Transcript
Mwinship (00:00) good morning. Hi.
Jason Zednick (00:02) Good morning, everyone. How are we today?
Mwinship (00:08) Wonderful.
Jason Zednick (00:10) Good, good.
Mwinship (00:12) Good. I have tomorrow off, so it’s even better.
Jason Zednick (00:16) Ah, fantastic. Lucky you. I was just thinking I should take some time off. I should… and I will win. I just don’t know when don’t know when.
Kunal Parwani (00:36) Right.
Jason Zednick (00:40) Yeah, let’s chat. Let’s start with KP today. I think… how’s it going? KP? How are we doing? How are the sort of change from, hey, we’re going to consolidate all of these to like, hey, we’re actually going to change some of these departments for kids and then see where we are. How is that yep?
Kunal Parwani (01:09) So, as I said, over, the providers as well as the payers that are under kind of the pfk umbrella. So, I did pull the enrollments there’s. A couple of things I want to confirm. So let me share my screen.
Kunal Parwani (01:53) Okay. Can you guys see my screen? Yes. All right. So, just to start off all these providers that you sent over, all of them should be good. Like I said, I pulled all the enrollments except this one provider. She is deactivated in medallion. So I’m just going to skip her. But other than that, I was able to find all other providers. So that’s good. The other piece is if you could just confirm that this was the list of the payers that.
Mwinship (02:36) you have. So it’s the caresource, medicare. I’m sorry, caresource, medicaid.
Kunal Parwani (02:42) Yep. So I’m not even stopping at the like I’m not going towards the line of business. So, if it’s caresource, or buckeye, I’m pulling it regardless of the lob for now.
Mwinship (02:56) Okay. So, did you, I didn’t see caresource, did you have caresource listed in there?
Kunal Parwani (03:00) I did have caresource listed in there. I’m not sure why I’m… not seeing. So I do have caresource. Let me take a quick look one sec.
Kunal Parwani (03:21) I wonder if this is throwing it off or it’s a different… capitalization.
Kunal Parwani (03:41) Give me just one sec.
Kunal Parwani (04:06) I want to see if Mitch hit the… capitalization changed anything. Yeah, there’s caresource right there. Wow. Okay. Interesting. Yeah, that will happen sometimes. So I also had tricare. Tricare?
Mwinship (04:28) No, tricare can be removed. They’re not part of.
Kunal Parwani (04:31) Yeah, they’re only showing up because of the word humana. Ah, gotcha. So… okay. That’s definitely better. Okay. So, we have mbetter from buckeye… health plan that’s because I’m looking for buckeye so I can remove any of these anthem blue cosmos shield, buckeye health plan, caresource, humana, Molina, and uhc, and.
Mwinship (05:02) Amerihealth, caritas. Okay.
Kunal Parwani (05:16) Okay. Yeah. It’s probably also because of the way I was.
Kunal Parwani (05:25) The way I was pulling it. Okay. So I’ll add that. One thing I do want to ask you is let… me pull up…
Kunal Parwani (06:09) So, is it easier for you to see kind… of each enrollment on its own line or so, for example, right now, what I have is let’s say Aetna, Ohio, it has three lines of business and one practice, you’ll see three lines for that enrollment over here based on how many lobs or practices are on there. So, is it easier for you to kind of determine if it’s on one line or is it okay that it’s split out by practice and line of business… is kind of what I want to get an idea of because you’re going to have to go through this and identify essentially which enrollments to switch to pfk?
Kunal Parwani (07:09) And I am pulling in the payr id as well.
Mwinship (07:11) Okay. And we can on quite a few of them, we could potentially go through and pull out with the payr ids that I had uploaded because the medicades have a different payr id.
Kunal Parwani (07:24) Okay.
Mwinship (07:26) So that’ll help a lot. Okay?
Kunal Parwani (07:31) That definitely will. Okay. You know what? I will leave it the way it is in terms of the structure… where each row essentially represents not just an enrollment but a lob and a practice for that enrollment.
Mwinship (07:56) Okay. And that will still help even though we’re leaving those different entries there with the duplicates.
Kunal Parwani (08:04) Yeah… yes, because we’re going to end up switching the full enrollments at least a few of them to pfk. Okay.
Mwinship (08:16) So,
Kunal Parwani (08:17) for example, just to show you here? So enrollment id is essentially a unique kind of an identifier that’s given to any enrollment. So this corresponds to one enrollment line in medallion. So if you see this is the same number… or the same id, this will represent. So even though there’s four rows here that’s probably because.
Kunal Parwani (08:51) probably because it is for different lines of business.
Kunal Parwani (08:56) the fact that it has the same id, the same enrollment id means it represents one line, oops, one line in medallion, and we are going to switch the payr on the enrollment, which is going to switch the payr on the, you know, on the lobs that are underneath or the practices that are underneath medallion. Oops. Sorry, underneath that enrollment. So we should be okay there. The only thing is we need to identify and you said payr id will help in trying to figure out. So I kind of did leave the payr id in there as well. Yeah. And we can kind of go from there.
Mwinship (09:40) Okay, perfect. So.
Kunal Parwani (09:41) I’ll add amerihealth because I think that wasn’t there before. Yep. Okay. So I’ll add the amerihealth piece and just give you guys access to that sheet and we should be good to at least kick this off.
Mwinship (09:55) Okay, perfect.
Kunal Parwani (10:00) But, yeah, that’s all the update from me for that.
Jason Zednick (10:06) Wow, thank you. KP. Appreciate it of.
Kunal Parwani (10:08) course all.
Jason Zednick (10:10) Right. So, Melissa, I know you had some questions. Yes, let’s yeah, let’s get into it. Okay?
Mwinship (10:20) So, I think the first question that we had was regarding the medicaid applications and I know Tina has sent over several emails on this as well, following… the applications and transferring the providers back to her dashboard. Is there a way that we can have this done? Like sooner… than later? He?
Tina.Ferguson (10:45) Melissa, he did send me a bunch back today, okay? And I sent him another list. So it’s in process.
Mwinship (10:51) Okay, perfect. Yeah.
Jason Zednick (10:53) I think the instructions from the Ohio… PDF, they’re like slightly out of date, the UI has changed a little bit.
Tina.Ferguson (11:05) I pulled it right off the dashboard too. Yeah, that’s interesting.
Jason Zednick (11:09) Yeah, because when I opened it, I was like this is a little different. I was able to figure it out of course, because I was able to transfer them, but I think my team just, you know, it wasn’t clicking for them, but we figured it out. I know how to do it now. Okay? I’ll get the six… or seven that you sent in that second batch. I’ll try to do it today and get them back over to you and.
Mwinship (11:37) Then Tina, I know you had another question regarding the caresource application? Yeah.
Tina.Ferguson (11:42) Like an email I sent you, it appears that they’re using the wrong portal and they’re requesting a contract and not an enrollment.
Jason Zednick (11:53) Yeah, that, so I haven’t had the opportunity to dig into that email yet. If that is the case.
Tina.Ferguson (12:00) I was thinking they probably need access to our portal.
Jason Zednick (12:06) Yeah. I had the same thought that if it’s a, I would call it similar to, well, let me ask you, do you know for caresource, is it a… I’ll use the term power user just because that’s familiar to us? Is it like a power user situation or would we just get direct access to your?
Tina.Ferguson (12:27) I think, Melissa, I don’t know who do you do that or?
Mwinship (12:31) I can’t I am an administrator on that. I think it’s just direct access to be honest.
Tina.Ferguson (12:37) Right. And I think Brooke needs to add it too. So maybe we can do two at the same time.
Jason Zednick (12:45) Okay, great. So what we do in that instance, when it’s direct access is in the, let me pull it up.
Jason Zednick (13:15) And the group profile.
Jason Zednick (13:30) There’s an external accounts section, right? So we can just save the credentials there and the team can access it that way. So, let me take a look at your email.
Tina.Ferguson (13:41) It wouldn’t be for each provider. It’s like I have a caresource account and Melissa has a caresource account. Yeah. So it’s not by provider a.
Mwinship (13:51) User would get the access for all of copc providers.
Jason Zednick (13:55) So, it would be like a power user situation then?
Tina.Ferguson (13:58) Yeah, it’s not called a power user, but yes.
Jason Zednick (14:01) Yes, I’m using that as short name. Okay?
Tina.Ferguson (14:03) Gotcha.
Jason Zednick (14:05) Okay. Then that’s great. I.
Mwinship (14:09) Would just need to know who needs to have access.
Jason Zednick (14:13) Okay, perfect. Yeah. So let me review… that. Let me check with the team, see what they’re doing. And then I can talk to my lead and get you.
Jason Zednick (14:30) Information on who… should be set up for that account? Like what should the email address be that we can then manage?
Kunal Parwani (14:48) Okay. All right.
Mwinship (14:54) And then Tina, I think the next one is yours as well. Actually the next couple. So it’s regarding the medicare applications.
Tina.Ferguson (15:04) Yeah, I noticed some inconsistencies on the medicare applications. I didn’t see where any locations were at it. There weren’t any practice locations at it, and I wasn’t sure why that was being done that way. And then I also noticed the mailing address hasn’t been updated. One of them had a mailing address still in Texas.
Tina.Ferguson (15:27) And I also had a question. Usually CGS sends us approval letters and I didn’t see those were uploaded and I didn’t know if you guys were saving those somewhere else in case we need them.
Jason Zednick (15:40) If we receive the approval letter, we will load it to the enrollment. Once we record it. Sometimes we don’t we’re not the recipient of those depending on the agency… but if we are getting them, we should be loading them for you. If you have examples of the… mailing address issue or locations not being added, can you email me those? And I can mark them as we call it incidents and escalate with the team and have.
Tina.Ferguson (16:14) Them, correct?
Jason Zednick (16:16) With their crew?
Tina.Ferguson (16:18) Okay. Yeah.
Mwinship (16:21) And then, Tina, I do believe the next one was yours as well using central Ohio primary care physicians inc, for the name of the practice locations when enrolling?
Tina.Ferguson (16:31) Yeah, we talked about that previously.
Jason Zednick (16:33) Yeah, that is their instruction. They are instructed to do that. Okay? I checked right before it’s called. I was like, well, let me make sure I wrote it down like I thought I did. And I did so like, I was very clear on that. So if there’s an issue.
Tina.Ferguson (16:46) On the caqhs, you guys aren’t updating those, right? That’s ours because I had one provider that someone added practices in, but then didn’t fill them in and he had like 167 errors and we have those built in caqh, and we export them into their application. So we don’t have to fill them out every time. Yeah, that’s correct. Yeah, if something needs added, they should be tasking us, right?
Jason Zednick (17:16) Yes. Okay. Yeah, correct. We are not managing caqhs. Okay. Yeah.
Mwinship (17:26) And then I think.
Jason Zednick (17:27) Although, let me just… because sometimes it can be a little unclear if we have the logins.
Tina.Ferguson (17:38) Right. That’s what I was wondering.
Jason Zednick (17:40) And it’s for an enrollment. It’s possible. Someone’s like I’ll just like go change it, but,
Tina.Ferguson (17:47) yeah. I went in to work on him and it was 167 errors. I’m like what in the world is going on here?
Jason Zednick (17:53) What provider was that?
Tina.Ferguson (17:55) Pandya, P a ND y, a. All right. And I thought maybe they were just gotten confused since you guys managed some people’s caqh. Yeah.
Jason Zednick (18:06) It’s possible. So, I don’t want to say we didn’t do it because it could easily happen. So, let me take that example. What was the?
Tina.Ferguson (18:13) The first one Milan?
Jason Zednick (18:17) Milan. Okay. Great. Let me… just go talk to that team and be really clear, make a task, don’t go.
Tina.Ferguson (18:25) Right. Yeah. Because if they just need locations added, I can go in and export that into their caqh, instead of sitting and typing in all that information.
Jason Zednick (18:36) Yeah, perfect. Yeah, I will, I’ll speak to them about that, yes.
Tina.Ferguson (18:41) Melissa, do we want to discuss the moonlighting thing then?
Mwinship (18:45) Did you want to go over the other? Yeah, I do want to discuss that, but did you want to go over the other questions that you had?
Tina.Ferguson (18:52) I thought we covered most of them. I’m looking.
Mwinship (18:55) The enrollment applications?
Tina.Ferguson (18:57) Yeah. The only other thing besides the approval letters from medicare is I didn’t see where you were saving the medicaid applications a copy into medallion. I didn’t know if you guys had those somewhere else.
Jason Zednick (19:12) No, we should be saving it to the line. Okay. I will remind them to do so. I.
Tina.Ferguson (19:22) thought maybe it could possibly be since you switched people that were doing them too.
Jason Zednick (19:27) Yeah. It’s possible. It’s one of those things that if it’s supposed to be there because we, for obvious reasons like we’ll want to be able to like, okay, what was submitted, let’s look and that is a, very useful tool. So.
Tina.Ferguson (19:41) I think that’s it, Melissa, other than this moonlighting thing?
Mwinship (19:45) Okay. So moonlighters are a hot topic here at copc and one of the questions that I wanted to ask, is there anything that we can do in medallion for like a provisional credentialing for our moonlighters? So they’ll come on board and they’ll work under a supervising provider at the hospital. Most of them end up after their residency is done, becoming full time employees at copc. But in the meantime, is there something that we can do? I?
Tina.Ferguson (20:21) Think what the problem is, Jason, when I put them in to be credentialed, they haven’t finished their residency. So, your people were coming back and saying I couldn’t credential them because their residency isn’t done, but that’s why they would be moonlighting first because they’re still in their residency.
Jason Zednick (20:39) Yeah. So let me ask like.
Jason Zednick (20:47) Other than residency being, you know, not requiring residency to be complete. Obviously, are there any other?
Tina.Ferguson (20:57) No, it’s everything is, I’ve completed everything else. It’s just, they haven’t finished their residency yet. Yeah.
Jason Zednick (21:03) Every, every, all the other verifications would still apply. It’s just right? That one. Okay. So… I don’t know, I,
Tina.Ferguson (21:16) don’t know they sent me a task and I didn’t know if I could just reply back and say, you know, move forward with that or?
Jason Zednick (21:23) Yeah. Let me because.
Mwinship (21:25) The thing, is once if, is, if they are moonlighters and we have like a provisional credentialing, you know, when they get ready to become full time, they’re you know, at that point, we would put them through again, which so.
Tina.Ferguson (21:44) If we, I think she means if we put them through as moonlighters, and then we put them through again as an initial, will the dates update in medallion? Then if we do two different committee times, yeah.
Jason Zednick (21:59) One field would. So, so, so it would be a two step process because once you approved the provisional credential, it would create a re, credential according to the normal rules. And so we would need to cancel that re credential which is easy. Enough. It’s not difficult and then put a new initial in. And then once that initial completed, it would update the most… recently credentialed field, but it would still show the provisional credential as the initial credentialing date.
Tina.Ferguson (22:38) And that’s something you would have to do for us.
Jason Zednick (22:41) That would happen automatically. So, let me ask the question is, would you want the initial credentialing date to indicate the provisional or the full… credentialing date?
Tina.Ferguson (22:55) I think that we’d want to go with the initial credentialing date to have the re, cred dates based on?
Mwinship (23:01) I would agree.
Jason Zednick (23:05) Here. Let me… let me pull up a profile. I.
Tina.Ferguson (23:12) Have four pending in there on half tasks.
Jason Zednick (23:18) And also.
Tina.Ferguson (23:20) Like they’re going to finish the residency in June and they start in September if we wait till the end of June to put them in and the insurance enrollments are going to take, they’re going to start working and their insurances won’t be done yet.
Jason Zednick (23:36) So, so… there’s sort of two fields of data here. There’s the initial credentialing date, and then the latest. So if you do… a we’re just going to pretend this is a provider, right? And pretend this was the provisional date. If we be like, okay, great. They’re coming on full time, we’re going to do a new initial. This date is going to update this latest credentialing date, and we’re going to do a re, credential based, you know, three years after this date, that’s fine. That’s pretty standard. However, this date in the data won’t change. So you’ll have that provisional date listed as the initial credentialing date, not just for data concern at all.
Tina.Ferguson (24:27) I don’t think.
Mwinship (24:28) It’ll be a concern when.
Tina.Ferguson (24:31) I do the drop down to request an initial credential, will it allow me to do that twice?
Jason Zednick (24:37) Well, you would, but what you would have to do is you would have to find.
Jason Zednick (24:46) Actually, let me just use an npi because it’s much easier to search. That way… you would have to hopefully there’s one here. Yeah, you would find like their scheduled… re, credential and you’d have to cancel it.
Mwinship (25:02) Now, we can’t do that because remember, I had that one and I had to have it sent to you to do French valid.
Jason Zednick (25:12) Oh, okay.
Mwinship (25:13) Because we don’t have that additional level… of access that you have.
Jason Zednick (25:20) What’s the volume that we’re talking about?
Tina.Ferguson (25:24) It’s usually right now, I have four. So ranges between one and four.
Jason Zednick (25:32) So that’s not that bad. So, like, I wouldn’t be concerned about like, hey, shoot me an email. I can delete them. And then, yes, you can come in and request a new initial credentialing. Okay, it would only be blocked if this was scheduled, but I don’t mind deleting those if the volume’s low enough like that.
Tina.Ferguson (25:48) Yeah, it’s not tremendous.
Jason Zednick (25:51) Yeah.
Mwinship (25:56) Okay. So we can do a, I just want to make sure because I have to report back to our committee. Well.
Jason Zednick (26:03) Let me talk to my team first because right now, I’m just thinking logistics, okay. I want to talk to my team about in terms of like sort… of their.
Mwinship (26:15) Okay. I’ll wait on you then. Yeah.
Jason Zednick (26:17) Just because, you know, we have like, you know, process and, you know, our certifications and stuff. I just want to make sure it’s not a problem in that regard and we might have to get it documented. Okay. So, in some way and I just don’t know what their concerns would be, but I think in terms of logistics, I see a path, I just need to clear it all. Yeah. Okay. And,
Mwinship (26:40) then moving on from moonlighters, I did have a question. So we have some additional payers that are not delegated payers, but that we do rosters for… is there a way that if we send those payers that we can have like a roster drop for those additional payers?
Jason Zednick (27:10) Is that for like new enrollments or is it like it’s for?
Mwinship (27:14) New enrollments?
Allissa.Chute (27:17) Updates and terms? Okay?
Jason Zednick (27:20) The same as a delegated roster? Yeah.
Allissa.Chute (27:24) It’s the same.
Jason Zednick (27:25) So,
Jason Zednick (27:32) what’s the cadence?
Mwinship (27:34) It’s monthly, like the delegateds?
Allissa.Chute (27:40) It’s a total of 12 rosters.
Jason Zednick (27:44) Including the delegateds also.
Allissa.Chute (27:46) Yeah, that’s all of them.
Jason Zednick (27:52) So, it sounds like it… behaves exactly as if it were delegated, but yes, but it’s not. Okay. Yes. So, I don’t see any reason that we can’t support… that. It would just, it would be exactly like we support the delegated rosters. There’s a couple of things to like keep in mind is that our delegated rostering process does not… it’s separate from the enrollment records. So the enrollment records wouldn’t be updated in that way. We have… another process where we do support rosters… for non delegated payers in which you would submit your requests as normal? We sort of, you know, look and say, like what are all the open requests? Okay? Let’s drop all these to the rosters and send it. KP, can I like, yeah… what do you think? Like, what would you recommend?
Kunal Parwani (29:11) So, I mean, I don’t know if… like, we’ll be able to support it through the delegated piece, if it’s not a delegated pair… that’s something to bring up? I can find that out the PE rosters that you’re referring to Jason, I think this might fall into that bucket.
Jason Zednick (29:41) Okay. I.
Kunal Parwani (29:42) will still, you know, try to find some more information, but I think they’ll fall on the PE side, not on the delegated piece.
Jason Zednick (29:53) Yeah, my, only, how do we, or do we just not handle terms on the direct roster process?
Kunal Parwani (30:02) On the PE one?
Jason Zednick (30:04) Yeah, yeah.
Kunal Parwani (30:05) Yeah, unfortunately, I have no idea about those since it’s the PE team that runs them.
Jason Zednick (30:12) Got it. Okay.
Kunal Parwani (30:13) I can’t hold that completely. Yeah.
Jason Zednick (30:17) So, Ohio team, I have sort of two questions I need to get clarity on like what’s the cadence of how we send those rosters out and then whether we can support terms on those rosters as well. But we… do have the ability to support that. It’s just a question of those two things… and.
Mwinship (30:48) All right. So… I’ll wait to hear back from you on that one as well.
Jason Zednick (30:54) And you said you have about 12 of them?
Mwinship (30:56) Well, that is including the delegated?
Jason Zednick (31:01) Oh, okay. That’s.
Allissa.Chute (31:03) delegated. And not delegated?
Mwinship (31:05) Right.
Jason Zednick (31:06) Okay. So.
Mwinship (31:08) How many is it off of? So we have what the seven delegated?
Jason Zednick (31:12) So, about five? Yeah. Okay. Yeah. Let me just like get some clarity on the process on sort of… when those rosters go out, if we can set the cadence or not. I’m just not clear on that and then handling of terms. Yeah.
Kunal Parwani (31:38) We have eight delegated, just by the way. Oh, is.
Mwinship (31:40) it eight?
Jason Zednick (31:41) It’s eight? Yeah. Okay.
Mwinship (31:43) So, then it’s only four non delegated. All right.
Jason Zednick (31:47) So, I’ll ask, yeah. All right. Yeah, I’ll find out and we’ll we definitely short answer is that we definitely support roster submissions.
Kunal Parwani (32:00) And then, sorry, just before we end, I just wanted to show what I’ve added to the sheet just so you kind of know how to go through it. I’ve added this column that says switch to pfk. It’s a checkbox. So it’s easier for you to kind of go through essentially whichever enrollment we want to switch to pfk. You can go ahead and just mark that and that’ll give me an easy indication of what to switch and I’ll review it after you obviously go over it, but, yeah.
Mwinship (32:33) Okay.
Kunal Parwani (32:36) Sweet. Well, I’ll share this with you guys.
Kunal Parwani (32:41) All right.
Jason Zednick (32:46) Anything else?
Mwinship (32:50) And then just,
Jason Zednick (32:52) oh, compliance.
Mwinship (32:55) Compliance information?
Jason Zednick (32:56) Policies. Yeah, I have the policy. Someone sent it to me. Okay? And I’ll forward that to you and then the freight squad and abuse training. They sent me a screenshot of… that’s from one of our systems and they were like, hey, will this work? And I’m not sure. So I’m going to share that with you? Okay?
Mwinship (33:13) And you let me know.
Jason Zednick (33:15) Exactly.
Mwinship (33:15) I’ll send it to the compliance director and see if that’s something we’ve never been asked this before. If we have, nobody’s said anything and we don’t make our external partners do our compliance testing and stuff like that. So, yeah.
Jason Zednick (33:36) We definitely do it. I’ve definitely done it. I just don’t know what they’re looking for in terms of.
Mwinship (33:41) I don’t it’s human. It’s hard to tell yeah.
Jason Zednick (33:45) Fair enough. So, I’ll send you that and you just let me know if they want something else.
Mwinship (33:49) Okay, perfect. That’ll work. Yeah.
Jason Zednick (33:51) Okay, great. All right. Well, thank you all. I got a lot of follow ups here. I’ll try to get to these as soon as I can. I’m going to put Tina, getting those providers back in your dashboard, sort of at the top and then we’ll go from there.
Mwinship (34:12) All right. Sounds good. All right. Thank.
Jason Zednick (34:15) You all.
Kunal Parwani (34:17) Thanks, everyone. Bye.