Transcript
Hillary Perez-Godfrey (00:00) hi, Hillary. Hi, good morning. I have actually an immediate need or not immediate, but dr Sahas’s profile, when I was like loading all his documents and everything, I had loaded his foreign, school transcripts and residency, and I had added it to a number of his documents. I actually have his efm… what’s it called elmg? What’s… it called ecfmg. And I replace it. But when I was reading the instructions through support, it said, you know, put it in notes, but then you guys have a disclaimer that nobody monitors notes. So I need to replace the document.
Naomi Denson (00:56) Okay. What was the provider?
Hillary Perez-Godfrey (00:58) Dr, Sahas, our MD… Prem, sahasran.
Naomi Denson (01:06) Okay. I see it.
Hillary Perez-Godfrey (01:19) Let me share my screen.
Hillary Perez-Godfrey (01:30) This, this one correct? See how it’s under residency diploma and then medical diploma. So the ecfmg is not the same thing as the other two. So I need to replace the actual document and I have that.
Naomi Denson (01:48) Okay. So you would just come over here and put update document?
Hillary Perez-Godfrey (01:52) It’s not, I don’t even have the right hand side on my screen for whatever reason. Am I not in the right mode or something?
Naomi Denson (02:05) Wait, hold on. Maybe you can’t yeah, I don’t think you can delete it. So, all right. What I’m gonna, yeah. So what you’ll need to do is actually, can you share your screen?
Hillary Perez-Godfrey (02:16) Sure.
Hillary Perez-Godfrey (02:30) So here under his, where is it his documents, right? So I go here. Sorry, that’s Sam.
Hillary Perez-Godfrey (02:45) And then we go down to documents and then see when you get to see, I don’t have it. It’s disabled. There’s nothing over here to the right for me.
Naomi Denson (02:53) It is, so it’s… do you, if you scroll to the very bottom… to the right… so you might need to like zoom your screen out, like you might be zoomed in too far. It’s not going to let you update the actual document that’s in there. So we’ll have to find it and delete it and then re, add it.
Hillary Perez-Godfrey (03:18) Okay. Hold on. Let me try something. There we go.
Naomi Denson (03:21) There we go. Okay, there it is there it?
Hillary Perez-Godfrey (03:25) Is right here. So go here, delete.
Naomi Denson (03:28) It, and then add a new one.
Hillary Perez-Godfrey (03:30) Okay. And then at… the top, yep, upload.
Hillary Perez-Godfrey (04:03) It doesn’t have a, it doesn’t have a, do I need to replace the name for the title with his first and last name? I would.
Naomi Denson (04:12) Yeah, on the actual file. Okay. No. So for, no, for, in this, it shouldn’t that’s just on the licenses, but you can rename the title. So, you know, what you’re looking at, yeah.
Hillary Perez-Godfrey (04:30) There you go. Okay. Sorry, no, it was because you’re exactly right? It was because of the zoom. So I’m good now. Okay. Perfect. I thought it was because maybe it was like, you know, the first time loading an original document that for whatever reason, it was disabled for me. So that makes sense now.
Naomi Denson (04:48) Okay, perfect.
Hillary Perez-Godfrey (04:50) Sorry, go ahead.
Naomi Denson (04:51) Okay. Hope everybody had a nice weekend. All right. Let’s see, let me get back here. All right. So we’re going to do our payor enrollment training today.
Naomi Denson (05:06) Let me shift my screen back. Okay? So we are in the demo org. So you can see what everything looks like with the data in here. So majority of this is going to be from your payers tab here. So as you start making requests in medallion, your payer list will be built. So this is built by request made. So it just outlines the individual payer names with, the requests that are in process or completed for that payer in each bucket. So you can use this if you want to look for a specific payer to link in to look at just payers with that name to filter those out. Or you can just simply click into the enrollment requests tab here and it will give you all enrollment requests of all types, all payers, group provider enrollment. You can toggle to look at just group enrollments. You can look at just individual provider enrollments. But overall, you’ll see the payer name, the state, the request owner. We’ll either say medallion or client if it’s something that you all, are owning and working and just tracking in medallion the request type, new provider enrollment, new group enrollment, demographic updates, revalidations, you’ll see the request type there… provider’s name, and the link to their profile, provider profile, percentage, completion… lots of details here. The group requested the practices requested, and then the statuses. We’ll walk through those in just a moment. But you’ve got a lot of information on here, the date you created the request intake complete, and then app submission date. You can change your settings here. If there’s certain things that you want to see or don’t want to see. You can adjust those via the settings gear icon in the platform here. So let’s start with the… requesting process. So requesting a new enrollment from the payers tab, you have this blue button request, new payer enrollment, single demographic update, bulk, demographic update or revalidation. So there’s multiple different ways to do these. But starting with new payer enrollment, you will see this screen pop up. You can choose either medallion as the owner or it’ll say my diabetes tutor to make it a client owned request. So majority you’re going to use medallion, you want us working that enrollment, submitting it to the payer following up et cetera. So you’ll indicate who the enrollment is for. So group provider, if you’re doing a new group enrollment with a new payer, you would select the group, you would select the state or payer and payer or payers. I think. Yeah. Okay. So in group enrollments, you can do one payer. And then you’ll select the lines of business, it’s only going to let you select the lines of business that payer specifically offers. And.
Hillary Perez-Godfrey (08:17) is that specific to mydiabetestutor or is that based on your data availability for that provider?
Naomi Denson (08:24) It’s based on the data for that payer?
Hillary Perez-Godfrey (08:28) Okay. And how do you vet that? Do you contact the payers themselves and find out what programs they offer? Yeah?
Naomi Denson (08:36) We have a payer research team that’s dedicated that’s built all of our back end resources and triggers for these. So they’ve done all of the research with the payers and vetted which lines of business they offer. So.
Hillary Perez-Godfrey (08:51) If I was to, for instance, on our uploading process, if I was to indicate marketplace in addition to medicaid and there was an, and that wasn’t necessarily per that payer. Do you guys flag that back to me for clarification? Do you correct it automatically? How does that roll out?
Naomi Denson (09:14) I’ll have to look into that… because I think on… the back end when we’re doing the imports, it doesn’t block it from a recent experience that I had, but I think the team was looking into that. Okay. So, but… you wouldn’t be able to request it for future enrollments.
Hillary Perez-Godfrey (09:39) Got it. Okay. And then just as a follow up question, sort of along the same adding lines of business. So, for instance, my contracts, let’s say my contract says commercial or let’s say my contract says medicaid only from the original contract. And a lot of the payers are sort of doing these like at any time we can add on, you know, it’s part of their contract language that they can add lines of business. And next thing, you know, if you look on their enrollment screens like via their portal, is that they have us populated for commercial and other things? Is that something that you guys would automatically import based on their records? Or again, I guess I would want to know sort of as a quality assurance, are you requesting clarification from me or is it something that you guys would feed directly from the payer?
Naomi Denson (10:33) Yeah, it doesn’t feed directly from the payer. So it would have to be something that you notify us of.
Hillary Perez-Godfrey (10:38) Okay. And,
Naomi Denson (10:42) then, so if you’re doing a new group enrollment and you’re entering a brand new payer for this group, it’s going to also ask if you want to enroll providers too, and you can say yes or no. So if you say yes, you’ll select the providers that you want to be enrolled under that group. You can select multiple. And depending on how many providers you select, you can see it’s creating one group request. And then it will create as many provider enrollment requests separately as you select. It’s going to flag providers that are missing a license in the state you selected. So just that’s what that red indicator means. And then if you want the same lines of business for the provider, you’ll select that. And then on the next screen is where you’ll indicate the practice, individual practice locations that you want. You only have one currently. So you would just select your one practice location for the group and the provider, or you can enroll each provider at their associated locations if they have them, which all of yours do.
Hillary Perez-Godfrey (11:45) So that would be the easiest default for us is to check that box up on top.
Naomi Denson (11:49) Yeah, since you only have one group and one practice profile, yeah, you can definitely just do that. And then hitting next, it’s just going to give you a screen to indicate any additional notes that you might feel relevant to share… going back for providers, if… you are just doing a new provider enrollment. So there’s a couple of ways that this works. You can do you have a new provider onboarding, right? You want this one provider enrolled and you want them enrolled with this group, you’re going to choose the state and the payer. So when you’re choosing the payer, it’s going to give you this section at the top will say enrolled with my diabetes tutor. And then it will list all of the payers that you currently have. Oh good.
Hillary Perez-Godfrey (12:47) Okay.
Naomi Denson (12:47) So you can, it’ll give you this check box here and it’ll select all of those payers including the enrollment processing. So if you have enrollments in process for the group, you can select those two. So you check the box, it’ll include all of your existing enrollments and then all of your in process payers as well. And then it’ll create a separate request for each payer. If you just need one payer for this provider, at this time, you can just start typing in here, whatever the payer name is. And it’ll pull up what our standard payer name is. And you select that if you’re only doing one provider, you can do multiple payers on a single request workflow and it’ll create the separate requests as needed. You can say, I want to use the same lines of business for all payers, yes or no. If you do, yes, you’ll just select them. It’ll only allow you to select from what all of the payers you chose offer. So Aetna doesn’t offer managed medicaid. So, because you selected Aetna and uhc, you’re being limited there. But if you select no, for unitedhealthcare, you have the ability to add in the extra line of business. Alternatively, if you have three new providers or two new providers that you are needing enrolled, if you select multiple providers, you can only select one payer. Okay?
Hillary Perez-Godfrey (14:16) So in your experience, so your advice then I mean especially with our low, you know, we don’t have as many providers available. Your recommendation would be easier to do one provider at a time to all of our enrolled lines of business as opposed to multiple providers at one line of business at a time. Yes?
Naomi Denson (14:38) Yes, that would be the easiest route for you guys if you have just one provider or 210 payers. Yes, because if you do it this way, it’s going to be two providers, and then you have 12 different enrollments whereas you could do one provider, all 12 enrollments twice following. Yeah.
Hillary Perez-Godfrey (15:01) Now, will our registered dietitian with the states with state requirements, license requirements versus those new? Will those come, I guess, have we been able to figure out a workaround for mydiabetestutor in our population or will some of those or will those just go through or so like for instance, let’s say I have a provider in Nevada. She has a Nevada license, she has a Illinois license, she has a New Mexico license, but she’s also going to be practicing in. California is a license protected state. So will she, is it set up in your system? So it’ll read her CDR to get her into California contract. Yeah. And.
Naomi Denson (15:47) This is the process that I was saying that they’ve so it used to not let you submit if they didn’t have a state license, right? But now with certain profession types, it will, so it won’t block you.
Hillary Perez-Godfrey (15:57) Okay. And.
Naomi Denson (15:58) Then the intake team and our PE team have notes that say, look for the certification in the state of California for these provider types and not a license. Perfect. Thank you. One other thing when you’re enrolling providers, if you choose a state and payer combination that does not have an existing group enrollment or request already in process in the platform, it’s going to flag you. It’s going to say there’s no group enrollment found for this payer. Do you want to add the existing enrollment or request to enroll the group? It will still let you submit without doing this. But if this is a payer that has a prerequisite to have a group contract in place first, then our team’s going to task out again and say, hey, you need to either confirm if you already have a group contract or request to enroll the group because we can’t add the provider. If there’s no group contract… does that make sense? Yes, perfect. All right. And then on the next screen, you… will choose the practice location. So you’re just going to check this box, but… because we’re in a demo org… they don’t have them, I don’t know why this is doing this. But so we’ll choose that box. And then on the next screen, it’s not letting me, I’m just going to check this. You can choose no practice association to bypass that, but you won’t be doing that because you have a practice location. And then on the next screen for the individual, for the provider enrollments, it’s going to ask you, do you want to show them in the payer directory? Same answers for all enrollments or you can uncheck that box and vary it by the provider, but you can choose, yes, no, or varies by location and line of business. And you can just enter a description on there. And then it’s going to ask what’s your desired effective date application, submission, date, provider, start date at your organization or other. And then it’ll allow you to enter a… specific effective date that you’re seeking.
Naomi Denson (17:55) And then on the next screen, we’ll just say that I,
Hillary Perez-Godfrey (17:58) have a question about that. So if a payer requires their own credentialing, so, okay, I’m, sorry. So the effective date is more so in our case affiliation date.
Naomi Denson (18:13) So follow.
Hillary Perez-Godfrey (18:15) What I’m saying because the payers are going to have future approval dates based on their own internal processes.
Hillary Perez-Godfrey (18:22) So I’m assuming it would be an affiliation date since we’re going to be adding them to an existing contracted group?
Naomi Denson (18:29) Record, right? So, this is the effective date that you want for the provider and granted, some payers don’t allow you to dictate that. They just give it like it’s based on, you know, they’re effective the way for the application. But there are some payers that will allow you to say what’s the start date, what’s the effective date here. So, are we using the date that we submitted the application, or are we using the provider start date from their profile?
Hillary Perez-Godfrey (18:56) And if we use the provider start date with our organization, could that potentially reject the application that you guys are submitting or will they be able to override that?
Naomi Denson (19:05) No, right here, we have a note final enrollment decisions and effective dates are controlled by the payer. Got it. So if they say no, we’re not giving you that they’ll give us the true effective date. They’re not just going to reject it because of the effective date requested. Okay, thank you. No problem. And then the next screen is just requesting any additional notes that you might need to share information, anything relevant, totally optional. And then you would just click submit. Once you click submit on an enrollment request, you’ll see it loaded in here and it will go into a requested status. So the requested status is the initial status that you see after making the request. And then usually within 24 hours, it should flow over into our intake team’s, bucket, which is this processing bucket. However it will stay in intake. If the provider’s profile is not complete, meaning less than 85 percent complete, and they have not signed their agreement.
Naomi Denson (20:06) And then it will flow over into our intake team. Our intake team will review the profile, make sure that, you know, the Coi that we have isn’t expired, the licenses that are on file aren’t expired. We have all of the relevant information that we need for the submission. And then once it reaches an intake complete status is when you are charged towards your consumption in your contract for that request. So if you have any time between the requested status and intake complete… and you decide you don’t need that enrollment, the provider left suddenly and you want to cancel it, you can do so without being charged. Once it reaches intake complete, it counts towards your consumption on your contract. Got it. So you’ll see all of the statuses here. There’s different request status. This is like an overall status requested, medallion processing needs attention, payer processing, et cetera. And then the next status column is where it gets a little bit more detailed. So requested intake, complete, review, intake, pending client information. They’ve made a task application submitted, following up on application et cetera. So with all of those statuses in your support center over here under the help option, and then payer enrollment resources, you have this article here that outlines all of the statuses that you could see and what they mean. So if you ever see a status and you’re not quite sure you can refer here. Another thing about the status is there’s one called pending dependencies. So if you submit a provider to be enrolled with medicaid and Aetna better health, managed medicaid, we can’t submit the Aetna better health for managed medicaid until they’re approved for medicaid. So it’s going to go into a pending dependency status and it’s going to show that request is blocked. So it’s going to go into a hold phase and it’s going to show this request is blocked by this other request because we can’t submit this one until this one’s done as soon as the request that’s blocking us is marked complete. In medallion, this pending dependency status will flip to dependencies met, making it workable. Again. Does that make sense? Yes?
Hillary Perez-Godfrey (22:26) What does stopped mean?
Naomi Denson (22:30) Stopped means you reached out to us and said, hey, I don’t need this anymore. Hey, I accidentally requested this twice requested this for the wrong provider. So there’s different reasons that a request could be stopped. So if our team ever has to stop a line, we would task out to you first and say, hey, this is our findings with this payer. We can’t move forward. We need to stop this line. Their panels are closed, whatever the case may be based off of the initial attempt for submission. So there’s different status categories. So provider was deactivated. Other, we would… provide notes on the reasoning and it would send you an email. You could reach out and request us to stop lines. So there’s multiple reasons that it could be stopped or denied.
Naomi Denson (23:29) Processing is going to be from intake all the way through payer submission, follow up like dependencies met. So you’re going to see those in processing all the way up until we’ve confirmed with the payer that the enrollment is complete and everything associated to the request is verified. And then it would roll into this completed status. When it rolls over into the completed status, it still stays here. But it also goes into this enrollments tab as an existing enrollment. And then the other thing is the needs attention box here. This is anything that has a task on it. So anytime you see needs client attention, intake is going to be that there’s a task on the profile. So it’s not going to be immediately leaked to this request. So that’s where you’re going to see them in this overview tab. You’ll see all tasks in this overview tab all the time. But if it’s a payr specific request from our operations team, it will be tied to the request line and you’ll be able to see it linked right here. It’ll just say one admin task, and then you can click that and it’ll basically just drop this down and show the task here for you to review what’s connected to that. Sometimes you’ll see maybe you have 14 requests that are in, needs attention. You go to your overview tab and you only have two tasks. So you may wonder why do I have 14 lines on hold? But only two tasks that’s because we can do what’s called task bundling. So if we need the same thing, an updated Coi, for example, for seven of the lines that you have requested for the same provider, they can bundle those together and you’ll see like a drop down in here that shows all of the lines that are affected. I guess it’s not going to show me that here. Let me see. It’s. Not going to show me an example but it’ll bundle them. So once you resolve that task for one, it resolves it for all seven requests for that provider. So that you’re not completing the same task seven different times. Does that make sense?
Hillary Perez-Godfrey (25:39) Okay.
Naomi Denson (25:42) So, anything needs attention, just know that if it’s in, needs attention is pending response to a task and the task is open and not marked completed SLA for that request line stops. So you have the 10 day contracted SLA for us just from the time you request or from the time intake complete to the time we submit to the payer, if there’s an open task on the request line, the SLA is paused until we get everything that we need to move forward. All of these enrollment requests are you can filter to whatever by state, by provider facility. You don’t have multiple groups but you could filter by group or status. But this whole table here is exportable. So you can export this to an external report CSV file either based on filters made or just the entire report.
Hillary Perez-Godfrey (26:39) If I hover over the yellow progress button to the right of teams, will it tell me the reason there as well?
Naomi Denson (26:47) This is the provider’s profile completion. Got it. What do you mean? The reason why?
Hillary Perez-Godfrey (26:56) Well, like you said is like if these are, well, this is in the all section, but if it was in needs attention and I was to hover it over here in the yellow, would it also tell me what we need to address in the needs there? Or do I, can I only see it in the overview section? Do you follow what I’m saying? Is it one in the same? Yeah, it?
Naomi Denson (27:15) Should, so let’s see… yeah, if there were actually tasks set to these providers… because it’s a demo org, they’ve not or they’ve been, let me see. Hold on. Let me do something real quick.
Naomi Denson (27:41) It won’t. Let me mark it off. If this was open, then it would show over here. So on the profile completion dial, it would show the task at the bottom here. It would say one provider task or one admin task or one task, and you could click into it that way, just like on the providers screen… let’s see… if you hover over this and it does have a task. See it’s going to show this one task outstanding. Got it.
Naomi Denson (28:17) With the enrollment requests, when we submit the application, follow up on the application, you’ll be able to see all of those details in the notes section. So when we submit the application, you’re going to see a note that says we submitted it on this date. This is how we submitted it. This is where we submitted it. This is the tracking number. These are… the forms that we submitted with. It will all be attached. So you can see everything that was done, same with follow ups. We called this phone number, we spoke to this person. We got this reference number. This is what they told us. If they’re emails, there will be copies of the emails attached to the follow ups as well. If you ever have a question on a request line, have an update. Maybe the payer sent you a welcome letter in the mail and you want to share that with us because they mailed it to you and not us. You can click this, get support button. And then when you click get support.
Naomi Denson (29:19) It would say, what do you need help with? You can say you need a request to hold request to cancellation request, an update, provide an update. So you can share documents or letters or emails if you received them and were not on them for whatever reason that relates to this specific request. So you can always go through support. If you have a question about a specific request, want an update, have a question? You can do that all through the notes section on the line. So on the line notes and then get support and that will create a ticket that ties it to that line. So it’s tracked and a history is kept on. You know, anything that happens with that request line, you do have the option to add notes here, but no one is alerted. If you add a note to a request line like they are for tasks. So if you leave a note on an actual request line, just know that it may not get seen until the next time it’s followed up on. So if it’s something urgent, always go through, get support so that it’s all tracked and seen… sooner rather than later.
Naomi Denson (30:33) You also have the abilities to request demographic updates, request revalidations. So I’m going to show you the bulk demographic update first. So the bulk demographic update provider changes their name, you’re adding a new practice location, whatever the case may be. So if it’s for the provider, you would select medallion owned provider, choose your provider and then what needs to be updated. So you want to add a practice location and you want to say what practice location needs to be added, we’ll pick this one additional details if necessary, providers starting… at this location on this date, whatever the case may be there. If you have notes, you can select the provider’s name. So what aspect is changing their last name? They got married? What was it before? And what is it changing to? So you can add details about the name change if necessary provider was married, name change effective this date. Anything that you might have that’s relevant on the next screen, it’s… going to allow you to select the enrollments since this is a bulk demographic update. So you need this change to all of their existing enrollments. So you can create the 12 stepper request to all of their existing enrollments. So, you know, you don’t miss any. It will give you this flag. If there is a request pending, this could be because they’ve got new enrollments that are still in process. So it’ll give you this alert down here that says any pending new enrollments must be completed before medallion can begin working demographic updates. So we have to wait for the initial enrollment to process all the way through until we can submit a demographic update to the payer.
Naomi Denson (32:27) Any questions there? No. Okay. And then for the single demographic updates, revalidations, I always recommend going through the existing enrollment. So we could go to the provider’s profile. For example, you can see all of the providers payers for just them and within their profile as well. So if we went to his existing enrollments and we wanted a demographic update on just this one, we can hover over these three dots on the right request demographic update. It’s going to pre populate it with that one enrollments information. And then when we say practice locations, it’s already going to show you the practice locations that exist within that enrollment that have already been verified. So do not remove these. We’re just going to click in here and add the one that we need as an additional. So it’s going to turn green. If you click the X mark here, it’s going to show that you want us to terminate this location with that payor and add this new one. So unless you want that removed, just make sure, that you’re leaving everything in here as it populates and then only adding what you need added? Does that make sense? You can add new lines of business if they, the payers entered into a new line of business offering, you can select new lines of business that you want to add here. This is medicare. So it’s not going to let me add any new ones. But if you want to add new lines of business for a provider or group’s enrollment that you don’t currently have contracted and would like to, you can do that through this as well.
Naomi Denson (34:17) And then the same thing, same process for demographic update or revalidation. So you can request revalidations through this process. So find the existing enrollment that you need to request. It’s. Going to pre populate with the provider’s information and that enrollments information. It’s going to show you the practice locations and all the information associated. And then the only thing it’s going to ask is have you received a notice about your revalidation, if you received a letter or an email of some kind, you can check, yes, upload that there. That way we have, is it a reference or just check? No? And then we’ll reach out to the payer or follow their standard revalidation process, to get that done.
Naomi Denson (35:00) Any questions there?
Naomi Denson (35:13) So, and then again, all of these tabs here, you can filter by anything you want, set bookmarks if it’s something you’re going to be checking in on frequently. And then they’re again all exportable by… filters or by the entire report itself. But you also have your analytics report here that I’m going, yes. So it looks a little bit different in your instance because we’ve updated our reporting functionalities. So it’s a little bit fancier and more detailed on your side and not this demo report, but it will show, you know, the status of your requests that are in process, how many of them are in each phase. Why is it showing licenses? I clicked the wrong thing. So statuses of your enrollment requests, it’ll have all of your completed enrollments outlined, status, transition times and turnaround times. It’ll show you turnaround times by payer, by state and calendar days, average turnaround times entirely. So you have all of these, this reporting available. And then, they are also exportable just like the provider summary reports and everything like that we’ve looked at in the other platform.
Naomi Denson (36:37) Let’s see, let’s switch gears and go look at your… instance. Really quick. Any questions while I’m switching over… that you can think of yet?
Hillary Perez-Godfrey (37:00) No, but I’m sure I’ll.
Naomi Denson (37:02) probably have a lot.
Hillary Perez-Godfrey (37:03) of these same questions like when we’re actually live in this and not still in the build up?
Naomi Denson (37:09) Yes, you will. It’s okay.
Hillary Perez-Godfrey (37:11) Because it’s a lot. And actually, this makes more sense than the spreadsheet does than the excel spreadsheet does.
Naomi Denson (37:22) Understood. Yes, absolutely. And then one other piece in the payers tab that I wanted to show you is the caqh management. So you have your caqh management, we’ve enabled it for your providers. So you can see the status. So some of these providers they’ve already gone through, we’ve reattested them based off of their completed profiles. So it’ll show you their last attestation date, and then their reattested by date. So their next due date for reattestation. So this is the way that you can track those are completed. If you ever have something come up where, you know, something’s changed off cycle and you need that updated, you can reach out to support and say, hey, we need these updated in caqh and our team can contact our internal caqh management operations… team to pull those in sooner.
Hillary Perez-Godfrey (38:12) So, why does it say queued… and it’s not due until like may?
Naomi Denson (38:21) Because it’s synced because it’s enabled and it just means that it’s queued and our team is watching them and then they’ll pull in to assign them when needed. So.
Hillary Perez-Godfrey (38:34) Will, like, for instance, Elsa, whose show’s completed? Will she go back into a queued thing when she gets close to reattestation? Also? Yes. Okay. So these are always going to be ever changing through their cycle?
Naomi Denson (38:49) Yes, they will. Yes, I’ll have to figure out exactly what the timeline is on when they switch from completed to queued. But it won’t just stay completed forever. It’ll constantly refresh because this is connected to caqh. So even if somebody else goes in and reattests them outside of medallion’s team, this will sync and queue back up to reflect the most current date. Okay?
Hillary Perez-Godfrey (39:21) Yeah, that’d be useful to know the timeline on that. Like, for instance, dr Sahas’s, I just got out of his caqh file and it said 71 days until… So I was wondering what his would look like. Prim.
Naomi Denson (39:43) Yep. It says queued. I see this was synced to 27.
Naomi Denson (39:55) So, what does his caqh profile currently say is next?
Hillary Perez-Godfrey (39:59) It just says reattest due in blah, blah, 71 days. So I guess that would be my thing is, when would we expect it to show? Like… when does it get reattested?
Naomi Denson (40:19) Let me get some more details on the actual timelines of the status changes because you’ll see queued and then it’ll move and they’ll assign it out to a team member. So it’ll go from queued to assigned processing… provider, client input. Requested. Sometimes, you know, they change their passwords, we don’t have it. We’ll have to task out and say, hey, what’s your new password? We can’t get in, got it or they have another employer that we don’t have information for in medallion that is blocking us from completing the reattestation and then the pending caqh approval is when we upload new cois, they have to approve it before processing the attestation entirely. So we’ll upload the Coi and then when we get that approval, it’ll go back into a completed status to show that it’s everything’s good to go. But I can definitely, I’ll reach out to the team and ask for timelines on, you know, when they transition from completed back into a queued status and what the counts… are there for the days between.
Hillary Perez-Godfrey (41:21) So, I have a question in regards to a payor. Okay. So we have a letter of agreement with an ipa and they’ve… credentialed our providers, I guess. Do you need an actual contract in order to add them as a payor enrollment? Or will you operate off a Loa as well? What? So?
Naomi Denson (41:45) What is the process for you to add your providers?
Hillary Perez-Godfrey (41:50) They’ll actually send me emails saying so and so needs a new Coi. So, and so needs to do xyz. So there’s something that they’re I’d have to get more specifics and I can have that ready for our Wednesday call. But specifically, it’s imperial health plan, which is out of southern California.
Naomi Denson (42:13) Yeah. We would, that payer process scoping template. We would make sure that we have that added on there. Dreama. I don’t know if you’re familiar with that one.
Hillary Perez-Godfrey (42:23) It’s not on there because I excluded loas.
Naomi Denson (42:27) Yeah, I’m asking Dreama if she knows anything about the loas and how we handle those, or if we do.
Dreama Hembree (42:32) No, I would want to look at that because if there’s a specific Loa way that we enroll new providers that is not aligned with our payer directory, we would want to put that as a custom call out for your project plan. So, are we excluding loas, like just across the board for a reason? Or what was, the thought behind that?
Hillary Perez-Godfrey (42:58) Is that a me question or a Naomi question?
Dreama Hembree (43:01) I guess it’s a, you question, Hilary, like why were you excluding the loas? Are we not?
Hillary Perez-Godfrey (43:06) Because they were loas and not actual, you know, 39 page contracts.
Dreama Hembree (43:11) But we’re still enrolling the provider with the payer, correct?
Hillary Perez-Godfrey (43:15) Well, that’s what I was, one of the one I guess that opens the discussion is, I mean, they are performing credentialing activities for them and they are paying, you know, there is an exchange of money and there are terms to the agreement. So, I guess is me adding imperial health because it’s a Loa and not an actual contract, does not exclude the ability to request that they be added as a payer. I guess I needed clarification. I didn’t know. I could use loas.
Dreama Hembree (43:53) I would say, and Naomi correct me if I’m wrong. If we are adding any providers with the group to this payer, we would need to know their information and have them in your payer list. Otherwise, you’re not going to be able to request enrollments in the platform, you know, all of that good stuff. Okay? On the back end. Like Naomi was saying, we look at the payer enrollment process and we make sure that that’s aligned with our standard enrollment functions with our payer directory. And if there’s something different, like you have a specific way to enroll providers that we don’t standardly follow, we would build that out in your project plan. So our team knows, instead of it doing this way, we do it this specific way for this group. Does that make sense? Yes. Okay. So, yeah, I would say unless Naomi has a reason not to, that, those would be included.
Naomi Denson (44:50) Okay.
Hillary Perez-Godfrey (44:51) Very good. And we,
Dreama Hembree (44:52) can walk through that and talk through that as we go. So.
Hillary Perez-Godfrey (44:55) Okay. Yeah, no. And it’s actually because we’re doing business with them right now and my documents are not lining up, you know, some of the legacy stuff that I wasn’t involved with in the beginning of the contracting process. So, I’m still trying to play catch up because things are, it’s not consistent, right? They’re like they did an Loa for endocrinology, but yet they’re credentialing my registered dieticians. So things aren’t matching up on my end and, you know, that’s I guess maybe part of my pause once I get more clarification, I could add them at a later time going, okay. Now that we have this all squared away, I want to go ahead and add them and I can do that as well, right? New group enrollment new?
Dreama Hembree (45:38) Payer enrollment, add a new payer? Yes.
Hillary Perez-Godfrey (45:39) Yeah. Add a new payer?
Naomi Denson (45:41) Yes. Okay.
Hillary Perez-Godfrey (45:45) I don’t have any more questions. Nashaun, you’ve been quiet?
Hillary Perez-Godfrey (45:55) Nishan, no, mute.
Hillary Perez-Godfrey (46:03) Guess he doesn’t have any questions. No, I don’t have anything else. It’s okay. And I could easily, I know that we got all those payer ids that we originally input were all corrected. It’s causing some more questions on my end, but they’ve all been corrected. So I’ve highlighted if I can share what it looks like right now. Yeah. And the reason why is, I think I recall that I said, hey, as we start touching stuff, I want to make sure you guys know that we’ve changed things, right? So let me go here, provider enrollment… share.
Hillary Perez-Godfrey (46:56) Okay. So provider enrollment tab, anything that’s green? Well, this was me confirming that they were contracted, right? For this line of business. So, you’ll notice that all this is now updated as new payer ids as to what they previously were.
Naomi Denson (47:18) Okay. So.
Hillary Perez-Godfrey (47:20) I wanted to bring that to your attention. The other thing, is I know I need to go through because if they’re blank, then it needs to be an N a, not a none, right?
Naomi Denson (47:32) Yes. Okay. That is true. And then on the… yes… and then the group enrollment one and even the provider enrollment ones, if we are going to add loas, those would need to be added on here too.
Hillary Perez-Godfrey (47:50) Right. And then.
Naomi Denson (47:52) I see imperial health is on here.
Hillary Perez-Godfrey (47:54) I’m sorry, I,
Naomi Denson (47:56) see, imperial health is on here? Oh, okay.
Hillary Perez-Godfrey (48:00) Then that’s fine. And then I guess that would be the only other question is even if it’s an Loa, I would still put the status of par because literally for me participation means a full executed contract. Yes. Okay.
Naomi Denson (48:18) Yes, ma’am okay.
Hillary Perez-Godfrey (48:20) And these have been updated as well. So I highlighted them in green. I’m just trying to remove a lot of the, you know, because I had inputted no nonsense. And then now I’m at a different point where I need to update this. Okay?
Naomi Denson (48:35) Yeah. You just let me know when you’re done with your updates. And then I’ll pass off to Nico to do his thing. Okay?
Hillary Perez-Godfrey (48:44) So, realistically, if we can get this completed by Wednesday, would we be able to see everything now in our live system by the following week?
Dreama Hembree (48:57) Hopefully.
Naomi Denson (48:58) It would depend on Nico’s review, and if he has any feedback or questions or call outs, but if everything goes smoothly, then that would be the goal. Yes.
Hillary Perez-Godfrey (49:10) Okay. And then once we do the initial load off this template… once we get the, okay, it’s all been imported, we work solely within the actual platform and no longer in this version, correct? Correct? Okay.
Naomi Denson (49:28) That is correct. Yes. Ma’am. Okay. I.
Hillary Perez-Godfrey (49:31) don’t have any additional questions. Obviously, you, know I wanted, I would have liked this week to have been my deadline but I definitely want April one to be sort of like, I think that’s still our target. Yes… yes, or the first Monday of April or whatever that is.
Naomi Denson (49:51) Yeah, that was what we, you had wanted the April first. Okay? So the sooner we get that back and finalized, the quicker we can move and the group enrollments are going to be the key to getting started with net new providers.
Hillary Perez-Godfrey (50:07) Right. Okay. So that brings up another question.
Hillary Perez-Godfrey (50:09) I have a brand new. So I have three providers that never went through the process with the previous vendor. And so I would want… I need to find out like where they’re at, to be honest with you, I don’t even know where their enrollments are at. Okay, I can add those providers to the lines of business under provider enrollment requests, right? Okay. Yes.
Naomi Denson (50:40) If they are not completed and you either want to import them as a client online for you to continue processing or as a transfer line for us to pick up the follow up. If you put it as a transfer line though, we do need you to share the details of the enrollment, like submission, date, tracking, numbers, things like that.
Hillary Perez-Godfrey (51:01) What if we don’t have any of… that was not relayed to us on the transfer date? I mean, from the previous vendor… like it was just indicated to us as onboarding or excuse me in process. But I don’t have any of those details. So you.
Naomi Denson (51:24) don’t know if it was submitted to the payer at all?
Hillary Perez-Godfrey (51:28) That’s what they told us but I don’t have like date stamps. I don’t have anything like that.
Naomi Denson (51:37) Okay. And they didn’t share any tracking numbers or anything atns with you?
Hillary Perez-Godfrey (51:42) No, but I mean, I guess maybe that if you could maybe send me a quick email of what I should be asking for like literally what they sent us was just like the last payer report that I had given, you know, that I had shared or what we were working off of. But they never gave us any of like the details of those that were in process or revalidation dates or anything. They pretty much isolated it to that one document. Okay?
Naomi Denson (52:11) Let Dreama and I take that back and find out exactly what the payer enrollment team would need to take over enrollments. I know there’s some enrollments that are like done through availability that we wouldn’t be able to follow up on because we don’t have access to the login that was submitted that they submitted through. Okay. So there’s some limitation to what we can take over and follow up on just like especially with availability because you can only follow up on it if you submitted it from your account. And obviously, if we can’t log in and see it, we wouldn’t be able to follow up especially with like blue plans because they’re impossible to get a hold of. But let me take a look at your sheet and see which payers you have. Do you have some on that request tab already?
Hillary Perez-Godfrey (52:58) Well, no, I haven’t put anything there yet. I do have the original document they shared with us and I guess if you can offer, I guess… you know, like what terminology of what I could ask from them? I don’t know if I would get it but I could at least identify. So if they’re onboarding, that means that they never went through any actual payer enrollment processes because they were just on the intake process. But if they specifically say in process, then one would think that they should be able to offer updates. And so with that being said, I guess is if you can give me the catchphrases of what I might need to request. The worst they can say is they don’t have it, which would confirm my disappointment that’s why we’re having this conversation but I just don’t know what I need to ask for, I guess. OK.
Naomi Denson (53:53) Yeah. We’ll put something together for you. Let us just connect with the PE team just to double verify, OK, if they have any additional asks and then we’ll reach out, OK?
Hillary Perez-Godfrey (54:04) And I’ll go ahead and take a look at that last report from welter, so I can find out exactly even the volume that we’re looking at like how many payers, how many records? Yes. OK. Perfect. That’s all I have for today. Unless you have anything more to share with us?
Naomi Denson (54:25) I do not, we will connect again on Wednesday.
Hillary Perez-Godfrey (54:28) Perfect. Thank you, everyone. Bye. Have a good day, you too. Bye.