Transcript
Eveli Flores (00:00) hey, James.
James Donachie (00:01) Hey, Jessica. How are you?
Eveli Flores (00:04) Good.
James Donachie (00:06) What, oh, we got a Portland shirt today, oh.
Eveli Flores (00:10) Yeah, Portland thorns, they’re our women’s soccer team.
James Donachie (00:14) They’re like, they have like the best player, right?
Eveli Flores (00:18) I mean, Sophie, Sophia smith’s pretty good, but we traded my sister’s favorite Sam Coffey, okay. But she’s another, women’s national team up and coming starter. And then a lot of our, like, really good ones have all retired like sauerbrunn and, yeah, there’s we usually have good people, but we’ve.
James Donachie (00:44) not well. Denver just got a team like the summit, so, and they’re building a, a new venue for them too, which is going to be really cool. So, soccer, cause we have the MLS as a team or like a location, but they’re going to have their own dedicated location too, which will actually be like more in the city, which I mean, we’ll just be like, great for, just like bringing soccer like events cause they played, they play, they’re playing at mile high, which is like the football stadium, but the field is smaller.
Eveli Flores (01:24) Yeah. Which.
James Donachie (01:25) I think is like a big problem with like a lot of, the football state cause it’s just not, it’s not wide enough. But, yeah, it’s exciting.
Eveli Flores (01:36) Yeah, that’s awesome.
James Donachie (01:39) Denver goes crazy for sports all right. And thankfully, they’re like pretty decent cause I grew up outside of New York and, all the New York teams are not that good. So, I just get to pretend that I’m like a Denver, our hockey team is really good basketball’s pretty good. The broncos were like better, I guess the rockies are pretty bad, but outside of that, but it’s nice to have good sports. Yeah.
Eveli Flores (02:12) Nice to actually see you win games when you go, yeah.
James Donachie (02:14) Yeah. And the tickets are way more reasonable than New York probably because you’re not competing with like the 20,000,000 people that live in the New York metro, for one ticket.
Eveli Flores (02:27) Yup. Hey, Sabrina… you. Yeah, there you are. Hi, James.
James Donachie (02:35) Hey… how are you? I’m good. It’s been busy. It’s been, it’s been crazy. I, my computer also did a force free update to start my morning. And so, it then took like 45 minutes. So, that was a really fun way to just eat up a good portion of my quote, unquote catch up time, by just having a blank screen.
James Donachie (03:04) I had to work off my phone for my, like emails, and slack. And I was like, this is ridiculous. Well, we can, yeah.
Eveli Flores (03:16) I don’t think I added stuff, onto the agenda, but I could start with last week’s and then, yeah, type in a few. Honestly. One is the first one about like expired people is more just, I’m trying to get an accurate count of how many credentialing files you guys did in the last like year.
Eveli Flores (03:39) And I guess with people being termed, I don’t really have any way besides like our records which I didn’t start until like end of October and immediately revamped our process of how we tracked that. So I’m just trying to cobble together from a few different sources to get accurate, numbers. And then one of our, delegated partners wanted like a monthly, ongoing monitoring report saved down and I realized crap, I haven’t been doing that either like I had through the end of the year, but I’m like, oh, I’m guessing, I just need to pull that at a set time every month in order to capture people moving forward and I’ll just have to cobble together a report for the last three months.
James Donachie (04:29) Yeah. So this is like a known issue and I’m not going to defend it. I’m on your side, because it’s wrong, like it, there’s a product enhancement request and you guys are not the only ones that, so that the hack that I told you, if you wanted to, you can reactivate the terminated providers and then they will appear for the previous months that they were there, is one way that we can do it. What I can also do is I can open up a ticket, for the Craig count for the last year just to see if our backend has a way to, grab those like the cred files. I don’t know about, the monitoring reports. I can go, go ahead. I’m gonna, I’ll include it, when I submit it. I, yeah, I’m in agreement with you guys. I don’t understand like terminated is like this like medium delete and I, it doesn’t it.
Eveli Flores (05:37) Shouldn’t be. Yeah.
James Donachie (05:38) It’s like the, basically the product enhancement and I just like flagged you guys as like another client because the more that I can like put on like said tickets, then it’s like, hopefully it gets addressed like quicker it, you know, it’s to have like a, like, be… a way to like toggle them on or toggle them off. And that sounds to me like very easy, but I’m guessing why it hasn’t been addressed is it’s more complex, but, I, I’m I understand. And I wish I had like something better but I can try to, from, like my end just to see what type of reporting. Well.
Eveli Flores (06:21) And I mean, I know now. So like I’ll probably it’s middle of the month. I’ll probably pull one for April. But, I honestly, I’ve not played around like again, I came in, the people in the medallion constantly were gone and I had one girl with me that has since left. So I’m like, is there like a way? Cause I was receiving for a while like automatic reports were just being emailed to us as far as like a pair enrollment tracker when we were in the weeds of that, would there be a way to just have like the, ongoing monitoring reports emailed to me like the fifteenth of the month? Like that, I could set it up and make it a recurring report.
James Donachie (07:02) Let’s see… if there, I don’t know about the report. Let’s take a look. I’m going in.
James Donachie (07:22) because I’m going to share my screen. Okay? I can find you guys again. Okay. Here we are… so on the actual report builder, right? You’re like you can like create a report and then, and this is what makes me think it’s possible, but I’m going to have to get confirmation. You can schedule a cadence for you to receive that report. So you don’t have to go ahead and rebuild it. And then it will show like when the next one is. But for the pre built reports on the analytics tab, I’m… just wondering if there… is a way to get these sent out and, I… don’t see something on this thing takes forever to load… a.
Eveli Flores (08:15) Lot, which is.
James Donachie (08:17) probably also partially why they were like, oh, we’ll just hide terminated providers because there’ll be less data to pull over, if I’m an engineer, but, I can go ahead and see if we can, let me see if we’re able to get this to get like sent on like, like the fifteenth or the fifth, or something like that for, the month because I, that will probably be helpful too. So, let me see if I can alleviate that. I’m in.
Eveli Flores (08:44) The report builder, but I don’t see like the ongoing monitoring and stuff like mpdb as one of the drop down items… or, yeah.
James Donachie (08:53) Or?
Eveli Flores (08:54) Do I need to be in pay enrollment or credentialing service? What, what?
James Donachie (08:58) Credential aob, credentialing services and then, no, that’s not, those are service requests, I believe providers.
Eveli Flores (09:09) Yeah, that’s what I was just saying in searching, but I didn’t see. Okay.
James Donachie (09:12) So, yeah, maybe I, well, the report is already built. So, let me just see, but I know that like, there is another way. So, let me see if there’s a toggle on the back end that I need to like enable, monthly reporting, that’s like not on the like front end, of this. So, I could do, let me do some digging there. Okay?
Eveli Flores (09:41) Yeah, I’d appreciate it because I can probably just operate off what I had for December, save down and then start deleting out providers because we’ve gone through a wave of, since we’ve just got a 10 99 network of in January and February and March, like any inactive providers per year have been coming off. So that’s been like chunks of 20 and 30. I’m like, okay, that’d be a lot to suddenly toggle back on to get this data, but I.
James Donachie (10:10) know that it’s not, it’s like I have to say it because that’s like the solution they gave me. I don’t say it with any conviction like I don’t feel I’m like there still needs to be a better solve. Yeah. Okay. And then, yeah, what else?
Eveli Flores (10:33) I had, I know I,
James Donachie (10:35) still owe you that psych it’s on my it’s on my list. Yeah.
Eveli Flores (10:40) They emailed again today…
James Donachie (10:47) And our operations?
Eveli Flores (10:50) I think it was just a hey still working on your ticket.
James Donachie (10:54) Okay. Our operations team has been like on site this week too. So I have noticed a little bit of like, a slowdown just as they’re like all together, which is great because they’re working on solving thematic things, but that doesn’t help me today. Yeah.
Eveli Flores (11:18) And I wish I had done it for a shorter amount of time, so it would just time out and go away and I could resubmit it. But once stuff’s in there, I don’t think I can delete out requests or start new ones. If there’s an existing request in there. So I’m kind of stuck still.
James Donachie (11:36) Okay. Let me, I’ll see if I can push it again to just to see, what type of update like they like, if we can get anyone else on it as well, because… I don’t the escalation of the support channel is sometimes a little delayed.
Eveli Flores (12:07) Yeah. I just, it seems like it was held while people were investigating scipax, and then it something somewhere never got done… because the license verification itself like was completed… it’s loading.
James Donachie (12:28) Let’s.
Eveli Flores (12:31) see. Yeah, I’m four seven. So it’s been over a week now. Everything’s done. It’s just not moved on to file ready or for ready for review. Okay?
James Donachie (12:43) Let me, I’m gonna ping someone on the side and see if we can’t…, if, I can’t leverage someone here to get me. Let’s, get us moving.
Eveli Flores (13:05) And then the Stacy lear one was the other one that I followed up and haven’t heard back like as far as anything going on there or should I just try to figure out how to resubmit it on my own at this point? Let.
James Donachie (13:23) Me.
James Donachie (13:33) let me, give me after this call, I’m gonna, the Stacy lear one, is, this is strange. So let me give me after this call, I’m gonna try to hop on with someone and see what I can do there. And then I’ll give you an update and… I should have more direction on that. That. Yeah, I think.
Eveli Flores (13:56) That’s all I had Sabrina. Do you have other stuff? Do I have other stuff? Sorry, multitasking, of course, that’s.
James Donachie (14:07) okay. I’m guilty of that on like every internal meeting I have.
Sabrina Liu (14:15) Basically. Okay. Just follow up for, the same things as last week, wellmark, and then Wisconsin and better Texas. I think… let’s.
Eveli Flores (14:27) See.
Sabrina Liu (14:30) Wait, so the walmart has a task for headspace, this payroll, not release them to medallion jess. Were you able to see that task or?
Eveli Flores (14:41) Let me go. Take a look. I have not checked.
Eveli Flores (14:59) It just says credential information cannot be shared with third party organizations. So I guess they want us to reach out.
Sabrina Liu (15:12) Yeah, it seems so. Yeah.
James Donachie (15:16) I’ll talk with.
Eveli Flores (15:18) Sophie, but honestly, if nothing’s really been done on that, I’m fine with dropping this one too. Like I don’t know why we were pursuing some of these little one off tiny… health plans because I’ve been auditing with Shreya and… Maggie and we’ve got existing group contracts since like 20 21 with payers like blue cross blue shield Illinois. We have four providers that are credentialed and seeing patients there out of a potential 40. So I don’t know why there’s all this focus on expanding into new health plans when we’re not even properly utilizing our current contracts. But I will, yeah, I mean, nothing’s done on that yet. It seems like the apps didn’t get submitted or they did. And then it fell off. Yeah, I.
Sabrina Liu (16:13) don’t even wait for one mark. Is that a new contract or it says, what is the issue? It says, notification, never sent to credentialing email.
Eveli Flores (16:20) Basically, they were trying to start a new application in order to get access. It supposedly sent an email to the credentialing inbox, but we never got it. We can’t find it. So it’s gone nowhere. So, honestly, it’s another one that I would probably just write off like if, okay.
Sabrina Liu (16:39) That makes sense. If we can stop this enrollment. But I.
Eveli Flores (16:44) wasn’t here like when all these decisions were made of all the plans that they wanted to expand to. And then the company direction changed and that wasn’t the focus this year, which is why guang left because he was spearheading that. So definitely we still wanted to get a, all the existing contracts. And then that’s part of my goal is to kind of run through all of our payers figure out how many people are enrolled in each one and where we’re expanding and what our current strategy is, which needs an overhaul and.
James Donachie (17:18) Well, marked too, just knowing I’ve dealt with, they’re a blue and notoriously, and we.
Eveli Flores (17:26) keep running into issues with blues of, hey, we don’t like your practice location, like in Mississippi or, hey, if you want a psychiatrist, you must have a Dea, I’m like we’re not gonna have that and it’s a crap show which ones will accept our alternate?
James Donachie (17:42) I just got off. That was my last client call with it. Would, I think it’s technically they roll into hca which is like Illinois, Texas, New Mexico. But all those blues, it was exactly what you’re describing is basically what we’re I’m dealing with like another client right now where it’s just like they’re being very one, they’re slow to respond. Two, they’re not like it’s being like very, and it’s like, okay, is there anyone at like the client’s like, is there anyone at my, like we tried to reach out to them? They’re not getting a response and I’m just like the blues are like notoriously challenging, yeah.
Eveli Flores (18:24) Yeah, we’re fortunate to be delegated at least to the anthem. So that’s 12 that we’ve got agreements that’s huge.
James Donachie (18:30) Yeah.
Eveli Flores (18:30) Yeah. So that makes life much easier, but cool.
James Donachie (18:35) A lot of upfront work for delegation, but it is worth it.
Eveli Flores (18:39) Oh, God. Yeah. Okay.
Sabrina Liu (18:41) So, Jessi will check with Sophie or whoever the necessary people, right? Yeah.
Eveli Flores (18:46) Hopefully we can snagger for like our next Tuesday meeting like, hey.
Sabrina Liu (18:51) Oh, yeah. Yeah. I’ll put that on the agenda. Yeah.
Eveli Flores (18:54) Like let’s, can we do a quick review? Like are we sunsetting some of these? Like what are we still pursuing? But my general anticipation impression from her is like, yeah, let’s just wrap up what we can. And if not, well, nobody really. Yeah.
Sabrina Liu (19:12) Wait, so for, I think Wisconsin and Texas, those are new requests Wisconsin.
Eveli Flores (19:21) We reopened, I think because I had said close it. And then when I was talking to Janine about it, she’s like, no, wait, I don’t think that sounds right. I think they misinterpreted. So the question was like they were basically saying you have to be enrolled in medicaid in Wisconsin in order to be, in order to get enrolled with the blue cross blue shield in that state. And we’re like that’s never the case. Like we just choose commercials. Why would that be a gatekeeping factor? So.
James Donachie (19:52) I think Janine had.
Eveli Flores (19:53) Reopened that ticket. Yeah, we.
Sabrina Liu (19:55) haven’t really started the process. Yeah, not really. So, like might be to something else we drop.
Eveli Flores (20:03) Yeah. And then,
Sabrina Liu (20:05) also ambetter Texas because, well, I guess we didn’t complete the.
Eveli Flores (20:10) Application and we were just trying to run down the contract. I think it was because they kept sending us the pa contract and they were like saying, oh, Texas is done. You just need to sign the contract. And we kept getting the link for the Pennsylvania one instead of Texas. Oh, so we literally pull it up and be like it says ambetter Pennsylvania across the top of this contract. This isn’t the right one. Yeah.
Sabrina Liu (20:35) Yeah. I came in when we were getting that, but, okay, cool. So at least we still want to follow up with Texas and pa. Okay, James, do you have any updates on pa?
Eveli Flores (20:45) Or?
Sabrina Liu (20:46) Texas, I’m looking.
James Donachie (20:47) At it right now, I see that we have pa… there’s still three in process. Okay? They’re in payer processing. We should get… another update from the… team tomorrow. It looks like they’re set to reach back out on… pa. Okay? Just looking at when they have their follow up. So we should be getting another update there. I’ll keep tracking that one. Let me look at Texas now. Well, is it?
Sabrina Liu (21:30) At all possible to get the updates before our meeting today? Because I feel like in the past couple weeks, we keep getting the updates on Fridays.
James Donachie (21:39) Yes, I can try to work with the, let me try to see what I can do with the team. I know… they’re like working out of like a queue and they like set it, but let me see if they can like alter our dates before the meeting so that we could get it.
Sabrina Liu (21:58) Yeah, it’d be great to get like live updates during this meeting instead of always getting the emails so we can like make it a little easier. Yeah.
James Donachie (22:07) That, I mean, that is like the big, the other big frustration too is like for me, it’s like how the team’s like queues work. It’s like always, like I’m like always, I’m always waiting for updates that’s what I’m thinking across so many different people, but yeah, let me see what I can do there.
Sabrina Liu (22:26) Cool. Thank you. So we’ll just wait for those, oh, wait, you’re checking on Texas, right?
James Donachie (22:31) Yeah, I’m pulling it out. I’m gonna guess it’s the same, but, let me pull, go back over here and look at my fancy… okay, Texas?
James Donachie (22:49) Yeah. It looks like the same. It’s in payr processing. So it’s with the payr. It doesn’t look like there’s anything blocking it. I don’t know other… than like what’s taking on with the, like what’s going on with the payr, but I know they’re prompted to reach back out. Okay?
Eveli Flores (23:13) And, yeah.
Sabrina Liu (23:16) Or, I think last week you said that you couldn’t find the request. So, I’m glad that they are in the system and they’re processing. Yes. Yeah.
James Donachie (23:25) So, pa, is there and then let’s see. And then… Texas. Yeah, it looks like there’s is it three and three? I’m doing? I’m trying to just scroll through this. No, sorry, that’s not right. One, two, three four five. So there’s five total for Texas, but it doesn’t look like, okay.
James Donachie (24:02) I have these, I will figure out what’s going on and it also looks like there’s Illinois as well, right?
Sabrina Liu (24:13) Illinois? No, okay.
Eveli Flores (24:15) There is one, and I don’t understand that note either because it’s basically saying one.
James Donachie (24:21) That.
Eveli Flores (24:24) hey, it requires a credit group requires… it’s kind of a jangled messed up message, but I think it’s trying to imply that our group needs to be credited in order to be contracted with the state of Illinois.
Eveli Flores (24:41) And then it’s also saying ambetter is a national plan. So the group should not have a separate contract for Illinois, which is not what we’re experiencing or maybe that’s part of the problem with Illinois and Texas. It seems like ambetter Pennsylvania was different and needed a different contract than Texas, but that might be part of the disconnect as well if they were actually trying to add the first one, the ambetter Pennsylvania, and then add Texas to that contract. But yeah, no, I see a task for Illinois in here that accreditation is required which we’re not accredited and groups don’t get accredited. So, I don’t exactly know what’s going on with that request.
Sabrina Liu (25:24) Also, we’re not pursuing Illinois. I think I mentioned last week that because you gave a follow up on ambetter Illinois, and I think it was a confusion because we were following up on Aetna Illinois, not ambetter. I mean, there’s a,
Eveli Flores (25:37) request in there that hadn’t been followed up on in a while or?
James Donachie (25:43) I.
Eveli Flores (25:43) mean, I can clear it out. I don’t know we’re.
Sabrina Liu (25:45) not doing ambetter, Illinois, jess, right? So we can just stop that. Okay? We’ll.
James Donachie (25:50) clear it out. Okay. So you guys are going to clear out Illinois? Yeah.
Sabrina Liu (25:58) Yeah, there’s nothing for Illinois.
Sabrina Liu (26:05) And then just curious. So for the blue cross blue shield, Wisconsin, is it just pending as well? Yeah.
Eveli Flores (26:14) It’s still pending, it’s in my queue. So it’s probably, yeah, they haven’t reached back out to me for any other info?
Sabrina Liu (26:25) Okay. Sounds good. Yeah, we’ll just keep these open and if we don’t get anywhere, I’m sure we could just stop pursuing these, jess. We’ll just see what they say. Yeah, well.
Eveli Flores (26:38) I’ve got to get other stuff in house organized before I can start looking at payer enrollments and it’s going to be a lot of knocking on doors and asking for what our current roster is because I trust none of our data.
James Donachie (26:52) Oh, jess, it sounds like a serious undertaking you have. Yeah. Well, we’ve.
Eveli Flores (26:59) got like we used to be a different company that got bought by headspace. And so there’s like old contracts under the old name, and most of them were updated before I joined, but then billing will be like, hey, we’re not getting paid in North Carolina anymore. And I’m like they got the old name. Still. Let me fix that. So, stuff.
James Donachie (27:18) Like that before.
Eveli Flores (27:20) Nobody existing knew that we were contracted with highmark. We’re like, oh, what a fun surprise that we just learned.
James Donachie (27:29) So,
Sabrina Liu (27:30) I’ll add the onemark thing to the agenda, but just a heads up, I’m going to be gone for the next two weeks. I’m just taking vacation.
Eveli Flores (27:36) Oh, nice. Where are you going? Yeah?
James Donachie (27:38) More importantly.
Eveli Flores (27:40) Yeah, I’m.
Sabrina Liu (27:40) going to Singapore and Vietnam. I’m super excited.
Eveli Flores (27:43) That sounds.
James Donachie (27:44) Awesome. Yeah. Are you going to Singapore first? And then Vietnam, and then back home, yep. And what I got to ask, what do your flights look like? What are my flights? Yeah. Like what, how are you getting there? What route are you taking to? Oh, I’m just, I’m.
Sabrina Liu (28:09) just doing lax to Singapore. Yeah, Singapore to, so it’s like, I’m lucky, I live near Ish, it’s like I’m an hour away from lax. Okay. Yeah. And then Singapore to like Da Nang this like city in central Vietnam, and then a flight to south Vietnam for Hanoi, and then back to la. That would be awesome. Yeah. So, two cities in Vietnam.
James Donachie (28:36) So, oh, that’s really cool. And Singapore is like, I haven’t been, but it’s like a huge metro, like it’s like bigger than like la and New York like, and like tons of like that’s going to be, I’m really jealous that’ll be super fun. Yeah.
Sabrina Liu (28:56) I’ll take you guys when I’m back, but I got to hop for my other meeting. Yeah.
James Donachie (29:00) Thank you. All right. Bye bye.