Transcript
Barret Pickering (00:00) morning.
Barret Pickering (00:55) Vanessa, and Jermaine, is Naomi joining us today?
Dreama Hembree (00:59) I believe so.
Barret Pickering (01:01) I had problems.
Dreama Hembree (01:05) Getting into the call, so she might be having issues there. She is… it would not allow me to use my camera either. So, I apologize for that. Oh.
Barret Pickering (01:17) No worries. I don’t know what the deal is with teams doing that because when I join external meetings, the same thing happens to me.
Naomi Denson (01:29) Hi, everyone.
Barret Pickering (01:30) Hey, Naomi. How are you? I’m.
Naomi Denson (01:33) good. How are you?
Barret Pickering (01:34) I’m excellent as always as your motivational speaker.
Naomi Denson (01:38) Yes, team Barrett.
Dreama Hembree (01:43) Are we gonna get some Tony robbins energy up in here?
Barret Pickering (01:48) No.
Naomi Denson (01:51) I’ll have to send you, I’ll have to find like a video of the Guy I was telling you about yesterday and send it to you because he’s just so intense and happy all the time that I think he would really enjoy it. Oh.
Dreama Hembree (02:05) Who would enjoy that? I don’t know.
Naomi Denson (02:08) We were all really scared of him the first time we walked into the meeting because nobody told us what we were doing. And now he’s like all of like, it’s been like six years and he’s still like my bestie, we still talk because he was just so fun. But anyway, we have Dreama and Vanessa here. Anybody else we’re waiting on from your side? Is gab coming or anyone else?
Barret Pickering (02:35) No, I don’t know if we necessarily need gab… worst case, we can pull it out of her of whatever’s needed.
Naomi Denson (02:44) Okay. All right. Dreama. You ready? Yeah, yep.
Dreama Hembree (02:48) I’ll go ahead and share my screen. Hopefully, this works on teams on the browser.
Naomi Denson (02:55) And are you recording this? Do you mind if we record it?
Barret Pickering (03:00) Yeah. I can record this.
Naomi Denson (03:04) To make sure.
Barret Pickering (03:12) Okay. We’re good to go.
Dreama Hembree (03:16) Hopefully y’all, can see that… yep. Okay. I keep getting a thing saying we can’t access your camera and all kinds of errors. So hopefully it doesn’t fail on me. Okay. So the goal today is to kind of go line by line through each payer, review the current enrollment process that you all are following, kind of compare it to the medallion standard process enrollment, and then make sure there’s not any custom processes that we need to call out to the team to follow, just to make sure that we’re aligned on each payer. So, I did notice that there was quite a few that were added to this. So, and then they look like they haven’t been completed. So, I don’t know that we’re going to be able to get to all of them. So I might have to assign some homework. We will start with Aetna for Arizona, column F for the current group enrollments, obviously, we need to, we need to know that information. So, do you all know that, or is it something’s pending? Are we waiting on someone to verify?
Matthew Spurling (04:28) How does that, how do you find that define that Dreama?
Dreama Hembree (04:32) Say that again? I’m sorry, how?
Matthew Spurling (04:34) Do you define that column? What does current group enrollment mean?
Dreama Hembree (04:37) So, is there a current group enrollment in place for the payer? Do.
Naomi Denson (04:42) you have a contract?
Matthew Spurling (04:44) Yeah. Oh, do you have a contract? Okay?
Dreama Hembree (04:46) Do you have a contract? Yes, anything?
Matthew Spurling (04:48) On everything can be, yes, then for that?
Dreama Hembree (04:50) Everything is yes. And it’s at the group level, they’re not individual contracts.
Matthew Spurling (04:55) You got it. We only do at the group level, you’re correct?
Dreama Hembree (04:58) Okay. So, all, yes, for column out. All right. And then the,
Matthew Spurling (05:05) I’m sorry, let me stop you. One more, one more clarifying question especially because we’re talking, all I see right now is Arizona on here. We have to be mindful of bifurcating RH… revere, rhg, of Arizona versus village in Arizona because that does change the narrative slightly. So, to everything on everything we’re seeing on here, it would be, yes, for revere or rhg of Arizona, however village does not have a contract with Arizona priority care or caremore, carelon?
Naomi Denson (05:50) Yeah, I think for the village providers, we’ve already got their processes in place. So, we’re following the race that we transferred over. So, I think everything on this is related to revere, as long as the team that’s handling the village provider enrollments, knows which payers they should be requesting.
Matthew Spurling (06:08) Great. Thanks for that clarification Naomi. So yes, then everything can be, yes on here.
Dreama Hembree (06:14) Okay. What was that? Sandy? Did you have a question? Nope? Oh, okay. All right. So yes, for this one. And so the non standard enrollment process that just basically is asking, is there something that you are doing to submit your enrollments that doesn’t follow the standard process on the payer’s website? And if that is a yes, then we would call that out. So do you know if you are following a non standard enrollment process for Aetna?
Matthew Spurling (06:49) So this one, we’ll have to check in with gab on this one Barrett. I would be highly, I would be very shocked if we had a nonstandard enrollment process different than what is set up on the website for any of the payers. I.
Barret Pickering (07:05) Want to say, I’ve talked to her about these. I’ll get with her and pull the ones that are nonstandard but I think all of the Arizona ones are standard. There were only a couple later maybe in Massachusetts that were nonstandard. I could be wrong. I’ll get back with gab. She’s been out and still maybe out. I don’t know what she’s doing, but when she’s back, I’ll get ahold of her.
Dreama Hembree (07:34) Okay. All right. So we’re going to leave the nonstandard enrollment process column kind of blank until we verify that. I do see like further down for, you know, Massachusetts and I think she added some Tennessee payers that she did call out. Yes, there was some nonstandard enrollment processes. And then she’s linking some rosters.
Matthew Spurling (07:55) Go ahead. Sorry to interrupt you Dreama. So I think now that we know what this is defined as we can more appropriately update it. So I think column F, we should be good to say yes, across the board. Column H should be homework for us to go back and populate now that we have an understanding of what that means. Okay?
Dreama Hembree (08:12) Perfect. And then of course, column I plays into kind of column H with it being delegated. And if that is the case, then, you know, what is the cadence there? Who are we submitting those to? And she has filled in some of that here. We need to know obviously the cadence, the roster that you’re all using, who does it go to here on the distribution list? And then of course, any exclusions? Inclusions?
Matthew Spurling (08:40) Who do we have as yes right now? Devoted and imperial. So imperial is a yes… devoted. I’m not aware of that being a yes. And I need to find documentation of that because I think that would be my next question is if we have delegation on any of these, where’s the documentation tied to it, I don’t have that documentation. So I think Barrett put in the chat humana and alignment those.
Barret Pickering (09:09) Were village? Yeah.
Dreama Hembree (09:14) Those are village?
Barret Pickering (09:17) I’ll sit down with gab and I’ll like we’ll screen share and I’ll make sure she like.
Matthew Spurling (09:23) And so Barrett, as you’re having those conversations with gab if she says, yes, she needs to provide the documentation like we know we have for imperial and humana. Okay? Slash also clarify, is that humana one for Arizona? Is it for Massachusetts? I think it’s for Arizona. But if it’s going to be, yes, then I need documentation. The contract that has that documentation to keep on file, got it. And.
Dreama Hembree (09:53) Then Barrett to kind of follow up on that regardless if it’s a delegated agreement or not here. In columns, J is a roster leveraged for submission and she’s got yes marked on, you know, some of the ones that are not delegated, we would need to have that linked here. So we can a, make sure that it’s the same roster that, you know, medallion’s using or if there’s something different. And then for mapping purposes, we need to make sure that of that second got it.
Matthew Spurling (10:22) So, Dreama, J is only populated if I is a yes.
Dreama Hembree (10:26) No… because you can have a non delegated payer and still use a roster.
Matthew Spurling (10:34) Okay. I just wanted to make sure because I see your column L here as well for roster submission. So I wasn’t sure if J was just tied to I or I see now it’s a link to the template. Okay? So.
Dreama Hembree (10:45) J and L would be buddies. Yeah. Okay. So do we want to go ahead and continue going through the rest of these, if we need to get with gab or what do you prefer?
Matthew Spurling (10:58) Yeah, I would say anything in I, that is not filled in today, we can mark as no. Okay. And then we will still follow up with everything else to validate the ones that say yes today.
Dreama Hembree (11:13) Okay. So no, on all of these for delegation. We.
Matthew Spurling (11:17) Don’t have a lot today. So my expectation, is there’s maybe one or two?
Barret Pickering (11:22) Yeah. And I know the major payers are not delegated.
Dreama Hembree (11:29) Okay. What about let’s see? Okay. So we’re going to do yes on all of these?
Dreama Hembree (11:43) I guess the health spring is a yes on that one order now… where she care areas… hello.
Dreama Hembree (12:06) All right. I think that takes us through Arizona. And for Massachusetts, are we just continuing yep?
Matthew Spurling (12:18) Same thing. Yes. And no like that cigna, Massachusetts, that should definitely be a, no. We do not have delegated agreement with commercial row 23 that’s no.
Dreama Hembree (12:36) Masshealth which is a medicaid. Is this a no for delegation, correct?
Barret Pickering (12:50) All right. I put an hour on glab and I’s calendar tomorrow to just hammer this stuff out and all these links and supporting documentation.
Dreama Hembree (12:59) Okay. Those.
Matthew Spurling (13:01) Are nos 30 and 31?
Dreama Hembree (13:16) And then eternal health. Is this a delegated payer?
Matthew Spurling (13:21) Not that I’m aware of.
Dreama Hembree (13:24) No. So we’re changing this,
Matthew Spurling (13:27) So, let’s put that Barrett, let’s check it. Let’s anyone that has a, yes, Barrett, let’s get the documentation from gab. So anything that says yesterday Dreama, that will be our fall, our takeaways to validate that. It truly is a yes.
Naomi Denson (13:39) Okay. I’m.
Matthew Spurling (13:41) not aware. I’m not aware of that being one that’s we’re delegated for, is why I’m getting to that.
Dreama Hembree (13:46) Okay. And then same thing with Aetna is.
Matthew Spurling (13:51) Tennessee is all nos, right? Dawn. We don’t have any delegated credentialing, no, we don’t yeah, yeah, no. Okay. But we can check off that one for row 39 group enroll, current enrollment. Yes, those are obvious. Yeah.
Naomi Denson (14:09) Thank you for calling. That was my bad. No.
Matthew Spurling (14:12) You’re good. We get the definition of what it means now. So that’s helpful. Yeah.
Dreama Hembree (14:16) No, that’s fine right now, blue cross right now for Tennessee. Yes.
Dreama Hembree (14:29) Delegation… medicare, yes?
Dreama Hembree (14:50) All right. I think that is all of them. So other than going through the nonstandard enrollment process, Barry, you’re going to get with gab on that. So… I don’t think there’s a lot that we can do in terms of that. Would you agree, Vanessa on that? We’re kind of stuck until we get that piece of it?
Barret Pickering (15:08) Yeah. So I just need to pull whether it’s standard or nonstandard. And then all the supporting documentation for the delegated? And then the links in what is that? K and L, those are the things, yeah.
Dreama Hembree (15:25) So if it’s standard or not, is there a roster used for submission? And if this is a yes, then we need to have that linked here regardless of delegation. Okay? And then of course, if it is delegated call out, you know, the process or the delegation. And then of course, if it’s a nonstandard enrollment process, call that out as well. Who are you submitting it to? Are you submitting it to like a provider rep? Or is there something like I said other than what the payer calls out on the website as standard enrollment? If you’re using anything other than that, then we would need to know that.
Naomi Denson (16:07) Okay. I have a question. The cigna Massachusetts was changed or marked as no for delegated. It was previously marked. Yes. And I have a roster. So we’re confirming that cigna Massachusetts is not delegated because if so, I need to cancel the ticket for the delegated roster build.
Matthew Spurling (16:29) So, okay. Maybe we need to define this further. So when I read delegated agreement, I’m thinking that we have an agreement in place with the payer stating that we are on the hook for managing the credentialing work for providers. Is that yes? Okay. So the answer to that definitely should be a no, then. Naomi? Okay.
Naomi Denson (16:52) So I will cancel the cigna Massachusetts. The other ones that I had originally were eternal health.
Matthew Spurling (16:58) Devoted.
Naomi Denson (16:59) imperial health. Yeah.
Matthew Spurling (17:02) So, I would say we need to follow up as soon as possible related to those because I’m not aware of eternal, either, I’m not aware of eternal or devoted. I think we’re feeling okay with imperial?
Naomi Denson (17:15) What about humana? So.
Matthew Spurling (17:17) That you just struck the next one which we do have a delegated contract for humana. I think we need to further suss out what that truly means. And if it’s still in place today?
Naomi Denson (17:28) Okay. Yeah, because we have.
Matthew Spurling (17:29) A file?
Naomi Denson (17:30) Of all of the delegation agreements, and the only ones I’m seeing in here are humana, united, pehp… and imperial slash steward. So.
Matthew Spurling (17:42) I mean, we got that same, Barrett and I got that same file yesterday. The PE one I believe is a Utah health plan. So we’re not contracted in Utah through revere, so that you don’t have to worry about. And to your point, I think the ones that we got to check on, we think imperial is a, yes. We’ve got to make sure humana, Arizona. We’ve got to make sure humana is specific to the Arizona market and whether it’s still in place, same goes for united. Okay?
Naomi Denson (18:13) Yeah. Let me know once you, as soon as you guys have confirmed all of that because I need to make sure that the appropriate rosters are requested for the delegation build with Greg… and that’s.
Matthew Spurling (18:25) what we should definitely have, sorry to interrupt you that’s what we should definitely have is if there’s a yes, we should have in a similar folder to what you got from gab, they list a contract that has all of the, has the devoted that we know it has the imperial like there should be a folder that we should have populated with each of the payers that have a yes with a delegated arrangement contract.
Naomi Denson (18:48) And we need the roster too. Yes. And.
Matthew Spurling (18:51) Then roster two totally agree.
Naomi Denson (18:53) Awesome. All right. Thank you.
Matthew Spurling (18:57) Thank you. I think we’re totally aligned like that’s. The big thing for me right now is I see devoted as a yes, but the folder that you and I both looked at doesn’t have a devoted delegated arrangement in it?
Matthew Spurling (19:13) So, Barrett, we got devoted eternal, I think, and I know we don’t have one for cigna Massachusetts. So I wouldn’t even bother with or, you know what Barrett ask gab, the question in case somehow she negotiated that with liberty, but I’m not aware of that.
Barret Pickering (19:30) Okay. So, cigna.
Matthew Spurling (19:31) Mass, cigna, mass, Dreama?
Dreama Hembree (19:34) Cigna. Mass? Okay. Yeah.
Matthew Spurling (19:36) Which I know Naomi mentioned she’s got the ticket for. So we got to check that one.
Barret Pickering (19:42) Okay. So it’s humana, Arizona… devoted of Arizona.
Matthew Spurling (19:49) Eternal of Arizona slash Massachusetts and cigna of mass.
Barret Pickering (19:58) Got it. I will ask about those. Okay? I.
Dreama Hembree (20:04) think we’re probably at the point where we need further information to kind of go forward on any of these. So that helps some, get some of that taken care of. And now Barrett has a bunch of homework to do.
Matthew Spurling (20:18) Well, Dreama, can we keep going actually? Because I think roster submission there’s still the opportunity that I think everybody should also be aligned that if we have a yes listed in roster submission leveraged, we should have a template, right?
Dreama Hembree (20:31) Correct. And,
Matthew Spurling (20:32) so, what we need to figure out from GAAP is, or Aetna of Massachusetts, Arizona, is it a roster or is it manually done? And if it’s a roster, what does that look like? If it’s not obviously manual, there should be, would we need more detail from all of these ones too? Barrett? Yes.
Barret Pickering (20:54) You’re talking column L?
Matthew Spurling (20:57) Column J that then ties to L, oh,
Barret Pickering (21:00) okay. Got it.
Matthew Spurling (21:02) So, we should have, if it’s a yes, like row 12, we got to follow up with just because of the fact that it says yes, but then there’s not a link on L… whereas column J, we need J to have either yes or no. If it’s a yes in J, we then need to have L.
Dawn Gautreaux (21:20) Got it.
Dreama Hembree (21:23) And then if it’s a yes here in H, then we need to have K.
Matthew Spurling (21:30) Yep, which ideally we do not. Ideally, we don’t have a lot of H’S it says, yes.
Barret Pickering (21:39) Yeah, I’d say the majority of H because I’ve talked about this with gab before, I’m pretty sure most of these are standard enrollment processes and.
Dawn Gautreaux (21:48) I probably marked some Tennessee ones as non standard, but they’re probably standard now that I know the definition of it. So we can.
Matthew Spurling (21:54) Go back and do that too.
Dawn Gautreaux (21:55) Yeah, we can change those. Do?
Dreama Hembree (21:57) You want to look at the Tennessee ones? Okay. So, for Aetna Tennessee, you have non standard enrollment? Yes. Do you want to change that to a no? Yeah.
Dawn Gautreaux (22:06) So, I follow, however the website is, I don’t do anything different than what they ask?
Matthew Spurling (22:10) Okay. But.
Dreama Hembree (22:11) You do? Okay. So, this is just the W9? Okay? Because.
Dawn Gautreaux (22:19) They do ask for that as part of the enrollment. So I think that’s why I was like, is that the non standard part is because they ask for something additional?
Dreama Hembree (22:27) Yeah, no, just whatever the payer has on their website is what we consider standard.
Barret Pickering (22:32) Yeah.
Dreama Hembree (22:33) So, you’re not using a roster that’s just the W9.
Dawn Gautreaux (22:38) And that’s just the link to the website?
Dreama Hembree (22:41) Oh, okay. Okay.
Dawn Gautreaux (22:42) Yeah.
Barret Pickering (22:48) How come column H is titled non standard enrollment process instead of just standard enrollment process. Yes, no, I.
Dreama Hembree (22:58) did not make this? I did not. I.
Vanessa Persha (23:02) Literally asked myself the same thing the other day, Barrett, I was like.
Barret Pickering (23:06) Can.
Dreama Hembree (23:07) we.
Vanessa Persha (23:08) just make it standard. That would be easier for me to comprehend, right?
Dreama Hembree (23:12) Because your brain has to go, your brain can’t process the negative there. Yeah. Okay. So we’re changing and better to know, yeah, is a roster leveraged. This is so.
Dawn Gautreaux (23:26) With every, with the embedded roster, if you have an app that you’re doing, you have to have a collaborate a collab agreement signed by their supervisor.
Dreama Hembree (23:34) Right. So these are just for your pas. Okay. That’s.
Dawn Gautreaux (23:36) yeah. I just didn’t know where to put it? I didn’t know where to put it. So I just put it there. Okay. No.
Dreama Hembree (23:42) No, that’s okay. And this is the roster that you’re.
Dawn Gautreaux (23:44) that’s the roster. Yeah. And.
Dreama Hembree (23:46) then it’s monthly by the, on the fifth. So, but you’re not delegated, correct?
Dawn Gautreaux (23:53) You’re still sending a monthly, we just send a monthly one. Yeah, just so they keep up with who we have and whatnot, we’ve had some issues with ambetter in the past. So, just to keep that continuity, okay?
Dreama Hembree (24:04) So, just for adding single providers, you’re still leveraging this roster, correct?
Dawn Gautreaux (24:11) I still use that same roster. Yeah. Okay. But I didn’t.
Dreama Hembree (24:14) ask that, go ahead. I’m sorry, I,
Dawn Gautreaux (24:16) did just find out that there actually is a provider form that you can fill out for a single provider. So that is an option, but I’ve always just submitted the roster even if it’s just been one provider. Okay?
Dreama Hembree (24:29) And then the distribution list here that you’re sending it to, is this so?
Dawn Gautreaux (24:35) This looks like that’s what that’s who I would send it to that’s their the.
Dreama Hembree (24:40) box? Okay. This is your team here. Okay? I didn’t realize I didn’t see that. Okay. That’s your team?
Matthew Spurling (24:46) Can we talk through that in a little bit more detail? So Dawn, on a monthly basis? Are you sending just updated providers, any like ads changed terms or are you sending a full roster?
Dawn Gautreaux (24:56) Usually we just send our full roster, but I can’t… I was sending a full roster and then it was just terms and ads, but I also still continue to send full roster just because it was me… you can do either, whatever.
Dawn Gautreaux (25:14) I mean, they don’t require to do a monthly roster. You can just send in a roster with providers, ads and terms. So whatever makes the easiest for this, we can not do it monthly. I mean, we should have had struggles with them in the past, so that’s why I just did it as monthly.
Dreama Hembree (25:31) Okay. And Vanessa, we’re not, we don’t send a full roster monthly if it’s non delegated, correct? Correct?
Vanessa Persha (25:39) Yes, we would only submit, add team changes in terms. You guys would just need to submit any full rosters as required by the payer. Okay?
Matthew Spurling (25:48) Okay. And so, can we just talk through that a little bit more if the agreement is not delegated? However, the payer’s expectation is to send something on a monthly basis that’s where we should populate this cadence component because we do have some payers in the Massachusetts market who ask us to send it up on a regular cadence or a monthly cadence. It?
Dreama Hembree (26:16) Would only be your.
Vanessa Persha (26:18) Ads. Yeah, your ads terms and changes rosters if those have a specific cadence that’s what we would need populated here?
Matthew Spurling (26:27) Okay. Like some of the, a couple of the payers have a cadence for ads terms, changes, but then also on a monthly basis, expect a full roster that’s.
Vanessa Persha (26:38) what we understand from the instructions that were provided here, well, you, since you all are going to manage the full monthly roster, we don’t need to know when you’re submitting those. It’s just the cadence for the ads terms changes.
Matthew Spurling (26:49) Got it. Okay. So, you’re only managing ads terms, changes, not managing full roster sense?
Vanessa Persha (26:55) Correct for your non dials, some.
Dawn Gautreaux (26:57) Of that Tennessee stuff then? Okay?
Matthew Spurling (27:00) So, Barrett that we got to take that back to and make sure that Clint knows that folks on the team are going to have to still send in full roster, monthly rosters to certain payers. Yeah.
Dreama Hembree (27:11) I.
Vanessa Persha (27:11) know that one. We’re.
Dreama Hembree (27:13) good on that. Okay. And then, so I think we still have some time blue cross blue shield of Tennessee. It’s a non delegated. Now, we’re changing this to no, correct. This is not just a standard, correct?
Dawn Gautreaux (27:27) Yeah, it’s just standard.
Dreama Hembree (27:33) It’s doing that through a vanity. And, okay. All right. That one’s that one’s pretty easy, straightforward for cigna. We have that’s.
Dreama Hembree (27:50) just your W9 there’s. So you are using a roster, this is the template and you’re sending it to intake at pdm. Okay. That’s standard? Okay? Just a link letter, W9? Yep. Okay. Got on that one? Oops. Yes… health, spring. Okay. And,
Dawn Gautreaux (28:20) that… cadence would change because, I wasn’t aware. I didn’t know that the full roster was done by us and that’s what they’re asking for monthly is a full roster? Okay?
Dreama Hembree (28:30) So, you’re just using this, but you’re still using this roster for the ads changes all of that. And then just here is the full roster is what you’re submitting? Okay. Yes. Okay. And then you’re submitting that to.
Dawn Gautreaux (28:48) Crystal. Yeah.
Dreama Hembree (28:51) Okay. I was just kind of, I don’t know what the standard payer process. I’m not looking at it right now, but this seems to be kind of non standard to me that it would go directly to her.
Dawn Gautreaux (29:02) I guess that would be non standard support. It’s a rep. Okay?
Dreama Hembree (29:06) So, you’re sending it straight to the rep. Okay? All right. So, I’m going to mark this one. Yes, because that’s a, that’s kind of a, that’s a good example of the non standard, if normally, you would send it at like, you know, an intake and cigna or something generic like that, where this is going to someone specific. So I will mark that one. Yeah. So you send this and you just send this to her just as you’re adding them, correct. It’s not on a weekly or anything like that. No, okay.
Matthew Spurling (29:37) So, let’s take that one back and under, I’d like to understand more why we are following a non standard process there. We can talk about that later, okay? Perfect.
Dreama Hembree (29:46) I can switch it back to no, what? Yeah, go ahead, Vanessa. Sorry?
Vanessa Persha (29:50) Is that health spring we’re looking at? Yeah.
Dawn Gautreaux (29:53) Yes. Okay.
Vanessa Persha (29:54) So, I am, our standard enrollment process is to update caqh, and if it’s a provider joining an existing group, we do reach out to the designated provider relations contact rather than submitting individual forms. So this one is technically a standard process treema. Okay?
Dreama Hembree (30:11) Okay. Thank you for that. Yep. All right. And then for devoted, is this a no Dawn?
Dawn Gautreaux (30:22) Yeah, I just follow what they do. Sorry. Okay.
Dreama Hembree (30:25) No, no, you’re good. You’re good. And then there’s your form we can.
Vanessa Persha (30:31) Blame the nomenclature of that.
Matthew Spurling (30:32) That column.
Dreama Hembree (30:33) I agree. It is, you do have to think about it. You’re like what is this asking me? Yeah, I.
Dawn Gautreaux (30:39) was just like if I have to submit anything additional than just a roster, that must mean that it’s not standard.
Dreama Hembree (30:44) Let’s start everything. So you’re using both of these.
Dawn Gautreaux (30:52) That’s the roster. And then they have that independent panel form that you have to fill out for the apps that are on?
Dreama Hembree (30:59) The roster, oh, for the, okay. Got.
Dawn Gautreaux (31:01) It, yeah, they go hand in hand. Got.
Dreama Hembree (31:03) It. Okay. I see you called that out here. Got it. All right. So… we decided it was a yes. And then for humana, were we checking on, yeah, it was humana, Arizona that we were checking on, not humana Tennessee.
Dreama Hembree (31:33) On that standard for humana?
Dreama Hembree (31:39) Medicare is pretty straightforward, just like a 55. I, yeah. Okay.
Dreama Hembree (31:48) And then Oscar, so, no, and then there’s the template and then rosters. Okay. All right. That takes care of Tennessee.
Dawn Gautreaux (32:00) There might be a few more there’s. Just a big space because I kind of, yeah, I’m.
Dreama Hembree (32:03) sorry, there was a big space I’m.
Dawn Gautreaux (32:05) a bit deep, a little over detailed. Sorry?
Dreama Hembree (32:08) I thought we were to the end, right? No, no, I just got ahead of myself there. Okay. So current group enrollment, no. And then we’re no, I’m delegated, right? For crime health. Okay?
Dawn Gautreaux (32:30) Roster that cadence is for full roster. So, okay. Okay.
Dreama Hembree (32:36) I’ll go back and take those out now that I know what that’s for. Okay? All right. So we’re good on this one. So railroad that one’s pretty straightforward. Yeah, Tennessee… medicaid, this is a no, no.
Dreama Hembree (32:59) Okay. You’re not doing anything? Yep. Okay. That’s your standard one for uhc, you… do have recurring enrollment for these guys. Yeah. Sorry, you’re okay.
Dreama Hembree (33:22) Uhc is not delegated, right? For. , Tennessee. No. And.
Dawn Gautreaux (33:28) On this one, I don’t use that bulk roster. I just add mine in as… I get them, but I did say that it was an option to add a bulk roster. So that’s why I put that roster there, so.
Dreama Hembree (33:43) I don’t know, but you’re just using the portal, right? I’m using the,
Dawn Gautreaux (33:47) portal, correct? Yeah. Okay.
Dreama Hembree (33:53) Okay. So, yeah, we’ll just mark that one as standard then.
Dreama Hembree (34:03) I can’t self let out. Okay?
Dreama Hembree (34:15) And well, care and the no, which you are using. Okay? That’s a collab agreement there’s your time. Okay? So.
Dawn Gautreaux (34:24) Yeah, the non standard approach is going to be no on that one. And the cadence is for a full roster, got.
Dreama Hembree (34:32) It, and it’s just going to the regular support email, okay, perfect. And then well, point and say, yes.
Dreama Hembree (34:46) And you’re using that template and it’s just going through availability. All right. Yeah. Okay. That was fairly painless. Hopefully for you. All, anything else that we need to look at?
Dreama Hembree (35:06) Any questions? What are those other tabs? Do those need things? Naomi? What?
Matthew Spurling (35:14) Do we have for Massachusetts? I think we’ve done, Tennessee. I.
Dreama Hembree (35:20) Think we were going to, I thought we were needed, you guys needed to circle back on Massachusetts. Did I skip over?
Matthew Spurling (35:28) Let’s see. So we… have… I think we can talk through some of these, so.
Matthew Spurling (35:44) Aetna is non standard. Blue cross is non standard. Blue cross is a manual submission. So, I’m glad to see. That says, no.
Matthew Spurling (35:59) Yeah, Aetna Massachusetts, non standard enrollment process.
Dreama Hembree (36:04) It is a non standard enrollment.
Matthew Spurling (36:06) Process. It is not, it is not a non standard.
Dreama Hembree (36:08) Okay. No.
Matthew Spurling (36:10) We use the roster. We’re good there, blue cross, blue shield. We follow the typical process that we know, which is a manual submissions, right?
Dreama Hembree (36:25) So, we know we already did that one.
Matthew Spurling (36:28) Cca, non standard. We got that. Yeah, we got that.
Matthew Spurling (36:38) Obviously, so the non standard or I guess this one is cca, is medicaid. It should not be medicare. It’s medicare and medicaid. Sorry, looks like we have that misappropriate that’s not correct. So, it should be both medicare and medicaid. Cca is a little different because it’s medicaid. You have to participate in masshealth to participate in cca, you got that down in column P there or they have a mce form capital M, capital C, capital E form that can be filled out if they did not participate in masshealth. I don’t know how familiar you all are with the massmarket.
Dreama Hembree (37:28) So, masshealth is one of your payers. So we would be enrolling in them anyways, that’s the state medicaid, correct?
Matthew Spurling (37:34) Correct. Typically, there are particular practices that opt out of participating in medicaid. And if they opt out of participating in medicaid, then they would need to fill out an mce form.
Dreama Hembree (37:49) I will make a note of that just to make sure that’s called out, go ahead.
Vanessa Persha (37:52) Vanessa, I was going to say Dreama, column D for masshealth would be medicaid, ma.
Matthew Spurling (38:00) Sorry, not for masshealth. Masshealth truly is just medicaid.
Vanessa Persha (38:06) Yeah, that’s what I’m saying… masshealth Massachusetts line 27 where it says no match found for payer name, yeah.
Dreama Hembree (38:16) In.
Vanessa Persha (38:17) medallion, that’s just straight medicaid.
Matthew Spurling (38:20) Yes. Oh, yes, totally agree. Yeah.
Vanessa Persha (38:23) So, it would be medicaid, ma there. And then it’s traditional medicaid for the line of business.
Dreama Hembree (38:29) Okay. I think they’re going to rerun those after we do this, but I will fill that in. Okay, thank you for calling that out.
Naomi Denson (38:36) Yeah, I’m working on it right now to rerun the payer names that were added after we did the initial mapping.
Dreama Hembree (38:42) Okay. Thank you. Naomi. Okay for CTA go.
Matthew Spurling (38:46) Ahead. So, cigna looks good.
Dreama Hembree (38:52) Yes, for cigna, and then, Fallon.
Matthew Spurling (38:56) Fallon, we do follow their standard process. We had the non standard component to that was that they had wanted us to send a roster every other week.
Dreama Hembree (39:07) Oh, okay. A full roster. Okay. Yeah. Okay. All right. So, let’s leave that now.
Matthew Spurling (39:20) First health, first health should be, no, no… just the regular. Yeah. Okay. Same thing. We got onto a cadence where we were sending in rosters on a regular basis because we had so many issues.
Dreama Hembree (39:40) And then humana, that’s a, no, correct. Yeah, we’re not.
Matthew Spurling (39:44) Delegated from Massachusetts. Both of those are no, yeah, both of those are no.
Dreama Hembree (39:49) And then masshealth. We talked about that one already, yes.
Matthew Spurling (39:57) Mgbhp should also be, no. I’m pretty sure all this should be no… okay.
Matthew Spurling (40:15) For united, have you all worked? United has kind of updated their enrollment process to be utilizing some platform called MPP.
Dreama Hembree (40:28) I have not personally utilized it. Okay. It’s.
Matthew Spurling (40:32) totally new. Okay. My.
Vanessa Persha (40:34) Practice profile?
Matthew Spurling (40:36) Yes, you got it. You got it. Yes. Okay. Cool. So, we were transitioned to that back in November time frame. So hopefully, that still counts as a standard process and you’ll see the enrollment template as MPP. Yeah.
Dreama Hembree (40:51) United has their groups where they kind of designate it to use the online portal, use the, you know, group profile portal. Yeah. So they don’t really have any rhyme or reason there. Okay? So, we’re good on all of these. These are non standard here’s. The roster. We’re good on these.
Dreama Hembree (41:20) And then U. S, family health. This is the no. And then it’s just regular. Okay, employee providers only.
Matthew Spurling (41:34) Does that same word to you ladies that our U. S, FHP goes to Aetna?
Dreama Hembree (41:45) Are you looking at the directory? Vanessa? I’m.
Vanessa Persha (41:48) pulling it up right now, U. S family?
Dreama Hembree (41:50) Okay. Thank you. I see what state?
Vanessa Persha (41:53) Is this for mass?
Dreama Hembree (41:55) Massachusetts?
Vanessa Persha (42:22) I actually don’t see that we have full instructions in here. I need to flag this one for review, but I don’t see any reference to Aetna. Yeah.
Dreama Hembree (42:35) I was.
Matthew Spurling (42:36) Surprised to see that too. So we should take that one back Barrett as well. U. S, family health plan. Do we truly submit to Aetna? Because I thought U. S, FHP was through?
Dreama Hembree (42:52) No. So, you know, we need to look at that one.
Barret Pickering (43:04) You said ask if it’s or Aetna? Yeah, current contacts?
Matthew Spurling (43:09) Are set up as Aetna? Which that doesn’t sound right to me?
Dreama Hembree (43:17) Okay. So that one didn’t know so well, point no.
Matthew Spurling (43:22) Also standard.
Dreama Hembree (43:24) Standard. Okay. Yep. And then, well sense… no.
Matthew Spurling (43:42) Well, sense. Okay. Let’s see. There is a minimum data sheet for well sense.
Dreama Hembree (44:01) Great. And then eternal health. This one says mass and easy. So we need to separate those two. So.
Dreama Hembree (44:15) We have eternal health up on easy already there.
Matthew Spurling (44:18) Should be. Yeah, I think we did because it was flagged as delegated… seeing you.
Dreama Hembree (44:34) I think it listed out up here. Am I missing it? No?
Dreama Hembree (44:45) Okay. All right. So, we need to add eternal health to easy, but we’re checking on that one to see if it’s delegated, right? Yeah, correct.
Matthew Spurling (44:54) I don’t believe it is, but we’re going to check… well, since, actually, yes.
Dreama Hembree (45:06) Let me make two separate lines for this one. So, for Massachusetts, we’re just doing.
Dreama Hembree (45:16) This is definitely not delegated for Massachusetts, correct? For eternal health?
Matthew Spurling (45:25) Eternal health. I’m pretty sure it’s not well, that’s what we’re checking on, but I’m pretty sure it’s a no, okay.
Dreama Hembree (45:31) I’m going to do this one as a, no, just so we know that we need to look at that one again. And then estrana for Texas.
Dreama Hembree (45:46) This one’s just standard, right?
Matthew Spurling (45:51) Do we want Texas in here Barrett?
Matthew Spurling (45:57) No, we get one Texas.
Barret Pickering (46:00) Delete it. The plan would be that everything goes well, and that we just handle all the enrollment stuff through the end of may, and then we just never think about Texas ever again. I’m hopeful we’re.
Dreama Hembree (46:18) deleting Texas. Just.
Barret Pickering (46:20) Get rid of it. I have.
Naomi Denson (46:22) A question on eternal health. Does it go by any other name? I’m not showing that in our directory?
Matthew Spurling (46:28) It does not, it’s very small. Honestly, don’t even know what their account is, but they’re very small in Massachusetts and Arizona. Okay?
Naomi Denson (46:38) Do you have a link to their website that you could add here? I see the roster link, and then email contacts because they have like a website, I googled it, and it’s coming up with a portal called nirvana health. Does that sound right? Nope?
Naomi Denson (46:55) Eternalhealth. Com, and the four providers log in, looks like it’s through nirvana. Yeah, if you guys have a link that you can share for… that one, so we can get it added to the payer directory? Yeah.
Matthew Spurling (47:12) I just sent the link in the.
Dreama Hembree (47:33) I don’t, do we know why this?
Naomi Denson (47:36) Is?
Dreama Hembree (47:36) Here must be single tab. Do not create separate tabs because I obviously deleted az off of there. Was that from me or is that, did gab put that in there?
Matthew Spurling (47:48) I assume again, put that in there. I think that’s directly from the request from eternal health, which was she historically has put each state on a different tab with the rosters they want one.
Dreama Hembree (48:00) Tab.
Matthew Spurling (48:01) With both Arizona and Massachusetts, they have one team that works it and sets up for Arizona plus Massachusetts at the same time.
Dreama Hembree (48:09) Okay. So, Naomi, how are, so I mean, I might need to put that back as az and Massachusetts because she had that combined. So I was going to make two separate lines, one for the obviously az market and then for Massachusetts, but if they’re wanting?
Matthew Spurling (48:26) Do we need to, yeah?
Dreama Hembree (48:27) Yeah. On.
Naomi Denson (48:30) The, the payer mapping sheet. I did create two lines because our tool won’t pick it up if there’s duplicate or medical states identified and plus.
Dreama Hembree (48:39) We’re not sending full rosters. We’re just sending the ads change deletions.
Dreama Hembree (48:54) So, how do we call that? I, we could take it offline, but does that need to be called out separately that it needs to be on one roster for both states? I.
Naomi Denson (49:02) would think so because I mean when you submit requests in the platform, you can only do one state. So we need to make sure that they’re being combined and not separated. I would just definitely just have a note of it so that we make sure that… the assignments are done appropriately for the.
Dreama Hembree (49:25) Payers to use that back to. Yes, just so that is so, yeah.
Naomi Denson (49:29) You’ve realized?
Dreama Hembree (49:30) That I need to call that out in the background. Okay? Most?
Matthew Spurling (49:33) Most pertinent will be it being listed with Massachusetts, the population? I think we only have 45 Arizona members whereas we have over a 1,000 Massachusetts. So I’d prefer it to be called on called out under the states of Massachusetts than the non standard can be, make sure that the Arizona is pulled in as well. Okay?
Dreama Hembree (49:56) Covered all of it besides what needs we need to circle back on. So we had Arizona, Massachusetts, and then Tennessee, we got rid of Texas. Did?
Matthew Spurling (50:08) We have all the Tennessee ones. I thought I saw that, was that not checked off as? Yes, I?
Dreama Hembree (50:14) Might have left that one. No. Okay. Cool.
Matthew Spurling (50:17) Which I think that one we’re good with it being, yes dude. Yeah, you know, okay.
Matthew Spurling (50:26) Any questions?
Dreama Hembree (50:27) Now to.
Matthew Spurling (50:28) Barrett’s point, is there anything we got to fill out on the other tabs? No, you.
Naomi Denson (50:32) Don’t do anything on the other tabs except for the payer mapping. When we’re done mapping those payers that weren’t included originally. Then after we confirm them, I’ll send it back to you guys for you to confirm the standard payer names. Thank God. This is for when we import existing enrollment later, it’s just a check box.
Dreama Hembree (50:53) Okay. Well, we appreciate your time. I know that was probably not the funnest activity you could imagine, but Barrett, let me know if there’s any questions when you meet with gab that you need help on or clarification on and I’m happy to jump in. We’ll.
Barret Pickering (51:09) do, luckily, we have good examples here to work off of so I can be like just scroll down and look, this is what we need.
Naomi Denson (51:18) Yeah.
Dreama Hembree (51:18) Let me know if there’s any questions, anyone, and we appreciate your time. Anything else? Naomi? Did you have anything for them? Thank?
Barret Pickering (51:26) You all so much. I appreciate it.
Naomi Denson (51:28) Thank you, everybody. Thank you.
Matthew Spurling (51:29) Thanks.
Naomi Denson (51:30) Joel.