Answers to Provider Questions about ICD- 10. Health Plan/Payer Specific Questions

Answers to Provider Questions about ICD- 10 Health Plan/Payer Specific Questions Below are commonly asked questions with answers that are specific to each health plan. If and as appropriate, additional details may be on each health plan s web site. Other information resources may be there are well. Direct links to each health plan s ICD10 information are: Aetna Asuris NW Health CHPW Cigna FCH GHC HCA L&I Molina Premera Regence United http://www.aetna.com/healthcare-professionals/policies-guidelines/icd_10_faq.html https://www.assets.asuris.com/provider/claims-and-billing/submitting-claims/icd10/ http://www.chpw.org/for-providers/icd10-home/ https://shomesso.cigna.com/content/cigna%20central/business/function%20unit/cigna%20legal/enterprise%20compliance/p df/general_icd10_faq.pdf https://www.fchn.com/corporate/tradingpartners/icd-10status.aspx? https://provider.ghc.org www.lni.wa.gov/claimsins/providers/billing/billlni/electronic/5010.asp http://www.molinahealthcare.com/medicaid/providers/common/hipaa Premera Blue Cross: https://www.premera.com/wa/provider/eligibility-and-claims/icd-10/ Premera Blue Cross Blue Shield of Alaska: https://www.premera.com/ak/provider/eligibility-and-claims/icd-10/ LifeWise Health Plan of Oregon: https://www.lifewiseor.com/provider/eligibility-and-claims/icd-10/ http://www.wa.regence.com/provider/claims-and-billing/submitting-claims/icd10/ https://www.unitedhealthcareonline.com/b2c/cmaaction.do?channelid=6fa2600ae29fb210vgnvcm1000002f10b10a Note: The answers to these questions are likely to be refined over time as more specific information becomes available. Page 1

ICD- 10 Pre- Auth Questions Note: The terms ICD9, ICD10, ICD code(s) refers to codes and/or descriptions for diagnoses and/or procedures. Answers should reflect the broad definition of these terms. Questions & Answers Do you outsource any part of the pre-auth process? If yes - should providers contact that organization about their readiness or just work through you? If providers need to contact them who are they? Aetna Our ICD-10 Program encompasses planning for any vendors that we use. As a result, there isn t a need for providers to contact any vendors directly. Asuris Asuris does outsource the pre-auth process for some services such as AIM Specialty Health and CareCoreNational. Asuris is currently working with the vendors about their readiness and will provide updates. We will provide an update as this process is defined if the vendors need to be contacted directly. CHPW Cigna FCH GHC HCA L&I Molina Premera Regence United Yes, for some specific areas we have vendor assistance with pre-auth. Providers should contact CHPW. We outsource some pre- authorizations for example high- tech radiology and are testing with all of our vendors and trading partners. Though we do not anticipate a problem with authorizations, we encourage Health Care Professionals to test with any vendor they may utilize during their normal course of business FCH does not outsource any part of the pre auth process. No, we do not outsource any part of the pre-auth process. Yes, for some specific areas such as MRIs and Pet Scans Yes, the department does outsource some parts of some of the prior authorizations. Providers should contact the department, who will make the expectations know to the contractor. The UR process currently contracts with Qualis Health and we are working with them on planning and readiness. We do in a few areas but we will be working directly with those vendors to ensure readiness and develop testing strategies; providers should work through Molina. Yes, we use AIM Specialty Health for imaging services. Providers should contact their provider network representative with questions about readiness. Regence does outsource the pre-auth process for some services such as AIM Specialty Health and CareCoreNational. Regence is currently working with the vendors about their readiness and will provide updates. We will provide an update as this process is defined if the vendors need to be contacted directly. We have vendors that we use for certain services, for example some radiology services, but providers should work through us. Page 2

In all situations where your organization is responsible for overseeing, managing or otherwise conducting the pre-auth process. Pre-Auth Lists, Clinical Guidelines & Forms Questions & Answers 1. Will your pre-authorization policy AND/OR your guidelines for requesting pre-authorizations change with the implementation of ICD-10 If yes, how will they change and when will the revised policy/guidelines be published? Aetna We do not anticipate significant changes at this time. Asuris We do not anticipate at this time that our pre-authorization policy will change based upon implementation of ICD-10. CHPW Policies and guidelines are not anticipated to change since CHPW requires service codes rather than ICD procedure codes in its pre-authorization process Cigna No, currently ICD 9 codes are utilized to issue pre-authorization. This process will continue with ICD 10. FCH Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. GHC Pre-authorization and medical necessity guidelines/lists/processes currently do not include ICDspecific information and will not be impacted by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information that they do now. After October 1, 2014, we will only accept ICD10 codes if a diagnosis code is being provided on a request for authorization. HCA We do not anticipate significant changes at this time. L&I Prior auth requirements / policy will not change. Most of our requirements are based on CPT codes Molina We do not anticipate any changes to our policies at this time. Premera No. Regence We do not anticipate at this time that our pre-authorization policy will change based upon implementation of ICD-10. Page 3

United Our goal is to keep processes as they are today, but these plans have not yet been finalized. 2. When does your health plan intend to update and release your pre-authorization lists to include ICD-10 codes/descriptions? Aetna Our pre-auth requirements are based on services and not strictly based on diagnosis. We do not currently intend to change our pre-auth requirements at this time. CHPW The CHPW pre-authorization list is driven by service code and not diagnosis code. Change related to implementation of ICD-10 is not anticipated. We will continue to assess. Asuris ICD codes and descriptions are not specified in our pre-authorization lists and we are not planning to add them. Cigna Any materials that health care professionals may need to reference will be available effective 10/1/2014. FCH Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. GHC Pre-authorization and medical necessity guidelines/lists/processes currently do not include ICDspecific information and will not be impacted by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information that they do now. After October 1, 2014, we will only accept ICD10 codes if a diagnosis code is being provided on a request for authorization. HCA Any materials that health care professionals may need to reference will be available effective 10/1/2014. L&I Not Applicable Molina Our pre-auth requirements are based on services and not strictly based on diagnosis. We do not currently intend to change our pre-auth requirements overall the same types of services that need a pre-auth now will need them with ICD-10. Premera Sixty-90 days before compliance date for those few ICD-10 procedure codes that are on our pre- and post-service review lists. Regence ICD codes and descriptions are not specified in our pre-authorization lists and we are not planning to add them. United We don't publish a list at a code level; only categories are defined. Those are published annually as Page 4

part of the Administrative Guide (published on UHCOnline on or about 12/31, and is effective 1/1 or 4/1, depending on the contract. 3. When does your health plan intend to update and release your medical necessity lists/guidelines to include ICD-10 & related codes/descriptions? Please be as clear as possible about any revisions to medical lists/guidelines/policies that will be triggered by the transition to ICD10. Aetna We plan to update our medical policies on-line in July of 2014. CHPW Asuris Cigna FCH GHC HCA L&I CHPW medical policy is not driven by ICD coding. Changes are not anticipated Most of our medical policies which outline medical necessity do not contain ICD coding so will not need to be updated for ICD-10 implementation. The few medical policies that do have descriptions will be updated prior to ICD-10 implementation. The updates would occur at least 90 days prior to implementation. Internally our staff refers to industry standard ICD tables published by Milliman to identify an estimated length of stay when hospitalized or if case management services will be required. Our internal tables with ICD codes will be updated and ready for staff by 10/1/2014. Our plan is to support updates or changes to our coverage, medical, or medical- necessity policies as part of the normal annual update process. ICD- 10 codes have been added to the policies along with the corresponding ICD- 9 codes. All of our policies are currently available on our public website as well as the secure Cigna for Health Care Professionals website (www.cignaforhcp.com). We also will provide information about major policy updates in our quarterly newsletter to our network health care professionals, Network News. Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. Pre-authorization and medical necessity guidelines/lists/processes currently do not include ICDspecific information and will not be impacted by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information that they do now. After October 1, 2014, we will only accept ICD10 codes if a diagnosis code is being provided on a request for authorization. We anticipate this happening in early to mid 2014, but we are still finalizing our plans. Not Applicable Page 5

Molina Premera Regence United At this time we do not anticipate any significant change to our medical necessity policies. At least 90 days prior to compliance date. Most of our medical policies which outline medical necessity do not contain ICD coding so will not need to be updated for ICD-10 implementation. The few medical policies that do have descriptions will be updated prior to ICD-10 implementation. The updates would occur at least 90 days prior to implementation. The work to update the lists/guidelines is currently ongoing and a release date has not yet been determined. 4. If a pre-authorization is currently required for a service associated with an ICD-9 diagnosis and that diagnosis crosswalks to multiple ICD-10 diagnoses, will all services with all of these ICD-10 diagnoses require pre-authorization after 10/1/2014? For example, when ICD-9 diagnosis XYZ maps to ICD-10 diagnoses AB7R and HY8T, will all services with diagnoses AB7R and HY8T require a pre-auth? Aetna Authorizations provided prior to the conversion will be carried over for services post 10/1/2014. Asuris CHPW Cigna FCH GHC HCA L&I Molina How we will handle this situation still needs to be determined. TBD This is still under review as we build our ICD 10 tables. Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. Pre-authorization and medical necessity guidelines/lists/processes currently do not include ICDspecific information and will not be impacted by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information that they do now. After October 1, 2014, we will only accept ICD10 codes if a diagnosis code is being provided on a request for authorization. TBD Not Applicable As we do not pre-auth based solely on ICD-9 codes, we would consider an auth after the ICD-10 implementation in the same manner we do today. Exact details of our requirements are still under Page 6

consideration. Premera We do not require specific ICD-9 diagnosis codes for our prospective reviews at this time. Regence How we will handle this situation still needs to be determined. United These plans have not yet been finalized, but will be communicated when determined. 5. When will you update your online tool to be compliant with ICD10? When will you update your fax form? Will your updated fax form replace the current form (being a combined ICD9&10 form ) or will it be an additional form? If you will have two forms, are there timeline restrictions for the use of either form? Aetna We will be compliant prior to 10/1/2014 but detailed timing is not available at this time. Asuris We will have minor updates to our pre-authorization request online form and fax form and will update prior to the October 1, 2014 implementation date, most likely update and announce in our August 2014 provider newsletter. We will finalize a decision related to whether we use one or multiple forms in the near future. CHPW Our Care Management system is ICD-10 enabled. CHPW medical policy is not driven by ICD coding so changes to our fax form will not be necessary. Cigna Any changes to systems where ICD 10 codes are utilized is currently under revision and will be ready by 10/1/2014 FCH Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. GHC Unknown at this time. HCA Any changes to systems where ICD 10 codes are utilized is currently under revision and will be ready by 10/1/2014 L&I Forms will be updated Molina Dates of when forms and tools will be updated are still under consideration, as is our exact cutover process. Premera Fax forms will be updated at least 90 days before compliance date. We are still working on the forms and have not made a decision about whether we will have a combined form or two separate forms. Page 7

Crossing the 10/1/2014 boundary We are still planning the timeline for our online tools, but they will be updated by the compliance date. Regence We will have minor updates to our pre-authorization request online form and fax form and will update prior to the October 1, 2014 implementation date, most likely update and announce in our August 2014 provider newsletter. We will finalize a decision related to whether we use one or multiple forms in the near future. United By the October 1, 2014 implementation date. 6. How will authorizations for inpatient stays that cross the 10/1/14 implementation date be addressed? For example if a patient is scheduled to be admitted on Sept 30 with an expected length of stay of 5 days, will how many pre-authorizations be required and will ICD9 or ICD10 information need to be submitted with the pre-auth? Aetna Pre-authorization ICD codes should be based on the date of submission of the pre-authorization. The claim ICD codes should be based on date of service or discharge. Asuris Pre-authorization ICD codes should be based on the date of submission of the pre-authorization. The claim ICD codes should be based on date of service or discharge. How we will handle this situation internally still needs to be determined. CHPW No change: Pre-authorizations are based on submission of service codes vs ICD procedure codes Cigna Cigna uses CMS guidelines for dates of service that cross the compliance date. FCH Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. GHC If an authorization for any service spans the implementation date, we will honor the ICD-9 code through the end of that authorization with the exception of outpatient authorizations for our Access PPO plan being offered in January 2014. We will evaluate how we will accommodate new authorizations with ICD10 diagnosis codes for our Access PPO plan as the implementation date gets closer. HCA Details are not available at this time, however, ICD9 should be used for pre-certs submitted prior to compliance date (10/01/2014); ICD 10 for pre-certs submitted post compliance date L&I To be determined Molina We are still evaluating our approach but do not believe this to be a significant issue as we don t auth Page 8

based solely on diagnosis/pcs code. Premera We will be evaluating our systems capabilities to determine our approach Regence Pre-authorization ICD codes should be based on the date of submission of the pre-authorization. The claim ICD codes should be based on date of service or discharge. How we will handle this situation internally still needs to be determined. United These plans have not yet been finalized. 7. How will you handle an authorization that covers multiple dates of service, some of which are prior to 10/1/2014 and some after? (e.g. Chemotherapy is authorized for 6 visits with 3 occurring before 10/1 and 3 occurring after) Will 2 different pre-authorization numbers be required? Aetna If this is certified before 10/1/2014 with ICD-9 codes, it will carry over even if the services are provided after 10/1/2014. Asuris The approach to this situation is still being analyzed. It is possible that a single pre-authorization will be sufficient CHPW Two pre-authorizations will not be required since the process is reliant on service codes vs ICD codes. Cigna Cigna uses CMS guidelines for dates of service that cross the compliance date. FCH No 2 different pre-authorizations will not be required. Since ICD-specific information does not need to be supplied to us for any pre-authorization, our pre-authorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of preauthorization, it will be accepted regardless of date. GHC If an authorization for any service spans the implementation date, we will honor the ICD-9 code through the end of that authorization with the exception of outpatient authorizations for our Access PPO plan being offered in January 2014. We will evaluate how we will accommodate new authorizations with ICD10 diagnosis codes for our Access PPO plan as the implementation date gets closer. HCA The approach to this situation is still being analyzed. It is possible that a single pre-authorization will be sufficient L&I Probably a single authorization Molina At this point we believe a single authorization will suffice. Premera No. We will accept the ICD-9 code for the entire approved range of services. Page 9

Regence The approach to this situation is still being analyzed. It is possible that a single pre-authorization will be sufficient United These plans have not yet been finalized. 8. What is the earliest date (prior to 10/1/2014) that your health plan will accept pre-auth requests with ICD-10 codes/descriptions? Aetna Exact timing is still being determined, however providers should plan to use ICD9 for pre-certs submitted prior to compliance date (10/01/2014); ICD 10 for pre-certs submitted post compliance date Asuris We accept pre-authorizations 60 days prior to service Our Pre-authorization Request Form allows entry of an ICD code or description; however our preference is the ICD code. We are currently considering if it will be feasible for us to allow ICD-9 or ICD-10 coding on the Pre-authorization Request Form 60 days prior to October 1, 2014. The situation may also change because we plan to upgrade our pre-authorization system. If it does, we will update this response with additional details CHPW These plans have not yet been finalized. Cigna Cigna uses CMS guidelines for dates of service that cross the compliance date. FCH Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. GHC To be determined HCA Exact timing is still being determined, however providers should plan to use ICD9 for pre-certs submitted prior to compliance date (10/01/2014); ICD 10 for pre-certs submitted post compliance date L&I To be determined Molina We have not finalized our approach but the tentative plan is to begin accepting ICD-10 coded authorizations 9/1/14. Premera We will be evaluating our systems capabilities to determine our approach Regence We accept pre-authorizations 60 days prior to service Our Pre-authorization Request Form allows entry of an ICD code or description; however our preference is the ICD code. We are currently considering if it will be feasible for us to allow ICD-9 or ICD-10 coding on the Pre-authorization Request Form 60 days prior to October 1, 2014. The situation may also change because we plan to Page 10

upgrade our pre-authorization system. If it does, we will update this response with additional details United These plans have not yet been finalized. 9. How will you handle the situation when there is a conflict between the ICD code/description version that was authorized and the ICD code/description version that was used for the actual date of service? Aetna Asuris CHPW Cigna FCH GHC HCA L&I Molina Premera We do not anticipate changes in our process due to the conversion to ICD-10. Aetna will handle ICD9-ICD10 conflicts in the say way as it currently does when there is a conflict between the ICD9 code that was authorized and the ICD9 code that was billed? This is not an issue for our current claims system as we don t use the diagnosis codes in our matching logic between the claims system and our pre-authorization system. However this could change prior to the cutover if we upgrade our pre-authorization system. If it does, we will update this response with additional details. CHPW does not use diagnosis code in our matching logic. The process to match a pre-auth to a claim for payment edits against many other fields and will not reject a claim solely based on the ICD code version. Since ICD-specific information does not need to be supplied to us for any pre-authorization, our preauthorization and medical necessity guidelines/lists/processes will not be affected by the ICD10 implementation. As such, updated materials, tools and forms will not be required. For all procedures requiring a pre-authorization, providers should continue to supply the type of information, e.g. general diagnosis description, that they do now. If ICD9 or ICD10 information is supplied by the provider at the time of pre-authorization, it will be accepted regardless of date. If an authorization for any service spans the implementation date, we will honor the ICD-9 code through the end of that authorization with the exception of outpatient authorizations for our Access PPO plan being offered in January 2014. We will evaluate how we will accommodate new authorizations with ICD10 diagnosis codes for our Access PPO plan as the implementation date gets closer. TBD To be determined We do not believe this will be an issue as we don t auth only based on the dx codes. We are evaluating our exact requirements but our objective is to avoid the need for revised/new authorizations where possible. We will look at the diagnosis and manually match the claim to the approved review if necessary to allow the claim to pay. Page 11

Regence United This is not an issue for our current claims system as we don t use the diagnosis codes in our matching logic between the claims system and our pre-authorization system. However this could change prior to the cutover if we upgrade our pre-authorization system. If it does, we will update this response with additional details. These plans have not yet been finalized. Page 12

ICD- 10 Claims Questions Claims Processing Questions & Answers 1. What steps have been/will be taken to prevent claims from being inappropriately denied due to ICD10 coding or mapping problems, causing cash flow interruptions? Aetna We have engaged the impacted areas of our company in business assessments and planning for the move from 18,000 ICD-9 codes to more than 140,000 ICD-10 codes. Our program incorporates remediation of our impacted systems and vendor tools, affected business processes and policies. We are not anticipating problems with claims handling but we have mitigation plans in place for any issues should they arise. Asuris If denial is due to the claim containing non-compliant ICD codes based on date of discharge, please follow our Corrected Claims process for resubmission of a corrected claim with the corrected diagnosis information. Our Corrected Claims process can be found the Claims & Billing section of our Provider Web Site. CHPW Cigna FCH If ICD codes on the claim are compliant but other problems related to mapping caused the denial, please contact your assigned provider consultant to report the issue and for appropriate steps for resolution. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.assets.asuris.com/provider/. We will have in place an internal escalation process to quickly resolve issues related to mapping so that claims can process correctly. CHPW will develop and execute a detailed testing program long before the ICD-10 effective date. Partnering with our providers in the testing effort will be welcomed. We have been testing ICD-10 internally since 1Q2013 and will continue to test through 1Q2014 to ensure proper receipt and processing of claims. Testing included: Loading ICD-10 codes on all platforms Receipt of electronic, paper, and direct data entry transactions with new ICD-10 codes Processing of ICD-9 and ICD-10 codes concurrently based on dates of service or discharge Claim logic based on date of service or discharge date along with authorization match logic Claims coded from medical records in ICD-9 and 10 using HIMSS/WEDI industry data FCH has a dedicated ICD10 Implementation Team that has assessed systems, business processes, policies and procedures. These systems, policies and procedures have been remediated for ICD10 Page 13

GHC HCA L&I Molina Premera Regence implementation. FCH will also perform end to end testing by participating in the HIMSS/WEDI Testing Pilot Program. We will make every attempt to avoid claims being inappropriately denied or delayed. We will have a process identified to respond to providers claims inquiries and respond expeditiously. HCA has begun an impact assessment and system remediation project. ICD-10 will be done prior to the deadline and providers will be invited to test their system with the HCA Medicaid ProviderOne system. Providers should bill the most appropriate ICD-10 code. Adjustments should be submitted with correct code. L&I will prepare its processes to respond to ICD-10 questions. You can use the medical provider contacts listed here http://lni.wa.gov/main/contactinfo/claimsins/provider.asp to get assistance. Molina is interested in coordinating with providers and facilities to help understand and mitigate potential impacts and is interested in obtaining ICD-10 coded claims for detailed testing and financial analysis prior to implementation We do not anticipate any significant issues. We will monitor claims closely to ensure any impacts are identified and resolved early in the process If denial is due to the claim containing non-compliant ICD codes based on date of discharge, please follow our Corrected Claims process for resubmission of a corrected claim with the corrected diagnosis information. Our Corrected Claims process can be found the Claims & Billing section of our Provider Web Site. If ICD codes on the claim are compliant but other problems related to mapping caused the denial, please contact your assigned provider consultant to report the issue and for appropriate steps for resolution. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.wa.regence.com/provider. We will have in place an internal escalation process to quickly resolve issues related to mapping so that claims can process correctly. United We will not be mapping ICD-9 codes to ICD-10 codes. ICD-10 codes will be loaded into our system. If there are inappropriate denials, providers can contact our Customer Care area for resolution, as they do today. 2. If claims are denied en masse due to ICD10 coding or mapping problems, what will be the notification and resolution process? How should providers engage in the process? Aetna While we do not anticipate this type of problem, appropriate communication plans will be in place to notify submitters should we encounter this situation Page 14

Asuris CHPW Cigna FCH GHC HCA L&I Molina Premera Regence If ICD10 coding is denied en masse due to coding or mapping issues that are due to system issues at Asuris, please contact your assigned provider consultant to report the issue and for appropriate steps for resolution. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.assets.asuris.com/provider/. We will have in place an internal escalation process to quickly resolve issues related to coding and mapping so that claims can process correctly and will work directly with individual providers to resolve any payment issues. We will use our Provider Web Site, newsletter, and other available communication vehicles, as necessary to communicate issues and resolutions for en masse issues affecting large numbers of providers. Detailed processes for error notification and resolution will be developed in collaboration with our providers in early 2014. Multiple communications mechanisms will be employed. The notification and resolution process that occurs today will not be changing. An ICD-10 code is defined as a code that has been coded to its highest level of specificity and Cigna will follow the CMS General Claims Submission Information Guidelines for accepting and rejecting both paper and electronic claims, which includes those services that cross the compliance date. FCH has communication mechanisms in place including Provider Bulletins, FCH website, Provider Webinars and Email Blasts (for provider for whom we have their email addresses.) Providers should engage us through their Provider Relations contact who can elevate issues to the ICD10 implementation team for resolution. We will identify a process to remediate any denials and communicate that process to our providers. Our extensive testing process is designed to identify any such en masse issues prior to the implementation deadline. HCA is striving to have as little disruption as possible. If unforeseen outcomes occur, HCA will use its normal provider communications processes to communicate and mitigate the resolution. L&I will be preparing its processes to respond to ICD-10 issues. If unforeseen generalized issues occur, information on the response, and ways to engage the process will be communicated through the Provider Web http://lni.wa.gov/claimsins/providers/. Although Molina strives for minimal disruption in operations, we acknowledge that with any implementation there is a potential for an unforeseen event to occur. Molina will institute proven strategies to any area requiring it. A contingency plan will be developed if needed. We will follow our current process for resolving claims payment issues. If ICD10 coding is denied en masse due to coding or mapping issues that are due to system issues at Page 15

Regence, please contact your assigned provider consultant to report the issue and for appropriate steps for resolution. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.wa.regence.com/provider. We will have in place an internal escalation process to quickly resolve issues related to coding and mapping so that claims can process correctly and will work directly with individual providers to resolve any payment issues. We will use our Provider Web Site, newsletter, and other available communication vehicles, as necessary to communicate issues and resolutions for en masse issues affecting large numbers of providers. United 3. When claims are adjudicated under ICD-10, do you expect to maintain the ICD-9 levels of timeliness in adjudication, i.e. for a similar clinical encounter, will the ICD-10 claim be adjudicated in the same timeframe as was the ICD-9 claim? If not, what differences do you expect? Will timeliness of adjudication be part of your testing? Aetna We do not anticipate delays in claims processing. Asruis Yes, it is our intent that the adjudication timeliness will remain the same. CHPW We are not anticipating changes in adjudication timeliness, but ICD-10 claims testing beginning Q1 2014 will reveal potential issues and provide time for remediation. Cigna There are no changes on claim timeliness adjudication from ICD-9 to ICD-10. Yes, adjudication timeliness is part of the testing. FCH We are expecting that adjudication time will remain the same when implementing ICD10. We will also be tracking adjudication time during testing. GHC The adjudication timeframes are expected to remain the same and that will be part of our testing. HCA L&I If providers bill with valid ICD 10 codes, we don t anticipate any problems or differentiation from current timeframes. Timeliness will be part of our testing. Molina We expect to maintain the same timeliness standards as we do today. We will be evaluating all processes and impacts to our anticipated response times and will be putting together a plan to mitigate any impacts related to the ICD-10 transition. Premera Yes, It is the stated goal of Premera s ICD10 program not to affect timeliness of claim adjudication. Regence Yes, it is our intent that the adjudication timeliness will remain the same. United Yes, United s goal is not to affect timeliness of claim adjudication. 4. As of 10-1-2014, will your system be able to accept ICD-9 codes for dates of service PRIOR to 10- Page 16

01-2014 and ICD-10 codes for dates of service AFTER 10-1-2014? Aetna Yes, Aetna is prepared to support ICD-9 and ICD-10 codes after the 10/1/2014 implementation date for the appropriate dates of service. Asuris Yes, we will have a dual use period starting October 1, 2014 where we will accept and process valid ICD-9 (DOS before Oct 1 2014) and valid ICD-10 codes (DOS after Sept 30, 2014). We will follow CMS guidelines for how to process claims that span the ICD-10 implementation date. CHPW Yes, CHPW will be prepared to accept and process both ICD-9 and ICD-10 codes on electronic and paper claims after the 10/1/2014 effective date. The state of industry-wide and regional provider readiness in Q2, 2014 will be a major determinant. ICD-10 codes will not be accepted on production claims prior October 1, 2014, except for testing purposes. Cigna Cigna will support the processing of electronic and paper claims based either on the date of service for outpatient settings or the discharge date for inpatient facility settings. Claims submitted with a date of service or discharge date prior to the compliance date will be processed using ICD-9 codes. Those claims submitted with a date-of-service or discharge date on or after the compliance date will be processed using ICD-10 codes FCH FCH will follow CMS guidelines regarding which ICD version is applicable for which dates of service GHC Yes. Claims would process according to dates of services and would map to appropriate ICD codes. We will be following the CMS guidelines for how to process claims using the date of discharge and date of service parameters. HCA Yes, claims will process according to the dates of service using whichever code set is appropriate. L&I L&I will follow the CMS guidelines for how to process claims. In the L&I systems, ICD-9 codes will be accepted for dates of service through 09-30-2014 and will not be accepted for dates of service on or after 10-01-2014. In the L&I systems ICD-10 codes will be accepted for dates of service on and after 10-01-2014 and will not be accepted for dates prior to 09-30-2014. For claims that span the ICD-10 implementation date, our systems will follow the CMS guidelines indicated above. Molina Yes, Molina s systems are scalable and can accommodate the simultaneous processing of ICD-9 and ICD-10 coded claims based on date of service/discharge Premera Yes, we will be able to accept ICD-9 codes for dates of service/discharge 9/30/14 and earlier and ICD-10 codes for dates of service/discharge 10/1/14 and later; however, ICD-9 and ICD-10 codes cannot be combined on the same claim for any overlapping dates. Regence Yes, we will have a dual use period starting October 1, 2014 where we will accept and process valid Page 17

ICD-9 (DOS before Oct 1 2014) and valid ICD-10 codes (DOS after Sept 30, 2014). We will follow CMS guidelines for how to process claims that span the ICD-10 implementation date. United Yes 5. On claims submitted with codes from Chapter 19 of ICD-10-CM Injury, Poisoning and Certain Other Consequences of External Causes Diagnosis Codes, will the use of the secondary code from Chapter 20, External Causes of Morbidity be required? Will a claim submitted without the secondary code be denied? (Concerns have been raised related to the level of detail now provided in this section. Many times that detail is not known.) Aetna Our requirements for E-codes will not change with ICD-10 implementation. Asuris Our requirements for E-codes will not change with ICD-10 implementation. Currently we require hospitals to use E-codes to clarify circumstances for emergency room visits and also to enter up to three E-codes if an injury, poisoning or adverse effect is the cause for seeking medical treatment or occurred during the medical treatment. We do not require E-code use for professional claims CHPW Cigna FCH GHC HCA L&I Molina Premera Regence There is no regulation mandating the use of ICD-10-CM codes for External Causes of Morbidity (V00-Y99) as a condition of the ICD-10-CM implementation on October 1, 2014. Therefore Cigna has no specific requirements regarding the submission of External Causes of Morbidity. FCH requires that the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM and the International Classification of Diseases, 10th revision, Procedure Coding System (ICD-10-PCS) coding guidelines be followed as well as the AHIMA Standards of Ethical Coding Yes, external cause does require primary coding with ICD-9s now. Our assumption is that the ICD- 10 Final Ruling will have the same requirement. When ICD-10 is implemented and the guidelines require the external cause dx, then a code from Chapter 20 should be billed. External cause diagnosis cannot be billed alone. They always are a secondary diagnosis. Yes, a claim submitted without the secondary code will be denied. ICD-10 is not expected to have an impact on this type of processing. New rules will be applied similar to current ICD-9 processing which, in most cases, does not require a secondary code. Codes for External Causes of Morbidity are not currently required by our claims submittal process. Additional planning and requirement development is required to make that determination No Our requirements for E-codes will not change with ICD-10 implementation. Currently we require hospitals to use E-codes to clarify circumstances for emergency room visits and also to enter up to Page 18

three E-codes if an injury, poisoning or adverse effect is the cause for seeking medical treatment or occurred during the medical treatment. We do not require E-code use for professional claims United 6. Tables A-D in CMS s MLN 7492 (https://www.cms.gov/outreach-and-education/medicare- Learning-Network-MLN/MLNMattersArticles/downloads/MM7492.pdf) give guidance to providers for billing claims that span the periods where ICD-9 and ICD-10 codes may both be applicable, e.g. visits prior to Oct. 1, 2014 and visits on or after Oct. 1, 2014 must be billed on separate claims. Does your organization fully implement all of the guideline in MLN 7492s? If not, under what conditions will providers need to follow a different guideline when billing claims to your organization? Aetna Aetna s ICD Claim Date Rules are in alignment with CMS as outlined in MLN 7492 Asuris We will follow CMS guidelines for how to process claims that span the ICD-10 implementation date. CHPW Cigna Cigna is following CMS guidelines FCH FCH will follow the MLN 7492 guidelines GHC Group Health will be following the MLN7492 guideline HCA L&I L&I is implementing its ICD-10 changes based on the guidelines in MLN 7492s Molina Molina will follow MLN 7492 Premera We will follow MLN 7492 guidelines. Regence We will follow CMS guidelines for how to process claims that span the ICD-10 implementation United date. United Healthcare's Medicare plans will follow MLN 7492. Though the other product lines have not yet been finalized, they will most likely follow the guidance in this MLN as well. Updates for these product lines will be posted when that information becomes available 7. In anticipation that some health plans, e.g. MediCal, will not be ICD10 ready by Oct 1, 2014, the processing of crossover/secondary claims will be problematic. For each of the scenarios outlined below, will you adjudicate the claim, will you deny that claim, or will take some other action? i. Scenario 1: You receive a crossover claim from a health plan that is not ICD10 ready (it is coded in ICD9). How will you process it? Page 19

ii. iii. Scenario 2: You will send a crossover claim to a health plan that is not ICD10 ready. In what ICD version will you send it? Scenario 3: A provider submits a claim to a health plan that is not ICD10 ready (it is coded in ICD9). After that health plan processes the claim, the provider sends you the secondary claim that is coded in ICD9. How will you process it? Note to Providers: Check with your practice management/information systems vendor to see if you can send a claim in both ICD9 & ICD10 formats. Some EMRs must have both fields in order to do this. Aetna Awaiting guidance from CMS Asuris Awaiting guidance from CMS CHPW Awaiting guidance from CMS Cigna Awaiting guidance from CMS FCH FCH will be ICD10 compliant and will not be accepting ICD9 codes for dates of service on or after the compliance date. GHC Awaiting guidance from CMS HCA Awaiting guidance from CMS L&I Awaiting guidance from CMS Molina Awaiting guidance from CMS Premera Awaiting guidance from CMS Regence Awaiting guidance from CMS United Awaiting guidance from CMS 8. Will your acceptance of Not Otherwise Specified (NOS) codes change from ICD9 to ICD10? If so, how? Aetna No, our handling of Not Otherwise Specified codes will not change from ICD-9 to ICD-10. Asuris No, we do not anticipate any changes at this time. CHPW CHPW will accept an ICD-10 NOS code if it is the only code the documentation supports. For ICD-9 NOS codes that are mapped to an ICD-10 code, CHPW requirements for the ICD-10 code will be the same as those for ICD-9, as long as the description of the code does not change. Cigna As long as it is still a valid ICD code, there will be no change. FCH FCH acceptance of Not Otherwise Specific NOS is not anticipated to change. FCH requires coding to follow the ICD-10-CM book Official Guidelines for Coding and Reporting. Following the Page 20

GHC HCA L&I guidelines is required under HIPAA. There will be NOS ICD10 codes. If there is no specific ICD 10 code then it is appropriate to use a NOS code. However there may be more specific codes in the ICD10 code set that weren t in the ICD9 code set. L&I has no plans to treat ICD-10 NOS codes different from ICD-09 NOS codes. L&I will implement ICD-10 with minimal changes and slowly add any policy changes if they are warranted. Molina No. We expect claims to be coded to the most specific level possible based on the known condition, as we do today. Premera Acceptance of Not Otherwise Specific (NOS) codes will not change from ICD9 to ICD10. We will continue to require claims to be coded to the most specific level possible. Regence No, we do not anticipate any changes at this time. United Currently, there are no changes, though we cannot rule out changes in the future. 9. During and after the transition to ICD10, do you anticipate any changes to your current policy regarding adjudicating paper claims for primary and secondary billing (CMS 1450 aka UB04 - for inpatient and CMS1500 for outpatient)? Do you anticipate any changes to your policy of sending paper vouchers/ remittance advices and checks? If so, what will be the policy changes? Aetna Asuris No, we do not anticipate any changes for either of these In Washington, we are in the process of moving to the requirement of only accepting electronically submitted medical claims. This requirement is not related to the ICD-10 implementation, however, once the requirement is in place, we won t accept paper claims. The requirement will occur in 2014, however we have not yet set an effective date. CHPW We do not send paper vouchers or checks to participating providers and do not anticipate any changes to this existing process. CHPW will continue to accept paper claims from providers when billing the health plan as a primary payer or as a secondary payer. CHPW currently offers both 835 electronic RA remittance and paper RA s, as well as EFT and paper checks. There is a push with CORE III (a federally mandated operating rule) for EFT for CMS payers to have most every provider on EFT the first of this year. We re working on that project right now. So basically CHPW won t drive the change necessarily in moving from a paper RA/check to an electronic version. But we will follow CMS and State guidance. Page 21

Cigna FCH GHC HCA L&I Molina Premera Regence No changes are anticipated to either policy. We do not anticipate any changes to our current policy regarding adjudicating paper claims for primary and secondary billing (CMS 1450 aka UB04 - for inpatient and CMS1500 for outpatient). We do not anticipate any changes to our current policy of sending paper vouchers/ remittance advices and checks. There are no immediate changes planned for our processes. HCA does not expect any policy changes related to paper claims, remittance advices or checks as a consequence or byproduct of the change to ICD-10 codes. At this time the Department will not making any changes to our paper claim policies. In addition we will not be making any changes to our paper vouchers or remittances. There are no policy changes at this time We do not anticipate changes to our policy. In Washington, we are in the process of moving to the requirement of only accepting electronically submitted medical claims. This requirement is not related to the ICD-10 implementation, however, once the requirement is in place, we won t accept paper claims. The requirement will occur in 2014, however we have not yet set an effective date. Contract Implications We do not send paper vouchers or checks to participating providers and do not anticipate any changes to this existing process. United 10. Will my interactions with your organization change because of ICD-10? Aetna No, The normal providers service operations will be utilized for assistance related to ICD-10. Asuris No CHPW CHPW does not anticipate any changes in its interactions with its providers as a result of ICD10. As we proceed through our transition, we will communicate any changes we believe will improve our responsiveness to provider claims issues after the effective date. Cigna No, Cigna does not anticipate any changes in its interactions with its providers as a result of ICD-10 FCH No, our goal is to make this transition as seamless as possible. GHC Nothing will change. Our first line access will remain Provider Assistance Unit. HCA No. Normal provider support processes be utilized for assistance related to ICD-10. Page 22

L&I Not that we can anticipate. Molina Molina strives for minimal disruption and will assess needs and interactions as it relates specifically to each organization. Molina will require submission of valid ICD codes based on the date of service / discharge. Premera No. We do not anticipate any significant issues and will work with providers to ensure a smooth transition. Regence No United Our goal is to make the transition as seamless as possible. 11. Will ICD-10 create a financial impact on my contract? Will the health plan require the execution of a new contract or a contract addendum in preparation for ICD-10-CM/PCS? Aetna Since contracts can be specific with each provider organization, we suggest you talk directly with your health plan representative or ICD-10 contact. We are currently assessing the impact of ICD-10 to all provider contracts and will be working with those contracted entities directly on any changes that may be required to accommodate the transitions to ICD-10. It is important to note, the ICD-10 conversion was not intended to transform payment or reimbursement. However, it may result in reimbursement methodologies that more accurately reflect patient status and care Asuris Our goal is for the transition to be neutral to both provider and payer. Financial impacts will be monitored and discussed at contract renewals. CHPW CHPW encourages providers to work through their Provider Contracting Representative, to insure ICD10 will have no financial impact to their contract. This may occur if a provider has reimbursement associated with ICD10 specific codes. Cigna Cigna's plan is to support updates or changes to payment schedules as part of normal re-contracting activities. Cigna contract negotiators will work with health care professionals to include any necessary contract language in agreements to address the implementation of ICD-10 FCH Contracts can be specific with each provider organization, we suggest you talk directly with your health plan representative or ICD-10 contact GHC Since Contracts can be specific with each provider organization we suggest you talk directly to your healthplan representative. Most of our current agreements support the change to ICD-10 HCA No new contracts will be required for approved providers submitting claims to HCA. Contracts with managed care organizations do not include diagnostic codes in coverage description so there is no anticipated financial impact on these contracts. L&I N/A for our organization Page 23

Molina Premera Regence United Molina will review each contract individually and formulate a strategy that meets the specific needs of that contractual relationship. Only those contracts containing specific ICD-9 codes will be renegotiated. However, all provider contracts will be amended to add verbiage regarding compliance with the CMS mandate and standard HIPAA file format transactions. Since contracts are specific to each provider organization, we suggest you talk directly with your health plan representative. Our goal is to maintain payment neutrality. Our goal is for the transition to be neutral to both provider and payer. Financial impacts will be monitored and discussed at contract renewals. One of our primary goals of our ICD-10 transition is to maintain consistency in our provider reimbursement. We don't anticipate any major recontracting needs specific to the ICD-10 transition, but understand there may be case by case instances that need to be addressed. We are currently engaged in analysis and review of contracts for impacts as a result of the ICD-10 transition. It is our goal to have ICD-10 compliant contracts prior to the October 1, 2013 federal mandate. 12. For those instances where you function as a network that reprices claims, and then forward the claim to a payer for payment, how will you identify those payers that are ready to accept ICD-10 and those that are not? Will you mitigate these payers, or is there an expectation that the providers send ICD-10 to the network for pricing for those payers that are ready, and send ICD-9 codes to the network for pricing for those payers that are not ready? Aetna Asuris CHPW Cigna FCH Not applicable Not applicable as we do not function as a network that reprices claims or forwards claims to a payer for payment. However, regardless of the readiness of any other backend processor, we would not expect a provider/facility to send some claims in ICD-9 and some in ICD-10 format for dates of service beginning 10/1/14. Not applicable Cigna will be working closely with the entities that re- prices claims and will make sure that they are ready to accept ICD- 10 claims by 10/1/14. FCH has conducted a survey with all Payers to assess their ICD-10 readiness. FCH has sent bulletins to our Providers and Payers requiring the use of ICD-10 coinciding with the industry. In addition, FCH is encouraging our Payer customers to participate in the National Pilot Testing conducted by the Lott Group. FCH will also be performing testing between our trading partners to ensure that claims data is properly exchanged for ICD- 10. FCH supports and accepts standard X12 v5010 transactions which provide for the Page 24

Mapping GHC HCA L&I Molina Premera Regence ICD10 indicator. This was tested coinciding with the change from version 4010 to 5010 and remains in place today. Not applicable. Group Health Cooperative, Group Health Options and KPS do not function as a network and reprice claims at this time. Not applicable. HCA only sends claims to other payers for COB purposes. Not applicable Not applicable We will work closely with the entities that re-price claims and will make sure that they are ready to accept ICD-10 claims by 10/1/14. Not applicable as we do not function as a network that reprices claims or forwards claims to a payer for payment. However, regardless of the readiness of any other backend processor, we would not expect a provider/facility to send some claims in ICD-9 and some in ICD-10 format for dates of service beginning 10/1/14. United 13. Will you utilize a crosswalk or translation for ICD-10 CM Codes and ICD-10 PCS codes? (Please note any difference in how you will handle CM codes or PCS codes.) And if so, specifically how? Will claims be reviewed and adjudicated using ICD-10 codes, or will the ICD-10 be mapped to ICD-9 in order to determine payment? Aetna Asuris CHPW Cigna FCH GHC HCA Aetna will follow the compliance rules established by CMS. The CMS GEMS is being used by Aetna as a clinical equivalence tool to remediate business rules with ICD-9 codes. This allows us to convert them to the ICD-10 code-set. After October 1, 2014, standard transactions submitted will be processed using the ICD-10 codes submitted, or the ICD-9 codes submitted for dates of service prior to October 1, 2014. No CHPW will be using the native redefinition approach for our claims system. Intention at this time is to use a crosswalks or translation tools internally during a transition period for reporting only. Cigna will be able to support both ICD-9 and ICD-10 by the compliance date and have no plans for a crosswalk as a contingency FCH will remediate all policies and procedures and configure systems to include ICD10 and will process ICD10 natively. Group Health Cooperative, Group Health Options and KPS will adjudicate using ICD-10 codes. HCA will not implement an automated crosswalk of codes. HCA is doing an equivalency Page 25

mapping process so that codes with the same or approximately the same definitions will process the same. ICD-10 will be processed directly by the system, not as a function of a crosswalk. L&I L&I is modifying our systems to directly process ICD 10 codes we receive for dates of service after October 1, 2014. Claims will be reviewed and adjudicated using ICD-10 codes. Our use of the GEMs is for analysis and preparation. Molina Molina will configure systems to process ICD-10 codes natively and does not intend to convert ICD-9 codes to ICD-10 codes for claims processing Premera We will not use crosswalks for translation of ICD-9 codes into ICD-10 codes or vice versa for claim processing. Regence No United Translation. 14. How are you utilizing GEMs? Aetna GEMS is being used by Aetna as a clinical equivalence tool to remediate business rules with ICD-9 codes. This allows us to convert them to the ICD-10 code-set. Asuris We are using GEMS to help translate our business rules from ICD-9 to ICD-10 and ICD-10 to ICD- 9 for our back-end aggregate reporting. CHPW GEMS will be one reference to facilitate the native redefinition process and creation of a crosswalk where necessary. Cigna Cigna will use the GEMs as a guideline to build an enterprise baseline reference map to support ICD-9 to ICD-10 translations. Cigna have also put in place an ICD-10 code Translation Taskforce that has been working together to make decisions for the enterprise on ICD-0 to ICD-10 translations, considering their affects on upstream and downstream systems and processes. FCH GEMS is the basis of our ICD10 Translation Tool we used to translate ICD9 codes to ICD10 codes to add ICD10 codes to our business rules. GHC Group Health Cooperative, Group Health Options and KPS are not planning to use the GEMs for adjudication at this time. HCA HCA is using the CMS equivalency definitions in conjunction with similar definitions from other states and payers to determine our own definition for use in claims processing. L&I We are using the GEMs for analysis and preparation. Molina Based on CMS direction Molina will use the GEMs as a guide to assist in the understanding and translation of ICD-9 codes to ICD-10 to make policy and system support decisions. Page 26

Premera We ve created our own benefits maps by using GEMs and information from other Blue plans. Regence We are using GEMS to help translate our business rules from ICD-9 to ICD-10 and ICD-10 to ICD- 9 for our back-end aggregate reporting. United We will be using a hybrid approach for converting data from ICD-9 to ICD-10. We are utilizing the GEMs as well as a code mapping tool. 15. If you are utilizing GEMs, are you also utilizing the Reimbursement file? How? Aetna Aetna is not using GEMS for claims handling and reimbursement. Asuris We are not using the CMS Reimbursement Map as we are not translating claims from ICD-10 to ICD-9 for adjudication and payment purposes CHPW Not applicable Cigna Not applicable FCH FCH is not using the Reimbursement Mappings for reimbursement. GHC Not applicable HCA No L&I Not applicable Molina Not applicable Premera No Regence We are not using the CMS Reimbursement Map as we are not translating claims from ICD-10 to ICD-9 for adjudication and payment purposes United 16. What mapping tools will you be using or will you be creating your own mapping? Aetna CMS has provided General Equivalency Mappings (GEMs) as an approach to define reasonable alternatives for mappings between ICD-9 and ICD-10 codes in both directions. Aetna has been using the CMS GEMS as a starting point for crosswalk development, but has in some instances adjusted the mappings based on our own clinical review. Asuris We will be using mapping tools such as Nav-10 only for internal trend analysis. All claims processing will use native ICD codes. CHPW CHPW currently has a mapping tool based on GEMS. Cigna Cigna will use the GEMs as a guideline to build an enterprise baseline reference map to support ICD-9 to ICD-10 translations. Cigna have also put in place an ICD-10 code Translation Taskforce that has been working together to make decisions for the enterprise on ICD-0 to ICD-10 translations, considering their affects on upstream and downstream systems and processes. Page 27

Outreach & Testing FCH HLI Leap SmartGems will be used for ICD10 translation to add ICD10 codes to business rules allowing our systems to process ICD10 natively. GHC We are creating our own mapping based on GEMs. HCA HCA is using the CMS equivalency definitions in conjunction with similar definitions from other states and payers to determine our own definition for use in claims processing. L&I Some specifics in this area are under discussion and undetermined at this point. Molina Molina finalized contract negotiations to utilize an analytics and code translation tool to assist in the understanding of potential impacts and the translation of ICD-9 codes to ICD-10 to make policy and system support decisions. Premera We ve created our own benefits maps by using GEMs and information from other Blue plans. All claims processing will use native ICD codes. Regence We will be using mapping tools such as Nav-10 only for internal trend analysis. All claims processing will use native ICD codes. United We are utilizing the GEMs as well as a code mapping tool. 17. When do you plan to reach out to your contracted network? Aetna Communications are part of our ICD-10 conversion plan We will keep providers informed about our progress throughout the entire transition, utilizing existing communication methods such as the OfficeLinks newsletter as well as Aetna.com. Asuris We have been communicating with our contracted network since February 2011 and will continue through 2014. CHPW CHPW initiated ICD-10 transition communications with network providers in January 2012 and will continue doing so through the 2014 implementation date. Cigna Cigna will continue to communicate updates regarding our progress towards compliance to health care professionals and hospitals through: Our quarterly health care professional newsletter, Network News Frequently Asked Questions (FAQs) available on the secure Cigna for Health Care Professionals website (CignaforHCP,com) Cigna health care professional service representatives FCH FCH regularly communicates with providers via the FCHN website, newsletters, and bulletins as well as regularly participates in educational seminars. GHC Currently working on our communication plan more information to follow. Multiple communication mediums will be employed including, but not limited to, our provider newsletter, Page 28

our provider manual and provider.ghc.org. HCA Outreach to providers and clearinghouses will begin in the first quarter of 2014. L&I Currently working on our communication plan more information to follow Molina Molina will have a thorough communication plan to keep network providers apprised of Molina's progress, determinations and timelines. We anticipate providing information via existing communication vehicles such as provider newsletters, Molina s website as well as provider service representatives on site visits. Premera Premera has been communicating with providers about ICD-10 since early 2011 through Network News, EDI News, provider workshops, and provider website. Communications will continue through these vehicles. Regence We have been communicating with our contracted network since February 2011 and will continue through 2014. United It is anticipated our trading test plans will be communicated in 2013. 18. What will be your process for testing all ICD10 related transactions, e.g. claims (837), Eligibility and Benefits (270-271), Remittance Advice (835), etc., with multiple clearinghouses yours and the providers? Aetna Asuris CHPW Cigna While we are still finalizing our testing strategy, testing with clearinghouses will play a critical role. It is critical for providers not to delay planning and preparation. We recommend that providers contact their billing or software vendor to understand their plans for conversion and testing. We will test with Availity and Office Ally, the two clearinghouses who receive all our electronic claims from the various vendors. This testing will begin in late 2013/early 2014. We will also test with selected providers/facilities in 2014 and are currently in the process of establishing a test plan. This collaboration will include technical testing that validates the clearinghouse send/receive functionality of all the formats identified above and could include testing from provider to clearinghouse, clearinghouse to Availity and Availity to Asuris. However, we will not test with every provider/facility. It is the provider/facility s responsibility to contact their clearinghouses directly to ensure they have coordinated testing with other clearinghouses. CHPW will collaborate with providers who wish to test end-to-end during that phase of the ICD10 project. CHPW receives all claims with the exception of one group, through the Availity clearing house. Specific processes will be developed and communicated as we progress through the internal testing phase. Cigna will be ready to start test externally with a predetermined set of trading partners and vendors in the fourth quarter of 2013 through to the compliance date Page 29

FCH FCH is participating in the National ICD10 Testing Program as well as reaching out to other providers and clearing houses that may not be involved in the Program. GHC Yes, we will be testing with clearinghouses as well as testing with our large volume providers and any others that want to test with us. HCA HCA will invite providers to send test 837 files. HCA will return test 835 files. HCA will do similar testing with clearing houses and billing agents in concert with and also independent from providers. The HCA 270 and 271 Eligibility transactions do not include diagnostic codes therefore no impact is anticipated. L&I We will test ICD-10 transactions with clearing houses using the established processes we have in place for verifying our billing transactions. Molina Molina will complete interface testing with clearinghouses submitting claims on behalf of our contracted providers. Additional planning and development is required to determine the process Please establish your specific requirements with your vendor Premera We are in the process of developing testing plans and will begin testing with select providers and clearinghouses in the first half of 2014. Regence We will test with Availity and Office Ally, the two clearinghouses who receive all our electronic claims from the various vendors. This testing will begin in late 2013/early 2014. We will also test with selected providers/facilities in 2014 and are currently in the process of establishing a test plan. This collaboration will include technical testing that validates the clearinghouse send/receive functionality of all the formats identified above and could include testing from provider to clearinghouse, clearinghouse to Availity and Availity to Regence. However, we will not test with every provider/facility. It is the provider/facility s responsibility to contact their clearinghouses directly to ensure they have coordinated testing with other clearinghouses. United We plan to begin testing with clearinghouses starting in Nov/Dec 2013 and continuing in 2014. 19. Will you conduct ICD-10 testing directly with all providers? If so, when? Aetna We will keep providers informed about our progress on the ICD-10 conversion, including timelines and testing. We plan to conduct targeted testing and will contact directly those entities involved. We anticipate sharing dates related to testing throughout 2013. Asuris No. We will test with selected providers/facilities beginning quarter one of 2014 and are currently in the process of establishing a test plan. CHPW CHPW is planning to test directly with our providers. Since CHPW must migrate to a ICD-10 compliant administrative system in the 2013-2014 period, testing with targeted providers is anticipated to begin before the end of Q1, 2014. Several providers have already expressed interest Page 30

in collaborating on this effort. Dates for the collaborative testing will be finalized when internal testing results have achieved acceptance standards Cigna No, Cigna will only be conducting ICD-10 testing with a predetermined set of trading partners and vendors in the fourth quarter of 2013 through to the compliance date FCH Our testing will be with all of our trading partners. FCHN has begun testing electronic transaction version 5010 that will be ICD10 compliant. FCH is also participating in the National ICD10 Testing Program. GHC We will test with a select group of providers with an initial outreach planned for January 2014. HCA HCA will invite providers to test during August and September. Due to the limited timeline, HCA may not be able to accommodate all providers during testing. L&I Currently working on our communication plan more information to follow Molina Molina is interested in coordinating with providers and facilities to help understand and mitigate potential impacts and would request claims natively coded in ICD-10 and anticipates beginning external testing in April 2014. Premera We are in the process of developing our testing plans and will begin testing with select providers and clearning houses in the first half of 2014. Regence No. We will test with selected providers/facilities beginning quarter one of 2014 and are currently in the process of establishing a test plan. United We plan to test with a variety of entities beginning in Q1 2014. 20. Do you plan on conducting any type of provider education or training on revised processes? Aetna The best source of information on our progress is aetna.com, http://www.aetna.com/healthcareprofessionals/policies-guidelines/icd_10_faq.html where Aetna has detailed information about our approach to ICD-10, as well as any training for providers. This is the most current source of information and will be updated throughout the next several years as work continues on this important project. Asuris We don t expect any revised processes at this time. We will keep providers abreast of our ICD-10 progress via our Provider Web Site, www.assets.asuris.com/provider/. CHPW CHPW is currently evaluating options for both internal training as well as options to partner with our providers. Cigna We do not anticipate any revised processes but do have sources of training available on www.cignaforhcp.com > resources > medical resources > ICD-10 FCH Any changes would be announced via FCHN website, newsletter or bulletin. GHC Will communicate with our network providers about any changes in process. Page 31

HCA The HCA provider outreach and communications plans are still in progress but additional information will be available during the first quarter of 2014. L&I Currently working on our communication plan more information to follow Molina Molina anticipate providing information via existing communication vehicles such as provider newsletters, Molina s website as well as provider service representatives on site visits. Premera We have no plans to provide ICD-10 training to providers or send automated notifications about ICD-10 training. We will continue to communicate implementation status and direct providers to industry information and education and training resources, however. We will communicate this information to providers in the Network News, EDI News, provider workshops and on the provider website. Regence We don t expect any revised processes at this time. We will keep providers abreast of our ICD-10 progress via our Provider Web Site, www.wa.regence.com/provider. United UnitedHealthcare has an external ICD-10 Outreach site, where providers and other constituents can find information about ICD-10. In addition, our UnitedHealthcare market specialty, provider and hospital facility advocates will serve a critical role in helping us communicate with providers regarding our ICD-10 program. To help respond to questions, there is a UnitedHealthcare ICD-10 question box. People can submit their questions at ICD10Questions@uhc.com and a response will be emailed within 15 business days. 21. How do we sign up for an automatic notice for any training you will be offering? Aetna We do not have an automated system for training notification. The best source of information for providers is aetna.com, http://www.aetna.com/healthcare-professionals/policiesguidelines/icd_10_faq.html where Aetna has detailed information about our approach to ICD-10. Asuris We will notify providers via our newsletter, The Connection Online SM of any training opportunities and would provide a link for online registration at that time. CHPW TBD Cigna Training offerings can be found on www.cignaforhcp.com > resources > medical resources > ICD- 10. FCH Please see the FCHN website to sign up for publications. GHC Not applicable HCA HCA utilizes a general provider list serve to send out notices of this nature. Providers interested in joining the list serve can do so at https://fortress.wa.gov/dshs/hrsalistsrvsignup/ L&I We will not be providing general ICD-10 training to our external customers. Molina Molina will establish a thorough communication plan to keep all providers informed of Molina's Page 32

progress, timelines and communication methods. Premera We do not plan on delivering ICD-10 training for providers or send automated notifications about ICD-10 training. Regence We will notify providers via our newsletter, The Connection Online SM of any training opportunities and would provide a link for online registration at that time. United UnitedHealthcare has an external ICD-10 Outreach site, where providers and other constituents can find ICD-10 training that is available and our provider advocate and provider relations network will assist in releasing additional information regarding available training. 22. During the transition period from ICD-9 to ICD10, to what extent, if any, do you expect timeframes to change for provider hold times on the phone and/or for other follow-up processes with providers? Are you putting processes in place so that current levels are maintained? Aetna We do not expect delays for customer service. This is one of many issues being handled in our contingency planning. Asuris We are still analyzing the approach for the cutover. We intend to mitigate any ICD-10 impacts. CHPW Our objective is not to experience negative change in hold times. Staffing model, organization and process for handling ICD-9/ICD-10 questions post 10/1/2014 will be determined by Q1, 2014 Cigna As far as the phones, we are providing extensive documentation and training to Customer Service Reps but can't anticipate if there will be longer hold times. We are training and preparing for it. FCH We do not anticipate any increase in provider hold times on the phone or related to other follow- up processes. Staffing for phones and follow- up will be adjusted as needed. GHC We will maintain current processes and timeframes. HCA L&I We don t expect significant impacts to provider hold times. No process changes are needed at this time. Molina We expect to maintain the same timeliness standards as we do today. We will be evaluating all processes and impacts to our anticipated response times and will be putting together a plan to mitigate any impacts related to the ICD-10 transition. Premera The goal of our ICD10 program is not to impact customer service processes including current service levels. In addition systematic monitoring of actual results will be performed following implementation to identify if there is any impact and to take appropriate action. Regence United We are still analyzing the approach for the cutover. We intend to mitigate any ICD-10 impacts. United s goal is not to impact customer service processes. Monitoring will be performed following implementation to identify if there is any impact and appropriate action will be taken. Page 33

23. Who do I contact with my ICD-10 questions or concerns? Aetna You should contact your normal relationship manager for any questions on ICD-10. Asuris Please contact your assigned provider consultant. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.assets.asuris.com/provider/. CHPW CHPW has posted an email address on its website for submission of and response to inquiries. Cigna The Relationship Manager who you normally work with will be your contact, since they will be responsible for helping health care professionals manage ICD-10 readiness and compliance FCH Please contact your Provider Relations Representative and they will put you in contact with the ICD10 Implementation Team. GHC Icd10@ghc.org HCA Questions can be directed to hipaa-health@hca.wa.gov L&I ICD10@lni.wa.gov Molina MolinaI.CD10@MolinaHealthCare.Com. Premera Please call Premera Physician and Provider Relations and request to speak with your health plan representative. Regence Please contact your assigned provider consultant. If you are unsure who that is, you can locate the information in the Contact Us section of the Provider Web Site at www.wa.regence.com/provider. United ICD10Questions@uhc.com Page 34