Transcript
Sandhya Kapila (00:00) there, bye… have you found your child?
Naomi Denson (00:10) 18 times?
Kelley Gear (00:11) She’s never happy.
Sandhya Kapila (00:14) Too. Funny.
Sandhya Kapila (00:23) Oh, Kelly’s here.
Sandhya Kapila (00:28) Is Jacqueline here? She’s coming. Hey, Kelly there. How are you? Pretty good, you?
Kelley Gear (00:38) Good.
Sandhya Kapila (00:39) Thank you. How are you feeling better? I hope.
Kelley Gear (00:41) Yeah, a little bit better.
Sandhya Kapila (00:43) Okay, good. I’m just gonna wait for Jacqueline.
Sandhya Kapila (01:01) And I’m getting answers for you on the parallel on an MD app form, whether that’s something that we could include, in our onboard, on our, in our pocket, so you can use that as part of like the provider onboarding versus you needing to like.
Kelley Gear (01:19) I also emailed with a list of all the providers and the hospitals that they’re in and the H, or contact of hca to get the start dates. And I asked her if it was possible to, just for me to just help parallel on this without having all these doctors to have to sign this form. Hoping maybe she says no, but, or that they don’t have to, but I’m not gonna lie. She’s not the nicest person. So, okay.
Sandhya Kapila (01:52) So, we’ll see what she does. Fingers crossed. She’s having a good day. I just.
Kelley Gear (01:58) Asked one of my colleagues. I’m like, is it just me or is this woman not very nice and she goes, she’s horrible. I was like, okay, it’s not just me.
Sandhya Kapila (02:09) Oh,
Kelley Gear (02:10) did I do something to this person? Oh.
Sandhya Kapila (02:12) Man? Well, hopefully you get a positive response from her… but I will follow up as well when I hear back from the team. Okay, cool. I think Jacqueline’s just on another call, but we can get started. This would be something that she would work with you on as your engagement manager, but I do want to make sure that we make the best use of this time too. Can you see my screen? Okay, perfect. Okay. So, to get started, what Jacqueline did was we mapped the parent name that you shared with us with what we have in medallion. So, we just wanted to check with you to make sure that, you know, that makes sense to you? And you agree? So medicare, we have it listed as medicare, Florida… tricare, we have it as tricare east humana, military. Is that accurate? Does that sound good? Yeah.
Kelley Gear (03:22) I think we’re going to need to make us, I think we’re going to have to make two lines, one for sunshine and one for ambetter because they are two different things.
Sandhya Kapila (03:30) These are two different ones.
Kelley Gear (03:32) Okay. Yeah. I mean, ambetter is part of sunshine, but sunshine has its own separate two, if that makes sense. Okay? So, it’s like it really is two. I guess.
Sandhya Kapila (03:45) Okay. So, should we change this to just sunshine? And then this would be ambetter. Yeah. Okay. Naomi, do you have any insight on those… ones?
Kelley Gear (04:01) I would think, can we look at the options under the payer name? It’s after the sunshine one, see if there’s a different one?
Sandhya Kapila (04:11) Yep. I can do that. Yeah, we can do that.
Kelley Gear (04:14) Ambetter from sunshine would definitely go with that ambetter one, but.
Sandhya Kapila (04:18) Okay. I’m just going to highlight these… two so that we can.
Naomi Denson (04:22) Look, I’m pulling up the open directory.
Sandhya Kapila (04:26) Thank you. And both of these would be managed medicare.
Kelley Gear (04:31) Yeah, medicaid. Yeah. Oh.
Sandhya Kapila (04:34) Medicaid. Sorry. Yeah, medicaid. Yep.
Naomi Denson (04:36) So, ambetter, so sunshine, we have ambetter from sunshine health or sunshine health?
Kelley Gear (04:47) Right. So, sunshine would be sunshine health, and that ambetter one would be the one that you’ve got there.
Naomi Denson (04:53) The ambetter from sunshine health?
Kelley Gear (04:55) Yeah.
Sandhya Kapila (05:03) Great. All right. For unitedhealthcare, we have it as unitedhealthcare. BCBS. Florida. We have it as Florida blue, Cigna, humana, Aetna. Is Aetna better health of Florida?
Naomi Denson (05:20) No, that’s just, that should just be Aetna. It should be just. Aetna. Better health is the managed medicaid, mco, got it. Okay?
Sandhya Kapila (05:28) Thanks, Naomi. And then Oscar, we have as Oscar.
Sandhya Kapila (05:39) Great. So, under your current group enrollments, you’re enrolled with all of these currently, correct?
Kelley Gear (05:46) Say, yes, for this one, the sunshine and the ambetter medicaid, we just signed a contract with them agreeing, to be in network actually just some of our, it’s not going to be all of the providers, it’s just some of them. Okay. But, it, I’m going to say yes, because it should go through any time now, they all, you know, they have, the packets and every or the doctor’s names and the roster and the whole thing, so.
Sandhya Kapila (06:15) Okay. Naomi, do you suggest we leave that as, yes, since there’s it should be any minute now or do you recommend setting that as no until we get it?
Naomi Denson (06:26) I think if they’re expecting it to be back any day now that you wouldn’t just leave it as, yes.
Sandhya Kapila (06:31) Perfect. If.
Naomi Denson (06:33) Anything changes or you turn out not to go into the agreement or something happens. We can always, you know, change it back later.
Kelley Gear (06:42) Okay.
Sandhya Kapila (06:44) All right. And so your priority, you’ve listed here, I’m going to ambeders and sunshine, should I set that as low medium or high?
Kelley Gear (06:53) I just had them as low because, oh,
Sandhya Kapila (06:57) because they’re yeah, that’s okay. Do you have rosters? Are you leveraging rosters for any of these payers?
Kelley Gear (07:06) I had a roster for sunshine and ambeder. They were the same one. I believe unitedhealthcare. Okay? But I do unitedhealthcare online. So I don’t really submit a lot of roster with them.
Sandhya Kapila (07:24) You don’t have a roster with them. Okay. And then, do you have a link for those rosters that you could just share with us here for sunshine and ambeder?
Kelley Gear (07:39) Perhaps. Okay.
Sandhya Kapila (07:42) When you have it.
Sandhya Kapila (07:47) And you can just pop it into the document too, since you have access to it… poor and.
Naomi Denson (07:57) better, sunshine, where did my screen go? I’m going to take over for a second, Sandhya go.
Sandhya Kapila (08:08) For it, I’m going to stop sharing. Yep, go ahead is.
Naomi Denson (08:11) This, the roster, does this look familiar?
Kelley Gear (08:16) Yes, that is that horrible. Horrible thing.
Naomi Denson (08:19) Yeah. Okay. And then let’s see that was ambeder from sunshine. The other one, you had one for sunshine? Okay. Is it the same thing?
Kelley Gear (08:32) Those were the same one? Yeah, it was one in the, we submitted one roster for both of those. Okay.
Naomi Denson (08:41) That was just what I wanted to ask. So the rosters are already in there, Sandhya?
Sandhya Kapila (08:46) Oh, perfect. Okay. Cool. So, I’ll just put that currently, same as? Okay. Yeah, perfect. Thanks Naomi.
Kelley Gear (09:02) Of course. All right.
Sandhya Kapila (09:03) Oh, and I’m not sure. Sorry, I thought I was sure I will go ahead and share again. Okay. So, for most of these, you have these listed as non standard enrollment processes. So just to confirm, is there anything that you do outside of what’s listed on like the website for… the ones marked as no, no, I.
Kelley Gear (09:30) Mean, I, just… for, I mean, for medicare, if they’re already a Florida provider, those are fairly easy because I can just log on to our pcos, and add them. Otherwise, I have to, you know, do the whole form, the whole application form and everything. But I usually, to be honest, I usually get the provider’s pcos login and we do it together. I look, I’m on the phone with them and I let them know we’re doing it. I submit it from theirs. But rather than sending in the paper form or anything, we do it all online. Okay, try to fill out the certification. You have to certify them first. And if they’re not already a provider, and then they go into the credentialing automatically on that and do all that online as well. Unitedhealthcare. I log on to the portal, the unitedhealthcare portal, the onboard pro and blue quatch, blue shield, we go through availability and add them.
Sandhya Kapila (10:39) Okay. I’m going to make it a little smaller.
Kelley Gear (10:42) Cigna… if they’re already for the provider, it’s just an email to a link letter that’s what for those? And if they are not a provider, the only way for them to do it is to call them, which is hideous. Okay. Oscar… I have no idea. I’ve never done it. Okay. That’s the one that health alliance does. Oh, yeah.
Sandhya Kapila (11:14) Naomi, do you know if we have something already set up for Oscar and Aetna actually, because also for Aetna, right? Kelly, you have that the health alliance does it?
Kelley Gear (11:26) Yeah, I do the, I do the mid levels, I do that online as well. Okay?
Naomi Denson (11:35) Okay. So, for… Aetna, do we have a process for the mid levels?
Kelley Gear (11:45) I just go online and add them to our, yeah.
Naomi Denson (11:48) That’s that’s our process. It’s the request.
Kelley Gear (11:53) To be a provider or whatever?
Naomi Denson (11:56) Yeah, at the, like, it asks you if you want to link them to an existing group, and all of that via, yes. Yeah. Okay.
Sandhya Kapila (12:07) So Naomi, would we need like a project plan just to specify that it would, we would only be doing it for mid levels because the health alliance credentials MDS dos and dmps.
Naomi Denson (12:17) No, because we would, we wouldn’t do the MDS dos and dmps unless they requested them from us, which they wouldn’t be. So we would just work what’s requested?
Sandhya Kapila (12:26) Perfect. Okay. Cool. So, I can just mark this as no, then, since it’s not a standard process or so since it is a standard process.
Naomi Denson (12:40) Yes. Yeah, that’s standard all.
Sandhya Kapila (12:42) Right. Okay. And then for Oscar?
Naomi Denson (12:44) For Oscar, we’re requesting to add positions to an existing contract so that we email our roster with the provider info.
Naomi Denson (13:06) Thank you. What state is this?
Sandhya Kapila (13:11) Florida… the oscars?
Naomi Denson (13:25) Provider?
Naomi Denson (13:38) If we’re listing a new contract?
Sandhya Kapila (13:43) Yeah, the,
Naomi Denson (13:44) health line says the same thing. So, it’s just mid levels. How do you do the mid levels? Is it through the submission of the roster to rosters at highoscar com, with a W9?
Kelley Gear (13:55) I have never done it that’s one that’s new that I want to do. So.
Naomi Denson (14:01) You don’t have a group contract with them? Either you don’t have any active enrollments with Oscar? No, I.
Kelley Gear (14:10) Do our, the health alliance that we work with. They do the MDS, the dos, and the podiatrists… they credential them with Oscar, but they don’t do. Oh,
Naomi Denson (14:25) okay. Currently, none of the mid levels are credentialed, but you want them to be correct? Okay. So, you don’t have a standard process for that currently. So we would just follow our process. Yes, the standard process provided by the payer, yes, perfect. Great. What’s the other one that says added through availability? The other says it’s.
Sandhya Kapila (14:47) not, it’s Florida.
Kelley Gear (14:50) Blue, Florida.
Naomi Denson (14:51) Blue that’s standard too. Florida blue’s all done through availability. So it wouldn’t be non standard. Okay, great.
Sandhya Kapila (14:58) Thank you. And then just wanted to ask about the pcos one. Naomi, do we need to right away? Get a surrogacy? Or access to the pcos? We get.
Naomi Denson (15:11) Surrogacy, so, I have the instructions in our team page, Sandhya, for the pcos for them to grant entity level access for your groups at pcos. And then as you request enrollments for individual providers, we’ll request surrogacy separately as requests are made for the provider’s account.
Sandhya Kapila (15:33) Okay. So then, Kelly, I’ll send you those instructions as well. We’ll.
Naomi Denson (15:37) also send the instructions to grant us the access to availability too, so that we have access to the group npis.
Kelley Gear (15:45) Okay.
Sandhya Kapila (15:52) Perfect. For this one, I submit for certification online, tricare. Is that something that we also do Naomi?
Naomi Denson (16:02) Which one?
Sandhya Kapila (16:03) Tricare?
Naomi Denson (16:05) Tricare? Yeah. Is it tricare?
Kelley Gear (16:07) Tricare?
Naomi Denson (16:08) East.
Sandhya Kapila (16:08) humana, military?
Naomi Denson (16:10) Yeah. The certification online. Yeah, perfect.
Sandhya Kapila (16:18) This week, I’m just making sure we go through all of these guys. Okay? I think we’re good then.
Kelley Gear (16:25) Providers are going to have to submit a new delegate form for… hca… which one… hca hospitals? Oh, sure.
Sandhya Kapila (16:43) Oh, she responded to you. Okay. So she said that they are going to each provider is going to have to sign it.
Kelley Gear (16:52) Okay.
Sandhya Kapila (16:52) And so I will confirm with you whether that’s something that we can add to as part of our provider onboarding. So, if it would be in their profile versus like you having to reach out to each provider. So let me, I’ll get confirmation on if that’s something that we can do. Naomi, this is for the paralon forms for the hospital forms, the hospital app… for to set up, set us up as delegates. Each provider needs to sign their own form. And so we’re just trying to figure out if it’s something that Kelly would need to reach out to each provider to get done, or if we can add it to them Jen.
Naomi Denson (17:35) Said we handle that. Okay?
Sandhya Kapila (17:37) So, we could just add it to medallion as a form for them to fill out.
Naomi Denson (17:40) Well, she’ll send it out.
Sandhya Kapila (17:42) She’ll send it out. Okay?
Naomi Denson (17:43) Let me make a request. So she’ll send it out to them. Okay? When you make the request for the appointments, so.
Sandhya Kapila (17:50) There’s nothing that Kelly needs to do in terms of like adding us as delegate, like filling out that group info section, that delegation form. Okay?
Naomi Denson (18:03) Okay. I don’t think so. The conversations that I’ve had with Jennifer with other customers, is that we just, we handle that as it comes. Okay. There is an email and information that we can send over to you if you want to proactively let them know that medallion is a delegate. And then the individual provider forms we would handle as they come.
Sandhya Kapila (18:32) All right, Kelly, we’ll follow up with that info as well.
Kelley Gear (18:35) Okay. Cool.
Sandhya Kapila (18:37) Do you have any other questions that we can answer right now?
Kelley Gear (18:43) Actually, yeah… on the.
Kelley Gear (18:51) Let me find it. Yep, provider enrollment. Yeah, the provider enrollment one.
Kelley Gear (19:02) All the way over wait, is it that one? Hold on?
Kelley Gear (19:10) Hold on. Let me find it.
Kelley Gear (19:24) I don’t know which one it’s on, but what does it mean whenever it’s asking? Is it is something par, status P a R status? What does that mean? Like non, par link to group? What does that mean?
Naomi Denson (19:42) Ah, I’m having trouble, okay? On the provider enrollments tab for the non, par link to group, par, not linked to group. So that’s for these enrollments, did you submit an application to have them linked to your group’s contract? Par, not linked to group would mean they’re in network technically somewhere. Maybe they’re linked to an old employer’s group contract. They have an individual agreement or non par, could mean that, you know, they aren’t enrolled directly as a participating provider. But on the other, there’s another column that says no credentialing required direct enrollment. So no credentialing required would mean that there’s no application process to submit that provider to become par, but they maybe see patients under supervision of a physician and you bill through the physician who’s enrolled. So, direct enrollment means you’re submitting an application directly to the payer for that provider, or you did, it was done via direct enrollment to have them enrolled. No credentialing required means you didn’t have to do anything, but they can see patients still with that payer with the supervision of a physician who’s enrolled. Okay? Does that make sense?
Kelley Gear (20:57) Yeah. So, par, linked to group means that you?
Naomi Denson (20:59) You don’t know if it makes sense. Par, linked to group? Yes, would just be you submitted an enrollment request to have them linked to your group contract and they are in network and participating. Okay?
Kelley Gear (21:19) What’s the password?
Naomi Denson (21:26) Is there another question?
Kelley Gear (21:33) I don’t think so. Okay. I think I’m okay. I’m getting there with this thing. I’ve got my whole schedule blocked off today. I haven’t been able to do a whole lot, but I’m trying, I’m telling people to leave me alone so I can try to get this done.
Sandhya Kapila (21:52) Okay. Great. Well, please reach out if you do have questions.
Kelley Gear (21:57) Okay. I will. All right. Okay. Thank.
Sandhya Kapila (21:59) You. Thanks so much, all.
Kelley Gear (22:01) Right. Talk to you later. See ya.
Naomi Denson (22:03) Bye.
Kelley Gear (22:04) Bye.