Transcript
Jim Espinoza (00:00) hello?
Naomi Denson (00:02) Hi.
Jim Espinoza (00:13) Do you know if we have an update on the payr mapping stuff?
Naomi Denson (00:18) No idea.
Jim Espinoza (00:23) Is James still driving that?
Naomi Denson (00:26) The payr scoping… he had… the conversation. I guess they had met with them and we’re going to communicate back on the need for the new template, but not totally sure. Do we have payr data for them?
Jim Espinoza (00:47) We have to import groups. We have the list of groups, the list of payr’s kind of just like the payr names that they’re associated with. And I’m supposed to go to all practices.
Dawn Urbani (01:00) But we need.
Jim Espinoza (01:02) the payr names to be able to import those. Yeah.
Naomi Denson (01:05) We have an older version, but I don’t know if it’s all inclusive because.
Jim Espinoza (01:12) Yeah, no, this new set definitely had some that were like net new.
Naomi Denson (01:17) Okay. Yeah, not totally. Yeah… I don’t know who the… host goes on here.
Jim Espinoza (01:30) I think it’s James. Yeah.
Naomi Denson (01:41) There he is.
Naomi Denson (01:47) Hey, James.
James Donachie (01:48) Hey, good morning. Good morning. Well, I guess it’s probably not as morning for everyone else as it is for me. It’s only nine 30 and somehow, I’ve been having to bounce around all morning. I know that… let’s let Don in… and Patty, Leia. Joe.
James Donachie (02:25) Hello, hey, Don.
Dawn Urbani (02:28) How you doing? I’m.
James Donachie (02:29) doing all right. How are you? Good?
Dawn Urbani (02:34) Glad it’s Friday.
James Donachie (02:35) Yeah, we were just saying it was quite the marathon to get to just this point of the week over here at medallion. We had a bunch of meetings.
Dawn Urbani (02:46) Yes, yes, story of my life, story of my life, lots of meetings.
James Donachie (02:52) Yes, that’s basically all Naomi and I do is we hop from one place to another one, zoom link to the next, and try to stay afloat in the interim.
Dawn Urbani (03:04) I think that’s what most jobs are nowadays, right? That is the life. Yeah.
Naomi Denson (03:09) People ask me, can I schedule some time with you? I’m like if you can find it sure.
Dawn Urbani (03:14) Yeah, exactly.
James Donachie (03:17) Well, maybe… we can get three to five minutes back off of this meeting if we’re efficient. So, I wanted to start off with. So, Don, I asked Naomi about that new payr, I forget the name of the template, but the payr?
Naomi Denson (03:40) Process scoping, template.
James Donachie (03:42) Yes, payr process scoping template world’s longest name. There have been some important updates to the data that… from the previous template that has really helped our operation team. And then in turn helped your guys’ team because there were some gaps in the information.
Naomi Denson (04:06) Do you want me to highlight James?
James Donachie (04:09) I was just going to say maybe we can highlight the changes and get that from your team.
Dawn Urbani (04:15) So, before you go on, I think it might be important to have Loretta haythorn on the call and I don’t think she’s on today because this… may have to come from her. And I know she had voice concern because she has provided this information about three times now.
Naomi Denson (04:34) Yeah. So, I’m only seeing one version that we received from our old template and it… is pretty different than the new template as it’s missing a lot of important details that we need to scope out your processes for that you currently have in place for enrollment versus what our standard processes are to ensure that from the get go, any enrollments that we’re submitting are done correctly?
Dawn Urbani (05:04) So, was this template like just created over the last couple weeks because Janine had given us and maybe I don’t know if I’m confusing this with something else. But Janine had given us a report roster to fill out and we had our payr strategies team fill out their portion and we filled out our, we have been filling out our portion.
Naomi Denson (05:29) Is this something?
Dawn Urbani (05:30) Different? I’m not sure which I’m.
Naomi Denson (05:32) not sure which one you guys have currently, I just put a link to the one that I found from November 20 25, the process, the whole payr process, scoping like updates to the template. The new template and all of our like our new steps to review this were implemented at the end of February 20 26. So it’s essentially the same template. There’s just some additional columns that help identify where project plans might be needed. If you submit via a roster. If you have any specific rules surrounding your enrollments on, you know, different provider types or how you bill or, you know, standard process when you call, like when you look at a payr’s website, you look up, how do I enroll a provider? If you don’t follow that specific process and submit exactly those forms for your providers and you have a direct contact or you have an agreement where you can submit a roster, non standard to add new providers to your group. So that’s what this, the purpose of this is so that we stay aligned with your processes. And if this is not done and the payer scoping, like we’ll have a payer scoping call to walk through them and align, then everything typically would be submitted via the standard process. Meaning we have our internal directories. We’ve called the payers, we’ve done our research on their websites. This is how you submit these enrollments and we would follow just that. So anything extra or nuanced that you guys have in place could be missed and then it could cause issues down the road.
Dawn Urbani (07:12) Okay. So I actually just tried to click the link that you sent and I don’t have access.
Naomi Denson (07:17) It.
Dawn Urbani (07:17) says.
Naomi Denson (07:18) anyone with the link should have access.
James Donachie (07:21) Donna, I can.
Jim Espinoza (07:22) Yeah.
Dawn Urbani (07:25) It says, sorry, you do not have permission to visit this site?
Naomi Denson (07:28) Oh, it must be it’s because it’s a Google.
Dawn Urbani (07:31) Yeah.
Naomi Denson (07:32) Google sheet.
James Donachie (07:33) Yeah. I can download it and I was just going to say I’ll download it and send it to you in an excel format, Donna.
Naomi Denson (07:43) Yeah. If you could download that one, James and send it to her and the new one. So she can see the differences?
Dawn Urbani (07:51) Okay. So the one that you put in the chat was a Google sheet was the old one from November? Yes. Okay.
James Donachie (08:03) Yeah, it looks like… maybe the third of November, this one was filled out. Okay?
Dawn Urbani (08:10) Yeah, but I wasn’t here yet. So I don’t I’ll have to take a look at it.
James Donachie (08:15) Okay. I can send over. I know there’s lots of competing… stuff we’re working on, but I did just want to, I did want to call that out because like as Naomi said, that additional information now that it’s being implemented, we’re seeing our operations run a lot more smooth. So it’s worth the extra data on our upfront to make sure that we’re doing stuff correctly. And then I’m.
Naomi Denson (08:48) attaching them in the chat for you right now as well.
James Donachie (08:51) There we go. I will, we’ll get them two places. And then Jim, I know it was only yesterday afternoon you got the data, but I think I saw in the slack messages you were able to kind of look through it. And there were still some comments and you wanted just to kind of chat through here?
Jim Espinoza (09:15) No. So the data that we got back yesterday is the second email I sent with like the priority stuff to unblock some of the work we’re still missing like provider data with… like the start dates and the ckh numbers and all that stuff. But we did get practice information back and I can work on getting those updates into platform.
James Donachie (09:36) Awesome. So priority one is now in that data’s in on our side. You’re going to work on getting it uploaded, but you didn’t see any gaps in it that would prevent you from uploading it. We got everything we needed.
Jim Espinoza (09:51) From the practice side. Yeah.
James Donachie (09:52) Okay. And then provider side, we’re still working on which is we knew that was going to take a little bit longer. So I think we’re on track. This is where we expect it to be.
Dawn Urbani (10:09) Sounds good. Anything else?
James Donachie (10:12) I don’t think so. Don, I know we’re going to have a we’re going to have calls next week to kind of keep things going with the mpdb and all that fun stuff. And so I’ll send over, I know that Naomi linked this. I know that Jim will probably take his extra little bit of time here and try to get that practice location stuff uploaded. So I’m happy to give everyone some time back and let your team work on that provider information as we just keep moving forward. Okay?
Dawn Urbani (10:47) So you’re going to you’re? Going to send me those as excel spreadsheets? Yeah, I.
James Donachie (10:50) will send them over as excel and I.
Naomi Denson (10:54) put them in the chat as excel as well.
James Donachie (10:56) Yeah. So if anyone just grabbed them from there, you can.
Naomi Denson (10:58) Download them from the zoom chat right here… but James can include them in the follow up email too.
James Donachie (11:05) Yep.
Dawn Urbani (11:06) Now, would this hold us up from moving forward, if it takes us some time to fill to complete this document?
Naomi Denson (11:13) Yes, it definitely can with payor enrollment because we want to ensure that everything is done correctly when we go live. And then there, it’s a huge help to reduce any errors, or issues with the submissions after we go live with payor enrollment.
Dawn Urbani (11:33) What do you, what do you think the anticipated time would be to complete this document?
James Donachie (11:37) I think you guys have a lot of information in here already. Yeah. So.
Naomi Denson (11:41) You could copy and paste the payor names and some information from the original sheet into that one. And really, you would just be filling in the other columns. Do you use rosters? Do you have any nuanced processes? Do you have any notes, or any other information on this to share? What some customers also do is they might have a folder somewhere or a sheet somewhere that outlines all of their current processes and sops for their different payors… internally. You could share that with us and then we would have a call to walk through each one of the payors on the list and compare it to what your process is versus what our process would be. So, there is a lot of information already on there. I would just make sure to take a pass at it and make sure all of the payors that you currently enroll with or plan to enroll with, are listed there. And that is up to date. And then I think the states column, so it’s payor per state. The ones in the original sheet, just say asterisk one. So I don’t know what that state means. I.
James Donachie (12:46) Think it’s just Pennsylvania, right? Don.
Dawn Urbani (12:47) Yeah, it should only be Pennsylvania.
Naomi Denson (12:49) So,
James Donachie (12:49) that part already, one major thing done. That column, I can even pre fill it out for you, Pennsylvania all the way down. Okay? But I don’t think it will take that long to Naomi’s point. It’s like if you’re using a roster and it’s like a yes, no. And then if it is a yes, then it would just be including the roster so that we make sure we have it and it’s just kind of working through.
Dawn Urbani (13:16) So, when you say including the roster?
James Donachie (13:18) Like the template that you guys send over because each payer has different… rosters that they like what required fields on their roster templates. And so you would just share the blank one with us and we can, we’ll distribute it to our team?
Naomi Denson (13:38) Yeah. So we’ll look at the rosters that you send to us and see if it’s one that we already utilize or already have on file. And then it also allows us to map that for automation to make things easier. Okay? And we’ll build that directly into your instance for mlh, so that it’s connected to your enrollments and our teams are directed to follow that process.
Dawn Urbani (14:03) Okay. Just for full disclosure, I will be away at a conference for two days next week. So I’m not sure how much time we’ll be able to devote to this next week. So, it may take a couple weeks.
James Donachie (14:15) What conference are you going to?
Dawn Urbani (14:18) It’s a mainline health.
James Donachie (14:19) Conference. Oh, okay. Yeah. Well, hopefully the weather’s nice. Wherever you’re going and you.
Dawn Urbani (14:27) Same campus, same campus, pretty much just down the road from where I usually report to. Oh, nice.
Naomi Denson (14:36) Well, you can’t even pretend it’s a vacation?
Dawn Urbani (14:39) No, it’s not a vacation? No, not at all.
James Donachie (14:43) All right.
Naomi Denson (14:45) Well, you said that’s next week?
James Donachie (14:47) Yes. So.
Naomi Denson (14:48) Will we, will everyone be there? Are we still going to meet next week?
Dawn Urbani (14:54) Yeah, we’re supposed to meet next Friday.
James Donachie (14:56) Okay. Perfect. All right, everyone. Thank.
Naomi Denson (15:01) You talk to you soon, take.
James Donachie (15:03) Care. Enjoy the weekend.
Dawn Urbani (15:05) Thanks, you too. Bye bye.