

Health Risk Assessment Tool Medicare

MedStar Medicare Choice (HMO plans) MedStar Medicare Choice Dual Benefit (DSNP plans) MedStar Medicare Choice Care Benefit (CSNP plans) Monthly premium – increased monthly premium Transportation – decreased number of one-way trips Cardiac and pulmonary rehabilitation – increased of ER & Urgent Care Copay – increase in OP Copay Surgery in an OP Hospital Facility – increase in OP Copay Surgery in an Ambulatory Surgery Center (ASC) – increase in Skilled Nursing Facility Copay (SNF) – increase in prescription drug copay – Rx Deductible Increase in Tiers 3, 4, & 5 NOTE: The above grid does not reflect all benefit changes for 2018 11

2018 Dealer Phone Number DentaQuest Avesis Dental Member Services: (844) Vision Superior Vision Pharmacy Benefit Manager Express Scripts, Inc (ESI) CVS Member Services: (855) Provider Services: (855) For Training Purposes Only – Do not circulate

(District of Columbia) (Maryland) Monthly Premium Plan $36 in addition to your Medicare Part B premium $27 in addition to your Medicare Part B premium during the year Out-of-pocket (the out- annual out-of-pocket costs your total) $6,700 for all benefits covered by Medicare Hospital inpatient care and inpatient mental health care $350 copay per day (days 1-5) / Intensive Copay $300 per day (days 1-5) / Mental Health $350 per day (days 1-5) / Acute Skilled Nursing Facility (SNF) $0 copay per day (days 1-20) $ copay per day(s) Physician Office Visit – Primary Care Physician (PCP) and Specialist $5 co-pay for each PCP visit $50 co-pay for each specialist visit H HMO DC H HMO MD NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits – refer to the EOC.

(District of Columbia) (Maryland) Outpatient rehabilitation (eg, occupational, physical, speech, and language therapy) $40 copay per treatment visit Surgical facilities – $400 copay per surgery Ambulatory Surgery Center (ASC) – $350 copay for surgery Urgent Care $80 copay per visit Urgent Care $50 copay per visit Durable Medical Supplies 20% of cost per item Diabetic Providers NOTE: This grid is for training purposes, DO NOT distribute to the beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits – refer to the EOC

Patient Portal Tutorial

(District of Columbia) (Maryland) Laboratory Services, X-rays and Advanced Radiology Imaging Services (eg CT scans, MRIs, MRAs, PET scans, Nuclear Medicine and Stress Tests) 20% Coinsurance for diagnostic tests / procedure $0 lab services copay $20 copay for x-ray or ultrasound $200 copay for any advanced radiology imaging service (eg CT scan, MRI, MRA, PET scan) 20% coinsurance for therapeutic radiology Preventive services $0 copay for annual wellness exam, routine physical exam, covered by Medicare Vaccinations (eg, flu and pneumonia) and preventive exams, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurements. NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits – refer to the EOC

The prescription drug benefit will have six tiers of drugs as follows: Tier 1: Preferred Generic Drug Tier 2: Generic Drug Tier 3: Preferred Brand Drugs Tier 4: Non-Preferred Brand Drugs Tier 5: Specialty Tier Drugs 6: Select maintenance drugs

The Part D deductible is $405 applied to drugs on levels 3, 4 and 5 of the formulary. Initial coverage level: $3,750 Prescription drugs One-month supply (up to 30 days) Three-month supply (up to 90 days) Tier 1: Your favorite generic drug $4 copay $12 retail copay $10 copay by mail Tier 2: Generic drugs $15 copay $45 copay retail $37.50 copay by mail Tier 3: Preferred Brand Name Drugs $47 copay $141 copay retail $ copay Mail order Tier 4: Non-preferred brand name drugs $ 100 copay $300 copay $250 mail order Category 5 Drugs (one month’s cost only) 25% 25%. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits – refer to the EOC

Initial Coverage Limit (ICL) $3,750 Coverage Gap Once total drug costs reach $3,750, members receive a discount on brand name drugs and generally pay no more than 35% (excluding the fee dispensing) of the plan cost for each brand. drugs and 44% of the plan cost for generic drugs until annual out-of-pocket drug costs reach $5,000. Threshold of $5,000 in Accident Coverage Benefit stock Once the member’s annual out-of-pocket drug costs reach $5,000. $5,000, the member will pay the greater of: Generic drugs (including brand name drugs treated as generic), or: $3.35 copay, or 5% coinsurance For all other drugs, either: $8.35 copay, or low-income subsidy (LIS) Medicare beneficiaries with limited income and resources may be eligible for extra help to pay for prescription drug costs called income-low input subsidies (LIS). NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits – refer to the EOC

Zing Health Provider Documents

21 2018 MedStar Medicare Choice (HMO) Additional Benefits and Services Our MedStar Medicare Choice plan provides the following additional benefits: Vision Dental Benefit Fitness Benefit Nursing Line MedStar does not cut its additional benefits.

(District of Columbia) (Maryland) Routine Vision $0 copay for routine eye exam per year $135 copay toward the cost of one pair of eyeglasses (brands and lenses) or contact lenses per year $100 copay toward the cost of a pair of glasses (brands) . and lenses) or annual contact lenses Dental Services Preventive Dental Services $45 copay for routine preventive dental visit Preventive Dental Services Covered

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  1. Medicare Online Portal For ProvidersMembers will no longer have MedStar Medicare Choice as of 1/1/18 if they live in a reduced service area County MedStar Medicare Choice will no longer serve Anne Arundel, Baltimore, Charles, Calvert, St. Mary's members have to choose a new one. A Medicare Advantage plan offered in their area or back to Original Medicare Members may continue to file claims and appeals during the timely filing period Providers may continue to file claims and disputes during the timely filing period Expect to continue receiving call from them. nominated members and providers serving those members as exhausted from their previous plan year.Healthsun Health PlansMaryland Hospitals MedStar Franklin Square Medical Center MedStar Good Samaritan Hospital MedStar Harbor Hospital MedStar Montgomery Medical Center MedStar Southern Maryland Hospital Center MedStar St. Mary's Hospital MedStar Doctors Memorial Hospital Community Hospital Holy Cross Hospital Holy Cross Hospital Germantown Washington Hospital Adventist Hospital Prince Hospital George Calvert Memorial Shady Grove Hospital Medical Center Washington, D.C. MedStar Hospitals Georgetown University Hospital MedStar National Rehabilitation Network MedStar Washington Hospital Center 7/6/17 Contributed by K.Fisher * Image is at MedStar Health at Federal HillMedStar Health Research Institute MedStar Rehabilitation Network NRH MedStar Pharmacy MedStar Physician Partner PromptCare MedStar Surgery Center MedStar Visiting Nurse Association RadAmerica Multispecialty Care CentersMedStar Medicare Choice will continue to offer three Medicare Advantage products for 2018 for a total of 6 plans (3 plans for the District of Columbia and 3 plans in Maryland). Cost sharing may vary for certain benefits between District of Columbia plans and Maryland plans. See benefits grid for details. Product Name Product Name Medicare Advantage HMO MedStar Medicare Choice (HMO) Medicare Advantage D-SNP (Special Needs Eligible Plan) Medicare and Medicaid Enrollees MedStar Medicare Choice Dual Advantage (HMO SNP) Medicare Advantage C-SNP (Special Needs Eligible Plan advanced special needs) Diabetes mellitus and chronic heart failure MedStar Medicare Choice Care Advantage (HMO SNP)HMO Plan 2017 Premium HMO Plan 2018 Premium District of Columbia $17.00 $36.00 Maryland $27.00 DSNP Plan 2017 Premium DSNP Plan 2018 Premium District of Columbia $33.20 $30.70 Maryland 2017 CSNP Plan Premium 2018 CSNP Plan $30.70 ColumbiaHealth Risk Assessment Tool MedicareMedStar Medicare Choice (HMO plans) MedStar Medicare Choice Dual Benefit (DSNP plans) MedStar Medicare Choice Care Benefit (CSNP plans) Monthly premium - increased monthly premium Transportation - decreased number of one-way trips Cardiac and pulmonary rehabilitation - increased of ER & Urgent Care Copay - increase in OP Copay Surgery in an OP Hospital Facility - increase in OP Copay Surgery in an Ambulatory Surgery Center (ASC) - increase in Skilled Nursing Facility Copay (SNF) - increase in prescription drug copay - Rx Deductible Increase in Tiers 3, 4, & 5 NOTE: The above grid does not reflect all benefit changes for 2018 112018 Dealer Phone Number DentaQuest Avesis Dental Member Services: (844) Vision Superior Vision Pharmacy Benefit Manager Express Scripts, Inc (ESI) CVS Member Services: (855) Provider Services: (855) For Training Purposes Only - Do not circulate(District of Columbia) (Maryland) Monthly Premium Plan $36 in addition to your Medicare Part B premium $27 in addition to your Medicare Part B premium during the year Out-of-pocket (the out- annual out-of-pocket costs your total) $6,700 for all benefits covered by Medicare Hospital inpatient care and inpatient mental health care $350 copay per day (days 1-5) / Intensive Copay $300 per day (days 1-5) / Mental Health $350 per day (days 1-5) / Acute Skilled Nursing Facility (SNF) $0 copay per day (days 1-20) $ copay per day(s) Physician Office Visit - Primary Care Physician (PCP) and Specialist $5 co-pay for each PCP visit $50 co-pay for each specialist visit H HMO DC H HMO MD NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits - refer to the EOC.(District of Columbia) (Maryland) Outpatient rehabilitation (eg, occupational, physical, speech, and language therapy) $40 copay per treatment visit Surgical facilities - $400 copay per surgery Ambulatory Surgery Center (ASC) - $350 copay for surgery Urgent Care $80 copay per visit Urgent Care $50 copay per visit Durable Medical Supplies 20% of cost per item Diabetic Providers NOTE: This grid is for training purposes, DO NOT distribute to the beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits - refer to the EOCPatient Portal Tutorial(District of Columbia) (Maryland) Laboratory Services, X-rays and Advanced Radiology Imaging Services (eg CT scans, MRIs, MRAs, PET scans, Nuclear Medicine and Stress Tests) 20% Coinsurance for diagnostic tests / procedure $0 lab services copay $20 copay for x-ray or ultrasound $200 copay for any advanced radiology imaging service (eg CT scan, MRI, MRA, PET scan) 20% coinsurance for therapeutic radiology Preventive services $0 copay for annual wellness exam, routine physical exam, covered by Medicare Vaccinations (eg, flu and pneumonia) and preventive exams, including mammograms, Pap, pelvic, prostate, colorectal exams and bone mass measurements. NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits - refer to the EOCThe prescription drug benefit will have six tiers of drugs as follows: Tier 1: Preferred Generic Drug Tier 2: Generic Drug Tier 3: Preferred Brand Drugs Tier 4: Non-Preferred Brand Drugs Tier 5: Specialty Tier Drugs 6: Select maintenance drugsThe Part D deductible is $405 applied to drugs on levels 3, 4 and 5 of the formulary. Initial coverage level: $3,750 Prescription drugs One-month supply (up to 30 days) Three-month supply (up to 90 days) Tier 1: Your favorite generic drug $4 copay $12 retail copay $10 copay by mail Tier 2: Generic drugs $15 copay $45 copay retail $37.50 copay by mail Tier 3: Preferred Brand Name Drugs $47 copay $141 copay retail $ copay Mail order Tier 4: Non-preferred brand name drugs $ 100 copay $300 copay $250 mail order Category 5 Drugs (one month's cost only) 25% 25%. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits - refer to the EOCInitial Coverage Limit (ICL) $3,750 Coverage Gap Once total drug costs reach $3,750, members receive a discount on brand name drugs and generally pay no more than 35% (excluding the fee dispensing) of the plan cost for each brand. drugs and 44% of the plan cost for generic drugs until annual out-of-pocket drug costs reach $5,000. Threshold of $5,000 in Accident Coverage Benefit stock Once the member's annual out-of-pocket drug costs reach $5,000. $5,000, the member will pay the greater of: Generic drugs (including brand name drugs treated as generic), or: $3.35 copay, or 5% coinsurance For all other drugs, either: $8.35 copay, or low-income subsidy (LIS) Medicare beneficiaries with limited income and resources may be eligible for extra help to pay for prescription drug costs called income-low input subsidies (LIS). NOTE: This grid is for training purposes, DO NOT distribute to beneficiaries. Grids are not submitted to CMS for approval. Subscription items must have a CMS tracking number to be shipped. Do not use Benefit Grid to identify benefits - refer to the EOCZing Health Provider Documents