Transcript
Malia Emberson-Lafoa’i (00:00) hey, guys. Hello? Welcome. Yeah.
Rheta Larson (00:09) Today?
Malia Emberson-Lafoa’i (00:10) How we doing? Team? Good?
Rheta Larson (00:13) How’s everyone on Selma? Good, good.
Malia Emberson-Lafoa’i (00:19) Good. I’m… sorry, I couldn’t join last week.
Rheta Larson (00:26) That’s okay. No worries. I know raunaq did, which looks like you’re joining. Hello. I know there was a few updates on y’all side of the house for things. I don’t have too many action items. It’s just some of the things that we discussed last week that I’m kind of just reiterating for the sync but happy to give you all for anything in particular and just wanted to check to see if we’re waiting on anyone else.
Malia Emberson-Lafoa’i (00:54) I’m not sure where Karissa is, but whilst we wait for her, I have a question for you. I, it has come to my attention that our availability profile is not up to date. So it still contains our previous dba and our previous provider, our previous practice name. We’re running into a couple of issues with some of our physicians failing to obtain prior auths from providers from payers. I’m just wondering whether, you know off the top of your head rather like how material the information in availability is to how you connect with payers?
Rheta Larson (01:39) I am not off the top of my head, familiar with that. Like readily available information. Is there a particular, is it all the providers availability profiles? Is there certain ones? Are you seeing like a mix of this? You?
Malia Emberson-Lafoa’i (01:55) Could wait to mix, right? It’s a mix. It’s not just, it’s not. Sorry, I was, what is the question? Rada asked me whether we were having problems with a mix of providers. It’s just dr ansari right now, but I think someone needs to verify, we need to verify everything that’s on there. We’re not having any problems just yet, but, you know, that doesn’t mean that there are no problems. Well, also with dr nissanen now, yeah, wait, dr nissanen hasn’t been able to file any prior auths as well. Yeah, we got that email from, we got that nissanen or ansari, it was nissanen. I completely misread it. Did I miss? No, maybe I misread it dude.
Rheta Larson (02:40) If you want to send over any, if you’re receiving email communication. Sorry. Yeah, if you want me to dig into anything there, I’m happy to look into that further. Okay, I know we talked about ansari last week, so, but this was specifically for tricare. So this is for medicaid, right? The availability profile.
Malia Emberson-Lafoa’i (03:03) Not medicaid. This is, no, this is for tricare. Yeah, availability is used for like a few inch orders. Okay?
Rheta Larson (03:11) So this is back on the ansari, tricare. Is this regarding the link location for the paseo and versus la jolla. I know that was another outstanding topic item for his tricare. Yeah.
Malia Emberson-Lafoa’i (03:24) So we have him at the moment when we call tricare, he is enrolled at paseo, but not rolled at la jolla, but… he is in network at la jolla, because like we, when we call the pro insurer and they say that he’s enrolled there’s like some issue on availability. Do you guys like, do you guys help manage the availability account or no?
Rheta Larson (03:51) Not that I’m aware of, I know we fill out what’s necessary in order for us to go in for those specific enrollment requests that we receive, but I’m not sure what the extent is, and if there is a particular list the team is working off of, I’m happy to dig into that further with you all and the pair enrollment team and just see what we do and don’t do or like what’s on the client’s end to manage versus medallions? Yeah.
Malia Emberson-Lafoa’i (04:16) I’m pretty lost on when it comes to availability.
Rheta Larson (04:21) Are you receiving communication from them or is there if, you know, I’m.
Malia Emberson-Lafoa’i (04:27) just kind of digging around our availability profile to be honest and just like seeing whether seeing where there are problems like in the moment, there are those two issues which I touched on. Plus when I look at the individual providers like that’s that list isn’t updated. And I guess my concern is just… I don’t know how this profile interacts with payers and whether like information if information isn’t completed on the, on availability, whether that has any, maybe that, whether that’s impacting our prior or I think it seems like let’s just figure it out at that. And I think, yeah, I’m putting some time with Chris and you were two PM today.
Rheta Larson (05:13) Yeah.
Malia Emberson-Lafoa’i (05:14) And we’ll go through it? All right, cool. Thank you. I.
Rheta Larson (05:18) Do want to say at one point in time this was, I was trying to look back at our other notes. I do want to say at one point in time, I know availability was something you all have brought up on our agenda and you had asked if medallion updates, y’all’s provider directory to the payers every night. Yeah, that is out of scope for us. Like that is the client responsibility to complete that process. It’s differed per payer, but you should essentially follow the payer instructions. So for availability, it will be done through the portal for the group. But, if you have any specifics you want to dive into, I know specifically, just as a whole updating the payer directory is not something medallion does to the period every 90 days that’s something the client would need to assume responsibility on. Yeah.
Malia Emberson-Lafoa’i (06:08) All right. Let’s have a chat with Chris today. Cool. All right. Aside from that, my only update is that I was able, yeah, to get onto the city of San Diego to update that business license. So we should get that hopefully this week. Okay? I’ll get Samira to keep an eye out for it and then we should be able to submit that along with the Coi?
Rheta Larson (06:32) Okay. Amazing. So we were holding off on that. Yeah. So we heard back. So with that said, do you want us to start working on the resubmission? Or just wait until that’s received, if?
Malia Emberson-Lafoa’i (06:42) If you think that it’s worthwhile working on the resubmission, if you guys can get work done, then I think move ahead with it. Okay?
Rheta Larson (06:52) I will push the team here, thanks.
Rheta Larson (07:02) And I… think I can, I think what we decided, if I’m not mistaken, we’re going to leave it in the same request. I don’t think we need to open a new one but I’ll just make sure if we do, I’ll just input it myself or, and, or let you all know like what the next steps? Are there? Great. Anything else with medical group enrollment? Okay? And then from last week, we talked about greater Tri cities ipa. And then claritive, I think there was only two for Joseph Chan and group the group demo. All of these have been marked as stopped. So if you go to the payers, you should be able to now see those in the stopped column for those particular entities. Just wanted to flag that because I know it was a call out where y’all were marking some of the open action items. The team did close those and then close the request as well. Okay. And then for ansari, tricare, this one was the one where you were directing us to hold off for now on the demo update for next steps. So he’s.
Malia Emberson-Lafoa’i (08:09) already, I think he’s already in network on that location. So if you can get some, get someone to actually we’ll just double verify that and add that to medallion just so that it reflects correctly. Yeah, it’s probably a matter of us just adding it to medallion, I think.
Rheta Larson (08:30) Okay. So you’re stating that he is in network with la jolla. Yeah. Because when we got the update, I think we had saw that he was only linked to the paseo Valencia or the laguna hills location. And then we were working to resubmit the demo, but we paused on that wait.
Malia Emberson-Lafoa’i (08:49) Sorry, pause. So, when you say when you say that you just give me two seconds, I’m sorry, talking to someone outside?
Rheta Larson (09:01) No. I was just saying we checked on when you all flagged us on the tenth.
Malia Emberson-Lafoa’i (09:06) Yeah, we,
Rheta Larson (09:07) we followed up with the payer with the tricare enrollment and it looked like he was only linked to the following location, which was the laguna hills. We did not see that la jolla was yet linked but you’re saying he is, I just want to make sure we’re clear there. Wait.
Malia Emberson-Lafoa’i (09:21) How did you check, how did you guys check? You just check the medallion portal and not call the pair, right? Right? I?
Rheta Larson (09:29) Can see how the team reached out. I got the update from the team directly. Let me see if I can dig on how they reached out. They might have put a note in too. Give me one second because.
Malia Emberson-Lafoa’i (09:44) we, I think we also called the pair and then we failed. Yeah, this… is… crazy. Maybe the room is not fully shut.
Malia Emberson-Lafoa’i (10:00) Is that it? No, no, no, no. It’s people that are slacking me. Okay? And then following up with me because they can see me here. Okay. Yeah. If you could just check… that would be great. I need to write. I need to do this today.
Rheta Larson (10:16) Yeah. It looks like it was an email response from, the payer directly. We got the email response upon checking practitioner. I’m sorry, MD has already added to the group Salma, health allocation, laguna hills, and he may now accept blue shield of California membership billed under the group as reference to the provider’s end. But they didn’t reference the other address. They just said that was… the okay tied to it. So I can double check again via email and just call that particular address. If they didn’t reference the other address?
Malia Emberson-Lafoa’i (10:52) Yeah, if you could, I mean, whichever way is the easiest for you to, can someone call the pair and basically just confirm if this location is added. I’m 99 percent sure that it is. But if it’s possible to do it like today, then you do it otherwise, like let us do it. If it’s if you think it’s simple. It’s not possible for medallion to do it today. I’ll just pick someone. I,
Rheta Larson (11:19) will let that individual know if we can have them call today. I’m not certain if I’ll get back to you during this time, but I can email you if I don’t hear back within like the next hour or two. I would suggest you all just call, but I hate that we’re receiving conflicting information because the email just indicates that one, if y’all get something, let us know.
Malia Emberson-Lafoa’i (11:43) I think we should just call. Yeah. Okay. Yeah, we got it. I’m asking someone to call. All right, Reda, could you please forward that email to myself? Raunaq, and Karissa, or just everyone on this call? Just so that we can see that trail and so that we have the context for that email. And then hopefully there’s a number on there that we can call as well? Yeah.
Rheta Larson (12:09) There, is it’s amazing the chat for y’all yeah.
Malia Emberson-Lafoa’i (12:15) I think for expediency, I think we should just call all.
Rheta Larson (12:18) Right. Let me actually just put it right here. It’s 802 five eight. Like really hard to see. Two, five, eight, three, zero nine one. Okay. Yeah… I’ll forward that over once I get with that specialist as well legend.
Malia Emberson-Lafoa’i (12:39) Thank you. All right.
Rheta Larson (12:41) In terms of next steps, we’ll con or y’all, I’ll let you know we’ll call and then if you don’t hear back first, I know y’all, said y’all, will call also, but we’ll also get clarification if not, do you want us to proceed with submitting resubmitting for the demo update? I.
Malia Emberson-Lafoa’i (13:02) Will get back to you for dr ansari data. Yeah, back to you. We’re checking right now. Just hold off for an email. We’ll send you an email later today. So, or we’ll just start a demographic update if needed. Right? Yeah, we’ll just start one on medallion and then we’ll email you as well, letting you know that we’ve started it because if we could, that one I think will be of high urgency for us if we need to, if we need to do it. Okay. Gotcha. All right.
Rheta Larson (13:30) Those are some of the action items we already chatted through availability. Anything that new that y’all would like to chat through any of the open enrollment requests you want to look into?
Malia Emberson-Lafoa’i (13:43) Yes, there was one. So, I know that… your team had reached out to Sarah sanabari to get her to fill out her optum application, which is a paper application. I, on my understanding is she never filled out that application, which makes sense. She was on leave. I’ve asked if you guys can resubmit it to her. I’m not sure whether that has happened. So if you could just follow up, like at the moment, she doesn’t have any outstanding tasks. And… I have, I’m just trying to open this up. Okay? So, they’ve sent me the, they’ve sent me the link again. All right. So I’m just going to send this to her. They’ve sent it in a completed top. They’ve sent it in the completed task, which is why I didn’t get it. Okay. My queen, can you please sign here. Also. That sounds great.
Rheta Larson (14:47) So we’re good with her. You don’t need anything further?
Malia Emberson-Lafoa’i (14:49) I will let you know. I’m just going to try open the link. Yeah, the link works. Okay, great. So she has that she will sign. I’m just maybe, I guess the thing that I’m a little bit concerned about is the task is completed on medallion, even though she hasn’t signed it yet. So what’s the best way for me to tell you guys that it’s been signed?
Rheta Larson (15:15) If you can respond directly back to that one, I can reopen it is.
Malia Emberson-Lafoa’i (15:17) It, yeah, thank you. It’s that first one doc, you signed signature needed. Yeah, I will.
Rheta Larson (15:23) I can’t because I’m I need a hijack as me, but I’ll reopen this one. Yeah, cool.
Malia Emberson-Lafoa’i (15:29) If you can reopen that one and then she’ll sign it today. I’m sure. And then just,
Rheta Larson (15:36) mark it once it’s done as completed. So the note pops into our view for review or pop a note sounds.
Malia Emberson-Lafoa’i (15:43) Good. Okay.
Rheta Larson (15:45) I’m glad that it’s working and.
Malia Emberson-Lafoa’i (15:49) Then where did Nathan go? I’m getting Nathan to work on that… incredible.
Karissa Weight (16:01) There are two spots in back to dr ansari, there are two spots in availability that look like we’re causing errors. Big bold and red. I just sent you a screenshot of that raunaq, do you think that is relevant to what we have going on here?
Malia Emberson-Lafoa’i (16:17) Let me have a look. I’ll just send it to you. This is his profile on availability. Yes, you.
Karissa Weight (16:34) Really have to dig it’s deep into his personal profile. It’s not coming up as like a related to Zoma, but he doesn’t have an Ein social security number and it looks like the whole, the address, it’s saying that we don’t have a valid phone.
Rheta Larson (16:50) Number tied?
Karissa Weight (16:52) To any of these?
Malia Emberson-Lafoa’i (16:58) Let’s finish with medallion and then let’s talk about research.
Malia Emberson-Lafoa’i (17:06) So, anything else you guys have… anything else that’s outstanding on the agenda?
Rheta Larson (17:15) No, I’m just marking the saraswanabari one. I don’t see anything outstanding. I know we went through last week, some of those open tasks which a lot of those were just waiting or holding on until otherwise stated. So, there’s only four and ready. And then there’s quite a few that y’all have marked as done that our team will review and push forward. So I’ll poke the team for those. But other than that, those are the only other updates. And then I know Jake had mentioned he closed the loop with me last week that he reached out to you via text and y’all have been handling that communication.
Malia Emberson-Lafoa’i (17:48) Yes, that the 5,000 dollars is the credit that he’s going to be applying to our account. Could you please follow up with him once that’s done? And just like send us an email of confirmation? Yep. Yeah.
Rheta Larson (18:00) If you got confirmation from him, I’ll follow up with him to push that through. And then you should be receiving something actually from accounting and finance versus Jake, but he’ll close it via email with them on copy.
Malia Emberson-Lafoa’i (18:14) Got it. And then I think one thing that I would love to like now that I think our account is pretty like stable. One thing that I would love to do on these calls is to look at open requests and then get like a summary of how many of those are within sop and how many of those are outside of sop in terms of following up as well as like closing if there’s anything beyond like six weeks or eight weeks. We should, we should be flagging those as like issues because typically, we see four to six weeks, right? And Nikki, just like a flag for you here. Like before these calls, please spend 30 minutes on the medallion portal so that you have an idea. And then ideally, this is a conversation between you and Rheta where you guys can kind of go over outstanding requests that are processing. And then we should have a list of the requests that are outside of the sop, which is two weeks. So if there are requests that are in processing, but haven’t been followed up in two weeks, or there are requests that have been followed up in two weeks, however they’ve had more than two follow ups. But the so on the third follow up, typically medallion does a phone call. So, if there hasn’t been a phone call, then I would also love for you to flag that. And then we would request that as has been getting phone calls there and it’s fine. Like next week onwards.
Malia Emberson-Lafoa’i (19:44) If we can like, please spend half of the time… doing this on the call. That would be super helpful. Okay. Does that work right now? That sounds?
Rheta Larson (19:57) Good. Yeah, I’m I know week over week that’s typically what I do follow for the follow up at least and we’ve been on track for follow up. I think maybe like four have fallen outside by one day, but the team was on those and then at least for payer processing our because there’s two buckets that we’ll look at. We’ll look at the follow up which is separate from how long they’ve been processing since applications submitted that’s a little different. I know every payer is different. So depending on the nuance of the payer, it could take up to that 90 to 120 days that’s when we’ll start prioritizing if they’re far exceeding that, which I don’t think y’all have too many. I can double check and pull that list as well. But definitely, for an ongoing structure, I’m happy to list that and then just have the stats there for you all. And then Karissa and Nikki y’all are welcome to pull that in your analytics tab as well. A lot of this information here should be able to give you some of that data that you’re looking at just week over week. And this might be helpful. You can pull reports. You can save reports. So that way you’re not having to do it manually each time. But I can also walk through all that with you if y’all, haven’t explored that those options. But sounds good. If there’s anything else on the ongoing structure that you want, let me know. And then I think y’all, all have access to this. So definitely feel free to add anything you see fit here on the agenda before our next sync. So Karissa, and Nikki, if you flag something, say something, email me, put it here, tag me and then I’ll look at it.
Malia Emberson-Lafoa’i (21:36) That works. Awesome. If there’s nothing else, then I think we can give back time, perfect.
Rheta Larson (21:46) I have my action items. I know Salma has theirs. If there’s anything you need from me, let me know, but I hope y’all, have a wonderful Tuesday. Thank.
Malia Emberson-Lafoa’i (21:54) You bye.