Transcript
Sandhya Kapila (00:00) hello? Hey, I.
Amy Frana (00:03) Did not get a chance to go compare to the payr directory on those columns. The other thing when we do and Sandhya real quick before they join, if they give us information that is not aligned to our payr directory, if we have the chance, we want to direct, like we want to switch them to our process. Like unless there’s some reason it’s.
Niccole Russell (00:27) unique. So.
Amy Frana (00:29) Even with these tier threes, I think it’s worth or I should say especially with these T threes, I think it’s worth trying to push as much as we can to that, so we can help with that. I just didn’t get a chance to do it before this call.
Niccole Russell (00:44) I also want to note that if we say it’s not a payr. And what we mean by a payr is they don’t pay provider claims. If they say it truly is a payr, they’re getting paid for those claims on those providers, then we ask them to provide an sop for us to be able to add.
Lauren Henderson (01:07) That.
Sandhya Kapila (01:11) okay. That sounds good. All right. It looks like there are folks in the, waiting room, worked for this one. I don’t understand. I don’t.
Amy Frana (01:19) get it either. Like what creates it and doesn’t so, no.
Sandhya Kapila (01:23) Idea. I’m gonna let them in.
Sandhya Kapila (01:37) Hey, Ashley. Hey, how are you? Good? How are you? Hey, Lauren. How are you?
Lauren Henderson (01:45) Muted, hi.
Sandhya Kapila (01:47) Hey there. Thank you guys for joining. As I shared, we have Amy and Niccole joining us. Amy leads up the engagement management team and Niccole is an engagement manager on the team.
Sandhya Kapila (02:00) They’re gonna be chatting with you through the payr process scoping sheet and just to better understand what your current processes are. So I will actually let them introduce themselves and then take it from here.
Amy Frana (02:13) Awesome. Thanks. So Lauren and Ashley, nice to meet you. I’m Amy frana, as Sandhya mentioned, so our team really helps support the implementation process in kind of this, the payr mapping, scoping all of those pieces so that we can make sure your processes are aligned to either what we have as our standard process or we’re able to make notes and make sure that our team is fully aware of what it is that we need to kind of modify to help with your account. So Niccole is a member of my team. I’ll let her take it away. She’s really the, this mean expert in this space, but we’ll be helping you through this as over the next few weeks with implementation, you’ll see you might see us a bit more.
Niccole Russell (02:58) Hey, I’m Niccole, I report to Amy as she said, I have been looking over your payr enrollments, I guess, names and kind of the processes that you’re going through. Thank you, Sonia. So this is really where I’m going to be focused in with you all is we have an overall sign off on column a. So once whatever you call the payr, we may have something different. Maybe they were also known as, or they changed their name back some time ago, something like that. We’ve seen across the board with different clients. So you would do an overall sign off on column a. So column B is what you are calling the payr. And then column D is what medallion is calling the payr. So the ones that are highlighted in yellow. Now I do have the PE team confirming that information as to what we should actually name that for you. All the ones that are not yellow, if you want to go ahead and review that, sign off on that, or if you have any comments, you can add that over in your comment section as well. Now, I will say I did see Aetna had a roster. We actually do not have a roster mapped for Aetna for California. So fantastic there that can be mapped for you on our side. The only thing that we ask and I believe I saw notes to where this was submitted. Is that correct?
Lauren Henderson (04:23) Yeah, yeah.
Niccole Russell (04:26) Also, in addition to that, are there any sort of prerequisites needed for that enrollment. So if there’s medicare or medicaid that need to be enrolled before this, then list any prerequisites there as well. I see submission, is there follow up information over there? Let me pull up. I’ve got one right here too. So for all. Okay. So I see where the roster is to be submitted. Is that where we would also follow up?
Lauren Henderson (05:06) No… we’ve been really… transparent this whole time. We had some turnover in December. And one of the individuals that left was the person who oversaw credentialing and in full transparency, we did not have all these processes completely nailed down with her and I don’t even think she was doing all of them correctly anyway. So over the past three months, I have been doing that deep dive and getting all the information from our contacts or whoever I can. And I did actually just as I was communicating with Edna because our contact there is really responsive. She helped add one person. And then she said, go ahead and if you have to do like a bulk enrollment, fill out the roster here’s, all the details. I ran it by her before I even sent it in. And she had missed a few things. So I updated that. When I sent it over, you get an auto response and it gives you who to follow up with. It’s. Not the email that’s here. I can copy and paste some of that in if you want. But it does come back as an auto response for following up with those additions. And it says large rosters could take up to 30 days, but it has all that detail in the auto reply. Okay?
Niccole Russell (06:27) That’s fine. I think, I mean if you have it, you can add it. That’s great. If not, when someone submits it, they should see that as well. Okay. Well, let me confirm Amy with automations. I’m not sure that we would see that email. Oh, we should.
Amy Frana (06:51) I believe is my understanding. But if you have an example because this is where like we understand different companies will have different processes in general, like if it’s something that is truly unique, we’re happy to oblige if there’s a way that like it’s just this is how you’ve been doing it but really are open just making sure that the enrollments are correct and we need to pivot how we do it. We’ll talk through all of that piece. So that’s where if you have an example, it would be great to see. We should be able to see as they come back, but we’d have to get clearer confirmation on that.
Lauren Henderson (07:30) Okay. Yeah, no problem. And.
Niccole Russell (07:32) then I do see availability portal there. So we would need to be granted access for that. Okay?
Lauren Henderson (07:43) Who would, who… would be the user? Who would we add? So.
Niccole Russell (07:53) It is going to be, let me confirm.
Niccole Russell (08:14) Actually, let me just drop this into the chat. It looks like it’s going to be for Emily johnson. And then I have her email address here. So I’ll just send over these instructions. If you’re good with that, I can throw them in this chat here.
Lauren Henderson (08:29) Yeah, that’s fine.
Niccole Russell (08:31) Okay. And it has her email address and everything that needs to be added as well. Okay. Let’s see. Let me see here. I see a list of non standard enrollment processes. So again, as Amy said, we’ll just kind of review that up against what we currently have in our payr directory.
Lauren Henderson (08:55) Yeah. And honestly, I’m… not so sure if they are non standard or not. I was just kind of going based on a lot of this information, I’ve just gotten an email correspondence with our… contacts at.
Niccole Russell (09:11) The, okay. Yeah. Okay. So is it fair to say if we have an enrollment process for these payers, you’re willing to follow that? Yeah. Okay. Easy enough. Let’s see. And that’s really all that I have. I think everything here looks good again just on the roster, getting a follow up email if we could have that and then to know if a prerequisite is needed. Because as we create project plans for you specifically. So if a payor is unique to you, anything like that, then at that point, we have to create this form that goes in our payor directory. And those are some of the questions where it’s submitted the follow up, any contacts, if there are prerequisites that are required. So any of that information would definitely be.
Lauren Henderson (10:07) Helpful. Okay. For cedars, what I am discovering, they’re a newer organization with us that we’re contracted with, but the insurance is really, they’re more of like a provider organization. They’re not the insurance. So the insurance really is blue shield blue cross. So I think we can remove them. That’s what I’m seeing, I can try and find out more, but I was even looking or working with our intake manager the other day and she was showing me some of the referrals that are coming through and they are the payers are like blue cross blue shield that kind of thing. So, cedars is… the managing organization I guess, and the referring organization but not fully… responsible for the payment. Okay? So what I’m understanding with credentialing is it needs, they just need to be credentialed with the payer which is one of the ones we already have listed. Okay?
Niccole Russell (11:11) So they don’t pay claims for providers. Gotcha. Yeah. Okay. So Sonia, I think you can remove that cedars from the list. So we don’t import that information.
Lauren Henderson (11:22) And then the other two that I, from what I understand and the information I’ve gotten back is kaiser doesn’t require us to do anything at this time and neither does ipa, okay? Go.
Niccole Russell (11:38) Ahead I.
Lauren Henderson (11:39) Was just going to say for ipa, they said for ancillary providers because we only provide speech and OT to them. Only the facility needs to be credentialed. And for kaiser, I went back and forth with both our contracting specialist and their provider data support management. And one said here’s where you send update your practitioner roster. And then the other sent me to credentialing. Credentialing told me they don’t have us in the system. They said you don’t need to be for speech and OT. And then the PDS contact said we don’t send those to regional credentialing. I don’t need a roster. So that’s where I’ve gotten with kaiser. Okay? Which some of this seems odd to me. But I know we also haven’t submitted anything to them. So, okay. And I.
Niccole Russell (12:31) know some payers as well like will enroll based off of claim information. It sounds like kaiser’s not doing it based on these.
Lauren Henderson (12:38) Yeah, because we’re not getting denials or anything, you know? Okay?
Niccole Russell (12:41) Yeah, that’s probably what it is probably at a group level then which we don’t need to add that. Okay? So that.
Lauren Henderson (12:48) and preferred ipa would both be, I guess the group level. Okay? So.
Niccole Russell (12:54) Sonia, I guess based on what she said, we can remove kaiser and preferred ipa as well. Thank you for that clarification. Lauren. Yeah. And then if you find that you’re receiving denials, we can always add these in. So don’t think that this is a one stop shop, we can always continue to add to your payers. Okay?
Lauren Henderson (13:20) Blue cross medical. I’m assuming is the same as the anthem portal… but I’m trying to figure something out with our behavior contract through anthem because they’re saying our name isn’t matching up. So I don’t have the full detail on that right now. Okay. I think that’s the only one I’m missing though. Okay. So.
Niccole Russell (13:43) If you, I think if you want to sign off, yes on any that you’re comfortable with, we can always come back to the ones that you’re not sure on right now? Okay? That.
Sandhya Kapila (13:52) Works.
Sandhya Kapila (13:57) Thank you. Okay. Great. Thank you… Niccole. Amy, I think we can talk about this offline too. If you guys want to have another meeting with Lauren and Ashley afterwards, just to chat through this in more detail, we can schedule that too. Okay? Or you guys can just join our weekly meetings which are on Mondays.
Niccole Russell (14:21) Okay. Sounds good. Cool.
Lauren Henderson (14:25) Thank you guys and Lauren while.
Sandhya Kapila (14:28) I have, you, can I run the bulk import?
Ashley Johnson (14:32) Yeah. I want to make sure.
Lauren Henderson (14:34) I have questions for you too. Perfect. Great.
Ashley Johnson (14:37) We also just have to send another notice saying, hey guys. They’re doing the import as, you know, we’re working with medallion. Like we previously said, just know that that’s starting. So you’re going to get some notices? Okay?
Sandhya Kapila (14:50) Perfect. Yeah, just let me know when… yeah, as I was about to do it yesterday, I was like, wait, they may get notices. So let me just check in with you guys. So, yeah, let me know whenever you’re ready for me to do it. And then I will do it.
Ashley Johnson (15:07) Yeah, no problem. I will get that email out after this meeting. So I think maybe if you could do it, Lauren, do you think around midday? Just, I’m just thinking if we’re trying or maybe tomorrow? Because I’m thinking if we’re going to want them to see the email before they get the notices from medallion… but I mean, really, they might not even read the email tomorrow. Yeah?
Lauren Henderson (15:33) Okay. I don’t think it really matters. And if they’re really concerned, they’re going to ask questions, yeah.
Ashley Johnson (15:38) Okay. So then you’re good to go. I also uploaded the information. We had a ton of people respond. So whereas we had about 20 people before, we now have 40. So for the external accounts that you can pull over.
Sandhya Kapila (15:52) Awesome. Perfect. That sounds great. Yeah, I’ll make sure that the, I think I had put waiting on customer in our ticket. So I’ll make sure they didn’t put anything in. And even if they did, I’ll just ask them to do another round. So that sounds good. Okay, perfect.
Sandhya Kapila (16:09) So I will actually, I’ll wait till the end of the day then to do the bulk import just to give you guys time if that’s okay. Yeah, yeah. Okay.
Lauren Henderson (16:22) I have questions about the provider enrollment. Yes. I’m hoping you can tell me an easier way to do it because it seems like a beast. I will be on one payer and it’s going to be because of multiple locations. I’m going to have at least 100 lines. So I feel like with all of our payers, we’re going to be, it’s going to be like a 1,000 lines. Am I like, let me, I started, let me share. Okay, I don’t know if you know a better way or a workaround or steps I can skip?
Sandhya Kapila (16:57) Yeah. Oh no, yeah. Let me, let me see. And then we can, okay… I have so many windows.
Lauren Henderson (17:09) Open. Okay. So I started putting this is going to end. All these people are going to end up being just for Aetna plus a few additional lines. Like you can see Ariel’s here three times Bailey’s three times because they’re at multiple locations that they’re enrolled with. Also. So I’m having to add those additional lines if they have multiple locations. And then of course, like a lot of this here is I can just drag down and have it, you know, auto fill as the same and same with like this stuff. The locations I’ll have to fill in this stuff is, you know, copy paste, but I’m just wondering if… I’m missing something or it really is just a grueling task it.
Sandhya Kapila (18:05) Is, and I’m just thinking if there’s a way for us just to make it easier for you just to be like, okay, well… this same information applies to. And if you want to do that, then I think that’s.
Lauren Henderson (18:20) fine. I’m yeah. What do you mean? The same information applies?
Sandhya Kapila (18:26) So, because you said you have to do it for every single payer.
Lauren Henderson (18:31) It might be different though, like it’s easy and it’s not that it’s the biggest but, and it’s so easy because it’s just a roster. So you’re we’re able to submit everybody super easily… there’s other, but most of the same people are enrolled in… providence also, but some of them don’t specifically state the location. So I can just put their like main location. Do you know what I mean? Yeah, I can just keep working through it. I will, my plan is next week not to, you know, schedule any additional meetings for myself outside of what I already have scheduled and really just tackle this.
Sandhya Kapila (19:16) Okay. So I.
Lauren Henderson (19:17) can just keep chipping away at it and I think if I do that and just dedicate all the, all my time next week to it, I can get it done by the end… of the week. Okay?
Sandhya Kapila (19:28) That sounds good. And then, I mean, honestly, if you need more time for that, that’s okay. I was actually going to ask you if you wanted to do the group enrollment piece too. Maybe you already did. Sorry. Hold on. Let me look at your, can you just go over to the group enrollment tab? Yeah.
Lauren Henderson (19:42) I haven’t done that yet. Okay?
Sandhya Kapila (19:44) Yeah. So if you want to do the group enrollment piece first, because I think that would probably be a faster task.
Lauren Henderson (19:49) And then, you know?
Sandhya Kapila (19:51) As you’re able to go through the provider enrollment, we can do that.
Lauren Henderson (19:55) Okay. So that would be each of the payers we essentially just went through on the payer scoping, but also each location under that payer, yes, exactly. Okay. Yeah, a couple questions on this though while I do have you, yeah.
Sandhya Kapila (20:16) So, one.
Lauren Henderson (20:17) I just confirmed with Aetna. They don’t have like revalidation dates. She said, let me look at my email. She responded saying it’s… not a bad idea to spot check like our roster from time to time if we want to request it from them. And she said depending on the therapist and how they get loaded, Aetna might send a biannual directory validation. Okay? But aside from that, there’s no real like revalidation date. So just leave that blank.
Sandhya Kapila (20:53) You can just put na for those.
Lauren Henderson (20:55) Okay. Payr id that’s just the payr id that we use for like our clearinghouse, yep. Okay. And then I’m assuming group names just start legal name or our dba, correct? Yeah.
Sandhya Kapila (21:09) It’s the same name that you put in that group profiles tab.
Lauren Henderson (21:12) Okay, perfect. And then I have a question how quickly like let’s say I get through this by the end of next week, how quickly does this get transferred into your system?
Sandhya Kapila (21:21) Yeah. And so then I’d need to work with our dev team to get our technical solutions team to import that data into the system. It just depends because we would have to do the mapping similar to what we’re doing right now with the payr mapping. Now that we do that piece ahead of time, it should be a faster process. So it should probably take between one to two weeks to get that into our platform. Okay?
Lauren Henderson (21:46) That’s because some of these are part of a newer roster that I sent over, but they said it shouldn’t take more than 30 days. So I was like, do I put it here or should I put it on the transfers? But I think if we’re looking two to three weeks out from now, they should have been added. Okay, perfect. So I’m going to leave them here and I’ll just use the link to group. And really, I’m not that concerned with Aetna. So, okay. That I’m concerned with I’ll put on the request and mark them as a transfer.
Sandhya Kapila (22:18) Okay. That sounds good. And I’ll double check with our TSM’s too to make sure that like the one to two week timeline is accurate as well. And I’ll follow up with you. Okay? Yep.
Lauren Henderson (22:29) Okay. So based on that, just because our team wants to know, and I know this is riding on our information and your information, when would we be able to start requesting like in the system versus like the spreadsheet to add new or transfers or whatever?
Sandhya Kapila (22:47) So that would be, so once we have all of the profiles completed… once we have all that payr, well, basically, once we have all the payr information and enrollment information… and the majority of the data that is not the majority, like all the data that is in the group and practices medallion account. As soon as that has been updated and is accurate, then we can, for timeline purposes.
Sandhya Kapila (23:16) Let me actually just look at the timeline that I put together for, okay… for you guys. And this timeline was based on, you know, just a standard timeline. I’ll need to make it.
Sandhya Kapila (23:46) So our go live date for is early June. Okay. Yeah.
Lauren Henderson (23:55) But I was gonna say by June, we’re gonna be in a really good place. Yeah, our.
Sandhya Kapila (23:59) Go live date is early June. But just seeing how you guys have been like on top of just giving us all the data, I can see it being earlier. Okay? Yeah.
Lauren Henderson (24:11) Okay. Compared to other organizations, are we a hot mess?
Sandhya Kapila (24:15) Absolutely, not, absolutely. Not. Yeah. And I’m a.
Lauren Henderson (24:20) little validation every now and then. Yeah, no.
Sandhya Kapila (24:22) No, this is, it’s actually been great. Okay. Yeah. And so that’s the thing because this is because I also started in January. Yeah, this is so newer to me.
Sandhya Kapila (24:33) And after every call because Naomi’s usually on our calls and our calls are usually very quick and I was like, hey, am I doing something wrong? What?
Lauren Henderson (24:40) Are we missing? Like,
Sandhya Kapila (24:41) no, she goes. This is great. I’m like, okay, good.
Lauren Henderson (24:43) Okay.
Sandhya Kapila (24:44) So, no, we’re all good. We’re all on the right track.
Lauren Henderson (24:49) Okay, perfect. Thank.
Sandhya Kapila (24:50) You guys. Thank you guys for just being so cooperative. It’s been great.
Lauren Henderson (24:54) Yeah. Okay. We’re really excited for this. My birthday is June sixteenth, so that’s going to be the goal and I’ll celebrate then.
Sandhya Kapila (25:01) That’s awesome. Mine is June eighteenth, so, you know, celebrate.
Lauren Henderson (25:04) Celebrate.
Sandhya Kapila (25:07) Awesome. All right. Well, thank you guys so much, and I’ll follow up with timeline. Okay?
Lauren Henderson (25:12) Perfect. Oh, and, I thought that Niccole was going to put that email in the chat, but I didn’t see it.
Sandhya Kapila (25:18) Oh, okay. I’ll ask her to.
Lauren Henderson (25:19) Email it. That’d be awesome. Yeah.
Sandhya Kapila (25:21) We’ll send that over. Okay? All right. Thank you. See you.
Lauren Henderson (25:24) Guys. Have a good day. Bye.