RFI REQUEST FOR INFORMATION. BlueCare Tennessee Clinical Laboratory Services RFI #

Transcription

1 RFI REQUEST FOR INFORMATION BlueCare Tennessee Clinical Laboratory RFI # BlueCross BlueShield of Tennessee 1 Cameron Hill Circle Chattanooga, TN RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 1 of 9

2 Table of Contents 1 REQUEST FOR INFORMATION (RFI) RFI Purpose, Background and Intent CORPORATE OVERVIEW BlueCross BlueShield of Tennessee (BCBST) BlueCare Tennessee (BCT) TennCareSelect (TCS) BlueCare Plus HMO DSNP State of Tennessee TennCare Program Advantage Target Population BCT Historical Utilization GENERAL INFORMATION Proprietary or Confidential Information Amendment/Addenda/Right to Cancel Submission Instructions Industry Discussions Submittal of Questions Point of Contact for BCBST and Deliverables RFI Planned Schedule RFI PROVIDER QUESTIONS... 7 Attachment A Confidentiality and Non-Disclosure Agreement (CNDA)... 9 Attachment B Pricing Proposal Medicaid BCT and TCS... 9 Attachment C Pricing Proposal Advantage... 9 Attachment D Pricing Proposal BlueCare Plus (DSNP)... 9 Attachment E BlueCare Tennessee Lab Exclusion List... 9 Attachment F 2014 Lab Utilization by CPT Code per Line of Business... 9 RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 2 of 9

3 1 REQUEST FOR INFORMATION (RFI) 1.1 RFI Purpose, Background and Intent BlueCare Tennessee is distributing this RFI to seek and gather input, suggestions, and feedback as we conduct a market check for the following lines of business: BlueCare Tennessee, BlueCare Plus, TennCareSelect and Advantage (collectively herein referred to as BCT ), for the provision of excellent quality and efficient healthcare to our members through Point of Service Laboratory Testing or Traditional clinical laboratory services. This RFI is intended to provide interested Providers with information to enable them to demonstrate their capabilities to provide clinical laboratory services to improve members health outcomes, increase patient satisfaction with care, control expenditures, as well as propose creative, competitive solutions for value-added services, i.e., Member Home Visits, Home Kits, and multiple community outreach opportunities. Responses should include a summary of how the Provider would administer and deliver Point of Service Laboratory Testing or Traditional clinical laboratory services statewide, as well develop and implement value-added services: Member Home Visits, Home Kits, and community outreach events. Provider should submit a response describing their Provider network, authorization, coordination, scheduling management and reimbursement protocols. Provider must be capable of filing claims. Providers are required to submit cost models designed to include a feefor-service arrangement for each line of business. This RFI is issued solely for information and planning purposes. It does not constitute a Request for Proposal (RFP) or a guarantee to issue an RFP in the future. This RFI does not commit BCT to contract for any supply or service. Responders should be advised that BCT will not pay for any information or administrative costs incurred in response to this RFI; all costs will be solely at the interested party s expense. Not responding to the RFI does not preclude participation in any possible, future RFP; if an RFP is issued, qualified candidates will be notified. 2 CORPORATE OVERVIEW 2.1 BlueCross BlueShield of Tennessee (BCBST) BlueCross BlueShield of Tennessee, Inc., headquartered in Chattanooga, Tennessee is committed to conducting business with ethics, integrity and in accordance with all federal, state and local laws and regulations. The compliance, risk and quality management program model enables the communication and oversight necessary for this commitment. Additional information concerning the organization, operation, goals and objectives of BCBST is available from our website, at BlueCare Tennessee (BCT) BCT is an independent licensee of the BlueCross BlueShield Association and a licensed HMO affiliate of its parent company BlueCross BlueShield of Tennessee, Inc. Founded in 1993, the Chattanooga-based company focuses on managing care and providing quality health care products, services, and information for the State of Tennessee s TennCareSM programs. BCT contracts with the State of Tennessee, through the Bureau of TennCare, to manage and deliver integrated physical health, behavioral health, and long term care services to over 550,000 members statewide. A primary goal for BCT is helping TennCare members become healthier. Explore our Web site and learn more about us at TennCareSelect (TCS) TennCareSelect is the State s self-insured TennCare Health Maintenance Organization that is available to select TennCare Enrollees effective July 1, It is administered by BCT and has the same benefits as all other MCO s. TennCare Enrollees cannot choose TennCareSelect, only the Bureau of TennCare can enroll members. Some of the State's groups for TennCareSelect include: Children receiving Social Security Insurance (SSI) benefits; RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 3 of 9

4 Children who are in the custody of the state; Children who are in an institutional eligibility category; Enrollees with intellectual disabilities; and Enrollees who may be temporarily living out of state. In some areas of the state, other TennCare MCOs cannot serve all Enrollees. TennCareSelect is the backup program in those areas. 2.4 BlueCare Plus HMO DSNP BlueCare Plus is an Independent Licensee of the BlueCross BlueShield Association. BlueCare Plus is an HMO Special Needs Plan (SNP) with a contract and a contract with the Tennessee Medicaid Program. BlueCare Plus focuses on managing care and providing quality health care products, services, and information for government programs. We take great pride in serving the people of Tennessee statewide, both in our products and services and in our numerous outreach activities. BlueCare Plus is an HMO SNP plan that works with each member and a team of professionals to offer the most appropriate programs to meet physical, behavioral health and long-term care needs ranging from preventive initiatives to care coordination. The BlueCare Plus program is designed for people who have (Parts A and B) and Medicaid with unique special needs, the program operates as the individual's point of contact for both and Medicaid benefits and services. Part D prescription drug coverage is included in the BlueCare Plus program with the addition of vision, hearing, dental and transportation benefits for our BlueCare Plus members. 2.5 State of Tennessee TennCare Program TennCare is the State of Tennessee s Medicaid program that provides health care services for 1.2 million Tennesseans and operates with an annual budget of approximately 8 billion dollars. The TennCare program operates under a Section 1115 waiver from the Centers for and Medicaid (CMS) in the United States Department of Health and Human. It is a demonstration program. The principle being demonstrated by TennCare is that a state can organize its Medicaid program under a managed care model and generate sufficient savings to extend coverage to additional populations who would not otherwise be Medicaid eligible, without compromising quality of care. TennCare is one of the oldest Medicaid managed care programs in the country, having begun on January 1, It is the only program in the nation to enroll the entire state Medicaid population in managed care. The State of Tennessee contracts with managed care organizations for the administration of the TennCare programs under the Contract Risk Agreement (CRA) and the TennCareSelect Agreement (TSA). Provider(s) will need to base their RFI responses on the CRA, including Amendment 13, and the TSA, including Amendment 33 as well as the State wide Agreement effective January 1, The documents can be downloaded from the following links: On January 1, 2015, a new five-year contract took effect extending our 20-year partnership of service to the State of Tennessee and our TennCare members. 2.6 Advantage Advantage Program - BCBST contracts with to provide a Advantage Plan offering four Advantage Local Preferred Provider Organization (LPPO) products. BlueAdvantage (PPO) BlueCross BlueShield of Tennessee offers four Advantage Preferred Provider Organization (PPO) products: BlueAdvantage Diamond, BlueAdvantage Ruby, BlueAdvantage Garnet and BlueAdvantage Sapphire. Currently, the four PPO products are available in all 95 counties. RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 4 of 9

5 BlueChoice (HMO) BlueCross BlueShield of Tennessee offers two Advantage Health Maintenance Organization (HMO) products: BlueChoice and BlueChoice Plus. Currently, the two HMO products are available in 65 counties: Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Cheatham, Chester, Claiborne, Cocke, Coffee, Cumberland, Davidson, DeKalb, Fayette, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hawkins, Henry, Hickman, Jackson, Jefferson, Knox, Lawrence, Lewis, Lincoln, Loudon, Madison, Marion, Marshall, Maury, Meigs, Monroe, Montgomery, Morgan, Overton, Perry, Polk, Rhea, Roane, Robertson, Rutherford, Sequatchie, Sevier, Shelby, Smith, Sullivan Sumner, Trousdale, Union, Warren, Wayne, White, Williamson and Wilson. 2.7 Target Population The Provider must be able to provide and manage Point of Service Laboratory Testing or Traditional clinical laboratory services to all BCT members throughout the State of Tennessee and its contiguous counties. BCT reserves the right to carve out certain codes and geographical areas from this RFI. BCT currently serves approximately the following number of members: Region Name Region Location Total Membership as of 3/31/2015 BCT East East Grand Region 187,724 BCT West West Grand Region 146,709 BCT Middle Middle Grand Region 141,049 TennCareSelect Statewide 49,047 DSNP Statewide 4,257 Advantage Statewide 91, BCT Historical Utilization Refer to Attachment F. 3 GENERAL INFORMATION 3.1 Proprietary or Confidential Information Any information contained in the RFI responses is proprietary or confidential must be clearly designated. Be advised that all submissions become the Property of BCT and will not be returned. BCT will maintain the confidentiality of Provider s Information marked Confidential of Proprietary in accordance with applicable laws. Interested Providers are required to read, sign, and return the included Non-Discrimination Agreement, Attachment A with their RFI responses on or before May 22, Amendment/Addenda/Right to Cancel BCT reserve the right to alter and/or cancel the RFI timeline or other portions of this RFI at any time. 3.3 Submission Instructions Interested parties who need additional information or have questions about this RFI may submit RFI QUESTIONS electronically to [email protected] on or before 5 PM (EST) April 30, All final RFI responses must be submitted at a minimum in Microsoft Office 2007 compatible software version. Responses are due by May 22, RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 5 of 9

6 3.4 Industry Discussions At our discretion, BCT may or may not choose to contact responders. In the event we choose to contact responders, such contact and discussions are only intended to gain additional clarification of the Provider s potential capability to meet the service requirements. 3.5 Submittal of Questions Questions regarding this Request for Information shall be submitted via to [email protected], please clearly indicate RFI Lab in the Subject line of all s. Verbal questions will not be accepted. Questions shall not contain proprietary information. We do not guarantee a response to questions received within two (2) days of the due date. 3.6 Point of Contact for BCT and Deliverables The point of contact for this RFI and all deliverables should be ed to:[email protected]. Clearly indicate RFI Lab in the Subject line of all s. 3.7 RFI Planned Schedule Action Date Time (ET) RFI Issued to Providers 4/22/ PM Receipt of Provider Questions 4/30/ PM BCT Response to Provider Questions 5/7/ PM RFI Response Due 5/22/ PM RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 6 of 9

7 4 RFI PROVIDER QUESTIONS 4.1 Contact Information: Organization Name: President & CEO: NPI Number: Complete Mailing Address: Phone Number: Website Address: Contact Person s Name and Title: Dun & Bradstreet Number: Contact s Address: Contact s Phone Number: Organizational Background 4.2 Provide a brief history on your organization including headquarters, divisions and operations. Include how long your organization has been in operation and whether it is owned by a parent company, or whether it owns other companies as a parent organization. 4.3 Submit a description of your major facilities. 4.4 Does your organization have the capability to deliver Point of Service Laboratory Testing or Traditional Clinical Laboratory statewide for both physician office practices and facilities? 4.5 Does your organization hold an unrestricted license in Tennessee? 4.6 Describe certifications currently held. 4.7 Provide a copy of all certifications obtained by your laboratory. 4.8 Provide a listing of Point of Service testing available and Traditional lab testing with turnaround time from draw to results submission to ordering provider. 4.9 Provide an outline of Provider s Quality Improvement and Utilization Review program Describe prior authorization services for esoteric and pathology labs Provide a list of available testing by CPT code Does your organization meet the National Committee for Quality Assurance (NCQA) accreditation? 4.13 What differentiates you from your competitors? RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 7 of 9

8 Service and Access 4.14 For each of your locations, list services provided. Indicate service availability in Tennessee and its contiguous counties (if partial counties, please note). Where only limited services are offered, please indicate and explain. Where additional services are provided, please details Do you provide services on a 24-hour basis? In what manner? Please describe processes of receiving request for services (from patient, from physician, from emergency department), dispatching care, and following up with regular provider (if applicable). Please provide your turnaround time for results of lab testing to be available for the ordering provider How many patients do you service a day? Describe your capacity to accept additional patients, without restricting quality or access to services. Describe experience dealing with large fluctuations in service demand Describe, in detail value-added services/programs your organization has successfully implemented. Describe the focus of the value-added services/programs, the method of implementation, and document program results. Tell us about any lessons learned with these value-added services/programs Which value-added services/programs does your organization recommend for each BCT line if business as part of your RFI response? Why? Staff Selection and Training 4.19 Describe Provider s screening process for recruiting employees and monitoring existing employees. Describe sanctioned background check processes Does Provider provide training for its staff? Describe training content and curriculum, Payment/Administrative 4.21 Describe your organization s electronic billing capabilities and willingness to use BCT billing format HL Describe the payment models you believe have been most successful in the delivery of the Point of Service Laboratory Testing or Traditional Clinical Laboratory What cost saving initiatives have you previously implemented? 4.24 Does your organization have the ability to provide laboratory values electronically? 4.25 Please include samples of standard reports Describe a timeline for operational readiness from the time of a potential contract award date to full implementation After review of the State and Federal CMS Contracts requirements, are there any requirements that you believe that your organization could not comply with or would provide significant challenges? RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 8 of 9

9 RFI Attachments Attachment A Confidentiality and Non-Disclosure Agreement (CNDA) See separate document for review and signature. Attachment B Pricing Proposal Medicaid BCT and TCS See attachment Attachment C Pricing Proposal Advantage See attachment Attachment D Pricing Proposal BlueCare Plus (DSNP) See attachment Attachment E BlueCare Tennessee Lab Exclusion List See attachment Attachment F 2014 Lab Utilization by CPT Code per Line of Business See attachment RFI - Point of Service Laboratory Testing/Traditional Clinical Laboratory Page 9 of 9

10 Attachment A Confidentiality and Non-Disclosure Agreement (CNDA) This Confidentiality and Non-Disclosure Agreement ( Agreement ) is entered into by and between BlueCross BlueShield of Tennessee, Inc., for itself and on behalf of its Affiliates and Representatives, (Collectively BCBST ), and, for itself and on behalf of its Affiliates and Representatives, (Collectively ), and shall be effective on and after the date of the last signature executed below (its Effective Date ). Recitals. BCBST and may be collectively referred to as the Parties or individually referred to as a Party, Disclosing Party, Receiving Party, or Recipient and have requested that each Party furnish the other with certain information which is considered confidential and proprietary. Each Party may also obtain additional information regarding the other during the course of discussions between the Parties that prompted the original request for information (the Parties Discussions ). The purpose of this Agreement is to set forth the terms and conditions under which such information will be disclosed concerning the BCT Clinical Laboratory RFI ( Subject Program ). As an inducement to each Party furnishing the other with the information, and as a condition to each Party furnishing such information to the other, each Party agrees that it will, and will cause each of its Representatives (as defined herein) to comply with the provisions hereof. 1. For purposes of this Agreement, the term Affiliates is that which is defined in Subpart 2.1 of the FAR. 2. Confidential Information shall mean all oral and written information in any form or medium, concerning the subject matter of the Parties Discussions, and shall include, but is not limited to, technical, business or financial information, and that is: 1) is marked with the legend CONFIDENTIAL INFORMATION or an equivalent conspicuous legend, otherwise identified as, legally entitled to protection as, or is of the type or nature that a reasonable person would understand it to be confidential, proprietary, privileged or trade secret information; or (2) if it disclosed orally or visually, and is identified as Confidential at the time of disclosure and is subsequently reduced to writing specifically identifying the items of a Confidential nature and is furnished to the Recipient within fifteen (15) days of disclosure; or (3) is disclosed by or on behalf of a Party (the Disclosing Party ) to the other Party (the Receiving Party ) related to the Parties Discussions. Confidential information includes information by the Disclosing Party, as well as all copies. If Confidential Information includes Protected Health Information as that term is defined in 45 C.F.R. Section of the federal privacy regulations, and would be subject to the protections pursuant to the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ), then each Party shall comply, not only with this Agreement with respect to such Protected Health Information that is part of Confidential Information, but also with the HIPAA regulations at 45 C.F.R. Parts 160 and 164 pertaining to the privacy and security of Protected Health Information to the extent that such HIPAA regulations are applicable to such Party, including the execution of appropriate and mutually agreeable Business Associate Agreements pursuant to such regulations. Attachment A_BCBST_CNDA-Exclusive Lab RFI Page 1 of 4

11 The term Confidential Information does not include information that: (1) is based on documents in the Receiving Party s possession prior to disclosure of information and was not acquired directly or indirectly from the Disclosing Party; or (2) was in the public domain at the time of disclosure, or subsequently became part of the public domain through no fault of Receiving Party; or (3) was legally received on a non-confidential basis from a third party, who is not known to be bound by a confidentiality agreement preventing the disclosure of such information; or (4) was independently developed by the Receiving Party without reliance on or knowledge of the Disclosing Party s Confidential Information. 3. Representatives means a Party s officers, directors, members, employees, or consultants, who receive Confidential Information and/or participate in the Parties Discussions pursuant to this Agreement. 4. The Receiving Party agrees that it will, and will cause its Representatives to, maintain in confidence all Confidential Information. In this regard, the Receiving Party agrees to disclose Confidential Information only to Representatives who need to know such information for the purpose of the Parties Discussions and shall take all necessary and reasonable precautions to prevent such Confidential Information from being disclosed or provided to any unauthorized person. The Receiving Party agrees that it will not, and will cause its Representatives not to, use Confidential Information for any purpose other than the purpose of the Parties Discussions without first obtaining the Disclosing Party s express written consent. Receiving Party shall be responsible for any improper disclosure or use of Confidential Information by any of its Representatives. The term person as used in this Agreement will be interpreted broadly to include, without limitation, any corporation, company, partnership, limited liability company, natural person or government entity. 5. In the event the Receiving Party or any of its Representatives is requested or becomes legally compelled (by deposition, interrogatory, request for documents, subpoena, civil investigative demand or similar process) to disclose any Confidential Information, then the Party so requested or compelled shall provide the Disclosing Party with prompt written notice of such request or requirement so that the Disclosing Party may seek a protective order or other appropriate remedy and/or waive compliance with the terms of this Agreement. In the event that such protective order or other remedy is not obtained, or that the Disclosing Party waives compliance with the provisions hereof, the Party so requested or compelled agrees to furnish only that portion of the Confidential Information that it is advised by counsel is legally required to be disclosed and to exercise reasonable efforts to obtain assurance that confidential treatment will be accorded the Confidential Information. 6. Upon written notice from the Disclosing Party, the Receiving Party agrees to immediately return or destroy all Confidential Information and any copies in whatever medium utilized containing any such Confidential Information. In addition, the Receiving Party agrees to destroy all copies of any analyses, compilations and studies or other documents including notes and other writings that it prepared containing or reflecting any Confidential Information., Each Party, however, shall be entitled to retain copies of any computer records and files which have been created pursuant to its automatic electronic archiving and back up procedures. 7. Except as may be necessary, in the opinion of counsel, to comply with the requirements of law, governmental regulation or any securities exchange on which any securities of Attachment A_BCBST_CNDA-Exclusive Lab RFI Page 2 of 4

12 either Party hereto may be listed, without the prior written consent of the Disclosing Party, the Receiving Party will not, and will direct its Representatives not to, disclose to any person either the fact that the Parties Discussions or that the Disclosing Party or the Receiving Party has requested or received any information, including Confidential Information, from the other Party, or any terms, conditions or other facts with respect to the Parties Discussions, including the status thereof. 8. The parties agree that remedies at law for any actual or threatened breach by Receiving Party of the provisions of this Agreement would not be sufficient remedy. Accordingly, the Receiving Party acknowledges and agrees in advance that in the event of any actual or threatened breach of the provisions of this Agreement by it, and without prejudice to any rights and remedies otherwise available to the Disclosing Party, the Disclosing Party may be entitled (a) to equitable relief, including by way of injunction and/or (b) to compel specific performance without the need of proof of actual damages. 9. Nothing in this Agreement shall be construed as establishing any joint venture or other business relationship or as granting any license or right under any patent rights or as representing any commitment by either Party to enter into any license or other agreement by implication or otherwise. 10. It is the intention of the Parties that the provisions of this Agreement shall be enforced to the fullest extent permissible under the laws and public policies of each state and jurisdiction in which such enforcement is sought, but that the unenforceability (or the modification to conform with such laws or public policies) of any provision hereof shall not render unenforceable or impair the remainder of this Agreement which shall be deemed amended to delete or modify, as necessary, the invalid or unenforceable provisions. The Parties further agree to alter the balance of this Agreement in order to render the same valid and enforceable. 11. This Agreement constitutes the full understanding of the Parties and a complete and exclusive statement of the terms and conditions of their agreement relating to the subject matter hereof and supersedes any and all prior agreements, whether written or oral, that may exist between the Parties with respect thereto. Except as otherwise specifically provided in this Agreement, no conditions, usage of trade, course of dealing or performance, understanding or agreement purporting to modify, vary, explain or supplement the terms or conditions of this Agreement shall be binding unless hereafter made in writing and signed by both Parties to be bound, and no modification shall be effected by the acknowledgment or acceptance of documents or forms containing terms or conditions at variance with or in addition to those set forth in this Agreement. 12. The restrictions expressed in this Agreement are in no way to supersede or eliminate any rights which the Parties otherwise may have pursuant to state or federal law pertaining to trade secrets or proprietary information. 13. It is further understood and agreed that no failure or delay by either Party in exercising any right, power or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any right, power or privilege hereunder. 14. This Agreement will be governed by and construed in accordance with the laws of the State of Tennessee Attachment A_BCBST_CNDA-Exclusive Lab RFI Page 3 of 4

13 15. This Agreement shall be binding upon and inure to the benefit of the Parties hereto and shall be binding upon and inure to the benefit of the successors, assigns, personal representatives, executors and administrators of the Parties hereto. This Agreement may be executed by facsimile transmission and in two or more counterparts, each of which shall be deemed an original and which, when taken together, shall constitute one and the same instrument. Any signatures delivered by a Party by facsimile transmission or by transmission, including in Adobe portable document format, shall be deemed an original signature. IN WITNESS WHEREOF, the Parties have executed this Agreement intending to be bound on and after its last signature date below, referred to as the Effective Date. BlueCross BlueShield of Tennessee, Inc. By: Title: Signature: Address: Date: [Company Name] By: Title: Signature: Address: Date: Attachment A_BCBST_CNDA-Exclusive Lab RFI Page 4 of 4

14 Line of Business: Medicaid - BlueCare Tennessee and TennCareSelect NPI Tax ID CPT Code Modifier Attachment B [Offeror's Name]: Proposed Laboratory Pricing by Procedure RFI - Clinical Laboratory Do you offer this service (Y/N) % of Proposed Comments 1

15 Line of Business: Advantage NPI Tax ID CPT Code Modifier Attachment C [Offeror's Name]: Proposed Laboratory Pricing by Procedure RFI - Clinical Laboratory Do you offer this service (Y/N) % of Proposed Comments 1

16 Line of Business: BlueCare Plus - DSNP NPI Tax ID CPT Code Modifier Attachment D [Offeror's Name]: Proposed Laboratory Pricing by Procedure RFI - Clinical Laboratory Do you offer this service (Y/N) % of Proposed Comments 1

17 BCT RFI - ATTACHMENT E BlueCare Tennessee Lab Exclusion List The Primary Criteria for the Exclusion List is as follows: Test Results needed in an Outpatient Setting to Facilitate Immediate care of the Patient. NOTE: Codes added during the Q review are indicated by green highlights CPT Code Description Collection of venous blood by venipuncture Collection of capillary blood specimen (eg, finger, heel, ear stick) Collection of blood spec from implantable device (port) Collection of blood specimen from central line, venous *80048 Basic Metabolic Panel Electrolyte Panel *80061 Lipid Panel *80076 Hepatic Panel Amikacin Gentamycin Tobramycin Vancomycin *80299 Methotrexate Urinalysis, by dip stick or tablet reagent; non-automated, with microscopy Urinalysis, by dip stick or tablet reagent; automated, with microscopy Urinalysis, by dip stick or tablet reagent; non-automated, without microscopy Urinalysis, by dip stick or tablet reagent; automated, without microscopy Urinalysis; qualitative or semiquantitative, except immunoassays Urine pregnancy test, by visual color comparison methods Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay) Ammonia Amylase Bilirubin; Total Bilirubin; Direct Blood, occult, by peroxidase activity, multiple specimen Blood, occult, by peroxidase activity, single specimen *82310 Calcium Chloride; Sweat CK, total Creatine Kinase (CK) (CPK); MB Frac Creatinine; blood Creatinine, other source Fetal fibronectin, cervicovaginal secretions, quantitative Gases; Blood Updated March 19, 2015 CPT is a registered trademark of the American Medical Association

18 BCT RFI - ATTACHMENT E BlueCare Tennessee Lab Exclusion List Gases, blood with O2 saturation, by direct measurement, except pulse oximetry Gases; Blood O2 saturation only Hemoglobin-oxygen affinity (po2 for %50 hemoglobin saturation with oxygen) Glucose, body fluid, other than blood (CSF) Glucose; quantitative, blood (except reagent strip) Glucose; blood, reagent strip Glucose; Post Glucose Dose Glucose tolerance test, 3 specimens (includes glucose) Glucose, blood by glucose monitoring device(s) Helicobacter pylori; drug administration Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use Lactate *83615 LDH *83655 Lead Fetal lung maturity assessment; flourescence polarization Fetal lung maturity assessment; lamellar body density Lipase Magnesium Microfluidic analysis, tear osmolality Natriuretic Peptide Phosphatidylglycerol *84100 Phosphorus Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative Potassium; Serum CSF Protein Protein, total, other source (CSF) Sodium; Serum *84439 Free T4 *84443 TSH *84450 AST *84460 ALT Troponin, quantitative Troponin, qualitative Urea Nitrogen; Quantitative *84550 Uric Acid Gonadotropin, chorionic (HCG); Quantitative Gonadotropin, chorionic (hcg); qualitative Bleeding time Updated March 19, 2015 CPT is a registered trademark of the American Medical Association

19 BCT RFI - ATTACHMENT E BlueCare Tennessee Lab Exclusion List Blood count; spun microhematocrit Hematocrit *85018 Hemoglobin Blood count; hemogram and platelet count, automated, and automated complete differential WBC count (CBC) Blood count; platelet automated Blood smear, peripheral; with written report Fibrin degradation products, D-dimer; qualitative Fibrin Degradation Products, D-Dimer; quantitative Hemoglobin, fetal for fetomaternal hemorrhage Platelet aggregation, each agent Prothrombin time Prothrombin time substitution, plasma fractions, each Sedimentation rate, erythrocyte, automated Sickling of RBC, reduction Thromboplastin time, partial (PTT); plasma or whole blood Thromboplastin time, partial (PTT); substitution, plasma fractions, each Heterophile antibodies; screening Immunoassay for infectious agent antibody, single step Skin test; candida Skin test; unlisted antigen, each Skin test; coccidioidomycosis Skin test; histoplasmosis Skin test; tuberculosis, intradermal Antibody; influenza virus Antibody; Mycoplasma Antibody screen, RBC, each serum technique Antibody elution (RBC), each elution Antibody identification, RBC antibodies, each panel for each serum technique Antihuman globulin test (Coombs test); direct, each antiserum Antihuman globulin test (Coombs); indirect, qualitative, each reagent red cell Blood Typing; ABO Blood Typing; RH (D) Blood typing; antigen testing of donor blood using reagent serum, each antigen test Antigen screen for compatible unit, patient serum Compatability test each unit; immediate spin technique Compatability test each unit; incubation technique Updated March 19, 2015 CPT is a registered trademark of the American Medical Association

20 BCT RFI - ATTACHMENT E BlueCare Tennessee Lab Exclusion List Compatability test each unit; antiglobulin technique Compatability test each unit; electronic Thawing fresh frozen plasma Thawing frozen blood Pooling of platelets or other blood products Pretreatment of RBCs with chemical agents Pretreatment of RBCs with enzymes Pretreatment of serum with drugs Pretreatment of serum by dilution Pretreatment of serum with inhibitors Pretreatment of serum by differential red cells Splitting of blood products Smear, primary source with interpretation, Gram or Giemsa stain for bacteria, fungi, or cell types Smear, primary source with interpretation; wet mount for infectious agents (e.g., saline, India ink, KOH preps) Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites Infectious agent antigen detection by enzyme immunoassay technique; Influenza, A or B, each Infectious agent antigen detection by enzyme immunoassay technique; Streptococcus, group A (Rapid Strep) Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B Infectious agent antigen detection by immunoassay with direct optical observation; Clostridium difficile toxin A Infectious agent antigen detection by immunoassay with direct optical observation; Influenza (Rapid Flu) Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A (Strep Test) *88160 Tzanck smear Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, first episode, each site Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, first episode, each site, interpretation and report Cytopathology, eval of fine needle aspirate; immediate cytohistologic study to determine adequacy for dx, each separate additional episode, same site Updated March 19, 2015 CPT is a registered trademark of the American Medical Association

21 BCT RFI - ATTACHMENT E BlueCare Tennessee Lab Exclusion List **88300 Level I Surgical Pathology, gross exam only **88302 Level II Surgical Pathology, gross and microscopic exam **88304 Level III Surgical Pathology, gross and microscopic exam **88305 Level IV - Surg Path, Gross and Micro Exam **88307 Level V Surgical Pathology, gross and microscopic exam **88309 Level VI Surgical Pathology, gross and microscopic exam **88311 Decalcification procedure **88312 Spec Stain; Grp I for Micro Interp and Report **88313 Spec Stain; Grp II for Micro Interp and Report Histochemical stain on frozen tissue block Pathology consultation during surgery First tissue block, with frozen section(s), single specimen Each additional tissue block with frozen section(s) **88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure **88342 Immunohistochemistry; Ea Antibody **88346 Immunoflourescent Study; Direct Method Electron microscopy, diagnostic **88367 Morphmetric analysis; in situ hybridization, quantitative, each probe; automated Bilirubin, total, transcutaneous Hemoglobin (Hgb), quantitative, trancutaneous Cell count, misc. body fluids Cell count, misc body fluids with differential count Sweat collection by iontophoresis Semen Analy; Presence/Motility Incl Huhner Test Semen Analy; Motility and Count Semen Analysis; Complete Semen Analysis Presence And/Or Motility of Sperm Sperm; Cerv Mucos Penetrat W/Wo Spinnbarkeit G0434 Drug Screen by CLIA waived test, per patient encounter Q0111 Wet mounts, including preparation of vaginal, cervical or skin specimens * Excluded for Members age 11 and younger only ** Excluded for Outpatient Surgical setting only Updated March 19, 2015 CPT is a registered trademark of the American Medical Association

22 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total COLLECTION OF VENOUS BLOOD BY VENIP 67, , , , ,182 1,886 3,687 38,042 56, , , UREA BREATH TEST, C-14 (ISOTOPIC); UREA BREATH TEST, C-14; ANALYSIS BASIC METABOLIC PANEL (INCL: 82330, 3 3, , , , BASIC METABOLIC PANEL 14,171 53,925 6,037 74, ,676 25,368 10,651 46, GENERAL HEALTH PANEL. (A) ,148 1,298 1,690 29, , ,324 6, ELECTROLYTE PANEL ,708 3, , COMPREHENSIVE METABOLIC PANEL 92, ,741 7, ,718 1, ,461 49,963 39,042 44, , OB PANEL, MUST INCLUDE OR (85 10, , LIPID PANEL 62,994 8,198 9,009 80, ,400 40,827 15,939 33,518 90, RENAL FUNCTION PANEL 1, , ,893 1,047 1,184 4, ACUTE HEPATITIS PANEL 7, , HEPATIC FUNCTION PANEL 7,017 6, , ,032 3,178 3,218 8, AMIKACIN (blank) CARBAMAZEPINE TOTAL , CARBAMAZEPINE FREE CYCLOSPORINE (blank) DIGOXIN , DIPROPYLACETIC ACID (VALPROIC ACID) 3,726 1, , ETHOSUXIMIDE (blank) GENTAMICIN (blank) 18, , , ,074 2, HALOPERIDOL (blank) LIDOCAINE (blank) , LITHIUM 1, , (blank) (blank) PHENOBARBITAL 27, , , ,728 4, PHENYTOIN; TOTAL 1,470 1, , PHENYTOIN; FREE PRIMIDONE 3, , PROCAINAMIDE; WITH METABOLITES QUINIDINE SIROLIMUS TACROLIMUS 562 1, , THEOPHYLLINE (blank) TOBRAMYCIN TOPIRAMATE VANCOMYCIN (blank) QUANTITATION OF DRUG, NOT ELSEWHERE 27, ,314 29, , ,942 9, ACTH STIMULATION PANEL; FOR ADRENAL CHORIONIC GONADOTROPIN STIMULATION CHORIONIC GONADOTROPIN STIMULATION GLUCAGON TOLERANCE PANEL; FOR INSUL GLUCAGON TOLERANCE PANEL; FOR PHEOC GONADOTROPIN RELEASING HORMONE STIM GROWTH HORMONE STIMULATION PANEL INSULIN TOLERANCE PANEL; FOR GROWTH CLINICAL PATHOLOGY CONSULTATION; LI CLINICAL PATHOLOGY CONSULTATION; CO URINALYSIS BY DIP STICK OR TABLET; 63 4,308 14,497 18, ,898 6, URINALYSIS BY DIP STICK OR TABLET; 9,468 82,785 11, , ,795 11,840 12,951 29, URINALYSIS BY DIP STICK OR TABLET; 614 4,906 90,577 96, ,620 16, URINALYSIS BY DIP STICK OR TABLET; 27,380 42,096 81, , ,937 5,468 23,502 34, URINALYSIS QUALITATIVE OR SEMIQUANI 6, , , URINALYSIS BACTERIURIA SCREEN EXCEP Page Number 1 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

23 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total URINALYSIS MICROSCOPIC ONLY , URINALYSIS 2 OR 3 GLASS TEST URINE PREGNANCY TEST BY VISUAL COLO ,038 69, , VOLUME MEASUREMENT FOR TIMED COLLEC UNLISTED URINALYSIS PROCEDURE (BR) ASPA GENE ANALYSIS, COMMON VARIANTS (blank) (blank) (blank) BCKDHB GENE ANALYSIS, COMMON VARIAN BCR/ABL1 TRANSLOCATION ANALYSIS; MA BCR/ABL1 TRANSLOCATION ANALYSIS; MI BCR/ABL1 TRANSLOCATION ANALYSIS; OT BLM GENE ANALYSIS, 2281DEL6INS7 VAR BRAF, GENE ANALYSIS, V600E VARIANT VRCA1, BRCA2, GENE ANALYSIS; FULL S VRCA1, BRCA2, GENE ANALYSIS; 185DEL VRCA1, BRCA2, GENE ANALYSIS; UNCOMM BRCA1 GENE ANALYSIS; KNOWN FAMILIAL BRCA2 GENE ANALYSIS; KNOWN FAMILIAL CFTR GENE ANALYSIS; COMMON VARIANTS 2, , CFTR GENE ANALYSIS; KNOWN FAMILIAL CFTR GENE ANALYSIS; DUPLICATION/DEL CFTR GENE ANALYSIS; FULL GENE SEQUE CFTR GENE ANALYSIS; INTRON 8 POLY-T CYP2C19, GENE ANALYSIS, COMMON VARI 2, , , , CYP2D6, GENE ANALYSIS COMMON VARIAN 1, , , CYP2C9, GENE ANALYSIS, COMMON VARIA 1, , CYTOGENOMIC CONSTITUTIONAL MICROARR CYTOGENOMIC CONSTITUTIONAL MICROARR (blank) F2 GENE ANALYSIS, 20210G>A VARIANT 1, , , F5 GENE ANALYSIS, LEIDEN VARIANT 1, , , FANCC GENE ANALYSIS, COMMON VARIANT FMR1 GENE ANALYSIS; EVALUATION TO D FMR1 GENE ANALYSIS; CHARACTERIZATIO FLT3, GENE ANALYSIS, INTERNAL TANDE G6PC GENE ANALYSIS, COMMON VARIANTS GBA GENE ANALYSIS, COMMON VARIANTS (blank) (blank) HESA GENE ANALYSIS, COMMON VARIANTS HFE GENE ANALYSIS, COMMON VARIANTS HBA1/HBA2, GENE ANALYSIS, FOR COMMO IKBKAP GENE ANALYSIS, COMMON VARIAN IGH@ GENE REARRANGEMENT ANALYSIS TO IGH@, VARIABLE REGION SOMATIC MUTAT IGK@ GENE REARRANGEMENT ANALYSIS, E COMPARATIVE ANALYSIS USING SHORT TA COMPARATIVE ANALYSIS USING SHORT TA CHIMERISM ANALYSIS, POST TRANSPLANT CHIMERISM ANALYSIS, POST TRANSPLANT JAK2 GENE ANALYSIS, P.VAL617PHE VAR KRAS GENE ANALYSIS, VARIANTS IN COD LONG QT SYNDROME GENE ANALYSES; FUL LONG QT SYNDROME GENE ANALYSES; KNO (blank) MCOLN1 GENE ANALYSIS, COMMON VARIAN MTHFR GENE ANALYSIS, COMMON VARIANT 1, , MLH1 GENE ANALYSIS; FULL SEQUENCE A MLH1 GENE ANALYSIS; KNOWN FAMILIAL MLH1 GENE ANALYSIS; DUPLICATION/DEL MSH2 GENE ANALYSIS; FULL SEQUENCE A Page Number 2 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

24 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total MSH2 GENE ANALYSIS; DUPLICATION/DEL MSH6 GENE ANALYSIS; FULL SEQUENCE A MSH6 GENE ANALYSIS; DUPLICATION/DEL MICROSATELLITE INSTABILITY ANALYSIS MECP2 GENE ANALYSIS; FULL SEQUENCE MECP2 GENE ANALYSIS; DUPLICATION/DE NPM1 GENE ANALYSIS, EXON 12 VARIANT PML/RARALPHA, TRANSLOCATION ANALYSI PMS2 GENE ANALYSIS; FULL SEQUENCE A PMS2 GENE ANALYSIS; KNOWN FAMILIAL PMS2 GENE ANALYSIS; DUPLICATION/DEL (blank) (blank) SMPD1 GENE ANALYSIS, COMMON VARIANT SNRPN/UBE3A, METHYLATION ANALYSIS SERPINA-1, GENE ANALYSIS, COMMON VA TRB@, GENE REARRANGEMENT ANALYSIS T TRG@, GENE REARRANGEMENT ANALYSIS, UGT1A1, GENE ANALYSIS, COMMON VARIA 1, , VKORC1, GENE ANALYSIS, COMMON VARIA 1, , HLA CLASS I & II TYPING, LOW RESOLU HLA CLASS I & II TYPING, LOW RESOLU HLA CLASS I TYPING, LOW RESOLUTION; HLA CLASS I TYPING, LOW RESOLUTION; HLA CLASS I TYPING, LOW RESOLUTION; HLA CLASS II TYPING, LOW RESOLUTION HLA CLASS II TYPING, LOW RESOLUTION HLA CLASS II TYPING, LOW RESOLUTION HLA CLASS I & II TYPING, HIGH RESOL HLA CLASS I TYPING, HIGH RESOLUTION HLA CLASS I TYPING, HIGH RESOLUTION HLA CLASS I TYPING, HIGH RESOLUTION HLA CLASS II TYPING, HIGH RESOLUTIO HLA CLASS I TYPING, HIGH RESOLUTION MOLECULAR PATHOLOGY PROCEDURE, LEVE 4, , MOLECULAR PATHOLOGY PROCEDURE, LEVE 12, , , , MOLECULAR PATHOLOGY PROCEDURE, LEVE MOLECULAR PATHOLOGY PROCEDURE, LEVE MOLECULAR PATHOLOGY PROCEDURE, LEVE MOLECULAR PATHOLOGY PROCEDURE, LEVE MOLECULAR PATHOLOGY PROCEDURE LEVEL MOLECULAR PATHOLOGY PROCEDURE, LEVE MOLECULAR PATHOLOGY PROCEDURE, LEVE (blank) 12, , , , (blank) (blank) (blank) (blank) (blank) ACETONE OR OTHER KETON BODIES, SERU ACETONE OR OTHER KETON BODIES, SERU ACETYLCHOLINESTERASE ACYLCARNITINES; QUANTITATIVE EACH S ADRENOCORTICOTROPIC HORMONE (ACTH) ADENOSINE 5-MONOPHOSPHATE CYCLIC ALBUMIN; SERUM, PLASMA OR WHOLE BLO 1, , , , ALBUMIN URINE OR OTHER SOURCE QUANT ALBUMIN URINE MICROALBUMIN QUANTITA 6, , ,912 2,022 3,303 12, ALBUMIN URINE MICROALBUMIN SEMIQUAN ,402 2, ,114 3, ALCOHOL (ETHANOL) BREATH ALDOLASE ALDOSTERONE ALPHA-1-ANTITRYPSIN; TOTAL Page Number 3 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

25 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total ALPHA-1-ANTITRYPSIN; PHENOTYPE ALPHA-FETOPROTEIN; SERUM 7, , ALPHA-FETOPROTEIN; AMNIOTIC FLUID ALPHA-FETOPROTEIN; AFP-L3 FRACTION ALUMINUM AMINES VAGINAL FLUID QUALITATIVE AMINO ACIDS; SINGLE QUALITATIVE, EA AMINO ACIDS; MULTIPLE QUALITATIVE, AMINO ACIDS; SINGLE QUANTITATIVE, E AMINOLEVULINIC ACID DELTA (ALA) AMINO ACIDS 2 TO 5 AMINO ACIDS, QUA AMINO ACIDS, 6 OR MORE AMINO ACIDS, AMMONIA 706 1, , AMNIOTIC FLUID SCAN (SPECTROPHOTOME AMYLASE 3,375 18, , ,030 2, , ANDROSTENEDIONE ANDROSTERONE ANGIOTENSIN II ANGIOTENSIN I CONVERTING ENZYME (AC APOLIPOPROTEIN DENY INV/N10 2, , , , ARSENIC ASCORBIC ACID (VITAMIN C) BLOOD ATOMIC ABSORPTION SPECTROSCOPY, EAC BETA-2 MICROGLOBULIN BILE ACIDS; TOTAL BILIRUBIN; TOTAL 2,528 3,606 3,015 9, , BILIRUBIN; DIRECT 5,965 4, , , , BIOTINIDASE EACH SPECIMEN BLOOD OCCULT PEROXIDASE ACTIVITY, Q ,268 2, ,611 2, BLOOD OCCULT PEROXIDASE ACTIVITY, Q BLOOD OCCULT PEROXIDASE ACTIVITY, Q 182 1,560 1,927 3, , BLOOD, OCCULT, FECAL HGB BY IMMUNOA ,658 5, CADMIUM CALCIFEDIOL (25-OH VITAMIN D-3) 22,020 4, , ,613 5,398 4,923 24, CALCITONIN CALCIUM; TOTAL 2, , , CALCIUM; IONIZED 284 1, , CALCUIM; URINE QUANTITATIVE TIMED S CALCULUS; QUALITATIVE ANALYSIS CALCULUS; QUANTITATIVE ANALYSIS, CH CALCULUS; INFRARED SPECTROSCOPY CALCULUS; X-RAY DIFFRACTION CARBOHYDRATE DEFICIENT TRANSFERRIN CARBON DIOXIDE (BICARBONATE) , CARBON MONOXIDE (CARBOXYHEMOGLOBIN) CARCINOEMBRYONIC ANTIGEN (CEA) - DE 1, , , CARNITINE (TOTAL & FREE) QUANTITATI CAROTENE CATECHOLAMINES TOTAL URINE CATECHOLAMINES BLOOD CATECHOLAMINES FRACTIONATED CERULOPLASMIN CHEMILUMINESCENT ASSAY CHLORIDE; BLOOD , CHLORIDES; URINE CHLORIDES; OTHER SOURCE CHOLESTEROL, SERUM OR WHOLE BLOOD, 8, ,514 12, CHOLESTERINASE; SERUM CHOLINESTERASE; RBC CHROMATOGRAPHY QUALITATIVE; COLUMN CHROMATOGRAPHY QUALITATIVE; PAPER CHROMATOGRAPHY QUALITATIVE; THIN LA CHROMATOGRAPHY QUANTITATIVE COLUMN; 2, , Page Number 4 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

26 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total CHROMATOGRAPHY QUANTITATIVE COLUMN; ,143 2, CHROMIUM CITRATE COLLAGEN CROSS LINKS ANY METHOD DEN COPPER CORTICOSTERONE CORTISOL; FREE CORTISOL; TOTAL 1, , CREATINE COLUMN CHROMATOGRAPHY MASS SPECTROM 4, , , , COLUMN CHROMATOGRAPHY MASS SPECTROM 169, , ,825 1, ,357 32, ,549 46, COLUMN CHROMATOGRAPHY MASS SPECTROM 14, ,866 16, , , COLUMN CHROMATOGRAPHY MASS SPECTROM 3, ,499 5, , , CREATINE KINASE (CK) (CPK); TOTAL 3,089 6, , ,959 4,965 2,424 12, CREATINE KINASE (CK), (CPK); ISOENZ CREATINE KINASE (CK) (CPK); MB FRAC 93 5, , , , CREATININE; BLOOD 1,933 4,642 3,227 9, ,521 5,071 2,329 8, CREATININE; OTHER SOURCE 69,263 2,700 23,266 95, ,129 13,601 1,933 17,194 32, CREATININE; CLEARANCE CRYOFIBRINOGEN CRYOGLOBULIN QUALITATIVE OR SEMI-QU CYANOCOBALAMIN (VITAMIN B-12) 14,664 1, , ,711 3,943 4,301 16, CYANOCOBALAMIN (VITAMIN B-12) UNSAT CYSTATIN C , CYSTINE & HOMOCYSTINE URINE QUALITA DEHYDROEPIANDROSTERONE (DHEA) DEHYDROEPIANDROSTERONE SULFATE (DHE 1, , DESOXYCORTICOSTERONE DEOXYCORTISOL DIBUCAINE NUMBER DIHYDROXYVITAMIN D 1, 25-1, , ELASTASE, PANCREATIC (EL-1) FECAL,Q ENZYME ACTIVITY BLOOD CELLS, CULTUR 32 1, , ENZYME ACTIVITY IN BLOOD CELLS CULT ELECTROPHORETIC TECHNIQUE, NOT ELSE ERYTHROPOIETIN ESTRADIOL 2, , , ESTROGENS; FRACTIONATED ESTROGENS; TOTAL ESTRIOL 6, , ESTRONE ETHYLENE GLYCOL ETIOCHOLANOLONE FAT OR LIPIDS, FECES; QUALITATIVE FAT OR LIPIDS, FECES; QUANTITATIVE FAT DIFFERENTIAL, FECES, QUANTITATI FATTY ACIDS, NONESTERIFIED VERY LONG CHAIN FATTY ACIDS FERRITIN 10,178 3, , ,647 2,876 3,307 10, FETAL FIBRONECTIN, CERVICOVAGINAL S 260 1, , FLUORIDE FOLIC ACID; SERUM 8, , ,286 1,484 1,733 7, FOLIC ACID; RBC GALACTOKINASE RBC GALACTOSE GALACTOSE 1-PHOSPHATE URIDYL TRANSF GALACTOSE 1-PHOSPHATE URIDYL TRANSF (blank) GAMMAGLOBULIN IGA, IGD, IGG, IGM, E 7,116 2, , ,340 1, , GAMMAGLOBULIN IGE 2, , GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLA GASES, BLOOD, PH ONLY GASES BLOOD ANY COMBINATION PH, PCO 0 3, , , , Page Number 5 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

27 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total GASES BLOOD; W O2 SATURATION BY DIR BLOOD GASES O2 SATURATION ONLY BY D HEMOGLOBIN OXYGEN AFFINITY GASTRIC ACID ANALYSIS, INCLUDES PH GASTRIN GLUCAGON GLUCOSE BODY FLUID, OTHER THAN BLOO GLUCAGON TOLERANCE TEST GLUCOSE; QUANTITATIVE, BLOOD 5,671 3,171 10,223 19, ,192 1,401 2,832 5, GLUCOSE; BLOOD REAGENT STRIP 0 5,949 6,101 12, ,696 1,344 3, GLUCOSE; POST GLUCOSE DOSE 7,388 1,224 1,682 10, GLUCOSE; TOLERANCE TEST (GTT), 3 SP 2, , GLUCOSE; TOLERANCE TEST, EACH ADDIT 1, , GLUCOSE 6-PHOSPHATE DEHYDROGENASE ( GLUCOSE 6-PHOSPHATE DEHYDROGENASE ( GLUCOSE, BLOOD BY GLUCOSE MONITORIN ,735 20,283 38, ,848 5,681 12, GLUTAMYLTRANSFERASE GAMMA (GGT) 2,041 1, , , GLUTATHIONE GLYCATED PROTEIN GONADOTROPIN; FOLLICLE STIMULATING 4, , GONADOTROPIN; LUTEINIZING HORMONE ( 3, , GROWTH HORMONE, HUMAN (HGH) (SOMATO HELICOBACTER PYLORI : BLOOD TEST AN HAPTOGLOBIN; QUANTITATIVE HELICOBACTER PYLORI; BREATH TEST AN HELICOBACTER PYLORI; DRUG ADMINISTR HEAVY METAL SCREEN (ARSENIC, BARIUM HEAVY METAL; QUANTITATIVE, EACH HEMOGLOBIN FRACTIONATION & QUANTITA , HEMOGLOBIN FRACTIONATION & QUANTITA 2,454 1, , HEMOGLOBIN; BY COPPER SULFATE METHO HEMOGLOBIN F (FETAL) CHEMICAL HEMOGLOBIN F (FETAL) QUALITATIVE HEMOGLOBIN GLYCOSYLATED (A1C) 39,613 6,276 5,875 51, ,800 9,827 21,886 55, HEMOGLOBIN; GLYCOSYLATED (A1C) BY D 0 0 3,189 3, HEMOGLOBIN METHEMOGLOBIN QUANTITATI HEMOGLOBIN PLASMA HEMOGLOBIN SULFHEMOGLOBIN QUANTITAT HEMOGLOBIN UNSTABLE SCREEN HEMOSIDERIN QUALITATIVE B-HEXOSAMINIDASE, EACH ASSAY HISTAMINE HOMOCYSTINE 1, , , , HOMOVANILLIC ACID (HVA) HYDROXYCORTICOSTEROIDS 17- (17-OHCS HYDROXYINDOLACETIC ACID 5-(HIAA) HYDROXYPROGESTERONE 17-D HYDROXYPROLINE; FREE HYDROXYPROLINE; TOTAL IMMUNOASSAY FOR ANALYTE OTHER THAN 7,821 2, , , , IMMUNOASSAY FOR ANALYTE OTHER THAN IMMUNOASSAY ANALYTE QUANTITATIVE BY , , IMMUNOASSAY ANALYTE QUANTITATIVE, N 5,152 2, , , , INSULIN; TOTAL 5, , , , INSULIN; FREE IRON 10,181 2, , ,433 3,355 2,418 13, IRON BINDING CAPACITY 8,489 1, , ,498 1,932 2,108 8, ISOCITRIC DEHYDROGENASE (IDH) KETOSTEROIDS 17-(17-KS); TOTAL KETOSTEROIDS 17-(17-KS); FRACTIONAT LACTATE (LACTIC ACID) 46 4, , , , LACTATE DEHYDROGENASE (LD) (LDH) 3,483 6, , ,000 1,672 2,198 4, LACTATE DEHYDROGENASE (LD) (LDH); I Page Number 6 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

28 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total LACTOFERRIN, FECAL, QUALITATIVE LACTOFERRIN, FECAL, QUANTITATIVE (R LEAD 14,378 2,030 14,654 31, FETAL LUNG MATURITY ASSESSMENT; LEC FETAL LUNG MATURITY ASSESSMENT; FLU FETAL LUNG MATURITY ASSESSMENT; LAM LEUCINE AMINOPEPTIDASE (LAP) LIPASE 3,646 33, , ,093 4, , LIPOPROTEIN DENY INV/N , , LIPOPROTEIN-ASSOCIATED PHOSPHOLIIPA 1, , , , LIPOPROTEIN, BLOOD; ELECTROPHORETIC LIPOPROTEIN, BLD; HIGH RESOL'N FRAC , , LIPOPROTEIN BLOOD QUANTIT-LIPOPR PR 1, , , LIPOPROTEIN DIRECT MEASUREMENT; HIG LIPOPROTEIN DIRECT MEASUREMENT VLDL LIPOPROTEIN DIRECT MEASUREMENT LDL , ,346 5, LUTEINIZING RELEASING FACTOR (LRH) MAGNESIUM 6,598 21,870 2,249 30, ,138 8,097 3,525 15, MANGANESE MASS SPECTROMETRY & TANDEM MASS SPE 2, , MASS SPECTROMETRY & TANDEM MASS SPE 70, ,953 84, ,066 7, ,112 18, MERCURY QUANTITATIVE METANEPHRINES MICROFLUIDIC ANALYSIS UTILIZING AN MUCOPOLYSACCHARIDES ACID QUANTITATI MUCIN SYNOVIAL FLUID (ROPES TEST) MYELIN BASIC PROTEIN CSF MYOGLOBIN 117 2, , , , MYELOPEROXIDASE (MPO) NATRIURETIC PEPTIDE 2,151 7, , ,716 5, , NEPHELOMETRY EA ANALYTE NOT ELSEWHE , , NICKEL NUCLEOTIDASE OLIGOCLONAL IMMUNE ORGANIC ACIDS; TOTAL QUANTITATIVE E ORGANIC ACIDS; QUALITATIVE EA SPECI ORGANIC ACID SINGLE QUANTITATIVE , , OSMOLALITY; BLOOD OSMOLALITY; URINE OSTEOCALCIN OXALATE PARATHORMONE 2,686 1, , ,656 1, , PH, BODY FLUID, EXCEPT BLOOD 58, ,459 66, , ,292 13, PHENCYCLIDINE (PCP) 36, ,215 43, , ,664 10, CALPROTECTIN, FECAL - DENY INV/N , PHENYLALANINE (PKU) BLOOD PHENYLKETONES QUALITATIVE 0 0 1,671 1, PHOSPHATASE ACID; TOTAL PHOSPHATASE ACID; PROSTATIC PHOSPHATASE ALKALINE 1,380 1, , , , PHOSPHATASE ALKALINE; HEAT STABLE PHOSPHATASE ALKALINE; ISOENZYMES PHOSPHATIDYLGLYCEROL PHOSPHOHEXOSE ISOMERASE PHOSPHORUS INORGANIC (PHOSPHATE) 2,968 11,351 8,393 22, ,925 2,578 1,105 5, PHOSPHORUS INORGANIC (PHOSPHATE); U PORPHOBILINOGEN, URINE; QUANTITATIV PLACENTAL ALPHA MICROGLOBULIN-1 (PA PORPHYRINS, URINE; QUALITATIVE PORPHYRINS URINE; QUANTITATION & FR PORPHYRINS FECES; QUANTITATIVE POTASSIUM; SERUM, PLASMA OR WHOLE B 871 2, , , , POTASSIUM; URINE Page Number 7 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

29 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total PREALBUMIN PREGNANEDIOL PREGNANETRIOL PREGNENOLONE HYDROXYPREGNENOLONE PROGESTERONE 2, , PROCALCITONIN (PCT) PROLACTIN 3, , PROSTAGLANDIN, EACH 0 0 1,692 1, PROSTATE SPECIFIC ANTIGEN (PSA); CO 3 1 2,432 2, PROSTATE SPECIFIC ANTIGEN (PSA); TO 3, ,484 6, ,143 2,456 6,364 14, PROSTATE SPECIFIC ANTIGEN (PSA); FR ,695 3, ,466 2, PROTEIN, TOTAL, EXCEPT BY REFRACTOM 1, ,656 4, , , PROTEIN, TOTAL, EXCEPT BY REFRACTOM 3,057 1, , , ,026 3, PROTEIN, TOTAL, EXCEPT BY REFRACTOM , PROTEIN; REFRACTOMETRIC ,691 13, PREGNANCY-ASSOCIATED PLASMA PROTEIN 1, , PROTEIN; ELECTROPHORETIC FRACTIONAT , , , ELECTROPHORETIC FRACTIONATION & QUA PROTEIN; WESTERN BLOT W INTERPRETAT PROTEIN; WESTERN BLOT, W I&R, BLOOD PROTOPORPHYRIN, RBC; QUANTITATIVE PROINSULIN PYRIDOXAL PHOSPHATE (VITAMIN B-6) PYRUVATE PYRUVATE KINASE RECEPTOR ASSAY; PROGESTERONE RECEPTOR ASSAY; ENDOCRINE, OTHER TH RECEPTOR ASSAY; NON-ENDOCRINE (SPEC RENIN RIBOFLAVIN (VITAMIN B-2) SELENIUM SEROTONIN SEX HORMONE BINDING GLOBULIN (SHBG) 1, , SIALIC ACID SODIUM; SERUM, PLASMA OR WHOLE BLOO 571 1, , SODIUM; URINE SODIUM; OTHER SOURCE SOMATOMEDIN , SOMATOSTATIN SPECTROPHOTOMETRY, ANALYTE NOT ELSE 59, ,297 64, , ,765 13, SPECIFIC GRAVITY (EXCEPT URINE) SUGARS, CHROMATOGRAPHIC TLC OR PAPE SUGARS; SINGLE QUALITATIVE EACH SPE SUGARS; MULTIPLE QUALITATIVE EACH S SUGARS; SINGLE QUANTITATIVE EACH SP SULFATE, URINE TESTOSTERONE; FREE 1, , , TESTOSTERONE; TOTAL 4, , , ,407 5, THIAMINE (VITAMIN B-1) THROMBOXANE METABOLITE(S), INCLUDIN THYROGLOBULIN THYROXINE; TOTAL 9, , , ,160 5, THYROXINE; REQUIRING ELUTION THYROXINE; FREE 21,138 7,214 1,414 29, ,567 4,100 7,342 22, THYROXINE; BINDING GLOBULIN (TBG) THYROID STIMULATING HORMONE (TSH) 49,523 13,233 2,579 65, ,350 14,483 19,666 60, THYROID STIMULATING IMMUNE GLOBULIN TOCOPHEROL ALPHA (VITAMIN E) TRANSCORTIN TRANSFERASE; ASPARTATE AMINO (AST) 3,182 2, , ,142 1, , TRANSFERASE; ALANINE AMINO (ALT) (S 2,903 2, , ,704 1,058 1,685 4, TRANSFERRIN , , Page Number 8 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

30 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total TRIGLYCERIDES 3, , THYROID HORMONE (T3 OR T4) UPTAKE O 5, , , , TRIIODOTHYRONINE T3; TOTAL (TT-3) 3, , , , TRIIDOTHYRONINE (T-3) FREE 5, , , ,378 4, TRIIDOTHYRONINE (T-3) REVERSE TROPONIN, QUANTITATIVE , , , , TRYPSIN; FECES QUANTITATIVE 24-HOUR TYROSINE UREA NITROGEN; QUANTITATIVE 1,578 3,396 2,545 7, ,120 2, , UREA NITROGEN; SEMIQUANTITATIVE UREA NITROGEN, URINE UREA NITROGEN, CLEARANCE URIC ACID; BLOOD 7,405 5, , ,537 1,820 2,461 8, URIC ACID; OTHER SOURCE VANILLYMANDELIC ACID (VMA), URINE VASOACTIVE INTESTINAL PEPTIDE (VIP) VASOPRESSIN (ANTIDIURETIC HORMONE A VITAMIN A VITAMIN, NOT OTHERWISE SPECIFIED VITAMIN K VOLATILES ZINC C-PEPTIDE 2, , , GONADOTROPIN CHORIONIC (HCG); QUANT 13,095 11, , GONADOTROPIN CHORIONIC (HCG); QUALI 1,047 19,709 2,272 23, GONADOTROPIN, CHORIONIC (HCG); FREE 1, , UNLISTED CHEMISTRY PROCEDURE (BR) , , BLEEDING TIME BLOOD COUNT; AUTOMATED DIFFERENTIAL BLOOD SMEAR; MICROSCOPIC EXAM W MAN 274 3, , BLOOD SMEAR; MICROSCOPIC EXAM WO MA BLOOD COUNT; MANUAL DIFFERENTIAL WB BLOOD COUNT; SPUN MICROHEMATOCRIT 0 0 5,963 5, BLOOD COUNT; HEMATOCRIT (HCT) 2,781 4,444 8,378 15, , , BLOOD COUNT, HEMOGLOBIN (HGB) 3,941 6,549 27,709 38, ,211 1,140 4, BLOOD COUNT COMPLETE, AUTOMATED & A 63, , , , , ,726 35,472 38,421 52, , BLOOD COUNT; COMPLETE, AUTOMATED 13,553 33,106 2,588 49, ,194 18,890 6,682 29, BLOOD COUNT; RED BLOOD CELL (RBC), BLOOD COUNT; RETICULOCYTE, MANUAL BLOOD COUNT; RETICULOCYTE AUTOMATED 2,087 6, , , BLOOD COUNT; RETICULOCYTES AUTOMATE BLOOD COUNT; LEUKOCYTE (WBC), AUTOM BLOOD COUNT; PLATELET, AUTOMATED RETICULATED PLATELET ASSAY BLOOD SMEAR PERIPHERAL INTERPRETATI ,296 1, BONE MARROW, SMEAR INTERPRETATION CHROMOGENIC SUBSTRATE ASSAY CLOT LYSIS TIME, WHOLE BLOOD DILUTI CLOTTING; FACTOR II PROTHROMBIN, SP CLOTTING; FACTOR V, LABILE FACTOR CLOTTING; FACTOR VII, PROCONVERTIN CLOTTING; FACTOR VIII (AHG), 1 STAG CLOTTING; FACTOR VIII RELATED ANTIG CLOTTING; FACTOR VIII, VW FACTOR RI CLOTTING; FACTOR VIII, VW FACTOR AN CLOTTING; FACTOR VIII, VON WILLEBRA CLOTTING; FACTOR IX (PTC OR CHRISTM CLOTTING; FACTOR X (STUART-PROWER) CLOTTING; FACTOR XI (PTA) CLOTTING; FACTOR XII (HAGEMAN) CLOTTING; FACTOR XIII (FIBRIN STABI CLOTTING; FACTOR XIII (FIBRIN STABI CLOTTING INHIBITORS OR ANTICOAGULAN Page Number 9 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

31 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total CLOTTING INHIBITORS OR ANTICOAGULAN CLOTTING INHIBITORS OR ANTICOAGULAN CLOTTING INHIBITORS OR ANTICOAGULAN CLOTTING INHIBITORS OR ANTICOAGULAN CLOTTING INHIBITORS OR ANTICOAGULAN ACTIVATED PROTEIN C (APC) RESISTANC FACTOR INHIBITOR TEST COAGULATION TIME; ACTIVATED EUGLOBULIN LYSIS FIBRIN DEGRADATION PRODUCTS; AGGLUT FIBRIN DEGRADATION PRODUCTS; QUANTI FIBRIN DEGRADATION PRODUCTS, D-DIME FIBRIN DEGRADATION PRODUCTS, D-DIME 415 6, , , , FIBRIN DEGRADATION PRODUCTS, D-DIME FIBRINOGEN; ACTIVITY , FIBRINOGEN; ANTIGEN FIBRINOLYSINS OR COAGULOPATHY SCREE COAGULATION/FIBRINOLYSIS ASSAY, WHO COAGULATION AND FIBRINOLYSIS, FUNCT FIBRINOLYTIC FACTORS & INHIBITORS; FIBRINOLYTIC FACTORS & INHIBITORS; FIBRINOLYTIC FACTORS & INHIBITORS; FIBRINOLYTIC FACTORS & INHIBITORS; HEINZ BODIES; DIRECT HEMOGLOBIN OR RBCS FETAL FOR FETOMA HEMOGLOBIN OR RBCS FETAL FOR FETOMA HEPARIN ASSAY HEPARIN NEUTRALIZATION LEUKOCYTE ALKALINE PHOSPHATASE WITH MURAMIDASE OSMOTIC FRAGILITY RBC; UNINCUBATED OSMOTIC FRAGILITY RBC; INCUBATED PLATELET, AGGREGATION (IN VITRO), E PHOSPHOLIPID NEUTRALIZATION; PLATEL PHOSPHOLIPID NEUTRALIZATION; HEXAGO PROTHROMBIN TIME 7,093 25,718 9,979 42, ,724 23,582 32,914 65, PROTHROMBIN TIME; SUBSTITUTION PLAS RUSSELL VIPER VENOM TIME; UNDILUTED RUSSELL VIPER VENOM TIME; DILUTED REPTILASE TEST SEDIMENTATION RATE ERYTHROCYTE; NON 72 1, , ,534 2,069 3, SEDIMENTATION RATE ERYTHROCYTE; AUT 8,769 5,660 2,223 16, ,258 1,810 1,598 7, SICKLING OF RBC REDUCTION 2, , THROMBIN TIME; PLASMA THROMBOPLASTIN INHIBITION; TISSUE THROMBOPLASTIN TIME PARTIAL (PTT); 2,276 16, , , , THROMBOPLASTIN TIME PARTIAL; SUBSTI VISCOSITY UNLISTED HEMATOLOGY & COAGULATION P AGGLUTININS, FEBRILE EACH ANTIGEN ALLERGEN SPECIFIC IGG QUANTITATIVE ,248 1, ALLERGEN SPEC IGE QUANTI/SEMI-QUANT 47,681 13, , , ,509 6, ALLERG SPEC IGE QUALITATIVE, MULTIA ANTIBODY IDENTIFICATION; LEUKOCYTE , ANTIBODY IDENTIFICATION; PLATELET A ANTIBODY IDENTIFICATION; PLATELET A ANTINUCLEAR ANTIBODIES (ANA) 7,416 1, , , , ANTINUCLEAR ANTIBODIES (ANA); TITER 1, , ANTISTREPTOLYSIN O; TITER ANTISTREPTOLYSIN O; SCREEN BLOOD BANK PHYSICIAN SERVICE; DIFFI BLOOD BANK PHYSICIAN SERVICES INVES BLOOD BANK DR. SERVICES AUTHORIZE D Page Number 10 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

32 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total C-REACTIVE PROTEIN 7,262 6, , ,888 2,044 1,536 6, C-REACTIVE PROTEIN; HIGH SENSITIVIT 2, , , , BETA 2 GLYCOPROTEIN I ANTIBODY, EAC 1, , CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY 2, , ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIP (blank) (blank) COLD AGGLUTININ; SCREEN COLD AGGLUTININ; TITER COMPLEMENT; ANTIGEN EACH COMPONENT 2, , , COMPLEMENT; FUNCTIONAL ACTIVITY, EA COMPLEMENT; TOTAL HEMOLYTIC (CH50) COMPLEMENT FIXATION TESTS, EACH ANT CYCLIC CITRULLINATED PEPTIDE, ANTIB 1, , DEOXYRIBONUCLEASE, ANTIBODY DEOXYRIBONUCLEIC ACID (DNA) ANTIBOD 1, , DEOXYRIBONUCLEIC ACID (DNA) ANTIBOD EXTRACTABLE NUCLEAR ANTIGEN ANTIBOD 6, , , , FLUORESCENT NONINFECTIOUS AGENT ANT 2, , FLUORESCENT NONINFECTIOUS AGENT ANT 283 1, , HUMAN GROWTH HORMONE (HGH), ANTIBOD HEMAGGLUTINATION INHIBITION TEST (H IMMUNOASSAY FOR TUMOR ANTIGEN QUANT IMMUNOASSAY FOR TUMOR ANTIGEN - DEN 1, , IMMUNOASSAY FOR TUMOR ANTIGEN QUANT IMMUNOASSAY FOR TUMOR ANTIGEN QUANT HUMAN EPIDIDYMIS PROTEIN 4 (HE4) DE HETEROPHILE ANTIBODIES; SCREENING 684 2,520 3,648 6, HETEROPHILE ANTIBODIES; TITER IMMUNOASSAY FOR TUMOR ANTIGEN; OTHE IMMUNOASSAY FOR INFECTIOUS AGENT AN 3,455 1, , IMMUNOASSAY INFECTIOUS AGENT ANTIBO IMMUNOELECTROPHORESIS; SERUM IMMUNOELECTROPHORESIS; OTHER FLUIDS IMMUNODIFFUSION; NOT ELSEWHERE SPEC IMMUNODIFFUSION GEL DIFFUSION QUALI IMMUNE COMPLEX ASSAY IMMUNOFIXATION ELECTROPHORESIS; SER , IMMUNOFIXATION ELECTROPHORESIS; OTH INHIBIN A 6, , INSULIN ANTIBODIES INTRINSIC FACTOR ANTIBODIES ISLET CELL ANTIBODY LEUKOCYTE HISTAMINE RELEASE TEST (L CELLULAR FUNCTION ASSAY INVOLVING S LYMPHOCYTE TRANSFORM MITOGEN OR ANT B CELLS, TOTAL COUNT MONONUCLEAR CELL ANTIGEN, QUANTITAT NATURAL KILLER (NK) CELLS, TOTAL CO T CELLS; TOTAL COUNT 4, , T CELLS; ABSOLUTE CD4 & CD8 COUNT, 1, , T CELLS; ABSOLUTE CD4 COUNT STEM CELLS (IE CD34), TOTAL COUNT MICROSOMAL ANTIBODIES, EACH 2, , NEUTRALIZATION TEST, VIRAL NUCLEAR MATRIX PROTEIN 22, QUALITAT PARTICLE AGGLUTINATION; SCREEN EACH , PARTICLE AGGLUTINATION; TITER EACH RHEUMATOID FACTOR QUALITATIVE RHEUMATIOD FACTOR; QUANTITATIVE 6, , , , TUBERCULOSIS TEST, CELL MEDIATED IM TUBERCULOSIS TEST, CELL MEDIATED IM SKIN TEST; CANDIDA Page Number 11 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

33 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total SKIN TEST; UNLISTED ANTIGEN, EACH SKIN TEST; HISTOPLASMOSIS SKIN TEST; TUBERCULOSIS INTRADERMAL ,439 4, STREPTOKINASE ANTIBODY SYPHILIS TEST; QUALITATIVE 17,753 2, , SYPHILIS TEST; QUANTITATIVE ANTIBODY; ACTINOMYCES ANTIBODY; ADENOVIRUS ANTIBODY ASPIRGILLUS ANTIBODY; BACTERIUM NOT ELSEWHERE S ANTIBODY BARTONELLA ANTIBODY BLASTOMYCES ANTIBODY BORDETELLA ANTIBODY; BORRELIA BURGDORFERI (LYM ANTIBODY; BORELLIA BURGDORFERI (LYM , ANTIBODY; BRUCELLA ANTIBODY; CAMPYLOBACTER ANTIBODY; CANDIDA ANTIBODY; CHLAMYDIA ANTIBODY; CHLAMYDIA IGM ANTIBODY; COCCIDIOIDES ANTIBODY; COXIELLA BRUNETII (Q FEVE ANTIBODY; CRYPTOCOCCUS ANTIBODY; CYTOMEGALOVIRUS (CMV) ANTIBODY; CYTOMEGALOVIRUS (CMV), IG ANTIBODY; DIPTHERIA ANTIBODY; ENCEPHALITIS, CALIFORNIA ANTIBODY; ENCEPHALITIS EASTERN EQUI ANTIBODY; ENCEPHALITIS, ST. LOUIS ANTIBODY; ENCEPHALITIS, WESTERN EQU ANTIBODY; ENTEROVIRUS (EG, COXSAKIE ANTIBODY; EPSTEIN-BARR VIRUS, EARLY ANTIBODY EPSTEIN-BARR VIRUS, NUCLEA , ANTIBODY EPSTEIN-BARR VIRUS, VIRAL 2, , ANTIBODY EHRLICHIA ANTIBODY FRANCISELLA TULARENSIS ANTIBODY; FUNGUS, NOT ELSEWHERE SPE ANTIBODY GIARDIA LAMBLIA ANTIBODY HELICOBACTER PYLORI 3, , ANTIBODY; HELMINTH, NOT ELSEWHERE S ANTIBODY; HEMOPHILUS INFLUENZA ANTIBODY HTLV-I ANTIBODY; HTLV OR HIV ANTIBODY, CON ANTIBODY; HEPATITIS, DELTA AGENT ANTIBODY; HERPES SIMPLEX, NON-SPECI ANTIBODY; HERPES SIMPLEX, TYPE 1 4, , ANTIBODY; HERPES SIMPLEX, TYPE 2 6, , ANTIBODY; HISTOPLASMA ANTIBODY HIV ANTIBODY HIV ANTIBODY; HIV-1 & HIV-2, SINGLE RES 33, , HEPATITIS B CORE ANTIBODY (HBCAB), 1, , HEPATITIS B CORE ANTIBODY; IGM ANTI HEPATITIS B SURFACE ANTIBODY (HBSAB 2, , HEPATITIS BE ANTIBODY (HBEAB) HEPATITIS A ANTIBODY (HAAB), TOTAL 1, , HEPATITIS A ANTIBODY (HAAB), IGM AN ANTIBODY; INFLUENZA VIRUS , (blank) ANTIBODY LEGIONELLA ANTIBODY; LISTERIA MONOCYTOGENES ANTIBODY; MUMPS ANTIBODY MYCOPLASMA ,206 2, Page Number 12 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

34 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total ANTIBODY; NEISSERIA MENINGITIDIS ANTIBODY; PARVOVIRUS ANTIBODY; PROTOZOA, NOT ELSEWHERE S ANTIBODY; RESPIRATORY SYNCYTIAL VIR ANTIBODY RICKETTSIA ANTIBODY; ROTAVIRUS ANTIBODY; RUBELLA 3, , ANTIBODY; RUBEOLA ANTIBODY SALMONELLA ANTIBODY SHIGELLA ANTIBODY; TETANUS ANTIBODY TOXOPLASMA ANTIBODY TOXOPLASMA IGM TREPONEMA PALLADIUM 2, , ANTIBODY; TRICHINELLA ANTIBODY; VARICELLA-ZOSTER 2, , WEST NILE VIRUS, IGM WEST NILE VIRUS ANTIBODY; VIRUS, NOT ELSEWHERE SPEC ANTIBODY YERSINIA THYROGLOBULIN ANTIBODY 1, , HEPATITIS C ANTIBODY 9,277 1, , HEPATITIS C ANTIBODY; CONFIRMATORY SERUM SCREENING FOR CYTOTOXIC PERCE SERUM SCREENING FOR CYTOTOXIC PERCE HLA TYPING A, B, OR C, SINGLE ANTIG HLA TYPING A, B, OR C, MULTIPLE ANT HLA TYPING DR/DQ, SINGLE ANTIGEN HLA TYPING DR/DQ, MULTIPLE ANTIGENS HUMAN LEUKOCYTE ANTIGEN (HLA) CROSS HUMAN LEUKOCYTE ANTIGEN (HLA) CROSS (blank) (blank) (blank) (blank) (blank) (blank) UNLISTED IMMUNOLOGY PROCEDURE ANTIBODY SCREEN, RBC, EA SERUM TECH 3,344 9, , , , ANTIBODY ELUTION (RBC), EA ELUTION ANTIBODY IDENTIFICATION, RBC ANTIBO ANTIHUMAN GLOBULIN TEST; DIRECT EA ANTIHUMAN GLOBULIN TEST; INDIRECT, ANTIHUMAN GLOBULIN TEST; INDIRECT, AUTOLOGOUS BLOOD COLLECTION & PROCE BLOOD TYPING; ABO 2,313 11, , , , BLOOD TYPING; RH (D) 2,345 11, , , , BLOOD TYPING; ANTIGEN TESTING OF DO 0 4, , BLOOD TYPING; ANTIGEN SCREENING FOR BLOOD TYPING; RBC ANTIGENS, OTHER T 45 2, , BLOOD TYPING; RH PHENOTYPING, COMPL BLOOD TYPING; FOR PATERNITY TESTING COMPATIBILITY TEST EA UNIT; IMMEDIA 0 3, , , , COMPATIBILITY TEST EA UNIT; INCUBAT COMPATIBILITY TEST EA UNIT; ANTIGLO 0 2, , BLOOD TYPING; FOR PATERNITY TESTING 0 1, , FRESH FROZEN PLASMA, THAWING, EA UN HEMOLYSINS & AGGLUTININS; AUTO, SCR IRRADIATION OF BLOOD PRODUCT, EA UN VOLUME REDUCTION OF BLOOD/BLOOD PRO POOLING OF PLATELETS OR OTHER BLOOD PRETREATMENT OF RBCS FOR ANTIBODY D PRETREATMENT OF RBCS FOR ANTIBODY D Page Number 13 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

35 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total PRETREATMENT OF SERUM USE IN RBC AN PRETREATMENT SERUM USE IN RBC ANTIB PRETREATMENT OF SERUM USE IN RBC AN SPLITTING OF BLOOD OR BLOOD PRODUCT UNLISTED TRANSFUSION MEDICINE PROCE CONCENTRATION (ANY TYPE) FOR INFECT CULTURE BACTERIAL; BLOOD, AEROBIC W , , , , CULTURE BACTERIAL; FECES W ISOLATIO 1, , CULTURE, BACTERIAL; STOOL, AEROBIC, 1,983 1, , , CULTURE BACTERIAL; ANY SOURCE EXCEP 16,908 11,620 2,757 31, ,470 2, , CULTURE BACTERIAL; QUANTITATIVE AER CULTURE BACTERIAL; QUANTITATIVE ANA CULTURE BACTERIAL; ANAEROBIC W ISOL 1, , CULTURE BACTERIAL; ANAEROBIC ADD'L CULTURE BACTERIAL; AEROBIC ISOLATE 11,957 7, , ,567 3, , CULTURE PRESUMPTIVE PATHOGENIC ORGA 18,710 12,476 5,245 36, CULTURE PRESUMPTIVE PATHOGENIC ORGA CULTURE BACTERIAL QUANTITATIVE COLO 44,393 26,088 1,391 71, ,098 7,411 1,602 20, CULTURE BACTERIAL W ISOLATION & PRE 15,948 5, , , , CULTURE FUNGI ISOLATON W IDENTIFICA CULTURE FUNGI ISOLATON W IDENTIFICA , CULTURE FUNGI ISOLATON W IDENTIFICA CULTURE FUNGI DEFINITIVE IDENTIFICA CULTURE FUNGI DEFINITIVE IDENTIFICA CULTURE MYCOPLASMA ANY SOURCE CULTURE CHLAMYDIA ANY SOURCE CULT TUBERCLE OR OTHER ACID FAST BA CULTURE MYCOBACTERIC DEFINITIVE IDE CULTURE TYPING IMMUNOFLUORESCENT ME CULTURE TYPING IMMUNOLOGIC METHOD O 4,603 3, , CULTURE IDENTIFICATION BY NUCLEIC A 2, , , , CULTURE, TYPING; IDENTIFICATION BY 1, , , , CULTURE, TYPING; IDENTIFICATION BY CULTURE TYPING OTHER METHODS DARK FIELD EXAMINATION ANY SOURCE I MACROSCOPIC EXAMINATION ARTHROPOD MACROSCOPIC EXAMINATION PARASITE PINWORN EXAM (CELLOHANE TAPE PREP) TISSUE HOMOGENIZATION FOR CULTURE OVA & PARASITES DIRECT SMEARS CONCE 1, , MICROBE SUSCEPTIBILITY STUDIES ANTI MICROBE SUSCEPTIBILITY STUDIES ANTI , MICROBE SUSCEPTIBILITY STUDIES ENZY MICROBE SUSCEPTIBLE MICRODILUTION O 14,560 12, , ,019 4, , SUSCEPTIBILITY STUDIES MICRODILUTIO SUSCEPTIBILITY STUDIES MACROBROTH D SMEAR PRIMARY SOURCE W INTERPRETATI 2,806 4, , , , SMEAR PRIMARY SOURCE W INTERPRETATI , SMEAR W INTERPRETATION; SPECIAL STA SMEAR, PRIMARY SOURCE W INTERPRETAT 1, , SMEAR WET MOUNT FOR INFECTIOUS AGEN 198 5,786 19,709 25, TISSUE EXAM BY KOH SLIDE SAMPLES FR ,739 2, TOXIN OR ANTITOXIN ASSAY TISSUE CUL VIRUS ISOLATION; TISSUE CULTURE INO VIRUS ISOLATION; TISSUE CULTURE, AD VIRUS ISOLATION; CENTIFUGE ENHANCED VIRUS ISOLATION; ID BY NON-IMMUNOLO INFECTIOUS AGENT ANTIGEN DETECTION INFECTIOUS AGENT DETECTION BY IMMUN INFECTIOUS AGENT ANTIGEN DETECTION INFECTIOUS AGENT DETECTION BY IMMUN INFECTIOUS AGENT ANTIGEN DETECTION; INFECTIOUS AGENT DETECTION BY IMMUN Page Number 14 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

36 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total INFECTIOUS AGENT DETECTION, HERPES INFECTIOUS AGENT DETECTION, HERPES INFECTIOUS AGENT DETECTION, INFLUEN 374 1, , INFECTIOUS AGENT DETECTION, INFLUEN 374 1, , INFECTIOUS AGENT DETECTION, LEGIONE INFECTIOUS AGENT DETECTION, PARAINF 391 1, , INFECTIOUS AGENT DETECTION, RESPIRA , INFECTIOUS AGENT DETECTION, PNEUMOC INFECTIOUS AGENT DETECTION, TREPONE INFECTIOUS AGENT DETECTION, VARICEL INFECTIOUS AGENT DETECTION, NOT OTH INFECTIOUS AGENT DETECTION, POLYVAL ASPERGILLUS- INFECTIOUS AGENT ANTIG INFECTIOUS AGENT DETECTION BY ENZYM INFECTIOUS AGENT DETECTION BY ENZYM , INFECTIOUS AGENT DETECTION BY ENZYM INFECTIOUS AGENT DETECTION BY ENZYM INFECTIOUS AGENT ANTIGEN DETECTION ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION ENZYME IMMUNOASSA 8,177 1, , , ANTIGEN DETECTION ENZYME IMMUNOASSA ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA HIV-1 ANTIGEN(S), W/HIV-1 & HIV-2 A 1,557 2, , ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA 32 12,464 1,281 13, ANTIGEN DETECTION BY ENZYME IMMUNOA 9 1, , ANTIGEN DETECTION BY ENZYME IMMUNOA ANTIGEN DETECTION BY ENZYME IMMUNOA 1, , ANTIGEN DETECTION BY ENZYME IMMUNOA ,575 5,865 19, ANTIGEN DETECTION BY ENZYME IMMUNOA 262 1, , ANTIGEN DETECTION BY ENZYME IMMUNOA INFECTIOUS AGENT DETECTION MULTIPLE INFECTIOUS AGENT DETECTION BY NUCLE INFECTIOUS AGENT DETECTION BY NUCLE BORRELIA BURGDORFERI AMPLIFIED PROB CANDIDA SPECIES DIRECT PROBE TECHNI 1, , CANDIDA SPECIES AMPLIFIED PROBE TEC 22, , CANDIDA SPECIES QUANTIFICATION CHLAMYDIA PNEUMONIAE AMPLIFIED PROB 4, , CHLAMYDIA TRACHOMATIS DETECTION DIR CHLAMYDIA TRACHOMATIS DETECTION AMP 53,780 4,610 6,128 64, CHLAMYDIA TRACHOMATIS QUANTIFICATIO INFECTIOUS AGENT DETECTION BY NUCLE , CYTOMEGALOVIRUS AMPLIFIED PROBE TEC CYTOMEGALOVIRUS QUANTIFICATION CHLAMYDIA TRACHOMATIS, ENTEROVIRUS, 4, , INFECTIOUS AGENT DETECTION BY NUCLE INFECTIOUS AGENT DETECTION BY NUCLE INFECTIOUS AG DETECTION BY NUCLEIC 3 1, , INFECTIOUS AGENT DETECTION BY NUCLE GARDNERELLA VAGINALIS DIRECT PROBE 1, , GARDNERELLA VAGINALIS AMPLIFIED PRO 3, , GARDNERELLA VAGINALIS QUANTIFICATIO 3, , ANTIGEN DETECTION, HEPATITIS B VIRU ANTIGEN DETECTION, HEPATITIS B VIRU ANTIGEN DETECTION, HEPATITIS C DIRE ANTIGEN DETECTION, HEPATITIS C AMPL ANTIGEN DETECTION, HEPATITIS C QUAN 2, , Page Number 15 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

37 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total ANTIGEN DETECTION, HERPES SIMPLEX V 3, , ANTIGEN DETECTION, HERPES SIMPLEX V ANTIGEN DETECTION, HERPES SIMPLEX V ANTIGEN DETECTION, HERPES SIMPLEX V ANTIGEN DETECTION, HIV-1 AMPLIFIED ANTIGEN DETECTION, HIV-1 QUANTIFICA 1, , ANTIGEN DETECTION, HIV-2 AMPLIFIED ANTIGEN DETECTION, LEGIONELLA PNEUM 2, , ANTIGEN DETECTION, MYCOBACTERIA SPE ANTIGEN DETECTION, MYCOBACTERIA SPE ANTIGEN DETECTION, MYCOBACTERIA TUB ANTIGEN DETECTION, MYCOBACTERIA TUB ANTIGEN DETECTION, MYCOBACTERIA AVI ANTIGEN DETECTION, MYCOBACTERIA AVI ANTIGEN DETECTION, MYCOPLASMA PNEUM 4, , ANTIGEN DETECTION, NEISSERIA GONORR ANTIGEN DETECTION, NEISSERIA GONORR 53,467 4,552 6,064 64, ANTIGEN DETECTION, NEISSERIA GONORR (blank) (blank) (blank) 4, , STAPHYLOCOCCUS AUREUS, AMPLIFIED PR STAPHYLOCOCCUS AUREUS, METHICILLIN 3, , ANTIGEN DETECTION, STREPTOCOCCUS GR , ANTIGEN DETECTION, STREPTOCOCCUS GR 5, , ANTIGEN DETECTION, STREPTOCOCCUS GR STREPTOCOCCUS, GROUP B AMPLIFIED CO 1, , TRICHOMONAS VAGINALIS, DIRECT PROBE 1, , (blank) 13, , INFECTIOUS AGENT DETECTION BY NUCLE INFECTIOUS AGENT DETECTION BY DNA O 39,846 1,538 1,185 42, , , INFECTIOUS AGENT DETECTION BY DNA O 9, , INFECTIOUS AGENT DETECTED BY NUCLEI INFECTIOUS AGENT DETECTED BY NUCLEI INFECTIOUS AGENT ANTIGEN DETECTION INFECTIOUS AGENT DETECTION W DIRECT INFECTIOUS AGENT ANTIGEN DETECTION ,511 75, , ,379 4,789 6, RESPIRATORY SYNCYTIAL VIRUS 67 4,539 6,239 10, INFECTIOUS AGENT ANTIGEN DETECTION INFECTIOUS AGENT ANTIGEN DETECTION INFECTION DETECTION IMMUNOASSAY W D INFECTION DETECTION IMMUNOASSAY W D , , , ,237 2, INFECTION DETECTION IMMUNOASSAY W D INFECTIOUS AGENT DRUG SUSCEPTIBILIT INFECTIOUS AGENT GENOTYPE ANALYSIS INFECTIOUS AGENT GENOTYPE ANALYSIS , INFECTIOUS AGENT PHENOTYPE ANALYSIS INFECTIOUS AGENT PHENOTYPE ANALYSIS INFECTIOUS AGENT ENZYMATIC ACTIVITY INFECTIOUS AGENT GENOTYPE ANALYSIS (blank) (blank) UNLISTED MICROBIOLOGY PROCEDURE (BR NECROPSY (AUTOPSY) GROSS EXAM ONLY; NECROPSY (AUTOPSY) GROSS & MICROSCO CYTOPATHOLOGY FLUIDS WASHINGS OR BR CYTOPATH FLUID WASHING/BRUSHING NOT CYTOPATHOLOGY CONCENTRATION TECHNIQ CYTOPATHOLOGY, SELECTIVE CELLULAR E ,997 2, ,229 2, CYTOPATHOLOGY, IN SITU HYBRIDIZATIO CYTOPATHOLOGY, IN SITU HYBRIDIZATIO SEX CHROMATIN ID PERIPHERAL BLOOD S CYTOPATHOLOGY CERVICAL VAGINAL REQU 4, ,256 7, Page Number 16 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

38 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total CYTOPATHOLOGY CERVICAL OR VAG COLLE 9, ,949 11, CYTOPATH CERVICAL OR VAGINAL W MANU CYTOPATHOLOGY SMEARS CERVICAL/VAGIN CYTOPATH SLIDES CERVICAL OR VAGINAL CYTOPATH SLIDES CERVICAL OR VAGINAL CYTOPATH SMEARS ANY OTHER SOURCE SC CYTOPATH SMEARS ANY OTHER SOURCE PR CYTOPATH SMEARS ANY OTHER SOURCE EX CYTOPATHOLOGY SLIDES CERVICAL/VAGIN CYTOPATHOLOGY SLIDES, CERVICAL/VAGI CYTOPATHOLOGY, EVALUATION OF FINE N CYTOPATH EVALUATION OF FINE NEEDLE , , CYTOPATHOLOGY CERVICAL OR VAG; AUTO CYTOPATHOLOGY CERVICAL OR VAG; AUTO 22, ,892 28, , , CYTOPATHOLOGY, EVALUATION OF FINE N FLOW CYTOMETRY CELL CYCLE OR DNA AN FLOW CYTOMETRY, CELL SURFACE, CYTOP FLOW CYTOMETRY CELL SURFACE CYTOPLA 3,262 2,556 2,507 8, ,452 3,353 4,192 9, FLOW CYTOMETRY, INTERPRETATION; 2 T FLOW CYTOMETRY, INTERPRETATION; 9 T FLOW CYTOMETRY, INTERPRETATION; UNLISTED CYTOPATHOLOGY PROCEDURE TISSUE CULTURE FOR NON-NEOPLASTIC D TISSUE CULTURE FOR NON-NEOPLASTIC D TISSUE CULTURE FOR NON-NEOPLASTIC D TISSUE CULTURE FOR NEOPLASTIC DISOR TISSUE CULTURE FOR NEOPLASTIC DISOR CRYOPRESERVATION FREEZING & STORAGE THAWING AND EXPANSION OF FROZEN CEL CHROMOSOME ANALYSIS FOR BREAKAGE SY CHROMOSOME ANAYLSIS FOR BREAKAGE SY CHROMOSOME ANALYSIS COUNT 5 CELLS CHROMOSOME ANALYSIS COUNT CEL CHROMOSOME ANALYSIS COUNT 45 CELLS CHROMOSOME ANAYLSIS ANALYZE C CHROMOSOME ANALYSIS AMNIOTIC FLUID CHROMOSOME ANALYSIS IN SITU HYBRIDI MOLECULAR CYTOGENETICS DNA PROBE EA 11, , MOLECULAR CYTOGENETICS CHROMOSOMAL MOLECULAR CYTOGENETICS CHROMOSOMAL MOLECULAR CYTOGENETICS INTERPHASE I MOLECULAR CYTOGENETICS INTERPHASE I CHROMOSOME ANALYSIS ADDITIONAL KARY CHROMOSOME ANALYSIS ADDITIONAL SPEC CHROMOSOME ANALYSIS ADDITIONAL CELL CHROMOSOME ANALYSIS ADDITIONAL HIGH CYTOGENETICS & MOLECULAR CYTOGENETI LEVEL I SURGICAL PATHOLOGY GROSS EX ,168 1, LEVEL II SURGICAL PATHOLOGY GROSS & ,959 3, LEVEL III SURGICAL PATHOLOGY GROSS 1,183 1,918 5,617 8, ,532 3, LEVEL IV SURGICAL PATHOLOGY GROSS & 14,325 7,339 32,619 54, ,683 7,645 43,450 52, LEVEL V SURGICAL PATHOLOGY GROSS & 896 1,267 6,635 8, ,361 3, LEVEL VI SURGICAL PATHOLOGY GROSS & DECALCIFICATION PROCEDURE **ADD ON ,346 1, ,535 1, SPECIAL STAIN INCLUDING INTERPRETAT 2, ,994 6, ,309 4, SPECIAL STAIN INCLUDING INTERPRETAT ,648 5, ,614 3, SPECIAL STAIN INCLUDING INTERPRETAT SPECIAL STAIN INCLUDING INTERPRETAT CONSULTATION & REPORT ON REFERRED S CONSULTATION & REPORT ON REFERRED M CONSULTATION COMPREHENSIVE W REVIEW PATHOLOGY CONSULTATION DURING SURGE PATHOLOGY CONSULTATION DURING SURGE ,170 1, Page Number 17 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

39 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total PATHOLOGY CONSULTATION DURING SURGE PATHOLOGY CONSULTATION DURING SURGE PATHOLOGY CONSULTATION DURING SURGE IMMUNOHISTOCHEMISTRY (INCLUDING TIS 1,357 1,430 6,452 9, ,278 1, IMMUNOFLUORESCENT STUDY EA ANTIBODY , IMMUNOFLUORESCENT STUDY EA ANTIBODY ELECTRON MICROSCOPY DIAGNOSTIC MORPHOMETRIC ANALYSIS; SKELETAL MUS MORPHOMETRIC ANALYSIS; NERVE MORPHOMETRIC ANALYSIS; TUMOR MORPHOMETRIC ANALYSIS TUMOR IMMUNOH , , MORPHOMETRIC ANALYSIS TUMOR IMMUNOH NERVE TEASING PREPARATIONS EXAMINATION AND SELECTION OF RETRIE MORPHOMETRIC ANALYSIS, TUMOR IMMUNO MORPHOMETRIC ANALYSIS, IN SITU HYBR , , MORPHOMETRIC ANALYSIS, IN SITU HYBR PROTEIN ANALYSIS OF TISSUE BY WESTE MICRODISSECTION (EG, MECHANICAL, LA MICRODISSECTION (IE, SAMPLE PREPARA MACROSCOPIC EXAMINATION, DISSECTION UNLISTED SURGICAL PATHOLOGY PROCEDU BILIRUBIN, TOTAL, TRANSCUTANEOUS 0 5 1,743 1, HEMOGLOBIN (HGB), QUANTITATIVE, TRA 0 7 1,701 1, HEMOGLOBIN, QUANTITATIVE, TRANSCUTA CELL COUNT MISCELLANEOUS BODY FLUID CELL COUNT MISCELLANEOUS BODY FLUID 108 1, , LEUKOCYTE COUNT, FECAL , CRYSTAL ID BY LIGHT MICROSCOPY W OR FAT STAIN FECES URINE OR RESPIRATOR MEAT FIBERS FECES NASAL SMEAR FOR EOSINOPHILS SPUTUM, OBTAINING SPECIMEN, AEROSOL SWEAT COLLECTION BY IONTOPHORESIS-T UNLISTED MISCELLANEOUS PATHOLOGY TE CULTURE OF OOCYTE(S)/EMBRYO(S), LES SEMEN ANALYSIS PRESENCE/MOTILITY OF SEMEN ANALYSIS; MOTILITY AND COUNT SEMEN ANALYSIS COMPLETE SEMEN ANALYSIS PRESENCE & OR MOTILI SPERM ANTIBODIES G0103 PROSTATE CANCER SCREENING; PROSTATE ,790 1,210 2,636 6, G0123 SCREENING CYTOPATHOLOGY, CERVICAL O G0124 SCREENING CYTOPATHOLOGY, CERVICAL O G0143 SCREENING CYTOPATHOLOGY SMEARS, CER G0144 SCREENING CYTOPATH, CERV/VAG, IN PR G0145 SCREENING CYTOPATHOLOGY, CERV/VAG I ,528 1, G0148 SCREENING CYTOPATHOLOGY SMEARS CERV G0306 CBC, AUTOMATED (HGB, HCT, RBC, WBC, G0307 CBC AUTOMATED (HGB, HCT, RBC, WBC; G0328 FECAL BLOOD SCREENING IMMUNOASSAY ,863 2, G0416 SURG PATH GROSS/MICROS EXAM-PROSTAT G0431 DRUG SCREEN, QUALITATIVE; MULTIPLE 21,287 20,964 21,363 63, ,284 1,182 11,108 15, G0432 INFECTIOUS AGENT ANTIBODY DETECTION G0433 INFECTIOUS AGENT ANTIBODY DETECTION G0434 DRUG SCREEN OTHER THAN CHROMATOGRAP 34,901 5,146 61, , ,328 10, G0435 INFECTIOUS AGENT ANTIGEN DETECTION G0452 (blank) G6040 (blank) P3000 SCREENING PAPANICOLAOU SMEAR, CERVI P3001 SCREENING PAPANICOLAOU SMEAR, CERVI P7001 CULTURE, BACTERIAL, URINE; QUANTITA P9603 TRAVEL ALLOWANCE ONE WAY COLLECTION 23, ,371 24, , ,888 11, Page Number 18 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service Advantage HMO Total

40 RFI ATTACHMENT F BCT 2014 LABORATORY UTILIZATION DATA BY LINE OF BUSINESS Procedure Code Description Independent Lab BlueCare BlueCare Plus Advantage LPPO Advantage HMO Outpatient Facility Practitioner Other BlueCare Total Independent Lab Outpatient Facility Practitioner Other BlueCare Plus Independent Lab Outpatient Facility Practitioner Other Independent Lab Outpatient Facility Practitioner Other Advantage Total Total P9604 TRAVEL ALLOWANCE ONE WAY COLLECTION P9612 CATHETERIZATION FOR COLLECTION OF S P9615 CATHETERIZATION FOR COLLECTION OF S Q0111 WET MOUNTS, INCLUDING PREPARATIONS Q0112 ALL POTASSIUM HYDROXIDE (KOH) PREPA Q0114 FERN TEST S3645 HIV-1 ANTIBODY TESTING OF ORAL MUCO S3650 SALIVA TEST, HORMONE LEVEL; DURING S3854 GENE EXP PROFIL PANEL IN MGT OF BRE Grand Total 2,333,473 1,538,344 1,328,638 5,200,455 18,859 10,552 13,250 42, , , ,116 1,858,286 1, ,825 5,718 Advantage HMO Total Page Number 19 LEGEND: Period: Claims Date of Service: 1/1/14-12/31/14 with 3 months run out Reported by Units of Service