UK
HUMANA
OVERVIEW OF
ADMINISTRATIVE SERVICES
OCTOBER 3, 2001
HUMANA PARTICIPANTS
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Cindy Wise, Director of Large Group Sales
Ninette Gaither, Director Large Account Executives
Terri Lacefield, Director Operations, Self-Funded Solutions
Reno Altschul, Account Manager, Lexington Market
Debbie Griffith, Manager Self-Funded KY Market
Carla Whaley, VP Commercial Sales
Betsy Warren, Clinical Manager, Outcomes Analysis
Kevin Zurlage, Director Provider Operations, Lexington
Market
Agenda
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Reno Altschul
Introduction
Cindy Wise
Humana Today
Terri Lacefield
Operations
Kevin Zurlage
Network
Betsy WarrenPharmacy
Cindy Wise
Administrative Services
Humana in the Future
University of Kentucky/Humana
Network Strategy
Goals
• Maximize member access to participating providers in
a PPO network
• Access best provider discounts to lessen costs to
University/Employees
Strategy
• Utilize Humana’s cost effective network wherever
member access is adequate
• Supplement with Choice Care Network for wider
coverage and more provider choice
• Fill gaps with Healthstar/PPO Next network to offer
maximum number of members access to PPO plan
Humana/Choice Care Network - 88 counties
Humana & Healthstar (PPO Network) - 11 counties
Choice Care & Healthstar (PPO Network) - 12 counties
Boone
Kenton
Campbell
Humana (Indemnity) - 9 counties
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13
Gallatin
24
Robertson
Carroll
4
4
Oldham
Henry
3
13
Jefferson
338
Hancock
Henderson
4
101
Union
6
Webster
12
Livingston
Crittenden
3
McCracken
Ballard
Daviess
70
McLean
4
Hopkins
93
15
4
Carlisle
128
24
Marshall
4
Hickman
6
Fulton
5
Lyon
12
Graves
20
Trigg
9
Ohio
13
Muhlenburg
7
Christian
58
Todd
5
Edmonson 5
Warren
17
Simpson
6
Barren
3
Allen
6
Marion
6
Metcalfe
4
Monroe 5
Adair
4
Cumberland
2
Mercer
91
Rowan
21
Bath
23
Wolfe
14
Estill
20
Jackson Owsley
Rock19
7
castle
17
Pulaski
170
Laurel
24
Russell
8
Wayne
21
Clay
7
Knox
11
13
Mccreary
Elliott
4
Morgan
4
Boyle
67
Casey
6
Carter
13
Clark
244
Madison
275
Lincoln
23
Greenup
19
Lewis
9
Fleming
14
Bourbon
181
WoodFayette
ford
325
9941
Washington
Mason
60
Harrison
51
Jessamine
744
Taylor
2
Hart
6
3
Scott
244
4
Spencer
14
Larue
10
Grayson
15
Butler
6
Logan
6
Hardin
133
Owen
15
Shelby
26
Bullitt
11 Nelson
10
Breckenridge
5
Grant
21
4
Trimble
Whitley
21
Floyd
92
Breathitt
77
Perry
133
Knott
17
Leslie
19
Harlan
98
Bell
23
Calloway
11
UK Actives and Retirees
Pike
24
Fayette & Surrounding Counties
Humana &Choice Care Network Participation
County
Fayette
Bourbon
Clark
Jessamine
Madison
Woodford
TOTALS
Hospitals
5/5
1/1
1/1
0/0
1/2
1/1
9/11
Area Penetration Hospital - 90%
Primary Care
Physicians
245
13
17
15
39
20
369
Specialist
Physicians
830
14
50
0
66
15
1008
Area Penetration Physician - 90%
Statewide Penetration Hospital - 79% Statewide Penetration Physician - 76%
Network Status/Next Steps
• Expand Choice Care Network
– 124/214 targeted physicians completed
– 4/12 targeted hospitals completed
• Pulaski County
• Humana/Choice Care Networks
Humana Today
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Health Benefits Company - 40 years old
Kentucky Corporate Office with National Presence
15 Years of Experience in Self Funding
Presence in all 50 States
Disease Management
– Disease Management News Ranked Humana Best in Nation
– Disease Management Purchasing Consortium Recognition
• Internet Abilities
– Top 10 Ranking by Web Criteria for User Experience &
Accessibility
– Ranked 29th of 500 in PC Week
• Web Site Link to Healtheon/MD
• Onsite Claims Summary for Individuals
Humana Today
• Technology
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On-Line Enrollment and Eligibility Verification
Automated Enrollment
Secure, Convenient Access to Health Records
Information Management Software for Claims
Payment and Customer Service
– ID Card Requests On-Line
– Member Benefit Information
– SPD On-Line Requests
UK Administrative Services
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Claims Administration
Network Access
Utilization Review (Personal Nurse)
HumanaFirst
HumanaBeginnings
Interface with Stoploss Carrier
Reports (Monthly, Quarterly, Annually)
On-Site Representation - Local Representatives
- Monthly On-Site Claims Processor
• ID Cards
• Production of Summary Plan Descriptions (SPD’s)
Humana in the Future
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Testing New Products on Ourselves
Emphysis
Provider Directory Printing on Demand
E-Mail Access to Customer Service
Notification of Doctor’s Appointment
Smart Card Technology
Constant Evolution
Making it Easier to do Business with Us: Lexmark, GE, Dell
Computers
@ Humana:
Revolutionizing the Health Care Experience
for our Large Group Customers