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NONDISCRIMINATION OF HEALTH CARE SERVICEDELIVERYAmbetter complies with the guidance set forth in the final rule for Section 1557 of the Affordable Care Act,which includes notification of nondiscrimination and instructions for accessing language services in allsignificant member materials and physical locations that serve our members.All providers who join the Ambetter Provider Network must also comply with the provisions and guidanceset forth by the Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR).Ambetter requires providers to deliver services to Ambetter members without regard to race, color, nationalorigin, age, disability or sex. Providers must not discriminate against members based on their paymentstatus and cannot refuse to serve based on varying policy and practices and other criteria for the collectingof member financial responsibility from Ambetter members.Newborns’ and Mothers’ Health Protection ActThe Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act) provides protections for mothersand their newborn children relating to the length of their hospital stays following childbirth. Under theNewborns’ Act, group health plans may not restrict benefits for mothers or newborns for a hospital stay inconnection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a deliveryby cesarean section. The 48-hour (or 96- hour) period starts at the time of delivery, unless a woman deliversoutside of the hospital. In that case, the period begins at the time of the hospital admission. The attendingprovider may decide, after consulting with the mother, to discharge the mother and/or her newborn childearlier. The attending provider cannot receive incentives or disincentives to discharge the mother or herchild earlier than 48 hours (or 96 hours). Even if a plan offers benefits for hospital stays in connection withchildbirth, the Newborns’ Act only applies to certain coverage. Specifically, it depends on whether coverageis “insured” by an insurance company or HMO or “self-insured” by an employment-based plan. (Check theSummary Plan Description, the document that outlines benefits and rights under the plan, or contact theplan administrator to find out if coverage in connection with childbirth is “insured” or “self-insured.”) TheNewborns’ Act provisions always apply to coverage that is self-insured. If the plan provides benefits forhospital stays in connection with childbirth and is insured, whether the plan is subject to the Newborns’ Actdepends on state law. Many states have enacted their own version of the Newborns’ Act for insuredcoverage. If your state has a law regulating coverage for newborns and mothers that meets specific criteriaand coverage is provided by an insurance company or HMO, state law will apply. All group health plansthat provide maternity or newborn infant coverage must include in their Summary Plan Descriptions astatement describing the Federal or state law requirements applicable to the plan (or any health insurancecoverage offered under the plan) relating to hospital length of stay in connection with childbirth for themother or newborn child.November 13, 20208

KEY CONTACTS AND IMPORTANT PHONE NUMBERSThe following table includes several important telephone and fax numbers available to providers and theiroffice staff. When calling, it is helpful to have the following information available:1. The provider’s NPI number2. The practice Tax ID Number3. The member’s ID numberHEALTH PLAN INFORMATIONAmbetter from TennesseeDepartmentAmbetter from Tennessee7100 Commerce Way Suite #285Brentwood, Tennessee 37207Phone: 1-833-709-4735ambetteroftennessee.comPhoneFax/Web AddressProvider ServicesNAMember ServicesNAMedical Management Inpatientand Outpatient PriorAuthorizationConcurrent Review/ClinicalInformationAdmissions/Census ay- 711)Care 24Behavioral Health PriorAuthorizationN/A24/7 Nurse Advice LineNAPharmacy Solution1-866-399-0929Advanced Imaging, cardiac, andtherapy (MRI, CT, PET,Myocardial Perfusion Imaging,MUGA Scan, Echocardiology,stress echocardiology,Outpatient PT, OT, ST) (NIA)1-800-424-4945NACardiac Imaging (NIA)1-833-709-4735NA(Relay- 711)EnvolveVision.comEnvolve VisionNovember 13, 20209

HEALTH PLAN INFORMATIONEnvolve DentalEnvolveDental.comInterpreter ServicesTo report suspected fraud,waste and abuseEDI Claims assistanceNovember 13, 2020NA1-866-685-8664NA1-800-225-2573 ext. 6075525e-mail: EDIBA@centene.com10

SECURE PROVIDER PORTALAmbetter offers a robust Secure Provider Portal with functionality that is critical to serving members and toease administration for the Ambetter product for providers. The Portal can be accessed atambetteroftennessee.com.Functionality All users of the Secure Provider Portal must complete a registration process. Once registered, providers may: Check eligibility and view member roster View the specific benefits for a member View members remaining yearly deductible and amounts applied to plan maximums View status of all claims that have been received, regardless of how submitted Update provider demographic information (address, office hours, etc.) For primary care providers, view and print patient lists. The patient list will indicate the member’sname, id number, date of birth, care gaps, disease management enrollment, and product in whichthey are enrolled Submit authorizations and view the status of authorizations that have been submitted for members View, submit, copy and correct claims Submit batch claims via an 837 file View and download explanations of payment (EOP) View a member’s health record, including visits (physician, outpatient hospital, therapy, etc.),medications, and immunizations View gaps in care specific to a member, including preventive care or services needed for chronicconditions Send and receive secure messages with Ambetter staff Access both patient and provider analytic toolsManage Account Access allows you to perform functions as an account manager such as adding portalaccounts needed in your office.DisclaimerProviders agree that all health information, including that related to patient conditions, medical utilizationand pharmacy utilization available through the portal or any other means, will be used exclusively for patientcare and other related purposes as permitted by the HIPAA Privacy Rule.November 13, 202011

CREDENTIALING AND RECREDENTIALINGThe credentialing and re-credentialing process exists to verify that participating practitioners and providersmeet the criteria established by Ambetter, as well as applicable government regulations and standards ofaccrediting agencies.If a practitioner/provider already participates with WellCare in the Medicaid or a Medicare product, thepractitioner/provider will NOT be separately credentialed for the Ambetter product.Notice: In order to maintain a current practitioner/provider profile, practitioners/providers are required tonotify Ambetter of any relevant changes to their credentialing information in a timely manner but in no eventlater than 10 days from the date of the change.Whether standardized credentialing form is utilized or a practitioner has registered their credentialinginformation on the Council for Affordable Quality Health (CAQH) website, the following information must beon file: Signed attestation as to correctness and completeness, history of license, clinical privileges,disciplinary actions, and felony convictions, lack of current illegal substance use and alcoholabuse, mental and physical competence, and ability to perform essential functions with or withoutaccommodation Completed ownership and control disclosure form Current malpractice insurance policy face sheet, which includes insured dates and the amountsof coverage Current controlled substance registration certificate, if applicable Current drug enforcement administration (DEA) registration certificate for each state in which thepractitioner will see Ambetter members Completed and signed W-9 form (initial credentialing only) Current educational commission for foreign medical graduates (ECFMG) certificate, if applicable Curriculum vitae listing, at minimum, a five year work history if work history is not completed onthe application with no unexplained gaps of employment over six months for initial applicants Signed and dated release of information form not older than 120 days Current clinical laboratory improvement amendments (CLIA) certificate, if applicableAmbetter will primary source verify the following information submitted for credentialing and recredentialing: License through appropriate licensing agency; Board certification, or residency training, or professional education, where applicable; Malpractice claims and license agency actions through the national practitioner data bank(NPDB); Federal sanction activity, including Medicare/Medicaid services (OIG-Office of Inspector General).November 13, 202012

For providers (hospitals and ancillary facilities), a completed Facility/Provider – Initial andRecredentialing Application and all supporting documentation as identified in the application mustbe received with the signed, completed application.Once the clean application is received, the Credentialing Committee will usually render a decision onacceptance following its next regularly scheduled meeting in accordance to state and federal regulations.Eligible ProvidersAll eligible providers are required to complete the credentialing process. All eligible providers mustbe recredentialed every 36 months. Professional providers: MD, DO, PsyD, PHD, AUD, BCBA, OD, DC, CNM, DPM, LCSW, LCPC,LMFT, PA, APN, APRN ANP and CNP, CNS, RD, LAC and DN Institutional providers: Hospitals and AncillaryNon Registered CAQH ProvidersPrimary care providers cannot accept member assignments until they are fully credentialed.Practitioners/Providers are required to self-register with CAQH ProView at https://proview.caqh.org. TheCAQH will email the provider a Welcome kit with registration instructions. Practitioners/Providers receive apersonal CAQH Provider ID, allowing them to register on the CAQH website at proview.caqh.org and obtainimmediate access to the ProView database via the Internet.Once obtaining authenticating key information, practitioners/providers will have the opportunity to createtheir own unique user name as well as password to begin utilizing the system at any time.Credentialing CommitteeThe Credentialing Committee, including the Medical Director or their physician designee, has theresponsibility to establish and adopt necessary criteria for participation, termination, and direction of thecredentialing procedures. Committee meetings are typically held at least monthly and more often asdeemed necessary. Failure of an applicant to adequately respond to a request for missing or expiredinformation may result in termination of the application process prior to committee decision.RecredentialingAmbetter conducts practitioner/provider recredentialing at least every 36 months from the date of th

the Participating Provider Agreement, providers are required to comply with the provisions of this manual. Ambetter routinely monitors compliance with the various requirements in thmanual and may initiate is corrective action, including denial or reduction in payment, suspension, or termination if there is a failure to