Transcript
Naomi Denson (00:00) hey, Tim. Hello? Hey, hey.
Naomi Denson (00:13) Long time. No, see. Alright. Let’s see who’s here. Alright? Two of my stalkers and Hillary and Nashaun. Oh.
Naomi Denson (00:31) Good morning. Oh, Hillary’s. Still coming on there’s Hillary?
Naomi Denson (00:42) Good morning. How’s everybody doing… good?
Hillary Perez-Godfrey (00:48) I don’t know if I have much update for y’all today. I was expecting the template to be more complete for you, but I know that we’re still working on the same target dates.
Naomi Denson (01:07) Okay. For one?
Hillary Perez-Godfrey (01:09) Yeah… I’ve just been busy with other. We just executed a contract yesterday, so definitely… want to transfer that one over since it’s Illinois.
Naomi Denson (01:23) Okay.
Hillary Perez-Godfrey (01:24) Yeah. So Nashaun, can you give the group an update please?
Nashaun Lee (01:31) For Illinois, Aj pass?
Hillary Perez-Godfrey (01:33) No, for the medallion?
Naomi Denson (01:37) For the medallion?
Nashaun Lee (01:39) Say that for me again, for.
Hillary Perez-Godfrey (01:41) the medallion template and the import so we can go live on April first.
Nashaun Lee (01:46) Oh, yeah. Yes. I’m planning to go ahead and have that completed by the end of this week. So hopefully, I should be pinging you with that back Thursday evening by the end of the day.
Naomi Denson (01:55) Okay. Yeah. The group enrollment, existing enrollments would be the priority to go live with net new providers. So I just want to make sure we’re focusing on that one.
Nashaun Lee (02:04) You said group enrollments, what were the other one?
Naomi Denson (02:06) What was the other one? The group enrollments tab. Okay. So for net new providers, and then we can focus on any transfer requests or provider enrollments. Okay. Got it. Perfect. All right. Perfect. Any questions about the template and none on there? What’s remaining on there to be filled out? Looks like we’re just working through like the lines of business piece on there and maybe some effective dates?
Hillary Perez-Godfrey (02:35) Can you bring up the, can you show it to us? Just so?
Hillary Perez-Godfrey (02:45) So, Nico, everything that I’m putting in green has been, you know, is like triple verified. And then those payer ids are different than what we had before. So I reached out to my biller for her to give us the, you know, and I was very clear about the trading partner id, but that’s what she gave me now, I actually have a question in regards to blue cross to me. It just doesn’t make any logical sense that with like their different plans since blue cross is so big that they still have one payer id. Is that correct? Because I don’t agree with my biller on that. Do you know, from your experience, I,
Naomi Denson (03:36) don’t know because in California, they are separate enrollment processes for blue cross and then blue shield. So they would technically be separate contracts.
Hillary Perez-Godfrey (03:48) No, no, no, I know that. But like I’m talking like within blue cross, they’ve got commercial. They’ve got medicare, they’ve got, oh.
Naomi Denson (03:56) Yeah, no, I wouldn’t think so.
Hillary Perez-Godfrey (03:59) Can you ask your subject matter experts please in billing if they can, at least, I need a starting point to go on that one.
Naomi Denson (04:10) Let’s see.
Naomi Denson (04:15) Dreamer, are you on the call dreamer? Do you know, typically, I don’t see the billing id or the provider id change for lines of business? No. Okay. Dreamer, is your subject matter expert engagement manager?
Hillary Perez-Godfrey (04:32) Got it. Right. Well, no, just my reason is, you know, I think it’s blue shield. They have a medicaid product, you know, as a managed care and.
Naomi Denson (04:42) You would think that they?
Hillary Perez-Godfrey (04:43) Would want to keep that bucket of beans separate from their other stuff. I don’t know. I mean, I know that BC oo, I and BS oo, I are valid ids. I just, for some reason thought that there might be more for California even.
Naomi Denson (05:07) I don’t know, California is weird and difficult.
Hillary Perez-Godfrey (05:10) Sure. Is.
Naomi Denson (05:12) Always was my least favorite payer to work when I was in that life. Well.
Hillary Perez-Godfrey (05:17) The other thing, is like with all your medicaid managed care plans, you know, they have a different managed care medicaid plan for most every county. And there’s 58 counties in California. You know what I mean? So it’s like, yeah… okay. And then I think we had a couple of questions. I think that you were going to.
Hillary Perez-Godfrey (05:47) And it was more so that stemmed from, was it yesterday during our training, the platform training? Do you recall? I don’t I’m sorry?
Naomi Denson (05:56) Or Monday? Yes. Was it Monday? I?
Hillary Perez-Godfrey (05:59) Don’t even remember what’s today Wednesday.
Naomi Denson (06:03) Yeah. Let me go back and look. I’ve got to send you that recording too. I was thinking about that this morning. Let’s see.
Naomi Denson (06:30) Oh, yeah. We’re going to ask the… PE team all of what they need for the transfer… requests as far as tracking numbers and things like that. Dreama, did you take that back? Or do we have any more clarity on that? The notes from the call say Naomi and Dreama will take it back. So I can do that. If you haven’t already reached out, I have not, no, okay. And then I’m waiting on a response from a caqh team about the timelines for the status transitions. And that was all on my end. Said Hillary, you’re working on the reviewing… the last report from the previous vendor to identify the volume of payers and records for in process enrollments?
Hillary Perez-Godfrey (07:30) Yeah. The individual providers, are… you know, I’ve got that. I was able to pull up the organic file on that one. I guess… I have an.
Hillary Perez-Godfrey (07:47) Okay. Yeah. I need to plug in like their provider number off that last report. So where we’re starting to run into issues and this isn’t a you issue. And maybe you can advise. So I was not the, we have had networking people, contracting people with my diabetes tutor that predate me. And a good example is imperial health, right? Imperial health plan is an ipa. When I approach to get a contract, obviously, I’m trying to figure out what specialty they’re going to load us in. And then therefore, that specialty dictates who’s getting credentialed and who’s not, what if I end up doing line of business, medicare and it’s only doc. And then it’s wrong? Like what if there are RDS? Is your system able to like? Would you guys, when you’re doing your transfers with the payers? Would you be able to be aware if there was a questionable error? Like why are RDS? Are there? No, it’s only what?
Naomi Denson (09:07) No, we don’t sync directly with the payers. So anything that we’re importing is coming based off of you as the source of truth. Yeah. So it doesn’t sync like the platform doesn’t sync directly with the payer systems or anything like that to verify anything that you’re providing to us. Does that make sense? Yeah. So.
Hillary Perez-Godfrey (09:28) Right. No stress. No pressure. Is that basically… everything that medallion does is based on what I tell them? Okay.
Naomi Denson (09:41) Yes, you are medallion’s source of truth to tell us what you need and what you want. Okay? As far as enrollments go and what you have?
Hillary Perez-Godfrey (09:52) Okay. Yeah. We’re starting to find out that like our lines of business, you know, like we start off with a contract and I only have my hands on, let’s say commercial and then the payers are adding line, you know, how they sort of go. Oh, and any line a bit, you know, that sort of disclosure of and anything else that we add is automatic. And then you’re like why are we seeing your medicare advantage patients? And I can’t find any amendment.
Naomi Denson (10:22) So,
Hillary Perez-Godfrey (10:23) now, I’m backing up and having to look at every contract I have, so this created.
Naomi Denson (10:29) more.
Hillary Perez-Godfrey (10:30) work, you know, to get it, right? I mean, I guess, but I guess the only thing that I’m comfortable with is that if we let’s say load at medicare advantage and then they add a medicaid product, then at that point, I can bring that to your attention and then add it in.
Hillary Perez-Godfrey (10:50) Yeah. Okay. And if I’m doing the math on our original scope scoping for the 300 enrollments, let’s say roughly let’s say hypothetically every single provider could go through credentialing, realistically that’s 10 payers… 30 providers, 10 plans, right?
Naomi Denson (11:16) Okay. So it’s 30 providers, 10 payers… per provider. So that would be 300 enrollment requests in medallion. Okay? And,
Hillary Perez-Godfrey (11:26) how, in your experience, how often do you see where people underestimated their enrollments and they’re needing to quote unquote borrow from year two?
Naomi Denson (11:38) All the time?
Dreama Hembree (11:40) Okay.
Naomi Denson (11:41) All the time… and it’s not even just borrowing from the next year. You can, it pulls from other SKUs, yeah, other SKUs in the current year too that maybe you’re underutilizing. Okay. So it’ll pull from that year first. And then… you’ll be working with, you know, Peter, I think Peter’s your account manager. He’ll be like checking in on your consumption regularly and having syncs executive partnership syncs with you guys to go over consumption and discuss if there’s a need to increase volumes anywhere and things like that. And then you’ll also have Dreama throughout the partnership to check in there as well. Got it.
Hillary Perez-Godfrey (12:22) And Dreama, you’ll be, are you able to make suggestions when I have those discussions with Peter or will he already be aware of that and bring that to my attention? Yeah.
Dreama Hembree (12:32) Peter will be the one that deals with you directly on consumption and like contract level things, I’ll be the one that like operationally that partners with you. I mean, certainly, I can take something back to Peter for you or pull him in, you know, if we need to. And then after you go live, I’ll be setting up check ins with you usually weekly in the beginning. And then, you know, as we kind of move into maintenance mode or, you know, whatever we can adjust from there. And.
Naomi Denson (13:02) Then Hillary, I don’t know if I’ve shown you this part yet, you have this usage tab in your platform under account. Okay? So this shows you what you purchased what you’ve used so far and what you have left.
Naomi Denson (13:25) Okay. So as you start making new payr enrollment requests, those will start flowing into this list as well. Got it. But this is the overall contract volumes and amounts that you have and what you’ve utilized and what’s remaining for a total number. Okay? Only admins have access to this in the platform. So don’t worry if providers can’t see this or anything like that. It’s just any admin users, but you do have direct access in the platform to check in on it as needed.
Hillary Perez-Godfrey (13:54) Go ahead and go to my overview, please?
Hillary Perez-Godfrey (14:04) Your overview, oh, my providers, I apologize. Oh.
Naomi Denson (14:07) Okay. There’s 35. Currently they’re active? OK?
Hillary Perez-Godfrey (14:18) This is thawne Ortega… TH. Oh, okay. I need to disaffiliate… her effective April first, and.
Naomi Denson (14:34) So,
Naomi Denson (14:44) yeah. And then remember, you go to the members tab and find them by their email, and then we can deactivate. You want me to deactivate it?
Hillary Perez-Godfrey (15:02) Yeah, it’s next week. Yeah. OK. So end date under providers, yep.
Naomi Denson (15:12) Under providers. So we’ll just look at this one. Determination date is in the provider’s profile, professional info, got it. And then employment details. OK? And then.
Hillary Perez-Godfrey (15:26) Go down to the members tab, the members and deactivate. OK. Yes. And then if they come back and that’s the same.
Naomi Denson (15:35) So, you can reactivate them too, and everything that was in their profile comes back as it was, OK?
Hillary Perez-Godfrey (15:40) And then the same thing reverse is with activation, right? So, if I get a provider, we’re going to add them, and then that’s when we activate.
Naomi Denson (15:49) Them.
Hillary Perez-Godfrey (15:50) Through you guys to start the process. So, and,
Naomi Denson (15:54) when you get a new?
Hillary Perez-Godfrey (15:55) Provider, sorry, invite member. Sorry, yeah. So.
Naomi Denson (15:57) You invite them, put in their few details here. And then this box is default checked. So when you click invite member, it’ll automatically send them the invitation to do their profile.
Naomi Denson (16:06) But you can uncheck this box if you’re going to hold off or wait to invite them. And if you do need to hold off or wait to invite them, maybe you’re going to do work in their profile first or you want to wait till closer to their start date, you would just come back in here and it will say not invited here and you would just click the little paper airplane to send them their invite or come over here and click it’ll, say send invite if it’s the first time?
Hillary Perez-Godfrey (16:35) Is there a section to add like notes that I can go back to with my providers where, you know, it’s like or reminders for myself or is that something I need not?
Naomi Denson (16:47) Necessarily reminders, but there is a note section here. Okay? That you can leave notes to and you can even add a note and then send a notification to the provider if you need to notify them of anything. Okay? So it’ll send them to you, right?
Hillary Perez-Godfrey (17:04) No, I was just thinking more of like an internal thing and can that be exported on reports for notes or is notes not something that’s reportable?
Naomi Denson (17:18) So, you do have on the provider directory tab, I believe there’s yeah… there’s a notes section right here. So you can add notes in the provider directory, and then you can export the directory into a report. Okay?
Hillary Perez-Godfrey (17:35) And that’s an internal only directory, right? So, for instance, let’s say… if I’m wanting to track, right? Like, so let’s say Kara schrager was on our Monday report that her license or her pli is going to expire, you know, at the end of this month and I’ve already gotten it even though I’ve already updated her file, but I sort of want to keep like a like I’ve completed this already. Just so when I’m going through my emails or anything that I have a reference point, is that something I can do here?
Naomi Denson (18:19) I’m not sure. I’m following the question. So you get like a.
Hillary Perez-Godfrey (18:23) Summary report.
Naomi Denson (18:24) That says her malpractice is going to expire, and then you go in and you update it in.
Hillary Perez-Godfrey (18:31) Her profile, right? It’s more of right? It’s more of just an internal thing for me like as I’m going through emails or if the provider reaches out to me again and I’m like I thought we did this but I don’t really know. So I can go to notes and go. No, no, no, you sent that to me already a week ago?
Naomi Denson (18:48) Yeah. You could put that in there, but you’ll also if their malpractice is expired or anything like that. I mean, it’s going to be showing in their profile directly. You can go into their profile and just look at the malpractice records and see. Did I add the current one or not… or the licenses? Did I update that or not if it’s a specific provider, but yeah, you could add notes to the provider’s profile to keep track of what you’re doing absolutely.
Hillary Perez-Godfrey (19:16) Okay. Let me because I just had one the other day and I’m like didn’t we deal with this already? Why am I? Why is the provider reaching out to me again? Let me find it. And then that’s really all I have.
Naomi Denson (19:37) Oh,
Hillary Perez-Godfrey (19:39) Kara schrager.
Hillary Perez-Godfrey (19:45) I’m good. She was just, her lead was asking when Kara schrager was going to get credentialed and I thought we already had her in the system so I can go to her start date, right? Kara schrager. See.
Naomi Denson (20:05) Yeah, her start. Yeah. So what’s the question on her? They’re.
Hillary Perez-Godfrey (20:11) asking when she can start signing her own charts. So I could have sworn she was already.
Naomi Denson (20:20) She’s in here, but we don’t have any enrollment.
Hillary Perez-Godfrey (20:23) No, no, no. I know that what’s her start date… professional? Okay. Again, it’s in there eight.
Naomi Denson (20:31) 23, 25, six.
Hillary Perez-Godfrey (20:33) 23. Okay.
Naomi Denson (20:34) Oh, six. Sorry. Okay. That’s weird. Okay. I’ll follow.
Hillary Perez-Godfrey (20:40) up that’s an internal issue. Okay? I don’t have anything else unless you have something for me nope.
Naomi Denson (20:51) That was all I had. I’ll just keep an eye out for the existing group enrollment so we can prioritize those to get them loaded so we can keep that target for one live date. Yes.
Hillary Perez-Godfrey (21:05) And any conflicts for next week for calls or anything? I?
Naomi Denson (21:10) Do not let.
Hillary Perez-Godfrey (21:12) me look and see what I have going on. Let me see. Nope. I’m clear for the first and that’s actually our next meeting. So we should be able to.
Naomi Denson (21:25) Yep. And I will, do you have an idea of how many net new providers you have that you’re going to be submitting enrollment score? And how many?
Hillary Perez-Godfrey (21:35) Say that one more time? How many?
Naomi Denson (21:36) Net like brand new enrollments you’re going to be needing at this, go live on four one, how many providers, how many payers? Is that the 300 that you’re saying or is it less than that?
Hillary Perez-Godfrey (21:47) No, no, no, most of them are just going to be a, what is it para analysis. And then I’ve got providers.
Hillary Perez-Godfrey (22:02) Wait, no, no, no, hold on. I’m thinking it’s definitely less than 300.
Naomi Denson (22:08) Okay. I’m trying to be able to give our team a heads up to know that how many requests are coming when you like go live, right? No, I.
Hillary Perez-Godfrey (22:21) don’t anticipate because there’s so many plans that only. Did dr Sahas, okay? Which makes it more complicated because some plans like will not credential RDS. So that’s the big, right? That’s the big one. Okay?
Naomi Denson (22:40) Yeah. If you can try to come up with a rough number before… we actually start submitting requests just so I can give them the go live heads up on the operations side.
Hillary Perez-Godfrey (22:51) Yeah. So hypothetically, if I was to, let… me just find out, I can, so hypothetically, if I was looking at my closeout roster, right? So, and then I look at the last payer report… I think that’s what I was trying to count like which ones excluding… well, looking at the, if you were to pick like dr Sahas out of the, I think I pasted him in already to.
Naomi Denson (23:26) The provider enrollment?
Hillary Perez-Godfrey (23:37) So, if we were to search just.
Naomi Denson (23:38) Dr.
Hillary Perez-Godfrey (23:41) Sahas.
Hillary Perez-Godfrey (23:54) There’s only three lines, right? Is that what we’re seeing there?
Hillary Perez-Godfrey (24:18) So he would be the most, right? That’s how we’re counting, right? Sorry.
Naomi Denson (24:22) I was muted, yes, 23 for him. Okay? And then.
Hillary Perez-Godfrey (24:27) If you were to search just one of our RDS, can you search Denise?
Hillary Perez-Godfrey (24:37) Row… yep. DG. Yep.
Hillary Perez-Godfrey (24:48) How many lines? Is that 21? No.
Naomi Denson (24:51) Yeah, 21. Yeah, 21. Okay. But those?
Hillary Perez-Godfrey (24:58) General memberships, you guys do not process, right? I need to correct that, but because that would be an okay. So, question, if it’s general membership and they don’t credential, the provider… that’s not par, but it’s not non par either you.
Naomi Denson (25:18) Still have to send a notification to the payer to add them somehow, right? You still have to notify the payer or send them like a linking application or something.
Hillary Perez-Godfrey (25:29) That they just have periodically. They have me send them a full roster.
Naomi Denson (25:34) Okay. So it’s not something that you’re going to request provider by provider, that action is needed on regularly… for these memberships. Yeah, that we wouldn’t do those, okay? And.
Hillary Perez-Godfrey (25:46) then Lasalle, I just got off the phone with them yesterday. They were a general membership. Well, they weren’t actually weren’t even a general membership, but we’re getting ready to get a new contract because they excluded all our dietitians before. So I’m going to have a professional contract for the advanced provider and the MD. And then I’m going to have an ancillary contract for the RDS. So in that case, how do we differentiate? Are those two rows or is it still the same row? Same payer and it’ll just have different values. So if it’s the.
Naomi Denson (26:23) Same row, same payer, same state, same group… same practices, it won’t create a duplicate. But one thing that you can do to differentiate is utilize like the payer id field. If they have different payer ids or you can use this as just like a unique identifier, and you can put RD group and then dietitian… group or contract something like that. If they don’t have that Nico, any thoughts there? They have two separate contracts for the same payer, just different… provider types that they cover… but it’s the same provider for both of them. It’s the same.
Hillary Perez-Godfrey (27:07) Payer or the same plan? And this usually happens. Well, it could happen to anyone. But what they do is they insist on having a professional contract for the MD and the advanced practitioners. And then they’ll have an ancillary or an quote allied contract for the RDS. Are they under?
Naomi Denson (27:29) The same group like tax id and npi everything?
Hillary Perez-Godfrey (27:33) Is the same same? Same? Then? I?
Naomi Denson (27:36) Don’t think we need to differentiate them because when we send, the, if, yeah, I don’t think we need to differentiate them. Would I be able if there’s nothing special that we have to indicate or a different type of application? No, but on a report on a report,
Hillary Perez-Godfrey (27:51) it might help me. Am I able to, I guess be on the payer name? I can’t mess, I guess. Is there?
Naomi Denson (28:00) Any, we can’t do custom payer names, but what some other customers do is if they have like a payer name, that maybe they know it by a different name or it shows up a different name to their billing team, they’ll add it to here. Okay. The payer id, since this one doesn’t have a payer id, you could utilize that and just say.
Hillary Perez-Godfrey (28:19) Lasalle RDS Lasalle professional. Yeah. Okay.
Naomi Denson (28:24) That makes sense. Because when you’re looking at the existing enrollments, it’s… going to show the payer id on here with the payer name when it’s added. So, if it were there, it would show it here. So you would see medicaid Arizona or Lasalle and then like dietitian or professional? Okay?
Hillary Perez-Godfrey (28:48) No, that helps me out a lot. And then that is something that can also be exported in the report, right? If I was sorting.
Naomi Denson (28:54) Yep. Okay.
Hillary Perez-Godfrey (28:56) That’s all I got guys.
Naomi Denson (28:58) All right. Thank.
Hillary Perez-Godfrey (28:59) You, Nashaun. Did you have anything else? Nashaun? Are you good?
Naomi Denson (29:01) Yep. All good on my end. Thank you. Reach out if you have any questions about that group enrollments tab. Thank you.
Hillary Perez-Godfrey (29:08) Appreciate it. Bye bye bye.
Naomi Denson (29:09) Thanks. Bye bye.