Transcript
ShirleyHooker (00:00) good morning. Hey, there, Naomi. How are you? Good. How are you? I’m good. Just one second, please, of course. Thank you.
ShirleyHooker (00:28) Okay. I’m not sure who else on our end is joining? Okay. That’s fine. Yeah, it’s just me and Kippy here. So far. Okay. Niccole had sent over there. She is, hey, Niccole. Hey, Niccole. I was just taking a look here at the payr processes, scoping and your questions that were on here and get those back to you.
ShirleyHooker (01:04) I do, I mean, I can go over a couple of them or let me see what I had already started.
Niccole Russell (01:19) Santa’s health. We added that one. We just added it as santa’s health corporation.
ShirleyHooker (01:27) Okay. Sinus health corporation.
ShirleyHooker (01:36) Okay.
Niccole Russell (01:40) Would you agree with that?
ShirleyHooker (01:41) One? Yeah, yeah, I believe. So, yes, yes, I’ll say yes on that one. Do you want me to mark that as true now then?
Niccole Russell (01:49) Okay, perfect.
ShirleyHooker (01:51) I will.
ShirleyHooker (02:07) Okay. I got that one marked.
ShirleyHooker (02:16) Okay. I started on a, okay, if we can go back, I was going through like your, yours that you have here. You researched Morgan white. Okay. So, for Morgan white, I had sent over the sheet on that one. Yes, Morgan white. On our end, it’s a national plan. We do receive payments. It is a ppo product line. We even have reimbursement rates and I’ve sent over the information on that one previously, too. And the contact is that lilius, genghis what do I have in here? Yeah. So lilius genghis is the contact information that I have there? Okay?
Niccole Russell (03:14) I’ll see if the team needs to reach out. They just sent some additional questions over this morning. They do have the workflows as well.
ShirleyHooker (03:22) Okay. They.
Niccole Russell (03:24) just had some additional information. They just wanted to make sure.
ShirleyHooker (03:29) So,
Niccole Russell (03:30) I’ll tell them if they need additional information, they can reach out to that contact if you’re good.
ShirleyHooker (03:35) With that, okay. And then the next one, let’s go to evolent. Again, it seems like we just keep going back from the evolent one. So for evolent, it asked if there was a question about us having access to a portal for evolent? Yes… there isn’t a portal available for evolent?
Niccole Russell (04:07) Okay. I’m not sure if during her research, I took it as, during her research, she saw that they had a portal and so she does have the workflow there as well. So I can let her know there is no portal.
ShirleyHooker (04:22) Okay. Yeah. And I did have the team send me over the last evolent form that they had submitted for a provider and is the form that I had downloaded and put in the processing and everything. So, I was just going to send that over as to show as an example of, you know, what is what’s used, you know?
Niccole Russell (04:54) Yeah, that would be great.
ShirleyHooker (04:57) Okay. So it’s like the linking letter and it’s the plw provider load form which you guys should have that too. I.
Niccole Russell (05:08) Did not see a form but I did see a roster?
ShirleyHooker (05:13) Yes, it looks like a roster. I apologize. Yes, that’s correct. Yeah. So, I can like open it and it opens in excel.
Niccole Russell (05:23) Yes, ma’am, yeah, I have the roster, but if you have an example, I think that may be helpful for them for that, for our pay your enrollment team?
ShirleyHooker (05:33) Yes, I do. I had them send me over the last, like I said, the last one that we had sent over and I have that. And so I’ll send that over as an example. Great. Yeah.
Niccole Russell (05:46) I’m hoping to get this rectified soon. I know it’s yeah, my apologies. I.
ShirleyHooker (05:50) Know. I know. Okay. And the other one, let’s see here. Would you be able to access to your evolent portal? We don’t have a portal. Yeah, we may find something there but nothing is available. Yeah. Does evolent make any payments to the group or the provider? No. Yeah, I would assume that they would receive payments. The group receives the payments… you know, I believe… so I.
Niccole Russell (06:23) think we’ve already addressed that.
ShirleyHooker (06:25) Okay.
Lia Hood (06:27) With all of these, like with most of these, we’ve already addressed especially with evalent that we do receive payment directly from them. Yes, I have that in an email from our contracting team that I sent over quite a while back, yes.
Niccole Russell (06:44) Yes. Okay. Well, they will continue to research that one.
Lia Hood (06:53) So, why? So, can I ask why we’re still researching? Evalent? I thought we had already made the agreement that we were moving forward with it and that you have the processes to load it.
Niccole Russell (07:05) We have your process, but from what the team is seeing, it is not a payer that can be enrolled across many.
Lia Hood (07:17) Entities, right? But I so, is that I’ll have to go back to my notes from my calls, but I thought we had already settled evalent that we were moving forward with it.
Niccole Russell (07:33) We have not settled evalent a couple of weeks ago. Mike was going to escalate that because we had not settled on it. And so it’s escalated now in house for us to try to rectify all of these but… evalent as of today… the way that it stands, they’re just saying that it’s client specific. And if it’s client specific, and not all entities can enroll across the board for all of our clients, we can’t load that into the system. So that’s what Mike was checking on for us. So.
Lia Hood (08:07) Has Mike not gotten a response back?
Niccole Russell (08:11) He’s escalated it within house. So we’re all kind of working together, trying to figure out the information.
Lia Hood (08:17) So, my concern is that this has been going on for like several weeks and we have providers that we need to get submitted.
Niccole Russell (08:24) Yes, ma’am… I do understand. We have our leadership involved as well.
Lia Hood (08:32) Okay. Yeah.
Niccole Russell (08:39) And then for global med management… the team reached out on the thirteenth of April to the contact that was listed here in the notes section, and they haven’t received a response back.
Niccole Russell (09:01) So, and I can share my screen so we can see what we’re I don’t know if everyone has it pulled up. My apologies. I know you do, Shirley, but here, the contact information that was provided, our team reached out here and we haven’t received a response back as of yet. So we’re pending on that one instablewell pending that one and Morgan white, I believe that was it. And then right up here for Aetna Coventry, we actually updated that to Coventry workers’ comp.
ShirleyHooker (09:39) We don’t have a workers’ comp agreement though that’s… let me get my notes on that one. I thought that one was already you.
Niccole Russell (09:53) Said Aetna. Yeah, Aetna was over here. We had Aetna better health of Florida, and that was not a match for you. You said it should be directly under Aetna. Right? The team advised that Coventry is part of Aetna Coventry workers’ comp would do the Aetna Coventry healthcare.
ShirleyHooker (10:16) Yeah, I don’t believe that that’s true on that one. Okay.
ShirleyHooker (10:27) It used to be Coventry first health, but not with workers’ comp.
Lia Hood (10:35) Yeah, I don’t think the workers’ comp portion is accurate. Yeah… let’s see.
Lia Hood (10:59) So, Shirley, I don’t know that there’s Shirley, I don’t know that there’s separate enrollment for Coventry.
ShirleyHooker (11:05) It’s not, it’s through Aetna. So.
Lia Hood (11:08) Then why would we have Aetna Coventry listed separate from Aetna? I.
ShirleyHooker (11:14) didn’t list it there, Niccole at the medallion team added this on here?
Niccole Russell (11:21) Well, this was on your payr, you had filled out two forms. So, you completed this one and then you also completed Naomi. What is it? The payr template? Yeah, that’s why this was one of the missing payrs Naomi.
Lia Hood (11:37) So, Shirley, on the other grid that you put together that’s probably where this came from is because it listed Aetna Coventry, effective dates?
Niccole Russell (11:46) Yes, yes, exactly. So this just needs to be Aetna. It goes with this.
Lia Hood (11:51) Correct. That is correct.
Niccole Russell (11:54) So… okay. Am I going to delete this line or should I just put Aetna here? And then we’ll put that, it’s a line of business type for Aetna.
Lia Hood (12:10) Yeah, I would just say leave it and we can put that, it’s a line and just make the note that it’s a line of business. Okay? And that way we’re all on the same page.
Niccole Russell (12:19) Yes… let’s see.
ShirleyHooker (12:38) Yeah, I’m just not seeing it on mine that’s fine.
Niccole Russell (12:47) Okay. There, and if you will, just if you want to sign off on that one and we’ll just leave that as Aetna. That’s.
ShirleyHooker (13:01) so, just mark that one as true then?
Niccole Russell (13:03) Yes, ma’am, and then I’ll mark this as true on our side as well. Yeah.
ShirleyHooker (13:17) Yeah, because I just wasn’t seeing it on that sheet one on that tab there, you know, where did that come from? Edna? Coventry?
Niccole Russell (13:26) Yeah, we, yeah, we, this is, I think what you had originally completed. And then as they were doing the import for the payers, they realized there were about five payers that were not added.
ShirleyHooker (13:37) Okay. Yeah.
Niccole Russell (13:39) So, that’s where that came from prominence. Health. Let’s see that one was added. This is another one santa’s health. Did we get? Oh, we got you to sign up on that one? Okay? Yeah. So, these are the only ones that we are pending. Now, let me take this out trying to get rid of the colors as we go. So, anything highlighted in yellow. So it looks like we’re missing evolent… globalmed, instavol, and Morgan white.
Lia Hood (14:28) Shirley didn’t we get some feedback from the contracting team on a few of these… and you and I just need to walk back through them.
Niccole Russell (14:45) I.
Lia Hood (14:45) was out last week training new staff. So Shirley and I didn’t have any time last week together. I think there may be a few that we have that we got some feedback from our contracting team that she and I just need to review. And I think those are a couple of them.
Niccole Russell (15:01) Okay. Perfect.
Naomi Denson (15:09) Okay. Thank you, Niccole. Any, just as we are wrapping up the pair mapping here, we’ll continue to load group enrollments for those that are on the template that have been mapped but not imported yet. Shirley, any progress on the existing provider enrollment template?
ShirleyHooker (15:30) For the existing ones, yeah, I just need to get that. I pulled everything and cleaned everything up, but I just, I want to go through it with Lia and get it and then I can get it sent over to you guys. The team does have a question though I had asked about terms and what the process was for terming providers out of medallion. And so they went ahead and did the deactivation for the providers for the terms? Who is responsible for notifying the payers of the provider’s terms?
Naomi Denson (16:13) Medallion does not currently handle terminations with payers, correct? Niccole, that hasn’t changed.
Niccole Russell (16:20) If you put a request in, I’ve heard that they do, but you will be charged for that request, alright?
Lia Hood (16:30) Shirley, so does that happen? Or do we need to put the request in?
ShirleyHooker (16:39) You’re asking me, the girls are usually notified. No?
Lia Hood (16:44) No, no. On the medallion side. So on the medallion side, it sounds like there’s uncertainty if medallion will do that.
Niccole Russell (16:53) We will do it. You just have to put a request in. So there will be a charge for it.
Naomi Denson (16:58) You have to leave the provider active until the… terminations and requests are complete. Historically, we weren’t handling terminations, so.
Niccole Russell (17:10) Yeah, historically, we were not. I was advised by payr enrollment that they do, as long as you put a request in, a lot of clients don’t do it because they don’t want to be charged.
Naomi Denson (17:22) Yeah. And they don’t want to keep the provider active in the platform.
Niccole Russell (17:26) Yeah, they would have to be active in the platform. Okay?
Lia Hood (17:30) Shirley, let’s circle back to this. We’ll probably have the girls do the terms.
ShirleyHooker (17:35) Okay. Got it.
Naomi Denson (17:40) And then, Shirley, we had met last week and talked through, you know, you had some net new providers that you were adding in.
Naomi Denson (17:47) I see that you’ve been working on completing their profiles. Do you have an eta on when you want to send out the invites to those that group. They?
Lia Hood (17:55) Have to be done as soon as possible. So, I didn’t realize they were not done yet. I, Shirley, I need those to get out like today tomorrow to get that work going.
ShirleyHooker (18:06) Okay. So go ahead and get those, the invites sent out. Then I’m ready to add the enrollments and do the request for the enrollments on them. But go ahead and do.
Naomi Denson (18:16) The invite, right? Are you going to send me invites or do you want to send me a list of their names?
ShirleyHooker (18:20) I’m sorry, I didn’t hear you. I apologize. Go ahead.
Naomi Denson (18:22) Do you want, are you going to send the invites to those handful of providers or do you want to send me their names and, I can trigger them it.
ShirleyHooker (18:30) Whatever you guys, whatever the process is going forward? I thought that I was sending it, doing it and sending it.
Naomi Denson (18:38) Out. Yes, you would be, I just wanted to make sure.
ShirleyHooker (18:41) Okay. That’s what I have it is that we would be sending the invites on it. Yes. So, yeah, I can get those. I can get those out, right? You know, like ASAP right now. Okay. There’s just, there was a, you know, a bit of the lag between the caqh import pool. So, when the girls were, you know, adding the providers and doing the caqh and then doing the import data, it, you know, some of them, they couldn’t do anything else until the next day, reviewing all of the information, adding all of the missing information that didn’t come over from caqh, or just making sure that the providers were clean. So that’s pretty much where we ended at. But… yes, they could, we can definitely get the invites over for them now. So I just wanted to make sure that I understood like the process part two, just, okay. The invite part of it and getting their enrollment. So I have them, we’re ready to submit for the enrollments request for them. So, okay, got it. I got, I’m good. I got it.
ShirleyHooker (20:03) Send them the invite and then go ahead and get the enrollments enrollment request.
Naomi Denson (20:13) Okay. And did we determine?
Naomi Denson (20:20) Exactly how many per provider we should be expecting? How many payers that we currently have mapped? Well?
ShirleyHooker (20:27) We do have some providers that new providers that only get enrolled with medicare and medicaid. Okay? So I want to make sure that I review those with Lia as well too. I mean, I’m going to say, yes, you know, making sure that those are added in there and then add the payor enrollment, but select oneoncology instead of medallion on there. I can have you, the providers are kind of in different areas in different sections. But let me pull up the list that the girls gave me. So.
Lia Hood (21:09) In short, Naomi, what she’s saying is that it will vary provider by provider with the number of enrollments that’ll need to be done.
Naomi Denson (21:16) And it’s still 10 providers, correct?
ShirleyHooker (21:19) Yes. Okay.
Naomi Denson (21:22) All right. Just wanted to give the team a ballpark for this initial push but I’ll just let them know that it’s 10 net new providers and to expect what at least 10 requests per provider at a minimum.
ShirleyHooker (21:38) It should, yeah, it should be, I have an empty and a mid level, see how many they sent over.
Lia Hood (21:49) I mean that’s probably safe?
ShirleyHooker (21:51) Yes, I would say, I would say yes, at least minimum 10.
Lia Hood (21:59) And surely, what we’re going to have to document is if any of those providers need to go to evolent or any of those other payers that medallion is not doing, we’re going to have to go ahead and make those submissions because we can’t wait and, we’ll just assign those payers to us in medallion’s system. So, and make our notes in their system. Although evolent’s not even loaded to make notes that’s my problem too. Is that like I don’t like we need a place to track this work in medallion’s system for the payers and document the payer list that’s my other challenge with this… payer process. Like I am now having to manage two different databases, right? I can’t even get a payer. I can’t even get a payer listed as a non par payer that you’re not going to do the work. But like I, so… surely, when we meet, we can’t like… this is the, really challenging part that medallion was supposed to fix was to have one place to do all of this. And now I’ve got two,
ShirleyHooker (23:20) Sorry, Lia, we are working to get those updated hopefully.
Lia Hood (23:24) I know I just, but I, but at this point, I can’t wait. So now I’ve got to have another place to document it. So surely we’re going to have to, we’re going to have to create our, that credentialing tuck and onboarding sheet.
ShirleyHooker (23:38) Okay. I can do that. They’re.
Lia Hood (23:40) going to have to manage. They’re going to have to manage it in two places. Yeah, because I don’t want it in the legacy system, correct? Because we should be moving out of the legacy system.
ShirleyHooker (23:51) Yes, correct.
Lia Hood (23:53) So, let’s, when we meet, let’s get that built out.
ShirleyHooker (24:00) Okay. Sounds good.
Lia Hood (24:01) And what we’ll list on there are all the payers that medallion’s not going to do. Huh, which also means that when we run reports, we’re going to have to remember that we’re going to have to edit whatever report we pull out of medallion to add these payers in there. Okay. I apologize, but I do need to drop. I have someone I’ve got williams reaching out to me, to, with something that’s going on. So, surely I will let you guys finish this call up. And if there’s anything else that you guys need from me, let me know. And surely we’ll touch, we can touch base a little bit later.
ShirleyHooker (24:42) Sounds good. All.
Lia Hood (24:43) Right. Thanks, everyone. Thank.
Naomi Denson (24:44) you. All right. So, okay. So you’ll get those 10 providers invited, submit the enrollment requests for those providers for the payers that we do have. Mapped. I did just get one small update on the caqh import escalation issues around the professional references, not coming over. Okay? I just want to make sure you can still hear me. So the professional references in… caqh actually don’t import at all because caqh does not provide an API to pull that information at this time. So, caqh doesn’t allow it with their API?
ShirleyHooker (25:29) Okay. Yeah.
Naomi Denson (25:31) They said, unfortunately, caqh doesn’t have that available in their API. So there’s no way for us to import it. Oh, okay. Professional references. But everything else that you called out in that document has been escalated with our engineering team as a high priority to look into… for resolutions and… okay, through these future issues.
Naomi Denson (26:03) And that was all I had currently just wanted to check in on those provider invites for the net new providers, and then review, the open payers with Niccole, and check in on the existing provider enrollment data which you are going to review with Lia before sending that over.
ShirleyHooker (26:22) One other last question that I just saw on my end too, what about when providers need to be added to another location? The demographic update, adding providers to, you know, to another location, working out of another location? Is that something… we?
Naomi Denson (26:50) Do that? Yeah. We had walked through that in our payer training on submitting. Either you can submit bulk demographic updates for all of their existing payers for that group. Okay? Or one by one, you can submit single demographic updates to add new locations.
ShirleyHooker (27:05) Okay. All right. Got it. Thank you. No.
Naomi Denson (27:11) Problem. Anything else?
ShirleyHooker (27:13) No, I’m good. Thank you. Appreciate it.
Naomi Denson (27:15) Thank you so much.
ShirleyHooker (27:17) Thanks. Thank you. Bye.