Transcript
Rheta Larson (00:00) hey, there. Thank you so much for y’all’s, patience. I ran a bit over apologies for that. Hi. How are you? I’m well, how are y’all, doing today?
Yolanda Clark (00:08) Great. Thank you.
Rheta Larson (00:10) Good to hear. Okay, let’s hop into it. Let me just pull up a.
Yolanda Clark (00:17) Few.
Rheta Larson (00:19) things on my end.
Rheta Larson (00:25) Okay. I know we had a few emails going back and forth. So, I think for the first one I wanted to hit was the site facility where… it’s giving all the threshold of the percentages there. I think that was an ask from your team. You know, if I’m okay?
Yolanda Clark (00:55) Yes, you have a little Healthstream. Oh, let me see.
Rheta Larson (01:06) Give me one second. I’ve been having issues with my zoom. Let me log out and log back in.
Rheta Larson (01:33) I didn’t think it would kick everyone, but I think it kicked everyone. Hi, hello. I was just on with everyone, but I think it kicked everyone. So might need them to rejoin if there’s a way you can notify them.
Yolanda Clark (01:49) Oh, okay. So, everyone was already on.
Rheta Larson (01:52) Yes, and I exited because my system wasn’t… working properly. So it kicked everyone.
Yolanda Clark (02:02) Okay. Let me.
Rheta Larson (02:04) Sorry about that.
Rheta Larson (02:36) All right. Bye. Sorry about that. I think when I ended the sync, it ended for all, it didn’t let me just end it myself. Can y’all, hear me? Okay, better on this one? Lisa.
Yolanda Clark (02:52) Perfect. She’s not on yet. Yeah, she on now. Okay. Bye bye.
Rheta Larson (03:03) Can you hear me? I, can y’all, hear me? Okay?
Yolanda Clark (03:08) Yes, perfect.
Rheta Larson (03:10) Okay. I think we have everyone back. Our majority. Are we waiting on anyone on Hamilton’s end?
LaShunda Chapman (03:19) I don’t think that we are.
Rheta Larson (03:23) Okay, great. I know Lisa’s.
Yolanda Clark (03:25) going to join, but I know she’ll just pop in once she gets off the phone.
Rheta Larson (03:30) No worries. So, one of the outstanding questions that we had was for the,
Yolanda Clark (03:35) I can’t hear a thing?
Rheta Larson (03:36) Can’t hear me?
Yolanda Clark (03:38) I can’t hear you?
Rheta Larson (03:40) Can y’all, hear me? Okay? I,
LaShunda Chapman (03:42) can hear you, you’re really low, but I mean, I can hear you. You’re just a little low.
Rheta Larson (03:48) Interesting. I don’t know if my system is messing up or what is this comfortable for you all, if I’m speaking in this manner?
LaShunda Chapman (03:57) Yeah, I can hear you.
Rheta Larson (04:00) Okay. I’m not sure if… after the sync you want to loop in, Yolanda. I don’t know if it’s her system or if it’s mine, but,
LaShunda Chapman (04:13) Bella, are you able to hear?
Yolanda Clark (04:15) I can hear fine.
LaShunda Chapman (04:17) Okay. Yep.
Rheta Larson (04:19) I don’t think she can hear us but we can hear her. Interesting. I’m sorry, she’s experiencing that. I.
Yolanda Clark (04:28) Can’t hear anything… I can’t hear? Can you hear me?
LaShunda Chapman (04:34) We can hear you. Yes. Okay.
Yolanda Clark (04:36) All right. Got it. Something happened. I don’t know. Thank you. Yeah.
Rheta Larson (04:41) So, okay. For burton too. I know that the site visit information is not something from y’all’s understanding that is a requirement for your payroll enrollment requests.
Rheta Larson (04:57) I have flagged this to the team because at this time, I know it’s not optional in the profiles. So what we’re doing is we’re taking it as kind of like engineering and product feedback so they can implement some sort of a solution to eventually make that optional. I don’t have a timeline there as to when we can consider that, but in the meantime, you should be able to add the requests as normal. And then I’ll have our team push those forward without the information.
LaShunda Chapman (05:31) So I guess… I don’t understand that because I submitted that request in January and so it’s being held for that information. So I just need to know since that now you’re saying, you know, possibly you can push it through. I need it pushed through because this is a medicaid payer and we are now, you know, we’re seeing medicaid, it’s the Michigan meridian. So if you go under the facilities… and then the Hamilton burton ii and then I went to payers, and it’s the Michigan meridian. It’s being held and it says need attention. So I need that application pushed through. It says audit, complete set tasks for site visit. And so it’s actually being held and they are, they being the payer, they are waiting for this application. So I just need to know like how soon can we get it submitted? And what’s the workaround for this? And then also moving forward because we are, you know, in the process of opening another facility, what’s the workaround for that? Will it already be in place when we, you know, start working on other facilities? Will you already have that workaround in place where we can kind of bypass this site visit requirement? So.
Rheta Larson (06:54) Again, in the profile, it’s a requirement. So it’s always going to like alert or like reflect to zero. But now that I understand it’s not a requirement for Hamilton. I’ll push it forward manually with the team. I’ll have them move this today. The exception here I think is medicare. Do you all have any medicare requests that you’re going to be inputting? I,
LaShunda Chapman (07:19) think we do our own medicare enrollment, right? I think Dana’s doing, the pay calls enrollment. Okay?
Rheta Larson (07:28) And I’m only calling that out because I did chat through it today with the payer enrollment team. I explained to them. This was a blocker for you all. And they said that it should not hold up the files like it’s not going to affect our workflow. The exception that payer there, that would need. It is medicare. So they just wanted to call that out, make sure you were aware. Okay?
LaShunda Chapman (07:51) Yep. I will confirm that with Dana, but I’m pretty sure because we have to get our ptan and everything. So, I think Dana does do the medicare enrollment. Okay?
Rheta Larson (08:02) Gotcha. So I’m gonna push this one forward as far as submission. I’ll have the team work on this one this week. I’ll get it assigned today, and that should take at least 24 to 48 hours for the team to review, complete the application and proceed with submission. So at least awesome. By end of week, we should have something tangible for you. Okay?
LaShunda Chapman (08:24) Great. So.
Rheta Larson (08:25) I’m gonna add this request here and then site, is it not necessary, push forward with intake? Okay? So that one I really wanted to hit on. And then I think there was a separate request tied to that initial request. Let me see if I recall correctly. It was for the… no. It looks like it was just two separate outreaches for the FQ HC burn too. Do you all have anything else you want to flag or go over?
Yolanda Clark (09:10) What about the existing license?
Rheta Larson (09:15) Existing license for who?
Yolanda Clark (09:18) On the, on the facility, it also has like the site visits is zero, but it also has the existing licenses at zero… for a lot of the facilities.
Rheta Larson (09:32) Do you mean the profile requirements?
Yolanda Clark (09:35) Yes, the profile requirement, okay?
Rheta Larson (09:38) Was this for, I think I actually see y’all’s request for Hamilton Whitmore lake. Yes, let me pull up Hamilton Whitmore proposal is at 77 percent. So this is just standard to the medallion profile. I see the malpractice was entered. So, I think we’re good there, but existing licenses would pertain to any like providers who hold active licenses. Y’all, aren’t tying any specific providers to Hamilton Whitmore at this time. Are you, or are all providers going to be tied to Hamilton Whitmore?
Yolanda Clark (10:21) Colleen say that?
LaShunda Chapman (10:25) Field is specifically asking for provider license information?
Rheta Larson (10:31) Yeah, this is just okay. Just.
LaShunda Chapman (10:33) Medical license information, correct?
Rheta Larson (10:35) Yeah. So, if they hold an active state license, then you can add that license info there, but it’s not necessary. Otherwise? Okay. It.
Yolanda Clark (10:43) Should be in her provider profile. You’re talking about the individual, right?
Rheta Larson (10:47) Yep. It will be tied to the individual. Yep. So y’all can use that as a space for any of the provider Hamilton or Hamilton Whitmore providers, if you see fit. But I typically don’t see clients do that. They tend to leave it blank as well.
LaShunda Chapman (11:04) Okay.
Rheta Larson (11:07) But yeah… unless there’s some necessary items that are required for the payer enrollment and that will be specific to the payer that’s when our team will task you with administrative or provider tasks saying like, hey, we’re missing malpractice insurance for X, y and Z, then we need you all to upload the necessary information. I.
LaShunda Chapman (11:27) Think initially that’s what Dana was asking for something, some type of document that has like payer requirements for payer enrollment. So, you know, all payers ask for malpractice insurance, all payers ask for clia information. Do you have something like that? Because like just now we’re just now learning that we don’t have to populate information in the existing license info, you know, field or is it just, I know payers each payer is kind of different, but do you have like a general document that we could work from to just populate that information so that we don’t have to inundate you with, you know, a bunch of emails asking, is this information necessary? So, I think originally that’s what Dana was kind of asking about?
Rheta Larson (12:18) Yeah. I don’t we do work off of like internal items that the team uses. It’s not necessarily client facing. So, I don’t know if there’s something we can give you all that highlights that per payer. Okay? Just because there’s so many, but with the nuance of like licensing, it’s the same concept, right? Like if you have a licensing request in a specific state, not every state is going to ask for the same information. So it will be more catered or tasked towards the request versus the profile as a whole. So, anything that’s relevant to intake will be cast during intake. Okay? Post intake. That’s when we’ll start getting into kind of like the detailed requirements per payer request. Okay? So I would say if you are concerned with anything like flag it, but you can input the requests already. Like it’s not going to stop you from inputting the requests. Okay? It will just show that like, hey, we can’t proceed with this until the profile’s up to a certain threshold and intake will highlight all of that. Okay? Like that hopefully answers your question a little bit more. I know it’s not very detailed but, it shouldn’t hinder your request basically.
LaShunda Chapman (13:29) Gotcha. Okay. I’m all set. I just wanted to know about the burton ii and the meridian, and how soon could we get that kind of pushed forward with, to the payer?
Rheta Larson (13:40) Yes, I just flagged that to the team earlier today and I’ll make sure they push this request forward as well so we can get that started.
LaShunda Chapman (13:51) Actually, I think for that particular site, I did on that date, I think I did several. Let me go back to that site.
LaShunda Chapman (14:07) I think I did several applications for that. Yeah, all the ones that need attention, especially the medicaid, let’s see the Mclaren health plan needs attention.
LaShunda Chapman (14:20) So, yes, I’m glad I thought of, I just thought about that. So all of the medicaid health plans, I need those dropped. Like I don’t mean to sound like yesterday. No, you’re good. Yeah. Yep. So all of those that are holding for medicaid, so the Mclaren, the blue cross, the meridian, the Molina, the hap, caresource all of those medicaid plans. I need those like pushed through immediately, okay?
Rheta Larson (14:49) I’m going to flag these same ones to the team and have them work on it. Okay?
LaShunda Chapman (14:54) How.
Rheta Larson (14:54) many are there? Let’s see. There’s about 18 pairs.
Rheta Larson (15:09) And,
LaShunda Chapman (15:09) I know with the blue cross complete, they won’t do anything without the blue cross. Let me see what the blue cross is holding for.
LaShunda Chapman (15:21) So, it looks like all the applications that I completed on one one are holding for site visits. So with that blue cross complete, they won’t do anything if blue cross is not completed.
Rheta Larson (15:35) Yeah. These are all, the site visits that I’m seeing on.
LaShunda Chapman (15:40) Exactly. Okay.
Rheta Larson (15:43) Yeah, we’ll push those forward. It looks like since they’re all the same requests that should be fine. If I hear anything different, I’ll definitely let you know, but since they’re all facility enrollments, we should be just fine. And I’ll flag that to the team as.
LaShunda Chapman (15:55) Well, okay. And I am asking for a retro date as well.
Rheta Larson (16:01) Did you put that in the notes for each one of them?
LaShunda Chapman (16:09) Please complete enrollment as an fqhc facility requesting a retroactive date as of one 126. Yes.
Rheta Larson (16:16) Perfect. Yeah. As long as the note is in there, the team will take note of that, but I’m going to jot it down here. And then I’ll make sure that when they, because I’ll have the team do this in bulk. And then once they do that, they can retro reach those.
LaShunda Chapman (16:32) Okay.
Rheta Larson (16:32) So, I have my action items for burton to facility. We’ll remove the intake request for the site visit since it’s not necessary for you. All exception there. Like I mentioned, is the medicare, so definitely check on y’all’s end. And then if I hear anything different from the team, I’ll send you an email, but we should be able to push these forward this week… but I’ll definitely give you an et on that for next steps. Anything else that you want to chat through Phuong?
LaShunda Chapman (17:05) Not for me. I’m all set.
Yolanda Clark (17:08) I had a question for the dates for enrollment on the payers, how often are those updated? Because it looks like a lot of them don’t have dates, effective dates for the payers enrollment.
Rheta Larson (17:27) Do you mean the completed enrollments?
Yolanda Clark (17:30) Yes, when you go up under each provider?
Rheta Larson (17:38) So, are you saying once we obtain enrollment? Yes?
Yolanda Clark (17:43) When is?
Rheta Larson (17:45) The date updated?
Yolanda Clark (17:48) Yes, let me go to one, so.
Rheta Larson (17:52) We’ll just note we’ll note the effective date on the line… and then essentially just close the request until it’s time for revalidation. So like whatever the revalidation date would be when we enact on the revalidation application. Okay? But do you have one in particular? You want me to review that? Maybe I can, so.
Yolanda Clark (18:16) Let me see this one, Abby Hilder. So, if you go to the provider, Abby Hilder… and you go to her payers… and then you go to the enrollment tab.
Rheta Larson (18:39) How do you spell her name? Sorry?
Yolanda Clark (18:42) Abby, a BBE y?
Rheta Larson (18:45) E y.
Rheta Larson (18:49) Okay. She has 17 requests, Abby hilden?
Yolanda Clark (18:55) Yes. And.
Rheta Larson (18:56) Which pair?
Yolanda Clark (18:59) Let me see. Let… me go back. Let me go to the arrow of her request.
Rheta Larson (19:10) So, these are going to be in flight requests. The way that you can read, this is like right now, she has nine processing payers. Okay? Huh. So she has humana, tricare, east, blue cross, so on and so forth. These are going to give you kind of an idea of where we’re at in the process for some of these. So these are in flight or they’re processing. Okay? She has seven completed enrollment requests. That medallion has done so for first health as the example here, which is part of Aetna. Okay. We got this enrollment completed for her as of December eighth, 20 25. Okay. And the effective date was listed as 1,121.
Yolanda Clark (19:52) Oh, okay. I see. So.
Rheta Larson (19:55) You should see this information relevant to the requests that are completed in the notes. Okay? Additionally, you’ll see this in the enrollments. So whatever one we were just looking at, you should be able to see the effective date there, which is 1,121, 20 25. And then when the revalidation date is.
Yolanda Clark (20:10) Okay. Now, what about the not applicable?
Rheta Larson (20:15) The na, ones that there’s no revalidation date for?
LaShunda Chapman (20:18) Huh. It’s.
Yolanda Clark (20:19) not time you’ll just do it when they get close to it or?
LaShunda Chapman (20:21) That maybe that insurance doesn’t require revalidation, oh, it.
Rheta Larson (20:26) Could be that, or it could be y’all, aren’t requesting us to revalidate in those instances, I don’t know if y’all, are selecting which ones we should and shouldn’t be doing, but that is correct. Yeah, if that one doesn’t require one or you just didn’t contract medallion to do the reval for those payers or providers?
Yolanda Clark (20:45) Okay. But let,
Rheta Larson (20:48) me know, if there’s someone in particular, you want me to look at just so you have better peace of mind on how to see at least what medallion completed, what we actioned and then what is currently existing in the enrollments for them?
LaShunda Chapman (21:00) So, once you do get an effective date from the payer saying, hey, this provider is now listed as participating with this insurance, you do list the effective dates?
Rheta Larson (21:12) Yes. Yeah. We do. So like back to that example that I used for abbey first health even though we got the notice on December eighth because that’s probably when our follow up cadence fell into review even though it was completed on the eighth as of a medallion platform or by the email from the payer, they did set the effective date of November 20 first 20 25.
Rheta Larson (21:39) So we’ve noted that here we’ll also attach anything relevant from the payers or like an approval notice. So you’ll see that information here?
LaShunda Chapman (21:48) Oh, nice. Okay. I know when we met internally, I can’t remember where we were at in medallion, but Dana was asking about effective dates and they weren’t there. So maybe it was just an instance where that provider was still processing for that insurance and that’s why it wasn’t there.
Rheta Larson (22:08) Right. So, these are for only the ones that we’ve completed right now. She has nine processing. So we don’t have any updates there.
LaShunda Chapman (22:15) For the effective date, right? And that would make sense why we wouldn’t have an effective date, right?
Rheta Larson (22:19) Yeah. And so, unless you all had specified like, hey, we’re going to retro then that’s a different case like once we get the approval from them, usually the payer will say retro, effective date to xyz.
LaShunda Chapman (22:31) Okay.
Rheta Larson (22:33) But we just need some time for processing on some of these. Okay? I would say like we’ll continue these conversations. If there’s any like providers, you know, that are priority or payers that, you know, that are priority, that’s kind of how I like to shape these combos. So I can ensure I hit anything that’s processing or anything that needs intention from y’all, so we can push them along. Okay? Does that help clarify the enrollment requests? And then the active enrollments?
Yolanda Clark (23:04) Yes, thank.
Rheta Larson (23:05) You. Yeah, great. Yeah. As you play around with this and you get more familiar with some of these lines. And these columns, let me know if there’s anything that doesn’t make sense or you have further questions on you’re. Always welcome to email me.
Yolanda Clark (23:17) Okay.
Rheta Larson (23:20) Perfect. Well, again, I have my action items, so I’ll get these sent over. Is there anything else you all wanted to address or flag?
LaShunda Chapman (23:33) No, I’m all set.
Rheta Larson (23:35) Okay. Well, I hope you’ll have a great rest of your Tuesday and I’ll talk to you all a bit later.
LaShunda Chapman (23:40) All right. Sounds good. Thank you.
Yolanda Clark (23:42) Thank you. Yep.
LaShunda Chapman (23:43) Bye.