Transcript
Naomi Denson (00:00) hi, Sandhya. Hi. How are you? Can you hear me? Good. How are you? Good?
Sandhya Kapila (00:10) Thank you. I.
Naomi Denson (00:12) Got an email that Hillary joined the meeting, but now she’s not here. So, I know she just joined too early, maybe, but perhaps… hi, Nico.
Niko Byron (00:23) Hey, Nico.
Sandhya Kapila (00:31) I’m trying to get my earphones in my husband’s out of town. So, my little one was, of course, they take advantage when one of us is not in town and they sleep in our room. So he’s still sleeping. I’m like, okay, let me get these earphones try to get these earphones untangled.
Naomi Denson (00:58) where is she? Yeah, it said she joined at nine two.
Sandhya Kapila (01:06) Nine two. Oh, so she joined like 30 minutes early?
Naomi Denson (01:09) Yeah, then.
Niko Byron (01:11) Like got back off. It seems like.
Naomi Denson (01:13) Yeah. She’s not in the waiting room anymore… but he’s in the data template. Does she know?
Niko Byron (01:26) She doesn’t.
Naomi Denson (01:30) I wish I could like put a note in the data template that she would see and be like, are you coming just like across the screen? Like hijack it?
Niko Byron (01:47) Let’s see maybe we can find what cell she’s in.
Niko Byron (01:55) All right. She’s in the group enrollments tab. You could make a new row underneath and be like, where… are you? Question mark, question mark?
Sandhya Kapila (02:13) And Nishan hasn’t joined either, right? No, and.
Naomi Denson (02:18) I looked, I was like, did I accidentally move the meeting later? But it was the same. Oh, there she is. Okay?
Naomi Denson (02:30) Hi, Hillary. Good morning. We were, I saw that you joined a little early and then I got on and you weren’t here anymore?
Hillary Perez-Godfrey (02:41) Yeah, for whatever reason, my brain was thinking seven o’clock seemed like a good time for the meeting instead of our normal seven 30. So you.
Naomi Denson (02:49) know we were joking. I was like she’s in the data import template. Let me just put a note in the cell that she’s in and be like, are you coming?
Hillary Perez-Godfrey (02:56) Yeah, no, I’m… I’ve actually realized a couple of things now that I’ve been trying to get this template done. Yeah… anywho, I think we’re almost there, right? I don’t… want to, I’ll at least talk so, I’m working on the group enrollments. Nishan worked on the provider enrollments.
Hillary Perez-Godfrey (03:35) Yeah. So, I don’t know. I did put some comments on there. So if we can look at that and if that has any bearing… or not, then can we discuss that? Don’t go to humana? Humana? Is a hot mess right now, but something more like a kern health system where there’s multiple effective dates based on the line of business. Okay? Nico.
Naomi Denson (04:07) Let’s see.
Hillary Perez-Godfrey (04:11) And then, so on the effective day for column E, I’ve been going with the earliest effective day. Yeah, that’s fine. Okay. And then if anything, just more notes for me… yeah, let’s see.
Naomi Denson (04:29) So the managed medicaid was effective 12 one, and then the medicare was effective one one quite.
Hillary Perez-Godfrey (04:35) A lot of them adding products later.
Naomi Denson (04:38) Okay. Yeah. And it’s not like there’s a huge gap in that and we’re not going to be requesting your providers to be effective back in December. So it shouldn’t be that yet. The earliest date is fine there.
Hillary Perez-Godfrey (04:51) Okay. And I guess there’s… issues in Texas, weather issues in Texas. He’s having internet issues so he can’t join. Okay?
Naomi Denson (05:04) So, where, which Texas? I’m.
Hillary Perez-Godfrey (05:07) sorry, Nashawn, he’s in, he said Houston. Oh, okay. He’s in Katy, Texas.
Naomi Denson (05:12) Oh, okay. All right. What other comments do we have here?
Naomi Denson (05:22) Calviva and healthnet?
Hillary Perez-Godfrey (05:24) Right. And that was just to call out that the medi cal product is under healthnet community solutions, as opposed to healthnet of California. So like same parent company, different things. So, I called them out separately even though they have the same effective date. Okay?
Naomi Denson (05:44) So, calviva and the payer mapping, we mapped it to calviva health because we have that payer. Is it supposed to be different?
Hillary Perez-Godfrey (05:50) No, no, no, I’m not talking about the name. I’m talking about the details of the contract, whatever you have. Calviva, is the medi cal product of healthnet. So that’s… their calviva.
Naomi Denson (06:07) Okay. And then you only have managed medicaid line of business. Yeah, that’s good, right? And then.
Hillary Perez-Godfrey (06:12) But when you look at healthnet. Which is the main contract, see medi cal is carved out. So, I have all my commercial stuff and my medicare advantage is under healthnet and only the medicaid is under healthnet. Calviva?
Naomi Denson (06:27) Yeah, that’s fine. Okay. They’ll load in separately since there’s two different payer names.
Hillary Perez-Godfrey (06:34) Are they? No… I have them as the same.
Naomi Denson (06:39) Healthnet. So healthnet loads in under healthnet of California. Yes. And then the calviva is going to load in under calviva health.
Hillary Perez-Godfrey (06:50) Right. But my biller with the separate.
Naomi Denson (06:51) Lines of business.
Hillary Perez-Godfrey (06:53) Separate lines of business. But my biller has it as the same payer id that’s not correct? Is it… the?
Dreama Hembree (07:04) Payer id? Is that probably what she’s referring to is the Edi payer id where you send claims to. So, yes, that would be correct.
Hillary Perez-Godfrey (07:14) Okay. Because I specifically, when I asked her for the trading partner id, this is still what she gave me.
Naomi Denson (07:22) Yeah, that’s for claims that’s for your clearinghouse.
Hillary Perez-Godfrey (07:26) Okay.
Hillary Perez-Godfrey (07:33) I’ve got to think so anyway. So for me, I obviously left my, these are going to be easy, the medicare’s and that I just became contracted with Aetna better health for one in 20 26. So I need to add that… but I just need to finish the medicaid. And so you see it’s not taking me long. Humana is a it’s saying I’m not because I don’t have a copy of my executed agreement. So I’m not feeling confident with that. So, can we hold on that one or would you, the idea is that we still want it to be loaded and still work it? It’s just, I need to confirm this status and get my date.
Naomi Denson (08:21) Yeah, you can. Yeah, we can load it as non par and you can confirm it there. But… are you actively let’s see provider enrollment? Are there any humana there’s humanas on here? So it’s saying par, link to group. So the group has to be par. You just don’t have the effective date?
Hillary Perez-Godfrey (08:43) Yeah. And this is where this is what’s gotten us in some problems before, is I would prefer to confirm first because I don’t have a contract. So.
Naomi Denson (08:57) Okay. If you aren’t are you sure that you have a contract? You just don’t know where it is to verify the information or you aren’t sure if you’re you are contracted at all?
Hillary Perez-Godfrey (09:07) Well, but you’re saying that we have humana on here? Yeah.
Naomi Denson (09:09) On the provider enrollments? Yes, I just don’t want you to load this unless you’re sure that you have a contract somewhere, you just need the details of it.
Hillary Perez-Godfrey (09:19) I do not have a countersigned fully executed copy of my agreement.
Naomi Denson (09:24) Okay. But if, yeah, because if we load this as an existing enrollment and then it’s determined later, you don’t have that group enrollment, the system won’t allow you to request a new one for the same group.
Hillary Perez-Godfrey (09:34) Okay. So, I need humana to be a POS?
Naomi Denson (09:40) Okay. We can always, we can remove that one and not import it. And then it’s super easy. You can add it manually later when you do verify it.
Hillary Perez-Godfrey (09:52) Okay. And then, but then we go here and we’ve got.
Hillary Perez-Godfrey (10:01) So, I don’t even know what the effective date would be. Let’s see… five, one, 23. Yeah.
Naomi Denson (10:08) And for the group enrollments, you can put in a, we don’t have to have the effective date if you want to just put in a, and load it. No, no.
Hillary Perez-Godfrey (10:14) No, we’re not talking. The same thing. I’m just like, I’ve… got 20 lines of providers that show linked to this, right?
Naomi Denson (10:25) So, do we want to hold on the provider?
Hillary Perez-Godfrey (10:28) Hold on, hold on. No, go ahead and load it.
Naomi Denson (10:34) Just the providers and not the group or both.
Hillary Perez-Godfrey (10:36) No. Load them both. Okay. I just don’t have an effective date. Okay. Can we move forward with that? Yeah.
Naomi Denson (10:46) Let’s see, and then just for, and,
Hillary Perez-Godfrey (10:50) I’m assuming see, and that’s the.
Hillary Perez-Godfrey (11:05) Okay. So, issues questions, Nashawn…
Naomi Denson (11:17) Just for reference on the lines of business, humana in California only offers medicare. They’re not one of the states that offers medicaid?
Hillary Perez-Godfrey (11:24) Okay. No, I’m looking where?
Naomi Denson (11:29) Are you?
Hillary Perez-Godfrey (11:30) I’m looking at what Nashawn, did, I don’t even know if I can make any?
Hillary Perez-Godfrey (11:42) Aetna.
Hillary Perez-Godfrey (11:47) Do I still have to put the lines of business even though if they’re linked, then it’s under the group. I’m confused yeah.
Naomi Denson (11:54) The lines of business because they can vary by provider. So they have to be loaded in there as source of truth, so that if later on, you know, you determine that you need a new line of business, it’ll show you what you have and you can request demographic updates to add additional. So it does have to have at least one true line of business, right? Nico, or can they all be false? I.
Niko Byron (12:22) Think they can all be false technically like our system does allow that, but that’s not necessarily how it should be. I guess, if that makes sense. Like there should always be a line of business if you want it to be accurate?
Hillary Perez-Godfrey (12:37) Okay.
Hillary Perez-Godfrey (12:44) Okay. So humana is the only one I’m going to flip it. I mean, obviously, I put all the colors here. The only thing I don’t have is the effective date. Is that going to work?
Naomi Denson (12:54) Yep, just put N a,
Hillary Perez-Godfrey (13:00) okay. And then the others I can have done in the next couple of minutes, that’s the easy part.
Naomi Denson (13:08) Okay. This.
Hillary Perez-Godfrey (13:10) Part right here. I… don’t know. I’ve been working on it.
Hillary Perez-Godfrey (13:24) Technically, I can enrollment method, why am I drawing a blank? Oh, because this is a transfer of our existing, right?
Naomi Denson (13:34) So, so, for, if they’re active and par linked to group, the enrollment method either would be no credentialing required, meaning that you don’t have to send an application for those providers or direct enrollment, meaning you submitted an application to enroll those providers. They went through the payer’s credentialing process and were added to the network. Okay? Usually, no credentialing required is if they’re being added to the, your group with the payer, like you send in a roster or some sort of form and they’re billing under a physician that’s credentialed. But yeah, I was gonna, I was gonna ask about all of these. I was like, do you not send any applications or are these?
Hillary Perez-Godfrey (14:16) No, I think this is more like we’ve already done it.
Naomi Denson (14:20) Yeah, it would be. Yeah. So that’s the, yeah, I would re, look at the enrollment method for the providers because most of these in my experience would be a direct enrollment unless it’s you know, that circumstance, where they don’t go through credentialing?
Hillary Perez-Godfrey (14:41) Can you, is the, for the individual, the actual provider enrollment? Is this in the data dictionary… the enrollment method? Like, for some reason, I don’t have the volume the values in here anymore? Yeah.
Naomi Denson (15:00) I was just looking at that. I was like, where did they go? I don’t know if it’s on… Nico, can we get the values like the, these columns added back in here? Looks like they were erased, which.
Niko Byron (15:18) ones, the like.
Naomi Denson (15:20) The like all of the attribute scope model, all these in there for the existing enrollments tab, looks like they got deleted somewhere. It’s.
Hillary Perez-Godfrey (15:31) like a row. It looks like there’s a couple of the rows missing.
Naomi Denson (15:34) Yeah, we can have those back in the one through eight at the top.
Niko Byron (15:38) Yeah. Let me try to grab those right now.
Naomi Denson (15:42) Yeah, those are helpful. I was looking, I was like, I thought maybe they were just hidden. I was going to unhide them but they did just get deleted. So.
Hillary Perez-Godfrey (15:49) All the ones that are yellow, it looks like it got like sorted in. I don’t know what that is. Oh, no.
Niko Byron (16:03) So, in the existing group enrollments tab?
Naomi Denson (16:06) Provider enrollments, provider?
Niko Byron (16:07) Enrollments? Okay?
Naomi Denson (16:19) Yeah, it looks like they came like down here somewhere but were typed over.
Hillary Perez-Godfrey (16:23) It’s like it got sorted and then typed over something’s going on.
Naomi Denson (16:27) Yeah.
Niko Byron (16:29) That’s okay. We can add them back in.
Hillary Perez-Godfrey (16:46) Did Nishan ever make it to the call, I.
Naomi Denson (16:48) Didn’t see him in the waiting room.
Naomi Denson (16:56) We do have him scheduled with us on Friday to go through the payer process. Scoping, yes, and on that, we’re just going to go through.
Hillary Perez-Godfrey (17:05) Each of the payers, I thought that was done. Yeah.
Naomi Denson (17:06) You did the template, but we recently implemented a new process where we are walking through each of your payers, making sure we have any key information relevant to that. Like you guys had a lot of nuances with like your RDS and the different provider types and how they enroll or if they enroll with certain payers. So we’re just going to go through that. I had sent my follow up last week to make sure any of those like notes or like rules were added to that sheet. Did you have a chance to look at that or Nishan, I haven’t seen it yet.
Hillary Perez-Godfrey (17:35) You know what we’re going to have to, he’s not going to be able to answer a lot of those questions.
Naomi Denson (17:43) Yeah, because I remember, we added this like this one like this note, where there’s specific nuances, where I know there have been a couple of occasions where you say, you know, we don’t enroll these providers or we do it this way or they have to be done separately or different?
Hillary Perez-Godfrey (18:00) Right. I don’t think he’s going to have that. Was there any availability? I mean, because the options you gave me, I just wasn’t available. Was there any availability for this to go next week?
Naomi Denson (18:12) Yeah, that’s fine. I,
Hillary Perez-Godfrey (18:14) think we need to reschedule then, and I need to be on, I need to be on that call.
Naomi Denson (18:20) Okay. When works for you next week? I’ve got, I’m going to be out Monday, but Tuesday and Wednesday, okay?
Hillary Perez-Godfrey (18:28) Tuesday, I have a block anytime between. So Tuesday April seventh, I have a block anytime between nine a. M pacific and one PM pacific or two P. M pacific actually.
Naomi Denson (18:42) So nine to two on Tuesday, so I can do one PM central, which would be 11… a. M pacific. Yeah.
Hillary Perez-Godfrey (18:52) Go ahead and send that. If you can just go ahead and change the meeting date and add me back in, then I’ll accept that. Yeah, I.
Naomi Denson (18:58) Had added you originally, I just left you as optional but I’ll take you off of optional. All right. So that is moved. So let me just.
Naomi Denson (19:15) And you are no longer optional, you have to be there.
Hillary Perez-Godfrey (19:20) Okay. There we go. Perfect. Thank you.
Naomi Denson (19:23) You’re welcome. All right. I.
Hillary Perez-Godfrey (19:26) Don’t have anything else, Nico, is there, I mean, or anyone Dreama? Is there anything that is, let’s… go back to the group enrollment, at least I feel better about that particular page. Is there anything that’s popping out, that you see as that I need to clarify or I need to correct?
Naomi Denson (19:50) The only thing that jumps out at me is where you have none here that should be in a, but that’s obvious any that are missing lines of business. But with you only having one group, one practice location is pretty straightforward. Any that you don’t have effective dates for you can put in a as an option. But I think other than that,
Hillary Perez-Godfrey (20:14) anyone happen to know the payer id for Aetna better health?
Naomi Denson (20:21) I think that would be, is that I don’t know if those are specific to payers or if they assign you a specific one, but… I don’t.
Hillary Perez-Godfrey (20:32) okay. So I just corrected those. But yeah, the ones that are, so now I switched colors because I was using one versus the other. So anything that’s orange is 100 percent ready to go. Okay? Anything that’s white is what I’m still currently working on. So you can see that there’s missing effective dates, the lines of business, but anything that’s orange, if you look across it’s all populated?
Naomi Denson (20:57) Yep. I see this one. I know I’m in better health. Okay. Yeah… we’ll just get the lines of business entered into these white ones, effective dates if you have them and a, if you don’t and then we should be good to go. Okay. So.
Hillary Perez-Godfrey (21:16) Yeah, I just have a couple meetings this morning but this is, I burnt out yesterday and I had a couple of fires to put out.
Hillary Perez-Godfrey (21:24) So let me finish that. I’ll send everybody an email that this, at least the group enrollment is ready to go. And then I’ll go back to this hot mess.
Naomi Denson (21:37) Okay. And then if you have time add in any notes to that payr, scoping, she said that we would review in our call next week just so that we have it documented. Okay? Somebody needs to review if you have time before our meeting next week, so that we can just have it all documented in one place.
Hillary Perez-Godfrey (21:58) Okay. There’s a couple, let me see. Okay. Yeah, no, I’ll go back to those notes. Okay? All right. And that’s all I have, all right?
Naomi Denson (22:11) Well, thank you, Hillary. We will be looking out for your email when the group’s enrollment tabs are ready.
Hillary Perez-Godfrey (22:16) Yeah, no, I wanted this done on Monday, but here we are on Wednesday. Okay?
Naomi Denson (22:23) Okay. Thank you.
Hillary Perez-Godfrey (22:27) Everyone. Thank.
Naomi Denson (22:27) you. Bye, bye bye.