Overview of Services provided to our affiliated providers

• Patient placement
• Patient Care Management
• Centralized Billing
• Centralized Contracting
• Community Based Marketing
• Provider credentialing
• Quality assurance
• Scope of Network

In addition, the following value added services are offered:

• Mock Survey Program - A proactive readiness plan for your next HCFA Survey
• CEU presentations
• Educational In-Services brought directly to your facility

Patient Placement

Each network affiliated provider is required to send weekly, and in some cases daily, census reports to our office. As a result, all MNS case management service representatives have an accurate assessment of the bed availability at each location. The case management service representative will communicate this information to the hospital discharge planner or case manager. Based on each individual payor requirements, MNS may facilitate the transfer of the patient to the facility and perform all necessary insurance verification and pre-certification functions prior to the patient's discharge.

Patient Care Management

By maintaining continuous contact between the payor and provider, our personable and professional case management services staff facilitates patient placement, care review or coordination, and discharge planning. Therefore, our complimentary case management services provide our payors and providers with consistent coordination of benefits and care, increased accountability, and also enables each payor/provider to have one contact for each individual patient.

Case management services are available 24 hours a day, 7 days a week, 365 days per year.

Centralized Billing

The provider is required to bill MNS directly in order to receive payment for applicable inclusive per diems, exclusions, and Part B services.

On behalf of the skilled patients residing with our affiliated providers, MNS invoices contracted Payors weekly based on payor medical management decisions regarding current progress and clinical case management information.

Centralized Contracting

Affiliated Provider Selection

MNS's contracting goal is to provide county access for each insurance payor as needed. In urban areas MNS enrolls affiliated providers based upon payor market demand. In rural areas we enter the market only if beneficiaries are residing in the market. This demand is dynamic as payors initiate or withdraw member products based on past successes or expected market performance.

From time to time MNS is directed to enroll specific affiliated providers by individual payors. This results in "select networks" within the greater MNS network. At every opportunity we offer the entire network to our payor contracting community.

MNS is independent and does not own, operate, or manage facilities. We serve for profit, not for profit, privately owned as well as corporately owned facilities. In order to operate in some states, MNS has instituted application and membership fees. If your state operates with such a fee then the policy regarding such follows the "Agreement for Membership Services".

Facilities at a minimum must pass our critical criteria as described in the MNS Quality Programs to be considered for membership in the MNS network. Occasionally an insurance contract may require a facility to meet a standard higher than MNS's credentialing criteria (i.e. JCAHO, CARF, etc).

Master Contract

Every affiliated provider executes a master contract with MNS. This contract delineates the responsibilities of both MNS and the provider.

These responsibilities include but are not limited to:

• Submission and Payment of invoices
• Selection of payer contracts
• Participation in quality programs

Selection of Payor Contracts

Each affiliated provider, upon joining the MNS network, has the opportunity to select any or all payer contracts that are available in there service area. After reviewing the contracted rates, the affiliated provider simply signs the rate sheet indicating they would like to participate, returns the signature sheet to MNS and may begin accepting patients. There are however a few exceptions. MNS has a few managed care contracts that require a separate application and/or enrollment process in order to participate in their network. The enrollment process still involves reviewing the rates, signing the rate sheet and returning the signature sheet to MNS. The key difference is that the provider cannot begin accepting patients until they are notified by MNS that their request to join that particular managed care network has been accepted. Beech Street, HomeTown and Medical Mutual are examples of those contracts that require separate applications and approval into their network. Note: payers can elect to utilize the entire network or selected providers to supply services.

A provider may choose to negotiate directly with a payer that they are currently utilizing through MNS if and only if the provider cancels the current payor contract with MNS. If a provider chooses to belong to other networks (this is also in keeping with our "win- win" philosophy) they may do so; however the provider may not have multiple contracts for the same payer.

MNS constantly monitors existing payor contracts and aggressively markets to new payers for additional contracts. As contracts are renegotiated/negotiated MNS sends network affiliated providers copies of the rates along with the corresponding rates sheets so that they may choose which contracts they wish to participate in through MNS.

Community Based Marketing

MNS will market your facility as well as the network to insurance payors, hospitals and physician groups. Although MNS performs extensive marketing efforts statewide, we strongly encourage our affiliated providers to promote their own facility and the network by distributing MNS published material which is available by calling MNS.

Also, affiliated providers may arrange with MNS to offer formal CEU presentations to outside referral sources. If requested, MNS will also arrange presentations with speakers from local insurance payors.

Provider Credentialing

Each facility is credentialed prior to becoming an affiliated provider in the MNS network and prior to the execution of a Network Agreement. MNS has been approved by several major insurance companies to conduct these credentialing surveys on their behalf. The credentialing process involves the following:

1. Review of the Request for Information (RFI)
2. Credentialing assessment conducted by a MNS representative utilizing the MNS Credentialing Tool
3. The MNS Credentialing Committee then reviews the collected facility data. The committee will make a decision concerning a facility's participation in the MNS network by combining standards set forth by OBRA (Medicare), JCAHO, and NCQA. The facility will be informed by a MNS representative of the committee's decision; if the facility is accepted into the MNS network a MNS representative will inservice the facility's staff regarding MNS services and processing of insurance patients.

Re-Credentialing

Re-credentialing will occur at a minimum of every three years. The re-credentialing survey consists of:

• Credentialing assessment is conducted by a MNS representative
• Review of facility file for current Licensure and Compliance to HCFA and Contracted Payor quality standards

The MNS representative will provide feedback to the facility management using the Summary of Survey Results concerning areas of strength, concern, and opportunities for improvement.

Quality Assurance

Each facility is credentialed prior to becoming a member of the network. MNS has received "delegated credentialing status" by several major insurance companies to credential each facility. Insurance companies are periodically surveyed by NCQA which gives them a quality seal of approval. Contracting with "credentialed" facilities is necessary for obtaining NCQA approval. This is as important to them as HCFA surveys are to all our members.

The MNS Credentialing Committee makes the final decision concerning a facility's initial or continued participation in the MNS network. The facility will be informed by MNS regarding their status of application and re-credentialing process.

Scope of Network

MNS currently serves preferred providers across the country in addition to servicing over 20 major Managed Care Organization contracts. The influence and enthusiasm generated by the network is considerable. In 1996, two local community-based SNF networks existed in Ohio and the market continued to grow to over ten. Despite PPS changes and the phasing out of some Senior Medicare + Choice plans in the state, MNS has thrived, consolidated and grown in membership and resources. We are proud to have over 300 member facilities in Ohio with an additional 350 facilities across the country. Our commitment to personal service, accountability, education and marketing has built a reputation that makes us a distinctive partner to both providers and payors.

Business Operations

MNS will bill each payor at the beginning of each week for those patients whose covered stay ended during the prior week, or for all patients at the end of the month. MNS currently bills electronically and is in the process of setting up EFT with each payor.

Affiliated Provider Claim Submission:

Affiliated Providers are to submit claims for all contracted payor patients to MNS.

Claims are to be submitted to:
Claims Processing
Management and Network Services
4892 Blazer Parkway
Dublin, Ohio 43017

Claim Form

Claims are to be submitted on a UB-92 along with a copy of the front and back of the patient's insurance card.

Date of Submission Requirements

Affiliated Providers are to bill MNS by the tenth day of the month for services rendered up to the last day of the previous month. This billing may include patients who have been discharged or those under continued care. MNS will not be obligated to pay claims submitted more than 90 days after the date of service.