Transcript
Gregory Campbell (00:00) hey, Naomi.
Melissa Mendez (00:01) Hi, Craig.
Naomi Denson (00:04) Unless it’s coming.
Gregory Campbell (00:06) Awesome.
Naomi Denson (00:09) Taking her a second to get let in, I guess there she is. Hi, Melissa.
Melissa Mendez (00:17) Hi, good morning.
Naomi Denson (00:18) Good morning. How are you?
Melissa Mendez (00:20) Good. How are you? I?
Naomi Denson (00:22) Am good. It’s almost Friday. Yeah, we have Greg back with us, our TSM now that we have some data for baptist. So, Greg, have you had a chance to review the file? And I have some feedback. So he wants to review what they sent over with us and his findings. Okay?
Gregory Campbell (00:46) Yes. Let me go ahead and share my screen one second.
Gregory Campbell (00:58) Okay. Here we go. So here is the data. I did send a quick follow up email, Melissa, just so you’re aware that we’ll be moving over to this sheet, which is a Google sheet as opposed to the excel that we were working off of previously. So you now have that link.
Gregory Campbell (01:15) The reasoning behind that is we have a new data validation tool that we run all of our data through. That will highlight errors as they come up so that you’re able to fix them in line and you’ll see when they resolve, the highlights will go away. So, looking at the provider data first, there are three errors with the providers that were listed. And the error is that there are three providers listed here with the same caqh number.
Melissa Mendez (01:41) Okay. So.
Gregory Campbell (01:43) That’s one where if you’re able to find the unique caqh number for these providers, if you get that into the sheet, that would clear these errors… perfect. And then for the group profiles, looks like there are two errors coming up. One is the taxonomy code. So this field only accepts either multi specialty or single specialty, not the actual code itself. Okay? And then you’re able to enter the taxonomy code into primary specialty. The options library shows what… values this field accepts. So if we go over to the options library, this lower tab here, if we go to groups group profiles, primary specialty. So these are all of the acceptable values for that field.
Melissa Mendez (02:35) Okay. Weird. I had actually just grabbed that from the medallion platform directly and I assumed it would be in the options library because I had a different health center that had that same primary specialty.
Gregory Campbell (02:49) Okay. In that case, we can take a look now. Maybe we can resolve this together. So it looks like you have community health.
Melissa Mendez (02:56) I.
Gregory Campbell (02:57) don’t… quite see that here. Let’s see maybe if I search.
Gregory Campbell (03:09) Group profiles, primary specialty? Is this? It no registered nurse, community health worker? Okay. Yes, atlantic center, community health is a valid option. So what we’re going to do here? We’re just going to take off this code in the front.
Melissa Mendez (03:28) Okay. And.
Gregory Campbell (03:29) That cleared that up. Okay? And then we can probably resolve this as well. So would this be a multi specialty or a single specialty group? I believe.
Melissa Mendez (03:42) Multi specialty? Does that just mean?
Naomi Denson (03:45) Like let’s see… what’s the npi? I can’t see.
Gregory Campbell (03:51) Npi ends in nine two six five.
Naomi Denson (03:54) What’s the full one, one seven eight.
Gregory Campbell (03:58) Zero one, nine, nine, two six five.
Naomi Denson (04:06) Looking them up on inpes. So they’re registered as a fqhc… I would put multi specialty since they’re they see like medical… dental vision, all of that, Melissa. Yeah.
Melissa Mendez (04:24) Yeah, that’s what I, that’s what I figured. Yeah. Okay.
Gregory Campbell (04:29) Perfect. So with that fixed, your group profiles are good to go. Okay, take a look at your practices. These are good to go as well. So, these cover all of our base profiles that need to be imported before we move forward to any of the enrollment data. So, once we have the updated caqh numbers, I’ll load the providers, but I can go ahead and load the groups and practices now that those are ready.
Melissa Mendez (04:52) Okay, great. And just want to make sure I have a copy of. You sent me a copy of this so that I can see exactly which providers have the duplicate caqh.
Gregory Campbell (05:03) Yes, and I’ll go ahead and just put that in the chat now just so that you have it. Okay. Perfect. But I did send that same link over email.
Melissa Mendez (05:11) Okay. Just wanted to make sure I saw that email come through. I just didn’t have a time, didn’t have a chance to check it, so.
Gregory Campbell (05:17) Yeah, of course. Yeah. Happy to work on together on this. So I can give you some color into the next steps that will come as a result of loading these.
Gregory Campbell (05:27) So currently all of your provider practice group associations are showing up as errors. Not because of anything wrong on your end. It’s just that this is checking against what’s currently in medallion. And we haven’t loaded these providers yet. So I think it’s actually a natural stopping point for us to just get each of these base profiles in. And then next week or as soon as we get all of them in, we can start processing all of the remaining tabs of the template. One thing we can get a jumpstart on. Though in the meantime is I noticed your provider enrollments seem to all be for this pair, Aetna. Better health. Is this the only pair that you’re looking to load for both providers and groups as a part of this import? Or would there be more there?
Melissa Mendez (06:14) Will be more. It’s just they’re getting a, they work with a current vendor. And so they don’t have a lot of the payer enrollment information. And that was one of the pairs where they had more information. But even from what I saw in their import template, even with that one pair, it didn’t seem like they had enough to actually do the import. So they’re… still gathering that information, but yeah, there will be more pairs.
Gregory Campbell (06:42) Okay. Got it. Yeah. So I didn’t paid too much mind into these for the same reason with the provider practice groups, a lot of these errors will go away once we actually load these provider profiles. Okay? But one thing that would be helpful is before I hand this over to our engagement managers to review and confirm all of these payer mappings. It would be helpful if we could get as many of the client payer names as possible into this sheet. And if that’s tracked elsewhere, happy to help translate that over. But yeah, the next step will be once we have as many of these payers as possible, I’ll send this over to our em, to review and confirm, yes, Aetna better health is referred to as Aetna for the state of Louisiana within our platform. And then once that’s done, we’ll have you confirm this as well just to check off. Yes, we agree to these mappings and we’ll move forward from there.
Melissa Mendez (07:38) Okay. What I can do, so they baptist had sent me like a report of their recent charge activity with their payers. And so I used that to prioritize their list of payers based on the recent charge activity for each one. And I asked them like please confirm that like, you know, I want your team to review and confirm that this prioritization is correct and they haven’t.
Gregory Campbell (08:10) they’re.
Melissa Mendez (08:10) still working with their vendor to figure out the like any nuanced processes that they have with any of the payers. So we have the payer scoping template where I prioritize their list of payers and they haven’t filled out any of the details about what any nuanced processes that they have with them. But I can send you the template that we have currently just so that you can at least see the list of payers that they currently work with and my initial prioritization of them. And then I am still waiting to get more information about any rosters or nuanced processes around billing or anything like that. But I’m just not sure that they’re even able to get that information because they, it seems like their relationship with their current vendor is not good and they don’t exactly trust that what the vendor is saying is accurate either. So, but if it’s helpful, I can at least give you that initial list.
Gregory Campbell (09:07) Yeah, I’d be happy to more than happy to take a look and just start prepping for that and maybe use that to start populating this as best we can. That is something that until we get all of the payers and all of the enrollment data added here. Like I noticed for some of the group enrollments, it looks like the payers themselves are missing from the sheet.
Melissa Mendez (09:32) Yeah. So that’s.
Gregory Campbell (09:33) one where like we can load for example, provider practice groups that doesn’t depend on the payers at all. Same goes for the external accounts. I know there are some more there’s some more data here to be filled in as well before we’re ready to load that. But we can prioritize loading all of these additional tabs before we get to the enrollments and work on that in the background. And then we can work with Naomi to help determine like what that timeline looks like for getting all of the data in for baptist.
Melissa Mendez (10:01) Okay. Yeah, that sounds great. And yeah, I think just whatever is ready to be imported. I don’t know why I feel like a lot of the health centers really struggle with the data import template. I’m not sure if they just find spreadsheets intimidating or what it is, but I have found that they find it a little more straightforward to enter information directly into the system a lot of the time. And so, I think if we get shell records in there for whatever we can, I will schedule a working session with them to help them navigate the platform and input the missing data. But yeah, I reviewed it. I saw that it seemed kind of incomplete, but if you can just help us get whatever you can in there, I think that would be helpful.
Gregory Campbell (10:45) Yeah, happy to help. And also, you’re more than welcome to share this sheet specifically with them. I know populating like an empty import template is really daunting because it’s just like deals with that much feedback. But I’m thinking maybe when we get them up to speed with this process of like how we just did today, walking through fixing the error for the group profiles, it might be easier for them as well to see like, hey, this is that this is the deal that I need to correct. So I’m happy to work with them and help out as much as we can.
Melissa Mendez (11:17) Okay, great. Thank you, Greg.
Naomi Denson (11:19) Is the data master at making it easier for our customers to know exactly what to fix and his awesome little triggers where it’s when it’s fixed, it’ll turn green and then, you know, you’ve done the right thing.
Melissa Mendez (11:33) Yeah, I love that. I think that’s that should be really helpful. Yeah.
Gregory Campbell (11:38) Awesome. Well, thank you. I’m going to turn it back over to you, Naomi. That’s all I wanted to cover on this and I’ll get to work on getting as much loaded as we can.
Melissa Mendez (11:46) Okay, great. Thank you… all.
Naomi Denson (11:50) Right. Okay. So we’ve got the data. We went through the data piece provider engagement. All 12 of the phcs providers have accepted. 10 of them have 100 percent complete profiles. Didn’t see where you had said maybe last week or the week before that southwest was planning their provider comms and invites. I don’t see that anybody’s been invited yet. Do we know timeline on that? Do they want us to send the invites in bulk? Or I mean, there’s only a handful of providers, so there shouldn’t be too many to send out where we’d need to do it in bulk. There’s not like hundreds of them, but right. Yeah.
Melissa Mendez (12:26) Let me check in with them because they had said that they were ready to, they were going to send them out like that day. So, I’m not sure what’s going on and.
Naomi Denson (12:35) Then once we get the provider data loaded for your email, I’ll go ahead and run the caqh imports for those providers. And then we can discuss the invites once that’s done, and we’re ready to move into that phase for the payer enrollment piece. We had talked last week about, you know, trying to prioritize that to get you guys some value with medallion while we wait on the credentialing obstacles to be cleared. Yeah, but southwest Louisiana priority health baptist, I have the old version of the payer priorities template for southwest didn’t know if they were going to be working on the new template.
Melissa Mendez (13:11) Yeah. I sent that over via email, but I haven’t heard back. So let me check in with them about both the new payer’s template and sending out invitation.
Naomi Denson (13:23) Okay. And then I don’t see for priority health or southwest. I think the intention was for them to manually add existing group enrollments. At least, I haven’t seen that they’ve added any of that yet. So I don’t know if that’s planning to come over on the template or if they’re still anticipating adding those in manually. I.
Melissa Mendez (13:40) Think they were going to add them in manually. I just received an email from priority today because I had reached out several times to their finance team who handles the payer enrollment up until then this point. I’ve been working with their HR manager but wasn’t getting what I needed from the finance team on the payer enrollment piece.
Melissa Mendez (14:02) HR manager reached out to me again this morning and said she’s actually going to help me with that, but we’re setting up a meeting to discuss. So hopefully she has the information or is getting it from finance. I’m not sure exactly the status of that, but I am going to be setting up a meeting with them very soon to talk about that.
Naomi Denson (14:23) Perfect. Any news on the three additional new centers coming on board?
Melissa Mendez (14:29) I have not heard anything, and Andy is out of office this week. He’s the one who’s handling that, but I’ll check in with him when he’s back next week.
Naomi Denson (14:40) Okay, perfect. And then the credentialing still sits where it is. Any movement there. We’re still struggling. It’s kind of just indefinitely on hold for the time being.
Melissa Mendez (14:52) I think so. Yeah. Okay.
Naomi Denson (14:58) I did see your email about baptist trying to give us the authorization for npdb and having the issue. It looked like there were no spaces in the org name that they typed in. So don’t know if she reattempted that and was able to get through.
Melissa Mendez (15:14) Yes. Actually, last night late last night, she sent me like the confirmation that said like the request was pending and I asked her for their data bank id so that I can.
Naomi Denson (15:24) Give it to you. Okay? I just checked my email. I have the request. So I just need their DB id. Okay? Yeah.
Melissa Mendez (15:30) I did send an email asking for that. So as soon as I get it, I will send it over to you.
Naomi Denson (15:36) Okay. And let me just, I’m going to review the request right now because sometimes they do it wrong and I have to approve it and then they have to make changes. So I just want to make sure she chose the right options… and pdv is super secure. So I have to wait for my code… let’s see.
Naomi Denson (16:07) Baptist community health services, and she did it, right? Okay. So I’ve got the agent authorization, just need the npdb and, or npdb dbid, there’s too many acronyms there. Yeah. All… anything else for me? Any other information on baptist credentialing… needs? I know they had said something about doing a one off and we had reviewed their policies. I sent over the packet of the ncqa. Did I send that over to you? I think I did. You did, yes, the packet of the ncqa, like inclusions. Yeah. So I didn’t know if they were still wanting to move forward with that and they were just going to own everything outside of that.
Melissa Mendez (16:55) Yeah, they seemed fine with it. Like they understood what was their responsibility still and what would be under medallion scope. So I don’t see any. Yeah, I don’t think we’ll have any issues there.
Naomi Denson (17:08) Okay. So that’s still on the horizon on the plan? We’ll just need their committee information.
Melissa Mendez (17:16) Yeah, yes. Yeah. And they said that they were, they’re still thinking through it, but we’re thinking about having Teresa and their CMO set up as reviewers, but I’m okay. Waiting to see for sure, but it sounds like they were discussing that and that was the plan, but I’ll check in and see if that’s been finalized, okay?
Naomi Denson (17:40) Perfect. Sounds good to me. Any other questions today?
Melissa Mendez (17:45) Yeah. So I was, when they had a question about payor enrollment, they were asking if it’s okay to bill under the group npi until credentialing for an individual provider is approved. And they just, they said that they’re they mentioned they’re getting paid already, but just wanted to make sure they’re following the correct process. So I, I’m honestly not even sure exactly what that means but if you have.
Naomi Denson (18:12) Any, it really depends on the payor, okay? And what’s in their contract with them. Most group level contracts do require to list the providers rendering providers and on the claim form.
Naomi Denson (18:33) But I mean, I can ask our internal payer enrollment experts, but if they’re getting paid… yeah. Do you know, do you know what billing forms they use?
Melissa Mendez (18:47) I don’t know.
Naomi Denson (18:49) Okay. Yeah. If we can find that out, it would be more helpful to give an accurate answer to know how they’re billing there’s you know, different form types that require… different npis… or tax ids, like if they’re billing at the tax id level for the group or if they’re billing at individual npi levels at the practice locations or with the provider.
Melissa Mendez (19:17) Okay. Let me see if they can provide a little bit more information around that then.
Naomi Denson (19:22) Yeah, it’s gonna, and it’s gonna vary by payer and contract type. All.
Melissa Mendez (19:26) Of that. Okay? So.
Naomi Denson (19:28) You can’t just say yes or no as a whole.
Melissa Mendez (19:33) Okay. And so then I was wondering because I will be meeting with them soon once we have at least some of the data in the platform. I want to help them navigate it, putting them missing pieces for everything. And I, you know, I know that they still need to provide us with the payer scoping template. And like I was telling Greg, I can send them at least the list of or send you both the list of payers that they have. And then we’re waiting on some information about billing and any nuanced processes. But what else, what exactly is needed to start submitting requests for payer enrollment? Because I’m wondering if they need to finish adding all current payer enrollment data before they start submitting requests or with like the one provider that’s new that they’re more in a hurry to get enrolled? Is it okay for them to submit a request for that provider while they’re still uploading the missing payer enrollment data? Yeah?
Naomi Denson (20:30) Typically, we like to see at a minimum the existing group enrollments because those will, if they submit a provider enrollment request for Aetna and there’s no existing group enrollment in their platform, our team’s going to look for that first because that’s a prerequisite to enroll an individual provider. Then we’re going to have to task out and say, hey, do you have this or do you need to request one? They’ll have to go in and add the existing enrollment at that point. So it just delays the submission process for the provider. If that information’s not already on there, same for medicare and medicaid, if they submit managed care plans or medicare advantage plans for enrollment, and the provider’s existing medicaid enrollment is not already in platform or they have not requested one. That’s gonna be the same thing. We’re gonna have to task out and say, hey, we need your medicaid id number added or your medicare number added so that we can submit this certain request to this mco plan. So there are certain blockers and things that we like to see. Now, it’s not gonna, you can always submit the request. It’s just gonna be possibly delayed in submission because we’re gonna have to task out and ask for that additional information.
Melissa Mendez (21:41) Got it. Okay. That makes sense. So the priorities would be that payer scoping template and getting in at least the group enrollment information into the system. Yeah. Okay. That makes sense. I’m trying to think if, okay, I got a kind of a weird question from southwest Louisiana. I think what they were trying to ask was whether medallion can support with getting a payer to allow a retroactive effective date for credentialing or enrollment, so that the provider can be, so they can be reimbursed for services that were rendered during a gap period. They were, they were, the way she was saying, it was like, can you help, can medallion help get back credentialing? Like if they weren’t actually credentialed with a payer for the past month, could they try to get that month covered? So, so that’s why that’s what I was thinking that they were asking.
Naomi Denson (22:38) Typically, if they submitted the enrollment and processed it, we wouldn’t request a back date on their behalf. If they had requested it from us, we submitted it and they wanted us to appeal for an earlier effective date. We would do that then. But if they’ve already processed the enrollment, that would lean with them, to handle.
Melissa Mendez (23:01) Is that like a, I don’t know, I, it, I had like a, I wasn’t exactly sure if it was like a sketchy thing or something because they, she seemed very nervous about it and I like,
Naomi Denson (23:16) it depends on the payer, there are some payers that will allow you to request a back date with a claim, like if you submit an active claim with the back date or they’ll back date up to like… from the effective date given. But not all payers will, some payers are just, this is your effective date. This is what we gave you. It’s either the application submission date, the date that the application was finalized and approved, and they will not wiggle. So, it depends on the payer depends on the timeline. If he was enrolled last year and they’re wanting a back date 18… months ago, that’s not going to happen.
Melissa Mendez (23:59) Yeah. Okay. Yeah.
Naomi Denson (24:00) It’s it all, payer enrollment is very situational.
Melissa Mendez (24:05) Okay. It’s a very,
Naomi Denson (24:08) hard thing to say yes or no without having, you know specific details on which payer, when were they enrolled? Do they have active claims? Is the payer’s process to grant beyond a certain timeframe?
Melissa Mendez (24:26) Got it. Okay. Well, I appreciate you teaching me because I don’t know. Okay. I think, yeah, those were the questions that I had that came through. I will check in with everyone, make sure that things are moving or that they start moving again. Hopefully, and, yeah.
Naomi Denson (24:50) Perfect. If anything else comes up, just let me know.
Melissa Mendez (24:54) Okay. Thank you so much. Thank.
Naomi Denson (24:56) You have a good day. Thank.
Melissa Mendez (24:57) You all. Thanks. Bye bye.