1.1 – STOLI Track: Disability/Life Speaker: Frank Best and David McDowell Description: Learn how to prepare for death claims on policies originated by investors and how the law has developed on resisting such claims. The presenters are David McDowell, of Edison, McDowell and Hetherington, and Frank Best, of Penn Mutual Life Insurance Company. Frank is Vice President, General Counsel, Insurance Operations, and Corporate Secretary. 1.2 – The Cost Containment Playbook: How to Win the Game Track: Fraud/SIU Speaker: Carrie Cunningham Description: In today’s world a health plan’s game is judged by how well it manages its resources and its risks beyond profitability. Every plan is held accountable by its stakeholders—members, clients, and its governing body. With rising healthcare costs and the ever-increasing pressure to contain them, winning the cost containment game is a daily challenge. There are critical plays that will help keep your team winning year after year! 1.3 – Federal Regulatory & Legislative Update Track: Legal & Regulatory Speaker: Marilyn Monahan Description: This workshop will address recent developments in federal health care reform, HIPAA, ERISA, and other federal laws and regulations that impact claims processing and the administration of employee benefit plans. The program will include a discussion of legislative and regulatory trends in Washington and across the nation, as well as a discussion of how one state (California) has been implementing health care reform and addressing other changes in the insurance market. 1.4 – Essential Health Benefits: The Regulators Threw Us A Curve Track: Healthcare Claims 1 Speaker: John Garner 1 Description: This session will discuss the complexities of compliance with the health care reform rules on essential health benefits. Each state is defining essential health benefits differently. Come learn about some of the many details on this complex new subject. 1.5 – Medicaid Roundtable Track: Healthcare Claims 2 Speaker: Rikki Haffner, Lupe Medina, Rowena Roxas Description: Bring your questions or ideas to share. 1.6 – Claim Administration and Health IT – What’s Happening and What’s to Come? Track: Technology & Data Reporting Speaker: Scott M. Robertson Description: From Operating Rules to EFT Enrollment, Attachments to ICD-10, Payer Certification, Health Plan IDs and more, there is a lot happening today in the world of IT that affects day-to-day processes for payers and providers. In this session we will discuss the current state of the industry, what recent rules have been released, what’s in the pipeline now, and what is on the horizon. We will also have an opportunity to discuss how it affects your operations. 2.1 – What Kinds of Cases Did Courts Look at Last Year? Track: Disability/Life Speaker: Michael Brisbin Description: Learn about current cases and developments impacting life insurance claim administration. You will hear from experienced inside and outside counsel who will explain recent cases and trends in life insurance case law and litigation developments. 2.2 – Take a Bite out of Rising Costs of Player (Workers) Injuries 2 Track: Fraud/SIU Speaker: Justine Andrews and Phyllis Bowman Description: The presenters will discuss how to actively lower the cost of workers’ injuries through development of policies and procedures, supervisor training and employee education. Legal & Regulatory 2.3 – Obamacare: Its Care and Feeding at the State Regulatory Level Track: Legal/Regulatory Speaker: Phil Howe Description: Learn how states are responding to Obamacare, particularly as to Exchanges. 2.4 – Common Problems with Specialty Drugs Paid Under Medical Track: Healthcare Claims 1 Speaker: Craig S. Stern Description: This presentation will focus on common problems identified with specialty claims paid under the medical benefit. Stimulating discussions will be provided, as well as shared numerous deidentified examples of actual claims and problems, to include, but not be limited to, incorrect quantity, code, NDC, etc. 2.5/2.6 – Navigating the Looming ICD-10 Business Impacts and ACA Operating Rules Track: Healthcare Claims 2 / Technology & Data Reporting Speaker: Michael Wilson and Peggy Honts Description: Focusing on the business side of the ICD-10 and ACA Operating Rules mandates, HCIM and AXIOM Systems will walk you through the steps to identify the key critical financial impacts that should drive your risk management plan and how to realize actual benefits from these regulatory mandates. While ICD-10 testing should be fully underway, we’ll review business and IT system testing best practices and demonstrate specific steps to achieve a successful implementation. We’ll also discuss 3 the scope, risk factors, and health plan attestation requirements of the ACA Operating Rules mandates and explain how to effectively implement all three phases for optimum efficiency. 3.1 – Impact of Disability Court Decisions Track: Disability & Life Speaker: Sherril Colombo, Dan Cozzo and Richard Lodi Description: Learn the impact of recent court decisions on disability claim handling. 3.2 – Current Medical Fraud Trends Track: Fraud/SIU Speaker: Mike McKee Description: Attendees will be provided with national, regional and California-specific medical fraud trends observed by the National Insurance Crime Bureau in the recent past, with emphasis on 2012/13 activities. These trends will not only cover medical services, but will also cover office activities, billing issues, and ancillary medical activities such as transportation, copying service, and translation services. 3.3 – California Legislative Update: A Review of New Laws and Trends Track: Legal & Regulatory Speaker: Marilyn Monahan Description: This workshop will provide an overview of bills the California legislature passed in 2012 and how those bills will impact the way you do business in the claims benefit environment. We will also discuss bills of interest newly introduced in 2013 and their progress through the legislature, supplemented with a discussion of recent legislative trends. 3.4 – HEDIS and Code Editing, Finding the Right Balance Track: Healthcare Claims I Speaker: Erin Mellas and Lori MacLeish Description: How to properly refine and/or manage your claims editing solution to maximize your return and prevent a negative impact on your HEDIS rates. 4 3.5– How was I supposed to know?? Track: Healthcare Claims 2 Speaker: David Rosen Description: The Affordable Care Act will create stress for health plans by applying unprecedented government scrutiny on any claim paid with Federal or State dollars to ensure quality and payment accuracy. Subrogation is one of the categories of scrutiny that is often misunderstood and underestimated by health plans in government business. The experts in subrogation, First Recovery Group, will share insight into how to protect your government business so that you know what you are supposed to know about subrogation. 3.6 – HIPAA Regulations: End-to-End Testing and Pilot Testing New Versions Track: Technology & Data Reporting Speaker: Debbie Meisner Description: CMS/OESS has initiated programs to explore the concept of end-to-end testing and pilot testing of new versions of HIPAA standards. This session will provide a brief overview of each of the programs along with status of the initiatives and any outcomes. 4.1 – Top Ten Things You Need to Know to Rescind in California Track: Disability/Life Speaker: Phil Howe Description: This session will take you through each of the key steps to rescind a life insurance policy in California with references to the CA Insurance Code and the essential CA cases. It will show you what you must do and must avoid. 4.2– Medical Identity Theft: Do You Know Whose Claim You Are Paying? Track: Fraud/SIU Speaker: Linda Vincent Description: Medical Identity Theft is the nefarious underworld of identity theft. Hearing more about data breaches? Wondering how it happens? Have you thought of what to do if your medical records are 5 compromised? And do you realize someone can be making money on your medical information? These and other thought provoking questions will be addressed during this lively presentation. 4.3 – Getting A Prosecution Home Run Track: Legal & Regulatory Speaker: Phyllis Bowman Description: This workshop is geared towards helping those in the field understand the prosecution perspective and what it takes to put together a successful case referral. Various factual scenarios will be given and participants will be expected to work them into given jury instructions to determine if there is sufficient evidence or not. 4.4 – Maximizing Your Audit Recovery Program: Best in Class in Payment Integrity Track: Healthcare Claims 1 Speaker: John-Michael Loke Description: This session will provide a discussion of the challenges and solutions payers are facing in building a best-in-class Payment Integrity Program. This workshop will focus on Audit & Recovery, PostPay and Pre-Pay Programs that work together to deliver a comprehensive approach to Payment Integrity. 4.5– Medicare Roundtable Track: Healthcare Claims 2 Speaker: Rikki Haffner and Marty Astor Description: Bring your questions or ideas to share. 6 4.6– New HIPAA Regulations: Are You Safe? Track: Technology & Data Reporting Speaker: John Garner Description: New HIPAA Privacy and Security Regulations require compliance by September 23, 2013. There is not much time left to come into compliance! This session will discuss the changes to the HIPAA Privacy and Security Regulations that affect health plans. 7