Transcript
Peter Bosworth (00:00) hey, Hillary.
Peter Bosworth (00:07) How are you? I think you’re on mute, sorry.
Hillary Perez-Godfrey (00:09) How are you?
Peter Bosworth (00:11) Well, thanks. How are you?
Hillary Perez-Godfrey (00:13) You know, you know?
Peter Bosworth (00:17) Oh, no, I do know. I do know.
Hillary Perez-Godfrey (00:22) Yeah. So, as,
Peter Bosworth (00:26) we move, what’s going on?
Hillary Perez-Godfrey (00:28) Well, I’m probably going to be letting my credentialing coordinator go.
Peter Bosworth (00:36) Okay.
Hillary Perez-Godfrey (00:37) So, that doesn’t affect moving forward because… obviously… I’m still doing all the work, but then that means that some of my other stuff doesn’t get done or, you know, or I work longer hours, right? So, what do you think I’ve been doing working the longer hours, right? So, but anyway… just to that won’t affect our real, you know, it’s just an internal thing that’s just stressing me out, but whatever, if.
Peter Bosworth (01:16) I kind of remember correctly, was the, because this is, weren’t you hiring the credentialing like this was a recent hire.
Hillary Perez-Godfrey (01:25) Yeah, it’s within 30 days and, you know, I was really clear up front just going like I need to be able to not have to have my eyes on this on a daily basis. And so I need you to be my point and understand the platform and ask the questions and all those things. And, you know, like every time we have our weekly touchpoint, I’m asking questions left and right. And then I’m like Nishan, do you have any questions? Nope? All good. There’s no, like self initiating kind of thing. And I was very clear with this role. It’s like I need somebody that’s going to know the systems that we’re currently in know the state credentialing, you know, also just be my quality control, right? And not have me be so in the weeds with every single one of this. And right now, the heavy lift is we have to be in the weeds because we are the source of truth to release the information for medallion to start working. And I’m like looking at the template… and it’s all my stuff. It’s not his stuff. So it’s just frustrating. I mean, I’m sure you can relate as a manager that, you know, when you’re like this is the job. This is the job description, you have conversations. These are the expectations. This is the priority. This is the due date, you know, and he just passed 30 days. And now I’m having to go back going. I need you to CC me on every email and I don’t like being a micromanager, but it’s like that’s where I’m at because he doesn’t offer anything. I have to turn around and go, you know, if you said, okay, your priorities are one two and three. Keep me posted with, you know, your updates and whatnot. Then somebody who’s truly invested is going to be like I completed this or I have a, I can’t move forward because of these roadblocks, right? It’s like that communication and I’m just not getting it. And so I’m having to go back and review what he’s doing. And then it makes me even go okay. Now, I’m even going to challenge what he is doing because I don’t trust him. So at the end of the day, I’m like going well, I’m doing the work already. So why am I paying somebody that I’m relying to do the work when I’m doing it already? You know what I mean?
Peter Bosworth (04:08) Right. So.
Hillary Perez-Godfrey (04:10) I’m sorry, I’m doing a social dump. You don’t need to be involved with that. I’m just, it’s frustrating because now I’m like now I’m having an executive call with Peter and I’m looking at the provider enrollments tab and the group enrollments tab. And I’m not seeing anything more updated since our call on Wednesday which was clearly that I want to be able to go live on Monday and we’re not there.
Peter Bosworth (04:35) Right? So, I know on Wednesday you went through and there was some cleaning up to do and like par status and stuff like that. And so do you anticipate all of that being kind of cleaned up by early next week?
Hillary Perez-Godfrey (04:50) No, I’m going to spend this weekend and I’m going to complete it that’s my fresh that’s my yell is that this is, he knew looking at this, right? So let me pull it up, hold on.
Hillary Perez-Godfrey (05:08) So this was obviously even just having the payr group enrollment listed. But so anything, so I was very clear, I said anything in green. I have already touched, meaning that there’s no question as to whether or not we’re contracted or not, right? So I said I need you to continue to pull all these contracts, start filling in the effective date, start going in and loading what we’re contracted for, right? I already filled all this in. So I’m not getting it. Are you unclear with what my directive was?
Peter Bosworth (05:53) No, I definitely get it.
Hillary Perez-Godfrey (05:56) So, you know, and so our biller provided this… and I need, I mean, we’re like trying to, I mean, we’re going to be going live with Aetna better health next… week?
Hillary Perez-Godfrey (06:16) So this is what I’m working on and my understanding is at least if I can get our payers that can get us one step closer, then I need to go over from the group enrollment. Then I need to go, okay for each plan. I need to put who our providers are, right? So here’s Aetna and of the ones that are green are the ones that I recently just verified are truly credentialed credential approved with Aetna. Right? So all this right here, anything that’s green there’s my effective date. So this is all cool. Yeah. And then I just have to decide, okay, am I transferring this? Am I, what are my terms, pair analysis versus… what does this mean?
Peter Bosworth (07:14) It, yeah, that means basically that we are submitting enrollments directly rather than doing delegated credentialing so you.
Hillary Perez-Godfrey (07:21) can, okay. And we’re not a delegated credentialing entity, right? We’re not big enough for that. So, but anyway, so the par status, right? So it’s either going to be par link to the group, non par, link to the group. What were the values? Again? I probably even deleted the.
Peter Bosworth (07:43) Yeah, it’s non.
Hillary Perez-Godfrey (07:45) Par, it’s.
Peter Bosworth (07:48) non, par, linked to group, par, not linked to group. So, three values. Okay?
Hillary Perez-Godfrey (07:56) Yeah, all these like seeds like these, this general membership. So this one is one because our language before all these general memberships are ones where like they don’t credential… dietitians. So realistically, I need to go back and actually just remove them when it’s general membership, correct?
Hillary Perez-Godfrey (08:23) Do you follow what I’m saying? Yeah.
Peter Bosworth (08:25) I do, I’m… so like do you have to send a notification to the payer in some way?
Hillary Perez-Godfrey (08:33) No, no, I mean technically nothing. So, so Cova is a letter of agreement and they only… we were under an actual agreement with them last year and for speed of credentialing since everything gets billed under the group tin, the group npi and dr Sahas, as the rendering is… we chose not to credential the RDS because RDS aren’t even licensed in California, right? So they, so welter identified this general membership. So they’re still there but they’re doing nothing for it. So that would be almost like realistically, all these providers, I would just remove from the provider enrollments tab that’s my thought process. Yeah, right. Yes. And.
Peter Bosworth (09:29) I’m looking through the note, I think you all talked about this on Wednesday and I’m pretty sure Naomi confirmed that on the Wednesday call, okay?
Hillary Perez-Godfrey (09:43) See, and part of this still, so it’s like a multi. And the reason why it’s taking so long is because I didn’t manage any of these contracts. Some of these were legacy prior to me. So, I wasn’t involved in the contract discussion. I wasn’t involved in the negotiation. And when you have like bigs like Signa and, you know, it’s just a generic contract that has a signature. It doesn’t mention what you’re contracted, you know, are you contracted for endocrinology or are you contracted for your diabetes program? And when you’re contracted for endocrinology, then that’s your doctor and your three MPS, when you’re contracted for diabetes education, then like the guidelines start getting a little gray, right? So I think that that’s what led to a lot of this general membership conversation. So like on this one. So even though we have all these providers, I was only able to verify these two and not only that, but because I wasn’t involved at the level of credentialing, like the enrollment is, we have a lot of accounts with these payers that I can’t get in as the administrator to verify the status because it says that my previous credentialing company still owns the administrator, right?
Peter Bosworth (11:06) Okay. Do.
Hillary Perez-Godfrey (11:07) You see the problems I’m running into it’s like, okay, I found the portal and then I try to create an access to the portal. I mean, Illinois is a perfect example is like I got access but it won’t allow me to pull in the npis that should be linked to my tax id number because I don’t have admin access. So, have you ever experienced that in the past? And if so, how have you guys either recommended to your customer to get around it? Or how have you been able to fix that? I’m not how.
Peter Bosworth (11:42) to get into the platform, access from a previous vendor, I don’t have a good answer on that. I imagine it involves getting in touch with the previous vendor… because they would be the ones in control of all of that.
Hillary Perez-Godfrey (11:57) Right. So, so you’re okay. So, are you saying then I send an email to the manager of this former company saying, hey, I’m having issues accessing provider rosters or our account under their provider portals because welter is identified as the administrator. Do I ask him which ones those are, and can he release that? Or does that fall on me to override somehow?
Peter Bosworth (12:28) And welter is the name of the previous vendor. Yeah, yeah. I think, I mean, I just know when with medallion, when we… well, we have the ability to like, we take over those payer portal logins and then we give them back, to you whenever like if a partnership ends or something like that. So it’s kind of baked into our process. But yeah, they would be in control of all that. So like whoever your previous account rep there, okay, they would be able to help you with that.
Hillary Perez-Godfrey (13:07) Okay. Well, maybe that’ll you know, cause, when we closed out the books, all they did was send me their final payer status.
Peter Bosworth (13:15) Right. So.
Hillary Perez-Godfrey (13:17) Literally, like this kind of stuff was all we got minus anything else… that’s where I was able to find out like these provider numbers, but… that’s it. Okay. So that’s my first. So that’s one of the first things I need to do is contact previous.
Peter Bosworth (13:39) I know, and it’s it sounds like a good Nashawn task. If I’m being honest, I’m sure you have a lot of going a lot going on. Well.
Hillary Perez-Godfrey (13:46) And you’re confirming what I already knew and the thing about it, is, this is a, this was a task is I need you to contact every payer, notify them that we’re no, you know, like do a broad notification. We no longer are affiliated with this. We need access to this. This is, you know, we’re now in house with, you know, naming even medallion as our support platform. And you know what I mean? It was like all laid out and I’m like, okay, I need you to notify every single one. And that was meant that was discussed on week one. Once you get through HR onboarding, these are going to be your priorities. Medallion number one continue to get our providers while we’re onboarding with medallion, continue to get our providers enrolled with hfs impact. And so now, so I have four applications with hfs impact that are confirmed received, I have an application number, but they’re in, you know, the infamous quote unquote in queue. So do you guys have any expedited opportunities with hfs impact in Illinois? Or do you just sort of wait the same way that we do… like if I was to transfer those four applications to you guys, do you have any faster response than I would just waiting?
Peter Bosworth (15:18) Well, I would say if the applications are already submitted, it’s probably best to just.
Hillary Perez-Godfrey (15:25) sit on it until they get approved.
Peter Bosworth (15:27) Sit on it until they get approved just because what is going to happen is like if we take over any in flight enrollments, the system will count them as a new enrollment in terms of your consumption. And you probably don’t want to do that. We will like follow up on it and all of that. But it’s probably best to start with a clean slate of just the work medallion is doing.
Hillary Perez-Godfrey (15:52) Okay. And now, once they get approved, does that become a para analysis then?
Peter Bosworth (15:58) Because I, already, once they get approved, it’ll be really easy for you to just come in and add them. It wouldn’t be a para analysis because there’s no mystery there like you just got… approved. So you would come to enrollments and add the enrollment here.
Hillary Perez-Godfrey (16:17) Okay.
Peter Bosworth (16:21) And then it’ll be saved in the system for the provider billing status will be active and we’ll have a record of it.
Hillary Perez-Godfrey (16:29) Okay. So at this point, I’m still only, I really don’t like this template spreadsheet because to me it’s a little bit more cumbersome. I would love to be able to directly load, but we’re not there yet. I have not been, we’ve gotten the two trainings right? The first overview. And then this week on Monday, we discussed payers, and then I was very clear going because we’re not actively requesting things in the platform. I will probably have many more questions once we’re really working in it. But right now we’re still in this import template format.
Peter Bosworth (17:06) Yeah. And that’s kind of where my thoughts coming into this call are just like I’d love to just get into all of the data that we can surface with these analytics tools on our calls on a go forward basis. But right now it really is like a matter of doing the dirty work in the import template.
Hillary Perez-Godfrey (17:27) Yeah. And this really is, I mean, I can see all the benefits already like that’s why I’m like I want to go live on the fourth because I even have our scheduling team is relying on that last report back on January first on who they can schedule, which providers for which plans. And I’m like going, it’s coming. It’s coming and, you know, it’s like, I understand all the tools that this is going to help our company, but I get it. I have to get past this process and it’s grueling and cumbersome… and I don’t want to get anything wrong that’s the other thing is that when I become the source of truth, what happens if I’m wrong on any of this? Yeah, wait.
Peter Bosworth (18:12) So, when you become the source of truth in the enrollment, I mean, in the import template and stuff.
Hillary Perez-Godfrey (18:16) Right. Like let’s say I’m loading all these providers via Aetna. And I say, okay, I want medallion to take over Aetna of California… right? And then it counts towards my SKUs… and I’m saying, and then it’s like, well, we can’t do any of it, but it would have already have counted, right? I mean, I don’t know… no, I just need to finish it honestly. I just need to finish it. And if that’s me doing it, then that’s me doing it. I do know. Oh, I do have a question.
Peter Bosworth (18:59) So,
Hillary Perez-Godfrey (19:00) American specialty health is the credentialing entity for registered dietitians. Okay? Under the blue cross plan. Okay? How does that work? Do I load American specialty health as the payer or do I ultimately load it as blue cross?
Peter Bosworth (19:26) I’ll tell.
Hillary Perez-Godfrey (19:27) you right now because the contract is with blue cross.
Peter Bosworth (19:29) Is this, what state is this?
Hillary Perez-Godfrey (19:31) California?
Hillary Perez-Godfrey (19:37) And the way that the rep explained it to me was that… American specialty health is contracted via anthem, blue cross for allied providers, registered dietitians fall under quote, unquote allied providers?
Hillary Perez-Godfrey (19:55) and however,
Peter Bosworth (19:59) what I can tell you is that it exists as a distinct payer in medallion. I can tell you that they.
Hillary Perez-Godfrey (20:07) Don’t get, but that’s not how we get paid.
Peter Bosworth (20:10) You get paid through blue cross blue shield, anthem. Oh, sorry, anthem. Okay. Let me.
Hillary Perez-Godfrey (20:18) All my notices for recredentialing come from American specialty.
Peter Bosworth (20:26) Then it would be American specialty.
Hillary Perez-Godfrey (20:29) But when I, and then when I try to disaffiliate a provider with American specialty, they’re like, well, we’ll reach out to the provider because apparently they have individual agreements… with those RDS and we’re just like loaded as one of the lines of business for the provider. So like they wouldn’t take my word for it. Like I was able to say this provider is no longer with us April first 20 26 and they’re like, okay, we’ll contact the provider and they’ll have to enter… that end date from their access. So, I guess that would be one of my takeaways is sort of like how, because I have no contract with American specialty health, they are not paying my bills.
Peter Bosworth (21:25) Yeah. So, I mean… I think American specialty health kind of is a contracted like vendor of anthem basically.
Hillary Perez-Godfrey (21:36) Sorry, my dogs are going to bark, sorry, one moment, please.
Hillary Perez-Godfrey (23:37) Do you have any kind?
Peter Bosworth (23:40) Of example, like anything you can provide more about what you mean about anthem paying out the claims?
Hillary Perez-Godfrey (25:24) I’m so sorry.
Peter Bosworth (25:26) Oh, no worries. I was just asking… you. So basically like American specialty health is a delegated vendor that controls access and reimbursement for certain service lines within anthem plans. So.
Hillary Perez-Godfrey (25:47) So, for our nutrition services, the checks are technically coming from American specialty because those are only able to be rendered by RDS. Oh, but I,
Peter Bosworth (25:59) thought you said some, I thought you said the checks are coming from anthem, but it depends.
Hillary Perez-Godfrey (26:03) They do, they do, but you just read that it was claims. So they process the claim, but the check comes from blue cross. I’m trying to figure that out right now. Nevermind. Let me, you know, let me do research with our biller. But that’s going to be like one of my things is, do I keep them listed under ash, right? Or should they be under the payer? You notice how there’s no payer id. So should that be an anthem? Should that be a BC zero zero zero one?
Peter Bosworth (26:38) Yeah. So, I just know that we have American specialty health listed as a payer medallion, and we also obviously have anthem.
Hillary Perez-Godfrey (26:51) I can ask that, I mean, this goes back to the whole source of truth. Do I put? So when I find out if I put BCC, if I put BC zero zero one, which is blue cross’s payer id, what does that, how does that translate over to you? What does anthem, I mean, what does medallion do with that information? Will this come up as a question? Will it just be received? And you guys are like, we’re just going to load it because that’s how you told us to load it.
Peter Bosworth (27:22) Well, what we do is like when you fill out the template in totality, we review it against our payer names that we have standardized in the system. And so, because we have American specialty health, obviously… we would notice the discrepancy if the payer name was American specialty health. And the payer id was anthem blue cross. And so that’s something that we would call out and basically ask for your clarification on.
Hillary Perez-Godfrey (27:48) Got it. So Nico would be able to go, this isn’t matched. This is a mismatch. We need confirmation clarification kind of thing. Yeah, we.
Peter Bosworth (27:57) Would identify the mismatch, but we wouldn’t be able to like tell you which one we would ask you to tell us which one it should be.
Hillary Perez-Godfrey (28:03) Okay. And so, can I ask you? So for blue cross in California in your database, do you have any other payer ids for blue cross besides… B, C0 zero one?
Peter Bosworth (28:53) I don’t know if we have the.
Hillary Perez-Godfrey (28:59) And I know we’re out of time, but, okay. So I have one more question. Okay? So let’s use kern health as the example. Okay? So this is, again, I start second, I don’t know if I’m thinking too hard on this or what. So, kern health system is contracted with us and they actively credentialed my nurse. I got to fix that. My nurse practitioners and my doctor, because it’s only a professional agreement. When I asked about the registered dietitians, they declined a separate contract for my dietitians… so do I leave them off or do I leave them in? But non par.
Peter Bosworth (29:50) So the non dietitians or sorry, the dietitians are receiving no payment. They’re not able to submit claims with kern health.
Hillary Perez-Godfrey (29:59) Not with their rendering npi. See this is the big difference is dsmes, that type of service. When we bill the payer, it’s our group tin our group npi, and all the services are filed under dr Sahas as the rendering. Okay, it’d be like a hospitalist who’s not really, they’re the one that rendered the care but the claim’s being filed with whoever you follow what I’m saying. So do I leave them? I guess the bottom question is, do I leave them off?
Peter Bosworth (30:37) Yeah. So this is a good Naomi question that I’m taking down.
Hillary Perez-Godfrey (30:42) Because if that’s the case, this import becomes way easier.
Hillary Perez-Godfrey (30:52) And part of my questions are reaching out. So I know the answer to kern. I verified that, I know the answer for a lot of these payers. I’m already knowing the answer is no, we will not credential your dieticians. So I guess the question is if the plan does not credential the dietician… do I leave them off the provider enrollment? Yeah.
Peter Bosworth (31:22) My instinct is, yes, because we are strictly worried about in terms of medallion, in the context of medallion, we’re strictly worried about providers who are requiring enrollment and who are therefore receiving, are able to bill like have an active billing status. Okay?
Hillary Perez-Godfrey (31:46) Okay. That’s going to change my, that’s going to change this a lot. And I’m glad I asked. So the other thing, is when you have a letter of agreement versus a fully executed agreement contract?
Hillary Perez-Godfrey (32:04) They’re not performing any contract. They’re not performing any credentialing. I guess, how can I make sure I have one area where I can get all the results even though there’s a variety of credentialing rules. Yeah… we.
Peter Bosworth (32:23) this is firmly my Naomi territory, but I’m also taking it down. I’m not sure exactly what the question is, how does this question differ from the… previous? Well?
Hillary Perez-Godfrey (32:37) I want one place that I can share with all of our, you know what I mean? So we’re ultimately, we use this for scheduling, right? If I was to download this out of medallion, I want to be able to have everything that we do in medallion even though providers might not be cred, you know, let me think this through Peter. Okay. I know what I’m trying to say, but I’m not articulating it correctly.
Peter Bosworth (33:06) Okay. I think, I know what you’re trying to say too. But here.
Hillary Perez-Godfrey (33:11) Are the questions? Yeah, that’s not realistic because I’m not paying for an enrollment, but I still want you to keep track, of my providers.
Peter Bosworth (33:20) Yeah, and you can add, you can add existing enrollments obviously for free so that there’s no cost associated with that. But I know we are over time, but these are the questions I’m taking back. American specialty health is a California payer that my diabetes tutor is credentialed with, but anthem is the ones that pays out the claims. Ash has some sort of partner relationship, vendor relationship with anthem as a tpa.
Hillary Perez-Godfrey (33:54) Ash, is, I guess, the bet, one of the better examples. And then the other example would be adventist. So, adventist health plan uses medpoint as their… medical management company. They also credential, you know what? I’m answering my own questions right now?
Peter Bosworth (34:17) Okay. Yeah.
Hillary Perez-Godfrey (34:19) No. Let’s just go ahead and reconnect. I’ve got too much going on that’s not. Okay. I know the timeline. I know that I need to get this loaded. It’s now falling back on 100 percent on my shoulders to complete. And I’m just trying to find the time in the day, which is a me issue and not a you issue, but I know what my goal was. Okay.
Peter Bosworth (34:40) Okay. Good. Well, we will get you some answers on these. And then when you meet with Naomi again, yeah, maybe she can dig into it deeper with you.
Hillary Perez-Godfrey (34:51) Okay. No, that sounds good. And I know that dream has been stepping up more and more involved. So, it’s more.
Hillary Perez-Godfrey (34:58) So on the calls, it’s like Naomi dream and I are, you know, having the conversations where I had hoped that it had been my credentialing coordinator asking these questions. Huh. So I can feel confident that they’re managing this on my behalf, but I’m not there. So now I’m moving backwards, yeah, not on your part, my part.
Peter Bosworth (35:20) Well, we’ll get there eventually.
Hillary Perez-Godfrey (35:22) We will. So, no, I’m still going to try to go for a Monday where I can send an email going, hey, this is as clean as it’s going to get. And I’m just going to have to work through the issues, but at least there’s data because right now nothing can be imported but I want to be able to send an email saying, let’s try to run with what’s here. Let’s start looking at real life, you know, inconsistencies… and work through those. But right now, we’re not even there, right? Okay. But groups has to happen before providers happen, right? That’s the succession.
Peter Bosworth (35:57) I mean, they’re all going to happen.
Hillary Perez-Godfrey (36:00) Simultaneously. Yeah, yeah. Okay.
Peter Bosworth (36:05) Okay. I’ll let.
Hillary Perez-Godfrey (36:06) You go, Peter and have a good weekend.
Peter Bosworth (36:08) Okay. Thanks Hillary you as well. Take care bye.