Become an Accepting Provider

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Putting “HEALTH” Back in Healthcare!

www.AcceptingProvider.com www.AcceptingProvider.com

Become an Accepting Provider When you combine an experienced and efficient non-profit health cost sharing organization with an expert wellness education and management platform, you get the most comprehensive health sharing program available today – Health Excellence Select!

The Health Excellence Select health sharing program

• Allows patients to take back control of their health care costs • Allows physicians to take back control of their patients’ health with no bureaucratic intervention • Offers its Members (your Patients) ten affiliate services to assist them in becoming an “in-control” Self-Pay Patient

What is Health Cost Sharing?

-2• It’s a program managed by a Non-Profit Organization that helps like-minded, healthfocused members share their medical expenses • It allows access to ANY Accepting Provider Physician or Hospital nationwide • A typical member pays less with healthshare • A membership satisfies the Federal Mandates of ACA for individual exemption…no penalty! • It has a 30+year track record of medical cost sharing success

What is an Accepting Provider?

It’s a Physician, Health Care Professional, Hospital or Medical Facility who agrees to accept reimbursements of Health Excellence Select’s cost sharing component, Liberty HealthShare.

Benefits to Accepting Providers:

• Increased revenue based on reimbursement rates of Medicare PLUS 50% - 70% • Prompt payment for services rendered • New Patient referrals • Assistance to grow your practice! (See details on page 8)

In the pages that follow, you’ll learn more about how Health Excellence Select and Liberty Healthshare have partnered to offer you an inspiring and exceptionally effective solution to benefit you, your patients and your practice!

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Become an Accepting Provider Become a Medical Affiliate

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Flowchart

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The Member’s Annual Unshared Amount (AUA) is the amount of eligible need that does not qualify for Sharing. This amount is paid directly by the Patient to the billing Physician or Provider.

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Putting HEALTH Back in Healthcare! Health Care BY Americans, FOR Americans Dear Physicians and other Healthcare Affiliates, As you are aware, medical offices must contend with many different types of health plans in the referrals, authorizations and uncertain reimbursements. Each patient potentially represents a different set of requirements. When a liberty health share member becomes your patient there are no referrals needed and very limited notifications, freeing the healthcare provider and staff of the cumbersome daily tasks which many offices experience when dealing with the rules of insurance companies. Liberty HealthShare is a health cost sharing program that provides our members with an affordable healthcare option without utilizing a network and with the flexibility to see the provider of their choice. Healthcare sharing is an acceptable choice in the affordable care act, and fulfills the individual mandate. All medical bills are re-priced by LHS/MedCost Solutions within 3 – 7 business days, giving us the ability for payment to be made within 30 days. Members are responsible for their Annual Unshared Amount of $500 for a single membership, $1000 for a couple, and $1500 for a family. All medical providers are reimbursed per the terms of the health share guidelines up to the maximum payable amount. Reimbursement is based on the following: • For all Physician-related office visits, payment shall be reimbursed and Medicare rate +50% for prevailing area where service is rendered. Claims must be submitted to MedCost Solutions on a HCFA 1500 form, or electronically, inclusive of the rendering address with street, city, state and zip code only, no PO boxes. • For all Inpatient – related services, payment shall be reimbursed and Medicare rate +60% for prevailing areas where services rendered. Claims must be submitted as above. • For all Outpatient – related services, payment shall be reimbursed and Medicare rate +70% for prevailing area where services rendered. Claims must be submitted as above. • Alternative therapies are eligible for sharing pending approval of a treatment plan. Reimbursement will be determined based on diagnosis, treatment and fees for prevailing areas where services are rendered and on an individual basis. Bills must be sent directly to the address shown on the member’s identification card. This program provides you, the provider of medical services, with timely, accurate and reasonable reimbursement for services rendered within your service area. The Medical Cost Sharing Summary has been attached for your review. Please feel free to contact me with any questions or concerns you have. I will be happy to discuss this with you, at your convenience. Thank you, Liberty HealthShare Phone: 855–585–4237 and ask for a provider relations representative email: [email protected] 4845 Fulton Dr. NW. Canton, OH 44718

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Putting HEALTH Back in Healthcare! Annual Unshared Amount Annual Unshared Amount (AUA) – first dollar amount of annual medical costs not eligible for sharing)* Single Couple Family

Annual Unshared Amount (AUA)* $500 $1,000 $1,500

*Note: the annual unshared amount (AUA) is the amount of an eligible expense that does not qualify for sharing, and is calculated upon each members enrollment date until their next annual enrollment date. Note: A medical expense incident is the charge (s) incurred for eligible medical treatment arising from any illness or accident of a sharing member, and any fees incurred by Liberty HealthShare to reduce such charges. All providers treating the same illness (diagnosis) are combined in the same incident.

Maximum Eligible Sharing Limit Per Incident 100% up to $1,000,000**

Single Couple Family

**Guardians Group is for catastrophic expense needs up to $1 million is included with Health Excellence Select. Note: The following expenses will not apply towards the maximum expense limit: (1) Reduced share amount for failure to follow healthcare management procedures. (2) Any charge excluded in the sharing guidelines. (3) Any other charges that exceed maximum limits.

Pre-Notification Step One: The Pre-Notification staff must be notified of the following services before occurrence:

•Inpatient confinements (including hospital, skilled nursing, inpatient rehabilitation facility & hospice care) •Emergency admission (within 48 hours) •Pregnancy/Maternity •Organ/tissue transplants services •Home healthcare services •Outpatient surgery

Step Two: Contact customer service at 855–585–4237 to verify eligibility of charges. Charges will be ineligi-

ble for sharing if timely notification is not received for all charges for rendered services listed above. Pre-notification (step one above) does not guarantee that your expenses will be shared. Please contact customer service to verify eligibility for sharing.

Liberty Healthshare Complete 100% up to $1 million after *Annual Unshared Amount Accidents (accidents are investigated for other party liability) Accidents Involving Recreational Vehicles

Chiropractic Services Limit 12 visits per Calendar Year Ambulance Services

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Putting HEALTH Back in Healthcare! Liberty Healthshare Complete 100% up to $1 million after AUA*

Diagnostic X-ray and Laboratory Services

Inpatient/Outpatient/Independent lab (outside lab)

Home Health Care

Limit 30 days per Incident

Maternity Care

Emergency Room Hospital And Physician Services (Routine treatment excluded)

Hospital Services

Inpatient: Daily Room and Board limited to the average semi-private room rate.

Physician Office Services

Normal delivery (including physician charges, office visits, hospital charges and birthing centers) cesarean section and/or complications treated as new incident with new per incident limits

Per incident visit. All other physician office services included per incident. (Charges billed by a physician if performed in the physician’s office: injection, surgery, lab, x-ray, special diagnostic interpretation.)

Per incident (charges must occur within 45 the days before or after any related medical incident)

Surgeon, Assistant Surgeon and Anesthesiologist Services. Inpatient/Outpatient services. Outpatient surgery facility

Prescription Drugs Therapy

Limit 20 visits per Calendar Year (Combined with Speech, Respiratory, Physical, Occupational Therapy)

Surgery

All Other Eligible Expenses (Unless limited by the guidelines)

Naturopathic and/or Alternative Treatments Treatment provided by a Naturopath or other practitioner of alternative treatments is eligible for sharing if such treatment meets the following criteria:

A. It treats a medically diagnosed condition. B. It is less invasive than conventional medical treatment for the diagnosed condition. C. It is less costly than conventional medical treatment and is expected to prevent more costly future conventional treatment. D. It is presented for prior approval to Liberty HealthShare™ and the member agrees to any alteration of the treatment plan made by Liberty HealthShare™.

To view and download a treatment submission form, you may click here.

Liberty Healthshare Complete 100% up to $1 million after *Annual Unshared Amount

Preventative Screening

Mammograms, Pap smears, PSA tests, Screening. Colonoscopies Limit: 1 every 2 yrs; 1 per yr. over 50

Wellness

Babies 0 -1 year – well baby checkups including vaccinations. Adults 1 year and older includes labs, x-rays (one per membership year)

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Two Ways to Participate: The Choice is YOURS You may participate in the Health Excellence Select comprehensive health sharing program in one of two ways:

Accepting Provider 1. Accepting Provider – you agree to accept the Liberty HealthShare reimbursement schedule from participating Health Excellence Select members.

Provider Affiliate 2. Provider Affiliate – you want to capitalize on Health Excellence Select’s comprehensive Health Sharing program in your practice to increase your patient base and improve your bottom line.

The Provider Affiliate platform is a NO Cost “Health Sharing Patient Awareness Program” that assists in communicating the benefits of Health Excellence Select and Liberty HealthShare to your Patients. As a Health Excellence Select Provider Affiliate, you will be equipped with a unique “Health Sharing Patient Awareness Program” Blueprint created by the Health Excellence Select team, tailored to meet the needs of your practice. Your HES representative will work with your staff to introduce and promote Health Excellence Select to your patient base. Experience… Efficiency… Expertise Let Health Excellence Select Be Your Partner to Enhance the Care of Your Patients AND your Practice

“Join Us Today!”

For more information, contact your HES representative.

Questions? Call (855) 816-4650 x404 Scan and email both forms to [email protected]

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Health Excellence Enrollment I understand I may enroll as BOTH an Accepting Provider and a Provider Affiliate. Please enroll our practice as an: o



o

Accepting Provider

Provider Affiliate

Practice Name:______________________________________Provider Tax ID: _________________________ Mailing Address:_______________________________________________________________________________ City: ________________________________________________State: ________________ Zip:________________ Phone: ____________________________________ Email: ____________________________________________ Contact Name: ______________________________________________Position:_________________________ Best time/day to call: _______________________Website: ________________________________________ -9-

Medical Specialty: ___________________________________________________________________________ Please list the name and address, if different from above, of any additional practice locations: Address

City

State, Zip

1 2 3 4 5 6 Are you looking for new patients? oYES

oNO

Do you treat patients outside of your geographic area? oYES

oNO

**PLEASE ATTACH A COPY OF YOUR CURRENT FEE SCHEDULE**

~ PLEASE CONTINUE TO THE NEXT PAGE AND ALSO COMPLETE THE LIBERTY ENROLLMENT FORM ~

Questions? Call (855) 816-4650 x404 Scan and email all forms to [email protected]

Provider Agreement Dear Doctor and Other Healthcare Providers: Thank you for your decision to accept Liberty HealthShare members into your service and billing system. Upon your signature and submission of this form, Liberty HealthShare will list you in our recommended provider directory. Reimbursement will reflect the rate shown on this signature form and will be sent to the Provider within the specified time period. For questions, please call 855-585-4237 and ask for a Provider Relations Representative or email us at [email protected].

Specialty: Provider Tax ID:

Email: - 10 -

Click here to submit electronically, OR

• print and fax to 216-456-8115 • scan and email to [email protected]