Transcript
Amy Barfield (00:03) I’m.
Carrie Reding (00:03) laughing, they just let us in. So we’re on the call. I’ve been gone all week. So, I’m trying to play, get up. Oh, I’m sure you are, I’m sure you are did.
Amy Barfield (00:18) You have a good time?
Carrie Reding (00:20) Oh, my goodness. I had a wonderful time. It was amazing. So, I ate so much food because it was free. Like when I tell you, I ate a lot of food, it was like two desserts a night. They’re like eat whatever you want. Okay? I know my daughter, her.
Amy Barfield (00:39) Favorite thing is the ice cream on top?
Carrie Reding (00:42) Oh, yeah, yeah. We did ice cream about every day. I had chocolate blueberry, I had strawberry. They had, I mean, all the flavors you can think of. It was delicious. You just walk up there and ask them for, they used to let you do your own, but now they have somebody like actually doing it for you. So, oh, really? But the shows were amazing. The shows were really good that, they did a, which cruise?
Amy Barfield (01:13) Line did you it?
Carrie Reding (01:15) Was the disney magic? Oh yeah. Does carnival do that? I don’t just their own, know. They do like comedy shows because my daughter, I was asking her because I haven’t been on another cruise. This is my first time, but I was asking like what the difference was and she’s like, well, they have like comedians and stuff like that you can go to, you know, but this is very, there’s some stuff for adults and there’s some stuff for kids. You know what I mean? So, yeah, I thought about doing, do you have kids, Amy? I.
Amy Barfield (01:53) have a 12 year old daughter. Oh.
Carrie Reding (01:55) She would love it. And then I have a three year old nephew that I claim is my son. Yeah, yeah, they would love it. And like I said, there’s so much stuff to do for the kids. We did, there… was drawing classes there’s, a whole kids club thing and they do lots of fun activities and they did like a pirate night for everybody and there was a big pirate party out on the deck and that was, we got all dressed up. It was, it was so much fun. So, yeah… my daughter’s 22 and she’ll be 23 in may and loves it.
Amy Barfield (02:32) Oh, good.
Lori Durkin (02:33) So, I wonder.
Amy Barfield (02:34) Like what’s too old for disney?
Carrie Reding (02:37) Is there, well, I don’t know that there is, I think you’re either a disney fan or you’re not my daughter. And I have gone to disney world two times we’ve been to disneyland. This is our first disney cruise. So we’re like big disney fans. So I don’t know that there’s an age limit. Yeah, right, right. And I will say this one, we did a couple of excursions. We went to the chichen Itza which is the Mayan ruins. We did that. And then we went and swam in a cenote, and you just like hiked down this big. It was like my gosh, it was like eight flights of stairs to get down in there. And it was like in this cave, it was really cool. So it was neat.
Carrie Reding (03:23) So, and the chichen Itza is one of the seven wonders of the world. So I can actually say I’ve seen one of the seven wonders of the world. Yeah, I’ve been to one. Probably won’t make it to the other ones but never.
Amy Barfield (03:35) Say, never, Keri. I.
Carrie Reding (03:37) will never say never, but it needs to be a little safer for me to go over to some, you know, other places. Yeah.
Amy Barfield (03:45) Maybe if it’s on a cruise excursion, you’ll go.
Carrie Reding (03:48) Yeah. Well, because they won’t turn you loose. If they think it’s unsafe, they’ll just keep won’t even port. If they think it’s unsafe, they’ll just keep on driving by. So, wow.
Amy Barfield (04:01) I know Svetlana’s been out. I hope she’s doing something relaxing. She’s still responding to some of my emails, so I know she’s still working despite being out.
Carrie Reding (04:12) Trying.
Amy Barfield (04:13) to keep up and address all emails. Is there anything that… I’m missing or urgent requests?
Carrie Reding (04:26) I.
Lori Durkin (04:26) have to hop in 20 minutes team. If that’s okay. I do actually, Amy on the Dawson? Yes. Did you have a chance to look at her? Like, I mean, even Svetlana was like super frustrated about this. Like there’s some kind of license issue at the group level. And the issue is that the location is missing at the group level.
Lori Durkin (04:52) So, I can like share my screen, but I’m not feeling too confident and that what… that’s even being addressed, right? You know what I mean? So I don’t even really know what’s going on but I know it up here.
Amy Barfield (05:08) Hang on for Montana medicaid.
Lori Durkin (05:13) Correct. So, is.
Carrie Reding (05:17) that the one for Janessa Dawson that just got stopped?
Lori Durkin (05:20) No, that’s complex care that got stopped. This is Theoria. So 40 claremount. Actually, let me just try to summarize this up here. Medallion… says this, the representative confirmed that there is no location of 40 claremount. Okay. We requested it here. It’s not there. So it’s still not there. 40 claremount is needed at the group level to build Dawson. I don’t know why another group app went in but now… there’s a license discrepancy… specifically. The system requires a doctor’s license for Scott Foley, whereas a different providers license was uploaded. And now we’re just following up. Like… did we send it in?
Juvy Patal (06:19) Like,
Lori Durkin (06:20) are we truly good? Yeah.
Amy Barfield (06:22) They did send it in. I thought I clicked on and, yeah, I checked the license that was attached there and it is Scott.
Lori Durkin (06:29) Foley.
Lori Durkin (06:35) And I’m assuming that it’s just like the un, you know, written rule here that they are going to go back to get a retro like right out of the gate on this, right?
Lori Durkin (06:43) Dawson. I think Dawson has hers noted here. If not, I can have JV, JV, do you have an earliest date of service by any chance?
Juvy Patal (06:57) I will double check.
Lori Durkin (06:59) Sorry?
Lori Durkin (07:05) She goes back to 20 24 that’s.
Juvy Patal (07:10) right. It… is.
Juvy Patal (07:18) Medicaid of Montana. It says here April first 20 25.
Carrie Reding (07:32) So, she should have been covered because her effective dates, 513, right? Or is that just for that one location?
Juvy Patal (07:40) Yeah, 513 for the one for the 40 clarion one, but we still need to retro to four four, 125.
Lori Durkin (07:57) For the location. And I mean, Dawson, I doubt where she’s 513 or 20 24. Okay. So, yeah, we just need this location backdated to five one and 25 and we’re like we’re nearing timely filing here real quick and I would imagine she’s not the only provider impacted by this that hasn’t come up yet. The MD would have less visits. So, anyway… all right.
Juvy Patal (08:23) Sorry, sorry, Laurie. Yeah, 24, we don’t need the retro back dates or if the earliest date of service is April first 25. So no need for retro, but we need that location at the group level. Yeah.
Lori Durkin (08:36) Back to five one don’t.
Amy Barfield (08:38) Need a retro. We just need added to this. Yeah.
Lori Durkin (08:41) We just need the location retro. I don’t know if that… just automatically goes back. We need 40 claremount at the group back to five one of 25.
Lori Durkin (09:08) Okay. Fine. Thank you. Appreciate it.
Amy Barfield (09:17) All right. Anything else? What else I should say?
Amy Barfield (09:24) You’re catching up, Carrie? I.
Carrie Reding (09:26) know. So I was like, I don’t know what I need right now? Yeah.
Amy Barfield (09:29) And a lot of things, I knew you and Svetlana were, you know, either not available or actually available. So I did.
La Toya Pough (09:36) Tag me.
Amy Barfield (09:37) Or Judy or lord. So they get responses but just wanted you to have visibility. Okay?
Amy Barfield (09:49) I think we have a portal meeting next week. Does that seem to be progressing well so far? And you’re getting movement?
Carrie Reding (10:01) Yeah, I think I have a few that need to set up Latoya?
Amy Barfield (10:08) If you, can you’re on that agenda or you can just send me a list of what is pending that way I can add it to our agenda and they can start working prior to our meeting, just in case we have questions or road walkers. We can work it on our meeting, okay?
Lori Durkin (10:26) I know I,
La Toya Pough (10:26) know that I sent Georgia to you yesterday. Yes. So, and I forward that over to Carrie. I think, she and sathana, may need access to that as well. I,
Carrie Reding (10:40) don’t have a Georgia user id. I don’t know if that needs to be set up by.
Lori Durkin (10:46) By.
Carrie Reding (10:47) urals group or do I tried to look for it today to try to set one up? But I didn’t see it but.
La Toya Pough (10:54) I will get with you because I, there are several more that I do need access to.
Lori Durkin (11:02) What do you need? I’m sorry, medicaid of Georgia. Yeah.
La Toya Pough (11:05) I have a, I have a login already. I just need it to be tied into the group of.
Lori Durkin (11:15) Complex care or all complex here. I got the Oria, I think, well, no, I don’t know Kevin has it and whatever. So, I don’t know if the Oria’s access would help you, but I’m happy to share what I got. Okay?
Amy Barfield (11:26) What’s your email, Latoya, real quick? They’re asking me what your email.
La Toya Pough (11:31) LP o UGH at theoreamedical. Com.
Lori Durkin (11:45) Sorry to hijack, but I do have something super important after this, if you don’t mind that’s.
La Toya Pough (11:50) that’s all I have.
Lori Durkin (11:53) Okay. Latoya, let me send you this, right quick. Okay?
La Toya Pough (11:57) Thanks, Lori you.
Lori Durkin (11:59) Can try it and I don’t know if you can like link complex care some kind of way or something, but you’re welcome to try it. I don’t know if they’re active. Kevin’s probably your best bet. And, I do have an authenticator I think for this for him if that’s needed. Okay. So real quick here, I’m sorry, guys. We’re… back to Jessica deal rice. So… I was working with medicare directly, hoping that they would be able to just take all of her claims as a special project and just work it. Bad… news. No. So this is the lady that medicare had her like RN license on file, but we sent in the NP or whatever she was and there was, you know, no lapse in her medicare enrollment, right? This is also the lady that medicare did like a 30,000 dollar take back on all of her claims in the interim of all that getting fixed. Right now. Where we’re at is… medicare does not care that we billed the claim timely, that… they took their money back, that her provider enrollment has no lapse, and that we could technically say it was medicare’s error. They don’t care. We have to do like a whole thing. So we have to do our original claim form, which is great a letter explaining why we’re filing it late because basically everything that happened in the past up until now, the original claim, the take back, the timely filing denial is basically a voided claim and we’re starting from the beginning. My question is I cannot find documentation that… explains that deal had no lapse. All I find is this reconsideration request that was denied?
Amy Barfield (14:20) Okay. I know the email.
Lori Durkin (14:29) Perfect. So if you could give me something because like all I got is a denial right now, it’s an unfavorable decision. I do have the medicare id report. Don’t know if I have, yeah, that shows her with two… different effective dates, right? Like we know that whatever she shows that she was termed right here.
Lori Durkin (14:58) Is her… DIEHL, but she’s now rice. So, okay, I guess what I’m getting at is if you have something that says it was like their fault and there was no lapse or whatever explains the situation because there’s nothing in medallion that I can use as… a document… says or?
Amy Barfield (15:27) She says the director of… as we have searched the issue and determined there was no gap in life there and their gap in bill… right?
Lori Durkin (15:39) I’m getting every other word from you, Amy, sir. I can’t ever hear you if you could please email that to me and I’ll use that. Okay? Wonderful. Thank you so much. There’s like a whole pile. There’s a whole bunch of money here. So thank you awesome.
Amy Barfield (16:09) Just forwarded it to you.
Lori Durkin (16:10) Wonderful.
Carrie Reding (16:26) Okay. Anything else? I don’t have anything right now? So.
Amy Barfield (16:41) Yeah. The only thing I would ask is for the… for the list of portals for next Wednesday that you’re still lacking. And then.
Amy Barfield (17:01) We had a request and I pushed back, just let me know your thoughts on this. Our medicare team is wondering if, when you make requests and I know we discussed this before, if you make requests for providers just to list, add providers to all three ptns or all two, all ptns in the group verse, and then just select a location for each of those ptns. I pushed back because, and said, no, we need to list all of them. It takes them a long time to like verify every location that it falls under that ptn. But right now, I’m finding like we’ve had a couple instances where we’ve added them to all the ptns. But then verifying locations, we find that there might be a specific location that was being requested that’s not on the group enrollment. And so then it comes back as, yeah, this location isn’t on the group enrollment, so we can’t verify that location or close that provider because of the location. We had one specifically I think for Theoria. And we can continue to add locations to Theoria. But I’m wondering if… we see that a provider linked to that location and approved with complex care. Now, we’ll be tasking out to say, do you want us to proceed with this enrollment with the group or the provider with medicare since they have open Ar, and I know with juvie, we’ve already kind of moved or rerouted some of those claims to complex care and stopped those. The other part of that is before we stop some of these medicare’s with Theoria. I’m noticing that there are few a few like commercial medicare plans that are pending on those medicare’s so we probably need to ensure that anything that’s any medicare approval for Theoria on commercial lines that need a medicare advantage line of business that those don’t have opening as well. Does that make sense?
Carrie Reding (19:22) Yeah, yeah, we… probably need to look at those on the case by case as.
Lori Durkin (19:29) Yeah, okay.
Carrie Reding (19:31) So, juvie there shouldn’t be, I mean, it should be pretty minimal, right? For Theoria, medicare, right? It.
Amy Barfield (19:41) Should, but I think you guys have some Ar, that’s still open like we had a provider that started in mid December. I can’t remember the specific name off the top of my head, but we had a provider that started mid December and she got enrolled with complex care. The problem we’re running into with Theoria is that the authorized official is still not updated with Michigan. And so, I’ve asked the team to update spetlana on the contract because right now it just has, I think Justin’s name, yeah.
Lori Durkin (20:13) Just so Michigan is linked to him personally. Let me see. I’m she was.
Amy Barfield (20:20) In communication with them, but they want a physical signature on from like, I think it’s section B or section 15 of the eight five five B. And I can’t provide a physical or Svetlana. I don’t think can get a physical signature from him, you know, unless she has one from a prior application that we can just change the date on. Oh.
Lori Durkin (20:46) God, I would imagine in good faith, we can contact, I’m happy to reach out to argavan if we need his signature. I mean.
Amy Barfield (20:53) Yeah, I would like to get one at least on file. That way. When we run into this issue, we can just fax that signature over and then we.
Lori Durkin (21:00) should have, I mean, Justin’s signature is on file and hands down, I know that, okay,
Amy Barfield (21:12) Like I would… talk through like moving forward what we’re doing with medicare Theoria and this ao issue. I know Svetlana had reached out to them because she’s listed on Ina, but, they still, like you said it’s owned somehow solely by Justin, so or argavan.
Lori Durkin (21:37) It’s Justin on his on.
Amy Barfield (21:41) His Ina, yeah.
Lori Durkin (21:43) I’m linked.
Amy Barfield (21:44) As we updated it, I thought we did it in call where we updated in the mppes section, but we also need to update the group enrollment to have Svetlana’s name on there as a managing director. That hasn’t been done yet. Okay.
Lori Durkin (22:05) But we can electronically sign for Justin. So, right, why can’t we just?
Amy Barfield (22:11) I don’t understand.
Lori Durkin (22:16) What are we trying to update again? I’m sorry, theorian?
Amy Barfield (22:19) Medicare. So, for Michigan, well.
Lori Durkin (22:23) What, what demo update needs to happen? Like what are we trying to enroll?
Amy Barfield (22:26) There were a couple providers. Whitney, is Whitney Peterson one?
Carrie Reding (22:33) Whitney Preston?
Amy Barfield (22:35) Preston, sorry. Juvie, do you remember what those providers named Tamara mills, I think was one. And we just ended up stopping them because they had approvals for complex care and we’re just rerouting claims. I,
Carrie Reding (22:55) don’t even see an Theoria enrollment for Whitney, Preston that.
Juvy Patal (23:00) One might have been, oh, it is for, Tamara mills.
Carrie Reding (23:08) Okay.
Lori Durkin (23:10) So, we… need the 855 R, signed by Justin. We’ve.
Amy Barfield (23:18) stopped it now. Svetlana said to go ahead and reroute those claims to complex care because she has an approval, but I guess the question, is like, if we have any others that we run into this issue because they won’t accept Svetlana’s signature?
Lori Durkin (23:32) Just pick Justin for now. We can sign it, send it to rcmcred, we have everything we need to digitally sign it. Okay? Yeah.
Carrie Reding (23:41) I, the issue, what you’re saying is because they weren’t enrolled with medicare Theoria. Have we checked the enrollment to make sure they don’t have advantage lines also for Theoria, that’s the problem Lori?
Lori Durkin (23:56) Because.
Carrie Reding (23:56) we’re stopping it to route to complex care, but we never enrolled with Theoria. So, do we have blue cross medicare advantage? We didn’t take that into consideration and we need to look at that now to go, okay, what do we need to do?
Lori Durkin (24:14) So, why… can’t we just, God, we’re like we’re running out of time here. Mills has been here forever. Yeah, she’s been here for a minute. Look, look, I’m getting to pico’s right now? Because I can see Michigan.
Carrie Reding (24:27) I thought Dana.
Carrie Reding (24:34) I don’t know, but if we’re not going to,
Amy Barfield (24:38) enroll.
Carrie Reding (24:39) them with Theoria, they’re going to have to be adjusted off.
Lori Durkin (24:42) Okay. Let me pull her up right now here. One second. What’s her name again?
Carrie Reding (24:45) Tamara mills. T.
Amy Barfield (24:47) A M a R a MILLS her.
Juvy Patal (24:52) Medicare. The earliest date of service is January 24 26, so.
Carrie Reding (25:03) Yeah. Do you have any medicare Ar.
Amy Barfield (25:05) Yeah.
Carrie Reding (25:05) I.
Lori Durkin (25:06) got you. Here. I’m about to show you my screen. So, I got one right here from 26, which she should be fine.
Carrie Reding (25:17) Well, blue cross isn’t going to retro anyway. So, right.
Lori Durkin (25:21) I don’t know that would be under complex care, but no, there’s no risk there’s. No, if I got to get rid of these, that’s fine, but no, there’s none.
Amy Barfield (25:31) I mean, like if she has an overall first date of service as January one or to?
Carrie Reding (25:39) Present, I mean,
Amy Barfield (25:40) could we not just stop all Theoria and just process everything?
Lori Durkin (25:46) Yeah. What’s the issue she’s approved with complex care?
Amy Barfield (25:50) Yes, with medicare.
Lori Durkin (25:52) Okay. Then, I mean juvie, am I missing something here? This is her earliest.
Juvy Patal (25:58) Yeah, that’s the earliest date of service and I think the complex care, I’ll go back. It’s I’ll go back to the message. I think she’s approved there, December.
Carrie Reding (26:13) And if they can just send us those to review on a case by case basis, if we’re stopping those medicare, I’ll make sure the team we let them know.
Amy Barfield (26:23) Okay. I just wanted to flag it. So if they’re requesting that, you know, to look at everything versus just closing what’s right in front of you. Yeah. So.
Carrie Reding (26:35) We don’t have to figure out later. Like why did we do this?
Amy Barfield (26:37) Yeah, yeah, or we shouldn’t have done that? Okay.
Lori Durkin (26:42) And I’m in pcos now. So for Michigan Theoria, it’s only argavan and Justin as of right now. So I guess if a signature is needed, just pop it out with that. But then I guess just do a paper 855 B and send her in as the new auth official.
Amy Barfield (27:09) Okay.
Lori Durkin (27:10) I have to hop for another call team. Thank you so much appreciate your time. Yeah. Have a good weekend. Take care. Bye, bye. Okay?
Amy Barfield (27:23) That’s all I have at the moment.
Carrie Reding (27:27) All right. I’m sure I’ll have more stuff next week. I’m trying to get through emails today.
Amy Barfield (27:32) Yeah, just so you know, Carrie, I don’t know if you were privy last week, I think right before you left, I pushed out several retro letters to production for uhc, humana. Okay. Humana, has you guys have a national contract? I wasn’t aware you had a national contract. I thought it was state by state. So now, I’m requesting Theoria, that they’re added all of our states to the national contract because we were getting denials for Tennessee and, you know, medicare and medicaid lines of business for other states. And so, I requested like, hey, theorian, we have a national contract. We need to be in all these states and under these lines of business and then explain the transition from Theoria to complex care that need to mimic the same will?
Carrie Reding (28:23) That take care of that humana, healthy horizons and all that.
Amy Barfield (28:28) That’s my hope. Yeah. Okay. Yeah, because the network is closed… for Tennessee. I can’t remember for Ohio, but that, yeah, that should be added to the national contract rather than just an individual state contract. So nice.
Carrie Reding (28:45) Nice. I,
Amy Barfield (28:45) haven’t got a response yet. So I’ll follow up again next week on that one… unitedhealthcare. I sent out three state letters… Missouri North Carolina. And there was one more, I want to say, Indiana maybe. Okay. So sent out some letters there for medicare medicaid lines of business. And then there were a few detailed retro requests for some providers. So those all got pushed out last Friday. So next week I’ll follow up on those and see if any movement because I haven’t heard anything from those payers yet this week, okay?
Amy Barfield (29:29) So, yeah, I’m in the production channels now with our team, whereas before, I was just communicating with our team leads and manager, and now they’ve given me access to production. So I’m pushing things a little harder. And so I’m seeing a lot more progress. So that’s good. Yeah.
Carrie Reding (29:46) Sometimes you have to be in the weeds to understand.
Amy Barfield (29:51) Yeah. I’ve been asking for it. They finally gave me access. So now I’m like I’m here, you’re going to hate me, but here we go.
Carrie Reding (29:59) Yep. So.
Amy Barfield (30:02) Anyways, I do see a lot more movement and I can see like what’s happening behind the scenes now and push for better direction. Hopefully we’ll start seeing some bigger movement. Yeah, anyways, that’s all I have. All right. If you run into anything today, Carrie, as you’re going through your emails or have any questions, let me know. Latoya, I’ll let you know once I have you added to Georgia medicaid, and then just start creating a list for me and add Carrie to it because Carrie may have access to something that she can quickly give you access to already. And then if not, then we can discuss that on Wednesday’s call, getting you access if you find that a portal requires you to have a username, go ahead and set that up with that payer. And then that way I can give that to our team to link you as an agent to whatever portals are available. Okay? Thank you. All right.
Lori Durkin (31:06) You girls have.
Amy Barfield (31:07) A great weekend. Welcome back, Carrie all.
Carrie Reding (31:09) Right. Thanks, guys. All right.
Amy Barfield (31:11) Bye bye.