Transcript
Connor Morley (00:00) hey, Nick.
Nick Vander Velden (00:10) How’s it going?
Connor Morley (00:13) It’s going.
Nick Vander Velden (00:15) Dude, dude.
Nick Vander Velden (00:29) Alright. Let me see.
Connor Morley (00:31) I do not see them in the call yet. A minute or two to join. Yep, there’s Rachel, cool.
Connor Morley (01:00) Hey, Rachel.
Connor Morley (01:20) Hey, Rachel. Hey, Norma.
Connor Morley (01:26) All right. For today, we have Nick on, he has some questions about your.
Connor Morley (01:43) Here’s, some questions on your provider enrollments, so that we can get all of that data. So I think we’ll just cover that for a little bit and try to get through that. And then Rachel, I think the only other follow up I have is the credentialing documents.
Connor Morley (02:05) I think you’re still on mute.
RachelsiPhone (02:17) Can you hear me now?
Connor Morley (02:20) Yeah, we can hear you well, we can hear you at least we can hear two of you.
Connor Morley (02:37) Can’t hear you anymore? Oh, there we go. Yeah.
RachelsiPhone (02:42) But there’s an Healthstream… how to figure out.
Connor Morley (02:52) Usually, I think if you just turn off the volume on your computer.
RachelsiPhone (02:58) It is off.
Connor Morley (02:59) Oh… interesting.
RachelsiPhone (03:11) Thank you. Sorry.
Connor Morley (03:17) No worries. That sounded good.
RachelsiPhone (03:19) Yeah, I can still hear myself.
Connor Morley (03:42) All right. Nick, do you want to pull up the provider enrollments in the meantime?
Nick Vander Velden (03:50) Yeah, I can do that. Make sure I get the right screen here.
Nick Vander Velden (04:12) Yeah. So, my primary question here is based on the fact that we have medical… behavioral, vision and dental enrollments all listed… here. So I just wanted to check on like because we’re trying to figure out making sure we get the right payers for the enrollments here. So I have, the two kind of as a starting example, the two eye institutes pulled up here. And then if I go over to the payer names, I… see some payers in here that are pretty obviously for vision like the cigna vision plan, davis vision. And then some listed that I can’t tell if they’re medical or vision. So like there’s Aetna ones, cigna. So I’m curious if like everything listed for these eye institutes… should be assumed to be vision enrollments or if there might be medical ones in here too? And like you’ve already listed vision for the payers that have vision. Does that make sense?
RachelsiPhone (05:49) Norma, do you want to take that one hold on? Okay on?
Norma Mendo (05:53) The vision providers, we do enroll the providers in vision plans, but they also bill in for medical product as well. So, rule of thumb is usually you have to do for example. And I’m going to give you an example. VSP is their vision, cigna is their medical.
Nick Vander Velden (06:14) Yeah. So in that case, it sounds like you guys have already like labeled the ones that are vision as like VSP or something. And then all the rest are medical. Is that like a safe assumption?
Norma Mendo (06:28) Correct. Okay. If you put vision at the end, they’re vision plans, yep, and they are some that will be a vision plan. There’s a very, I think like meridian for example, has their own medical plan and their vision plan together, but they’re mostly medicaid products. So it’s usually being used for vision, but they will pay some CPT, but on the back end that has nothing to do with credentialing. Yeah, I mean, with, yeah, credentialing just enrolls meridian health and that they, it’s whatever plan. We go directly to the payer plan, not the product. So, unitedhealthcare is a medical plan and they use imed for example, imed vision, yeah.
Nick Vander Velden (07:13) Exactly.
Norma Mendo (07:13) Yeah. I usually enroll all the visions first on the providers. And when that goes through, then they go straight to the medical after humana, they don’t have ppo anymore. They only have the medicare product advantage, which we wouldn’t need to anymore, right? Rachel do what the humana product for medical because we used to do only the ppo.
RachelsiPhone (07:40) Well, humana has the gold.
Norma Mendo (07:44) Has.
RachelsiPhone (07:45) like, yeah, we do the medicare advantage plans. I don’t know the eye institute as well as the MSC, but I know an MSC, we do have medicare humana, medicare plans. Yeah.
Norma Mendo (08:02) There are some, I do have to tell you that there are some vision plans that go directly to like the imed plan for vision. I’m sure, you know this, we really don’t fill out a credentialing. We just do a letter of intent or just a spreadsheet that says these are doctors and they automatically go into humana as a product. So, you will find that on your end on which ones, but most is vision plans. And there is a medical plan. The only one we do not. And we are not enrolled and we looked into this is united healthcare. We do enrolled our doctors in the medical plan, but we do not participate in their vision plan, which is marsh, cool.
Nick Vander Velden (08:52) Yeah. I think that was like the main question like I shouldn’t be.
Norma Mendo (08:56) I’m so glad, like I’m speaking the same language, right? Yeah, no.
Nick Vander Velden (09:00) Like I was, I’m like trying to make sure I don’t need to like break this unit out into like, you know, united for medical and then do the eye med as well for vision. So, I think that’s that answers my question that I had.
Norma Mendo (09:17) Yeah. I mean, we never did that before, but we find we found ourselves that we were getting a lot of emergency patients that stabbed themselves in the eye for something and it had nothing to do with vision CPT codes and they were being seen and it was medical product. I mean, medical CPT codes and we didn’t have them enrolled. So we took exactly the initiative to just put them all on the medical product. So cool.
Nick Vander Velden (09:41) All right. Yeah, I think all the dental ones looked straightforward to me. And then there.
Norma Mendo (09:52) Are two npis. I’m sure, you know, that I only see the one eight nine one, which is the Arizona. It should be the one two in there for Illinois, right?
Nick Vander Velden (10:01) Yeah. I think we have the, I think we have both of them in here for the Arizona and we have the Illinois, yeah.
Norma Mendo (10:10) But see the Illinois has the one eight. If… you look at it for the press, the npi of the group should be the one two, one, two, five, one, two, six, three, two four. If you go to, if you just put, yeah, see.
RachelsiPhone (10:32) Remember, this is where we had like I think I cop when I copied and pasted stuff, it ended up wrong, but I thought I sent an updated copy.
Nick Vander Velden (10:42) I think this one was updated. It might have not grabbed, the,
Norma Mendo (10:50) updated one. Yeah, it’s very simple. I mean, if you the way that I always remembered it so easy, Arizona has two mpis and it’s the way the one, you know, the one nine and the one eight. And then Illinois has three mpis one five for medical one, two four, I, and one zero for speech. It was so easy for me to remember it that way. It was just like one of those things. So I just kind of looked at glance when you were passing it through and it just caught my attention. Yeah.
Nick Vander Velden (11:26) Let’s see should?
RachelsiPhone (11:28) I try to find it and resend it to you.
Nick Vander Velden (11:32) Let me make sure I’m looking at the right sheet in what I have here. Is… this the right?
Norma Mendo (11:41) Mpi for that is the correct one? Yes. Okay.
Nick Vander Velden (11:43) Cool. I’ll get that.
Norma Mendo (11:50) Yeah. Yep. I can on the, on our chat, I can put down like the npis with the, yeah.
Nick Vander Velden (11:58) Do you want to re, add those? Because I think we had originally received… like practice data. That was, that made it one?
Norma Mendo (12:08) Five one, two dentals, one eight, one zero speech. And then the top one is one nine therapy. Yeah.
Nick Vander Velden (12:16) I guess, does this, do these look right here? I think this is il dental here there.
Norma Mendo (12:23) You go. Yeah, that might help you better.
Nick Vander Velden (12:26) Yeah. If these are, if these all look right then I think I can go off of that.
Norma Mendo (12:31) Hold on. Let me just, I’m just going to, just because of the two, one eight, six one, just making sure, yep, and one eight nine one. Yep. And one nine four. Yep. Yeah, it looks pretty, yeah, you have the right ones there. Okay?
Nick Vander Velden (12:50) Cool. I’ll make sure I’m using these sets of names and npis then.
Norma Mendo (12:56) Just real quick. Hold on the, just making sure Rachel, the utopias are good, right? Therapy, five eight, one, five, five, eight, five, five, dental, five eight, six, five. I, yep. You’re.
Nick Vander Velden (13:06) good.
Norma Mendo (13:07) Sweet.
Nick Vander Velden (13:11) Yeah. I think dental somebody.
Norma Mendo (13:12) Asked me a question the other day, Rachel, and I said, and, I mean, I usually don’t do a rezone until like this past year and somebody asked me a question. I went like to top of my head like five eight five one, but I didn’t like a little computer and I’m like my God, I’m so proud of myself. They’re like they’re not laughing. I am, but.
Nick Vander Velden (13:25) It’s.
Norma Mendo (13:28) like my, what’s my social, I have no idea, but, yeah, and,
Nick Vander Velden (13:34) then just to make sure the, is the az therapy institute and the speech language institute both all behavioral?
Norma Mendo (13:47) Repeat that. Again, the az therapy institute is using the one nine three two two zero six four, one. Yeah.
Nick Vander Velden (13:53) And then, for like service type, is that going to be behavioral enrollments?
Norma Mendo (13:59) Yes. Okay.
Nick Vander Velden (14:00) I.
Norma Mendo (14:01) think they, I think as of as a 20, what is it? 2014 15. They just separated everything. So, yeah, yeah, cool.
Nick Vander Velden (14:14) All right. That’s all that I have for today. Yeah. And.
Norma Mendo (14:20) then, you know, since we’re in that topic, you will be finding we’re I’m tackling some, you know, address on the five eight 515 for speech in Arizona. We’re trying to make sure that coordinates because we have had two, two primary locations before, but right now we’re like 75 percent all good on 58 15, you might find one or two there still with the one nine three eight nine old address.
Norma Mendo (14:48) But 58 15 is definitely the one that we need to address. And no questions on the fact that is the primary location, cool.
Norma Mendo (15:11) Did Connor leave us? Nope?
Connor Morley (15:14) I’m still here. Sorry. Can you hear me yep?
Norma Mendo (15:17) So, Connor, I just want to ask you a question before I forget on top of my head and I can brought it up to Rachel. I’ve been, and I know, I just want to hear that you, it does not matter on your end. But I’ve been assisting some of these providers to get going on this… to put all the information, you know, how it is to try to get a doctor to put in information. They act so incompetent and handicapped. But obviously, you already know that on your end, so.
Connor Morley (15:43) I’ve.
Norma Mendo (15:43) been finding that the caqh… information that we provided maybe two or four is not the same one that is connected to their Ada. When we, when they get into their Ada to update their caqh, it really doesn’t matter because you stated on our last… meeting that the dental providers, even if they have an Ada, we’re not, it’s not compatible on your end. So even if they update their caqh, eventually, it doesn’t matter or does it matter?
Connor Morley (16:17) So we don’t currently connect to the Ada. It’s just the caqh, but,
Norma Mendo (16:22) does the number itself matter to have the correct one… when you do any type of dental to dental enrollment on your end or any enrollments with we only have one, so.
Connor Morley (16:39) Sorry, what number specifically are we talking about?
Norma Mendo (16:43) The caqh numbers for the dental providers. I think I just noticed that it completes their enrollment even if I don’t have the caqh for the dental providers. So I’m good, right? I don’t need to target that. Correct. Okay. Good. That even makes the most sense. Yeah.
Connor Morley (17:00) I mean, caqh… like typically, what we’ve seen the caqh is used. Two primary ways with medallion. One is to fill out the information on the provider profile. The other way is just payers will, when they do the revalidation will pull the data from the provider’s caqh. So.
Norma Mendo (17:27) Is it important for us to have the proper caqh number there for you? Yes?
RachelsiPhone (17:32) I think we need to, okay.
Norma Mendo (17:35) So, then I will give Rachel the information so we can correct that for you?
Connor Morley (17:39) Yeah, it’s better to have the proper caqh. I will say for your group, I mean, the payers, regardless of what’s in medallion, the payers, when they do revalidation are pulling from the provider’s caqh id to see if anything’s changed if they’ve attested et cetera. For like most of your commercial payers?
Norma Mendo (18:05) No, I will correct it. We’ve been finding a little discrepancy on some providers having two numbers and we are fixing that. So I just want to make sure that that’s… just a little, yeah. Yeah. And.
Connor Morley (18:19) Maybe Nicole jump in if I’m off base here, but we don’t technically, do we technically need the caqh id to submit an enrollment?
Niccole Russell (18:32) Depends on the enrollment. Okay. Depends on the payer if it requires it or not. Yeah, which if you don’t have it listed there and it requires it, then we will task out for it.
Norma Mendo (18:44) Got it. We have really been pretty good about gathering all the caqh numbers. We just like I said, it’s just been one or two and from 300 doctors to have one or two with double caqhs but we fixed one. I’m getting on the other one. We don’t want to give you anything that doesn’t look perfect over here, so.
Connor Morley (19:01) Yeah. And it will be helpful if there is a caqh id that is incorrect. Okay… the problem would be, would come and show up. I think Nicole, it might show up during the initial enrollment, and then might show up again during revalidation. So it’s just better to have all that information correct?
Norma Mendo (19:24) Now,
Connor Morley (19:25) when we do it the first time, so it’s not just going to quiet us in three or two years from now.
Norma Mendo (19:32) Yeah, I have been hearing delta dental is kind of looking into going into caqh next year. So, 20 27 might be a whole different ballgame, right? We might as well tackle this now. Yep. Oh boy. Okay.
Connor Morley (19:46) In addition to that, in order to get you guys up and moving?
Connor Morley (19:59) We need those credentialing documents. So, Rachel, I.
RachelsiPhone (20:05) know, I promise I will get them to you. It’s been tough coordinating with dr Doherty. She went from VP of clinic operations to chief operations officer. So it’s… complicated how getting in touch with her a little bit, but I promise soon, I promise no.
Connor Morley (20:28) Worries, I do just want to like state like we do want to take about like a week to look over your bylaws and review it and make sure that we have everything set up that our sops look good before we can actually go in and start making and submitting any credentialing requests.
RachelsiPhone (20:48) Yeah, no, that makes sense.
Connor Morley (20:51) So, you know, if we get it next week, we would need another week to review it. And then we might have to change some things on our side in the system depending on what we’ve seen. You know, I want to get you guys live on… these credentialings as soon as possible.
RachelsiPhone (21:13) Yes, totally understand. Okay.
Connor Morley (21:17) All right. Other than that, I was just looking at your information… here so far, Nick. You’re all set with your payer enrollment questions. So it sounds like we can start to load that data in Nick. Do you have like end of next week?
Nick Vander Velden (21:43) Yeah, I’m gonna, there might be like one more payer that we need to get created in our system that we don’t have like as a standard one yet? But other than that, I think, yeah, ready to go with those. So end of next week sounds good?
Connor Morley (22:01) Okay. Thanks, Nick. And then from there, once we get those loaded… Nicole, we’re all set on the payer mapping, right?
Niccole Russell (22:17) I don’t think I’ve seen a payer mapping. Okay?
Connor Morley (22:24) Let’s just.
Connor Morley (22:31) Let’s complete that. So we can start doing some payer enrollments too. All right?
Niccole Russell (22:38) Yep. And then once I review that spreadsheet, Connor will run it through to see what’s a match for medallion names versus what you call the payer, just a little bit of a background how this is going to go. And then I will continue to do the research of what did not pull. And then we’ll kind of sign off on it if you agree with our naming convention as opposed to yours. Okay?
RachelsiPhone (23:04) I mean, I don’t think we have, I don’t think we’re really stuck on any naming convention, so, okay.
Niccole Russell (23:11) Yeah. And then if you have any specific processes, we’ll look at that as well and make sure that it’s added into a project plan that’s specific to your group. And if not, then we would just follow our normal standard enrollment process, okay?
Connor Morley (23:25) Perfect. And Rachel, not to say not to be too strict, but we don’t really create unique payer names. So if we see something on your side, we would map it to like the standard payer across all medallion customers.
RachelsiPhone (23:42) Yeah, that is totally fine. That’s what I meant like we are.
Norma Mendo (23:45) Perfect.
RachelsiPhone (23:46) Yeah, but you’ll.
Niccole Russell (23:48) get to keep a copy of that as well. So it should be on our sign off. You should get to, I think Connor provides that if I’m not mistaken, is that right? Connor? Yep. So you’ll get a copy of that as well. So when you’re making those requests, you’ll know how, what payer names, what to ask for?
RachelsiPhone (24:01) Yeah, perfect. Okay. All right. And.
Norma Mendo (24:05) Connor, have you seen anything that?
Connor Morley (24:07) Looks you?
Norma Mendo (24:10) Know, I mean, it looks all good on our payer enrollments and… you know, getting all the information in there looks pretty good on your end. I’m.
RachelsiPhone (24:20) 50 percent done with our group and the practice locations are like between 80 and 90 percent done, 89 and 92 percent done depending on them. I just need business licenses. So we’re getting the group stuff almost done.
Norma Mendo (24:35) Yeah. And you know, that’s I will get that for you, Rachel. That’s me. So I’ll get that for you. Yep.
Connor Morley (24:41) Nothing I’ve seen, on the group or the practices looks too bad. And if you guys get to like right now for the practices, I think you’re at 92 percent. I mean if we can still start making requests, if we’re not 100 percent complete on the practices, the group profiles… that one we do need to be closer to like 90 percent to start making some enrollments. Yes, but the, yeah, the key is going to be the providers and it, I was looking, it does look like your provider profiles are getting very close to, yes, almost all complete.
Norma Mendo (25:21) Yeah, making that priority helping out and that wasn’t last week, Rachel’s really on it more. So I will, she was able to give me a report that I’m working on currently. So we’ll get it going. Perfect.
Connor Morley (25:35) Yeah, it looks like you guys are about 50 percent of your providers are at 100 percent complete, which is fantastic. But it does not, you know, every provider doesn’t have to have 100 percent complete profile in order for you to start making requests, okay?
Norma Mendo (25:54) Okay. I might be taking a trip to Arizona, knocking on their doors, right? Yeah.
Niccole Russell (26:02) Hello? My.
RachelsiPhone (26:04) Next step is to email their bosses.
Norma Mendo (26:07) You.
Connor Morley (26:08) tell them Norma.
Norma Mendo (26:09) Yeah. All right. Telling insurance. Yeah. All right.
Connor Morley (26:16) Well, that’s all I had for today. Nothing looks too crazy, so we should be right on track. I just need those credentialing documents.
RachelsiPhone (26:28) Promise, wait. Sorry, we’ve had some, like I spent all this week looking at an audit that from a medicare medicaid plan where they aren’t finding the information. So I have to go see page 86, see page 57 for like 40 people. So, I’m sorry, I promise the audit is almost over.
Connor Morley (26:48) So, no worries. No worries. All right. Well, have a great rest of the week, everyone.
Norma Mendo (26:58) Thank you have.
Niccole Russell (26:59) A good day. Bye now.