Transcript
Naomi Denson (00:00) hey, Niccole.
ShirleyHooker (00:02) Girl. How are you?
Naomi Denson (00:04) Good. You ready for this?
Niccole Russell (00:06) Yeah, I’m trying to pull it up now.
Naomi Denson (00:09) Alright. Let me, let them in, alright?
ShirleyHooker (00:23) Hello? Apologize. We’re good. Apologize for being a minute late here.
Naomi Denson (00:32) That’s okay. I just joined too. So I apologize too.
ShirleyHooker (00:38) No worries.
ShirleyHooker (00:47) Real quick. So, on those deficiencies, those errors, the caqh error, a report that you sent over to me? Should I just reply with what needs to be corrected? Because there are, I found a reason for some of those errors are the incorrect caqh. So we have provider like Jared cohen and Ross cohen. And it looks like when it got carried down, Ross and Jared’s caqh are the one and the others. So it’s in.
Naomi Denson (01:35) Their medallion profile, it got swapped in their medallion profile?
ShirleyHooker (01:41) It, no, honestly, it got, it was how it was sent to, it was sent to you guys?
Naomi Denson (01:48) Right. So we imported the caqh ids to the wrong profile based on the import template.
ShirleyHooker (01:53) Okay. If that is the case.
Naomi Denson (01:55) And it’s a change that needs to be made in medallion, you can go ahead and update them to the correct numbers, either npi social or caqh id directly in the provider’s profile. And just let me know that you’ve made the change and I’ll re, trigger the import.
ShirleyHooker (02:09) Okay. And I did not see where I was able to do that. And so when I just go to the provider’s file, let me go go in. Oh,
Naomi Denson (02:33) the caq hids, and the provider’s profile.
ShirleyHooker (02:38) Yeah. So I’m over here in like Jared cohen, excuse me, Jared cohen, yep. Click his name, what’s that you?
Naomi Denson (02:49) Have to click his name to open up his profile fully.
ShirleyHooker (02:53) Okay. That’s what I was.
Naomi Denson (02:55) Expecting. And then it’s going to be under the professional info tab there. The second tab down on the left. Yep. Okay. And then you’ll just click that edit pencil on that first section there. Got it. And so you see qhid, you update it there and click save.
ShirleyHooker (03:12) Okay, perfect. So you can also see with that same existence too. Is his profile here? The email address? Do you see how it says Ross cohen instead of it’s? Jared cohen? So, yeah.
Naomi Denson (03:32) Oh, okay. Let me see. And.
ShirleyHooker (03:35) It’s because this email address on the template that was sent over to you, had it had, well, it had Jared on there, but the caqh part of it, I believe on this one here anyway, it just, yeah, it, I seen exactly what all those errors are that.
Naomi Denson (03:58) Okay.
ShirleyHooker (03:59) Yeah. So.
Naomi Denson (04:00) With the email crossing over like that, you will need to go into the members tab to update to the correct email address before we send invites. Otherwise they’re going to get an invite to the others profile. So make sure that those align and are correct?
ShirleyHooker (04:15) Absolutely. Yeah. And.
Naomi Denson (04:18) you have to do that. Yeah, through the members tab, not the provider’s profile.
ShirleyHooker (04:21) Okay. So in a basically, I can go ahead and update all this and I’ll just send you an email and letting you know what I updated and that it’s been updated. Yeah, perfect.
ShirleyHooker (04:34) Okay. And I think that, that’s where the, when the caqh is incorrect and it’s pulling over that’s where the mismatch is coming from as well too. When it says it mismatched social security number. Okay. Perfect. Yeah. Okay. I’ll go through and see if I can get these updated. And then I’ll respond and let you know, that I’ve got it corrected.
Naomi Denson (05:04) Okay. Sounds good. Okay. And then now for, the payer, the purpose of the call, the payer process, scoping review. So I’m going to give the floor to Niccole so that we can walk through each of your payers and align on these processes.
Niccole Russell (05:19) Okay. All right. Let me go ahead and share my screen here.
ShirleyHooker (05:23) Okay. I’m pulling up my, okay. And,
Niccole Russell (05:28) before we get started on the medallion name and the payer name, I did want to highlight over here. There are a few that the team is working through to see if we can add those to medallion. So those are the sops that you’ve sent over via doc via… document. And then we are having an issue with this layout here. For the devoted roster, there’s another one, sunshine. So it’s kind of like a math graph if you will of a roster.
ShirleyHooker (06:07) Devoted, the roster for devoted. Okay. Let.
Niccole Russell (06:09) Me, take a look at that. Yeah, devoted and sunshine are both. They’re kind of like a graph instead of a single column like this is laid out with a single column. They’re kind of math graphed. Can.
Lia Hood (06:23) you pull one up for us that we sent over so we can actually look at it live and walk through it with you. Yeah.
Niccole Russell (06:33) Just a second. Let me find that folder.
ShirleyHooker (06:36) I’m pulling up the roster over on my end real quick too.
Lia Hood (06:42) Yeah, I just want to see what they have, like what we sent. Like I want to look at their actual version. Yeah. Okay.
Niccole Russell (07:26) Oh, no, it was not devoted. I’m sorry, it was doctors.
ShirleyHooker (07:30) Doctors. Okay. Let me go into the wrong.
Niccole Russell (07:33) One. Sorry, it was actually doctors… and let me pull that one up here.
Niccole Russell (07:47) Doctor’s.
ShirleyHooker (07:48) roster… yep.
Niccole Russell (07:54) Yeah. So due to the layout of this roster, the team… has not figured out a way to map this. And then the sunshine was the other one and let me pull that one up. So here is sunshine… as well.
ShirleyHooker (08:19) Yeah, that sunshine one. Is that one’s pretty standard though? I mean, sunshine. Well.
Niccole Russell (08:25) It’s due to these different because it’s not single column like this last one.
Lia Hood (08:32) So, let me ask a question. Has your team figured mapped this to say this is the same roster we have for sunshine that we use for other practices and other groups?
Niccole Russell (08:50) We do not have this roster mapped for other groups?
Lia Hood (08:55) Is there a bit? I guess, let me re, ask that a different way. Is there a different roster or a different process that you all use?
Niccole Russell (09:06) No. Well, maybe a different process. So… let me pull up. Give me just a second.
Niccole Russell (09:43) This is what it currently looks like. So, right now, we would do online… we have applications. We’re looking at the roster, we just haven’t figured out a way to map it.
ShirleyHooker (09:58) There’s your loop practitioner roster… form right there.
Niccole Russell (10:04) Yeah, we haven’t figured out a way to map it. So we’re not, we’re doing it online. Okay?
Lia Hood (10:13) So even if it’s a new, if it’s a, because that says if a group’s already wait, it’s it said if a group’s already contracted and you’re just adding a provider to the group, you email that. So how do you, if that’s the payers process, how are you? Because I’m assuming going through the website, it’s going to create a new contract, correct? So, how are you doing a workaround using the online version? I’ve just not seen it. So I’m curious.
Niccole Russell (10:53) I don’t do this part of it.
Naomi Denson (10:56) Yeah, I think, I don’t I think with, so they have the online for network participation request form. And then the roster is there because it’s not mapped. It’s not automated. And I would think that our teams are manual… would manually be filling that out.
Lia Hood (11:18) Let’s see. Yeah.
Naomi Denson (11:20) The only network participation request provider enrollment request?
Lia Hood (11:32) So, what are you suggesting? Is what I’m is where I need help for these two rosters?
Niccole Russell (11:44) Let me get with the PE team and see how they currently do it. And then I can respond back to that.
Naomi Denson (11:50) And I’m going to look in Niccole to see if I can see any historical submissions, okay? From other customers, see how they were done.
Lia Hood (12:00) So, I’m because that’s what, I’m trying to understand, is it because you can’t standardize the roster? Are you telling me that we’re going to have to manage these payers or is there a different process that you’re going to follow that’s what I need to understand?
Niccole Russell (12:17) Okay. We’ll check on that for you. Thank you. So we’ll check on that for doctors and sunshine. All right. Other than that, let’s see what’s over here. So the team is reviewing, I think that’s all that was over here. Yeah. And then that was sunshine. Okay. So, for Aetna, we have Aetna, do you agree with that? Yes. All right. For Aetna, better health, we have Aetna better health of Florida. Do you agree? Yep? Alliant senior? We have alliant senior care.
ShirleyHooker (12:52) Agree. Yeah, I added the agree to all of the mappings and sent it over the scoping.
Niccole Russell (13:02) Okay.
Lia Hood (13:03) That’s fine. We can go through them if you want to log through them real quick.
Niccole Russell (13:06) Okay. And I have alignment as alignment health. Yep… amerihealth, caritas, Florida. Okay. Blue cross is Florida blue… benefit. Smart. Yes, that’s one of the ones we’re waiting on care plus, we have care plus health plans.
Lia Hood (13:28) And I think for benefit smart, Shirley, didn’t we say that we were.
ShirleyHooker (13:32) That’s the one that’s location only, that is.
Lia Hood (13:36) Yeah. And we don’t update that for any other group that participates with benefit smart? Yeah.
ShirleyHooker (13:43) Yeah. So I had put it on there that we would take that one off?
Niccole Russell (13:49) Okay. Naomi, am I good to go ahead and remove this?
Naomi Denson (13:53) I lost my hold on. I lost my screen. I was digging.
ShirleyHooker (13:56) What are we removing benefit? Smart?
Niccole Russell (13:59) Am I good to remove this? They said that they don’t.
Naomi Denson (14:01) no, leave it there, highlight it in red so that the TSM or I’ll highlight it on the payr map, highlight it in red. There. I’ll highlight it on the payr mapping. So the TSM knows not to import the ones that are on the import template for that one. Okay?
Niccole Russell (14:20) And then healthspring. We have healthspring. Communitycare, we have communitycare. Yes, it’s devoted. Yes. Now, doctors. Okay?
ShirleyHooker (14:36) Doctors, I have doctors healthcare plans. Yes. Yeah. Okay. Yes, go ahead, sorry.
Niccole Russell (14:42) All right. And then evolent, we’re pending on that one. Evolutions. We have evolutions, healthcare, Freedom health is freedom health. It’s freedom health, optimum care. Okay? Global excel matches, global med, is medpoint management on our end?
ShirleyHooker (15:05) That one, that one, I have a no on because, that is not.
Lia Hood (15:11) Yeah, medpoint is the mso, not… the payor. So, we, I mean, because, that one I’d want us to look at together and to see why you have what you have.
Naomi Denson (15:30) Do you have your other sheet up, with the payor mapping on it?
ShirleyHooker (15:35) I do.
Naomi Denson (15:37) Niccole, I just sent it in a message with you and Brenda a little bit ago.
Niccole Russell (15:42) Here, I’ve got it. This one.
Naomi Denson (15:48) Yeah. So on the let’s.
ShirleyHooker (15:52) See line 20?
ShirleyHooker (16:05) I had the link on it, gmmi. Com.
Niccole Russell (16:14) Okay. So, there is no PE, so we do not complete enrollments for that. Is that what you’re stating there?
ShirleyHooker (16:20) No, we do.
Niccole Russell (16:21) Okay.
ShirleyHooker (16:34) So,
Niccole Russell (16:43) well, I don’t know what happened there?
ShirleyHooker (16:45) That one is email notification with Loi… letter of intent to link provider to the group contract.
Naomi Denson (17:02) Okay. Yeah, we can just, put that back as C notes. I don’t know how that medpoint management got into there as the mapped name… or where it came from.
Niccole Russell (17:18) So, notes here… I’m not familiar. I’m not as familiar with Google sheets. How do I do that? Naomi? Excel?
Naomi Denson (17:32) It’s because it has the drop down options. So we’ll just have to, I don’t know how it?
Niccole Russell (17:39) Okay. We can come back to it. It’s blank.
Naomi Denson (17:41) I got it. I just copied it and pasted it from somewhere else.
Niccole Russell (17:46) All right. Guardian life is guardian.
ShirleyHooker (17:50) Yes.
Niccole Russell (17:52) Healthsun is healthsun, healthplan?
ShirleyHooker (17:55) Yes.
Niccole Russell (17:57) We’re coming back to hope hospice, humana. Is humana?
ShirleyHooker (18:01) Yes.
Niccole Russell (18:02) Coming back to these gipa, is gipa network. Yes. Okay. Longevity longevity healthplan?
ShirleyHooker (18:13) Yep. And,
Niccole Russell (18:14) we’ve got medicaid and medicare… Melina, is Melina, yes, coming back to that multi plan, we have claritib formerly known as multi plan, correct? Correct?
ShirleyHooker (18:27) Okay.
Niccole Russell (18:29) Oscar is just that, yes. And then partners direct health, correct? Good there. Positive. Ryan is positive healthcare, correct?
ShirleyHooker (18:42) Correct. Okay. Actually, wait, that is actually aids healthcare foundation mco of Florida. I put that on the sheet. Okay. Thank you. Did it not come? Yeah, that’s not the one that I had submitted over this.
Niccole Russell (19:16) One.
ShirleyHooker (19:19) I don’t know my sheet here. I have false with aids healthcare foundation, mco of Florida that I put in the drop box.
Niccole Russell (19:31) This is aids healthcare foundation. All right. And it’s healthcare foundation.
ShirleyHooker (19:40) Mco of Florida, inc.
Niccole Russell (19:47) Okay. So we’ll review that one… preferred health, preferred care partners.
ShirleyHooker (19:59) Correct. Yes.
Niccole Russell (20:01) And then quality health plan. Yeah.
ShirleyHooker (20:05) You’ve got quality health plans of New York. No, it’s quality health management LLC, and I sent over the sheet on that one. Yeah.
Niccole Russell (20:16) I’ll do this. All right. Railroad. Medicare is just that simply healthcare, just that solace health plan. Those should be good, sunshine. And then three rivers. We have contigo health plan.
ShirleyHooker (20:37) It was sold to contigo, and it’s now, configure health. Okay?
Niccole Russell (20:48) Okay. So it would still, I think we still have it labeled as contigo. So.
ShirleyHooker (20:53) Yeah, but it was.
Lia Hood (20:55) It’s now, can we get that updated in your system? Because it’s another, it’s a payer name change… to the correct actual, correct name.
ShirleyHooker (21:07) Configure health. I don’t know.
ShirleyHooker (21:30) I’ll put that one for you. So let’s put no here for now. And then.
Niccole Russell (21:37) Tricare, are you good with tricare east?
ShirleyHooker (21:40) Yes, tricare east, Rihanna military, correct?
Niccole Russell (21:42) Ultimate health plans is just that… unitedhealthcare and wellcare, so those are good.
ShirleyHooker (21:49) Yes. Okay. Yes, all.
Niccole Russell (21:51) Right. So, the ones that are marked, no, I’ll review with the team. This one, we’ll take off the list to make sure that it’s not import. Well, we won’t, take it off the list, but we’ll make sure it’s not imported with the information. And then I do have a team member in payr enrollment, reviewing all of the ones that you sent documents over on. So we’ll get back to you on those as well. Okay? And I will ask about the sunshine and doctors, how those are completed.
Naomi Denson (22:19) For the sunshine health, I did pull up a in process request for another customer for sunshine health and they are… submitting the request online and submitting the roster. So they’re manually filling out the roster. It’s just not mapped into the system to automatically populate like the others. Is my takeaway. Okay. Thank you, but we’ll still do it. It’s just not mapped. So.
Niccole Russell (22:46) Okay. So for doctors, Naomi, should I go ahead and put that as a project plan and just upload that roster and they know to complete that. So, sunshine’s doing the same thing?
Naomi Denson (23:01) Yeah, that’s what I would recommend here since it’s not mapped and it’s like, you know, difficult to map may not be mapped soon, but that is the process that they need to follow. That doesn’t align since the roster for sunshine is already in our internal directory. We follow that anyway. But the doctors one, if it’s not in our internal directory, then it needs to be a project plan.
Niccole Russell (23:24) Okay. I’ll check that out. Awesome. Thank you so much, Naomi. You’re welcome. All right. Well, that’s all that I have to share.
Naomi Denson (23:39) Any other questions or anything you guys want to ask about before we wrap this call?
ShirleyHooker (23:46) No, I’ll get those errors and get them corrected and sent over and I’ll send it over to you guys and let you know what I did. Yeah… I’ll let you know what I did and it’s corrected. Okay?
Naomi Denson (24:11) All right. Perfect. All right. You guys have a great rest of your day and just reach out if you have any questions or we’ll reach out if we have any further updates or questions. Yeah. Awesome. Thanks, you guys. Sounds good. Thank you. Bye.
ShirleyHooker (24:23) Bye.