Transcript
Naomi Denson (00:00) hello? Hi. Good morning. How are you?
Hillary Perez-Godfrey (00:16) Just another lovely day in the neighborhood.
Naomi Denson (00:19) Yes, ma’am, halfway through the week.
Hillary Perez-Godfrey (00:23) Yes.
Naomi Denson (00:24) Is Mashaun coming?
Hillary Perez-Godfrey (00:26) I hope so. Okay. All right. I,
Naomi Denson (00:32) don’t know if that’s you or Mashaun that’s in the meeting agenda?
Hillary Perez-Godfrey (00:38) It’s me.
Naomi Denson (00:38) Okay. It just says anonymous wolf. So today, you’re a wolf? Oh… all right. So, got your confirmation that the existing group enrollments tab is complete and ready. Nico is going to review that and get those loaded. Okay, Nico, I don’t know if you’ve done like an initial pass and have any questions?
Niko Byron (01:03) Not quite yet, but I’ll run it through. We have a data validation tool. So I’ll run it through that hopefully either probably tomorrow morning, I would think and we’ll have any questions we have or any sort of revisions that we need ready by then. And then once those get done, it looks pretty good.
Naomi Denson (01:18) At first glance to me, yeah.
Niko Byron (01:20) Usually if it looks pretty good at first glance, and if there are small errors things that we can fix too, we’ll just handle those. It’s just, it’s like information we don’t have. And then once that’s good to go, we’ll get them imported and the whole process usually doesn’t take too long. So.
Hillary Perez-Godfrey (01:36) What’s it called? It’s called like a data scrubber.
Niko Byron (01:40) Yeah, it’s like a data validation tool. Okay?
Naomi Denson (01:43) So it just cross checks the information in the template with what’s in medallion.
Niko Byron (01:47) Exactly.
Hillary Perez-Godfrey (01:48) Got it. Okay. And then I did put some comments on some of the groups it more had to do with, like where we had two separate effective dates. Obviously, the earlier of any of those would be our preference, right? Yeah.
Naomi Denson (02:08) Yeah, that’s totally fine. Yeah, we’ll import with the earlier date.
Hillary Perez-Godfrey (02:12) That’s typical practice. Yes. Yeah. Okay. And then I was able to, I don’t know if you were tracking earlier, but there were some that I had to remove. So we got clarification on the brand new day contract. Apparently, they don’t grandfather into central health, medicare plan, the smolina so that was removed, Cova’s, removed, key medical groups removed. So, what you see here is true active contracts.
Naomi Denson (02:55) Okay, perfect. All.
Hillary Perez-Godfrey (02:57) That’s vetted. And then on the one, what’s it called? Is it the payer scoping with like the,
Naomi Denson (03:05) payer mapping or the payer scoping?
Hillary Perez-Godfrey (03:07) Payer mapping with the applications and unique processes.
Naomi Denson (03:14) Oh, that’s the scoping. Okay. Sorry… next one, yes. Oh.
Hillary Perez-Godfrey (03:22) You know what? I didn’t do I believe? Oh… I didn’t go through column E again. It should be fine. Yeah.
Naomi Denson (03:40) We’re only going to work lines of business that you put on the request itself in the platform. This just gives us an idea of what you typically enroll with.
Hillary Perez-Godfrey (03:47) Right? And the template for the group enrollment for the lines of business is the source of truth. I guess. So if you find a mismatch default to the group enrollment tab, okay? And then before you go over to the individual providers, going back to that other one. So I, obviously, I didn’t really know. Not that one. I’m sorry, the scoping one again, yep, go to the right please.
Hillary Perez-Godfrey (04:26) And so what I did is I just put in the notes of like what I was aware of for enrollment, like the links, the portals, that kind of thing. Is that appropriate?
Naomi Denson (04:38) Yes, I’ll have to review it. Okay. Yes, that’s perfect. Typically, if you do it through the portal, that means it’s standard process, okay?
Naomi Denson (04:53) Now.
Hillary Perez-Godfrey (04:53) I did just get another email from Lasalle. I know that was one that we were waiting on and he replied back to me yesterday saying it was an hdo, which had me really weirded out because I specifically said individual providers. So let me see what he says. So, let me tell me if we need to put that as a non standard, what?
Naomi Denson (05:27) Do you mean by?
Hillary Perez-Godfrey (05:30) My point of contact replied back to me, Henry, because I asked him about confirming about, the portal and… he said we use an hdo credentialing process for ancillary contracts. Please see the attach for your credentialing. So it’s an hdo, it’s not an individual provider.
Hillary Perez-Godfrey (05:57) Let me show it to you. And then you’ll see. So it sounds like that they’re gonna, they want to credential.
Naomi Denson (06:06) the.
Hillary Perez-Godfrey (06:07) group and not individuals. So I just need clarification from that and I haven’t been able to touch bases with them this morning. Okay? Show you it. Yeah.
Hillary Perez-Godfrey (06:26) So, I think that this is done at my level and not you guys see because it’s all group based. It’s it there’s. Nothing individual. It’s.
Naomi Denson (06:35) all like, well, we can do group enrollments too. We could technically do that. I would just attach the form in this sheet. Okay? So I,
Hillary Perez-Godfrey (06:46) just download this and attach a link to it. You can.
Naomi Denson (06:51) Attach a link to it or just you can just forward it to me and I’ll get it to Dreama. Okay. Let me just forward the PDF to me in an email and I’ll get it on there. Okay?
Hillary Perez-Godfrey (07:03) Perfect. So we.
Naomi Denson (07:04) only need a group. We won’t be doing any individual enrollments as of.
Hillary Perez-Godfrey (07:07) This morning. So we’re already credentialed with them. But this is the one we’re in the process of possibly switching our contracts, right? So we’re in a professional endocrinology agreement with dr Sahas, and the NPS being credentialed and they’re in the process of talking because they want our program as our dsmes as opposed to individuals. So that’s where the hdo came from. So I don’t have the answer right now. So can I guess, can we, that would be the only one that’s popping out? Yeah, yeah.
Naomi Denson (07:44) I’ll have dreamer review this. And for the list all we’ll just wait for any requests to be made until you’ve confirmed with them what we should be doing. Okay?
Hillary Perez-Godfrey (07:56) So that’s what I have on that one. Okay? What’s next?
Naomi Denson (08:03) Only thing for me that the Nashaun, the individual provider enrollment? Yeah.
Nashaun Lee (08:08) So we’re good on that. So that is done. I’m just filling in this last row who is with this with MD CD. But then everything else is completed on that. So I’m going to fill in this last blank row. And then we’re good to go on that. I’m.
Naomi Denson (08:23) seeing still a lot of enrollments down here. So… general membership. So it should either be non par looks like for like it looks like you put no credentialing required. Are these supposed to be direct enrollments since they’re parlinked to group. We had talked about this last week. I think so the, no credentialing required that was on all of these, but it says parlinked to group or you do not send anything to the payer to enroll the providers and they’re just billing under a supervisor or what’s the context there? No?
Nashaun Lee (08:59) That one’s direct, I’ll change that. Yeah.
Naomi Denson (09:01) So that anything probably to group. My assumption is that it should be direct and then we’ve got some that are showing as general membership. So these need to either be parlinked to group, are not linked to group or non par? Okay?
Nashaun Lee (09:18) I see though, I see.
Naomi Denson (09:27) And then, are we gonna do any on the enrollment requests tabs for any that are still in process or are we holding off on that until you get your final report? Is that what I remember say?
Hillary Perez-Godfrey (09:39) It again, please enrollment?
Naomi Denson (09:41) Requests that are still in process with the other vendor?
Hillary Perez-Godfrey (09:46) Yeah, those are, let me look there’s any?
Naomi Denson (09:51) That are still open that you want to either import to continue follow up on your own or transfer to medallion for follow up. I’m.
Hillary Perez-Godfrey (09:58) leaning towards the transfer. Okay?
Naomi Denson (10:01) So, we’ll get the existing loaded first, and then the transfer sheet, you fill out this, we can import the requests with a transfer. We call it adopted status on our end. We would just need the details on the submission, like tracking numbers, where applicable submission dates, any relevant details on the submission that would be required for us to follow up? I think I sent a list over. If not, I have, I think you would ask me for exactly what’s needed. I think I sent that over, but if not, I’ll resend it. Can.
Hillary Perez-Godfrey (10:37) you just resend that please? Yes.
Naomi Denson (10:39) I will. And then I did confirm that with our availability team that we do have the access we need for availability. I do have our medicare team checking Pecos just to make sure we accepted it and that, that’s set up. I.
Hillary Perez-Godfrey (10:54) Just got an email this morning from… I just got an email this morning to allow… like just now.
Naomi Denson (11:07) Okay. Yeah. I actually pinged her a while ago, not today but a couple days ago or yesterday and I forgot to, she wasn’t in the channel for you guys. So it asked me to add her or not. So, I just realized earlier this morning that she hadn’t actually seen that yet.
Naomi Denson (11:24) So I was like, hey, Mike, can you check, so, yeah, yeah, that was Jill in there doing that and confirming. So correct with Pecos for the.
Hillary Perez-Godfrey (11:34) Because I need to request, it says something to act on this request, please log in and use the link below copy paste. So… what do I do here?
Naomi Denson (11:45) I’m not sure. It just.
Hillary Perez-Godfrey (11:47) Says a connection request was made by Jill Gardner. Yep, that’s us and CMS, if you’re an employee of my diabetes tutor to act on their research. So I have to approve it, right? Yes. Okay. So I need to approve Jill or? Okay?
Hillary Perez-Godfrey (12:08) Okay. CMS… so I’ll do that after this call. Okay? All.
Naomi Denson (12:15) Right. Perfect. And then you have, it was four providers that you have an urgent need for medicare enrollment not?
Hillary Perez-Godfrey (12:22) Urgent. I was just wondering is, you know, could we obviously start anybody that had an on like an onboarding as they’re in that line item? Those are what were new providers? Yeah, at the time with the transition from the previous vendor?
Naomi Denson (12:41) Right.
Naomi Denson (12:47) They’re they.
Hillary Perez-Godfrey (12:48) haven’t been, I don’t think that they’ve been picos enrolled for.
Naomi Denson (12:54) us. Okay. So, yeah. So you can put those on the enrollment request spreadsheet as a new request type. Let me show you. Hold on. I just realized I’m not showing my screen anymore because I gave it to you. So on the enrollment request tab, any that have already been submitted and you want us to pick up follow up, you’d list it as a transfer request here. And then any of those medicare enrollments that you want us to start on from scratch, brand new, you would list it as a new, and we can import all those requests at once. Okay? Or you can just put, you know, we can, once we get the existing group enrollments loaded, you can still add medicare enrollments directly to the platform. Okay? Let me just have dreamer do a final review of the payer scoping and sign off on it. But medicare is pretty straightforward. So not really a nuanced process there.
Hillary Perez-Godfrey (13:50) Okay. And I just got the go. We actually… in the past, we used to wait the 60 days. I mean, I’ll still notify you, but our two newest employees, I’ve been given the go for them to start enrollment. Okay? Pay your enrollment. So they would be like, I guess what I’m gonna say is a full across the board submission. So just put them under the provider enrollment requests as.
Naomi Denson (14:19) Well, yes. Yes. With each payer.
Hillary Perez-Godfrey (14:22) Okay. Yeah, you can.
Naomi Denson (14:24) Either do this. You don’t we don’t have to import this. The only reason we would have to import the sheet is for any of those transfer lines to get the adopted tag on them. But any new requests, once we get the existing group enrollments loaded, if you have a new provider, it would technically be much faster for you just to do it through the portal agreeing instead of taking the time to fill out sheet. So let Nico get the existing group enrollments done. And then would they be, would those providers be with every single payer?
Hillary Perez-Godfrey (14:56) I’ll have to just go through based off the individual there, there’s a couple that might not do RDS. So.
Naomi Denson (15:04) Okay. Let’s say you have the notes here for the ones that don’t do RDS, if you could add that in, yes, just, add a note here that says, I’ll put in a left from right?
Hillary Perez-Godfrey (15:25) Enrollment exceptions. Okay? Special circumstances for enrollment. Okay?
Hillary Perez-Godfrey (15:35) Perfect. Thank you for that. Okay. So.
Naomi Denson (15:40) This is.
Hillary Perez-Godfrey (15:42) one I’m currently fighting cigna just came up. So our contract is new. There was just like only a couple of providers that were approved. And so we’re like in process right now like actively these days. But two of our providers, they said, we’re not credentialing RDS right now. It’s not ever, it’s just they’re saying our market’s saturated or whatever, right? How do you, how one, what do you guys do when you start getting notices that are like outside of the intent of the contract? And how, what do you do with those? So, if you,
Naomi Denson (16:28) put a request in the platform and we got a notification from the payer that we’re not enrolling these panels closed. We’re not accepting any new providers right now. We would send a task to you and let you know, hey, payer came back. Said they’re not panels closed retry, in this time frame. Then we can stop the request and you can re, request it later on or we can put it on hold and then you can request us when you want us to start it again. So.
Hillary Perez-Godfrey (16:52) Does that task note go? Will it be within the individual providers tab? It’ll be an admin?
Naomi Denson (17:00) Task that you’ll see in your overview tab? Okay? And it’ll show on the payer request line as it needs client attention. So they’ll task it to you with a note that… says what the response from the payer was, if it’s not able to be processed, okay?
Hillary Perez-Godfrey (17:19) And so, if we wanted to try again or like I’m appealing it right now because obviously, they just executed our agreement and there’s no way that we could do business with the two RDS that we have, right? So it’s like you have to let us in, so.
Naomi Denson (17:40) Something?
Hillary Perez-Godfrey (17:40) Like that, do you ever appeal to the payers on our behalf or is that something that would be assigned as a task to me for me to act on? We do file?
Naomi Denson (17:49) Appeals with payers, and in certain circumstances, as long as we were the ones that started the enrollment and submitted it, maybe that our transfer lines, if they came back like that, we would push that back to you or just do a new submission, and try. But I don’t I’d have to verify honestly with our PE team on the appeal process for transfer lines. But I know if we are doing it and then they come back and say no, we would work with you on that, okay?
Hillary Perez-Godfrey (18:17) Because I just, if we have that admin task and let’s say we wait six months and now it’s like, okay, now, I want to go back that’s something we can extract up through the report builder or through analytics. Is that correct?
Naomi Denson (18:30) It would go into like, a stop typically a stop status with a stopped panel closed. And then you could reach out to support through that line and say, hey, can we reopen this and try again or you could just submit a whole new request so that you have all of that tracked separately. It’s up to you.
Hillary Perez-Godfrey (18:50) Okay. And so I understand Nika, when you do the groups, and barring any clarifications, and then we get this, will you, I know.
Naomi Denson (19:04) That we are.
Hillary Perez-Godfrey (19:05) telling you who our providers are, but do you go back behind it not? Do you go back to these payers and request rosters also to double scrub or is it only starting from with where we’re at? Yeah.
Naomi Denson (19:18) So the imports that we’re doing are based off of this, you are our source of truth. So we’re not double checking with the payers for anything that’s imported as an existing enrollment. We submit new requests. We will reach out to the payers and confirmed if they’ve already been enrolled. So we can determine what kind of an application is needed. We do a basically an initial discovery, okay? But we don’t do anything on existing enrollments. Okay?
Hillary Perez-Godfrey (19:45) So, you don’t have an option for us to do like a roster scrub?
Naomi Denson (19:50) Not for existing enrollments that are imported, there’s a separate contract offering that comes with additional cost that’s called par analysis. I don’t think that’s in your contract, but that is one where instead of importing them as existing enrollments, we would import them as par analysis requests where we’re doing that verification, but.
Naomi Denson (20:16) It doesn’t automatically verify or scrub anything when they’re imported as existing because we’re relying on you as a source of truth. Okay?
Hillary Perez-Godfrey (20:24) Is that something that you can maybe just add as a footnote for Peter for us to discuss at our exec level touch point?
Naomi Denson (20:42) And then, okay.
Hillary Perez-Godfrey (20:51) Because to me the biggest hurdle has been the blues like our contract says one thing, but then they’re like we automatically added you to all the lines of business. So like if you look at our group enrollment, we only have a medicaid contract. But when I did a like a availability?
Naomi Denson (21:11) You know?
Hillary Perez-Godfrey (21:13) Extraction for like who they have loaded, who they don’t it just lists all these like it goes commercial, yes, no, yes, yes, no. And, but it’s more. So, I guess, how did, how do I do that? How do?
Naomi Denson (21:29) I share that with you guys? What is it that you want to share? Like just so, so.
Hillary Perez-Godfrey (21:36) Blueshield or, you know, blueshield, let’s say we have only a medicaid contract, but… they’ve enrolled, they’ve automatically transferred some of our providers per this downloadable report to the other lines of business as well. But I have no… proof that.
Naomi Denson (22:00) That’s truly.
Hillary Perez-Godfrey (22:01) How it’s happened? You know, that we are automatically covered under those lines of business.
Naomi Denson (22:06) So.
Hillary Perez-Godfrey (22:08) How, what happens when I run into a discrepancy like that? Like let’s say maybe there was a notification going, you know, whatever lines we add you’ll automatically be loaded, but maybe that notification predated me. So I have no proof as a source of truth telling you this, just what ability you’re.
Naomi Denson (22:28) saying, if you load it as an existing enrollment and then later on there’s an issue and turns out you loaded it with a line of business that you don’t actually have or… we need to add?
Hillary Perez-Godfrey (22:39) More lines of business. Yeah.
Naomi Denson (22:43) So, from, that would just be a demographic update. So, the only issue is if you loaded it with commercial and medicaid and then turns out you only have medicaid and still need to add commercial, you would have to go in and find the existing enrollment and edit it to remove that line of business before it would allow you to request it. So if this said commercial and medicaid, you would have to remove the one that’s showing is existing because the system won’t allow you to request something that it says you already have. So it would be removed from the existing enrollment. And then a demographic update would be requested.
Hillary Perez-Godfrey (23:20) Okay. In your experience, is it better to have less and add more of the lines of business or less?
Naomi Denson (23:32) Like add less than you’re sure of and then add more later to the existing enrollment. Yes. Yeah, I would only put anything on an existing enrollment that you are absolutely sure of and you can always edit them later if you confirm something else is in network, okay?
Naomi Denson (23:54) Or request a demographic update from us if you need us to add it. Okay?
Hillary Perez-Godfrey (23:58) So, all my cygnus stuff that I’m doing right now because like I’ve got six notifications yesterday, confirming in process with the provider id?
Naomi Denson (24:09) Actually.
Hillary Perez-Godfrey (24:10) I believe I updated that on the provider enrollment tab.
Naomi Denson (24:16) Those would be.
Hillary Perez-Godfrey (24:17) Transfers?
Naomi Denson (24:18) Correct. Yes, if they’re already in progress. There’d be transfers. So we would need the details of, you know, submission date provider id tracking number, whatever we would need to continue to follow up with that. Okay? That’s.
Hillary Perez-Godfrey (24:34) for you guys to take it over. But what is the, what’s the value for the one where it’s like it’s in process with us and I want to just wait it out until the outcome.
Naomi Denson (24:48) Oh, if you’re going to, so, yes. So you can still add it to this request… tab. Okay? You would just put, is medallion owned, you would put false, that will import it as a client owned line that will allow you to track it in the system and then mark it completed is?
Hillary Perez-Godfrey (25:07) Medallion. Okay. And so that was column G that’s the part I kept missing?
Naomi Denson (25:15) Okay.
Naomi Denson (25:21) Anything else? Any questions from you, Nashaun?
Hillary Perez-Godfrey (25:25) Nope. All good on my end?
Naomi Denson (25:26) All right. If you will just shoot me a message. Is this done? Is this ready now? I’m just going to?
Nashaun Lee (25:33) That last column.
Nashaun Lee (25:34) I just want to fill in those missing blanks at the last one. And then I can go ahead and confirm with you.
Hillary Perez-Godfrey (25:37) All right.
Naomi Denson (25:38) Just send me an email and I’ll get it over to Nico to do his thing. All right, beautiful? All right. Anything else? Hillary? No?
Hillary Perez-Godfrey (25:48) I’m sure. I’ll have something as soon as I hang up the phone, but we’re good.
Naomi Denson (25:52) Awesome. All right. Well, shoot me an email if you do, and we will talk to you soon. Okay? Thank you. All right. Thanks. Bye.