Totally Connected.. Total Health Care Plans. Our Mission: To be the industry leader in providing quality, cost effective health care for our members

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1 Total Health Care Plans Network Updates Totally Connected.. March 2018 A newsletter for Physician Offices... The following ID cards help identify each THC product: Commercial HMO plans offered through small and large employer groups, as well as bronze, silver, gold and platinum level plans for individuals and families on the federal Health Insurance Marketplace. Effective 4/1/2018, a Healthy Michigan Marketplace Option will be available based on member eligibility. Commercial POS allows members choice through the THC network of providers, as well as through an extended wrap network with Cofinity/First Health for higher out of pocket expense. Healthy Michigan Plan is part of Medicaid expansion that provides care to eligible Michigan residents who have an income level at or below 133% of the federal poverty level. Medicaid provides coverage to Medicaid and MiChild beneficiaries in Wayne, Oakland and Macomb Counties based on eligibility requirements. Our Mission: To be the industry leader in providing quality, cost effective health care for our members

2 Fraud, Waste & Abuse False Claims Act What You Should Know THC has a robust compliance program, including a specific Special Investigation Unit (SIU), that is committed to ththeereduction of waste, fraud and abuse in the healthcare system. Our SIU may perform audits of claims data toto ensure compliance with billing and medical necessity guidelines. What is it? The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program. Due to our participation in both the Medicare and Medicaid programs, Total Health Care is subject to enforce the False claim act which pertains to any plan or program that provides health benefits, whether directly, through insurance or otherwise, funded directly, in whole or in part, by the United States Government or any state healthcare system. Knowingly includes having actual knowledge that a claim is false or acting with reckless disregard as to whether a claim is false. In addition to the federal law, the state has adopted similar laws under the Michigan Medicaid False Claims Act (MMFCA). The MMFCA is designed to prevent fraud, kickbacks and conspiracies in connection with the Medicaid program. Examples of false claims include billing for services not provided, billing for the same service more than once or making false statements to obtain payment for services. Penalties under the False Claims Act. Violations under the federal False Claims Act can result in significant fines and penalties. Financial penalties to the person or organization include recovery of three times the amount of the false claim(s), plus an additional penalty of $5,500 to $11,000 per claim. Violation of the MMFCA constitutes a felony punishable by imprisonment, or a fine of $50,000 or less, or both, for each violation. Any person who receives a benefit by reason of fraud, makes a fraudulent statement, or knowingly conceals a material fact is liable to the state for a civil penalty equal to the full amount received plus triple damages. Whistleblower Protection under the False Claims Act. The federal False Claims Act protects employees who report a violation under the False Claims Act from discrimination, harassment, suspension or termination of employment as a result of reporting possible fraud. Employees who report fraud and consequently suffer discrimination may be awarded (1) two times their back pay plus in- terest, (2) reinstatement of their position without loss of seniority and (3) compensation for any costs or damages they incurred. Qui Tam Plaintiff/Relator. An individual (called a qui tam plaintiff or relator) who is an original source of information can sue for violations of the False Claims Act. Under both the federal False Claims Act and the MMFCA, a qui tam plaintiff can receive between 15-25% of the total amount recovered if the government prosecutes and 25-30% if litigated by the qui tam plaintiff. Page 2

3 CHAMPS Requirement MDHHS has extended the mandatory deadline for enrolling in CHAMPS As mandated in the ACA and 21st Century Cures Act, all providers who render services to Medicaid beneficiaries are required to be screened and enrolled in the Michigan Medicaid program through CHAMPS. This law prohibits payment to providers who are not appropriately screened and enrolled. MDHHS is backlogged with enrollment applications because of this mandate which was originally slated to take effect on March 1, 2018 for medical claims and May 1 for pharmacy claims. Therefore, MDHHS will extend the date for claim denial beyond March 1 and beyond May 1 for pharmacy claims. Plans will be given at least 60-days advance notice before we will be required to deny claims from any typical rendering, supervising, ordering, referring or attending providers who are not enrolled in CHAMPS. Typical providers are those with an NPI. We will also be required to prohibit payment for prescription drug claims written by a non-enrolled prescriber. Atypical providers (those without an NPI) will be required to follow suit at a date yet to be determined. We will continue to update you as we receive additional guidance on this issue. Medicare ID Card Changes New Medicare Cards and ID Numbers Beginning April 1, 2018, the Centers for Medicare & Medicaid Services (CMS) will begin to phase out the use of Social Security Numbers (SSNs) from all Medicare cards. Medicare beneficiaries will begin to receive new ID cards in April All ID cards will be replaced by April This process will be transitioned over 21-months and be completed by December A new randomly generated number called a Medicare Beneficiary Identifier (MBI) will replace the SSN on ID cards and in various CMS systems. Claims can continue to be billed with the Social Security-based Health Insurance Claims Number (HICN) during the transition period. We encourage you to work with your billing vendor to make certain your system will be updated to reflect this change. Prepare for this change by visiting -and-education/medicare-learning-network-mln/mlnproducts/downloads/medicarecard-factsheet-textonly pdf Fraud, Waste and Abuse, continued from Page 2 If you have any information about fraud and abuse, please contact THC. You can report anonymously without giving your name by writing or calling: Total Health Care ATTN: Fraud & Abuse 3011 W Grand Blvd, Ste 1600 Detroit, MI Call: or toll-free at Fax: eliminatefwa@thcmi.com You may also report instances of fraud and abuse directly to the Office of Inspector General in writing: Michigan Department of Health & Human Services Office of Inspector General PO Box Lansing, MI You may call the 24-hour hotline at 855-MI-FRAUD ( ) toll free, or visit the website at or MDHHS-OIG-Michigan.org. You can remain anonymous. Page 3

4 Healthy Michigan Plan (HMP) MI MarketPlace Option Effective April 1, 2018, MDHHS will begin to transition certain Healthy Michigan Plan members to a MI Market- Place Option health care plan. Those HMP members age 21 and older with incomes above 100% of the federal poverty level who have been enrolled in HMP for at least a year without choosing a healthy behavior through a completed HRA (Health Risk Assessment) will be transitioned. These members may continue with Total Health Care, or opt in to a new MI MarketPlace plan. Beneficiaries with serious health conditions or complex care needs may be exempt and any beneficiary may appeal. While these members will transition to the marketplace, they will continue to be eligible for non-emergency medical transportation, family planning services from any provider and will be covered by out of network FQHCs. HMP Appointment Guidelines For beneficiaries enrolled in the HMP program, an initial appointment with their PCP must be scheduled within 60 days of enrollment. PCPs are required to complete the initial appointment within 150 days of when the member s coverage began. THC s MAR (Member Activation Representatives) team will help members schedule PCP appointments, complete their portion of the HRA, schedule transportation and make reminder calls. HRAs are mailed to new members with their Welcome packets. They are encouraged to bring them to their PCP appointment. THC will fax HRAs to PCP offices prior to scheduled appointments. A phone call will be made prior to sending the fax to alert the office to expect the HRA form. HRA Process PCPs are required to complete a health risk assessment (HRA) for each HMP member during the first 150 days of coverage and annually thereafter PCPs must sign the HRA form for it to be complete MAR team follows up with PCP to ensure receipt of completed HRA PCP must submit a claim with CPT code to indicate completion of the HRA. THC provides a $25 incentive for completion of the HRA form. THC will identify health triggers that require targeted interventions and customize care management approaches for each member. The PCP will be kept informed of member engagement with our case managers and share data with the PCP. Website Tools Please visit to visit our provider tool kit for HMP members and to locate a blank HRA form. Page 4

5 Medical Record Documentation Principals of Documentation What is documentation and why it s important? Medical record documentation is required to record pertinent facts, findings and observations about an individual s health history including past and present illnesses, examinations, tests, treatments and outcomes. The medical record chronologically documents the care of the patient and is an important element contributing to high quality care. The medical record facilitates: The ability of the physician and other healthcare professionals to evaluate and plan the patient s immediate treatment, and to monitor his/her healthcare over time Communication and continuity of care among physicians and other healthcare professionals involved in the patient s care Accurate and timely claims review and payment Appropriate utilization review and quality of care evaluations Collection of data that may be useful for research and education Servers as a legal document that describes a course of treatment (Excerpt from the 1995 Documentation Guidelines for Evaluation and Management Services) Components of Good Documentation A medical record contains many components including the following: patient registration form, consent to treat, HIPAA notice, medical history, medication list, problem list, preventive screenings, encounter form, practitioner orders, consultation reports, operative notes, nursing notes, laboratory reports, immunization records and discharge planning. Many providers document the visit on a patient encounter form or a progress note. A common technique used to document the visit is called SOAP: Subjective, Objective, Assessment and Plan. This method may also be referred to as MEAT: Monitor, Evaluate, Assess and Treat. Subjective Includes reason for the visit, review of patient s history of present illness, past social and family history and review of systems. Objective Includes the provider s findings from the exam Assessment Includes the thought process of the provider after reviewing patient s symptoms. Includes diagnosing patient and documenting significant findings, signs and/or symptoms Plan - Plan of care to treat a patient s condition including tests, treatments, procedures, directions given to patient, consultations and follow up. Other key documentation requirements include: Medical record entries should be accurately dated and signed by the person providing the service. A licensed Provider must co-sign any documentation performed by a non-licensed provider or other personnel (medical assistant, nurse..) Entries should be made in black ink in a paper chart and must be legible All pages of the medical record must contain the Patient s name and date Medical records may be dictated, handwritten, recorded on a form or entered into an Electronic Health Record system. Dictated records must include date of dictation and date of transcription. All signatures must be legible. A signature log or attestation statement may be used to identify an illegible signature. Date and time must be documented on progress notes and procedures All orders must be signed by Licensed Provider prior to services being rendered. Late signatures may not be accepted if record is audited. If an order for a test/procedure is unsigned, it may be supported if intent to order test(s) is documented in the Progress notes. If signature is missing from order and the intent is not derived from the progress notes, the unsigned order will be treated as though it was not received. Service(s) must be reasonable and necessary Indicate Late Entry for out of sequence entries continued on next page Page 5

6 Medical Record Documentation, cont. Do not black out any entries. If there is a mistake, draw a line through the error and initial and date. For Electronic Health Records, a reliable means to clearly identify the original content and modified content, date and authorship is required. Do not cut and paste notes from one record to another. All entries are unique to patient. Selecting appropriate Diagnosis and Procedure Codes from the Medical Record ICD-10 coding instructions are listed in the front of the Coding manual. Section IV provides guidance for selecting appropriate diagnosis codes for Outpatient Hospital and Physician Office settings. Guidelines indicate that Providers should select diagnosis codes that describe the reason for the encounter. If a diagnosis cannot be determined, code the signs and symptoms. A provider may include additional codes that describe co-existing conditions that are being treated during the encounter. Do not code conditions that were previously treated and no longer exist. However, do use a history code if it has an impact on the current condition or influences treatment. A provider may report chronic diseases that are treated on an on-going basis. Total Health Care, like most insurance companies, requires chronic conditions to be reviewed by provider each year and reported on a claim. Diagnosis codes and CPT-4 codes can be billed if they are documented in the medical record as being treated and are medically necessary. Documentation of Examination A provider examines the body areas and organ system(s) that are identified in the history of present illness. There are four Examination types: Problem Focused limited exam of the problem area Expanded Problem Focused exam of problem area and other symptomatic organ systems Detailed exam of problem area and other symptomatic organ systems (multiple systems) Comprehensive complete exam of organ system or multisystem exam 1995 Guidelines are not as specific as the 1997 Guidelines. The 1997 Guidelines have specific details about reviewing key body areas and organ systems. Both guidelines recommend that specific abnormal and relevant negative findings of the affected or symptomatic body area(s) or organ system(s) should be documented in detail as should any findings for asymptomatic body area(s) or organ system(s). Documentation of Medical Decision Making Medical Decision Making is the thought process conducted by a physician using his/her training, experience and expertise to determine what the problem is and how best to treat the condition. The following elements contribute to medical decision making: The number of possible diagnoses and management options The quantify of medical records that must be reviewed The number of tests that should be ordered The risk of complications, the rate of sickness (morbidity) or the risk of death (mortality) Impact of condition on patient s health Severity of presenting problem There are four categories for medical decision making based on the elements listed above: Straightforward minimal decision making required zero to one element above Low Complexity decision making includes two to three of the elements above Moderate Complexity Several of the elements above High Complexity Many of the elements above Continued on next page Page 6

7 Medical Record Documentation, cont. Documentation of Medical Decision Making Medical Decision Making is the thought process conducted by a physician using his/her training, experience and expertise to determine what the problem is and how best to treat the condition. The following elements contribute to medical decision making: The number of possible diagnoses and management options The quantify of medical records that must be reviewed The number of tests that should be ordered The risk of complications, the rate of sickness (morbidity) or the risk of death (mortality) Impact of condition on patient s health Severity of presenting problem There are four categories for medical decision making based on the elements listed above: Straightforward minimal decision making required zero to one element above Low Complexity decision making includes two to three of the elements above Moderate Complexity Several of the elements above High Complexity Many of the elements above To assign an E/M level code, read the specific instructions in the CPT-4 manual to determine the number of elements required to assign the level. Many E/M codes require all three elements to select the code (History, Examination and Medical Decision Making) or two out of the three elements. The code selection is based on meeting or exceeding the levels of the key components. Check code description to determine whether 2 or 3 elements must be met Review the documentation and match it to the level descriptions for each component Determine the highest level met (equal to or more than the requirements) Compare the levels of each key component and choose the highest level of code for which all key components have been met. Example: Setting: Office Visit (three of three components must be met) Chief Complaint: New patient presents with runny nose, coughing and headache HPI- No fever, No meds, No allergies PFSH Family history Asthma (mother), COPD & Lung Cancer (Grandfather), Patient smokes ½ pack per day but is trying to quit. ROS BP 120/86, R-18, P-80, Eyes- inspects conjuctivae/lids, EAC/TMs inspected, Nasal mucosa/turbinates, Neck no masses, Lungs CTAB, good resp effort, Cardio-CTA. MDM Sinusitis, RX Given Z-Pak, Information on smoking cessation given History Expanded Problem Focus Exam Expanded Problem Focus MDM Moderate CPT Select This code requires an expanded problem focus history and exam and a straightforward decision making. The history and exam meet the requirements for Expanded Problem Focus but the medical decision making is Moderate and meets or exceeds the requirement for the code. Therefore is the appropriate level. By using the SOAP note technique, E/M level selection should be easily achieved. Documentation takes effort but is very important to care for the patient appropriately and to ensure the physician receives adequate reimbursement and safeguards against audits and legal issues. There are many resources to learn about documentation improvement. Please visit the websites of these organizations to search for more information: CMS, AAPC, AHIMA, AMA and organizations for certain specialties. Continued on next Page 7

8 E & M Documentation Evaluation and Management (E & M) Documentation Evaluation and Management (E/M) service guidelines are in the CPT-4 manual at the beginning of the E/M section. There are several categories of E/M codes based on place of service and type of patient (new or established). Each category is further defined by the level of E/M. The levels of E/M services encompass the wide variations in skill, effort, time, responsibility and medical knowledge required for the prevention or diagnosis and treatment of illness or injury and the promotion of optimal health. (Excerpt from the 2015 E/M guidelines in the CPT-4 manual) Medicare publishes an Evaluation and Management Services Guide that includes more detail in selecting an E/M level and provides two variations of guidelines: 1995 guidelines and 1997 guidelines. The 1997 guidelines are more detailed than the 1995 guidelines. There are specific differences in documenting the History of Present Illness and the Physical Exam. Providers should consistently use one version for their guidelines. E/M documentation includes seven components: History Examination Medical decision making Counseling Coordination of Care Nature of presenting Problem Time The first three components, History, Examination and Medical decision making are key components used to select the level of E/M code. The other components contribute to selecting an E/M level by providing more detail about the service and medical decision making. If a provider spends more than 50% of their time counseling and coordinating care with patient and/or family face to face, then time shall be considered the key or controlling factor to qualify for a particular level of E/M service. Documentation of History Accurately recording a patient s history is an important part in selecting the appropriate E/M level. There are four key elements that comprise a patient s history: Chief Complaint (CC) reason for encounter History of Present Illness (HPI) development of the patient s current problem Review of Systems (ROS) review of body systems directly related to problem Past Family and/or Social History (PFSH) related to illness and disease History of Present Illness, Review of Systems and Past Family and/or Social History are defined further by the level of detail documented. This level of detail is dependent on clinical judgment and the chief complaint. This detail is used to assist providers in choosing the Type of History. This detail is covered in the E/M Guidelines found on the CMS website. See chart below: Type of History Chief Complaint HPI ROS PFSH Problem Focused Required Brief N/A N/A Expanded Problem Required Brief Problem Pertinent N/A Focused Detailed Required Extended Extended Pertinent Comprehensive Required Extended Complete Complete Page 8

9 NCQA & HEDIS Corner How to Improve HEDIS Scores! You ve heard the saying, It takes a village to raise a child. We can all relate to the fact that a team is more efficient and productive than an individual. So, too, is this true in health care. It takes an entire office working together to ensure patients don t fall through the cracks. From the front desk at check-in, to the check out process and everything in between, everyone interacting with a patient can be involved. And that includes Total Health Care! We re also working behind the scenes to capture data and do patient outreach. But we need to work together. Here s how Total Health Care can help coordinate with you: Arrange for transportation for a mammogram appointment or other needed service Provide patient-specific lists for outreach campaigns Arrange training on our SmarterHealth portal Help track down phone numbers if you have wrong patient information Arrange for electronic interface with your disease registry Call Provider Relations at 844-THC-DOCS to see what we can do for you. Be Classy - Complete your CLAS Training CLAS stands for Culturally and Linguistically Appropriate Services. CLAS Standards are national standards and guidelines established in 200 by the UD Department of Health & Human Services to advance health equity, improve quality and eliminate health disparities. THC has a diverse population of members with 38% speaking a language other than English as their primary language. CLAS training can help providers be aware and sensitive to members needs. Cultural sensitivity awareness is increasiningly important given that projections by the US Census Bureau show that the non-caucasian population will be more than 50% of the total population by THC is required to report completion of CLAS training by our providers. Please let us know that you have completed this important and informative training. Training is available through our website, Log in to the portal and select the More Information > CLAS Training on the Provider Page. Page 9

10 Quality Improvement Program Clinical Practice Guidelines Total Health Care s Quality Improvement Committee is continually focused on offering evidence-based recommendations to improve positive health outcomes. The following CPGs developed by MQIC (Michigan Quality Improvement Consortium) have been approved for use by our Quality Improvement Committee: Adolescent/Young Adult Health Risk Behavior Assessment General Principles for the Diagnosis and Management of Asthma Management of Acute Low Back Pain in Adults Management of Diabetes Mellitus Management of Uncomplicated Acute Bronchitis in Adults Prevention and Identification of Childhood Overweight and Obesity Prevention of Pregnancy in Adolescents years Prevention of Unintended Pregnancy in Adults 18 years and Older Routine Prenatal and Postnatal Care Treatment of Childhood Overweight and Obesity Acute Pharyngitis in Children 2-18 Years Old Adults with Systolic Heart Failure Routine Preventive Services for Infants and Children (Birth to 24 months) Routine Preventive Services for Children and Adolescents (Ages 2-11 yrs) Opioid Prescribing in Adults Excluding Palliative & End of Life Care Advanced Care Planning Management and Prevention of Osteoporosis Screening, Diagnosis & Referral of Substance Access to these MQIC Guidelines is available on the THC website, wwwthcmi.com > Provider page > Clinical Resources. Quality Improvement Initiatives In addition to the use of evidence-based clinical guidelines, the Quality Improvement Committee supports physicians through outreach interventions directly to members. These include member incentive programs, member telephone reminders and mailings, as well as educational materials related to specific chronic conditions. If you would like a copy of any of these materials, contact your Provider Relations representative. Pharmacy Edits for Opioids It addition to the new MQIC Opioid guideline, THC is working to address opioid abuse through pharmacy management; we track prescribing patterns on physicians and members who receive opioid prescriptions and involve case management when misuse is suspected. We additionally limit prescription amounts and require prior authorization for high-risk doses in an effort to curb misuse. In some instances, members will be locked in to filling prescriptions at a single pharmacy to avoid drug shopping. Physicians are encouraged to review resources made available from the CDC, including the training video Applying CDC s Guideline for Prescribing Opioids. overview/index.html Page 10

11 Access to Care Standards PRACTICE GUIDELINES AND STANRDS A. Access and Availability Total Health Care is committed to ensuring our members have access to the right care at the right place and in a timely manner. THC has developed the following standards which define appropriate access to medical care warranted by the severity of a patient s illness or medical condition. The ease with which members can access services based on the following timeframe expectations is a quality standard that will be monitored for our primary care physicians: Primary Care Physician Regular and Routine Care Appointments (i.e. preventive/wellcare, routine non-symptomatic, physical, annual GYN exam) Routine Non-Urgent (i.e. symptomatic ) Response Standards Within thirty (30) days Within seven (7) days Urgent Care Appointments (i.e. persistent diarrhea/vomiting, high fever) B. EPSDT/Well-Child Guidelines Well-child care and immunizations are an important component of a preventive care program. Total Health Care supports EPSDT Guidelines and expects PCPs to promote and schedule ageappropriate well-child exams and immunizations. Immunizations must be appropriately documented in the medical record and reported to the Michigan Care Immunization Registry (MCIR) as required by State law. Vaccines are available through the State of Michigan s Vaccinations for Children s Program for those who qualify. C. Preventive Health Guidelines Within twenty-four (24) hours Emergency Care (i.e. life-threatening conditions) Twenty-four (24) hours/ seven (7) days a week at any hospital Office Visit Wait Time for Scheduled Appointments Within 15 minutes, members should be taken to the exam room. Within 30 minutes, members should be seen by their doctor To encourage the appropriate delivery and use of preventive services at appropriate intervals, Total Health Care has adopted and implemented preventive health guidelines for prevention and early detection of illnesses. The use of preventive health guidelines is an essential component to help reduce the incidence of illness, disease, and accidents. Early detection of potentially serious illnesses may reduce the impact of illness on the member and associated health care costs. Additionally, use of preventive health guidelines has the potential to reduce unwanted variation in health care out- comes. Page 11

12 Patient Dismissal Policy Discharge process We require primary care providers (PCPs) to follow the following steps to discharge a member from their practice. Note: You may not contact members about discharge until Total Health Care has approved the discharge. Document the reason(s) for requesting discharge within the member s practice record. Document all resolution attempts within the member s practice record. Attach copies of your documentation from the member s record indicating reason for re- quest and resolution attempts. THC will review your request and documentation promptly. You will receive an approval or denial for each request. Notify the member that he or she has been discharged from your practice. You must offer 30 days of urgent/emergent care to the member following the discharge date. THC will reassign members to a new PCP. Typically, the new PCP assignment is effective on the first day of the first month after the 30-day discharge period. Acceptable reasons for discharge Discharge requests are automatically approved for the following reasons: Unpaid copayments or deductibles, with a minimum of a 90-day collection period. Collection attempts must be documented. Persistent non-compliance with a documented care plan which results in unnecessary utili- zation of health care resources. Non-compliance and steps to educate the member on ap- propriate use of primary care must be documented. Repeated no-shows for scheduled appointments. This is defined as three or more visits missed in a twelve month period. Dates of no-shows must be documented. Threatening behavior displayed toward practice staff. Behavior and practice response must be documented. Members previously discharged from the practice, prior to coverage with THC. Fraudulent behavior, with the case documented in the member s record. Cases that will be referred for special programs Doctor-shopping to obtain prescriptions. Details of this activity should be documented including dates of visit or contact with the member. Failed drug screen, in violation of practice illegal drug-free policy. Date of drug screen and policy must be documented. Page 12

13 Member Rights & Responsibilities Member Rights and Responsibilities All contracted THC providers are required to comply with the Rights & Responsibilities for all THC members. If a THC member fails to follow this code of conduct, please notify Customer Services at Member Rights & Responsibilities are posted on the THC Website at and can be made available to providers upon request. Advanced Directives The Patient Self Determination Act 1990 allows competent adults the right to make decisions concerning medical care, including the right to accept or refuse any medical or surgical treatment and the right to formulate Advance Directives. Advance Directives are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. PCPs are asked to encourage members, as appropriate, to plan for medical care in the event of loss of decision-making ability by developing a Living Will or Durable Power of Attorney for Health Care. A copy of the directive should be maintained in the patient s medical record. A copy of the Advance Directive Michigan Notice to Patient can be found at wwwthcmi.com / Members; More Options, or contact the Provider Relations Department at 844-THC-DOCS. Provider Satisfaction Survey Results Thank you to our provider offices that participated in our 2017 Provider Satisfaction Survey. We appreciate your feedback and will continue to work on process improvement to serve your needs. Here are the survey highlights: Overall Satisfaction 88% of respondants rated THC as either Very Satisfied or Somewhat Satisfied 46% gave top box score of Very Satisfied In Comparison with other HMOs 41% rated Top Box Score of More Satisfied with THC Overall Performance in Last 12 Months 54% rated THC as Much or Somewhat Better Thanks to all participants. You can let us know how we re doing at any time. Contact your Provider Relations Representative with any questions or concerns you may have. 844-THC-DOCS Page 13

14 Leadership Randy Narowitz Chief Executive Officer Nicole Roush Chief Financial Officer Robyn Arrington, MD Medical Director Clinical Operations Anita Nesby-Flowers, RN Manager, Utilization Management Karen Connolly, RN Director, Quality Improvement Pharmacy Amber Jones Pharmacy Supervisor Claims LaDawn Wyatt Claims Manager Provider Network Services Susan Ryan Executive Mgr, Provider Network Services Anita Wallace Provider Relations Representative Networks: Oakwood Olympia Independent Physicians A-M Monroe Allied Physicians Pamela Long Provider Relations Representative Networks: Beaumont St John Providence United Physicians Medical Network One OPNS PMC Lauren Mrozek Provider Relations Representative Networks: DMC PHO OSP Wayne State University Physicians Group Independent Physicians N-Z Judith Idris Provider Relations Brittaney Burdette Credentialing specialist Exchange Operations Amy Farr Manager Beacon Health Options Behavioral Health Providers