Transcript
Jijo.Mattamana (00:00) hey, gijo. Hey, Connor. How’s it going?
Connor Morley (00:04) Good. How you doing? Good. Okay. I know Sheldon’s not able to join. I did have a couple questions on some of the par analysis requests. Okay? Just because we were looking through, we still really haven’t heard back, but I found something that was interesting and could be part of the reason that we haven’t heard back about, some lines. But really what I wanted to go over is we’re missing provider and practice records in the system based on what you’ve sent us. So… we have, in that top payers spreadsheet, we had these providers listed and we don’t have them loaded into medallion, nor do we have them on our data imports. Okay. And,
Jijo.Mattamana (01:05) it’s yes, just these providers are the ones that have been this, yeah.
Connor Morley (01:10) It’s it’s actually, it’s a pretty low number of providers. That part doesn’t exactly concern me because it’s maybe like… a handful of lines in the par analysis. Yeah, they don’t exist. They don’t exist anywhere. I don’t know where to pull them or what we’re looking at in terms of what group or practice location they have. Okay?
Jijo.Mattamana (01:34) Looking at this quickly, I know… that dr, Emily shore. I don’t think she’s supposed to be included in the par analysis. So that one we can, it’s.
Connor Morley (01:54) sorry, what was her?
Jijo.Mattamana (01:56) Shore S, CH o RN provider?
Connor Morley (01:59) Npi. Let me double check to see if she was included in the par analysis. No… she’s not in the par analysis actually. So she’s just a missing. She was put in into the provider practice groups, but we don’t have her as a provider in the system.
Jijo.Mattamana (02:19) Okay. And she was a, she was like a provider that recently, just a lot. So maybe that’s part of the reason why she’s in the system though we didn’t get her into the par analysis, okay?
Connor Morley (02:32) So then for some of these providers, if they’re not meant to be in medallion… just let us know these. And then on top of that, what we noticed for the… provider practice group linking these practice names were not included initially. So I don’t know if they need to be added or… you’re okay with not having them?
Jijo.Mattamana (03:07) Yeah, I think so, did you get these practice names from the, our analysis? We?
Connor Morley (03:17) Got these practice names from the provider practice groups, but it impacts the par analysis because it impacts what we ask the payers like if they are enrolled with these practices. Okay?
Jijo.Mattamana (03:32) So, I… guess, can you ask the question again? So these practice names that we see here, they’re ones that we need to validate the naming convention on or what, I guess, what’s the we.
Connor Morley (03:48) Need to validate whether or not to include them in medallion right now. They’re not in medallion. Okay? As practices or clinics at all because they were not included in this clinic’s, practice data import. So I just have concerns that, you know, we’re going to be reaching out to the payers. In theory, we’re asking about this, but we have nowhere to actually document if they have, if they are enrolled with these locations.
Jijo.Mattamana (04:21) Okay. I think so quickly. Looking at the practice names in here, I think it’s just like a nomenclature thing like I think we have all the eye care associates correctly loaded. I think it’s just that they may be mentioned there by just the, of this vaccine because, you know, that I think it’s like really is.
Connor Morley (04:48) So, I think for eye care associates, we have six practices, right? And then it’s… Eugene, Lebanon, corvallis, Lincoln city, corvallis, different, corvallis actually, it’s five, but for the eye care, you have an additional three here, two albanese and a Darlene, that we and I don’t know this eye care associates albany… maybe if they are different and we hear back from the provider, it’s not going to show up correctly right now in the system.
Jijo.Mattamana (05:27) Okay. I can verify, do a quick search, but do you mind sending me this, is this in the tab somewhere?
Connor Morley (05:36) Yeah. So this is in our data import template. And I just created another tab that says missing records. Okay? Cool.
Jijo.Mattamana (05:45) Yeah, I can, let me, I can chase this down and see. Not sure.
Connor Morley (05:54) And if they match with like the key is going to be, if they do match with something in the system, they would need to match with either this clinics practice tab and one of the ones we have in here or if they’re not, and they don’t match and we want to include them, then we just need to create another line within the clinics practice tab… and essentially the same thing with the providers over here on the left too. If they, if we’re missing it or if there’s a mismatch on the mpi, but, or… email, we just need to know essentially what to do with these missing records. Okay? I.
Jijo.Mattamana (06:40) will I’ll take that as into, you know, we’ll face that down. Are you, are you sitting behind some of these?
Connor Morley (06:50) Okay. That sounds good. And in addition to that, I just wanted to confirm right now for any new payer enrollments that we’re making you guys do not have any group enrollments… right? That’s kind of what we discussed. We’ve we’ve discussed this a little bit a couple of times. You don’t have any group enrollments. Every provider is a direct enrollment with the payers?
Jijo.Mattamana (07:26) Yes, yep. Okay. Yes. Yeah, that sounds correct.
Connor Morley (07:30) And then there are no non standard enrollment processes that you guys have. And Vanessa, if you just want to clarify what standard versus non standard is.
Vanessa Persha (07:42) Yeah, no problem. Standard enrollment processes would be essentially just going to the payer’s website and utilizing the links and the forms that they have on their website. If you were to have a direct rep that you contact or that you submit your applications to rather than going to the website, that would be a special instruction that we would need to have. But I think Sheldon clarified that there were no special processes as far as he’s aware, everything just goes through the payer websites.
Jijo.Mattamana (08:21) Yeah, that’s my understanding as well. Okay?
Connor Morley (08:27) All right. I don’t have any concerns with that. Then. The only other piece is we talked with Sheldon… Maria, Maribel, and all of them about… getting the groups and the practices and the facilities. We need their profiles to be 100 percent complete… in order to do new payer enrollment.
Connor Morley (08:58) And right now, I don’t think we have any at 100 percent complete.
Jijo.Mattamana (09:04) Did we have a timeline of when I?
Connor Morley (09:09) Know he mentioned that it was going to take a while. I think it was going to be the end of this month but just something that is… going to delay us doing provider enrollment if it’s not completed. And this is a requirement in order to submit applications?
Jijo.Mattamana (09:27) Okay. So to submit applications, once we have this completed, we’ll be able to start that process. Is that very important? Yes. So if we had like a new provider or a provider that we wanted to add another plan for or something once this is completed and their provider profile is completed, is that what we need to get done? Or does this provider profile that we’re looking at right now not matter as much?
Connor Morley (10:00) So both have to be complete, both the group, the practice profile has to be complete as well as the provider profile has to be complete and the agreement signed in order for us to submit a new payer enrollment. Okay. Got it. So, looking at the system, there’s… a lot of providers that have not signed up. You do, I can filter to see you do have a good amount of providers who have started to log into the system and sign in and complete all of their information? Cool. But I would say that there’s still a good amount that have not.
Connor Morley (10:55) I would say 90 percent have not completed their profile at this point.
Connor Morley (11:07) Yeah. Okay. All right. And then in terms of if you do have a new provider that’s been added to the system, we… can start making enrollment requests for them today.
Jijo.Mattamana (11:31) For enrollment requests, if we wanted to let’s say enroll them in all of the plans, like for a specific group or practice, like what’s the like workflow that they have to go through and select, they have to know each individual plan for their practice or is there a way with the medallion to say all of the plans that are like associated with that practice?
Connor Morley (11:57) So give me one second while we take a look. So I just want to see, I don’t believe we have, we didn’t have any of your group enrollments. If you have those, we can load those so that you can select them all. So for example, if we did have a new provider and you associated them with Catalina eye care, we could enroll, we could select all for all of the payers that have group enrollments with Catalina eye care… only?
Jijo.Mattamana (12:31) If there’s a group enrollment though, right? So that means Catalina eye care specifically as a group is enrolled with that plan, not the specific provider, right?
Connor Morley (12:42) Correct, Vanessa, keep me honest here, but correct.
Jijo.Mattamana (12:46) Is there a way to like once we complete the part analysis, all of those… individual plans that we’re verifying now? Will I assume will want them to fall into that enrolled with Catalina eye care PC? Is that something that we’re able to populate into there? Because I’m just thinking through this like logistically like what plans will show the Sheldon team go in and click, yes, enroll for this, that the other kind of major pieces as possible?
Connor Morley (13:22) So, you… can associate payers with groups through like group enrollment. So if I’m just going to pull up Alvarado eye associates, for example, we can associate enrollments… with this group and all the practices that are associated with this group. Okay? So we can add and, I, I’m sorry, I forgot where the, where these guys are located.
Jijo.Mattamana (13:57) I’ll be there in California.
Connor Morley (13:59) California… but, you can associate like if we wanted to associate medicare with them or Aetna with them. We just want to make sure that we have the lines of business and the practice locations with Alvarado. So these two… and then Vanessa… because jijo, it sounds like you guys do not have group enrollments.
Jijo.Mattamana (14:30) All done at the provider level?
IPhone (14:32) I didn’t think they had group enrollments. Connor, I’m sorry, I’m just a little confused.
Connor Morley (14:38) So, they essentially want an easy way to have and associate payers with the groups. So that when they do make requests for like a net new provider, they can go into that, the payer request page and just kind of select all. And the only way I know how to do that is with group enrollments. Does that make sense?
IPhone (15:02) Right. But they don’t have group enrollments. So then they’re essentially is not another way.
Connor Morley (15:08) Okay.
Vanessa Persha (15:09) Well, actually, I was just thinking well, we could do and Lindsey, we may want to run this by operations to make sure this is the correct way to do it, but we would essentially create group enrollments in the platform that say the group is non par, and then add all of the payers that would typically belong to that group. So when the requests come in or when they want to make a request, all the payers will appear in the drop down, but it would be clear that the group itself is non par. These are new provider enrollments.
Jijo.Mattamana (15:50) Yeah. It sounds like that. Vanessa would be like ideally, what we’re looking for. And if we’re going through the exercise of the par analysis, is there a way to just like load that by practice? So then it’s easy, but to be clear, they’re not group enrollments to your point, but they are all associated with that group?
Vanessa Persha (16:16) Yeah. So Lindsay, let’s run that by Nicole and Sarah to make sure that that’s the correct workflow we should be using. So there’s no like downstream impact to their data. And then I just want to make sure jijo, since you don’t have group enrollments, all of your new provider enrollments, are you guys utilizing you have like billing information and everything like that you would be still linking the providers to that belongs to envision. These providers are not billing independently, correct? Yep. Okay.
Connor Morley (17:02) So, jijo, I think Vanessa and Lindsay are going to take that back to the team on how best to associate those payers with the groups. In general. We’re not doing any par analysis for group enrollments because we talked about not having group enrollments. So this might be something that we work on with Sheldon when we start to hear back to look at the payers at a certain, at certain locations and then kind of what Vanessa talked about adding them as non par group enrollments.
Jijo.Mattamana (17:39) Yeah. And I guess we like, we have the data in a spreadsheet somewhere, right? That has like by each group here, are plans or payers that we accept, that make up our, you know, top payers. Are we able to just use that similar type of list to like load that as like here’s the payers that we want for this group? I’m good.
Vanessa Persha (18:05) So, yes.
Connor Morley (18:09) We have like a group enrollments tab in the spreadsheet in the data import template. I think it would just be, you know, once we look back at the par analysis, which ones would you like, to include as the non par? And then again, I think we also need Vanessa and Lindsay to confirm if that is the right way to go about this, doing, the non par group enrollments? Okay?
Jijo.Mattamana (18:36) So it sounds like if we can do the non par group enrollment, we can then leverage this spreadsheet that we have that basically has this all broken out by clique and that can help possibly complete some of this. But Vanessa, I think we’ll have to go back and make sure that’s something we can do. Actually. Yes. Okay. Cool. I think that makes it easier then at least from my perspective because relying on the like Sheldon and team to figure out which plans need a request for each provider, I think, you know, what if they forget one or, you know, what? If one was left out? I think I’d rather have another source of truth to guide what plans they should enroll based off of which location and practice.
Connor Morley (19:20) Right. And this will be for like the new hired provider for providers with the par analysis, they’ll get a task that will say, do you want us to now move start the request process for this? Yeah. Okay. Good.
Jijo.Mattamana (19:40) Deal. So after this call, will you send out the kind of follow up Connor like you usually do? And then I’ll make sure to find out the missing records like where we’re at with that with the change?
Connor Morley (19:54) Yep. Okay. Yeah, I can send that out a little later. Do you need them right now or is it okay if I send them out tomorrow morning? Yeah.
Jijo.Mattamana (20:06) No, tomorrow morning is totally fine. Okay. All right.
Connor Morley (20:10) Hang on. I just want to go through my notes to see if there’s anything else I wanted to bring up. So we have the letterhead the… asc facilities and those asc housing providers. I loaded the providers themselves, but we should get the existing enrollments loaded later this week with all of the facilities, got it.
Jijo.Mattamana (20:41) And have you been working with Maribel? Do you have any questions on that?
Connor Morley (20:46) I didn’t have any questions on those. Everything looked good in terms of the linking. There. It’s just that these providers again, they’re not going to be logging into the system and completing agreements. So you’re not going to be going through like the tjc credentialing for them in medallion, but this will just be kind of like a source of truth for them. Yep. Okay. And I think then I don’t have any other questions for that. Okay, cool. And.
Jijo.Mattamana (21:18) Then when will they be? So once they’re loaded and when will like the continuous monitoring and all of that like be like available to Maribel to view?
Connor Morley (21:28) Yeah. The continuous monitoring should be available now as long as we have the bare minimum information on them. So, I think for those providers, if they were just added recently, some of them might not have very much information on.
Jijo.Mattamana (21:48) Them. We.
Connor Morley (21:49) Just really sometimes we need like npi information, I can get you a list but the ongoing monitoring is available in the analytics tab today.
Connor Morley (22:04) So, hang on while I pull up my screen. So we’re running ongoing monitoring for medicare, opt out npdb cmoig, and ofac and others right now. But this is just a envision wide list if they.
Jijo.Mattamana (22:27) Wanted to filter direct just for like the asc housing providers. Is there a way to do that or is it more difficult in?
Connor Morley (22:37) This screen, it’s a little more difficult. What we can do is if we can create a team and label it. I think we talked about labeling it asc housing providers add them. And then if like one of their, she… can go in directly to the provider profile and look at the verifications within the profile itself. So medicare opt out. The answer is no, we verified the npi here. We don’t have any license information, so we can’t verify that. And it looks like Sam were clean here and ofac were clean as well for this provider. Okay? So.
Jijo.Mattamana (23:26) And if anyone was to let’s say have any issues, they would show up on that kind of dashboard view before, right? So, regardless of if they’re in nvision or asc housing, they show up there, right? So then maybe it doesn’t matter if we see them by themselves. As long as if there’s an issue, it’ll be highlighted there. If.
Connor Morley (23:44) there’s an issue, it’ll be highlighted in both this screen right here and the verification screen in the analytics screen. And the ongoing monitoring, it will pop up first. Either in medicare, opt out, mpdb, wherever we find the issue. It will be the first it’ll show the issues first. And then if we do find an issue as well, the admins get a summary of that and an email notification in our weekly Monday update… admin summary emails. Okay?
Jijo.Mattamana (24:17) Cool. I think that’s good. I think that solves the issue.
Connor Morley (24:21) Okay. All right. That’s all I had for today. I can send you out the notes first… thing tomorrow morning.
Jijo.Mattamana (24:36) Awesome. I appreciate it.
Connor Morley (24:39) Thanks, Aaron.
Jijo.Mattamana (24:40) Thanks, Vanessa.
Connor Morley (24:43) Thanks, jijo. Bye bye bye.