Transcript
Tanisha Roebuck (00:00) hey, Jason.
Jason Zednick (00:01) Hey, good morning. Everybody. Good morning, good.
Dawn Candia (00:05) Morning, hello?
Jason Zednick (00:09) How are we all doing today?
Tanisha Roebuck (00:11) Not too bad. How about you? You? Alright?
Jason Zednick (00:15) Doing alright. Good. Had a nice weekend. So that’s good. Yeah.
Tanisha Roebuck (00:19) Yeah.
Tanisha Roebuck (00:20) Wonderful. Monday. Is… Dwayne going to be joining us today? Do you know? Lisa?
Tanisha Roebuck (00:30) I do not. Yeah, I don’t know.
Tanisha Roebuck (00:35) It’s today the sixth. Yeah, maybe, I know. He said he was going away for a few days.
Tanisha Roebuck (00:41) He did, but, yeah.
Tanisha Roebuck (00:43) Do you know what did he tell you what day it is?
Tanisha Roebuck (00:45) No, I forget. Yeah, me too, but not, he would be like away in teams and everything if he wasn’t here, so.
Tanisha Roebuck (00:52) Yeah, right. Oh, no, that’s true.
Tanisha Roebuck (00:55) Yeah. So it’s not today. I think it’s next week. I think you’re right. Yeah, I think it’s soon. I just forget. I’ll ask him when I.
Jason Zednick (01:13) Hey, well, if he shows up, I’ll let him in and if not, that’s okay. I’ll always follow up with him later. Yeah, what questions do we have today?
Tanisha Roebuck (01:27) So, I don’t know, but I sent you an email. We talked about the, you know, I was asking about decapitation. Yes. Yeah, Dwayne, he just sent a message. He’s not going to be able to make it.
Tanisha Roebuck (01:42) Oh, okay.
Tanisha Roebuck (01:43) He’s caught up on another call. So, he is in, let me see.
Tanisha Roebuck (01:48) Yeah. Okay. That was our problem.
Tanisha Roebuck (01:52) So, it’s the, we have a provider who wants to change his capitated sites for lab physical therapy and radiology. And… you know, how would we go about that in medallion? Is that something you guys do? Because it’s part of, I guess the credentialing, I don’t know Dawn can, do you want to speak to this at all?
Dawn Candia (02:19) No, it’s actually not, I mean, we don’t we… typically don’t get capitation information, you.
Tanisha Roebuck (02:28) Did that before you did it during the onboarding? Dawn. So, you guys do collect that?
Dawn Candia (02:32) Yeah. What do you mean? We did it during the onboarding?
Tanisha Roebuck (02:35) Yeah. During the onboarding? Yes, you absolutely did because it goes to ibc requires it.
Dawn Candia (02:42) Okay. Right. But we don’t do it. We don’t what do you mean that? What did we do? Is, what?
Tanisha Roebuck (02:46) I’m saying it’s like you collect the information and give it to the payer. And if it changes, it has to go over on like a change request.
Dawn Candia (02:52) Form, no, we almost, we sometimes don’t even get that information.
Tanisha Roebuck (02:58) Oh, interesting. I mean, it can go back in. It doesn’t matter. It’s anyway.
Tanisha Roebuck (03:03) Yeah, we’re just trying to think about if, is that, was that a function of credentialing… in the past? Like if you, but Dawn, you don’t even you’re not even sure if that, if you guys did it and it’s only for Pennsylvania sites because they have to select because they have, the capitation for like keystone health plan east and they have to select like, a lab facility, physical therapy and radiology for the patients that are capitated to them to where, you know, where they should go. But, and that’s what I was curious about the other day, you know, how do we select these? And if we make changes or if a doctor says I want to change my lab to something, do you recall ever doing that kind of stuff? Okay? So that’s yeah, that’s something. So that’s something we have to think about Jason. That’s why I asked, you know, asked you guys, but I don’t even know where that’s would be collected in medallion?
Jason Zednick (04:01) Yeah. So it’s not currently collected in at all now whether it’s something we would update or not. I’m not entirely sure. It’s not something I, I’m familiar with. It’s. Not something I’ve seen. I have asked the question I need to follow up today. I haven’t gotten an answer, but yeah, that’s on my list of things to check back in on this morning. Yeah.
Tanisha Roebuck (04:24) And then the other thing is, and Lisa and Dawn, maybe you guys can help me with this one. What if a provider is… coming? You know, it’s a new provider, and they’re you know, they’re joining advocare and their capitate, you know, their patients are capitated and they move the capitation over. How is that completed?
Jason Zednick (04:50) I mean, I think that’s a function of like, you know, what is the process with each individual payer? It’s not something that’s like defined in our default process. But if it is part of the enrollment credentialing process, then we can always sort of document those things and manage it if it’s a part of, that workflow.
Tanisha Roebuck (05:13) Okay. And I’m not familiar with that. That’s why I thought maybe if it came through credentialing with a new care center joining Dawn?
Dawn Candia (05:21) If a new care center is joining and they give us the cap information then, and that is asked on the application. When it’s submitted, then we absolutely will include that in the well, in the past, we’ll absolutely include that in the enrollment application. If it’s asked on the application, but some of them don’t is what I’m saying.
Tanisha Roebuck (05:42) Okay. Now.
Dawn Candia (05:45) If something comes up at a later time, you know, this is our cap site, you know, maybe the payer is asking for it, then we’ll reach back out to the care center, say, hey, what’s your capitation site? Because xyz payer is asking for it and we’ll give it to them that way. But it’s just not something that’s just always done and asked for within the enrollment process that when we were doing it. Yeah.
Tanisha Roebuck (06:08) And I’m not even talking about the capitation site. I’m thinking more about the actual capitated patients themselves. Like how do they move over when they join advocare?
Dawn Candia (06:19) Yeah. I don’t know. Maybe Lisa can answer that. I don’t know, do.
Tanisha Roebuck (06:23) You know, Lisa depends on the payer because right now, well, in the past, it was part of the enrollment. Now, it depends on the payer we’re submitting for new care centers. But as for new providers, I don’t think there is a process, okay… which there should be.
Tanisha Roebuck (06:43) Yeah, that’s what I’m thinking we have to figure out how it’s going to be done. And does medallion handle that? Or do we have to still do that?
Tanisha Roebuck (06:54) So, for the groups, we, you know, we submit the letter and we ask in the letter for them to do that, which is new. We weren’t doing it before. So I don’t know how it was getting done if it was getting done. But now, when we submit the letter under payer relations for the care centers that change form letter, I mean, I’m sorry, change forms in my brain, the link letter advising them. We put that in the letter. Can you please move all applicable panels only for new care centers? We’re not doing it for everybody that joins, because that would be a lot. So, but before I don’t know, you know what the process was because we weren’t doing the link letters. So.
Dawn Candia (07:35) Okay. Now, that language was in, if I’m not mistaken, that language might have been put into the tin change letter for new care centers joining.
Tanisha Roebuck (07:44) Oh, in the past, you mean?
Dawn Candia (07:45) In the past? Yeah.
Tanisha Roebuck (07:46) Okay. Gotcha. Okay. All right. Okay. Yeah, I just have these questions, Jason, they’re coming up because we’re working, on a spreadsheet with, you know, our processes, for enrollment of new care centers, new providers, changes and things like that. And that’s why they’re coming up now.
Jason Zednick (08:08) Yeah. No, it makes perfect sense. It’s a good question. Yeah. And I’ll follow up with my team, get a little more context and I think, yeah, where we find it is part of like the enrollment with specific payers, if it’s on the application and those are things that we can definitely adjust… what we’re doing if we need to, and manage that probably for sure. Okay.
Tanisha Roebuck (08:42) Otherwise, I don’t have anything else, Dawn. Do you or Tanisha have anything?
Dawn Candia (08:46) Yeah, I had a question, Jason. Yeah. So.
Jason Zednick (08:50) We.
Dawn Candia (08:51) got a couple of horizon par updates from Bethany today. So I wanted to find out now, I’m putting the par update in medallion, right? But the line item under enrollment request is still there. Do we need to move that? Remove that? And if so, how, because now there’s no line item under enrollments that’s you know, active and complete. But the old one that was on hold is still in the, you know, under enrollment request.
Jason Zednick (09:23) So, you’re updating the existing enrollments with the new information. But then there’s still the request that is out there for that task that’s already been completed.
Dawn Candia (09:39) On hold though. It’s on hold. Yeah, it’s on hold.
Jason Zednick (09:44) I think in that instance, if you can just let me know what you’ve updated and ideally, like what request is associated with it. I can go in and just stop the request and leave a note that it was updated. And that way there’s no conflict there. And we have the record. We know that you did it and all that good stuff.
Dawn Candia (10:12) Right. Okay.
Jason Zednick (10:15) I.
Dawn Candia (10:15) mean, I think it was… assigned to advocare, it says client owned, but nevertheless, it’s still sitting in enrollment requests and, you know, providers, look at that and they think, why is this still on hold? Not looking under enrollments to see that it’s actually complete? You know what I mean? I just wanted to remove it. So it didn’t look conflicting.
Jason Zednick (10:39) Yeah, that’s a good call out that’s a good. If it’s advocare owned. You should be able to use the request to complete it and record the update. So you don’t have to do the sort of double back.
Dawn Candia (11:00) So, can we look at Monica Wiggins because that’s like the.
Jason Zednick (11:02) first.
Dawn Candia (11:03) One that I did?
Jason Zednick (11:05) Let me pull her up. Give me one second, okay?
Jason Zednick (11:44) Well, Monica, I’m… showing it. You actually completed it.
Dawn Candia (11:50) Yeah, I did. But so the line item under enrollment request is still sitting there?
Jason Zednick (12:00) No, no.
Dawn Candia (12:02) It’s not, no.
Jason Zednick (12:03) No, yeah, enrollment requests you.
Dawn Candia (12:06) Don’t see a horizon there. Why do I see it on my end?
Jason Zednick (12:09) Horizon. Let me filter this and it’s complete. It was completed, but.
Tanisha Roebuck (12:15) There is another one on there that says owned by evercare, that still says pay your processing? I think that’s what she’s talking about?
Dawn Candia (12:22) Is that what I’m looking at? Yeah.
Tanisha Roebuck (12:24) Because when you scrolled down at first, I seen it, but when you searched it didn’t come up?
Jason Zednick (12:30) Yeah, I’ll undo it and you can show me, but what you did here, this is exactly it like this is exactly correct. So, this was great. But let’s look at.
Dawn Candia (12:39) The other one, let me undo this. There. It is. See it is that it horizon?
Jason Zednick (12:53) I just see the one horizon. I’m going to have high mark.
Tanisha Roebuck (12:56) Oh, dang. It must have. See, we didn’t look before. It must be gone now since you did that, but you’re not going crazy. It was there. I seen it myself.
Dawn Candia (13:07) Well, wait a minute, isn’t that it right there?
Tanisha Roebuck (13:10) But you completed that one? Yeah. Huh, it was two of them in there. One said client owned and one said advocare owned, yeah, right before the call. So, maybe once she did that, they followed up and closed it. I don’t know.
Dawn Candia (13:26) Yeah.
Jason Zednick (13:28) That’s true. But,
Tanisha Roebuck (13:29) you’re not going crazy Dawn?
Dawn Candia (13:31) Okay. Thank you for so much.
Jason Zednick (13:33) Well, yeah. So what I would just say is if it is client owned, you can complete that and you did it here. Like, this is exactly right. Okay. And so, so… yeah, so that’s so.
Dawn Candia (13:49) Should it still be showing up there under enrollment requests?
Jason Zednick (13:52) Yeah, because it’s still a request. It’s just complete like this is all of them, right? So, you have, you know, for Monica, you have three total that are completed three on hold one that needs attention. So over time, like you’re going to see everything even though it may be in one bucket versus another. Okay. Yeah. So you can see here like this one that was medallion owned this Delaware medicaid medicare one, it was completed as well. Yeah. Okay.
Dawn Candia (14:23) All right. I thought I did something wrong or didn’t do something? Okay?
Jason Zednick (14:27) I mean, it looks like you did it, exactly, right?
Dawn Candia (14:29) Okay. So, sounds great. All right. So then I’m going to do two more the same way after, you know, later on today. And so I guess I won’t need, I don’t really need to let you know then, right? No.
Jason Zednick (14:41) Yeah. If you’re just closing this line like that, then, yeah, no need to let me know at all. Okay. But if you’re doing it and you still feel like you’re seeing something weird or something you didn’t expect, then, yeah, I’m happy to like help work that out with you.
Dawn Candia (14:58) Okay. All right. And my other question, Jason, so now, the update that I made is only for horizon commercial, didn’t we have conversation with Greg and everything saying, talking about separating out commercial and NJ health because we don’t always get those at the same. Well, we never get them at the same time. So, you know, I was just updating the commercial line, but there’s… you know, the medicaid line is still open. I want to say you.
Jason Zednick (15:30) Can, when you complete well, you know, what?
Dawn Candia (15:32) Maybe not for this one. Who is, this? Isn’t this Delaware? Yeah, this is Delaware. So no, not for this one, but, you know, same thing for any other, for the other state, it would be the same difference. It’s not separated out.
Jason Zednick (15:47) There’s a couple of options like one you could, and it’s just sort of you wait… to close the enrollment until you get both notices or you can do actually.
Jason Zednick (16:09) I don’t know if an admin can do a partial completion. Let me, let me, sorry. Yeah, if a client admin can do, let me look at something real quick. Click around. I’m just gonna turn this in.
Jason Zednick (17:40) Let me think about this a little more. I’m not exactly sure what the button flow here is… and I don’t want to do anything… accidentally on your live data. So what I’m trying to get at, is there, you can do a partial completion of a line. So you can say like… you know, like,
Dawn Candia (18:08) you can just choose, the.
Jason Zednick (18:10) right, right. Which I did do. Yeah.
Dawn Candia (18:14) I did that. I chose everything except the managed medicaid line. Okay?
Jason Zednick (18:19) Yeah. And then you can come back when you get the notification on that. But.
Dawn Candia (18:26) That’s just that it’s a little confusing for the provider when they look in here. Yeah.
Jason Zednick (18:32) Yeah, no, that, I’m not sure there’s a good way around that part. But, let me click around and see if I can figure out like the best flow there. And again, the other option is just… hold it until both are complete, but that’s yeah, that’s not a good option. What you think to communicate, to the providers? Yeah.
Dawn Candia (19:00) Right. That’s not a good option.
Jason Zednick (19:01) Too good. Yeah. So.
Dawn Candia (19:05) Then the commercial and the medicaid’s are not going to be separate separated out.
Jason Zednick (19:10) Within Medan. It depends on how you submit it in, because if it’s part of the same request line, right? Like… then it’s all tied to the line. If it was submitted as two separate requests, that would be a different thing. But I don’t recommend that. I don’t think that’s a good.
Dawn Candia (19:28) Way to do it. Well, it’s horizon. So, you know, how Bethany submits. I mean, your team was in there before how they submit through the portal. I think you have to select horizon commercial, and then, you know, you can select the NJ help all on one. Yes, I want to say, yeah, yeah.
Jason Zednick (19:49) Which is exactly why I don’t recommend splitting it out. You can do it all in one application, but the notice is the tricky part. Yeah, let me know on this… or I’m just making a note. Okay?
Dawn Candia (20:17) All right. That’s all I had Jason?
Jason Zednick (20:20) Yeah, great. And then I did want to, I got your email about… Rakhi Patel and the start date… thing. So, I talked to my team about that. And they weren’t concerned. Well, first of all, a lot of the requests had already been with the payers with the original date. But the one that had been completed was qualcare, and they didn’t think it would be an issue with billing with the sort of two contracts and they call qualcare which is just one payer. But as an example, and they call and they ask like, hey, you know, like this is the concern, this is what happened and, you know, the rep at qualcare was just like, don’t even worry about it. It’s not going to be an issue at all. So we, we’re not anticipating, any problems there. The only possible exception was medicare, but medicare had not been submitted yet. And we told… the medicare team not, we told the medicare team to hold that one because it hadn’t been submitted. So… that is the update to that email that you sent.
Dawn Candia (21:33) Okay.
Jason Zednick (21:39) Yeah. So I know Duane couldn’t come, I have asked my team, their availability to meet to hopefully meet with Bethany later this week. I’m still waiting to hear back. Might not hear back until tomorrow just because we had a team member out sick, but… get out of that conversation. You know, hopefully, we can set something up this week that’d be really ideal. And,
Dawn Candia (22:09) Jason, did he, I’m not sure if you want to email. I know I said four for her, but I think her start time is five.
Jason Zednick (22:16) Five? Okay. That five… might be tougher on my team. Both of, my leads, their day ends at four, right? I was working with them, to be like, hey, like, I know it’s outside your hours, but can we do four just because, of the time necessity? So… yeah, maybe this is something, you know, Dwayne and I can.
Dawn Candia (22:49) Think of. Yeah, that’s, a conversation with Dwayne to see when, you know, he can work something out with her and you.
Jason Zednick (22:57) Yeah. I’ll… talk to my team and then talk to Dwayne and we’ll figure it out. We’ll we’ll for sure, find… some solution. Okay?
Jason Zednick (23:16) Anything else? Top of mind thoughts concerns?
Tanisha Roebuck (23:23) No, I don’t have anything else.
Dawn Candia (23:24) No, I don’t think so. Me either. All.
Jason Zednick (23:29) Right. Great. Well, well, thank you all. Appreciate your time. If I owe you an email, I promise, I’ll get to it. I’ll follow up on the capitation. I’ll take a look at this like partial completion sort of noodle… on what, the best way to manage that in a system and, well, we’ll just come back to it.
Tanisha Roebuck (23:52) Sounds good. Great. Thanks. Everyone. Have a good day.
Dawn Candia (23:54) All right. Thank you.
Jason Zednick (23:55) All bye.
Dawn Candia (23:57) Bye.