Transcript
Naomi Denson (00:00) hey, Jason.
Jason Zednick (00:02) Hi, Naomi.
Naomi Denson (00:04) Hi, are you ready? I don’t know as ready as we can be.
Jason Zednick (00:10) I guess. Yeah, all right.
Naomi Denson (00:16) I mean, but it’s just Kim here right now. Let me let her in.
Naomi Denson (00:27) Hi, Kim. Hey.
Kimwaters (00:29) We are getting it done.
Naomi Denson (00:32) Yeah, is mania coming?
Kimwaters (00:36) Yeah, I’m sure she is okay.
Naomi Denson (00:39) Just wanted to make sure just sent you an email provider practice group. So everything we’ve received so far is imported.
Kimwaters (00:45) That’s awesome.
Naomi Denson (00:46) You’ll also see in the payr process, scoping doc that… we have started a new tab called payr mapping. Jason is… still working through confirming. The mappings are correct on our end. Sometimes the system maps it to something completely off the wall. So as he confirms them, he’ll check the box in row or column F. And then you’ll just review that. So the client payr name in column a is the payr name you provided. And then medaille and payr entity is what it is in our system. And then you would just either check the box in H to confirm you approved the mapping or if you have any questions or feedback, you can leave notes in column I. So there’s still some… that we’re reviewing internally to confirm and then we can start working through this as well. Yeah.
Jason Zednick (01:46) And it looks like there’s a couple that we don’t have. I’ll be submitting for us to add those. And then that medaille and payr entity name will be two things. One, when you populate the existing enrollment data, it will be using that medaille name. And then in the future, when you’re making requests, it’ll be under that name. So there might be a bit of an adjustment as you realign how you think the payr is to what they are in medaille?
Kimwaters (02:18) Yeah. I was going to say like when we make requests because like not everybody’s going to be in, I mean, ideally, let me just show you what we have here. We’ve mapped… so far. All of this in… but like I think I sent you some examples of like the united tabs, right? This is what they currently had. So if we just say united, we’re good and you’re going to select all, or do I need to go in and put like all of the different subsidiaries for united health care?
Naomi Denson (02:58) Did you see the email that I sent back? Like for uhc, where I added notes?
Kimwaters (03:03) Yeah, I saw that you had added like the medallion payr names in there. Yeah. And like this is not an exhaustive list. This is just like the list that they had tracked. So like there’s definitely more. Yeah, I think we’ve got a pretty extensive like list. So the typical go.
Naomi Denson (03:20) Ahead, Jason, no.
Jason Zednick (03:21) No, please go.
Naomi Denson (03:22) Ahead. I was just going to say the typical thought process behind our payr directory is for… lines of business. So it can be done in one submission requests the same application through the same process at the same time. It’s the same payer name. If they have a completely separate application or submission process, then it’s typically a separate standard name. So like vaccn, all that, those are separate.
Kimwaters (03:50) Because.
Naomi Denson (03:51) it’s a separate process. And so,
Jason Zednick (03:52) a lot of those united, they are different because they’re different applications. I’ll use the.
Kimwaters (03:58) word, it requires a different application, yeah.
Jason Zednick (04:00) But then, for the most part, you know, most of, the plans are all just under the parent and we just keep it under the one name and we’ll and we will, yes, like, apply to all the plans under that name. Yeah.
Kimwaters (04:16) Yeah. And then I mean, every time, so basically, any time that they’re going in and just like selecting all like they do with like united again just as the example, then it’s we don’t have to break those out. It’s when there’s like a separate application that you need it broken out. Okay?
Naomi Denson (04:36) Yeah, it’s typically the thought process.
Kimwaters (04:38) Yeah, that’s fair even though like some of them are like some are fee for service, and some are commercial. Like none of that matters as long as it can go on the same app, right? Yeah.
Naomi Denson (04:50) Cause that’s how you’ll be submitting them in medallion is we want uhc, we want commercial, we want managed medicaid, we want medicare advantage. We want all of these lines of business which we would then submit and request at the same time.
Kimwaters (05:01) Okay, perfect. Then we only have a couple of additional to break out. Then I think everything else is accounted for. Okay?
Naomi Denson (05:10) Yeah. Like centene, they’re an umbrella payer, obviously, you have the delegation with Arkansas, but all of the other states we would need broken out by wellcare and better, all of their separate payers that fall under them because you can’t just submit an enrollment request directly to centene, it has to go through the payor… process, right?
Kimwaters (05:31) Tony, all of the import data… aside from the enrollment tabs which Felipe is helping us on has been loaded.
Jason Zednick (05:42) Awesome.
Naomi Denson (05:43) Yep. Thank you, Adalee. She’s on the call. She’s the queen.
Kimwaters (05:48) Well done, Adalee, you?
Naomi Denson (05:51) Guys did a good job, on the template apparently because we didn’t have to come back to you. Yeah.
Adalee Arreola (05:57) That’s a great template. Thank you so much for that. Usually. Yeah, there is some back and forth, but that was filled out perfectly. Awesome.
Kimwaters (06:04) Are.
Naomi Denson (06:07) we still, do we want to wait for mania to start the pay or scoping or I don’t see you?
Kimwaters (06:11) I’m gonna shoot her a note because I… would expect her to be here, yes.
Naomi Denson (06:19) I know we moved it. We added 30 minutes to the front of the call, so I don’t know if she’s still expecting it to start up in 30 minutes.
Kimwaters (06:36) We’re waiting on that, Tony. I had, I sent you a team’s message in all your spare time on a delegation, ask just on some new providers. So if you, whenever you have a second, you let me know what you think. Okay… I’ll take a look now and.
Naomi Denson (06:57) then I’m still working with mania on the caqh pdqs setup, so we can start the imports. I looped in our caqh rep at caqh, and he’s helping to expedite things. Yeah.
Kimwaters (07:10) That was awesome. Thank you. I saw that absolutely. And then met with Caroline and team yesterday on the provider invite. So that is we’ll have that, those customizations back to you this week? Awesome. And then I know you mentioned that we can have, we can do some modifications in the provider packet. One of the questions was like for a new provider, it sounds like we’ve got several new ones coming is, you know, it’s one thing for the import there’s. Still going to be information that’s missing, which we have most of that. We have all of that. So like we should be able to have most of that filled out for them so they can just kind of go in, and hopefully like a test and keep it. Super. Yeah.
Naomi Denson (08:00) Super straightforward. What we’ll do is now the providers are loaded in there. Once we get the caqh set up, we’ll run the imports from their caqh. And then we’ll be able to take a look and review and see, you know, what?
Kimwaters (08:12) What’s missing?
Naomi Denson (08:13) Consistently, is missing across the board… for them. So you can get an idea and I can do a bulk import for just, the data provider group. First. I can just do a couple of them at a time so you can use them as a sample test group without, and decide next steps from there. Okay?
Kimwaters (08:34) Great. And then, for new providers coming on board, if we have, I know you said there’s like there’s different requirements as far as like completing the entire file. But as far as like… hey, I need name npi, CA, QH id or whatever to be able to pull in their file. Like did they have to log in and initiate that or can we initiate that? So it’s the same kind of process you.
Naomi Denson (08:59) Can do that. We’ll set up a training probably next week and I’ll show you how to do that. So for ongoing, for new providers, we won’t import them. Like we have been, right. We’ll show that you how to add them manually to add them manually. You need their name, email, start date, profession type to create the profile. And then once in there, you add in the social security number, npi and caqh id. And then I’ll show you how to trigger the caqh imports manually. Okay?
Kimwaters (09:28) So, mpi, social security and caqh id? Okay. And I’m asking because Monia hunter and I were talking about what we, a lot of this starts before they officially start. Obviously. So what information we’re asking for prior, like around the time of, their like acceptance letter, so that we can make sure, yeah, a lot of that in like the paylocity, but it’s helpful for us to like grab that real quick from them.
Naomi Denson (10:02) Yeah. Just those required fields that run the provider import template. Yeah, would be needed to start and load the caqh, to get things going. Okay? Great. Any, any response from Monia? Not?
Kimwaters (10:17) Yet?
Kimwaters (10:22) It looks, I mean she’s responding to emails, which is what’s kind of funny.
Kimwaters (10:30) To us, like on some of these requests?
Kimwaters (10:41) Like she’s… going on vacation next week. So, I know she’s like heading down with rosters, and responding to emails, but let me see if I can get her.
Kimwaters (11:00) If you guys want to go ahead and pull it up, we can, you know, this is recorded. And if there’s any additional questions, I can definitely grab her, but I’ll try to get her in the meantime. Yes.
Naomi Denson (11:12) All right, Jason, you ready? I’m gonna share your screen… action. I can share.
Jason Zednick (11:39) So, Naomi, let me ask you sort of what’s the best like workflow here as we, yeah.
Naomi Denson (11:49) So we’re gonna go payer by payer, state by state, look at what not like just we’re gonna work down the row, review the, anything that’s roster eligible, anything that says or, and confirm the processes with them. Like what we have in medallion versus like show them the standard process from the directory and say, is this what you do? I see a lot of them are flagged as roster eligible. So we’ll need the roster templates for those. Yes, we’ve.
Kimwaters (12:28) got, yep, those are links in the credentialing… folder in.
Naomi Denson (12:35) The folder?
Kimwaters (12:35) Which they, I was asking her about those. And she said that while they’re in the folder, they’re also just the links that are available on the payer sites. So there may be a more updated page… template on those sites. So I wasn’t sure if that was something you could have stored or if you want us to go grab. And either way we can.
Naomi Denson (12:57) Yeah, we typically like you’ll share the roster with us. We will check to see if we already have it mapped in the system and compare them. So typically, they’ll have like a date like a revised date on the template somewhere. So we’ll see which one’s most recent, and then confirm which one we should be using because sometimes, you know, payers are like, no, keep using this one for certain situations. But yeah. So any of these rosters we’ll look in the enrollment folder to get links there. And then the first handful here devoted centene, humana through… roads nine all show that they’re delegated they.
Kimwaters (13:39) Are, so, I know in your email this morning, you said we could take those off of here.
Naomi Denson (13:44) Yeah. So yeah, we just added notes over. Yeah. So you have the delegated notes there. So we don’t really need to review the process. We have the contact information and the roster templates that I have sent over to Adalee to start being built. So the next one would be medicare part B. All clinics are contracted. Currently, 855 are for new grads. And then 855 by… and are, so those are the 855 B enrollments. I think I sent over the instructions to give us the access to Pecos and… availity.
Staff (14:32) There’s.
Naomi Denson (14:33) mania, yeah. So that’s how we will handle those. So, are there any nuances with how you enroll your providers individually in medicare, where practice locations are concerned? Anything that we should be aware of or is it just you go and you fill out the 855 R for that group in that state and then assign them to their practice location? Sorry?
Staff (15:01) I’m late.
Naomi Denson (15:02) Okay. Thanks for joining us mania, no worries.
Jason Zednick (15:04) No worries. Very.
Kimwaters (15:06) Good. We’re just starting with medic, like with, the medicare part B applications and then Naomi, the medicare part a applications, are.
Naomi Denson (15:16) Like.
Kimwaters (15:17) the rhc process. So that’s right below which we’ve got a separate document to send you on like the rhc process.
Naomi Denson (15:26) Okay. And normally,
Staff (15:29) what we do with the 855 B, we go into the individual providers to do the 855 from their profile, not ours.
Jason Zednick (15:40) Yeah, that matches what we do. We’ll request surrogacy, and then from the provider. And, yeah, that’s what we do.
Staff (15:48) Yeah. Now, we have, we hire a lot of new grads so it won’t be an 855.
Naomi Denson (15:55) It’ll be a high and an R… yes, it would be high and an R. So what we do is we’ll verify. So we’ll request surrogacy, or we’ll verify that they’re in the system, request surrogacy for them to their Ina, and then we’ll look to see if they’re already enrolled and participating in that state. If not, we’ll submit the I, and the R.
Staff (16:16) Okay. And with getting new grads a lot of times, sometimes they don’t even have npis.
Naomi Denson (16:23) Right. So you would hold off on making any payor enrollment requests for new grads until they have the npi, okay? Because we want to pay that for them. Yeah.
Staff (16:34) Because that’s something we do for new grads, if they don’t have it because they don’t teach that in medical school that they need to do that.
Naomi Denson (16:40) No, they don’t my mom’s a doctor. So I get lots of questions… but yeah. So once they have the npi issued, then we would start initiating the enrollment requests and then we would follow that standard… okay, you know, eight through five or our determination on what’s needed. And then the line 12 centene with multiple states we talked about. We need to break those down into their individual payors for the processes since those are non delegated. Are we? Okay. Yeah, yep. So are those payers? So you have centene listed here, but are the payers that fall under centene on here already or no? Or were they all just grouped in?
Jason Zednick (17:29) I added them to the payer mapping based on the email. Okay? And I think this is accurate… but they’re not on the scoping sheet now. Okay?
Naomi Denson (17:44) So we’ll add those to the scoping sheet so that you guys can identify processes there… for centene. And then Jason… you want to take it from here, starting with medicaid of Arkansas, just we’ll need to verify, you know, portal access needed, making sure that we have access to the group and pi in tmhp… anything special that you guys do with any of these state medicaid?
Staff (18:23) Or you just follow the process in the portal for enrolling any provider linking them to your group. We follow the normal state process.
Jason Zednick (18:31) Okay. Yeah. Let me, let me pull up. Let me just like pull up Texas because that’s the one I’m most familiar with. It’s the.
Staff (18:40) One I’m least one, I’m probably the least familiar with Texas.
Jason Zednick (18:44) Well, they’re slow and they.
Staff (18:48) Were, yeah.
Jason Zednick (18:50) So, let me just sort of show you what our standard looks like. And obviously, the details vary payer to payer wildly. But this is sort of just how it’s structured just to give you a sense. So, we have this directory that our team goes to and it’s like, hey, where’s the application? And then here’s the link. And then if there’s steps that need to be documented, we sort of include that. Here. We’ll also document any documents that are required to be submitted with it as well. And that’s just sort of how we structure what’s standard as well as dependencies. So for Texas, not all medicaid agencies are like this, but Texas requires a medicare enrollment first. So we’ll sort of have to append Texas medicaid to medicare. So when we say standard, like all of that sort of stuff is in here, there’s not often. Now, I will call.
Staff (20:01) you out on an exception, if they are a pediatric provider, they are not required to have a medicare id.
Jason Zednick (20:10) Yeah, that may be true. My experience is what they are. We have a pediatric clinic.
Staff (20:19) There, and those providers were not required to have medicare prior to being enrolled in the medicaid program for the pediatrics.
Jason Zednick (20:28) Yeah. So that’s a good point.
Jason Zednick (20:40) That’s a good example of a thing that we would document for you. Yeah. So, sort of with that… I,
Staff (20:55) know that we have been, you know, I know that we’ve been doing the enrollments. We go to our clinic account, our… well, our master account with Texas and initiate through there underneath the clinic.
Jason Zednick (21:09) Yeah, that’s what we’ll do we’ll for the portals for, you know, any of these that have portals, we will, when we can… get your login credentials from you and act directly on your behalf. If there’s a setup like Ohio does this where we create our own account, but you create a, I forget what they call it like delegate code. Yeah. Like that grants us access. So those providers will do it that.
Staff (21:44) Way. Yeah, cause Texas does it that way. Tennessee… does it that way. Indiana does it that way. North Carolina does it that way… those are the ones I can think of.
Jason Zednick (22:00) Yeah. For any of these… is there anything sort of unique to access medical that you can think of?
Staff (22:19) That.
Jason Zednick (22:20) Would be different from, you know, any other organization well?
Staff (22:23) I don’t know how familiar you are with Arkansas medicaid, like if they’re going to be a clinic provider, then there’s the PCP form that has to be completed. And there’s a pay to listed on the PCP form. It has to be the clinic provider id, not the… provider, not the individual provider’s, provider id. So, the payment routes to us for the PCP payments?
Staff (23:11) And we enroll them at, if we’re doing the initial enrollment for them, we enroll them as a member of a group, not as a freestanding provider… because then you don’t have supply banking information. You just do the section four?
Jason Zednick (23:32) Yeah. So, we have the section four piece documented, but it doesn’t look like we have that first piece documented. So that’s and,
Staff (23:41) if there’s an,
Jason Zednick (23:42) existing provider that?
Staff (23:45) They’re coming on board with us full time, then there’s a change of address form that needs to be completed and submitted. The PCP form needs to be completed and submitted as well as the section four, all that section four does is link them to us to bill under our clinic. It doesn’t update their demographic information or anything like that.
Jason Zednick (24:14) What was that first bit that you said?
Jason Zednick (24:21) If they are.
Staff (24:25) A clinic provider, then… it’s the PCP form… as well as if they’re coming on work for us full time, we need a change of address. If they’re already an existing provider.
Jason Zednick (24:45) Yeah. So, if they’re a clinic provider, then those pieces.
Staff (24:50) Yeah. Any provider that comes on with us full time, we need to do the change of address. If they’re an existing medicaid provider, they need a change of address form and a section iv form. If they are a clinic provider, they also need the PCP form. So, the,
Kimwaters (25:11) two call outs there, Jason, is, providers on our side are either clinic providers who… could also see patients at a nursing home. So, therefore are eligible to be a PCP, or they are nursing home only providers. And they’re not seeing patients in the clinic. So that’s they are not eligible to be a.
Staff (25:36) PCP with Arkansas medicaid, if they’re nursing home only, right? And,
Kimwaters (25:41) then we also have providers that are W ii and providers that are 10 99. And if.
Staff (25:50) they’re 10 99, they’re going to be PRN or part time, which means we will not update addresses et cetera. With their id. We will just have the section iv.
Jason Zednick (26:05) Naomi, I’m trying to think in medallion, how would we know whether they are clinic or nursing home only?
Staff (26:17) That’s also an issue with say, Arkansas blue cross. If they are nursing home only, we cannot enroll them in the commercial plans. They can only be enrolled in the advantage plans.
Naomi Denson (26:29) Let me see.
Naomi Denson (26:37) Let me just look at something really quick.
Kimwaters (26:41) All.
Staff (26:41) of our nursing homes everywhere except Georgia are linked under a clinic, the service address would be a nursing home address. When it goes out on the bill. But as far as everything credentialing is concerned, it’s a clinic address.
Naomi Denson (26:59) Okay. So.
Naomi Denson (27:07) So,
Kimwaters (27:07) as far as like the payr, the locations that they are tagged to Naomi would be the only way that you would know that right now because like the providers that are only tagged to the nursing home locations, which we would have to. I mean, it might be obvious or it might not, but we can definitely clarify that is how you would know at least on the import document. But I don’t know if there’s a way to indicate.
Staff (27:35) That.
Kimwaters (27:36) moving forward?
Staff (27:38) The document that we filled out for the locations, the only state that we include nursing home addresses on was Georgia and that’s because medicaid requires it to be the physical location that they’re practicing at.
Naomi Denson (27:52) So, there, my initial thought is in the provider’s profile. In the professional info section, there’s a place that has practice restrictions that notes could be added to and that we would need to include in a project plan, Jason to make sure that the team is reviewing that they can also be identified as primary… care or like specialist.
Staff (28:28) Okay. The nursing home providers would all be, they’re still primary care providers. They just don’t qualify for PCP assignments. They don’t hold panels of members… right?
Kimwaters (28:47) So, I’m looking in like,
Naomi Denson (28:50) this is.
Kimwaters (28:51) So cool. That there’s actually data loaded in here. Like where are you saying? There’s like restrictions, it says under in.
Naomi Denson (29:00) Professional info in a provider’s profile,
Kimwaters (29:04) So,
Naomi Denson (29:04) if you scroll down to practicing information, yeah. Okay. There’s if you click the little pencil to edit it.
Kimwaters (29:13) Oh, got it. Okay. So, these are some accepting new patients. Well, patients with ages, well, I guess like you could be in a nursing home and not have.
Naomi Denson (29:22) Yeah, those are optional. Yeah, these are all optional. We could just put in a note that he needs to refer to that. So, like there’s that practice restrictions section?
Kimwaters (29:34) There is one actually, well, okay, there is one that says care under here. It says primary care type. So, primary care manager or primary care specialist. We get all, I mean, what do you guys do with these fields? Yeah.
Naomi Denson (29:51) So, typically, my understanding is primary care manager would be like a PCP primary care, a traditional PCP, right? Yeah, primary care specialist would be that they are a specialist that is not a PCP. And that’s my understanding of that. Okay?
Staff (30:08) My worry anytime I see or hear the word specialist, is when it goes to a payer, if it says specialist of any kind, then they get a higher copay because they’re not counting as.
Kimwaters (30:21) Primary.
Staff (30:21) Care.
Kimwaters (30:23) Well, that’s why I was asking like what is the, what is this field like used for? Is it?
Naomi Denson (30:28) Because I would,
Kimwaters (30:29) argue like primary care manager is a true PCP, like in the traditional sense primary care specialist. That could mean a lot of different things, right? Like, well, our nursing home are just specialized in nursing home care. So like you could kind of argue like maybe that would work, but they’re not, you could also say like a women’s health clinic that does like OB gyn care is a, is also is primary care and a specialist. So I just want to understand like how these, how that field is being used and if it actually like goes anywhere, like what are the definitions of that? But like care delivery setting, we, it looks like it’s a required field anyway. And we at least could note all of our physicians that are clinic based. Yeah… it wouldn’t necessarily call out nursing home only though, but, it would note that, but we have to pick something and so like, is there they’re not hospitalists, but can we add nursing home to that list?
Naomi Denson (31:34) I can put in a request to do that cause.
Kimwaters (31:39) That really is the most accurate answer is like, to add like nursing home to that care delivery setting.
Naomi Denson (31:52) So, the three Georgia practice locations that I see that were alluded to the platform, those are all nursing home only, no.
Staff (32:02) Hawkins, those three are the clinics.
Naomi Denson (32:05) Okay. When.
Staff (32:08) I did the detailed sheet, I also included… the nursing home addresses… you see… in the provider practice, and.
Kimwaters (32:24) Monia is like included in the payer directories. Do you just not include the nursing home providers in the payer directories, cause that’s another call, right? So like we, we’re going to be saying yes or no to whether or not it’s an optional field, but we’re going to, we’re going to say yes or no to including them in a payer directory. So if we can add like the care delivery setting and whether or not they should be in the payer directory, like all nursing home providers should not be in the directory, everybody else should be.
Staff (32:53) Right now, those who are providers that we have that float between other clinics or they occasionally cover other clinics, we only put their primary site in as being included in the directory?
Staff (33:14) We’re kind of an odd duck, yeah.
Naomi Denson (33:17) And that’s why we have this call… and.
Kimwaters (33:21) that’s why we’re recording it because we’re not typing all this out.
Naomi Denson (33:27) So, what I’m going to do is once the call recording is ready, I’m going to clip it and send it to our PE leads and have them advise on the best way to identify the differences in the platform for the provider.
Kimwaters (33:45) Okay. That’d be great. And then Naomi, I sent you the rhc processes that we typed out. If we need to get any more granular than that, let me know. Manya you may have to. I also sent.
Staff (33:59) her a.
Kimwaters (34:00) Copy of the link to the rhc tracker just so she could see like that level of detail that gets tracked. You may have to grant her access to it because I couldn’t do that, but just so she can see that.
Staff (34:18) Okay. Better do that while we’re talking about it.
Naomi Denson (34:21) I just want to ask really quickly. You said that on the import template for the practices you put for Georgia, you put an additional address? Okay? Because I see where you filled out the secondary address line with a po box, okay?
Staff (34:39) On the provider tab?
Naomi Denson (34:46) So, I.
Staff (34:47) can tell you the correct tabs. I,
Naomi Denson (34:49) was looking at the practices tab for the practice locations?
Staff (34:58) Just a minute.
Staff (35:05) Okay. Let’s see.
Staff (35:15) Okay. No, actually, I did it on the… provider practice groups tab. If you pull up Tyler Jacobs, that’s… perfect. That’s a good example. Corey, Beth brown is a good example.
Naomi Denson (35:45) Okay. The practicing access to medical clinic?
Naomi Denson (35:58) I have to tell you that. Did I lose something in translation? Are we talking about Georgia or Arkansas? Georgia? Okay.
Naomi Denson (36:14) Okay. That’s what I thought. Okay?
Staff (36:17) Because on the, when I filled out the provider practice groups tab, like on Tyler, let me get back down here to him. Again. I lost him.
Naomi Denson (36:29) There he is.
Staff (36:36) Not Tyler Jacobs. Yeah. Okay. How did his email address end up there for a whole bunch of people, it shouldn’t have.
Staff (36:57) Why does that look weird now?
Naomi Denson (36:59) Because I filtered it to only those that have his email address on it. Okay?
Staff (37:04) Because his email address shouldn’t have been on anyone other than Georgia.
Kimwaters (37:13) What are, what are you looking at? Because I just see the three Georgia clinics, is there something else?
Naomi Denson (37:17) We’re looking at the provider practice groups tab.
Kimwaters (37:22) Oh, okay. I’m just looking at the screen you’re showing you’re back on the document. Oh,
Naomi Denson (37:26) yeah, you can go to that provider practice groups tab, and then on the provider email, can you filter by Tyler Jacobs? So clear, Tyler, okay?
Kimwaters (37:43) Yeah. Oh, yeah, definitely shouldn’t be in there for, and the mpi is listed multiple times. Oh, well, well, the, but that’s okay. But this is where I, yeah.
Staff (37:54) Cause I didn’t put Tyler on any of the Indiana clinics. So I’m not sure why he’s showing on Indiana.
Naomi Denson (38:01) Yeah. Well, those are all, those are different provider mpis. So, Adalee, when you did the ppgs, did any of them fail? No?
Adalee Arreola (38:09) None of them failed. So, I didn’t edit the file, but what the PPG import will do is use the provider mpi, as long as that’s correct?
Kimwaters (38:18) Okay.
Staff (38:20) Okay. Cause we’re.
Adalee Arreola (38:21) good. Yeah.
Staff (38:22) Cause for Tyler, he should have been at the Stanley street 37 31 bypass, the 30 20 jefferson, the eight one Alberta, the 200 south Kimberly. Those are all different locations. Part of those are nursing homes. The 37 31 bypass is a clinic, but the others are all nursing home and.
Kimwaters (38:46) If you go back to his actual profile, like I only see the, I only saw like the.
Naomi Denson (38:51) three locations linked to him and his profile. Yeah. Now, now.
Staff (38:57) These nursing homes all bill under that practice npi, but it’s a different physical location.
Staff (39:16) Is it like for Georgia when?
Kimwaters (39:17) The, when the claim goes, like, do we need to get claim examples? Like when the claim goes out, does it have the brunswick location? It?
Staff (39:26) Has the brunswick?
Naomi Denson (39:27) Do you have… an example of one of those applications that you’ve done in the portal that you could share with us? Just so we can see how it sits up and how it like connects to the different locations in medallion, like the different areas, if you have one that you like printed out after you submitted it, I.
Staff (39:53) don’t know if she printed him out when she submitted them or not. I… am looking.
Staff (40:05) I’ve got the different welcome letters, the approvals, Naomi?
Kimwaters (40:10) I expect we’re going to need at least one more of these calls like, yeah, probably a couple more. Is there mania’s out next week? So, is there time we can block maybe for Friday or… even tomorrow?
Kimwaters (40:31) Okay. Tomorrow morning… or?
Staff (40:49) Let me see. Will it? Let me add a document in the chat. Oh, it should.
Staff (41:05) There it is. Okay. There’s the one, the bayview application. I just added it to the chat. I mean, it looks like a normal application. Other than the address. Is the clinic, is the nursing home address instead of a clinic address?
Staff (41:29) Because Georgia, the applications are all set and they have a pay to provider id on them. So you’ll need our pay to provider id to… link them properly.
Naomi Denson (41:51) All right. We’ll take that back and look at it and loop in, the payroll leaves before we sign off on a process for that one to make sure that we are filling out their profiles correctly?
Kimwaters (42:06) So, you said something on you though the pay to provider ids for like the location level, is that what you’re saying?
Naomi Denson (42:14) It’s.
Staff (42:16) tax id level?
Kimwaters (42:17) It’s at the taxes that’s at the tax id level. Yeah.
Staff (42:19) Even the clinics use the.
Naomi Denson (42:22) Tax id. So this one for Tyler Jacobs looks like he was in virtual only and no, was PCP.
Staff (42:36) Because this is a nursing home only app, pay to, okay?
Naomi Denson (42:42) Here’s the service location. Okay? I see the mail to address, pay to address service location, go back to the service location.
Staff (42:56) Used.
Naomi Denson (43:00) okay. So the service location listed here is one two eight, eight, four west Cleveland street. Don’t… see that address as a practice location option in medallion, let.
Staff (43:15) me, look, I didn’t look to make sure that she had… okay practice location, right? That’s what I, that’s the email I sent you in question. How should I put these in there? Because these are nursing home locations that bill and pay under a clinic npi. But for Georgia, you have to list the locations individually. So there’s not a different npi number for it. It’s still, okay?
Naomi Denson (43:50) So, how many of these nursing home locations do you have that for… Georgia?
Staff (43:57) There’s one, two three four, five six, only eight. Okay?
Naomi Denson (44:01) So, let’s get those added to the practices tab. So we can load those in because that’s the location that you’ll have to select when you’re requesting the enrollments in medallion for us to know which one to include. And you can just use that practice npi that you’re billing under. You can reuse the npi… okay? On a profile. And I apologize. I was actually waiting for confirmation on that question that you had sent me about Georgia from our pay enrollment director. And then you sent it back and said the sheet was complete. So I totally forgot to circle back and that’s my bad, but those locations will add separately as separate profiles. Okay?
Staff (44:44) So, I need to put under the practices.
Naomi Denson (44:47) Let me actually create a like a new like a practices two tab. Okay?
Kimwaters (44:58) So it’s the clinic npi that it pays under and.
Naomi Denson (45:01) the address?
Kimwaters (45:03) For the location?
Naomi Denson (45:08) When you say the clinic npi that it pays under.
Naomi Denson (45:17) So, it’s okay. Like the one, yeah.
Staff (45:19) Like the one we’re looking at here on his, that nursing home is linked under our Sylvester npi. Yes.
Naomi Denson (45:28) And because we didn’t do any group npi’s for you. So we’ll default to the, using the practice location npi. So you would request, so just like with the payer names, if we have to submit a separate application for multiple practice locations, you would make one request for one practice location, one request for the other, so that we know which npi we should be using… but we’ll go through that on, our training as well.
Kimwaters (45:56) But not to complicate this, but like when you’re submitting to Georgia medicaid, Monia, are you having, are you able to put all of their practice locations on one document? Or do you have to submit an?
Naomi Denson (46:10) Application for every? Okay, separate?
Kimwaters (46:12) Enrollment? Okay. They’re.
Naomi Denson (46:15) difficult to do a new number for each one. Yeah. All right. A.
Staff (46:19) Number with an alpha modifier on it until they see, and then they start a new number. You were.
Kimwaters (46:25) Talking about y’all, were talking about Georgia yesterday and being complicated for a lot of reasons. So, yeah.
Naomi Denson (46:31) Yeah, enrollment days, I actually got somebody fired from Georgia medicaid. I.
Staff (46:38) Love you. I.
Naomi Denson (46:40) Had somebody on the cubicle on the other side of me going go, Naomi go. She faked, she doctored an email and said that she had sent it to me before and like copied and pasted things and like changed the dates on the sent date, in the thread and I was like that’s in a completely different font. Like, so I escalated that and she never answered the phone again.
Staff (47:11) Georgia applications are probably my least favorite applications. I mean, for the power of attorney form, they have gotten to the point that if the embosser, if they don’t have it that, you know, cleaned real well, where it’s real plain to tell the difference between a six and an eight or a zero, they’ll kick it back to you.
Naomi Denson (47:32) Them and Texas medicaid are notoriously bad because Texas medicaid will get an application. They’ll find the first thing wrong with it, send it back. You’ll fix that. And then they’ll find the next thing wrong with it. Send it back. I’ve gone back and forth with Texas medicaid 15 times because they won’t just review the entire application before they send it back. No, yeah. And yeah, anyway, that’s right now, Georgia rant. Yeah, they’re paying anyway, and,
Staff (47:56) right now, Oklahoma is approximately four months behind on everything.
Naomi Denson (48:03) Lovely.
Kimwaters (48:09) Okay. So, and, we’ve got 10 minutes left. Yes. Okay.
Naomi Denson (48:14) So, we’ll get the additional service location practices added to the platform. So you would request the enrollment under that location. Once you get to that group and I’ll we can, I’ll show you how to do that. So you don’t have to fill out the other long template. Okay.
Naomi Denson (48:32) All right. What’s the next pair? Jason?
Jason Zednick (48:35) This.
Naomi Denson (48:37) next 10 minutes, maybe we can cover one or two more. The… North Carolina, that one, the NC tracks. I know we’ll have to figure out, the access setup and the admin for that portal. Yeah.
Staff (48:55) I’m the admin for 90… nine percent of our portals, so.
Naomi Denson (49:01) Okay. Yeah. And.
Jason Zednick (49:03) then we’ll.
Naomi Denson (49:04) get access to that. Anything special or nuanced like that one or is it just Georgia that’s crazy?
Staff (49:10) It’s basically Georgia that’s crazy. Okay.
Naomi Denson (49:15) And then Missouri, Alabama… do you guys require? I think Alabama is one that requires medicare enrollment before they can enroll with medicaid unless?
Staff (49:26) It’s a pediatric unless?
Naomi Denson (49:28) It’s a pediatric? Can you make that we are pediatric?
Staff (49:32) In Alabama?
Naomi Denson (49:35) Requires medicare enrollment before medicaid excluding pediatric… you’re welcome?
Naomi Denson (49:54) United healthcare, you guys go through standard onboard pro? Yes. Okay. So, each of our specialists have their own onboard pro account. So the ones that are assigned to your account, you’ll receive a request to the tax id to grant them access to submit applications. And then they’ll request it in onboard pro directly and then they will set a task that says, hey, I’ve sent the request… for this, and then you’ll just complete the task once you’ve approved it. So… you’ll know who it’s who’s it’s coming from. Are you the only admin in onboard pro that they have an option to select from? So that we know that we can clarify only request from Monia. Well?
Staff (50:41) There’s three of us and either from myself or from Christina pinafore?
Staff (50:52) Because the third one is the billing team supervisor.
Naomi Denson (50:57) So, request for Monia or Christina?
Jason Zednick (51:09) But otherwise, everything is sort.
Naomi Denson (51:11) Of standard and then.
Kimwaters (51:14) On, on the medicaid’s like when rhc does come into play that rhc processes, doc, Naomi, I sent that to you during the call. So you should have it in your email, yes.
Naomi Denson (51:25) I saw it. So we’ll take a look at that, yeah.
Staff (51:30) The rhc needs to be a whole conversation all by itself.
Naomi Denson (51:37) And then Aetna… standard online submission form. Yes, Signa… that one’s the phone call you have to call in to initiate an application. Still, I don’t know it’s been like two years since I did. I think.
Staff (51:57) It’s all online is.
Naomi Denson (51:59) It all online now, I think.
Staff (52:01) They went available. Also… take a look… because I know at the last conference insurance conference I went to, they were talking about it.
Jason Zednick (52:16) Yeah. There’s a join… network link, yeah.
Jason Zednick (52:26) Looks… like for links there’s this email address that’s.
Naomi Denson (52:35) only to link in an already in network provider to an already in network group, so.
Staff (52:46) You can submit?
Kimwaters (52:47) A roster if you’ve got six or more… yeah.
Staff (52:53) Six or more at the same time?
Kimwaters (52:56) So,
Jason Zednick (52:56) that’s all standard. Okay?
Naomi Denson (53:02) Benefit management systems. I wasn’t quite sure which pair that was. I don’t know Jason, if you were able to identify that we don’t have that one.
Kimwaters (53:13) It’s a tpa, which is probably why it’s a little off.
Naomi Denson (53:19) Yeah. It looks like from the pair by state sheet that you guys shared, it appeared that it’s part of might be part of centene, is it delegated? Is it included in the delegation? No, is there a submission process for that?
Staff (53:35) It’s not, it’s not part of the delegated. And I’m not that’s one that the team that we’ve been having, do our enrollments. He’s supposed to be getting me notes.
Naomi Denson (53:49) Okay. Yeah, we just need to know, do you submit directly to them? Typically, what I’ve seen with tpas, is they’re not technically a payer with a network. So you’re submitting, they’re managing it via other payers, so they’re Aetna, cigna, all of the like those. Yeah.
Kimwaters (54:11) They’re just managing the process. So we.
Naomi Denson (54:12) wouldn’t actually do anything to submit there. So we may not need to add that one, but we’ll wait for any notes that you guys have.
Kimwaters (54:20) Manya, if you want to do an email, like just intro to Arun for me, then I can harass him if anything comes up while you’re gone.
Staff (54:31) I would love to do that.
Naomi Denson (54:34) And then I’ll and then, okay, so we’ll wait for that. And then summit Arkansas. We didn’t have that one and I wasn’t able to find really anything on it. Just looking around. So I didn’t know if you guys have any further information on summit?
Staff (54:49) Yes, it’s an mco. So… and their email and everything is summit… it’s summit community care… and it’s an online app through availity… in Arkansas. They’re called a pas P a SSE instead of mco?
Naomi Denson (55:38) Being here through.
Naomi Denson (55:53) Arkansas limited is rostered for mco enrollment… but is it a payer that you submit? Yes. Okay. Yes. If you can send a link to their website in order for us to add as a new payer, our team has to be able to do its due diligence to verify processes and things. So, if you have a link to the website for them, that would be great. And then we can put in a request, I.
Staff (56:23) Said the application is through a link through availity. So, I’m trying to find the administrators and I’m not.
Jason Zednick (56:30) Finding them. Okay?
Kimwaters (56:34) Oh, that’s more of like a payer like a patient facing.
Naomi Denson (56:38) Is that the one that I sent you yesterday, Jason?
Jason Zednick (56:42) I can’t recall was.
Naomi Denson (56:44) That, the one that I found yesterday because I know we were, I can’t remember.
Jason Zednick (56:50) Yeah. This does look like the patient facing.
Naomi Denson (57:00) Oh, that was the one that I sent summit community care. Okay? All right. So, we’re going to submit a request to have that one added as a payer for our team to review. Okay? It’s done through availity. No other specific nuances or rules that are special or particular that we should be aware of.
Staff (57:22) For Arkansas summit… caresource and I can’t think of the other, the third pass right now they.
Jason Zednick (57:34) All can do.
Staff (57:35) The enrollment via also… via roster and it’s the same roster for all three. Just like Oklahoma has one roster to be used all by all the mcos. I.
Naomi Denson (57:48) See the summit enrollment process document that is in the folder that you shared with us and it has, it does have the roster template linked into it. Okay?
Staff (58:10) Okay. Yeah. The assured benefits is Oklahoma state is the Oklahoma state medical association… and I can’t remember that he has to put on here exactly how to do it. He sent me a sheet cheat sheet back, but that one’s not on it. So I’ll have to go through it again, but it’s through the Oklahoma state medical association…
Naomi Denson (58:41) And we are at time. I do have a hard stop here for another call. So I will find some time. Jason. I don’t know what your calendar looks like tomorrow, if you have or tomorrow or Friday, mine’s kind of tight. I’ve got a couple of 30 minute spots but not really a full hour unless we want to do eight a. M Central Time.
Kimwaters (59:07) I mean, we’re up and going. So, are you?
Naomi Denson (59:14) Okay. With that, Jason, are you here? I don’t know what time zone you’re in, I’m.
Jason Zednick (59:20) on Eastern Time zone, what day were we thinking?
Naomi Denson (59:24) Either tomorrow or Friday.
Jason Zednick (59:32) Yeah, let’s talk. Let’s talk after. Okay?
Naomi Denson (59:39) All right. We’ll work out some time options for you guys and I’ll send you an email.
Kimwaters (59:44) Okay. All right. Thank you guys. All right.
Naomi Denson (59:46) Thank you. All right?
Jason Zednick (59:47) Thanks, y’all, bye.