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Founded in 1982 by Nazie Eftekhari The original Preferred Provider Organization

What’s New for 2016

✤  Continued Huge Growth!

✤  HealthEZ – 40% Growth

✤  America’s PPO - continues to be the primary network for Mayo Clinic Health Solutions for MN and WI

✤  Over 350,000 members through HealthEZ, national networks, insurance carriers and TPAs

Cost Plus Model - Health Reform•  HealthEZ administers partially self-funded plans – we are not an insurance company

nor do we have any government business •  Most of ACA has been implemented; biggest change was definition of small group –

delayed until late last year causing much chaos in the 50-100 market •  Employer Reporting causing many headaches

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Self-Funding in Health Reform MEC Plans Minimum Essential Coverage Only

HealthEZ ID cards state this on the front – Preventive Coverage Only

�for providers

✤  A HealthEZ member presents a HealthEZ ID card with the statement: No Payment Due at the Time of Service

✤  HealthEZ collects from the patient what they owe you

✤  You receive payment in full from HealthEZ, patient and plan funds, in one check

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with

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Illness Health

Chronic Condition

Management

AdvisingStep One

Foods

ChallengesSeminars

Activity BandsEZfit

Vaccinations

Preventive Care

Facilitation

Complex Care Management

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Advising

Step One Foods

Activity Bands

Challenges

Seminars

Vaccinations

EZfit

Boost Your Baby

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Claims

Biometrics

Comprehensive Health History

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Primary Care Models

✤  Primary Care Clinics

✤  Retrace Health

✤  Healthiest You

Other Models

Multiple benefit and network models in key national markets, including:

✤  Best-in-class plan design, carving out and dedicating key services to top performing providers.

✤  ACO-based plans, with moveable walls to allow for geographic and service flexibility.

Credentialing ProcessCriteria includes:

•  Current valid license to practice

•  Background of education and training

•  Board certification

•  Work history

•  Current malpractice insurance

•  We accept MN/SD/IA credentialing applications, universal credentialing application, as well as APPO custom application

•  All providers must be approved by the APPO credential committee

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Delegated Credentialing

Good for providers, good for payers:

•  Reduces turnaround for network participation

•  Quicker reimbursement from payers

•  Increases practitioner and patient satisfaction

Interested in becoming a provider in our delegated network?

•  Please see Chris Auger after the presentation

Member Education

✤  HealthEZ – access benefits, eligibility and claim status online 24/7

✤  Call Customer Service at 877-516-6687

✤  America’s PPO – 800-948-9451 •  If claims received, can call Customer Service with questions

•  Provider Services team is ready to assist with any other questions or issues and will work with provider and payer to get issues resolved as quickly as possible

•  All providers must be approved by the APPO credential committee

Organizational Structure

Executives

Provider Services

Finance

Amir Eftekhari President

Chris Auger Director, PPO

Josh Kutzler CFO

Ben Weidman Executive Vice President

Patrick Greenberg Provider Services Analyst

Kate Nelson Accounts Receivable Clerk

Jean LaFavor Vice President, Sales

Jaleesa Wright Provider Support Specialist

Emily Spear Staff Accountant

Eric Lamote Vice President, Risk