Transcript
Vanessa Persha (00:00) hey, girl. Hi, good morning. How are you? Good morning.
Shannon Costine (00:05) I just sent you a message about walking Tamara through the process. You had given me some instructions for her on this. I don’t think it’ll be much. It’ll just be like maybe showing her, okay? Let.
Vanessa Persha (00:19) Me go. I’m going to go in and look too because unless they took the other option away, I, you know, let me go. I.
Shannon Costine (00:30) Have other issues to go through with them that I feel so bad for them. They’re going through a few things. So I’ll go through that first. And then we’ll circle back to that.
Vanessa Persha (00:42) One. Okay. And they were trying to do a demographic update, right? Yeah. Okay. And.
Shannon Costine (00:48) I gave her the instructions from you. And then that’s when she came back. Like what I replied with was what you had given me with the other. Yeah. And then that’s what she came back with. And I haven’t to be honest with you. This whole forefront thing is taking my time. I.
Vanessa Persha (01:04) Had the day off yesterday. And when I tell you like, I spent the entire day thinking about this and like I had an aha moment in the shower when I was like hold on because I was reading your slack messages with Amy yesterday, and I was like when you said, I didn’t know they wanted the group name, like not listed on the application and I was like, wait, like I didn’t know that either. When I put the note about adding the dba names, it was that with the intention that the group name would still be on the app, but we would also put the dba name in the dba field. So, if their issue is that we should have put the practice dba name as the group name. I didn’t know that, right?
Shannon Costine (01:51) No, there was nothing to say that. Yeah, I’m going to invite them in. Okay?
Shannon Costine (02:03) I thought I admitted both. Oh yeah, I did. Hey guys. Good morning. Hey, good morning… Tamara. Every time you send me an email, I’m like God, poor thing. I feel so bad for you… so much going on so many issues, I hope we can resolve it. Let me, let Amanda in.
Shannon Costine (02:38) Hey, Amanda. Good morning.
Amanda Streeter (02:42) Hey, good morning, I.
Shannon Costine (02:44) Was just telling Tamara that I just feel so bad because I feel like she’s just having so many issues and I hope that we can work past those. Okay? So let’s go through those a couple of things to update you. Amanda you were asking about the line item where they should have completed that. And they didn’t so this is update from PE, ops they said the agent initially submitted the task because the line request only included medicaid lines of business. Although the provider’s enrolled, the payer does not enroll for medicaid. The task should have been a notification to complete it and close it. So it sounds like from what they’re saying that it was a misunderstanding. She said it’s been confirmed that the provider is enrolled and linked to the group. They’ve asked them to please close it out. My understanding is as of this morning, it’s been closed out.
Amanda Streeter (03:38) Okay. I’m not sure that I quite follow that, but that’s okay. I don’t know that I need to totally follow all of that and.
Shannon Costine (03:45) I can put this in an email to you too, if that helps.
Vanessa Persha (03:48) Okay.
Amanda Streeter (03:49) I’ll just reiterate that employee’s name is coming up again and I think at this point, we would prefer to not have.
Shannon Costine (03:59) mamprey.
Amanda Streeter (04:00) Yes, on our.
Shannon Costine (04:01) Files. Okay. Let me make a note too. I saw… that I believe it was in that one and one other one and that was my initial thought. We’ve got to remove him from this. Okay. The next issue that I have is… the ascension. I know, I’m saying that wrong. I’m sorry issue with John Perez and they replied back and said that the… practitioner, the arf was resubmitted and they corrected it, did not get any reasoning as far as why it happened or how it happened. They did change it from PCP to specialist and they’ve corrected it. I did tell them we’ve got to pay more attention to the specialty. You know, PCP to specialist is a big difference especially when you’re seeing patients listing in the directory. So I had that conversation with them Wednesday… but they did correct it and they did resubmit it. Have you had any, or seen anything since then, Tamara? Yeah. I mean, the thing?
TamraOhnesorge (05:16) Is we don’t just go through notes, sure. And we just don’t have that bandwidth. So my concern is we’re fixing these as we find them. But the big concern is, what about the ones we haven’t seen yet? That we don’t find in terms of claims issued?
Shannon Costine (05:35) Yeah, I’m wondering if Vanessa, do you think about suggesting an audit… what’s your thoughts? Oh, yeah.
Vanessa Persha (05:45) We can certainly do that. We would just have to define the scope of the audit in our request like exactly what if it’s a particular provider request group request within a specific timeline, but we can work through the details there and request that.
Shannon Costine (06:00) I mean, I agree with Tamara that if we’re having these issues, you know, like what else is out there?
Vanessa Persha (06:08) Agreed. Yep, we can certainly do that.
Shannon Costine (06:15) Anything that we can do to lift your burden, Tamara, there’s so much out there. Yeah.
Amanda Streeter (06:21) My comment to Peter over the last couple of meetings has just been the need to get a sense of comfort like a comfort level like, you know, none of us want to, none of us want to have to do any double checking. Certainly, Tamara doesn’t but we all feel very unsettled because of what we’re finding randomly. So.
Shannon Costine (06:45) Understood. And you shouldn’t have to feel that way. I feel that pain for you because I see it. So I have no excuse for them, just that we need to fix it.
Amanda Streeter (06:56) Yeah, an audit would be much appreciated.
Shannon Costine (06:58) Yeah, absolutely. And they’ll give us once we set the scope like Vanessa’s saying, and then we send that out, we should get a report back to be able to give you guys.
Vanessa Persha (07:09) Okay.
Shannon Costine (07:10) On the Molina issue, they were told that you all were not in network. I just don’t know if they got the wrong person, but they obviously are now aware that you are in network and that should not happen again. And we do have a copy of the contract as well.
Amanda Streeter (07:30) So that are all of those requests now back? Like open or active again? Because I was getting all the emails with all of them getting closed out. Whatever morning that was, has someone gone back and made all those requests active? Again? My?
Shannon Costine (07:45) Understanding is, yes. But let me double check to confirm that they fit those back to active. Okay?
Vanessa Persha (07:51) And Shannon, for what it’s worth maybe adding a note to the project plan that says, you know, they are in network and if you reach a member of provider services that says they’re not, we need to push back because there is definitely an agreement in place.
Shannon Costine (08:07) Okay. I’ve had.
Vanessa Persha (08:09) To do that for a few other customers and I’m just like take what the payer says with a grain of salt, right? It really depends who you get. And my golden rule is call three times and you take the best out of two answers. Yeah.
Amanda Streeter (08:22) I agree. So.
Shannon Costine (08:24) True. And you were on that side of the fence Vanessa?
Vanessa Persha (08:27) I was, yes. Yeah, yeah, it’s terrible. The payers use three, four different databases, you know, in provider services and they don’t always sync and it’s like it depends what department you call, what they say.
Shannon Costine (08:44) Or who you get that day.
Vanessa Persha (08:47) Exactly.
Shannon Costine (08:48) Next issue that I have is the provider being marked as clean even though she was not. Unfortunately, I don’t have an answer on that yet because our credentialing department is digging into that. I think it’s a bigger issue than I… should have an answer today. I’ll just say that because that should not be sliding. So, thank you for catching that. Again. You shouldn’t have to. Oh, let me, let Lindsay in. Hold on, sorry, guys.
Shannon Costine (09:25) And I’ve been.
TamraOhnesorge (09:26) talking with that provider, trying to get the details because the information that was in the file, it’s cut off. It doesn’t give me the incident in its entirety. So, I don’t know what actually happened in the incident. So, I’ve reached out to the provider to verify that information. And she called her employer. She never treated that patient. So she’s not sure how that I got attached to her because.
Shannon Costine (09:52) The patient.
TamraOhnesorge (09:53) Only had speech therapy with their group. And so I’m doing a little bit deeper, digging into that to get to the root cause I don’t know if the insurance attached, the wrong provider pulled the wrong report or what. But when I have more information, I’ll get back to you on that.
Shannon Costine (10:11) Okay, perfect. And I’ll do the same as soon as I have a response from our credentialing department on that. Okay? Lindsay sent me the spreadsheet on the adopted lines. So they are working through those to release them. But for any reason, you see any issues with that? Just let me know. But over the coming days, you should be seeing those getting released.
Vanessa Persha (10:33) The last one provider, I’m so sorry.
Shannon Costine (10:37) Lindsay, I’m sorry, what was that? Oh, I said, do you want me to send you an updated copy?
Vanessa Persha (10:42) On Fridays, just as we’re making progress.
Shannon Costine (10:45) Yes, if you could, that would be great. And I’m not sure why the live file is not working, but at this point, let’s just do that. Let’s just do it that way. Lindsay. Sounds good. Perfect.
Vanessa Persha (10:58) And I was going to say, yeah, for that one provider with the malpractice case, it’s been a long time since I’ve dealt with npdb stuff, but can the provider do a self query in npdb? And then they would be able to get all the details of the claim so that you have a little bit more information, Tamara… Vanessa?
Shannon Costine (11:20) I apologize for my ignorance here, but if we’re running it for them shouldn’t, they get the full file like the full report.
Vanessa Persha (11:28) They don’t have an npdb account set up yet?
Shannon Costine (11:32) Oh, okay.
Vanessa Persha (11:34) That’s.
Shannon Costine (11:34) right.
Vanessa Persha (11:34) That’s why we’re just collecting claims history, and we don’t you know, we know the carriers don’t always send the full scope of what actually happened.
Shannon Costine (11:45) Got it. Okay.
Vanessa Persha (11:47) Yeah. If the case was closed, it should definitely be an mpdb. If it’s still open, it won’t be in there.
TamraOhnesorge (11:54) Yeah, it’s closed. Yeah.
Shannon Costine (11:56) Okay. The last issue that I have is Vanessa, the one that you were going to help me walk through for Tamara for the specialty?
Vanessa Persha (12:06) Okay. Yeah. So I have the template or the request pulled up in medallion and Tamara, this is for the specialty change that you wanted to try to submit. Can you give me that provider’s name? So I can try to do it on my end?
TamraOhnesorge (12:24) I have several that changed. So I’m not sure which one I sent you it?
Vanessa Persha (12:29) Didn’t have a specific provider’s name. It just said you were give me one second, a provider that changed from an rbt to a bcba. Okay?
TamraOhnesorge (12:45) Is it, Christy? Gonzales?
Vanessa Persha (12:52) Is that Christy? With a?
TamraOhnesorge (12:53) K, it is and Z, for the end…
Vanessa Persha (13:05) Instance of medallion open here?
Shannon Costine (13:17) Wow. Vanessa’s doing that just to circle back. I will get you the next week once we get the audit complete, I’ll get you the information on that. We can go over the results, and then on the credentialing, I will owe you a response on that. Lindsay. Are you going to send one today? An updated one today? Or are you saying next Friday?
Vanessa Persha (13:42) I can send one today. Okay.
Shannon Costine (13:45) I wasn’t sure if you had anything updated since you sent it, so I’ll let the team know that you, we have another one coming?
Vanessa Persha (13:53) Okay. Sounds good. All right. So, Christy Gonzalez is already listed as a bcba in the platform. So, and she has a bunch of existing enrollments here.
Vanessa Persha (14:05) So, do you want me to try to walk through it? Like changing her carillon enrollment? Like submitting a demographic update?
Vanessa Persha (14:16) So, I do see the other checkbox listed on my side. Let me just share my screen really quickly.
Vanessa Persha (14:31) So here I did a new demographic update for provider, Christy Gonzalez for her carillon enrollment. And if you scroll down to the bottom, I have this other checkbox here. And then this is where you would put please update provider specialty from whatever she was before to bcba.
TamraOhnesorge (14:54) Okay. So I have a lot of payers that need to go out. And when I try to do a bulk demographic update, that’s not an option,
Shannon Costine (15:08) Which is the way that she should be able to.
Vanessa Persha (15:16) Oh, yeah. Very strange. Shannon, let’s get this submitted as product feedback. I don’t know why they would allow it for a single demographic update and not a bulk, what?
Shannon Costine (15:35) Do you think she should do in the meantime? So we can get this done, can we just select provider name and then put additional detail? Yeah.
Vanessa Persha (15:43) No, that will just throw them off completely. It’s going to have to be submitted individually… single demographic update. Let me just try something and see. Okay. No, it does change it every time I move.
Vanessa Persha (16:10) How many providers do you have like this Tamara?
TamraOhnesorge (16:14) It’s feast or famine? I mean, right now, I have probably three or four that just changed. And then I may go several weeks where I have again two or three change.
Vanessa Persha (16:28) Okay. Let me see. I will check immediately after this call to see if I have a template that we can fill out to do like a bulk import. There are some templates Shannon, that we can import without TSM. So let me, yeah, let me see if this is one that we can do. And then we can export their data out of the platform and just copy and paste it into the spreadsheet Tamara, and then send it to you for a review. So, if you have all the provider names and can confirm that you want it for every existing enrollment, then I can pull that data out of the platform and populate it. But I do need to check to see first if we have a template for that. Okay? In the meantime, if there’s any that you cannot wait on that need to go out right away, you’ll just have to do them one by one for now.
Shannon Costine (17:25) Thanks for doing that, Vanessa. Yeah.
Vanessa Persha (17:27) No problem. I’m going to while you guys continue. And even after this call, I’m going to look into our templates. Okay? The.
Shannon Costine (17:35) Last issue that I had is the dependencies. So we are still seeing the dependencies not they’re holding on those. So I’ve brought it up again to the team. I think that’s something that I’m going to ask the qaqc team to take a look at as well when we’re doing the audit to make sure that those are being released so we can’t we’ve told them multiple times. So this has got to, we’ve got to see some change on.
Vanessa Persha (18:04) That Shannon, are those being held up at intake or are they being held up once they reach peops?
Shannon Costine (18:09) Once they reach peops, okay?
Vanessa Persha (18:12) Let’s take a look and see if we can identify a specific agent that continues to task for these. I’m curious if it’s the same one that we’re having issues with on the other submissions and we can flag that to Peter and Nicole and see if there’s something we can do to like. There’s got to be some accountability here. Yeah.
Shannon Costine (18:31) And Alex is the one who actually called it. Okay? And I can confirm with him if there’s somebody specific, but that’s a.
17724534418 (18:39) Good call out guys.
Shannon Costine (18:41) Was there any other issues or concerns that you wanted to go over? I?
Amanda Streeter (18:46) Don’t think, we don’t have to this week, but I don’t think we’ve solved for our rbt question that we talked about with a provider type that has very little education requirements associated, but ends up having very extensive system requirements. Yeah.
Shannon Costine (19:05) So, what we did was we put it into tech support and we’re having them update that so that you don’t have to have any.
17724534418 (19:14) You know, you don’t have to submit any of that information. So I can follow up on that again and just see where we’re at.
Shannon Costine (19:19) They’re out on that ticket and let them.
17724534418 (19:21) Know that we need to get this done sooner than later.
Shannon Costine (19:24) Okay. Yeah.
Amanda Streeter (19:25) Because we’re doing we, that’s the royal, we, Tamara is doing enrollments herself that we would rather have you guys do because it’s useless with the number of requirements. So, I’m.
Shannon Costine (19:39) wondering if it’s something I’ll ask intake to see if it’s something that they can look past until we fix that, but I’m not.
17724534418 (19:46) Sure. So I’ll check into that again. Okay?
Shannon Costine (19:51) Tamara, was there any other issues concerns? You have? No… I.
Colleen Simpson (19:57) do still have one, that same issue with unitedhealthcare where they’re telling me that they need to close the line. If there’s an optum request open that. I just had three tasks this morning for the same issue. So, not sure how to get that addressed.
Shannon Costine (20:12) I will address it. Okay? Thank you.
Amanda Streeter (20:16) Do you need us to send you the patient, the example? Like the names? Do you have those? Yeah?
Shannon Costine (20:21) Yeah, if you have, if you have it, yeah.
Colleen Simpson (20:23) I can.
Shannon Costine (20:23) Do that. That would be, that would be helpful. All I can say is I’m sorry, and I will push it and we will work, continue to work past this.
Colleen Simpson (20:34) Okay. Yep. I will get those names too.
17724534418 (20:36) Thank you. Appreciate it. All right?
Shannon Costine (20:40) Guys. Well, if you don’t have anything else, I hope you guys have a great Friday and a great weekend and I will send you an update.
17724534418 (20:46) Prior to our meeting.
Amanda Streeter (20:47) Great. Thank you.
Shannon Costine (20:48) All right. Thanks everyone.
Vanessa Persha (20:49) Bye, bye bye.