Transcript
Sean Mercado (00:00) hey, Jack. How are you doing? Hey?
Jack Schell (00:02) Sean, I’m doing all right. Definitely getting a little sick here. To be honest. How are you? I?
Sean Mercado (00:10) Had the flu go through my house like last week and it was awful. So.
Jack Schell (00:14) Yeah, be careful. Allergies are quite wild right now and I think that it’s actually at a point where it’s just making me sick and it’s no longer just the allergies. So, but yeah, anyway, that aside.
Sean Mercado (00:29) Flonase?
Jack Schell (00:31) Yeah, I’ve never used flonase actually.
Sean Mercado (00:33) Really, it’s really good. Do like a 1,000,000 bucks after, you know, do a little nose spray.
Jack Schell (00:40) Totally. Yeah. But anyway… with that, sorry, it’s like really distracting, but yeah, I know that we haven’t talked in a bit, but you wanted to visit Mckenna.
Sean Mercado (00:56) Smith. Yeah. So I just want to kind of understand kind of like what the process is, you know, for this Mckenna smith piece, it was, you know, medallion unfortunately loaded the provider incorrectly in the system. And thus that led to a lot of denials that we can’t go back to. So, for some sort of relief for medallion that’s pretty much the punchline. So, you know, we don’t want to just send a legal letter and, you know, have it be some demand letter we don’t want to do that. I want to make sure like there’s some sort of like, you know, informal kind of like dispute resolution process that we’re working on together that’s more partnership focused. So, you know, I want to kick that off now and I just want you to like, you know, I just want to work with you about kind of like, okay, what does this process look like? You know, you know, who do we need to bring involved?
Jack Schell (01:50) You know, yeah. And,
Sean Mercado (01:52) then, you know, how do we resolve this to like both of our liking? Because it is money, right? It’s a monetary impact and, you know, it’s just kind of, you know, it is what it is. Sometimes these things happen, right? But, you know, I want to work through it together with y’all, versus at y’all, if that makes sense.
Jack Schell (02:15) I hear you in terms of us loading the provider incorrectly that’s I have to just have the team investigate that. And then obviously, like this isn’t a decision for me to make. And so I will involve whoever necessary to like review the Mckenna smith scenario in full. I, I’ll start there. I’ll start with the operations team and obviously escalating to like gabby so that she’s read in on like the investigation of the Mckenna smith enrollment. And then we’ll review that determine exactly where things went from initial import to like ongoing enrollment requests. And then likely, I’ll have to work with gabby and whomever to just assess what the impact is… great. So, like, I like that like that’s how that’s the process that I’m gonna have to follow. Like I don’t have any answers or like power right now, but like they’re gonna start with just doing a timeline investigation likely of just this enrollment process to see what to see what we find.
Sean Mercado (03:36) Okay. That sounds great. So, let’s kick that off.
Jack Schell (03:37) Because I know that she’s the, everything’s updated today, right? Like Mckenna smith is enrolled appropriately at this point. But, okay.
Sean Mercado (03:47) Yeah. So, it’s been updated? Yeah?
Jack Schell (03:51) Okay. All right. Well, I’ll kick that off internally. That’d be great. Just a review of her enrollment history. While I have you, I mean, is there, any other items that were high priority that, you know, we need to be discussing with regard to? No, I mean.
Sean Mercado (04:14) Right right now? I mean, well, I mean, the Alabama medicaid piece, right? You guys were gonna switch all that off? I don’t know what’s left on that. So that’s probably the only other one. And you?
Jack Schell (04:28) Know. Yeah, I know that, I know that Amy has like an extensive tracker for the Alabama medicaid issue and, or like correct corrections if you will, yeah.
Sean Mercado (04:37) We’re probably a little early because we have a meeting with Amy at the top of the hour too, and I bet she’ll probably provide that update. We’ve been meeting with her weekly and she’s been providing those updates at least to Aiden. And then when I can join, I’ll listen in as well. But I would say that’s the only other issue that we’re having, like with the whole, you know, I’m just very sensitive to the Mckinney smith because it’s like, you know, it’s over 300 K of denials. And so, you know, it’s unfortunate, but we have to kind of resolve that. So that’s just gonna be, you know, I just want to go through that process now with you to make sure that we’re putting time and effort behind that because it’s gonna, you know, it’s gonna be a big item with our CFO here shortly. Okay?
Jack Schell (05:32) All right. So, I’ll take that back. I’ll get gabby involved that’d.
Sean Mercado (05:37) be great. Yeah. And just remember this one was like she was enrolled as a non billing provider, it.
Jack Schell (05:48) Was like, she was, she wasn’t enrolled as fee for service. She was enrolled as like orp, right? Yeah, orp?
Sean Mercado (05:54) Right.
Jack Schell (05:55) Yeah. And like, from what I remember is like that’s how she was loaded in.
Jack Schell (06:06) Is this blue cross blue shield? Well?
Sean Mercado (06:11) The big one is, I think it’s all around mass health and like mass health, we can’t we don’t have the option to go back and re bill. So that’s the issue. Okay? You know, usually when there’s these like situations where, you know, there’s maybe a provider is loaded in correctly, and then we go back and then we go and we go fix it. Yeah. Well, that’s re, bill, and then we can actually capture that revenue. But with mass health, it’s like a different situation where we’re sol so well.
Jack Schell (06:50) We did, once it was found, it was corrected, right?
Sean Mercado (06:53) Yeah, yeah. But, you know, it took, I think, I think some time to correct it, right? So, that, that’s the piece and that’s why we’re asking for the relief that during that time, you know, we weren’t receiving those payments where we should have been, okay?
Jack Schell (07:16) All right. Well, I mean, I’m just, I’m gonna just escalate it, the request, yeah.
Sean Mercado (07:22) That sounds good. And, you know, let me give you next week to kind of do that due diligence and I will get a up to date claims file on her about like kind of like what’s outstanding? And, we can share that figure with you and then let’s try to target maybe the week of the sixth, you know, if like, you know, we want to meet on the eighth or the tenth sometime. Let’s let’s just go and like just let me know on what works for you and gabby just that just to talk about it again. I want to work with y’all, not at y’all, so I’m happy to kind of compare notes, see what we have and then work towards some sort of resolution that works for both parties for.
Jack Schell (08:10) Sure. Sounds… good. I, yeah, without the without like the timeline on it, I don’t have much to contribute right now, unfortunately. So… but yes, I will work on this and then we’ll target the eighth or the tenth as you mentioned for gathering together again to revisit it. Okay? You know, I’m curious about just like the program overall too. And typically, I am, you know, having monthly cadences with folks like yourself to ensure that we’re tracking from like an expectations perspective, execution, metrics, consumption, etc, also hoping to stand those meetings up with you since we do have some time left together. Yeah.
Sean Mercado (08:57) Let’s look around maybe like middle of April next week. I’m out for spring break. So like a dead week for me. But then I’m you know, I get back in the saddle the week after. So like let’s shoot for mid April on that. I would love to know kind of like where we’re at consumption wise, you know, very sensitive to that. So, yeah, would love to have that formal meeting with you Jack. Okay. All right.
Jack Schell (09:31) Sounds good. Enjoy the time off next week and I will follow up with you with times to meet on the eighth and the tenth. Okay?
Sean Mercado (09:38) Sounds great. Thanks.
Jack Schell (09:40) Sean. Enjoy your weekend all.
Sean Mercado (09:42) Right. You too. Feel better. Thanks.