Transcript
Barret Pickering (00:01) morning, Naomi. How?
Nicole Hillis (00:02) Are you? Good morning… stop?
Naomi Denson (00:06) It, it’s too early on a Monday for that Nicole.
Nicole Hillis (00:09) Too early. Oh, what time is it? Nine for you?
Naomi Denson (00:12) Nine? Yeah.
Nicole Hillis (00:12) Nine? Okay. You know, it is. I’ve been up since like 615.
Naomi Denson (00:17) 515. I have toddlers that don’t need sleep to survive.
Nicole Hillis (00:21) So… well, we converted our toddler’s crib, and we did, you know, like the big girl bed. So like she can get out at any time.
Naomi Denson (00:34) Mine are three and five and still sleep in my bed.
Nicole Hillis (00:37) I’m like, what are like, it was too early but we saw that she was starting to like try to like jump out of her crib, and I was like, no, no. And so we’re like, all right. It’s just let’s go to the next stage. And 615 is like early, my eight month old she’ll sleep until like seven, but.
Naomi Denson (00:56) Yeah, mine are my three year old. She’s a night owl. She will be up all night partying and then she will be, she’ll have a couple hours of sleep and she’ll be like, all right. I’m good to go. And then my five year old he’ll pass out at like four o’clock in the afternoon and sleep until like seven and I’m like, but they’re both in my bed. They’re.
Nicole Hillis (01:14) in your bed?
Naomi Denson (01:15) Yeah, because, yeah, I blame my husband because my oldest went from her crib straight to a full size bed and never slept with me. Lucky her and I’m like what is wrong with you two? I asked my five year old when he was going to stop sleeping in my bed, and he said, I don’t know, maybe like when I’m 20 and married and I’m like pretty.
Nicole Hillis (01:38) Sure. It has to happen before you get married. Yeah, I’m like.
Naomi Denson (01:41) I’m going to need you to get up before then. Like you have a whole bedroom. Yeah. And he’ll get so mad if my youngest goes in his room and I’m like you don’t even sleep in here. This is basically just a closet. I,
Barret Pickering (01:53) think, I do admire that he thinks he’ll be married by 20 by.
Nicole Hillis (01:57) 20, yeah. To.
Naomi Denson (01:59) His 14 year old sister’s best friend by the way.
Nicole Hillis (02:02) Oh, there you go.
Naomi Denson (02:03) That’s the only person he says he will marry.
Nicole Hillis (02:05) There you go. Do.
Naomi Denson (02:07) You have any?
Nicole Hillis (02:07) Little ones?
Barret Pickering (02:08) I haven’t no, I’ve got no little ones. Just dogs.
Naomi Denson (02:14) I have those too, and they also sleep in my bed. So I don’t sleep Morgan.
Barret Pickering (02:20) And I, we don’t allow the dogs in the bed. I think it’ll be a hard no on the children too. I’m sure.
Nicole Hillis (02:27) Just say no, just say no, I.
Naomi Denson (02:30) tried to just say no, and my husband was like, no, their room’s too far away and I was like we live in a bigger house now, but our old house, I was like I can stand in the doorway of our bedroom and touch his bedroom door. If I put my arm out. He was a bit, yeah, we finally got our old dog out of our bed just because we were afraid he was going to hurt himself jumping in and out and finally just got him trained to sleep just sleep on the floor. We took the crib mattress that they don’t sleep on and put it on the floor in our room.
Nicole Hillis (02:56) Oh, there you go. That’s perfect. I,
Naomi Denson (02:59) feel like somebody’s getting used out of it that’s.
Nicole Hillis (03:01) perfect. Well, happy Monday morning, yes.
Naomi Denson (03:04) Happy Monday.
Nicole Hillis (03:06) I was just talking with one of one of my colleagues just about like the whole credentialing.
Naomi Denson (03:15) Credentialing, or pay your enrollment?
Nicole Hillis (03:17) Credentialing. Okay. And just like how we’ve been doing it here and it’s so backwards and I’m like this is so bogus.
Nicole Hillis (03:28) It just, it doesn’t make sense because, okay… I will try not to ramble on because I just… they don’t start the credentialing in primary source until basically a provider’s network effective date… how that makes sense? Is there a reason is?
Naomi Denson (03:52) There a reason that they don’t do that?
Nicole Hillis (03:56) That’s what I’m trying to find out like it’s I’m like when you apply for privileges at a hospital, like you gotta go through credentialing first.
Naomi Denson (04:05) And then even so when you send the application to the payer, they credential first… right? So I don’t understand why they’re not credentialing them at the same. I have no idea at least even at the same time because even like hiring a provider, you have to have credentialing, like a lot of our customers do that at onboarding. Like that’s. The very first thing.
Nicole Hillis (04:26) That they do, we don’t and I thought it was bizarre when I first started because I would do the onboard, well, I do the onboarding for the employed providers. And then, you know, yeah, we would, I would, it wasn’t required that you like had to go online, but that was just my normal workflow what I did from medical staff office days and so that’s what I would get. But if they sent, you know, a license or a Dea, you could just put it together. And then with all of the pay or enrollment applications, once you have all of the required documents, then you send it off to the pay or enrollment team. And so like then they would do their process. And once they submit it to the payors, then, you know, they would add the providers in the system. And then once their network effective dates would start rolling in, they would show up on a report that then the steward healthcare network or revere medical network team would say this provider is coming on board. Their network effective date is six one. Well, it’s six two. So then they start their credentialing and then they’re doing all their primary source verifications so that they can get the file presented through to committee. So I’m like, so you’re vetting, we’re vetting for providers after they start, that doesn’t make sense?
Naomi Denson (05:49) You’re doing the work to have them enrolled in network when they may not move forward. In some cases. Yes, it seems like that seems backwards to me even doing it at the same time.
Nicole Hillis (06:01) It’s so backwards. Yeah. And I’m like, are you serious? Like I… so I’m just trying to understand. I’m like my thought is if they’re going through, if a provider is, you know, being set up in medallion and they’re going through the process… we can have medallion do primary source… and then use those primary source verifications to prepare their file for credentialing in the same process of going through payer enrollment and going through credentialing to prepare for the committee and then have them on cycle for every three years because that’s the ncqa requirements. I guess, yeah, like that’s how I would have would think everything’s.
Naomi Denson (06:50) going, so the actual credentialing file itself in medallion does not kick off. But as soon as the providers in the platform and they have all of their required data elements, their npi and everything like that, the monitoring kicks off with npdb license verification, oig, all of that. So those PSPS are already in there even without the full credentialing file. And then we pull updated ones into the credentialing file as we’re working it, right? But if they’re not even approved for credentialing internally, why are, why hold off? Like is there a reason that they don’t they do it that way? Is it more, is it cost more for different teams to do that? I have?
Nicole Hillis (07:30) No idea. We’re going to fix it. We’re going to fix it. We’re going to fix it. I’m sorry, I just, I was just like what it just made no.
Naomi Denson (07:40) Sense. I’ve never seen anyone do it that way. Me neither because most people’s thought process when they come on board is that the providers have to be credentialed first before they can start pay enrollment. And I’m like, well, the credentialing doesn’t block pay enrollment in medallion. They can be done at the same time, right? But I’ve never had somebody say they have to be enrolled before we’ll credential them because they’re being credentialed as part of enrollment with the payers.
Nicole Hillis (08:02) Yeah. So that’s I was, that’s the call that I was on. She’s, like, I know it’s backwards. I don’t know like.
Naomi Denson (08:13) Let’s at least not make it backwards and back it up to at least the same time, if not credential first. Well, I’m like, no wonder. Well.
Nicole Hillis (08:21) I’m like, no wonder affiliates and some of these providers wouldn’t get credentialed until like why it would take so long? Like, no wonder because you’re not starting until after they start, but.
Naomi Denson (08:35) What is their like official start date that they start scheduling with the effective date with?
Nicole Hillis (08:40) The payers, they’re like we don’t get, we don’t get, they’re not on a report until that report doesn’t get pulled until like after their effective date. So she’s like, so if they start on six one, they’re going to show up on the daily report like on six two, and then that will initiate my piece. And I’m like, okay.
Nicole Hillis (09:04) So, like even if it’s an employee provider, what if something comes back and like we wouldn’t actually hire them, does it happen often? No, but all it takes is one provider, right? To be like, oops, you have an open malpractice claim and because we never did our due diligence or whatever, but we’re doing it. Now, you have an expired license, right? You know, like oops.
Naomi Denson (09:29) You never actually went to medical school, right?
Nicole Hillis (09:32) Yeah, you never went. I mean, thanks for your diploma, but like I didn’t actually reach out to your training program or, you know, anyway, so it can definitely be fixed. Are we going to at all talk about or mention about ongoing license verifications?
Naomi Denson (09:54) Because we don’t we,
Nicole Hillis (09:56) do have that with you guys. I thought for some reason there was something that we didn’t don’t have with you guys, but you can do, and I thought that was expirations. So.
Naomi Denson (10:06) We have licensed expiration monitoring as part of the, so you purchased ncqa credentialing in the contract with that standard that comes with it is ncqa compliant monitoring, which is oig, Sam, npdb medicare, opt out medicaid exclusions, and then licensed expiration. Monitoring. So, what that does is it upon the license being entered into medallion, it verifies it through the PSB and then we start verifying it two weeks ahead of the expiration date for that. So, but anything that happens with our license in between there that’s reported to npdb is flagged through the continuous queries with npdb. And then you guys would get, hey, we found a new sanction or via the npdb. Okay. I thought there was.
Nicole Hillis (10:53) Something.
Naomi Denson (10:54) okay.
Nicole Hillis (10:54) All right. Yeah.
Naomi Denson (10:57) So, you purchased the ncqa compliant monitoring with it. It does not include as our comprehensive monitoring package, which is the ofac death master and CMS preclusions, but that’s those are the only three verifications that it does not include.
Nicole Hillis (11:14) But like what would we need those ones for only?
Naomi Denson (11:17) If it were typically only if it were a requirement for a delegated payer? So.
Nicole Hillis (11:22) I think that, that’s what we have to check on is that the reason why we had have ncqa is because we have delegated contracts. So now, that,
Barret Pickering (11:34) yeah, but we only have a couple. So.
Nicole Hillis (11:35) It’s we only have a couple, I thought we had like,
Barret Pickering (11:38) I mean, I can pull up the payerscoping it’s okay?
Naomi Denson (11:41) It’s so marginal. Yeah, actually, there were some that were called out during the payerscoping that had said they were delegated but weren’t actually delegated. So, I’m actually still waiting on a full list of who you guys were confirmed as actually delegated in which states?
Barret Pickering (11:54) I went through that. So, so.
Nicole Hillis (11:57) Let.
Barret Pickering (11:57) me find that sheet.
Nicole Hillis (11:58) And I’ll pull it back up. So like, okay. So, but like if our vendor is ncqa accredited, would that affect any of our delegated agreements? Like if we are still using an ncqa accredited vendor for all of our enrollments… would that, yeah, credentialing?
Naomi Denson (12:22) No. So, it, I don’t know if I’m following correctly. So, we are ncqa certified accredited, and we do that in cqa files you already have for delegated agreements that you already have. What I had brought up previously was you need to notify the payers that you’re designating a subdelegate.
Nicole Hillis (12:39) that’s right? That’s right? And.
Naomi Denson (12:42) they’ll ask for like our certificates and stuff. And after those conversations, let me know and I can get all of that for you, right? But it doesn’t do anything for any, anything with the payers that you’re doing direct enrollments with until you open up those discussions about a delegated agreement possibility. Okay.
Nicole Hillis (13:04) Barrett, do we know who’s checking with the payers?
Barret Pickering (13:10) I may give that to you and sperling to reach out. We’ll give it to sperling… whoever’s got those relationships.
Nicole Hillis (13:19) I think, yeah, it’d be matt because he’s more on the network.
Barret Pickering (13:22) So, matt’ll yeah, matt’ll reach out on behalf of a couple of them. And then potentially depends what Sarah loro’s, been doing with certain payers? Oh, that’s right? That’s right. Okay. So, it may be split between the two.
Nicole Hillis (13:35) Okay. All right. Sorry, I’m sure. That probably took up a little bit of time, but I just got thrown for a loop.
Barret Pickering (13:43) Will you write that down real quick that we need to send those out.
Nicole Hillis (13:47) The delegated? Yeah.
Naomi Denson (13:51) Yeah, reach out to your contacts that you delegated, yeah, reach.
Nicole Hillis (13:53) Out to the contacts? Okay?
Barret Pickering (13:56) Yeah. Let me, okay. So I found the sheet. We can just look at this real quick. Let’s see. Delegated. Yeah. So really, we had like this humana, one humana, and then this imperial… and that’s it, that was, it was the,
Naomi Denson (14:15) conclusion that’s the only really it’s filtered by only Arizona.
Barret Pickering (14:18) Oh, my bad, there’s probably like two more. Let me.
Naomi Denson (14:23) See what I put in because I had already put in tickets because gap had sent me a bunch of rosters and said that they were delegated on this sheet. So I put in tickets to build those delegated rosters.
Nicole Hillis (14:32) yeah, yeah.
Barret Pickering (14:33) And we went back through it.
Naomi Denson (14:35) Okay. So, humana, imperial for Arizona?
Barret Pickering (14:43) Yeah, the only ones I’m showing are?
Naomi Denson (14:49) Because previously, I had cigna, Massachusetts and I think we determined that is not.
Barret Pickering (14:53) That is not, oh,
Nicole Hillis (14:55) it’s not, okay.
Barret Pickering (14:57) This is, yeah.
Naomi Denson (15:00) Eternal health.
Barret Pickering (15:02) So, where did eternal go? Is that somewhere?
Naomi Denson (15:09) Do control F, good call?
Barret Pickering (15:11) It’s early here.
Naomi Denson (15:17) So, there’s seven rows of seven entries. Are there, is there any other than states?
Barret Pickering (15:25) What are you asking here? So this, I see like there’s a lot of seven results. Oh, there.
Barret Pickering (15:39) I’ve got none of them as okay. Yes on those.
Naomi Denson (15:44) Okay. So I can cancel the eternal health one because they’re not delegated, correct? I had devoted.
Barret Pickering (15:52) We’ve got devoted if.
Nicole Hillis (15:54) it’s a roster payer. Does that mean that it’s a delegated payer or not necessarily no?
Naomi Denson (15:59) So, the delegated roster builds are for delegated agreements only where we are automatically creating the rosters from the payers based off of credentialing dates… based off of their ncqa credentialing approval. So then they would automatically load down to the roster. We would send them to you. You would forward them to the contact at your delegated payers, the standard roster payers. Where it’s a direct enrollment. They just utilize rosters. We ask for those in here because we’re going to map those into the system for automation to then follow those roster processes. But it’s not part of the delegated contract piece.
Nicole Hillis (16:38) Gotcha. Okay. So it’s like we still someone on our team whether or not it’s me, I would then still have to send because.
Naomi Denson (16:50) They won’t, yeah, the delegated payers based on the agreement, they won’t accept their rosters directly from us. They have to come from you guys. Okay? Yeah.
Barret Pickering (16:59) You’ll probably.
Naomi Denson (16:59) End up with, so we generate them, we send them to you for review and then you send them off to the payers?
Nicole Hillis (17:03) We send them off. Okay?
Barret Pickering (17:04) Nicole, you’ll probably end up with Massachusetts on this front.
Naomi Denson (17:10) Okay. So it’s only humana. Yeah.
Barret Pickering (17:16) We’re humana in Arizona and imperial in Arizona. Okay?
Naomi Denson (17:20) I don’t have the roster for humana yet? Is it linked in here?
Barret Pickering (17:25) Yes, I.
Naomi Denson (17:27) have the imperial one?
Barret Pickering (17:29) Yeah. So.
Naomi Denson (17:31) It’s only Arizona. Okay?
Barret Pickering (17:36) As far as I know, I mean, and I’ve gone through this with multiple people. So, it’s been a struggle.
Barret Pickering (17:49) Ah, what did I just do? But I knew we had a limited scope of delegated agreements that’s why I knew it wasn’t a big deal from.
Naomi Denson (17:57) the beginning. Okay. So, you have six quantity of the delegation roster generation, so that’s per state per payer. So it’s per separate roster that we have to build.
Barret Pickering (18:09) Okay. So.
Naomi Denson (18:10) Right now, we only have two correct?
Barret Pickering (18:12) Correct. Okay.
Naomi Denson (18:15) I just need, I have the imperial one. I just need the humana roster, which is right there. So I’ll pull that. Okay? And I’ll stop all the other ones because we don’t need them. So, no, devoted.
Barret Pickering (18:31) No, devoted.
Nicole Hillis (18:32) No, devoted.
Barret Pickering (18:33) And we can, I will finalize this again. I’ve gotten this in front of a bunch of eyes… unless somebody came in here and just changed them on me. Could have happened.
Naomi Denson (18:52) Okay. I got this stopped and we’ll put in the one for humana, so he can start that build. Okay? If it will let me. Okay? All right. What else today? All?
Barret Pickering (19:03) Right. Nicole you want to leave the comms here on village providers, make sure we’re all good there. Well?
Nicole Hillis (19:09) I, you know, I would have had a little bit more time if I wasn’t thrown for a loop about our credentialing process right before this phone call, but I… I’m just… have, I think one provider that’s done, or that’s got la Rosa and daddari is?
Barret Pickering (19:31) Done with like,
Nicole Hillis (19:33) is ready to get submitted, right?
Naomi Denson (19:38) Like for their enrollment request that you submitted?
Nicole Hillis (19:41) Yeah, for their enrollment request?
Naomi Denson (19:43) So, I’ve got.
Naomi Denson (19:49) Daddari. Yes, I see they finally reached intake complete. And then I’m seeing, daddari and Armstrong whiting, and la Rosa all have applications that were submitted as well for medicare.
Nicole Hillis (20:09) Perfect. Yes. And so, because Dalton’s doing that part first. And when medicare comes in.
Nicole Hillis (20:27) Then my,
Naomi Denson (20:28) client online. So he’s done for medicare. Okay?
Nicole Hillis (20:35) Where did you see? Okay, hang on.
Naomi Denson (20:40) I’m sharing my screen.
Nicole Hillis (20:41) Oh, okay. Perfect. I’m usually have two monitors but I’m in my kitchen. So I’m.
Naomi Denson (20:46) only working off of one. So these are all of the medallion owned requests. I filtered out the ones that were client owned. So there’s 139 total. Okay. There are 20 processing. It looks like it’s only for the dairy the.
Nicole Hillis (21:05) Dairy? Okay?
Naomi Denson (21:07) Now, there’s 119 that need attention. Who was the other provider you thought was ready?
Nicole Hillis (21:18) La Rosa… or was it Armstrong la Rosa?
Barret Pickering (21:30) Yeah. We need la Rosa and Isaac?
Nicole Hillis (21:33) Isaac has not completed any of his stuff.
Barret Pickering (21:37) Okay. Well, that’s on him. Yeah.
Nicole Hillis (21:39) Well, yeah. I have to reach out to Brandon because.
Naomi Denson (21:42) there are two tasks in here that are still open if they’ve been completed. Oh,
Nicole Hillis (21:50) well, that’s right? They just need to.
Naomi Denson (21:51) Be marked. They just need to be marked done. And then they’ll push past intake.
Nicole Hillis (21:54) That’s right? His Coi, I already followed up with that. I think I made a note in la Rosa this morning. I’m still pending that because that can’t move forward until I have that. Okay? But those.
Barret Pickering (22:06) Are complete. They’re well.
Nicole Hillis (22:12) Not without the Coi. Okay?
Naomi Denson (22:16) His profile is complete, but there’s tasks from intake that they’re missing information from their review.
Nicole Hillis (22:22) Yeah. Where? Okay. So if I am on like I’m on dardari’s, I open him up. I see his profile. Where do I actually see? Like where would I look at opening him up that he is like through the next stage?
Naomi Denson (22:44) So you’re going to see that? So you can see it from the main payr screen or if you were just looking in his profile?
Nicole Hillis (22:52) Yeah. Like I’m on his profile?
Naomi Denson (22:55) So, the payr tracking under payr’s right here. Okay? Going under payr’s okay? And then you can see the different buckets. So there’s 21 that are processing, there’s two that are in here as requested but it looks like they were submitted as client owned. So we’re not touching these.
Nicole Hillis (23:12) Right. Yeah, that’s medicare medicaid, and acn. Okay. So it’s where it says under processing when I see it under there, and then where it says requested, it needs to.
Naomi Denson (23:24) Be data intake complete. As of Friday, it looks like. So our team should pick them up and start assigning them out for submission this week or… today, the next day or two. You should start seeing those being assigned out.
Nicole Hillis (23:40) For which ones?
Naomi Denson (23:43) So, they’re in intake complete. So they’re past the phase. They’re with our operations team now for PE. Okay? And where would I see.
Nicole Hillis (23:52) that on?
Naomi Denson (23:54) The enrollment line, you see the status here?
Nicole Hillis (23:58) Enrollment payers.
Naomi Denson (24:01) Can you see my screen?
Nicole Hillis (24:06) Nope. Hang on.
Naomi Denson (24:09) There we go. Okay. All right. So, they’ve got intake complete. They’ve made it through intake. So, they are with our PE team now, however, because the medicare and medicaid are in process, this one like any that have medicare advantage, those are going to be linked to that medicare request to pin the medicare approval. So once the medicare is approved, then we’ll submit those. Any that are just commercial. We’ll move forward and go forward with. But any that have managed medicaid or medicare advantage plans are going to hold and pin the medicare and medicaid enrollments being completed. Okay? So you’ll see those move into an on hold bucket and the status will say pinning dependencies. Okay? And then this column will show you which enrollments are blocking it.
Nicole Hillis (24:53) And when the team gets the effective dates, it will then unblock since.
Naomi Denson (25:01) Your team is owning the medicare and medicaid once he comes in and marks it as completed and puts that in it’ll, automatically unblock the dependent line.
Nicole Hillis (25:12) Okay. Cool. Okay. All right. So, what if, like, so if like Dalton is doing that? What… if Dalton is no longer here and he’s the one that submitted, how would I, like, we always need a backup? Right? Should always have a backup. So, if like just, I’m just saying like if Dalton’s not here, he’s on vacation. How would, then, I know that the medicare effective dates come in, I would need to make sure that I am.
Naomi Denson (25:49) That you have access to Pecos to follow up or verify? Or if he’s sending the email notifications, like the contact was like a general inbox, yes, like a fair enrollment at revere, or something like, that you’re monitoring that. And then the medicaid’s checking the portals, the az, cchs,
Nicole Hillis (26:10) portal that’s right? That’s what I need access to? Okay? Because again, those are dependent on then the medallion team submitting anything?
Naomi Denson (26:20) There that requires it, yes, that requires, medicare, yes. And.
Nicole Hillis (26:26) And where does it show? Again? Sorry that it’s pending it’s dependent on?
Naomi Denson (26:31) I know it, it’ll show us that pending dependencies. And then the dependencies here will show blocked by. And then when you hover over this or click into it, it’ll show you blocked by this provider’s, medicare Arizona line. So as soon as that’s approved, it’ll unblock it because the dependency’s been met. And then this status will change to dependencies met, triggering our team to work, it gotcha.
Nicole Hillis (26:55) Okay.
Nicole Hillis (27:03) Which is they’re pretty much all? Yeah.
Naomi Denson (27:06) As our team since either intake complete and our PE team will start reviewing them and linking them to dependencies. Okay? And then that will you’ll start seeing those get updated. And then as soon as the medicare medicaid lines that are client owned get approved and marked as completed. So they would change the status in here to complete. You can go to, I can’t do it right now. Hold on. I changed it to. So when… it’s completed, like… you can put tracking numbers in here. When it’s submitted requested, when it’s completed, you change this, you can just start typing in here to completed. Okay? Once you change it to completed, you’ll put in the par status, the effective date, the ptan, all of that information, the approval letter. Yeah, that will make it an existing enrollment and unblock, the pending lines. Okay?
Nicole Hillis (28:04) Okay.
Naomi Denson (28:07) Great.
Nicole Hillis (28:11) If one of my providers that’s not still yet done his stuff for a six one start date, if he did it this week, he would be one that I’d be like we really need to like high priority. But like, is there kind of a general, just a recommendation? I guess for us to keep in mind… like obviously, I want to avoid trying to urgent like request, urgent credentialing or enrollment? What is possibly, I guess like 30 45 days that we could get a provider enrolled with some payers… I have to like.
Naomi Denson (29:02) Try to avoid it. The standard turnaround time with payers is usually average 960 to 90 days, right? Sometimes 120 depending on the payer, right? It would just, are there requests in here yet? He just hasn’t done the work, yeah.
Nicole Hillis (29:15) He hasn’t he hasn’t done the work.
Naomi Denson (29:17) But the requests are in here. No, because you can go ahead and put the requests in and they’ll just sit and request it until he’s completed the profile. So that way as soon as he completes his profile, does he has a profile in here already? We’re just waiting for him to accept the invite and do the work. Yeah, Daniel.
Nicole Hillis (29:36) Isaac, yeah. So,
Naomi Denson (29:38) you can still go ahead and put their requests in and they’ll just sit in a requested status until he completes his profile. Okay?
Nicole Hillis (29:44) And.
Naomi Denson (29:45) that way if Dalton’s already doing the medicare medicaid, he can go ahead and add them in here unless… he’s working off the profile too to submit those. I have to yell at my dog really quick. Yeah.
Naomi Denson (30:04) Sorry. No, it’s okay. Okay. Does that make sense? You can still put them in here regardless of if the provider’s completed with their profile, it’ll queue them up but we won’t touch them until they’ve done their part, right? Okay. That way, at least they’re in there and ready to kick off as soon as he does that. Yeah, I have to remember. Yeah.
Nicole Hillis (30:25) It’s just, it’s the I’ve reminded I’ve reached out, but like now, it’s past a point where like you’re not responding, I’m not going to keep bugging you. So recruiter, can you?
Naomi Denson (30:33) Yeah. Okay. Understood this one, this?
Barret Pickering (30:36) One’s on him too, and I don’t mind pushing back. Like if he hasn’t done anything and we have to push the start date, that is not on us, that is, yeah, solely on him. And I’ll handle that battle for.
Naomi Denson (30:47) us because even after they’ve been invited to medallion, they receive five reminder emails and.
Nicole Hillis (30:52) I’ve even re, sent them like recent invite to provider and I’ve told him like, hey, just check your email box and, you know, I’ve texted him, but it’s you know, but, I just want to kind of, yeah, I just, yeah, I just want to know like what’s like a time frame? Like, especially if the recruiter has to really push a, push a start date. Okay? All.
Naomi Denson (31:12) Right. Usually average. I mean, medicare can take up to 60 days, I think, sometimes, yeah, but.
Nicole Hillis (31:18) He, I think he is practicing in the same state though that like he’s already in Arizona, yeah.
Naomi Denson (31:24) And sometimes it moves faster if he’s already enrolled in the state depending on the payer, you know, do they have to redo credentialing entirely by location? Like Georgia does it’s? Really annoying. But yeah. Okay. Sometimes it can go faster. Okay?
Nicole Hillis (31:40) And I had a question. I forget.
Nicole Hillis (31:48) When do we think? Where are we at? With like either other markets or the affiliate side… of an, of enrollment for?
Naomi Denson (32:02) Revere, yeah, not for village. Yeah.
Barret Pickering (32:05) Okay.
Naomi Denson (32:06) So, we were in our last call, we were still working through data. We decided that Greg was just going to import what we had and what we could. So let me check in on where he’s at with that. And we’ll need to, you know, establish a plan to get providers invited. Okay? On that side, who you want invited first. If we just want to invite everybody that’s in there and kick off, have you guys sent the comps to the revere side? Providers? Let them know… why are you laughing at me a… lot? It’s.
Nicole Hillis (32:42) a lot, once.
Naomi Denson (32:43) it gets going and we get everything off the ground, it gets easier. But yeah, the data can really, you know, clog some things up. And then I think we need to regroup on the payer scoping one more time. Barrett. I need to check with dream and Vanessa because I know there was a lot of stuff that was going back with you guys that we were trying to clarify and confirm on some things and.
Nicole Hillis (33:10) Can I just ask what all do you talk about like, in the payer scoping? Like is that at all benefit? Do I need to just be aware of it? Is that it’s.
Naomi Denson (33:21) basically beneficial, what is your process versus what is our process? And do you need a custom plan built into medallion to follow some other process that we don’t recognize as standard?
Nicole Hillis (33:33) It needs to be better than what was happening? Yeah.
Naomi Denson (33:36) So, we have internal, we have an internal directory for every payer. Basically, if you go to their website, search provider enrollment, how do you enroll the provider, right? We followed that there are customers that come in and say, no, we don’t follow this. We work with this contact. We send this roster. Okay? We have to attach these forms. We don’t wait for this. We don’t enroll this type of provider, only this type or we bill this way for this particular payer under this group instead of this one. So it’s just a whole thing that the good.
Nicole Hillis (34:11) News?
Barret Pickering (34:12) Is, I think we’re over complicating it? I think most of the things are like pretty standard. I think it was just like month to month changes of what those look like. And I think they are pretty standard for specific. Yeah.
Naomi Denson (34:25) And I mean, we have customers that come in sometimes and they say whoever was doing it for us before it wasn’t working, you do standard and we’ll build on it from there. But there are customers that come in that have long standing relationships with their payers and they have like nailed down a process that is not standard at all. Okay. They know how it’s supposed to work with their specific provider demographic on, you know, their patients and regions and things like that. So. Okay. But if you say, you know, whatever was happening before wasn’t working obviously. So we can, you know, take those payers from square one and start with the standard processes and what happens. And we can always build on it later. But, okay.
Barret Pickering (35:05) Yeah, we accept your advice here. This is, think of this as a little bit of a rebuild and we just want to do this probably in the best way y’all would think, yeah, yeah, but.
Naomi Denson (35:18) You wouldn’t you wouldn’t imagine how many times I have customers come in through implementation. I ask them over and over again about nuanced processes. They say we don’t have any. So we go through standard and then we submit the first five enrollments and they’re like, why did you do it this way? We’re like, well, we asked you 14 times to fill out the sheet and you said you didn’t have anything. So, yeah. So now we’ve got this whole new process in place with the payer scoping calls and going through payer by payer because we’ve had so many customers come back after the fact, like telling us we did it wrong. We’re like, well, you didn’t tell us to do it a different way. So.
Nicole Hillis (35:50) We’re not gonna do that. Yeah. Okay.
Naomi Denson (35:51) So now we go payer, by payer, state by state and make sure that we have overall sign off from all parties on an agreement on how we should be submitting them, okay?
Barret Pickering (36:02) Yeah. When.
Nicole Hillis (36:05) when there are like when there’s providers that they’re already enrolled, but then we need to add a secondary… practice location or they’re changing. I don’t I can’t remember, I’m sorry if I already asked this previously. What is the process with that? Is that that’s.
Naomi Denson (36:26) remember, yeah, we talked about this one before. So remember that’s the one, the existing enrollment has to be in platform. So you have to have it in that the provider’s already enrolled with the group that’s right? With this location. And then you can submit a demographic update to add new locations, okay, remove old locations and change their name, any demographic, right? Things? Okay. Cool.
Nicole Hillis (36:46) That’s a lot. Okay. All right. What, what else? Anything… do.
Naomi Denson (36:57) you, I wanted to ask because I was actually thinking about this, in bed at like midnight last night. I’m thinking about this call for Arizona. Do you only have the village providers in Arizona or do you have no providers in Arizona?
Barret Pickering (37:10) We have other providers, what?
Naomi Denson (37:12) I think might be helpful?
Barret Pickering (37:16) There’s separate contracts though. Yeah.
Naomi Denson (37:19) Exactly. And what I think might be helpful to be able to split them out in platform, if you just need to review the reviewer providers, is there’s a feature in medallion called teams and we don’t have to restrict access necessarily to anybody for just the reviewer providers, which is what the typically the purpose is to say this person’s responsible for these providers, they don’t need to see anybody else. But if we built a team called village and just put those providers in that team, when you report out, that team would show up on a report. Okay? So in just and I can show you really, it’s just in like where you invite new providers. So in the members tab, if you created a new team and just said village, okay, you could say, I want all of the providers that are linked to the village group to be in this team. So that when you build this and you can add team managers or team viewers if you want to restrict access anywhere. But if you wanted to build that, when you pull reports out of anywhere here… it’s not going to show here because you don’t have teams set up. Okay? There would be a column that would show here that says team. So you would be able to easily filter out and say these are my village providers that’s.
Nicole Hillis (38:38) pretty cool. And.
Naomi Denson (38:40) If you go to the support center to help, which they.
Nicole Hillis (38:45) All are in there right now. It’s all. Yeah, village.
Naomi Denson (38:47) Yes. So the… admin, faqs, teams management, this is just some information about the teams and creating them. It was just something I was thinking about last night because of the village providers. And then I was like, do they have Arizona providers from?
Nicole Hillis (39:03) Yeah, just.
Naomi Denson (39:04) For your side, too, do we need to separate them? How are we identifying? Who’s what? Once we start getting everyone in here rolling?
Nicole Hillis (39:13) Okay. And so,
Naomi Denson (39:14) even if it’s just the village team that you create, so you can just know who those providers are, even though you can look at them under the group profile and say, hey, these are all of our providers here. But I think it might be just.
Nicole Hillis (39:25) As other, yeah. Okay.
Naomi Denson (39:26) This is a secondary in case somebody maybe is linked to the group. And I don’t know. I was just thinking last night, I was like, how are we telling the difference between these providers without going into the group and going provider by provider? And, okay. So, okay, we do want to make sure that all the providers for village as they’re added going forward are linked to the group ahead of time, right? Like when they’re added to the platform you’re adding. So you go to the group profile, add provider, select the practice location, and then add the providers to that group or do it through their profile. But that way they fall under that team if you set them up that way. Okay?
Nicole Hillis (40:04) Okay. That’s good to know. Do, do you guys a different question? Do you guys know the payers that do back date?
Naomi Denson (40:17) Our team does our team, should I don’t write off? But our team should like for Arizona or any state?
Nicole Hillis (40:24) Yeah. Like any state, like, yeah, you know, enrollments might take 90 to 120 days, but you can’t submit an enrollment more than 60 days before the start date only.
Naomi Denson (40:37) For medicare is.
Nicole Hillis (40:38) It only for medicare.
Naomi Denson (40:39) I think it’s only for medicare because some payers I know will give the effective date that they approve it. Some will give the effective date of the submission. Some, you can request the effective date backdated a certain amount of time, and then some payers after approval, it’s all nuanced by payer and state. Okay?
Nicole Hillis (40:58) And is that like… is that something that like we would know like that? There’s you know, notes of like what payers like, what their specific, I guess processes.
Naomi Denson (41:14) Are, I mean, typically, that would be something that you guys typically, our customers will come in and say, I know we can get this. There is a new step that they built in to the request process that you’ve probably seen is selecting the hold on provider? Yeah.
Naomi Denson (41:38) We’re just going to make something, okay?
Naomi Denson (41:46) Really? Come on… you’re going to select the practice location and then it’s going to ask for application detail, desired effective date. So we can say application submitted date. We can request just the provider start date or other. But there is a note that final enrollment decision is effective or controlled by the payer. Okay? But there are payers, I know that you can get an effective date and then you can request a back date with a claim like especially like where emergency services are considered or if there was a claim, you need a back date as long as you submit the claim with it. Okay? But we can always, you can always default to the provider start date as the earliest date, and we would request that. And then if we get it, we get it. Okay. That kind of thing, okay? Or application submission date if the provider hasn’t started yet or we can use a future date or another date. Okay? All right. Sounds good. Does it? It does?
Nicole Hillis (42:51) It sounds great.
Naomi Denson (42:53) Okay. All right. Anything else guys? I know we went over. No, sorry. No, thank you. That’s it. It’s okay. I like talking to you guys. So it’s fine. It’s.
Nicole Hillis (43:03) a nice Monday morning. Welcome. Great to start off the week. It’s going to be a great week. You guys. I just know it.
Naomi Denson (43:11) Good morning, Barrett. Yes, good morning. Today’s. Going to be a great day. And do you know why?
Barret Pickering (43:15) I’ll be in Pensacola in a month, I’m.
Naomi Denson (43:18) not going to see you really. Oh, that’s.
Nicole Hillis (43:20) fun. Well.
Barret Pickering (43:21) Yeah. So we’re going over to gulf shores, but my friends are flying into Pensacola for a bachelor party. So I’m scooping them on the way over to gulf shores steer.
Naomi Denson (43:30) Clear Naomi.
Nicole Hillis (43:31) Steer.
Naomi Denson (43:31) clear. I’m going to hide in my house. No, I’m kidding. No. So, you’re going over to Pensacola beach? Yes?
Barret Pickering (43:38) We’re actually going to stay in gulf shores, but they’re flying into Pensacola airport. Oh, okay.
Naomi Denson (43:43) Yeah. Well, fun. I was in gulf shores a couple weeks ago because I had a friend down here too. Go to the hangout or, yeah, the hangout is fun. I’ve grown.
Barret Pickering (43:53) Up going so well, familiar with the hangout floribama, all the places.
Naomi Denson (43:58) All the places, all… right. Well, have fun. Are you going to be out there? When is that? Oh, yeah. When are you going? That’s.
Barret Pickering (44:08) in may? I’ll be working.
Naomi Denson (44:11) Okay. All right, guys. Well, have a great week. Have a great one. I will talk to you soon. Okay? See you. Thanks bye.