Voice FALL 2016 IN THIS ISSUE: NON-PARTICIPATING LAB USAGE PCP MEDICARE AFFILIATION LETTERS BLOOD PRESSURES: TAKE TWO MEDICARE OPEN ENROLLMENT

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1 FALL 2016 Voice IN THIS ISSUE: NON-PARTICIPATING LAB USAGE BLOOD PRESSURES: TAKE TWO SECTION 1557 NONDISCRIMINATION NEW ICD10 CODES DOCUMENTATION TIPS NEW ICD10 CODE FOR DIABETIC EYE CARE PATIENTS STAR RATINGS UPDATE PHARMACY QUALITY ALLIANCE: DRUG-DRUG INTERACTIONS PCP MEDICARE AFFILIATION LETTERS MEDICARE OPEN ENROLLMENT GUIDE TO DRUG INTERACTIONS IN-OFFICE SURGICAL PROCEDURES INJECTIONS REQUIRING PRIOR AUTHORIZATION HOLIDAY SCHEDULE EFT AVAILABILITY CHRONIC CARE MANAGEMENT CPT CODE 99490

2 NON-PARTICIPATING LAB USAGE Viva Health is dedicated to working with you to ensure quality care is provided at the lowest cost possible to our members. We need help from you to continue this effort. According to your provider contract, you should only refer patients to participating providers, including participating labs. If you use a non-par lab, look for communication from Viva Health regarding a change in our policy that may negatively affect your fee schedule. Our participating laboratories are as follows: PARTICIPATING LABORATORIES: Labcorp Quest Diagnostics Accupath Diagnostics Laboratories Inc American Esotertic Laboratories Assurance Scientific Laboratories Sequenom Center for Molecular Medicine Regional Biomedical Lab Compass Lab If you have a question regarding participating laboratories, please contact our Customer Service Department at or verify with your Provider Representative. BLOOD PRESSURES: TAKE TWO The blood pressure measurement is an important part of a member s health profile, and is the most commonly performed office test. As healthcare providers, getting an accurate picture of blood pressures and charting what happens over time is important to proper diagnosis and monitoring of hypertension. For members with a hypertension diagnosis, controlling blood pressure is vital to maintaining their health and preventing further complications. Small inaccuracies in blood pressure measurement can have considerable consequences on patient care. Overestimating or underestimating blood pressure may label a patient with pre-hypertension when true hypertension is present, or lead to inappropriate treatment with antihypertension medications. Additionally, blood pressure readings recorded in the chart are used for annual quality measurement assessment. This review process requires gathering documented blood pressures from physician charts to determine if the patient s hypertension is adequately controlled or not. Viva participates in this quality review process, and reports the outcomes to the National Committee on Quality Assurance (NCQA) and the Centers for Medicare &Medicaid Services (CMS.) The outcomes are then used in the health plan rating process. How can the clinician obtain more accurate blood pressure readings? Remember these key elements: If the patient needs to empty their bladder, allow them to do so beforehand. Allow the patient to sit quietly for a few minutes before taking his/her blood pressure. Make sure that the patient is relaxed and calm before proceeding. 1

3 Be aware that digital blood pressure monitors are extremely sensitive to body movements and positioning. If using a battery-powered digital blood pressure monitor, ensure the batteries are fresh and of good strength. The right cuff size is very important. Be sure to use the correct cuff size for the patient. Ask the patient to roll up his or her sleeve before applying the blood pressure cuff. If the sleeve is too tight, it may act as tourniquet, thereby giving an inaccurate reading. Ask the patient to sit up straight with their arm stretched forward, palm facing up, and slightly bent. The upper arm should be level with the heart. Some patients may wish to rest their arm on a table or armrest for added support. Feet should remain flat on the floor during the test. Both patient and clinician should refrain from talking during the test. If the reading is higher than goal, take the patient s blood pressure once or twice again for accuracy, and document the additional readings in the patient record. It is necessary to wait at least five (5) minutes between readings so that the flow of blood is restored in the arm. Recommended blood pressure guidelines for patients with hypertension are: Age 18-59: <140/90 Age (not diabetic): <150/90 If diabetic, any age: <140/90 For Viva members with hypertension, see your patient at least once annually, perform a complete physical exam, with a medication review, and document their blood pressure. And take two! SECTION 1557: NONDISCRIMINATION IN HEALTH PROGRAMS & ACTIVITIES In May, Health and Human Services (HHS) released Section 1557 of the Affordable Care Act, which addresses nondiscrimination in health programs and activities. This rule applies to any health program that receives Federal financial assistance from HHS. Section 1557 prohibits discrimination based on race, color, national origin, sex, age or disability in certain health programs. This builds on previous civil rights laws prohibiting sex discrimination in health care, including prohibiting the denial of health care or coverage based on an individual s sex, discrimination based on pregnancy, or gender identity, and sex stereotyping. Section 1557 includes a notice requirement for all covered entities. This notice is required to include a statement stating that covered entities do not discriminate based on the classes covered under the rule, a statement saying covered entities will provide free auxiliary aids and services to individuals with disabilities, information on how an individual can access free aids and services, contact information for the covered entity s Civil Rights Coordinator, information on how to file a grievance, and how to file a complaint with OCR. 2

4 In addition to the notice requirement, covered entities are required to include taglines in the top 15 non- English speaking languages in the state. The full notice and taglines are required to go on significant publications or significant communications targeted to beneficiaries, enrollees, applicants, or members of the public, which may include outreach publications or written notices pertaining to rights or benefits or requiring a response from an individual. It is also required to be posted in conspicuous physical locations and on the home page of the covered entity s website. For small-sized significant publications (brochures, fliers, etc.), the rule establishes a separate shorter requirement in lieu of the full notice. The covered entity must include a nondiscrimination statement and taglines in the top two non-english languages. Section 1557 was effective as of July 18, The final rule establishes that to the extent the provisions of the rule require changes to health insurance or group health plan benefit design, these provisions are applicable the first day of the plan year beginning on or after January 1, The rule also states that the notices and taglines are to be posted within 90 days of the effective date, which will be mid- October. Providers need to be aware of the new requirements and ensure compliance with Section For more information on Section 1557, please visit the Department of Health and Human Services website at: NEW ICD-10 CODES: EFFECTIVE OCTOBER 1, 2016 The Centers for Medicare & Medicaid Services (CMS) released the new 2017 ICD10 codes. ICD-10-CM changes include the addition of 1,943 new diagnostic codes with 422 revisions and some 3,651 new ICD-10 PCS inpatient procedure codes for FY 2017 and are available at: Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. ATTENTION PROVIDERS: IT IS MANDATORY THAT YOU BILL CPT CATEGORY II CODES ON YOUR Viva Medicare CLAIMS. NEW ICD10 CODE FOR DIABETIC EYE CARE PATIENTS CPT-II Reporting Code: 3072F Negative Diabetic Retinal Screening We appreciate your role as our valued partner in the comprehensive diabetic care of our members. As you are aware, diabetics can suffer from a host of eye and vision problems that can affect quality of life. These problems are revealed in a comprehensive annual eye examination, and this evaluation is an important contribution to proper management of the diabetic patient. HEDIS has recently approved a CPT-II reporting code (3072F) to demonstrate when a diabetic retinal screening is negative for retinopathy. Use of this code helps Viva Medicare tremendously in our HEDIS and Stars reporting, and may reduce future requests for medical records. There is no fee associated to the use of this code, and your claim should report a billed charge of $0 or $0.01. So when you have a Viva member who has a negative screening for diabetic retinopathy, in addition to your claim for services, please report CPT-II code 3072F. 3

5 ICD10 DOCUMENTATION TIPS Pressure (Decubitus) Ulcers -L89.xxx In ICD-10, there are 150 codes for pressure ulcers. Each code contains characters to report the site and laterality. Code assignment may be based on medical record documentation from clinicians who are not the patient s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient s diagnosis), since this information is typically documented by other clinicians involved in the care of the patient. However, pressure ulcers must be documented by the patient s provider. There are four stages of pressure ulcer: Stage 1 Stage 2 Stage 3 Stage 4 Unstageable Stages of Pressure (Decubitus) Ulcer Description Skin is intact with redness Shallow, open ulcer with red wound bed Subcutaneous fat may be visible Bone, tendon, or muscle is exposed Ulcer is covered with slough or eschar DM and Associated Conditions AHA s Coding Clinic for ICD-10-CM and ICD-10-PCS, Second Quarter 2016 clarifies the link between Diabetes and Associated Conditions according to the 2016 ICD-10-CM Official Guidelines for Coding and Reporting. The clarification states, The published advice is based on Guideline Section I.A.15 which says: The word with should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between two conditions linked by these terms in the Alphabetic Index or Tabular. The following example from the Alphabetic Index for the main term Diabetes and the subterm with demonstrates this linkage: Diabetes, diabetic (mellitus) (sugar) E11.9 with amyotrophy E11.44 arthropathy NEC E autonomic (poly) neuropathy E11.43 cataract E11.36 Charcot s joints E Chronic kidney disease E11.22 The subterm with in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word with. The physician documentation does not need to provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since the chronic 4

6 kidney disease is listed under the subterm with. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and due to some other underlying cause besides diabetes. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related. STAR RATINGS UPDATE PROVIDERS PLAY A KEY ROLE IN OUR SUCCESS CMS rates Medicare Advantage plans on a five star scale. Plans that earn 4 or more stars are eligible for quality bonus payments. The quality bonus dollars are used by Medicare Advantage plans to reduce out-of-pocket costs or improve benefits for patients. Viva Health is currently a 4-star plan. We need your help to maintain or improve our rating. Some key areas participating providers are asked to focus on with us include: Offering timely access to appointments. The member satisfaction survey CMS uses for this measure asks how often your patient was able to get needed care right away, or as soon as they thought they needed it. Maintaining short in-office wait times. The member satisfaction survey CMS uses for this measure asks how often your patient saw the person they came to see within 15 minutes of their appointment time. Tell your patients about how you have reviewed their medical records and the care they have received from other providers. Tell your patients how you are coordinating their services with other providers when multiple people are involved in their care. The member satisfaction survey CMS uses for this measure asks how often you have their medical records or other information about their care, and their care from other providers. CMS also asks if you helped your patients manage their care among different providers. 5 Assisting patients in securing routine preventive services: Breast Cancer Screening Mammogram every 2 years for females age Colorectal Cancer Screening adults age 51 to 75 who have one of the following screenings: Fecal occult blood test (gfobt or ifobt/fit) each year, or Flexible sigmoidoscopy every five years, or Colonoscopy every ten years Diabetes Care- adults 18 to 75 years of age with diabetes (type1 and type 2) who had a who had each of the following: Hemoglobin A1C (HbA1c) test at least annually and more frequently as needed Eye exam (retinal) performed annually if positive for retinopathy or every two years if negative for retinopathy Nephropathy monitoring kidney test or screen for nephropathy annually

7 Actively managing patients with high blood pressure, high cholesterol, or high blood glucose to get their levels under control. Having levels that reflect these conditions are in control and patient adherence to prescribed medicines for these conditions are heavily weighted by CMS in the star ratings. Scheduling follow-up appointments quickly after hospital discharge (within 7 days if at all possible, always within 30 days). Perform a medication reconciliation and submit on your claim using CPT code 1111F, or transitional care codes or as appropriate. Managing chronic conditions in the physician s office to prevent avoidable hospitalizations. The conditions CMS reviews include: Diabetes short-term complications (ketoacidosis, hyperosmolarity or coma) Diabetes long-term complications (renal, eye, neurological, circularity or unspecified complications) Uncontrolled diabetes Lower-extremity amputation among patients with diabetes COPD Asthma Hypertension Heart failure Bacterial pneumonia Urinary tract infection Cellulitis, and Pressure ulcer PHARMACY QUALITY ALLIANCE: DRUG-DRUG INTERACTIONS How are members included in the Drug-Drug Interactions measure? Medicare Part D members who received a prescription for a target medication during the measurement period and who were dispensed a prescription for a contraindicated medication with or subsequent to the initial prescription. How is Viva measured on the Drug-Drug Interactions measure? A lower score is better for this measure; thus, fewer members in the drug-drug interactions measure cause a lower score. How the provider impacts the measure: Please consider prescribing members formulary alternatives for target and/or precipitant drugs to avoid contraindicated and severe drug-drug interactions that can potentially cause harm. If formulary alternatives are prescribed to the member for target and/or precipitant drugs, then the member will not be included in the drug-drug interaction measure. Example # 1: Member is prescribed Sulfamethoxazole-Trimethoprim to treat an infection and also takes Warfarin for atrial fibrillation. To prevent the member from inclusion in the drug-drug 6

8 interactions measure, an alternative antibiotic should be prescribed. Sulfamethoxazole-Trimethoprim is contraindicated with Warfarin because it increases serum Warfarin levels, which significantly increases risk of bleeding. Example # 2: Member is prescribed Simvastatin 40 mg daily to treat hypercholesterolemia and also takes Amiodarone for atrial flutter. To prevent the member from inclusion in the drugdrug interactions measure, Simvastatin 20 mg or less or an alternative statin should be prescribed. Amiodarone significantly increases the risk for myopathy when co-administered with doses of Simvastatin exceeding 20 mg. CHRONIC CARE MANAGEMENT - CPT CODE Viva Health is the exclusive provider for Chronic Care Management Services for our members. We provide this through our team of in-house nurses and social workers and therefore will not contract with additional providers for this service at this time. Providers may refer any patient that may benefit from chronic care management to our Care Management Department. Because the health plan is the exclusive provider of these services for our members, claims we receive from other providers for the chronic care management code are not payable and are not billable to the member. You may contact your Provider Service Representative if you have any questions. PCP MEDICARE AFFILIATION LETTERS In compliance with the Centers for Medicare & Medicaid s (CMS) 2017 Marketing Guidelines, Viva Medicare ifs offering our Primary Care Physicians the opportunity to mail a continued affiliation letter. This letter lets your patients know that you are a contracted provider with VIVA MEDICARE. If you would like to participate, all you have to do is upload the patient list that you would like the letter mailed to and Viva Medicare will take care of the rest. The site you upload your patient mailing list to is a secure site and the list will not be used for any other Viva Medicare publications. For more information about Viva Medicare s continued affiliation letter, please visit our website or contact your Provider Representative. MEDICARE OPEN ENROLLMENT Medicare s Open Enrollment Period starts October 15th and ends December 7th. For most individuals, this will be the only time of the year that they can change their Medicare coverage. Your patients are most likely looking for ways to get more value for their health care dollar. Joining VIVA MEDICARE could be a benefit for them. If you think Viva Medicare would be a good fit for your patients please have them contact Viva Medicare directly at They can call and speak to someone seven days a week from 8 a.m. 8 p.m. TTY users can call 711. Here are a few things your patients should consider when choosing a Medicare Advantage Plan: 7 1. Are my doctors covered? 2. How much does it cost? 3. What happens when I travel? 4. Are my prescriptions covered? 5. How easy is it to use?

9 GUIDE TO DRUG INTERACTIONS (TARGET AND PRECIPITANT DRUG ALTERNATIVES) Target Drug (severe interaction with Precipitant Drug(s)) Alprazolam, Midazolam, Triazolam Warfarin Simvastatin (40 mg and 80 mg) Target Drug Formulary Alternative (safer alternative to Target Drug) buspirone, fluvoxamine, lorazepam Eliquis, enoxaparin, fondaparinux, heparin*, Pradaxa, SavaysaΣ, Xarelto atorvastatin, fluvastatinσ, lovastatin, pravastatin, rosuvastatin, simvastatin (5 mg, 10 mg, 20 mg) Digoxin MAO Inhibitors: isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine amantadine, bromocriptine, carbidopa-levodopa, carbidopa-levodopaentacapone, entacapone, pramipexole, ropinirole Precipitant Drug (contraindicated with Target Drug(s)) ketoconazole, itraconazole, fluconazole, posaconazole, voriconazole, miconazole Trimethoprim/ sulfamethoxazole NSAIDs: diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin Amiodarone Clarithromycin, erythromycin, azithromycin, telithromycin Sympathomimetics: amphetamines, atomoxetine, benzphetamine, dextroamphetamine, diethylpropion, isometheptene, methamphetamine, methylphenidate, phendimetrazine, phentermine, phenylephrine, pseudoephedrine, tapentadol, dexmethylphenidate, lisdexamfetamine Serotonergic Agents: buspirone, citalopram, cyclobenzaprine, desvenlafaxine, duloxetine, dextromethorphan, duloxetine, escitalopram, fluoxetine, fluvoxamine, meperidine, milnacipran, levomilnacipran, mirtazapine, paroxetine, sertraline, tetrabenazine, tramadol, trazodone, venlafaxine Precipitant Drug Formulary Alternative (safer alternative to Precipitant Drug(s)) ciclopirox, clotrimazole, econazole, nystatin, terbinafine Gram +/- aerobes amoxicillin, cephalexin Atypical doxycycline, levofloxacin NSAID alternatives acetaminophen, tramadol flecainide, mexiletine, Multaq, propafenone, sotalol Gram +/- aerobes amoxicillin, cephalexin, trimethoprim/ sulfamethoxazole Anaerobe metronidazole Atypical doxycycline, levofloxacin Clinical rationale for avoiding target and precipitant drug combinations Alprazolam and Triazolam are contraindicated with ketoconazole and itraconazole CONTRAINDICATED per the FDA package insert Bactrim: Not recommended in combination with Warfarin due to significantly increased bleeding risk per FDA package insert. NSAIDs: The effects of warfarin and NSAIDs on GI bleeding are synergistic and they create a higher risk of significant bleeding for the patient. Simvastatin: The risk of myopathy/ rhabdomyolysis is significantly increased by concomitant administration of amiodarone or verapamil with higher doses of simvastatin (greater than 20mg of simvastatin daily). Digoxin: Erythromycin and clarithromycin (and possibly other macrolide antibiotics) can increase digoxin absorption, resulting in possible digoxin toxicity. MAOIs are contraindicated with selective serotonin reuptake inhibitors (SSRIs, e.g., fluoxetine, sertraline, and paroxetine); dual serotonin and norepinephrine reuptake inhibitors (SNRIs, e.g., venlafaxine and duloxetine); meperidine and analgesic agents such as tramadol, methadone, and propoxyphene; the antitussive agent dextromethorphan; mirtazapine; and cyclobenzaprine. CONTRAINDICATED per the FDA package insert MAOIs are contraindicated for use with sympathomimetic amines, including amphetamines as well as cold products and weight-reducing preparations that contain vasoconstrictors (e.g., pseudoephedrine, phenylephrine, etc). CONTRAINDICATED per the FDA package insert 8

10 Target Drug (severe interaction with Precipitant Drug(s)) Target Drug Formulary Alternative (safer alternative to Target Drug) Precipitant Drug (contraindicated with Target Drug(s)) Precipitant Drug Formulary Alternative (safer alternative to Precipitant Drug(s)) Clinical rationale for avoiding target and precipitant drug combinations Theophylline Advair Diskus, Breo Ellipta, DuleraΣ, Symbicort Ciprofloxacin, fluvoxamine Gram +/- aerobes amoxicillin, cephalexin, azithromycin, trimethoprim/ sulfamethoxazole antianxiety lorazepam Ciprofloxacin: SERIOUS AND FATAL REACTIONS HAVE BEEN REPORTED IN PATIENTS RECEIVING CONCURRENT ADMINISTRATION OF CIPROFLOXACIN AND THEOPHYLLINE. These reactions have included cardiac arrest, seizure, status epilepticus, and respiratory failure. CONTRAINDICATED per the FDA package insert Fluvoxamine: If theophylline is coadministered with fluvoxamine maleate, plasma concentrations of theophylline can increase causing potentially serious adverse effects. Methotrexate Actemraᵝ, Cimzia, Humira, hydroxychloroquine, leflunomide, Remicade, Simponiᵝ, Xeljanzᵝ Trimethoprim/ sulfamethoxazole (Bactrim) Gram +/- aerobes amoxicillin, cephalexin, azithromycin MRSA clindamycin, doxycycline Methotrexate: Bactrim (sulfonamides) can increase serum Methotrexate levels leading to Methotrexate-induced toxicity. Carbamazepine clonazepam, clorazepate, diazepam, dilantin, divalproex sodium, ethosuximide, felbamate, Fycompa, gabapentin, lamotrigine, levetiracetam, Lyrica, Onfi, oxcarbazepine, phenytoin, primidone, Sabril, topiramate, valproic acid, Vimpat, zonisamide Clarithromycin, erythromycin, telithromycin Gram +/- aerobes cephalexin, trimethoprim/ sulfamethoxazole Anaerobe metronidazole Atypical doxycycline, levofloxacin CYP 3A4 inhibitors inhibit Tegretol (carbamazepine) metabolism and can thus increase plasma carbamazepine levels. Drugs that have been shown to increase plasma carbamazepine levels include: cimetidine, danazol, diltiazem, macrolides, erythromycin, clarithromycin. Drug requires prior authorization (PA) ᶲStep Therapy *Drug requires a coverage determination review for Medicare Part B or D ᵝ Drug excluded for Viva Medicare Extra Value (formulary exception required) and requires a PA on all other plans Σ Drug excluded only for Viva Medicare Extra Value (formulary exception required) PQA s 2016 Drug-Drug Interactions Display Measure. Formulary subject to change and available at forms and resources, formularies. Please consider prescribing members formulary alternatives for target and/or precipitant drugs to avoid contraindicated and severe drug-drug interactions that can potentially cause harm IN-OFFICE SURGICAL PROCEDURES Advanced medical technology paired with patient comfort and convenience has made it possible for physicians to perform more surgical procedures in the office. Below is a list of additional in-office surgery codes that now require prior authorization. Office Surgeries: 0238T, 10040, , , 17380, 17999, 19300, 19316, , , , 28344, 30120, , , 30620, , , , , 37500, , 37799, 67221, 67225, 67912, 69090,

11 INJECTIONS REQUIRING PRIOR AUTHORIZATION At Viva Health, we strive to keep our provider network informed of any changes to procedures that require prior authorization. Below is a list of injection, infusion, and supply codes that require prior authorization. Injections Requiring Prior Authorization: J0215 J0256 J0257 J0364 J0490 J0597 J0598 J0638 J0717 J0775 J0894 J1290 J1325 J1458 J1460 J1556 J1560 J1602 J1675 J1725 J1786 J1826 J1930 J2170 J2278 J2315 J2353 J2503 J2504 J0775 J0894 INJECTION, ALEFACEPT, 0.5 MG INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG INJECTION, BELIMUMAB, 10 MG INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNITS INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), CINRYZE, 10 UNITS INJECTION, CANAKINUMAB, 1 MG INJECTION, CERTOLIZUMAB PEGOL, 1 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) INJECTION, COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01 MG INJECTION, DECITABINE, 1 MG INJECTION, ECALLANTIDE, 1 MG INJECTION, EPOPROSTENOL, 0.5 MG INJECTION, GALSULFASE, 1 MG INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC INJECTION, GOLIMUMAB, 1 MG, FOR INTRAVENOUS USE INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG INJECTION, IMIGLUCERASE, 10 UNITS INJECTION, INTERFERON BETA-1A, 30 MCG INJECTION, LANREOTIDE, 1 MG INJECTION, MECASERMIN, 1 MG INJECTION, ZICONOTIDE, 1 MICROGRAM INJECTION, NALTREXONE, DEPOT FORM, 1 MG INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG INJECTION, PEGAPTANIB SODIUM, 0.3 MG INJECTION, PEGADEMASE BOVINE, 25 IU INJECTION, COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01 MG INJECTION, DECITABINE, 1 MG 10

12 J1290 J1325 J1458 J1460 J1556 J1560 J1602 J1675 J1725 J1786 J1826 J1930 J2170 J2278 J2315 J2353 J2503 J2504 J2507 J2562 J2793 J2796 J3060 J3145 J3262 J3285 J3315 J3355 J3357 J3385 J3396 J3489 J7180 J7183 J7185 J7186 J7300 J7307 INJECTION, ECALLANTIDE, 1 MG INJECTION, EPOPROSTENOL, 0.5 MG INJECTION, GALSULFASE, 1 MG INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC INJECTION, GOLIMUMAB, 1 MG, FOR INTRAVENOUS USE INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG INJECTION, IMIGLUCERASE, 10 UNITS INJECTION, INTERFERON BETA-1A, 30 MCG INJECTION, LANREOTIDE, 1 MG INJECTION, MECASERMIN, 1 MG INJECTION, ZICONOTIDE, 1 MICROGRAM INJECTION, NALTREXONE, DEPOT FORM, 1 MG INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG INJECTION, PEGAPTANIB SODIUM, 0.3 MG INJECTION, PEGADEMASE BOVINE, 25 IU INJECTION, PEGLOTICASE, 1 MG INJECTION, PLERIXAFOR, 1 MG INJECTION, RILONACEPT, 1 MG INJECTION, ROMIPLOSTIM, 10 MICROGRAMS INJECTION, TALIGLUCERACE ALFA, 10 UNITS INJECTION, TESTOSTERONE UNDECANOATE, 1 MG INJECTION, TOCILIZUMAB, 1 MG INJECTION, TREPROSTINIL, 1 MG INJECTION, TRIPTORELIN PAMOATE, 3.75 MG INJECTION, UROFOLLITROPIN, 75 IU INJECTION, USTEKINUMAB, 1 MG INJECTION, VELAGLUCERASE ALFA, 100 UNITS INJECTION, VERTEPORFIN, 0.1 MG INJECTION, ZOLEDRONIC ACID, 1 MG INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U. INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMAN), WILATE, 1 I.U. VWF:RCO INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U. INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR COMPLEX (HUMAN), PER FACTOR VIII I.U. INTRAUTERINE COPPER CONTRACEPTIVE ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANT AND SUPPLIES 11

13 J7308 J7316 J7336 J8562 J8565 J8705 J9015 J9020 J9025 J9033 J9041 J9043 J9047 J9055 J9155 J9179 J9207 J9228 J9262 J9266 J9293 J9303 J9306 J9307 J9310 J9315 J9328 J9330 J9351 J9354 J9355 J9357 J9371 J9400 S0088 S0122 S0126 S0128 S0132 AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE FORM (354 MG) INJECTION, OCRIPLASMIN, MG CAPSAICIN 8% PATCH, PER SQUARE CENTIMETER FLUDARABINE PHOSPHATE, ORAL, 10 MG GEFITINIB, ORAL, 250 MG TOPOTECAN, ORAL, 0.25 MG INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL INJECTION, ASPARAGINASE, NOT OTHERWISE SPECIFIED, 10,000 UNITS INJECTION, AZACITIDINE, 1 MG INJECTION, BENDAMUSTINE HCL, 1 MG INJECTION, BORTEZOMIB, 0.1 MG INJECTION, CABAZITAXEL, 1 MG INJECTION, CARFILZOMIB, 1 MG INJECTION, CETUXIMAB, 10 MG INJECTION, DEGARELIX, 1 MG INJECTION, ERIBULIN MESYLATE, 0.1 MG INJECTION, IXABEPILONE, 1 MG INJECTION, IPILIMUMAB, 1 MG INJECTION, OMACETAXINE MEPESUCCINATE, 0.01 MG INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG INJECTION, PANITUMUMAB, 10 MG INJECTION, PERTUZUMAB, 1 MG INJECTION, PRALATREXATE, 1 MG INJECTION, RITUXIMAB, 100 MG INJECTION, ROMIDEPSIN, 1 MG INJECTION, TEMOZOLOMIDE, 1 MG INJECTION, TEMSIROLIMUS, 1 MG INJECTION, TOPOTECAN, 0.1 MG INJECTION, ADO-TRASTUZUMAB EMTANSINE, 1 MG INJECTION, TRASTUZUMAB, 10 MG INJECTION, VALRUBICIN, INTRAVESICAL, 200 MG INJECTION, VINCRISTINE SULFATE LIPOSOME, 1 MG INJECTION, ZIV-AFLIBERCEPT, 1 MG IMATINIB, 100 MG INJECTION, MENOTROPINS, 75 IU INJECTION, FOLLITROPIN ALFA, 75 IU INJECTION, FOLLITROPIN BETA, 75 IU INJECTION, GANIRELIX ACETATE, 250 MCG 12

14 HOLIDAY SCHEDULE Thursday, November 24th & 25th (Thanksgiving): Closed Monday, December 26th (Christmas): Closed EFT AVAILABLITY Change Healthcare (formerly Emdeon) is VIVA Health s electronic payment and remittance administrator. There is no fee to use Change Healthcare (formerly Emdeon) epayment. Enrollment is simple and free. By enrolling with Change Healthcare, you can accelerate your reimbursement cycle, eliminate paper based claims payments, sorting mail, and making trips to the bank. In addition to receiving payments electronically, Change Healthcare epayment users can search, view, and print electronic remittance advices (ERAs). To get started contact Change Healthcare: Phone: Fax: Online: Mail: Attention - Emdeon Electronic Payment Service Enrollment P.O. Box Nashville, TN

15 NOTES 14

16 PRESORTED STANDARD US POSTAGE PAID BIRMINGHAM, AL PERMIT NO Important Viva Health information inside th Street North, Suite 1100 Birmingham, AL