As previously communicated, IBC is in the process of transitioning our claims processing system to a new platform,and this transition affects how you are paid for the Quality Incentive Payment System (QIPS) program.

During the migration, we will be working with you in a dual claims-processing and business-operating environmentuntil all of our business is on the new platform. Providers will likely have a mix of migrated and non-migrated memberson their panel.

For all members who have not yet been migrated to the new platform, all current business practices for QIPS willremain in effect, and we will continue to issue QIPS payments by paper check.

The following QIPS payment changes apply for members who have been migrated to the new platform:

• Capitation and QIPS payments will be combined into one payment and disbursed each month via electronic fundstransfer (EFT) on the current capitation schedule. Please note that if your practice is not yet enrolled for EFT, youmust register through the NaviNet web portal. Refer to the EFT User Guide, available on IBC NaviNet Plan Centralunder Administrative Tools & Resources.
• Retroactivity of up to six months will be applied to QIPS payments in the same way it is currently applied tocapitation payments.
• You will only be able to view reports to support the QIPS payments at a member level on NaviNet ? paper copiesare not available for members who have been migrated to the new platform.

Note: To view reports for members of our Keystone Health Plan East affiliate in Northampton, Lehigh, Berks, andLancaster counties in Pennsylvania and New Castle County in Delaware, providers must access the appropriateNaviNet Plan Central.

Accessing your QIPS rosters on NaviNet

The following are brief instructions to help you navigate through the new QIPS Rosters transaction:

• From the Plan Transactions menu, select ePayment, and then QIPS Rosters.

• Next, you will see a screen that allows you tosearch by month, provider, or tax ID number.With each new month, you will begin to builda history of stored reports, up to 13 months.Note: The January 2014 report will be the firstone available to you.
• Select Search, and the results of your searchwill appear. The results that appear reflectmember-level detail of your QIPS payment formigrated members only. This information willhelp you determine the EFT payment madein the month selected that corresponds tomigrated members eligible under QIPS.

At the top of your QIPS roster is a summary ofyour payments by membership, product, andQIPS type. Below the summary is member-leveldetail, including the following:

• the ability to sort by all fields (ascending anddescending);
• the ability to export the report in PDF formator text format so that the data can bemanipulated as needed;
• the ability to filter your search by:
  
  • member last name
  • member ID number
  • QIPS rate
  • payment type
  • QIPS type
  • provider ID

QIPS rosters will be available after the EFT payment has been deposited into your account.

Note: If you are enabled for EFT, you will no longer receive paper rosters/reports for migrated members. AllEFT-enabled providers must access QIPS rosters using NaviNet.

For more information

To help you better understand these changes, a new user guide is available that describes this transaction in greaterdetail. We encourage you to review the new guide in the NaviNet Transaction Changes section of our Business Transformation site.

If you have any questions regarding NaviNet transaction changes, please call the eBusiness Hotline at215-640-7410.

NaviNet^® is a registered trademark of NaviNet, Inc., an independent company.

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