Common use of ATTACHMENT I Clause in Contracts

ATTACHMENT I. Verification of Beneficiary’s MCO Enrollment The following report was submitted by the state of Kansas on November 23, 2012, as a part of CMS’ KanCare review. This report describes the approved process for an MCO, network and non-network providers, or the state to confirm enrollment of enrollees who do not have a card or go to the wrong provider (see STC 54). ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Xxxxxx State Office Building Phone: 000-000-0000 000 XX Xxxxxxx Street, Room 900-N Fax: 000-000-0000 Topeka, KS 66612 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxx Xxxxxxxxx, Governor Xxxx Xxxxxxxx, Director KanCare Implementation Activity: Enrollment Verification Date Posted: Nov. 23, 2012 State: The State’s enrollment broker provides multiple options for verification of eligibility and enrollment into a plan through the current Kansas Medical Assistance Program (KMAP) system. KMAP has been the system used by providers over the past decade to access information related to eligibility, managed care enrollment, claims status, and other information. KMAP will provide the following access points for entities to verify a beneficiary’s eligibility and KanCare enrollment in absence of a Medicaid or KanCare MCO ID card. Different access points are available to different stakeholders such as MCOs, network/non-network providers or DHCF. Access Point Functionality Availability MCO Providers Network Non- Network State Fiscal Agent KMAP Secure Entities enrolled with KMAP have access to 22 hrs/day X X N/A N/A Web Site the Secure Web site. Through the site, a user 7 days/week can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth  Social Security No. and date of birth  Name and date of birth State Secure Web Site Approved users have access to the KMAP Secure Web Site realm used by enrolled MCOs and provider by accessing a dedicated State Secure Web site. Through the site, a user can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth 22 hrs/day 7 days/week N/A N/A N/A X X  Social Security No. and date of birth  Name and date of birth ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Automated Voice Response System Entities enrolled with KMAP have access to the Automated Voice Response System by dialing 0-000-000-0000. Through the phone line, a user can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth  Social Security No. and date of birth 22 hrs/day 7 days/week X X N/A N/A MMIS Access to all Medicaid-related information by authorized users. Users would share information verbally with requesting entities. 22 hrs/day 7 days/week N/A N/A X X KMAP Customer Service All entities can reach a KMAP Customer Service agent by calling 0-000-000-0000 (provider) or 0-000-000-0000 (beneficiary). 8 am – 5 pm Monday - Friday X X X X N/A MCO Processes The MMIS provides each MCO eligibility and enrollment information via the 834 to allow the MCO to share through their own access points. N/A X X The following chart profiles the information returned by the various access points in response to eligibility or enrollment verification. Access Point KMAP Eligibility MCO Enrollment TPL Carrier Medicare Plan Name Phone Name Address Phone Part A Part B KMAP Secure Web Site X X X X X X X X State Secure Web Site X X X X X X X X Automated Voice Response System X X X X X X X X MMIS X X X X X X X X KMAP Customer Service X X X X X X X X MCO Processes X X X X X X X X In addition, providers have the option of using MCO resources to verify enrollment. Please see below: MCOs: ►UnitedHealth care: There are several options available to members, providers or partners if a member’s eligibility requires verification. UnitedHealthcare has developed a secure portal called xxx.XxXXX.xxx, available through a link on www.UHCCommunityPlan.comand available only to KanCare members, which includes functionality to check eligibility and view / print an ID card. United also maintains a provider website and provider portal, UHCOnline, that gives all providers access to critical and timely information through a single source, facilitating better and more responsive care. Providers have round-the-clock access to the portal. Once the provider has completed registration, UHCOnlineprovides access to a variety of comprehensive plan information, including functionality that ATTACHMENT I Verification of Beneficiary’s MCO Enrollment allows providers to verify member eligibility and view member ID cards. Information and training is provided during educational tours. Members are encouraged to contact the Kansas Member Services team for help with any questions, including inquiries about their eligibility. Member Services answers member calls live between the hours of 8 AM and 8 PM CST, Monday through Friday. Additionally, providers have the opportunity to contact Provider Services toll-free number 24 hours / 7 days a week to access the Self Service tool, which provides eligibility information over the phone through an automated system. ► Sunflower Health Plan: Sunflower providers and Non-Par providers can use the following methods to verify enrollees’ eligibility if they present for services without an ID card or go to the wrong provider. Network Providers can confirm eligibility in the following ways: Use automated IVR line Call Member Services Department Use Secure Provider Portal functionality Use the KMAP site Non-Network Providers: Call Member Services Department Use IVR line Register on secure provider portal as a non-par Use the KMAP site ►Amerigroup: If the provider is attempting to verify if a member has coverage and the member does not have an ID card, the provider can a) contact the Amerigroup Provider Services team at 1-800-454- 3730 and/or b) check the Amerigroup provider services web portal. To check eligibility on the website at xxxxxxxxx.xxxxxxxxxx.xxx/xx, providers can use the Amerigroup eligibility lookup tool to get the most up-to-date member information. The provider would log in to the provider self-service site, click on Eligibility & Panel Listings in the Tools menu and select Eligibility. Please see below Amerigroup Check Eligibility Screen Shot for a display of how the web page appears. ATTACHMENT I Verification of Beneficiary’s MCO Enrollment ATTACHMENT J UC Pool: HCAIP Uniform Percentages The table below provides the uniform percentages for the UC HCAIP Pool (STC 68). Should the state elect to revise the uniform percentages for DY 1, the state must submit a revised Attachment J by April 30, 2013. The state must submit a revised version of this attachment to CMS by February 28th of DY 2 through 5 for review and approval. DY 1 DY 2 DY 3 DY 4 DY 5 Uniform Percentage 20.35% Specialty Service Uniform Percentage 4% Tri-Level NICU Services Uniform Percentage 10.92%

ATTACHMENT I. Verification of Beneficiary’s MCO Enrollment The following report was submitted by the state of Kansas on November 23, 2012, as a part of CMS’ KanCare review. This report describes the approved process for an MCO, network and non-network providers, or the state to confirm enrollment of enrollees who do not have a card or go to the wrong provider (see STC 54). ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Xxxxxx State Office Building Phone: 000-000-0000 000 XX Xxxxxxx Street, Room 900-N Fax: 000-000-0000 Topeka, KS 66612 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxx Xxxxxxxxx, Governor Xxxx Xxxxxxxx, Director KanCare Implementation Activity: Enrollment Verification Date Posted: Nov. 23, 2012 State: The State’s enrollment broker provides multiple options for verification of eligibility and enrollment into a plan through the current Kansas Medical Assistance Program (KMAP) system. KMAP has been the system used by providers over the past decade to access information related to eligibility, managed care enrollment, claims status, and other information. KMAP will provide the following access points for entities to verify a beneficiary’s eligibility and KanCare enrollment in absence of a Medicaid or KanCare MCO ID card. Different access points are available to different stakeholders such as MCOs, network/non-network providers or DHCF. Access Point Functionality Availability MCO Providers Network Non- Network State Fiscal Agent KMAP Secure Web Site Entities enrolled with KMAP have access to 22 hrs/day X X N/A N/A Web Site the Secure Web site. Through the site, a user 7 days/week can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth  • Social Security No. and date of birth  • Name and date of birth 22 hrs/day 7 days/week X X N/A N/A State Secure Web Site Approved users have access to the KMAP Secure Web Site realm used by enrolled MCOs and provider by accessing a dedicated State Secure Web site. Through the site, a user can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth • Social Security No. and date of birth • Name and date of birth 22 hrs/day 7 days/week N/A N/A N/A X X  Social Security No. and date of birth  Name and date of birth ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Automated Voice Response System Entities enrolled with KMAP have access to the Automated Voice Response System by dialing 0-000-000-0000. Through the phone line, a user can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth  • Social Security No. and date of birth 22 hrs/day 7 days/week X X N/A N/A MMIS Access to all Medicaid-related information by authorized users. Users would share information verbally with requesting entities. 22 hrs/day 7 days/week N/A N/A X X KMAP Customer Service All entities can reach a KMAP Customer Service agent by calling 0-000-000-0000 (provider) or 0-000-000-0000 (beneficiary). 8 am – 5 pm Monday - Friday X X X X N/A MCO Processes The MMIS provides each MCO eligibility and enrollment information via the 834 to allow the MCO to share through their own access points. N/A X X The following chart profiles the information returned by the various access points in response to eligibility or enrollment verification. Access Point KMAP Eligibility MCO Enrollment TPL Carrier Medicare Plan Name Phone Name Address Phone Part A Part B KMAP Secure Web Site X X X X X X X X State Secure Web Site X X X X X X X X Automated Voice Response System X X X X X X X X MMIS X X X X X X X X KMAP Customer Service X X X X X X X X MCO Processes X X X X X X X X In addition, providers have the option of using MCO resources to verify enrollment. Please see below: MCOs: ►UnitedHealth care: There are several options available to members, providers or partners if a member’s eligibility requires verification. UnitedHealthcare has developed a secure portal called xxx.XxXXX.xxx, available through a link on www.UHCCommunityPlan.comand available only to KanCare members, which includes functionality to check eligibility and view / print an ID card. United also maintains a provider website and provider portal, UHCOnline, that gives all providers access to critical and timely information through a single source, facilitating better and more responsive care. Providers have round-the-clock access to the portal. Once the provider has completed registration, UHCOnlineprovides access to a variety of comprehensive plan information, including functionality that ATTACHMENT I Verification of Beneficiary’s MCO Enrollment allows providers to verify member eligibility and view member ID cards. Information and training is provided during educational tours. Members are encouraged to contact the Kansas Member Services team for help with any questions, including inquiries about their eligibility. Member Services answers member calls live between the hours of 8 AM and 8 PM CST, Monday through Friday. Additionally, providers have the opportunity to contact Provider Services toll-free number 24 hours / 7 days a week to access the Self Service tool, which provides eligibility information over the phone through an automated system. ► Sunflower Health Plan: Sunflower providers and Non-Par providers can use the following methods to verify enrollees’ eligibility if they present for services without an ID card or go to the wrong provider. Network Providers can confirm eligibility in the following ways: Use automated IVR line Call Member Services Department Use Secure Provider Portal functionality Use the KMAP site Non-Network Providers: Call Member Services Department Use IVR line Register on secure provider portal as a non-par Use the KMAP site ►Amerigroup: If the provider is attempting to verify if a member has coverage and the member does not have an ID card, the provider can a) contact the Amerigroup Provider Services team at 1-800-454- 3730 and/or b) check the Amerigroup provider services web portal. To check eligibility on the website at xxxxxxxxx.xxxxxxxxxx.xxx/xx, providers can use the Amerigroup eligibility lookup tool to get the most up-to-date member information. The provider would log in to the provider self-service site, click on Eligibility & Panel Listings in the Tools menu and select Eligibility. Please see below Amerigroup Check Eligibility Screen Shot for a display of how the web page appears. ATTACHMENT I Verification of Beneficiary’s MCO Enrollment ATTACHMENT J UC Pool: HCAIP Uniform Percentages The table below provides the uniform percentages for the UC HCAIP Pool (STC 68). Should the state elect to revise the uniform percentages for DY 1, the state must submit a revised Attachment J by April 30, 2013. The state must submit a revised version of this attachment to CMS by February 28th of DY 2 through 5 for review and approval. DY 1 DY 2 DY 3 DY 4 DY 5 Uniform Percentage 20.35% Specialty Service Uniform Percentage 4% Tri-Level NICU Services Uniform Percentage 10.92%

ATTACHMENT I. Verification of Beneficiary’s MCO Enrollment The following report was submitted by the state of Kansas on November 23, 2012, as a part of CMS’ KanCare review. This report describes the approved process for an MCO, network and non-network providers, or the state to confirm enrollment of enrollees who do not have a card or go to the wrong provider (see STC 54). ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Xxxxxx State Office Building Phone: 000-000-0000 000 XX Xxxxxxx Street, Room 900-N Fax: 000-000-0000 Topeka, KS 66612 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxx Xxxxxxxxx, Governor Xxxx Xxxxxxxx, Director KanCare Implementation Activity: :Enrollment Verification Date Posted: Nov. 23, 2012 State: The State’s enrollment broker provides multiple options for verification of eligibility and enrollment into a plan through the current Kansas Medical Assistance Program (KMAP) system. KMAP has been the system used by providers over the past decade to access information related to eligibility, managed care enrollment, claims status, and other information. KMAP will provide the following access points for entities to verify a beneficiary’s eligibility and KanCare enrollment in absence of a Medicaid or KanCare MCO ID card. Different access points are available to different stakeholders such as MCOs, network/non-network providers or DHCF. Access Point Functionality Availability MCO Providers Network Non- Network State Fiscal Agent KMAP Secure Entities enrolled with KMAP have access to 22 hrs/day X X N/A N/A Web Site the Secure Web site. Through the site, a user 7 days/week can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth  Social Security No. and date of birth  Name and date of birth State Secure Web Site Approved users have access to the KMAP Secure Web Site realm used by enrolled MCOs and provider by accessing a dedicated State Secure Web site. Through the site, a user can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth 22 hrs/day 7 days/week N/A N/A N/A X X  Social Security No. and date of birth  Name and date of birth ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Automated Voice Response System Entities enrolled with KMAP have access to the Automated Voice Response System by 22 hrs/day 7 days/week X X N/A N/A ATTACHMENT I Verification of Beneficiary’s MCO Enrollment System dialing 0-000-000-0000. Through the phone line, a user can verify eligibility by keying a valid combination of the following:  Beneficiary ID and date of birth  Social Security No. and date of birth 22 hrs/day 7 days/week X X N/A N/A MMIS Access to all Medicaid-related information by authorized users. Users would share information verbally with requesting entities. 22 hrs/day 7 days/week N/A N/A X X KMAP Customer Service All entities can reach a KMAP Customer Service agent by calling 0-000-000-0000 (provider) or 0-000-000-0000 (beneficiary). 8 am – 5 pm Monday - Friday X X X X N/A MCO Processes The MMIS provides each MCO eligibility and enrollment information via the 834 to allow the MCO to share through their own access points. N/A X X The following chart profiles the information returned by the various access points in response to eligibility or enrollment verification. Access Point KMAP Eligibility MCO Enrollment TPL Carrier Medicare Plan Name Phone Name Address Phone Part A Part B KMAP Secure Web Site X X X X X X X X State Secure Web Site X X X X X X X X Automated Voice Response System X X X X X X X X MMIS X X X X X X X X KMAP Customer Service X X X X X X X X MCO Processes X X X X X X X X In addition, providers have the option of using MCO resources to verify enrollment. Please see below: MCOs: ►UnitedHealth care: There are several options available to members, providers or partners if a member’s eligibility requires verification. UnitedHealthcare has developed a secure portal called xxx.XxXXX.xxx, available through a link on www.UHCCommunityPlan.comand available only to KanCare members, which includes functionality to check eligibility and view / view/print an ID card. United also maintains a provider website and provider portal, UHCOnline, that gives all providers access to critical and timely information through a single source, facilitating better and more responsive care. Providers have round-the-clock access to the portal. Once the provider has completed registration, UHCOnlineprovides access to a variety of comprehensive plan information, including functionality that ATTACHMENT I Verification of Beneficiary’s MCO Enrollment allows providers to verify member eligibility and view member ID cards. Information and training is provided during educational tours. ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Members are encouraged to contact the Kansas Member Services team for help with any questions, including inquiries about their eligibility. Member Services answers member calls live between the hours of 8 AM and 8 PM CST, Monday through Friday. Additionally, providers have the opportunity to contact Provider Services toll-free number 24 hours / 7 hours/7 days a week to access the Self Service tool, which provides eligibility information over the phone through an automated system. ► Sunflower Health Plan: Sunflower providers and Non-Par providers can use the following methods to verify enrollees’ eligibility if they present for services without an ID card or go to the wrong provider. Network Providers can confirm eligibility in the following ways: Use automated IVR line Call Member Services Department Use Secure Provider Portal functionality Use the KMAP site Non-Network Providers: Call Member Services Department Use IVR line Register on secure provider portal as a non-par Use the KMAP site ►Amerigroup: If the provider is attempting to verify if a member has coverage and the member does not have an ID card, the provider can a) contact the Amerigroup Provider Services team at 1-800-454- 454-3730 and/or b) check the Amerigroup provider services web portal. To check eligibility on the website at xxxxxxxxx.xxxxxxxxxx.xxx/xx, providers can use the Amerigroup eligibility lookup tool to get the most up-to-date member information. The provider would log in to the provider self-service site, click on Eligibility & Panel Listings in the Tools menu and select Eligibility. Please see below Amerigroup Check Eligibility Screen Shot for a display of how the web page appears. ATTACHMENT I Verification of Beneficiary’s MCO Enrollment ATTACHMENT J UC Pool: HCAIP Uniform Percentages The table below provides the uniform percentages for the UC HCAIP Pool (STC 68). Should the state elect to revise the uniform percentages for DY 11 and the inpatient net patient revenue threshold, the state must submit a revised Attachment J by April 30, 2013. The state must submit a revised version of this attachment to CMS by February 28th of DY 2 through 5 for review and approval. DY 1 DY 2 DY 3 DY 4 DY 5 Uniform Percentage 20.3518.55% Specialty Service Uniform Percentage 43.72% Tri-Level NICU Services Uniform Percentage 10.92%% Tri-Specialty Uniform Percentage 11.83% Tri-Specialty Inpatient Net Patient Revenue Threshold Date revised 12/23/2013 ATTACHMENT K DSRIP Focus Areas [PLACEHOLDER: Following CMS review and approval, the DSRIP Focus Areas (see STC 69) will be placed in this attachment] ATTACHMENT L ID/DD Pilot Project This Pilot Project sunsets on January 31, 2014 with the incorporation of ID/DD (KS-0224) LTSS benefits into managed care effective February 1, 2014. The following report was submitted by the state of Kansas on December 4, 2012, as a part of CMS’ KanCare review. This report further describes the demonstration year 1 DD Pilot Project discussed in STC 52. The value-added services referenced in the report below are the result of contract negotiations between the state and its contracted MCOs. These value-added services are funded through MCO overhead and are not expenditures for which the state receives FFP. The charts of value-added services provided by each MCO are illustrative examples, and reflect the anticipated value-added services as of December 4, 2012.

ATTACHMENT I. Verification of Beneficiary’s MCO Enrollment The following report was submitted by the state of Kansas on November 23, 2012, as a part of CMS’ KanCare review. This report describes the approved process for an MCO, network and non-network providers, or the state to confirm enrollment of enrollees who do not have a card or go to the wrong provider (see provider(see STC 54). ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Xxxxxx State Office Building 000 XX Xxxxxxx Street, Room 000-X Xxxxxx, XX 00000 Xxxxxx Xxxxx, MD, Secretary Xxxx Xxxxxxxx, Director Phone: 000-000-0000 000 XX Xxxxxxx Street, Room 900-N Fax: 000-000-0000 Topeka, KS 66612 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxx Xxxxxxxxx, Governor Xxxx Xxxxxxxx, Director KanCare Implementation Activity: Enrollment Verification Date Posted: Nov. 23, 2012 State: Network The State’s enrollment broker provides multiple options for verification of eligibility and enrollment into a plan through the current Kansas Medical Assistance Program (KMAP) system. KMAP has been the system used by providers over the past decade to access information related to eligibility, managed care enrollment, claims status, and other information. KMAP will provide the following access points for entities to verify a beneficiary’s eligibility and KanCare enrollment in absence of a Medicaid or KanCare MCO ID card. Different access points are available to different stakeholders such as MCOs, network/non-network providers or DHCF. Access Point Functionality Availability MCO Providers Network Non- Network State Fiscal Agent KMAP Secure Web Site Entities enrolled with KMAP have access to 22 hrs/day X X N/A N/A Web Site the Secure Web site. Through the site, a user 7 days/week can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth  X X N/A N/A • Social Security No. and date of birth  • Name and date of birth State Secure Web Site Approved users have access to the KMAP Secure Web Site realm used by enrolled MCOs and provider by accessing a dedicated State Secure Web site. Through the site, a user can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth 22 hrs/day 7 days/week N/A N/A N/A X X  • Social Security No. and date of birth  • Name and date of birth Automated Entities enrolled with KMAP have access to 22 hrs/day X X N/A N/A ATTACHMENT I Verification of Beneficiary’s MCO Enrollment Automated Voice Response System Entities enrolled with KMAP have access to the Automated Voice Response System by 7 days/week System dialing 0-000-000-0000. Through the phone line, a user can verify eligibility by keying a valid combination of the following:  • Beneficiary ID and date of birth  • Social Security No. and date of birth 22 hrs/day 7 days/week X X N/A N/A MMIS Access to all Medicaid-related information by authorized users. Users would share information verbally with requesting entities. 22 hrs/day 7 days/week N/A N/A X X KMAP Customer Service All entities can reach a KMAP Customer Service agent by calling 0-000-000-0000 (provider) or 0-000-000-0000 (beneficiary). 8 am – 5 pm Monday - ­ Friday X X X X N/A MCO Processes The MMIS provides each MCO eligibility and enrollment information via the 834 to allow the MCO to share through their own access points. N/A X X The following chart profiles the information returned by the various access points in response to eligibility or enrollment verification. Access Point KMAP Eligibility MCO Enrollment TPL Carrier Medicare Plan Name Phone Name Address Phone Part A Part B KMAP Secure Web Site X X X X X X X X State Secure Web Site X X X X X X X X Automated Voice Response System X X X X X X X X MMIS X X X X X X X X KMAP Customer Service X X X X X X X X MCO Processes X X X X X X X X In addition, providers have the option of using MCO resources to verify enrollment. Please see below: MCOs: ►UnitedHealth care: There are several options available to members, providers or partners if a member’s eligibility requires verification. UnitedHealthcare has developed a secure portal called xxx.XxXXX.xxx, available through a link on www.UHCCommunityPlan.comand available only to KanCare members, which includes functionality to check eligibility and view / print an ID card. United also maintains a provider website and provider portal, UHCOnline, that gives all providers access to critical and timely information through a single source, facilitating better and more responsive care. Providers have round-the-clock access to the portal. Once the provider has completed registration, UHCOnlineprovides access to a variety of comprehensive plan information, including functionality that ATTACHMENT I Verification of Beneficiary’s MCO Enrollment allows providers to verify member eligibility and view member ID cards. Information and training is provided during educational tours. Members are encouraged to contact the Kansas Member Services team for help with any questions, including inquiries about their eligibility. Member Services answers member calls live between the hours of 8 AM and 8 PM CST, Monday through Friday. Additionally, providers have the opportunity to contact Provider Services toll-free number 24 hours / 7 days a week to access the Self Service tool, which provides eligibility information over the phone through an automated system. ► Sunflower Health Plan: Sunflower providers and Non-Par providers can use the following methods to verify enrollees’ eligibility if they present for services without an ID card or go to the wrong provider. Network Providers can confirm eligibility in the following ways: Use automated IVR line Call Member Services Department Use Secure Provider Portal functionality Use the KMAP site Non-Network Providers: Call Member Services Department Use IVR line Register on secure provider portal as a non-par Use the KMAP site ►Amerigroup: If the provider is attempting to verify if a member has coverage and the member does not have an ID card, the provider can a) contact the Amerigroup Provider Services team at 1-800-454- 3730 and/or b) check the Amerigroup provider services web portal. To check eligibility on the website at xxxxxxxxx.xxxxxxxxxx.xxx/xx, providers can use the Amerigroup eligibility lookup tool to get the most up-to-date member information. The provider would log in to the provider self-service site, click on Eligibility & Panel Listings in the Tools menu and select Eligibility. Please see below Amerigroup Check Eligibility Screen Shot for a display of how the web page appears. ATTACHMENT I Verification of Beneficiary’s MCO Enrollment ATTACHMENT J UC Pool: HCAIP Uniform Percentages The table below provides the uniform percentages for the UC HCAIP Pool (STC 68). Should the state elect to revise the uniform percentages for DY 1, the state must submit a revised Attachment J by April 30, 2013. The state must submit a revised version of this attachment to CMS by February 28th of DY 2 through 5 for review and approval. DY 1 DY 2 DY 3 DY 4 DY 5 Uniform Percentage 20.35% Specialty Service Uniform Percentage 4% Tri-Level NICU Services Uniform Percentage 10.92%% Tri-Specialty Uniform Percentage 11.83% Date revised 11/28/2012 ATTACHMENT K DSRIP Focus Areas [PLACEHOLDER: Following CMS review and approval, the DSRIP Focus Areas (see STC 69) will be placed in this attachment] ATTACHMENT L ID/DD Pilot Project The following report was submitted by the state of Kansas on December 4, 2012, as a part of CMS’ KanCare review. This report further describes the demonstration year 1 DD Pilot Project discussed in STC 52. The value-added services referenced in the report below are the result of contract negotiations between the state and its contracted MCOs. These value-added services are funded through MCO overhead and are not expenditures for which the state receives FFP. The charts of value-added services provided by each MCO are illustrative examples, and reflect the anticipated value-added services as of December 4, 2012.