Transcript
Naomi Denson (00:00) peace.
Naomi Denson (00:43) Hey, Adalee. Hi, how’s it going? You can have the time back unless you’re just interested in hearing.
Kim (00:50) I might take the time back because I’m working on their rosters. Yeah.
Naomi Denson (00:55) That’s totally fine. I just added you because you said last time it got interesting and you.
Kim (00:59) Wanted to stay, it did get interesting. If something comes up like that again, let me know.
Naomi Denson (01:02) Okay.
Kim (01:04) All right.
Naomi Denson (01:06) Hey, Jason. Hey, Leigh. Hi, y’all, hi. All right. They are here. You guys ready can let them in.
Jason Zednick (01:14) Yeah, I.
Naomi Denson (01:14) guess. Okay.
Naomi Denson (01:21) If you just want to intro, Leigh to Jason… yes, it’s fine. Hi, everyone.
Jason Zednick (01:29) Hi, sunny.
Staff (01:30) Good morning. Good.
Jason Zednick (01:32) Morning, I’m Monya.
Naomi Denson (01:36) Kim’s here too.
Naomi Denson (01:39) All right. So, round two payer process scoping, we do have a new face on the call. Leigh Howell. I’ll let Jason introduce her, and then they’ll take over with the reviewing… of the rest of the sheet. Yeah.
Jason Zednick (01:53) So, I asked Leigh to join. Leigh’s, a very experienced engagement manager here at medallia, and so she just knows a lot of these payers very well, and she sort of agreed to come in and be a bit of a ringer to help us just get through the conversation, make sure we’re getting to the right questions and documenting the right materials. So, yeah, so that’s why she’s joining today. Leigh. I don’t know if you have anything you’d like to add to that? No.
Leigh Howle (02:23) I appreciate the intro. Hi, everybody. Happy Friday and happy to be here and support any way I can. I’ve been with medallion for about three years now, and I’ve been in PE for almost 15 years. So, I am familiar with rhcs. And Jason has already shared your payer processing scoping list. So, I’ve reviewed your payers already with Jason and yeah, just anywhere I can help out.
Kim (02:57) That’s great. Thanks for jumping in especially with the rhc background. I think that’ll be really helpful.
Jason Zednick (03:05) Yes, Kim, let me ask you a question. We were talking about the different plans that we need to break out to the payer… names in medallion. Like, I know we have the centene ones. I sort of broke out here already and I know you have the optum list and I can go through that to sort of identify which ones sorry the uhc list and I can go through that and identify, okay, which ones are a separate payer to medallion payer and which ones are just under uhc. My question is were there any more that you needed to send over so we could do that assessment?
Kim (03:52) Monya, you want to talk to some of that? I know you and I talked and that list is not a comprehensive list of all the uhc subsidiaries. Whenever we go into a market, we just select all plans to participate. So that’s definitely not probably like a comprehensive list if… I had to guess.
Staff (04:13) Right, because I said for the enrollments, when they’ve been going in, we’ve been selecting everything that’s available for the location and we make sure that the vacnn is included. But that’s the only special… call out that we currently do with the enrollment.
Jason Zednick (04:34) Okay. Well, I will take, Naomi had sort of already done this in that email. I’m going to take that mapping that she did load… it here. So we have the reference point so we can sort of see like, okay, like… you know, this all just goes under uhc and we’ll take care of it or these other ones go under optum’s the only one I can think of off the top of my head optum versus uhc. So I’ll do that. I’ll get it in here so we can talk through it that way.
Kim (05:11) And then Naomi, can you make a note that once we get through all the payer mapping, can we go back through and say, okay, this… is going to be like the number of enrollments because we talk about like if I’m trying to like think about budgeting and new providers coming on board? Like what maybe we were considering an enrollment versus what an enrollment would be considered in medallion may change and that would shift utilization. So I want to.
Naomi Denson (05:47) Yeah. And I think that will become more clear once we go through training as well and you see how the submissions, are done. And then like what counts as one request. So yeah, we’ll definitely go back through this before we wrap up implementation to make sure that all the payers are aligned… and, you know, I,
Staff (06:10) just under.
Naomi Denson (06:11) One request, you know? Yeah, right.
Staff (06:16) Yeah. I just loaded a copy of a product listing for one of our rhcs that just finally got loaded even though the date says 20 25 on it to the chat. So you can see, what normally rolls from just one application.
Naomi Denson (06:37) Yeah. And that’s the, is that, the… roster? Yeah.
Staff (06:44) No, this is the product list from the uhc portal.
Naomi Denson (06:54) Maybe download it and save it?
Jason Zednick (06:57) Yeah, I see.
Naomi Denson (07:00) Who… wins? Oh, why is it? Sorry, guys, my five year old’s homesick today. Yeah. So these all look, yeah, this is all done and confirmed through one submission via onboard pro, depending on which line of business that you request on the application?
Staff (07:21) Yeah, right. Yeah.
Naomi Denson (07:23) So, this would all fall under one request or could as long as you request commercial?
Staff (07:28) Medicaid?
Naomi Denson (07:30) Medicare lines?
Staff (07:32) Of business. Yeah, we request everything. Yeah. So.
Naomi Denson (07:37) That would be one request in medallion for all of these plans. Okay?
Jason Zednick (07:45) Okay. All right. So let’s go back to our scoping sheet. I think what… here, what I’d like to do is sort of start… knocking some of these off the list. So let’s just look at things I’ve already marked as not non standard or standard is a better way to say that we’re gonna come back to uhc later, medicare part B, it’s pretty self explanatory. I don’t think there’s anything else to really go through there? Aetna? When we spoke last week?
Kim (08:21) Jason, just on the medicare side, there’s for medicare part B. There’s not a lot more to talk through but the medicare part a is rhc enrollment. Yes.
Staff (08:32) Yeah.
Jason Zednick (08:33) I have your sheet that you shared the PDF. I’m gonna, I haven’t reviewed it yet. I’m gonna sort of put… something together that my team will reference and I’ll run that by you based off that and we can make changes accordingly. Yeah, 100 percent. Okay. And there’s nothing unique about Aetna enrollments that we need to talk through, right? Cigna and summit summit’s a roster. So we’ll set that up. Do we agree that we’re all good. There’s? Nothing unique to talk through?
Staff (09:13) Yeah, those are standard. So, okay, all.
Jason Zednick (09:15) Right. So, let’s go back to blanks… much bigger list. Okay? Centene, I’m gonna break out. We’ll have, I think three instead of one here? Let’s talk medicaid. We talked a little bit about this last week.
Jason Zednick (09:41) Is there anything for any of these states that?
Jason Zednick (09:51) AMC would be doing that. We wouldn’t be doing for everyone else.
Staff (10:00) Well, I can give you our normal process because I don’t know if you do it for other people or not currently medicaid of Arkansas. Like we said, if they’re an existing provider, we get their portal information, we submit the DMS change of address form, the section iv. If they are a clinic provider, we do the PCP form, and we make sure that our clinic is provider id is referenced on that PCP form. I don’t know if that would be part of what you would be doing or if I would still need an in house team to do it because you have to mark the counties that they’re going to be at et cetera, on the PCP form and we request the maximum 2,500 person limit… that’s the big call out on Arkansas is making sure the PCP form is done correctly.
Jason Zednick (10:58) Do you have a copy… of the PCP form?
Staff (11:04) I have a copy of all the forms darling.
Naomi Denson (11:07) Is it in that enrollment process folder that you shared with us? The enrollment guides?
Staff (11:13) I think the link is in there, oh.
Jason Zednick (11:16) Okay. If it’s there, then I can pull it if you.
Staff (11:20) Can’t get to the forms? Let me know.
Leigh Howle (11:27) And that does sound standard, Jason, but I think if there are templates that could be used in the project plan or sop, just that are available, I think that would be helpful to the PE team.
Staff (11:44) Yeah. See, they just Arkansas, medicaid just updated a lot of their forms in the last three months. So they are no longer accepting the older forms. You have to be sure it’s the current updated forms. I’m sure your team already knew that.
Jason Zednick (12:01) Yeah, that sounds fine. Okay. I’m going to leave Arkansas open for the moment. And then I’ll go back and I’ll sort of assess there.
Staff (12:17) Nothing. We don’t do anything different on Texas?
Jason Zednick (12:21) Texas is Texas? Yeah, although I did just recently hear that they’re working, they’re going to start working to overhaul the portal.
Staff (12:30) It needs it.
Jason Zednick (12:31) Yeah. It does. It’s not fun going like 15 pages deep to find a number.
Naomi Denson (12:37) Yeah. And if you forget your password, you are out of luck. Yeah, because it is so hard to get back to the place to reset it.
Staff (12:44) Yeah.
Jason Zednick (12:47) How about Oklahoma, Tennessee, Indiana?
Staff (12:50) Okay. Oklahoma again, is the PCP. We make sure you know, if they’re a clinic provider, that we request the PCP because the clinic is the PCP. So we make sure that they are linked to the clinic. Since our clinics are rhc, the clinic is the PCP, not the clinic or not the provider, but the provider has to be linked into Oklahoma and marked as PCP. Does that make sense?
Jason Zednick (13:25) It does, yeah.
Staff (13:30) Tennessee, I mean, we add them under the clinic and that’s how they get enrolled. We don’t necessarily do a individual provider enrollment there. We enroll them under the clinic.
Jason Zednick (13:46) Okay.
Leigh Howle (13:49) Oh, one quick thing on this, it may have come up already, but for Tennessee, Texas, like the portal to have access to, it would be, you know, for Tennessee, it would have to be the shared group admin login… and that would just go in the platform under external account. So the team could log in to submit. And then for any of the other portals like Georgia, Indiana, Texas, ideally, there would be a separate user or delegate added for those states, so that the rpe team doesn’t have admin access.
Staff (14:31) Right. And for Georgia, I mean, it’s every, they don’t issue the pin to do a portal until after they’re enrolled, right? It’s a new application every time.
Leigh Howle (14:46) Right. And I think it will be important, Jason to whatever… you all decide on who receives that pin letter that would be setting up that portal. We just need to make sure that email address is listed on the application.
Jason Zednick (15:03) All right. We.
Staff (15:05) Because our billing needs in those portals, we have routinely been the admin for all of our providers’ portals.
Jason Zednick (15:17) Lee, which states did you say? Have I’m going to use the term power user? I’m making that up access where we don’t need their credentials.
Leigh Howle (15:29) Texas, Indiana… Georgia. I… think North Carolina.
Staff (15:37) Yeah, because it has to go through NC tracks and we have to link you with that… id. Okay?
Leigh Howle (15:47) And we’ll want to make sure Jason that on all applications that their billing or whatever email address is going to be receiving that pin or any portal setups for any states that address, that email is listed on the application?
Staff (16:05) Yeah. It’s the credentialing email.
Kim (16:13) And Lee, you said something about external about something being put on the external accounts tab right now? We’ve just put everybody’s caqh logins on that tab. Are there other, are there other logins they need on that external accounts tab?
Staff (16:30) The dedicated pin would be, yeah.
Naomi Denson (16:33) There’s an external accounts tab in your group profiles as well that you would add your group level logins to any portals that we might need. And then you can add any provider portals that we might need access to directly in their individual profiles.
Kim (16:50) Monya. Is there anybody that I can work with to get that while you’re out or is Naomi, is it something that you would do, go ahead?
Staff (17:03) Yeah, for the medicaid’s.
Kim (17:06) you can.
Staff (17:09) Reach out to Kathy and Casey, according to which medicaid they work with? Okay… Kathy does, Tennessee, Casey does Indiana?
Kim (17:26) And those are all group level access that they’ve got. All right?
Leigh Howle (17:34) Oh, I had one random thought as well since we’re talking about the medicaid just to reduce tasks and, you know, prevent any delays with documents. If you all have the, I know for Georgia, the poa is always a big deal. If you have that already loaded into the platform under the provider profile, then we can tell the team don’t task out. Just go get the document from the provider profile. Same thing with Indiana. The ihcp form has to have the ao or owner signature on it. If there’s a template that we could just use. If you all are okay with that, then that could be linked to the project plan. Again, that would reduce the task and.
Leigh Howle (18:29) I think medicare, the… certification statement could be used in lieu of the E signature if you all wanted to have that uploaded as well, or if your providers are okay going in and signing.
Staff (18:44) We make the providers sign their individuals and any for the clinic, like the 855 signature for the clinic side comes to me.
Leigh Howle (18:58) Okay, perfect. Yeah.
Naomi Denson (19:02) I had instructed them to add the group officials, authorized officials in the group profiles and put a note in the channel for you, Jason on who the aos and signatories are and delegated officials.
Jason Zednick (19:18) Have those been loaded already?
Naomi Denson (19:21) It’s for medicare?
Jason Zednick (19:23) No. Sorry. I have that app… in the group profile. Has those been loaded? I?
Naomi Denson (19:33) Advised them to add them in there. I don’t know if they’ve been added yet, but.
Leigh Howle (19:38) I did point.
Naomi Denson (19:41) Them in that direction.
Jason Zednick (19:42) Yeah, I’m going to pull it up right now and check on sign.
Jason Zednick (19:53) Because I do know that.
Jason Zednick (19:58) I’m just going to check.
Staff (20:06) Yeah, we’ve been trying to send the Georgia medicaid poa out in our onboarding packet for our Georgia providers.
Leigh Howle (20:15) Awesome. That is great. Yeah. Even recently, you know, putting the date on the bottom of the form, it had to be like second, it had to be like the number two and an MD. They even rejected if it was like they’re just so picky on.
Staff (20:32) That form. Yeah, Naomi and I had that conversation at the last meeting. We’ve had them reject because the person who notarized it didn’t clean their notary stamp prior to doing it. So it was kind of smudged.
Jason Zednick (20:51) Okay. All right. I think we’re okay with the medicaid for now. Are there any objections?
Leigh Howle (21:09) If you have an Alabama template, that would be super helpful,
Staff (21:16) I don’t know if we do, because we haven’t done Alabama in a long time, that is our most, one of our most stable locations.
Leigh Howle (21:25) Okay. That’s good.
Kim (21:27) Monya, is there anything around or do we want to note this in a different place around like what we do with medicaid regarding rhc? Do we want that here? Or do we want to make another line for that?
Staff (21:47) It’ll probably take another line because clinic?
Kim (21:52) Yeah, yeah.
Staff (21:54) Because we, when we open a clinic, we do a general enrollment, and then when we become rhc, like in Arkansas, it’s another enrollment Oklahoma. And.
Staff (22:10) Tennessee, you know, it’s just an npi. It’s just a taxonomy update type thing and I don’t remember it’s been too long since Alabama rolled to rhc, and we’ve only got the one clinic there. I don’t remember what we had to do there.
Jason Zednick (22:24) That’s actually a really good point, Naomi. How… what were those facility enrollments right on the rhc side?
Jason Zednick (22:44) I’m trying to think of what I’m trying to ask like what’s the best way on our side to document that in the.
Jason Zednick (22:55) It was different.
Naomi Denson (22:56) For.
Staff (22:57) me too.
Naomi Denson (22:58) On how that is built out in the project plan separately between individual enrollment and like facility slash, referring them to rhc processes… right?
Jason Zednick (23:10) It’s like a duplicate entry, basically like we have to have one for the one side and one for the other, I think.
Leigh Howle (23:22) Yes, if there, so, with the rhcs if the, and there were some notes on here that the submission just is, you know, like under the group clinic, but if there are any payers that you all are contracted with that?
Naomi Denson (23:40) Would.
Leigh Howle (23:42) require a submission for credentialing under that facility rhc contract, that would be good information to list here as well?
Staff (23:57) Okay. Any of any… of the maps, which includes, you know, unitedhealthcare, Aetna. All of those, they require another application when you become rhc… because it’s a facility contract then.
Naomi Denson (24:18) Right. Is it? But do you have to do anything you, that’s for? Like, so you had mentioned before you take the group enroll it first and then you transition it to an rhc later. Do you have to do anything with the providers again?
Jason Zednick (24:30) No, no, the.
Staff (24:32) Providers stay just like they are nothing changes on the providers. In fact, when you become rhc, blue… cross, the Arkansas medicaid, you leave them linked to just the group clinic. They have to be under your group. You don’t ever build them out under the rhc, Oklahoma, is your exception, Oklahoma. When it becomes rhc, you have to be sure all your providers are still listed under it.
Jason Zednick (25:11) All right. Yeah.
Jason Zednick (25:20) Let’s I.
Kim (25:20) want to feel like really confident about that part, so it’s okay if we have to come back to it, but,
Jason Zednick (25:26) we’re going to have to come back to it. I think we should come back to rhc as its own thing as a conversation. I agree. Yeah. And then… Lee, Naomi, Sandhya, I think in terms of… what are the rhc specific… processes that we need to call out? What we need to think about is, how does that go in the plan for the team? Like that’s? Just not something I have seen done before on our side, it doesn’t seem complicated but I just, it’s… a conversation we should have.
Jason Zednick (26:17) And I mean, I used to talk about our blue cross because it’s just a big chunk and we can get rid of a big chunk which would make me happy. So they all require Dea number pride on rolling like that’s. Super helpful.
Jason Zednick (26:35) Anything?
Jason Zednick (26:44) Anything else that might be unique? I’m thinking probably not, but.
Staff (26:55) Ones that have the MCL plans, of course, require the medicaid.
Naomi Denson (26:58) Right. Yeah. Okay.
Staff (27:02) The map plans require the medicare to be processed.
Staff (27:10) Right. And blue cross, blue shield of Arkansas is my least favorite blue cross right now… that’s because they switched to a healthstream product and calling it the hub for their enrollments. Fun.
Naomi Denson (27:30) Are all of the other ones still using availity? Except for? I think blue cross of Texas doesn’t use availity. Do.
Jason Zednick (27:38) They.
Staff (27:40) no, they don’t yeah, they’re supposed to blue cross of Arkansas. You get your link through availity. Yeah. But that’s all you get your request for application, can go through there and then they send it back.
Leigh Howle (28:00) I had a quick question. So, I know when they moved to in availity to the roster automation tool in pdm for demographic updates, that when I sat in on the seminar when they first rolled that out, I was told on the ads tab that was for delegated entities only. And then I’ve recently learned that ads tab can be used to add new providers to go through credentialing. I was wondering for the blues that are submitted in availity, what your workflow is for new providers? Is that on that roster or do you all submit through payer spaces?
Staff (28:45) We’re submitting through payer spaces, Arkansas does not accept it for.
Leigh Howle (28:49) One thing… okay. Payer spaces, it is.
Staff (28:57) Yeah, no, payer spaces is where we’re doing the applications. We get the rosters are like for bulk, but if you’ve only got one or two, they send it back to you and ask you to go through their other… process. And we never do. We don’t ever have huge bulk at one time. It’s usually one or two providers at.
Jason Zednick (29:22) The most.
Leigh Howle (29:26) Okay. That makes sense. So, payer spaces will be for just small numbers of providers. If there’s ever a high volume, then it would be on the roster with the pdm automation tool, right?
Jason Zednick (29:43) Lee, is that all routine on our end? Does that check out? Okay, great. Great. All right.
Jason Zednick (29:56) All right. Trimming down, trimming, down… some of these are rosters, which is good.
Jason Zednick (30:11) Tricare west and east?
Jason Zednick (30:17) Anything you can imagine as being unique? I think probably not. They’re pretty… standardized.
Leigh Howle (30:32) So on the west, sorry. Yeah, go ahead.
Staff (30:41) I had got kicked out for just a second. I’m sorry.
Jason Zednick (30:43) Oh, welcome back.
Jason Zednick (30:50) Yeah. So try cairns.
Staff (30:54) I haven’t done any of the enrollments recently. We’ve been having a third party doing them. Let me see what he put on his.
Staff (31:06) Apply back to me.
Kim (31:17) Let’s see. We definitely want to, if there’s things that you guys know about. I mean, first, let’s launch and make sure that everything is smooth and working correctly, but we’re not necessarily trying to recreate exactly what we’re doing, like we really want to be.
Staff (31:41) More efficient. Yeah, we want to advance and do it the quickest easiest, yeah, quickest easiest way possible.
Kim (31:47) Just taking into account all of the nuances, right? So, if.
Staff (31:53) there’s but.
Kim (31:54) If there’s like new ways that you guys have had success doing some things, you know, we’d love to learn and see how that could potentially work… on our end.
Jason Zednick (32:08) I understand. Yeah, absolutely. With.
Leigh Howle (32:11) The tricare west ever since they, and I totally think they should have left hnfs, but when they did migrate over to triwest healthcare alliance, there were some contracts by certain tax ids.
Staff (32:26) I kicked out again, I’m going to turn my camera off since it keeps popping me in.
Leigh Howle (32:31) And.
Staff (32:32) out.
Leigh Howle (32:34) So,
Staff (32:37) he has been submitting the tricare east and west both by roster. Okay?
Leigh Howle (32:49) So, in Texas and I’m froze.
Kim (32:58) In Texas, we can still hear you, Monya. I had to turn my video off too. Internet was being weird, but we can definitely still hear you though.
Staff (33:08) Okay, good.
Staff (33:14) Like I said, we’ve been doing it by roster, both of them, you said, and there’s like tricare east in Arkansas, there’s specific counties that… are tricare east but not the whole state. But I’m sure you’ve probably already got that built out.
Leigh Howle (33:36) Yeah. We’ve got the tricare east down. It was the west. So, I did have a question on Texas, Oklahoma, especially for Texas. I know that blue cross blue shield got the, they’re the subcontractor through triwest healthcare alliance. And it seems to go if your contract did go with blue cross in that state on the application, there’s just a box to check to include triwest.
Leigh Howle (34:05) And so the credentialing is processed through blue cross, it goes a little bit faster instead of submitting the roster directly to the triwest healthcare alliance for processing, because then they just send it over to blue cross, but it really depends on where your contract sits. And if it’s directly with triwest, or if they transfer that to the subcontractor in the state… does that make sense? Yeah.
Staff (34:37) That makes sense. We’re just now getting enrolled with all of the triwest, so it’s probably, I know that the rosters have been submitted directly to triwest. So that’s probably where it’s all sitting.
Leigh Howle (34:53) Okay. Because.
Staff (34:55) The letters I’ve been receiving are coming directly from triwest. Okay? The welcome letters. Yeah.
Leigh Howle (35:06) So, Jason, that would be the process to follow.
Jason Zednick (35:09) So,
Jason Zednick (35:17) what am I trying to say? We have the portal documented, right? For triwest, if they’re going through a roster, then we should configure that we should set that up, right? Well.
Leigh Howle (35:27) Eth is good to go. That’s standard across the board.
Jason Zednick (35:30) Is eth the roster? I’m only looking at west right now?
Leigh Howle (35:32) Yeah, yeah. West is the one, the only suggestion… that I would make is to ask your blue cross reps in those states to, if they process the triwest enrollments, it is a little bit faster when it goes directly through them.
Kim (36:01) And Lee, is the expectation that because that transition happened that everything is being managed by them now. So that would be the expectation moving forward or like what have you seen around that? Yeah.
Leigh Howle (36:18) It is, most of the clients that I have are, it is submitted through blue cross. I was in a meeting actually with a blue cross rep in Texas and in Houston and she did confirm that because they were the subcontractor that my client at that time. Their contract transferred over to blue cross. And so all of the submissions, all of the enrollment, all the status… updates, everything came from blue cross blue shield.
Staff (36:51) Okay. Our blue cross rep is out of Austin.
Staff (36:58) Since we only have the clinics in big spring… I mean.
Leigh Howle (37:03) Definitely submitting straight to triwest works. You know, I mean, there’s we know it works and they can give status updates, welcome letters. Excuse me, but it is a little, it is faster to go just straight to blue cross. If they do have your contract for triwest?
Staff (37:22) Okay. The.
Kim (37:25) Next steps on our end is verify with our blue cross rep. If they have the triwest contracts, and then we can let you guys know.
Leigh Howle (37:35) That sounds like because it.
Kim (37:36) Sounds like triwest, is acting more like a middleman just passing off like handing off the agreement or the application.
Leigh Howle (37:46) I know Arkansas.
Staff (37:48) Does not have the contract with blue cross.
Leigh Howle (37:56) I’m not.
Staff (37:57) Nine percent. Sure. Arkansas, blue cross does not.
Leigh Howle (38:02) Some in Oklahoma, some, I think they split the state so some counties are subcontracted to blue cross and then others are using humana as a second party handoff, and they are like… another party involved with that submission. So it will be important to confirm that, in that state as well. And again, you know, submitting the tricarewest roster can always go to directly to the triwest healthcare alliance email. But just to make sure we get the fastest route for enrollment, I think that would be helpful.
Staff (38:57) It makes sense.
Jason Zednick (39:02) All right. OK… down. OK.
Jason Zednick (39:18) What is it? So, essence of care?
Jason Zednick (39:26) Let’s talk about that.
Jason Zednick (39:33) Pulling up on my end, what we have.
Leigh Howle (39:37) Hey, Jason, I had a quick question while you check on that one for healthspring on route. Do you all have a national contract for all of those states, no?
Staff (39:50) Individual? OK?
Leigh Howle (39:53) So, then the roster submission would… be split out or does that just all go to? And I know they have an npops email that’s used. We.
Staff (40:09) Do, when it’s, submitted based on tax id and state. OK, they split it that way.
Leigh Howle (40:20) OK. Sounds good.
Jason Zednick (40:32) essence healthcare… anything unique? I mean, we just have documented… submissions to new provider inquiry at lumeris. Com.
Staff (40:45) Yeah, it’s by roster and it is limited to the counties of Conway grant, lone oak, Perry prairie, and pulaski… so, it’s limited to tagging them to our clinics for lone oak, prairie grove, perryville, Sheridan, west fork and garfield. So that’s two tax ids?
Leigh Howle (41:44) do we have that roster, Jason?
Jason Zednick (41:47) I don’t believe so.
Jason Zednick (41:54) Naomi you… do.
Leigh Howle (42:01) I’m sorry, what was that?
Jason Zednick (42:03) Roster for essence healthcare?
Leigh Howle (42:09) I don’t know. I’d have to, if it’s in their file, then I have it, but I’ll have to check the parent directory to see if that’s what standard for us to use it’s.
Jason Zednick (42:20) Not in the directory. No let.
Leigh Howle (42:25) Me, take a look. We.
Jason Zednick (42:26) Have something else. Yeah, it’s… an email. We have a direct submission with a form.
Staff (42:41) See if I got it embedded.
Staff (42:49) And nope, I don’t have it embedded.
Staff (43:25) I was looking for it because again, we’ve had third party doing it. So… let’s see.
Staff (44:04) I don’t have a copy of the one that they’ve been using.
Kim (44:14) Monya, if you want, I can follow up with Arun to get that. Yeah, it’s the essence roster, yeah.
Staff (44:21) Because I’m sitting here looking through it and I’m not finding a copy of it. Okay?
Jason Zednick (44:27) Yeah, just forward it to us now and we’ll review it. Okay… health choice Oklahoma.
Jason Zednick (44:48) Anything coming to mind that might be unique about that? We, you know, go through the portal.
Staff (44:55) Ah, I found the client. Well, I… found the provider roster for essence. It just wasn’t in the, where I thought it would be.
Kim (45:14) Awesome. That was faster. I’d say that was faster than asking for it, Monya?
Staff (45:20) Well, this is a completed roster, but at least it gives you the general idea and basically, it looks like a humana roster for.
Naomi Denson (45:29) The most part. Alright, you’re so.
Jason Zednick (45:34) Cool. I will one.
Naomi Denson (45:40) Thing for health choice that I’m seeing… let’s see we have health choice Oklahoma.
Naomi Denson (45:55) But here you have Arkansas listed or I’m sorry, Missouri listed, but in our internal directory, it doesn’t show Missouri. It only shows Arkansas and Oklahoma for health choice. So we may want to look into that.
Jason Zednick (46:12) Yeah. On the mapping page.
Staff (46:14) See Missouri, we’re just getting started with Missouri. We’re just starting with, so it may or may not. I was trying to research and grab ones that pulled up showing that they had product for that area. So it’s a possibility it may not. Okay?
Naomi Denson (46:32) Yeah, we only have it for Arkansas and Oklahoma, not showing that it covers Missouri. Maybe that will help guide your decision.
Jason Zednick (46:43) I notated that when I was sort of reviewing these on the mapping page, when we, in our directory, don’t have a state that you included. I sort of just made a note here. So if you can review that, we could sort of find alignment where we need to.
Jason Zednick (47:11) Okay. But yeah, but for health choice just through the portal, I assume that’s what we have on our end. Yes. Okay, great. I also have it documented here for… a provider contract. Is that?
Jason Zednick (47:39) I think it may all be one application.
Staff (47:49) Yeah. Okay. That’s good. Okay. I’m sorry, my internet cut out.
Kim (47:56) Can you just say that one more time? Jason. So she’s yeah.
Jason Zednick (48:01) Yeah. I just have it written down as a contract, but it actually looks like it’s just an application. They’re calling it a contract. Okay. That’s all fine. This doesn’t okay. Yeah. All right. Health link.
Staff (48:38) Yeah, there’s nothing special about health link.
Staff (48:49) MHP, nothing special.
Kim (48:54) Those are my favorite by the way, the ones where they’re just not special. Those are the best.
Jason Zednick (48:57) Mine too. You and me both.
Jason Zednick (49:06) Multi plan or form of imperative managed medical in Texas like that’s fine. Anything else worth calling out?
Staff (49:17) No, yeah. No, that’s the only one. Okay?
Jason Zednick (49:25) Troy? Medicare?
Staff (49:29) Yeah, it’s a standard map but it’s just in North Carolina. Great.
Jason Zednick (49:36) Amerihealth North Carolina.
Staff (49:42) Just standard, nothing special about it. It’s a mco, I think actually.
Jason Zednick (49:57) Let me just check an RN real quick just to see, yeah, it’s like, their portal. Yeah. Okay. This looks, really standard. Okay, great. Great. Clover, anything clover does need?
Staff (50:14) No, it’s not anything weird back on me. I remember.
Jason Zednick (50:29) Just checking, our resource here real quick.
Jason Zednick (50:37) All right. Okay, great. Great.
Jason Zednick (50:45) Trillium.
Staff (50:47) No, nothing special there.
Naomi Denson (50:49) I mean, it, they’ve.
Staff (50:51) combined with another… company, so that all goes under trillium. Now, it used to be two split. I can’t remember what the other one was. I’d have to look now.
Jason Zednick (51:04) Oh, I wonder if we have it written.
Jason Zednick (51:10) Let me see.
Jason Zednick (51:15) I don’t get it right now. Medcast.
Staff (51:24) That one, I didn’t even remember being on there.
Jason Zednick (51:31) So, we have.
Jason Zednick (51:40) Yeah, looks like they just have like a portal, an online link through their site. Seems pretty standard.
Staff (51:52) North Carolina is fairly stable too. So, I haven’t done a whole lot. They’ve been with in the group for a while and I haven’t spent a while since I’ve touched any of the standard applications. So.
Jason Zednick (52:05) As soon as you select at Nevada health, Oklahoma, this is a roster. Is that right? Advantage? I got to map that we didn’t map that yet? This is a roster… community care.
Staff (52:25) Yeah, it is, it… will be a roster, but the panel’s closed right now. So we don’t have anyone enrolled in it, okay?
Staff (52:45) The mcos there in Oklahoma are now all three using the same roster. They got together and, yeah, they… got together and.
Staff (53:01) Did that recently, do?
Jason Zednick (53:04) Do we have that already? I’m looking, no, I thought I did.
Staff (53:11) But I’m not seeing it right there. I know I’ve got it in an email from them somewhere?
Jason Zednick (53:44) Yeah, when you find it, just send it and we’ll add it to the pile and work through that. All right. Just heads up. We got about six minutes left on the clock. Part of it is direct. It’s a roster.
Jason Zednick (54:13) First health, this is Aetna… just go through Aetna that’s probably standard, right? Yes… Oscar, you can see it as a note here. Panel closed… thanks.
Staff (54:36) Yeah, it’s the only state that they still are actually in.
Jason Zednick (54:39) That.
Staff (54:40) we service, they pulled out. They came to Arkansas and then pulled back out wow.
Jason Zednick (54:46) I didn’t know that.
Jason Zednick (54:51) Let’s talk alliant real quick paper application.
Staff (54:59) That’s what we.
Jason Zednick (55:02) were told. Let me take a look.
Jason Zednick (55:11) Lion health… and,
Kim (55:14) Monya alluded to this, but all of the kind of commercial, most of the, and Monya correct this, but most of the commercial like standard applications have been done by a third party most recently. So again just kind of going back to if there’s a more efficient way that you guys have to do some of this. We’re for those right now, we’re going off of the feedback they’ve provided.
Jason Zednick (55:40) Got it. Yeah. Okay. Yeah, we have, and… this may be the same thing, right? Paper application needs. We have like a PDF that’s just submitted.
Jason Zednick (55:56) So, this looks pretty standard like this looks normal and it may be the same thing as a paper app. I don’t think that’s probably any different. So this looks pretty like routine to me.
Jason Zednick (56:19) It’s not for myself.
Jason Zednick (56:23) The.
Staff (56:24) roster, I don’t have a copy of the roster for the Oklahoma mcos… but it’s through availability. I found the email blast I got and it was no, that was through availability… available in availability.
Jason Zednick (56:45) Is.
Leigh Howle (56:46) it, that, is it the same roster… that’s used like the roster automation that goes under provider data management?
Staff (56:56) I don’t think so.
Leigh Howle (57:00) Can you, would you forward that email to Jason and then Jason, if you could just send it to me so I can double check it?
Jason Zednick (57:06) Yeah, sure. Okay. Thank you.
Jason Zednick (57:16) Zealous.
Staff (57:27) We know they’re normally a tpa, but in Georgia, they actually have an map product.
Leigh Howle (57:43) Do you all have a rep or a contact in case we have issues getting status updates on submissions?
Staff (58:01) It’s not noted.
Jason Zednick (58:11) They have a enrollment… advisor, phone number on their site. I’m looking at it right now… that’s okay. I.
Leigh Howle (58:21) know, sometimes, you… know, we all know how payers can operate and it just depends on the volume that they’re working with and their systems changing systems sometimes can definitely create some delays with enrollment. So it’s always helpful just to have a direct contact in case there’s any issues getting status updates from just a generic email, but, you know, we can always just when Jason, you know, starts to do weekly syncs.
Kim (58:55) Those.
Leigh Howle (58:56) can be surfaced at that time?
Jason Zednick (58:59) Yeah, 100 percent, this happens quite often where, you know, we’re sort of following up on things and someone reaches out and they’re like, hey, it would be better if you emailed me over here. And then we just document that, let the team know, and we pivot like that’s. I’m having that conversation every week, with people. So we use 100 percent on point there. Okay. So… where are we at the moment? All right. We knocked out a huge chunk of these. I think there’s still some like details to be hammered out on some of these, there’s an rhc conversation for sure. And then we have… the remaining list, and standing up the rosters, we are at time now. Any parting thoughts or observations, before we hop off,
Kim (60:06) Naomi, I sent you a note just to grab a little bit of time because I just want to make sure we’re aligned on like dependencies and timeline to make sure like the June one, is successful and realistic. So, I… know we’ve got, we still have a lot left to do, but knowing like the, some of these things we’ll make our, you know, we’ll clear our calendars that there’s a lot of pressure for June first on our side. So, just let us know, what you need from us, to make that happen. Yeah?
Naomi Denson (60:42) Absolutely. I see your email that you sent over. I’ll definitely look at calendars and find some time to accommodate.
Leigh Howle (60:49) That.
Kim (60:51) Awesome. Thank you.
Jason Zednick (60:53) Kim, you and Naomi may have already spoken about this. So I apologize if I’m retreading here, with the June first go live target, are there any like I’m… not even sure, like high value high volume payers, you know, there’s going to be a lot of submissions for, right away.
Kim (61:16) We can, I can get some of that info for you, Jason. We’ve I know that, we’ve… got some providers that are going to be coming on. So if to that point like we can, I can get like that priority list. Right now, it’s kind of been a vague just that growth is coming. But, let me see if I can get more detail. I’ll be able to get more detail on that we know like, hey, if we needed to focus on certain states or areas because the load is one thing, right? And I think that’s just part of what I want to clarify like loading current info is one thing and it is super important for all of the delegation reasons, and things like that and the monitoring but like to get new providers on actively. Like, I guess, we definitely could prioritize… payers if we needed to, if there were some non standard things. Yeah.
Jason Zednick (62:18) Exactly. That’s. Sort of exactly where my head’s at just to get like a loose sense. So we can say like, okay, like we’re really looking at these. I’m gonna make another number. It doesn’t have to be anything like it’s like these three are gonna be priority. We can double down and make sure like, okay, our conversations are like, all right, this is what we’re gonna do. Is that different than what we talked about? Just those are sure we sort of assess. Yeah, no, that’d.
Kim (62:40) be great. And if there are some things that we need to come back to the team and say, hey, there’s this is what’s going to go live June first. And this is what we’re considering, you know, phase two obviously like we want to get as much knocked out by June one as we can. But if there’s some things that need to go past that I just want to be able to call that out very clearly. So, there’s alignment across the board, so.
Jason Zednick (63:06) Yeah, definitely. Yeah.
Kim (63:08) Well, yeah. Let me, let me ask, and money, you may have a better sense of what’s coming, yeah?
Jason Zednick (63:16) It’s especially important for, sorry. Sorry not to drop you money for that, for the roster, the direct enrollment rosters to know, you know, if we’re going to be heavy on those because it just has to be put in front of a team to build and that’s fine. Like we’re on track there, but it can sort of help prioritize knowing.
Staff (63:41) Most of our growth will come in spurts as far as individual provider enrollments, you know, they will be maybe one or two a month for a while. We’re looking at doing it for acquisitions here very soon, so.
Kim (64:00) You.
Staff (64:00) know, if we have four come in one month, of course, then there would be, you know, a greater group but they may not all even be in the same state, so.
Jason Zednick (64:10) Right.
Staff (64:11) There’s not, a real good picture to give you there, yeah.
Jason Zednick (64:16) Yeah, I get that.
Kim (64:18) Makes sense. All right.
Jason Zednick (64:20) Well, great. Well, we’re a little over. Thank you all for your time, I.
Staff (64:25) Just forwarded you the email from Aetna. And then I also dropped that universal roster for those Oklahoma mcos in the chat, so.
Jason Zednick (64:34) Perfect. Great. Thank you. All right. Have a great rest of your day. Awesome. Thanks.
Kim (64:40) You guys.
Jason Zednick (64:41) Friday?
Staff (64:42) Thank you.
Kim (64:44) Bye… bye… sweetheart. Feel better. Thank you.