Transcript
Dreama Hembree (00:00) hi, good morning, Sarah. Good morning.
Dreama Hembree (00:14) Good morning. Happy Friday. Y’all, yes, happy Friday. How are you guys doing? Doing good. Good.
Dreama Hembree (00:37) Hello? Hi. How are you? Good. How about you?
Sandhya Kapila (00:42) Good. Thank you. All right?
Sarah Melby (00:48) Okay.
Sandhya Kapila (00:49) So, I think we’re going to take this meeting to review the payr process, scoping doc. So Dreama is going to take over here just to ensure that we are following the right processes that you have. And if there’s anything additional that we need to change, Dreama will dig in and get those details from you. Yes. So Dreama, I’m going to hand it over to you all.
Dreama Hembree (01:11) Right. Let me share my screen and get started. Okay? Can you all see that? Okay. Yeah. Okay. So like Sandhya said, the goal of this call is to kind of go line by line and to make sure that we’re following standard processes or the processes that your organization is using to enroll. So if there’s anything custom, I’ll call that out to the team and create that in the background as a custom process for that enrollment. We’ll just turn at the top for blue cross blue shield. I don’t see anything on here that says standard or, you know, any particular roster that’s used. So, are you just using standard process for blue cross? We?
Sarah Melby (01:59) Do we go through MCC? I don’t know what you guys do for payers like that, but we do utilize MCC for most of the Minnesota payers like blue cross health partners, you care. Okay? All.
Dreama Hembree (02:14) Right. So we’ll go ahead and mark that one. Yes as a standard. And then for Aetna. I don’t see anything specific or custom on that one. Same thing for Aetna. Yep. Okay. And… then for carelon, I did look at the roster that you submitted, which was this one. And then I compared it to the one we had, which is different. So I’m wondering because I don’t know which one is the newest one. Any ideas when you got that one, Sarah? Or when that one was given to you guys?
Sarah Melby (03:06) This one is back from September. Okay. So I also sent quite a while ago when we had the Aetna carelon conversation, I sent the exact one back then as well.
Dreama Hembree (03:23) It’s this one. This is the one that I have right here. This is the one that I sent. So I’m thinking that ours might be more recent because yours says beacon and I know that they merged with carelon, and then ours says carelon. So I’m just going to,
Sarah Melby (03:42) I just took it. They led me to it on their website and that was the one that was out there.
Dreama Hembree (03:50) Right now, just recent or in September?
Sarah Melby (03:53) No, just recent. The original one that I sent you, that was blank was recent. Yes. It was literally the day that I sent it to you. I had called carelon, and that’s where they led me to it. This one would not be recent. The one that’s called that one. Okay? All.
Dreama Hembree (04:13) Right. I got it. Then. All right. I just want to make sure that we were, this one wasn’t the one that you guys were utilizing. Okay? Perfect.
Sarah Melby (04:21) That was the last one we sent in.
Dreama Hembree (04:23) Okay. So we’ll go ahead and mark yes on that one. And then I’ll just make myself a note but we need to compare.
Dreama Hembree (04:37) And then… for calm psych, whoops.
Dreama Hembree (04:47) Okay. So for commercial and EAP… we, Sandhya and Nico, maybe Naomi help me on this one because they’re needing commercial and EAP in the platform. We only show commercial line of business as available. So, what would I need to do in that instance?
Dreama Hembree (05:14) I’m not entirely sure.
Dreama Hembree (05:25) It’s for calm psych. Yeah, for calm psych. I checked in the platform and I have medicaid up right now. It’s just showing commercial as the only available line of business. So.
Dreama Hembree (05:40) Let me look into it while you go forward. Okay. All right. I mean, either way, we will figure that out Sarah in the background. So for calm psych, we’re not using any rosters or anything out of the ordinary besides needing the EAP, correct? Correct? Yep. Okay. So that money is, and then health partners. I didn’t see anything out of the ordinary on that one. Just standard enrollment on that one as well. Correct? Yep. Okay. And then hennepin, health, same. Yep. And then Minnesota medicaid. I see that you said we’re needing to have the telehealth form attached with the medicaid. I did look at our process on that, and it doesn’t call that out specifically, but it, I mean, we’re not, it wasn’t calling, it wasn’t directly discussing telehealth. So I will make sure that is included in the instructions. Do you, is that form just on the website? Is there just using their standard form?
Sarah Melby (06:54) Yep. Exactly. I think it’s like six to eight or six. I’m not don’t quote me on that, but I feel.
Dreama Hembree (07:02) Like that’s… right? I got that as a takeaway just to make sure that that’s included in the instructions and that form is linked. So we’ll go ahead and put, yes on that one. And then medicare is just medicare, right?
Dreama Hembree (07:21) And then optum, I thought I saw a note on this one. Yeah. Okay. So, dependency on medicare and medicaid, yep. That’s that’s standard. Okay. Perfect. Yes, south country health alliance. What about that one?
Sarah Melby (07:38) Nothing abnormal. That one goes through MCC as well. So, for us currently? Okay.
Dreama Hembree (07:47) And then, I know we had two tricares down here. We’ll go ahead and maybe it’s okay to take one of those off, right? Since they’re just duplicate, they’re not, this isn’t tied to any other spot in the spreadsheet that I would be messing something up, right? If I took one of these off. I.
Naomi Denson (08:04) don’t think so unless there’s like a space. Well, yeah, one of them says high priority, one of them says medium priority, but as long as the, yeah, it should, I don’t think, it should be fine. Okay?
Dreama Hembree (08:19) Do you want to just leave that marked high priority Sarah?
Sarah Melby (08:23) Yes, please. Yeah, yes.
Dreama Hembree (08:25) Okay. All right. So then I’ll leave that one blank. So, I know to delete that one and then ucare, anything for ucare, that we need to know about?
Sarah Melby (08:35) Nope, pretty standard. Okay.
Dreama Hembree (08:39) All right. Well, that was pretty painless other than the comparing the rosters and then the EAP for compsych. I think that is all I needed to go over.
Sarah Melby (08:57) I think the one thing I do want to note is like the other payers do offer EAP, but I believe it’s right on their application in the first place where compsych is different because it’s specific to EAP and commercial payers. Like optum has an EAP that, yes, we do enroll in, but it is still the basic form it’s just when you go through it and you guys just don’t have lines of business called EAP, but it is an option in their form. So we do EAP with optum as well.
Dreama Hembree (09:30) So, is optum the only other payer that you’re doing EAP with? Or if it’s available, you guys are doing it?
Sarah Melby (09:38) If it’s available, we’re doing it.
Dreama Hembree (09:40) Yep. Okay. Thoughts on that one, Naomi because we don’t have that as an option in any of the payer lines of business. Yeah.
Naomi Denson (09:53) I think we need to ask Brenda about the eaps and how we request those because typically, I think eaps… I don’t know. I’m not too familiar with eaps. I know that we, I’ve seen them processed here before, but, I think… we need to take that back to Brenda and see, okay?
Dreama Hembree (10:16) Sarah, do you know like off the top of your head which ones offer the EAP? Do all of the major carriers offer it? Because I don’t honestly know?
Sarah Melby (10:28) No, I don’t believe, no, they don’t all have it on there. So, I know it’s the compsych, the optum, and I believe I would have to double check but carillon might have it as well and that’s kind of why under the lines of business, I don’t know if you consider the eaps as commercial since they do run pretty, you know, close together. But if right now compsych and.
Sarah Melby (11:02) optum would be our three major ones.
Dreama Hembree (11:05) Okay. Let me take that back to the team and make sure that we… can either get that added in the platform, as a choice or maybe I call that out just as a custom process that we need to select the EAP enrollment as well when we’re doing that. So we’ll get that figured out on the back end. Any other questions for me regarding the payer scoping or anything else we need to discuss?
Sarah Melby (11:36) Nope. I don’t believe. So if we do start credentialing with other payers, do we just reach out and add them like?
Dreama Hembree (11:44) Adding like a net new payer to the platform? Yeah, yeah, you would just once you’re coming out of implementation, I’ll be setting up weekly meetings with you. And so going forward, I’ll be working with, you know, in the operations standpoint, and so if that becomes the instance where you need to add a new payer, yeah, just let me know and, we can get that put, into the platform?
Sarah Melby (12:14) Perfect. Thank you, Sandhya. Do you have anything for?
Naomi Denson (12:17) Sarah or hilke?
Sandhya Kapila (12:21) I just wanted to say that we are looking into those yellow, the yellow fields on the group enrollment.
Sarah Melby (12:29) And we’ll.
Sandhya Kapila (12:31) get back to you on that, it actually tagged Nico in because I couldn’t see anything either and.
Sarah Melby (12:37) It might be something super small, but I’ve tried everything and I’m like I don’t know what it is and.
Sandhya Kapila (12:43) It could be formatting because that’s what I noticed for one of the other ones. It was just the way that it was formatted.
Sarah Melby (12:48) So,
Sandhya Kapila (12:48) we’ll follow up. Okay? And I think that is all. So, now that we have the payor mapping, and then as we finalize the payor enrollment and group enrollment pieces, we can work on loading those in unless there’s any issues that we find in the payor enrollment, but I will reach back out to you. And then, yeah, then we’ll go from there. Did you have any other questions? I?
Sarah Melby (13:11) Don’t think so. So. Right now, there’s nothing you need from me except to go into medallion and update things as they come across that have already been completed, correct?
Sandhya Kapila (13:21) Exactly. So, because the caqh imports have been run for everybody. Excuse me, if you can go in and update the missing information that’s in there, that would be great, or if you’re tasking that to the providers themselves?
Sarah Melby (13:37) That’s another question. So in caqh, they don’t they only fill out the actual required. So I see a lot of our providers aren’t 100 percent. Do we only need the required information or do you want to complete it 100 percent?
Sandhya Kapila (13:53) I think we start working on it when it’s Naomi, correct me if I’m wrong, 70 percent complete or is it 80 percent?
Naomi Denson (14:00) 85?
Sandhya Kapila (14:01) Okay. I was wrong, 85 percent complete. So it needs to be 85 percent complete.
Naomi Denson (14:05) And then anything that’s not marked as optional that’s technically a requirement of their profile. Once you make the request, it’s at that 85 percent threshold. It moves into our intake team.
Naomi Denson (14:17) If there is still something missing that we need, they’ll task out for it. Okay, perfect. But unless it’s at 85 percent, it’s just going to sit and request it and our intake won’t, pick it up. Okay?
Justin (14:34) Then I have a question which, is there anything that we can or should be doing to prepare for different profile types? So that we can have reporting up and ready once we’re ready for like our supervisors to recognize, you know, who is, and who is not credentialed, anything to help us with one of our outstanding items will be, we need a clear roster and report for like our intake team, are we too early to be working on those things or?
Sarah Melby (15:07) That was actually the meeting that we had last week, Justin that you were out for. And so they did take us through some of the reports. They were checking on a roster. So, because we know we don’t want everybody to see everything. So they were checking on more of a roster that we could get for intake. But otherwise, they did walk through how we could manage setups and teams and whatnot. So either I can walk you through or they can again as well.
Justin (15:38) I’ll leave that to you. If you have a task to assign to me, I will do it.
Sarah Melby (15:43) Okay. And,
Sandhya Kapila (15:45) I will send you the recording. I think I missed sending that recording. So I’ll send that recording from Monday to my follow up notes from today.
Justin (15:51) All right. And then,
Sandhya Kapila (15:53) we can do another, like once we have all the data in the system too, we can do another session just to review the reporting as well.
Sarah Melby (16:04) Cool. Sorry about that, Justin. I did not fill you in on that during our meeting.
Justin (16:08) Well, and I shouldn’t have family emergencies. I need to be chained to my desk.
Sandhya Kapila (16:15) I hope everything is okay?
Justin (16:17) Yeah, it’s fine. Okay?
Sandhya Kapila (16:18) Good. Okay. Great. Well, thank you guys so much. And as always, please reach out if you have any questions.
Sarah Melby (16:25) Okay. That sounds great. Thank you. Thank.
Sandhya Kapila (16:27) You have a great weekend, guys. Bye. Take care.