Transcript
Sandhya Kapila (00:00) hey, good morning. Hey, Sonya. How are you? I’m good. Thanks. How are you?
Niccole Russell (00:04) Good. Doing well.
Lauren Henderson (00:05) Good.
Niccole Russell (00:07) Looks like they added a few. So we’ll go over those.
Lauren Henderson (00:11) Okay. Cool.
Niccole Russell (00:17) All right. I’ll let them. They’re not in yet. Okay? How is your week going?
Sandhya Kapila (00:25) It’s only Wednesday. Yesterday was very long. How about you?
Niccole Russell (00:30) Same… every day has been long. So, and already this morning, but I’m off Friday, so.
Sandhya Kapila (00:39) Oh, well, that’s good. That’s awesome. Yeah.
Niccole Russell (00:45) Yeah, I go to an annual, it’s an amusement park. My husband’s an ROTC instructor. Okay? He takes his ro kids every year to dollywood. I don’t know if you’ve heard of it. Oh, fun. Yeah. So yeah, I go every year with them.
Sandhya Kapila (01:02) That’ll be so fun. I love that cool.
Niccole Russell (01:05) I’m the chaperone.
Sandhya Kapila (01:07) That’s fantastic. How many kids are there?
Niccole Russell (01:11) I’m like I need it, oh.
Lauren Henderson (01:13) Yeah.
Sandhya Kapila (01:13) For sure. Definitely, it’ll be perfect. Okay. Lauren is here. So, I am going to.
Sandhya Kapila (01:29) Good morning, Lauren.
Lauren Henderson (01:33) Hi.
Sandhya Kapila (01:34) How are you? I’m.
Lauren Henderson (01:36) good. How are you? Yeah, thanks.
Sandhya Kapila (01:42) Just waiting on Ashley. Do you know if she’s going to be?
Niccole Russell (01:45) Joining.
Lauren Henderson (01:45) I think Ashley’s going to join okay?
Sandhya Kapila (01:47) Yeah, perfect. That sounds good. All right. Then I will hand it over to Niccole to take over. This is all right. Yeah.
Niccole Russell (01:57) Let me go ahead and share my screen here.
Niccole Russell (02:06) Okay. So, going through, we’ve signed off on everything. I know this one you were looking into it is part of anthem, so we would cover it as long as you selected the manage medicaid plan?
Lauren Henderson (02:23) Okay. Sorry. Yes, it is. It’s the same. It is the same. Yeah.
Niccole Russell (02:29) So, you marked this one as commercial and this one as manage medicaid. Yeah. So, I didn’t know if you wanted to go ahead and sign off on this.
Lauren Henderson (02:37) Oh, sure. Okay. And,
Niccole Russell (02:39) you would just have to when you request a line in medallion, you would just put, you know, whichever line of business you wanted both however you wanted to do that.
Lauren Henderson (02:47) Yeah. And I just did. I had tried to enroll one of our behavior therapists. They’re the blue cross medi cal plan and it was denied. I’m trying again because their support system said, no, they said they don’t see a contract, but we have a contract. The support system says, yes, there’s a contract. Go ahead and do it again. It’ll it should be approved. So, I’m trying that. Okay, one of our speech therapists did get approved. It did say that she won’t be enrolled in the medi cal plan because she doesn’t have a medi cal enrollment, but that’s fine. Okay. You really just want them enrolled in commercial anyway? Okay, great. And.
Niccole Russell (03:25) Then I noticed you added a few down here. So just to go ahead and sign off on this preferred ipa is preferred ipa? Okay. There. And then cedars, we have cedar provider network. Okay. It’s not an ipa, right?
Lauren Henderson (03:43) No, it’s like a medical group. Okay?
Niccole Russell (03:45) Just wanted to make sure because we do have an ipa, but I assumed it was this one. Yeah. And then kaiser, we have kaiser permanente of southern California. Yeah. All right. And then if you go over here to my notes, I just added this to your project plan, all of the descriptions and forms that you provided here have been added. Okay? Did we get availability access? Yeah, I received the invitation there and then for Aetna you… marked only if seeing adults.
Lauren Henderson (04:22) And.
Niccole Russell (04:22) Then for this one, I didn’t receive a prerequisite for that. So, just wondering if you had for ex minister?
Lauren Henderson (04:30) I think I had emailed and I haven’t heard back.
Sandhya Kapila (04:34) Okay. Our.
Niccole Russell (04:35) team will do the research. They.
Lauren Henderson (04:37) So far haven’t requested anything from us. So. Oh,
Niccole Russell (04:40) okay. Okay. Then we should be good there. All right. Well, that’s all that I have. It looks like we’re set on these payers. Okay? So, Sonia, since she agreed on everything, then we would be good to go ahead and import those payers.
Sandhya Kapila (04:54) Okay. That sounds good. Lauren, you had a couple of questions about the various blue cross blue shields yesterday, and I didn’t have a chance to talk to Niccole about those. So if you wanted to ask her about those, that would be great.
Lauren Henderson (05:08) Yeah. It was specific to the other workbook in terms of the group enrollment information. It’s the blue cross and the blue cross medi cal, and then the blue shield and the blue shield promise plan… because those, we basically split them based on discipline. So blue shield’s probably the easiest one blue shield commercial that’s our speech and OT contract. And then blue shield promise plan is the medi cal and that’s behavior. But it’s obviously all under blue shield of California as your medallion payer. However on the group enrollment, there are different locations assigned to like… how we term we talk about them. Does that make sense?
Niccole Russell (06:07) So if I’m hearing correctly because… it’s really two different requests from you in the medallion line, if you were requesting that for a group, then you would do one request with that specific group and then another request with the other specific group, right? Right?
Lauren Henderson (06:34) And the credentialing process is different also like the forms are different. But then it is that’s actually something I think you had a question on that I didn’t have. You had asked where the roster is for blue shield promise. It’s not like a physical roster. It’s their roster on their portal, which I can show you what that looks like too if you want. But so like blue shield promise right now has all of our locations, blue shield. Sorry… let me start over for our behavior team on the blue shield portal. It has, I think all of our locations for speech and OT, we only have four locations and we’re waiting for two to be added. So if I’m putting it on the group enrollment, my question was, should I put it how we call it and put those locations? Or should I put blue shield promise and then only mark essentially have like 10 blue shield locations, group enrollment lines and have four being commercial and six being medicaid. Do you know what I mean? Like how do I differentiate those group enrollments or what will it look like in the system? Like what it, I guess maybe if I know what the end goal is, that might help me understand how to input… it on the worksheet. Okay?
Niccole Russell (07:59) Okay. So you have one group associated with your practice?
Lauren Henderson (08:04) Okay. So.
Niccole Russell (08:08) If you’re doing a group enrollment, but it requires two separate forms?
Niccole Russell (08:19) Let me check on that. I would assume if it requires two separate. Okay. Yeah, let me check on that. I know that’s the medallion way. So I want to make sure that I’m telling you appropriately.
Lauren Henderson (08:33) I know none of this is credentialing stuff is simple or straightforward and what happened is the blue shield promise plan. Blue shield had been using a third party magellan. I don’t know if you guys are familiar, but they were using magellan to do their Aba services. Okay? And now they’re doing it internally, so they’re even still going through the contact I had, I was asking him some questions. He’s like honestly, I don’t know. I’m still working through this magellan transition. Okay? So that’s why they, it’s now added to like our practice management on their portal where before the behavior team wasn’t even on that, it wasn’t part of the internal blue shield credentialing, all of that?
Niccole Russell (09:15) So,
Lauren Henderson (09:16) that’s where it’s getting a little tricky. I just wanted to make sure this, yeah.
Niccole Russell (09:24) I’m sorry. So, did you receive the verbiage on that in a question form?
Sandhya Kapila (09:30) No, it was, it’s recorded. So it was in the transcript yesterday. So I will grab that.
Niccole Russell (09:34) Okay. Yeah. If you don’t mind, just shoot that over to me and then I’ll get with the PE team and find out.
Sandhya Kapila (09:41) Yeah, sounds good. Thank.
Lauren Henderson (09:43) you. And then I just wanted to make sure the step two on the blue shield for both behavior and speech and OT is clear… because like credentialing them fully is one thing. And then adding them to our roster is the second step that can either be done through the portal, which I’m waiting to see if that was successful yesterday or using the form that I had provided you guys with.
Niccole Russell (10:14) And that was on the anthem… or blue shield? Yeah.
Niccole Russell (10:24) Yes, I did put that in your project plan. Okay. Yeah, perfect. Okay.
Sandhya Kapila (10:40) And then Niccole, I guess for next steps when you create Lauren, this is, these are new processes that we’re running through. So just that’s why I’m asking her right now. So when you create the project plan, is that something that we’re going to have Lauren take a look at as well? Or is that just whatever’s notated in the spreadsheet, we’re going to go… by that?
Niccole Russell (11:09) Yeah. And if nothing is notated, we would just follow our standard enrollment process. Yeah.
Sandhya Kapila (11:15) And I think everything’s been notated, whatever we have notated?
Lauren Henderson (11:20) Okay. Sounds.
Sandhya Kapila (11:21) Good. And then Lauren, we’re going to get final sign off from you as we have like the project plans completed just so just to make, just to ensure that what you’re doing and the processes that we’re creating based on the conversations match expectations. And then we’ll go from there.
Lauren Henderson (11:40) Was the optum one clear? I think there was a question on that one too. Maybe it got resolved since the last time I looked at that sheet, let’s see.
Niccole Russell (11:53) Yes, it did. It was added to the project plan. Okay. Yeah.
Sandhya Kapila (12:03) Okay. Sounds good. Alrighty. Well, anything else?
Lauren Henderson (12:10) Not on my end. I’m almost through with, I think the group enrollment tab. I did add those additional locations that are closed and highlighted those. And then I am working through the provider enrollment. Okay. Sweet. Thank you. So.
Sandhya Kapila (12:35) Much. Yeah. All right. And I’ll look at, Ashley sent an email about one of your.
Lauren Henderson (12:40) Providers. Yeah. Okay. All.
Sandhya Kapila (12:46) Right. Okay. Well, thank you so much.
Lauren Henderson (12:48) Yeah, thank you guys.
Niccole Russell (12:49) Thanks. Bye bye.