Transcript
Norma Mendo (00:00) hey, Connor.
Connor Morley (00:01) Hello?
Niccole Russell (00:05) How are you today?
Connor Morley (00:06) Doing, good. Decided to go over this payr process scoping. Okay.
Norma Mendo (00:19) Hello? Oh, you can see me today?
Connor Morley (00:24) Hey, Norma, how you doing? She’s.
Norma Mendo (00:26) alive. I feel like I’m playing a game all the time. Like you can see me today? Can’t see me tomorrow? I am so unprepared guys because I just got back from vacation after three days. So, oh, what do you mean? It was, you know, taking care of my 100, no.
Connor Morley (00:41) Worries, we got a pretty light day planned. Well, I did want to talk to you a little bit about the payr’s all the payr’s that you have.
Norma Mendo (00:51) Okay. Because.
Connor Morley (00:52) We had a couple questions based on the payr enrollments, and I just wanted to confirm a couple things with you. So, number one would be, I have a list of the,
Connor Morley (01:09) the payr’s that you would potentially be using. Okay? And I just wanted to confirm that this is the whole list from… my understanding. So this was based on where is this, there it is. So we… can ignore the states for now. But this is the list of the payr’s that we have that you’ve listed in the.
Connor Morley (01:48) Information or that you’ve listed in the payr enrollments?
Norma Mendo (01:53) I’m just looking at the payr name, not the state, right?
Connor Morley (01:57) Yeah, just the payr name. Okay.
Norma Mendo (02:02) Edna?
Norma Mendo (02:12) It’s gonna look at that real quick hold on… there we go. Imedvision. Okay. Let’s bring it back up. We have.
Norma Mendo (02:35) Cigna… medicare… we’re just doing medicare for both states, Arizona and Illinois, right? Okay?
Connor Morley (02:46) And we can clarify that. Yeah.
Norma Mendo (02:51) Tricare west is both for both states. They already switched that so that’s just one tricare… unitedhealthcare, ESP… blue cross, Aman… MRC, multiplan, unitedhealthcare… Edna, blue cross, Illinois, cigna, davis vision.
Norma Mendo (03:17) Yeah, ppo… and premier is just another product, but it’s a separate enrollment. Okay? Illinois, medicaid, meridian… first health, I think first health goes into multiplan now… yeah.
Connor Morley (03:42) So, we’ll do like a little bit of mapping on our side to make sure that we’ve got the pair names, correct? Okay. What’s going to be important for some of these is I want to make sure that we number one, we have the correct line of business for all of your existing and potential future enrollments for these payers, like what can you choose here? Essentially, it would be commercial government, medicare, medicaid, managed, medicare advantage, things like that. And then also if you can assign, you know, which ones are your high priorities, like which ones, if we get an enrollment request for that goes to the top of the list, I see essentially and then are any of these roster eligible number one? And then if so, do you have a roster template?
Norma Mendo (04:31) Okay. And,
Connor Morley (04:32) then lastly, for each one of these, are there any non standard enrollment processes? And Nicole, correct me if I’m wrong, but the way that we define a non standard enrollment process is essentially anything that is not us logging on to their like payr portal or their website.
Norma Mendo (04:53) Yeah.
Niccole Russell (04:53) So, non standard is anything client specific. So if you don’t follow the standard way of submitting enrollments, then that’s what we would need your process for. Okay? So we can follow our payr directory and we have all of the standard enrollments, but if it’s special, then I’ll create a project plan that says, hey, this is how they complete, you know, Aetna or whatever… got.
Norma Mendo (05:20) It. Okay. Yeah, I can see what you’re saying. Okay. So like say involve who you go in there and do an initial in the website, basic… one, you know, page fill out and then they will email you with the roster because you can’t pull it out of that. So I can see what you’re saying. So, non standard. Okay?
Niccole Russell (05:40) Correct. Yeah. Got it. Okay. So on that, yes, no. If it’s non standard, you would mark, yes, and just provide your process to us.
Norma Mendo (05:49) Yeah. Okay. That’s an easy one. I think the vision plan says you probably are aware is like from mars, you know, that’s a total different species. But most of them lately, I have been noticed as of 20 26. They have or 20 25 November. They have encountered some rosters. It’s really much easier with the roster and some of them, they created a roster for some of them. So I can address that. Okay? Yeah.
Niccole Russell (06:17) And what you do, whenever you upload that roster template for us, I will take it up against an in house active roster template that we have. If it is not currently mapped in our system, then I’ll send it to our mapping team so we can work on getting that automated. Does your non standard?
Norma Mendo (06:36) Also talk… about which ones are the ones that they do unavailability or that’s also standard for you?
Niccole Russell (06:47) Availability is standard for us?
Norma Mendo (06:48) Okay, good. Okay. Yeah.
Norma Mendo (06:55) Most of most of them are listed on top of my head davis vision. I think the only one I don’t see there?
RachelsiPhone (07:03) Yes.
Norma Mendo (07:04) Oh, there it is. Okay. Got it. Okay.
Connor Morley (07:06) If there’s something that’s not on here, I just sent a link to this spreadsheet in the chat, just add it here because we want to make sure that we have payer plans for all of these. And I think the only one with a group enrollment is mercycare is my understanding.
Norma Mendo (07:26) Yeah. I just find out. Meridian is also group enrollment.
Connor Morley (07:32) Okay. Meridian’s not on the group enrollment tab that we are loading. So if you’d like us to load that, we can add that.
Norma Mendo (07:44) Well, it just popped up and I wanted to add a couple of providers and they only accept the group, but you have to do the initial online and they will just send you the group enrollment. So, yeah, it’s a standard as well too. It’s really a standard form.
Connor Morley (08:04) Nicole, is that group enrollment or is that? Yeah… it’s not group enrollment?
Niccole Russell (08:11) If you can’t enroll providers alone, then yeah, she would have to enroll the group to link the providers to it. Is that what you’re asking? Yeah.
Norma Mendo (08:20) So, what it does is it’s a much easier process before you had to do one by one and fill out the form online. And then they would give you another bigger form to fill out the whole thing. And now it’s basically a standard form that you add the same thing. It’s just a, it’s one of those standard, you know, basic enrollments that you just fill out. But unfortunately, you do have to give them that initial form npi online, whatever it is. But you can fill it all together. It’s just and then they send you the spreadsheet and that’s one, that spreadsheet does not change. It hasn’t changed. It’s going to be standard now.
Niccole Russell (09:03) Yeah. I mean, I know meridian is in our payr directory. So we do that standard process. Yeah.
Norma Mendo (09:08) All right. Yeah. Other than that, I think the difficult one is really going to be delta dental of Arizona where… they want to log in for everything, but I just reached out to the representative and we’ll give you a better answer to, you… know, there has to be a way that they will address it differently. So I’ll get you a better answer to that. Okay?
Niccole Russell (09:34) Oh, and also, let me just state for any standard enrollment processes specific to you. If you have any of those, then let us know along with the roster. We’ll need to know where to send that to, if it’s standard for you, but let us know if there’s a prerequisite medicare or medicaid are needed, who to submit the application and, or roster to and where to follow up. So those are kind of the main questions as I’m creating your payr.
Norma Mendo (10:08) Project plan.
Niccole Russell (10:10) Okay.
Norma Mendo (10:11) For medicaid here in Illinois or Arizona, they’re not rostered at all, they’re individually online.
Norma Mendo (10:27) Thank you.
Connor Morley (10:33) Okay. So take a look at these. Let us know the lines of business. If there are any rosters, if there are any non standard enrollments, and then what else I wanted to cover with you all is for your provider enrollments? Just wanted to confirm a couple of things because there was specifically a question that we had on, hang on while I pull this up… delta dental specifically… question on delta dental. We just wanted to confirm that we have the right practice information because I think what you have listed here for delta dental is… Illinois eye institute. So this kind of, we… wanted to double check that this is the right practice name.
Norma Mendo (11:33) No, not for delta dental.
Connor Morley (11:39) Okay. So that is a little concerning. But yeah. So we just have delta dental here for the practice of where’d.
Norma Mendo (11:55) it go where’d it go? Yeah?
Connor Morley (11:57) Illinois eye institute. So we didn’t know, we didn’t think that should be loaded and it doesn’t sound like it should, if it’s not Illinois eye institute. What should it be for… these providers with delta dental and well.
Norma Mendo (12:17) Can you go back to the providers real quick? That makes.
RachelsiPhone (12:21) me wonder if I dragged something and it copied down when it shouldn’t have.
Connor Morley (12:31) Potentially.
Norma Mendo (12:33) Oh, see those are all Illinois. Yeah… those are all Illinois dental. So just go back to there. I think it’s just a matter of changing the, yeah.
Connor Morley (12:46) I mean, if it’s not the Illinois eye institute, and it’s a different practice, like we can just change these right here. And then.
Norma Mendo (12:53) Yeah. All delta dental is?
Norma Mendo (13:01) The practice alone is delta. Listen to me is dental institute.
Connor Morley (13:10) This one, right?
Norma Mendo (13:11) Hold, on, hold on. Yep. Yeah.
Connor Morley (13:15) Dental institute. So, I think, yeah, that was, that one was our concern. So, these should all be delta institute. Oh,
Norma Mendo (13:23) you spelled it wrong? Oh.
Connor Morley (13:26) Yeah, it’s because you guys are watching me type right now?
Norma Mendo (13:30) Hey, yeah. See you caught one. I caught one. I like four eyes. I like five eyes. How many eyes do we have here? Eight? Oh, my God. We got eight, no, 10. We got 10.
Connor Morley (13:47) Institute. Yeah. All right. So that was the delta dental and delta dental premier envision we looked good, Illinois medicaid did?
Norma Mendo (13:56) You go back to delta dental premier because it was just a small.
Norma Mendo (14:04) Jessica Conway that’s interesting because basically in Illinois, delta dental of Illinois and delta dental premier. I enrolled them both products. The delta dental of Illinois is their ppo product period, and the delta dental of premier is their ppo premier for out of state because we have a lot of jurisdiction borders. So that’s all that’s a lot. And.
RachelsiPhone (14:32) I think I got like, I got that off of the list that you sent to me. So, if there are more providers, it just might not be that they were showing that they were in symplr?
Norma Mendo (14:42) Got it. Okay. So.
RachelsiPhone (14:44) That’s because that’s just the symplr list. Whatever was in symplr is what’s on there.
Norma Mendo (14:49) Yeah, premier came in Illinois just this past year. We, and that was probably one that we have to enroll all of them in premier… if that makes sense. Yeah.
Connor Morley (15:08) I only have 14 rows for delta dental.
Norma Mendo (15:15) I could look into that for you and I could probably reach out and see if they can pull up whatever is enrolled in the back end. I thought I had sent all of them last year in December. So I will check on that. We have a rep that she’s pretty good about pull, you know, like doing a report for us if we need to on who’s I know it’s a whole separate enrollment. So that’s why? Yeah.
Connor Morley (15:43) So, the delta dental and the delta dental premier, those I had concerns about just because yeah, did not look like they matched up with the right one. But no.
Norma Mendo (15:54) Worries, I honestly have to say that it could have been just the fact that I didn’t update it on the symplr which gathered all this information. It was, you know, after a certain amount of time, it was just like, okay, they’re in, let’s go, you know? Yeah. And delta dental is terrible about sending us letters of approvals. They’re awful once they’re in, I have to go into the website and check them. So it’s one of those. I mean, you might even have a better connection and contact… being who you are. I’m just a little, Norma over here. They don’t care.
Connor Morley (16:33) Norma, who, we will hound them until they get us the information.
Norma Mendo (16:37) There is a rep and I will give you that information because she’s the one that I personally was dealing with in the past. She, she left. So now it’s trying to hound them for sure.
Connor Morley (16:46) Gotcha. The other one was just this Arizona… healthcare cost containment system. We just need to double check this with the payer mapping just to see what this would relate to. And this.
Norma Mendo (17:00) one I think is the epip, right? The apep, so that’s the apep website, in Arizona, access apep, you have to add the provider as a registration in order for you to add them to all their medicaid products for the state. So, once they are in this, you know, they’re proved through access apep, they call it in Arizona healthcare cost containment, which is very, basically, their basic enrollment medicaid product, but they doesn’t really do anything until you enroll them to the other. I mean, plan to the products that you want under there to go in. So it’s a one enrollment and then you add whatever you want under it. So this is apep and you can probably their basic information of medicaid. So.
Connor Morley (17:58) Nicole, would this be like more of a prerequisite.
Connor Morley (18:08) for medicaid or medicare? Or, would this have its own distinct?
Niccole Russell (18:15) No, I think she’s just saying it’s all done under the apep portal. So it’s still, it’s she can list them individually, but we’re going to call it whatever is in our player.
Norma Mendo (18:26) Directory.
Niccole Russell (18:27) all of those lines may be called, you know, they would be called one specific name.
Connor Morley (18:32) Okay. All right. I mean, that makes sense to me. Yeah, I’m not too concerned about that then. Okay?
Norma Mendo (18:40) Yeah, just medicaid?
Connor Morley (18:43) Product. Cool. And then I think the other piece was there were some missing providers as well… and I just wanted to confirm. I just have to do a quick check of why… we… listed these as missing providers. So, give me one second, please. It’s been a crazy day, but, yeah, cmacph, midwestern. Com.
RachelsiPhone (19:25) He’s so he is deactivated. Oh.
Norma Mendo (19:30) Yeah. Copaco is a name that’s.
RachelsiPhone (19:32) Colin McPherson?
Norma Mendo (19:34) Oh, okay. Yeah, Rachel’s more experienced than the ones out there.
Connor Morley (19:38) Okay. Wait, hang on. Okay. So, the missing providers, this one is deactivated… there’s, etoker.
RachelsiPhone (19:50) Tokars, is deactivated too. The next one down. I’m not sure who that is. The next one down is newer, and I know she’s gone.
Connor Morley (20:05) So, deactivated.
RachelsiPhone (20:07) I don’t know who Christy? Yeah, she’s deactivated too newer. I don’t know who Christy Charles is, and the next one after her, mifflin is deactivated as well. They all just recently left.
Norma Mendo (20:24) Yeah, just within a couple of weeks, right? Rachel, like… wow.
RachelsiPhone (20:35) But I don’t know the other two. I don’t know who those are, let.
Norma Mendo (20:39) Me, see if I can look them up real quick. Hold on Becker. Just a second. Hold on. I have mine open completely here. So give me a second.
Connor Morley (20:55) You know, I’m not seeing Becker in medallion either active or deactivated.
Norma Mendo (21:04) Why don’t? I have her?
Norma Mendo (21:21) Might be Lauren, it actually is. I think hold on it’s actually whoa.
Norma Mendo (21:34) Hold on. It might be Illinois. I’ll only go into my other one. Let’s do this one here. Thank you.
Norma Mendo (22:05) I’m not finding that.
Norma Mendo (22:12) Oh, I found her. She’s an SLP. So hold on. I think she left already. She’s also deactivated. So, hold on. Let me go back in here. She says speech, okay, hold on, so.
Connor Morley (22:27) Becker was deactivated. And then Christy Charles,
Norma Mendo (22:34) Just go back in here. Hold on.
Norma Mendo (22:48) And then Christy Charles, let’s go see.
Norma Mendo (23:06) Okay. So she is.
Norma Mendo (23:13) She’s dr Barbora. And she also just left and was deactivated just recently as well. I’m 12 for 20 25. OK?
Connor Morley (23:24) That sounds good. And then… let me see if there’s anything else. I think there might be some confusion on the practice npi matching up. So, for Arizona multispecialty.
RachelsiPhone (23:46) Yeah… that’s this is where I feel like I must have dragged and it copied the wrong information… because they should be the same. So, I’m sorry, I can take a look at what I’m saying and fix it because that’s wrong clearly.
Connor Morley (24:08) No worries. I mean, we pulled in what we have for the practice npi right here. So, this is what we have. We just want to know if this is right?
RachelsiPhone (24:25) I mean, that’s right for the multispecialty clinic. The other one is not, but I feel like I probably just pasted and it pasted more than I wanted it to.
Connor Morley (24:36) No worries. This one in column AB is the correct one though.
RachelsiPhone (24:44) Yeah. Well, yeah, I’m going to go look at what I sent to you because I’m… worried that like when I like sorted and then copied and pasted, it didn’t do what I thought it was going to do.
Connor Morley (25:01) No worries. I mean, that’s why we kind of go through this process. We just, it is a little bit of a nightmare to change.
Norma Mendo (25:11) It’s a lot of information in one spreadsheet. Yeah.
Connor Morley (25:15) So, we just got to verify, we just want to verify that everything matches up.
Norma Mendo (25:19) Oh, no.
RachelsiPhone (25:20) I appreciate that.
Norma Mendo (25:22) Yeah, I didn’t have the same.
Niccole Russell (25:23) Issue, Rachel, I am kind of new to Google sheets. I usually use excel and I filtered something I was doing and it copied.
Norma Mendo (25:34) Oh, wonky.
Niccole Russell (25:36) Yeah.
RachelsiPhone (25:37) That’s what I mean? Like, I think that’s what happened? Yeah, I’m like that’s not supposed to be that way, so.
Connor Morley (25:44) I.
Niccole Russell (25:45) think it’s Google sheets.
RachelsiPhone (25:47) No.
Connor Morley (25:47) Worries. We just, yeah, I mean, we’re just going through and we’re trying to confirm because we want to make sure that we’re loading the right information.
Norma Mendo (25:55) Yeah. So.
Connor Morley (25:56) If this column AB is right, then we can use this can?
Norma Mendo (26:02) You go to the, which one is it, can you go to the front part and see the name of the, where you’re at? Okay. Got it.
Connor Morley (26:11) Typically, you know, all of the ones that?
RachelsiPhone (26:13) We have.
Connor Morley (26:14) Questions?
RachelsiPhone (26:14) On, is there a way for you to reshare this with me? Sure.
Norma Mendo (26:29) Just like that, Rachel, you see that? Just like that? Why don’t we just grab Connor’s brain and just like stick it on ours for a little bit, you know?
Connor Morley (26:40) Oh, you don’t want my brain? My brain is mush at this.
Norma Mendo (26:44) Point. Okay. Can you go back to the, how to list the line of business when they are different from the different mpi, just to kind of make sure that we are, exactly when we do a check and go in there?
Connor Morley (26:57) Sorry, what?
Norma Mendo (27:00) So, all.
Connor Morley (27:02) the lines of business for all of these payers, like on the payer enrollments tab, you can see them like right over here in columns like S through W… or X or y. So if they are commercial, it’s just true and everything else can be false. If it’s like government, then you can list or traditional medicaid, you can list it as true. There’s also a line for government. I’m going to be honest. I’m going to need Nicole’s help for the difference between traditional medicaid, traditional medicare and government?
Norma Mendo (27:46) Which traditional government would just be the traditional state. So it’s true, right?
Niccole Russell (27:53) Government is medicaid and medicare. So I’m not sure… what is it saying there? What is it saying?
Norma Mendo (28:03) On top?
Niccole Russell (28:04) National government payor needed for revalidation, oh.
Norma Mendo (28:07) This is a revalidation portion. Yes.
Niccole Russell (28:09) Okay. Yeah.
Norma Mendo (28:12) Okay. Even though it’s every I’m.
Niccole Russell (28:15) not used to that terminology either. So that one’s new for me?
Niccole Russell (28:26) Well, let’s see.
Connor Morley (28:30) All right, Nicole, could you take a look at that one? And then just let me know if we need to do anything else?
Niccole Russell (28:40) Well, it’s saying traditional medicare, it’s saying the same thing there. So I don’t it’s still not clear to me what government is for medallion. Yeah, I can look at it. Let me get some clarification on.
Norma Mendo (28:53) That, I mean, I’m wondering if it’s tricare or anything like arp would, no, but that would still be unitedhealthcare. So, yeah, I don’t know what the government would for.
Niccole Russell (29:04) Us, it’s just maybe usually we just refer to go my past life. We refer to government as like medicare or medicaid. Okay. So I can, I’ll check on that. I.
RachelsiPhone (29:15) Kind of figured that government was like tricare or since they had it broken out with medicaid and medicare, I assumed government would be like the va or tricare or that kind of stuff, but that’s what I was going off of and.
Norma Mendo (29:30) Then if that is true, if it’s tricare, then Rachel’s correct? It is false because we don’t revalidate that product.
Niccole Russell (29:38) Yeah, that makes sense to me. I,
Norma Mendo (29:41) mean, medicare, yes, it’s every five years and then medicaid’s every three. So, yeah… yeah.
Connor Morley (29:49) Okay. So I don’t think I have any other let’s see what else questions on provider enrollment. You answered my missing providers question just to confirm again, do we need another group enrollment for meridian?
Norma Mendo (30:15) Again, we can do the enrollment on a spreadsheet and send it to an email. Now, as of 20 26. So I would say you need to add it there because that’s what I’m doing. I just send in seven doctors to meridian, and they are in process and I did not need to go individually like I used to.
Norma Mendo (30:43) But this is all new to me. This was the only one time enrollment that I have ever done it this way. So, yes, it’s one standard spreadsheet group in one line and all the doctors lined up and just copy and paste all the information at the end and it goes in. So I don’t know how you want to call that. But to me that’s just a standard group enrollment.
Connor Morley (31:10) Nicole, this sounds like group enrollment?
Niccole Russell (31:14) I’m sorry, I was reaching out about the group.
Norma Mendo (31:17) Government the latest is with meridian?
Niccole Russell (31:23) Huh. Is.
Norma Mendo (31:24) Before you used to have to go in the website and do one by one and then when, you know, just kind of keep an eye on it. Now, you are able to use their standard spreadsheet… similar to yours. You know, and one line is going to be all the group enrollment, the group information, and then you just lined up all your doctors on the next line. And basically, the first three lines is just going to be different because it’s social security date of birth, but then the rest of the lines are all copied the same thing. So I would say that’s a group enrollment.
Niccole Russell (31:56) Yeah. If I have group information on there, I mean it, well… if it’s a roster, you’re going to have to provide group information as well, right?
Norma Mendo (32:06) It’s on the same page. It’s on the same spreadsheet. Yeah.
Niccole Russell (32:09) So that’s going to be group and provider.
Connor Morley (32:12) I’m so sorry, but I do have to jump to another call. It sounds like I think I got all the information I need for this and for group enrollment, we can like continue to discuss it, but it’s one provider. It’s one group enrollment for meridian. I’m not too worried about it right now. Okay?
Norma Mendo (32:32) I just wanted to make sure that on February, it seems to make it easier for you. That’s all.
Niccole Russell (32:36) Do you want?
RachelsiPhone (32:38) Us to go in and just check the provider enrollment. Since we do have, the… npi numbers that don’t look like they’re maxed. Is it okay if I just go in here and change anything that needs to be changed yep?
Connor Morley (32:54) Please, please do, if you can. Okay, I can do that. I’m so sorry guys. I just had to.
Norma Mendo (33:01) No, that’s no.
RachelsiPhone (33:02) No, please go ahead. Yeah.
Norma Mendo (33:05) Thank you. Bye.