Transcript
Christina Oneil (00:00) oh, hey, Gero, hey, I am.
Shannon Costine (00:03) Freezing and I don’t know why.
Vanessa Persha (00:06) Ugh. I am always freezing.
Shannon Costine (00:08) Ugh. It’s terrible and it’s like, I don’t know 80 degrees here, 90 degrees.
Vanessa Persha (00:14) Oh, my goodness.
Shannon Costine (00:16) I’m letting Stephanie in. Okay? Hey, Stephanie, how are you? Hey, I’m good. How are you? Good? Oh, let me, let Christina in.
Shannon Costine (00:34) Hey, Christina. How are you? Good? How are you?
Christina Oneil (00:38) Good.
Shannon Costine (00:40) I brought Vanessa on the call with us today. She’s one of our senior engagement managers. So I thought it would be good to have her to help answer questions. She may know something that I don’t as far as workflow goes, but if you don’t mind, Christina, can you just give us a little bit of what you’re looking for to do?
Christina Oneil (01:00) Yeah. So, part of the discussion that we had with our leadership team was making sure that we had a better understanding of how we’re providing the enrollments and how we’re prioritizing our enrollments that we’re requesting, right? And so we’ve been kind of working off of an assumption which we should never do. But we were working off an assumption that when we submit a request based off of, you know, because we send you guys, we get a new provider, we add the, we hit new request, we select the entity and the state and everything. And then generally, it pops up with all of the like… our contracted ones like the assumed ones that we’re going to be enrolling with, right? So then we were looking or then I was looking and there were, you, know we can uncheck and check and blah blah, but I was then looking at, sorry, my dogs are going crazy. I was then looking at, okay. Well, why would I have a service line for medicaid… or let me try this again. Sorry, if you hear them please. I’m sorry, this is the first time. Okay, all I hear is rumbling like over there, okay?
Vanessa Persha (02:18) You’re fine, Shannon and I were talking about our cats that like wait till we have meetings and, or I think that was somebody else.
Vanessa Persha (02:25) But anyway, they wait till we have meetings and then they run across our desk and throw papers everywhere and it’s always a good time a.
Christina Oneil (02:34) 100 percent. Okay. So, so we have a wellcare insurance, right? And the wellcare has a commercial line. It has a medicare line and it has a medicaid line. And so we were kind of going okay, well, in the state of Kentucky, you can apply for both medicare and medicaid at the same time. You don’t have to wait for one or the other. You can do them both, right? So, then we were like, okay. Well, why would wellcare be in process when we don’t have the medicare or medicaid line yet? Because generally speaking, as far as what I’ve always understood is that when you get the wellcare application, it says medicare, commercial medicaid, but most of the time, they do require the medicare and medicaid ids. And so I was like, well, why does that happen? Like, how can an application be at the payer without the medicaid and medicare ids right on it? Like, I know you can check all the boxes that you want to. But without that piece like that part didn’t make sense. So then I was like, okay, well, are we just doing? Are we creating two things? Are we creating more work in like, and not intending to? But with the assumption that they’re not going to work on wellcare until those dependencies, right? Are met, right? And then we were looking at medallion too and was like, okay, well, it doesn’t stay on hold for pending dependencies because technically they could submit the commercial application, but they’re just going to have to follow back up with the medicaid application. So it was kind of like an aha moment like, okay, are we just doing? Are we creating more friction for all of us? And not like not being methodical on, you know, we submitted requests. We’re going to do it for let’s say we’re going to do it for medicare medicaid first, right? And then next week or when we get those approvals back, we will do it for wellcare, like the managed, sorry, managed plans and we’ll do that and then we can just do it for the regular commercial ones. Like with medicare and medicaid at the same time or is by selecting multiple? Like if I do my commercial ones that I know are just commercial. And then I do my medicare and medicaid. Is there any type of assumption that says medicare and medicaid should be submitted first? Or are they just saying here’s, all the ones that I have to do, let me just go through them. You know what I mean? Does that make sense?
Shannon Costine (05:11) Yeah, Vanessa actually brought that up today when we were talking through your issue. I guess my first concern or question is, I know you were concerned with consumption. So are you having to submit them, the commercials, and then you go back and submit medicare and medicaid or is it one request for wellcare as an example for all three?
Christina Oneil (05:31) So that’s the part that I’m having a hard time getting the data around because, and I was trying to meet, you know, everything that’s going on. So I was trying to understand like, okay, is this something? Are we submitting the request again? I don’t think we are because I pulled up an application for Samantha Hawkins, but she’s a newer provider. So I don’t know if it was happening in the past that we were just resubmitting it, saying we don’t have this service line because I did find it’s hard to look in the data. But like I did find multiple lines for caresource as an example for Angela Triona, she’s just my hot button ticket. You know, she always is, she always is. But like, so I was like, okay, well, she has two caresource, Ohio for Pai, Ohio, like why would there be two? And we were charged for both. So I don’t know, I’m not that into, the data yet. Like I’m still trying to mumble it, but like Tabitha Hawkins, it was still like it’s a receipt commercial pending medicaid and medicare approval.
Christina Oneil (06:40) But then it kind of looked like that timeline also made it so that the time from the request submitted to the time from consumption to the time to from to actual like approval date, it does make it look like your 10 days are like, you know, like the 10 day SLA, it’s not really that 10 day SLA, because you don’t have that medicaid, right? Like, right? So it’s so needless, like it doesn’t align with the slas because of the fact that, you don’t have the pieces that you really need yet, right? Like, so, when you look at the SLA for, you know, what they’re sending around and doing all like and it’s you know, it’s leadership, right? Sure. We’re just like sending around data. But then when you actually look at it, you’re like, okay, well, yeah, the SLA might look correct because technically you got the commercial, but like back here, is they’re still pending on the higher like the priority payers, right? Like, and so that’s where I’m looking at it and being like the slas are 100 percent off.
Christina Oneil (08:05) They’re totally wrong. They’re like, this makes no sense at all. And then I’m like, okay, well, now, it makes a little bit more sense why there’s a discrepancy. Does that, you know what I mean? So.
Shannon Costine (08:16) Yeah, it makes sense. Vanessa, you look like you were going to say.
Vanessa Persha (08:19) something… no, I was just, I’m looking through like some of their well care requests. And I do see what you’re talking about where like we’ve submitted for well care, West Virginia for medicare advantage and managed medicaid. But then their medicaid and medicare enrollments with West Virginia are still in a payer processing status, right? So, how did we submit this application without those? Yeah, right. And then, you know, to your point now we’re showing that like technically, this enrollment should have been in appending dependencies… until those were completed. So like this application essentially like, yes, while we met SLA on paper, we didn’t actually submit an app because the payer is not going to accept it without the medicare and medicaid ids listed. I.
Shannon Costine (09:18) guess my question for you, Vanessa, or to them is what do you feel like the correct process is?
Vanessa Persha (09:26) So, I’m gonna, we need to take this back to peops and confirm my understanding though would be that like four year payers that offer commercial medicare advantage and the managed medicaid lines of business. In theory, you should be able to submit one enrollment request and then we would mark it partially complete once the commercial part is done. And then once the medicaid and medicare lines, once we have those id numbers, they can submit those to the payer and then mark those two lines of business complete. Like once they have that confirmation, where I don’t want to speak on their behalf. Like what like technically that’s doing work twice, right? Because we submit the app with commercial, then we have to go back and do a demographic update to add the two other lines of business. So that’s where I say I want to kind of get feedback from our ops team to confirm my initial process is if that’s how they do it? Because if not… then I could see where the concerns of consumption would come in because you’d have to submit the commercial request first to get that processed, then later go back and submit the demographic update for the other two lines of business. However, if you guys are fine with waiting for all lines of business to be submitted until those medicare and medicaid ids are issued, then it just turns into that line is just placed on a dependency. You request one line, all three lines of business, the whole line gets put into pending dependencies until medicare and medicaid are issued.
Christina Oneil (11:17) Originally, that’s what I thought was going to be happening is because when you’re selecting the lines of business, like I said, I just assumed that would be holding up pending dependencies. But again, like you said, when I’m looking at medallion and seeing all the managed medicaid or the managed plans that we know that we have wellcare, being our biggest payer, it doesn’t automatically put pending dependencies. And… that’s where.
Shannon Costine (11:51) Like,
Christina Oneil (11:51) I said, I think that that’s part of the issue with our gap. Yeah.
Vanessa Persha (11:57) Shannon, if you.
Shannon Costine (11:59) Have some time. I was just asking Nicole while you guys were talking and she says she’s pretty sure it’s one for one but she’s asking to confirm.
Vanessa Persha (12:10) Okay. Which means they’re counting wellcare,
Shannon Costine (12:12) three times.
Vanessa Persha (12:14) If they were to submit three separate requests, yes.
Shannon Costine (12:19) That’s what? Yeah, that’s what she’s saying.
Vanessa Persha (12:22) Okay. But today, Christina, you’re saying you submit one, it has all three lines of business and then you, in theory, you should see that line placed in a pending dependencies until those other medicaid and medicare’s are complete.
Shannon Costine (12:38) It sounds like what she’s saying is that three, even if it’s submitted as one, but don’t take that as gospel yet.
Christina Oneil (12:45) Well, and that’s where it’s kind of confusing, right? Because, and that’s where the numbers aren’t really matching up because it’s one application. So why would it be, why would it be three if you have three checkboxes, you know?
Vanessa Persha (13:00) Yeah. So, is the concern coming from like the total consumption volume that you guys are seeing in comparison to what has actually been worked by medallion. I want to make sure we have like Shannon and I have really clear guidance on like what we should be taking back to our ops team or even the account manager. So it would be helpful to kind of, I guess like let’s bullet point what your top concerns are, and then we’ll dig into the details more.
Christina Oneil (13:32) Did you forward? I put it in my, in an email to Shannon? I can forward it to you if you would like. Yeah, I.
Shannon Costine (13:39) can do, I can do that Christina.
Christina Oneil (13:41) But those are kind of it’s basically everything that we just talked about is we’re assuming by if it’s an application for wellcare, you have three lines of business like and that’s where like I’m not an enrollment specialist, but I went through and, I was like, okay, what did our old credentialing people do? Because I remember they would always do medicare and medicaid first and we didn’t have to ask like we didn’t have to do anything. We knew medicare and medicaid were always going to be first and that’s like that’s where they start, right? We knew that commercials and that kind of stuff was going to kind of going to happen. But then I looked at for applications for wellcare, and I was like there’s three checkboxes. Why are we? Like? I don’t understand like what the deal is. So.
Vanessa Persha (14:19) Yeah. So from what I understand, a PE service request should count as one consumption per line. So even though you have all three lines of business checked in that one request, you, that should count as one consumption. If you were to submit multiple demographic updates, then that would count as additional consumptions. But based on what I’m seeing now, like you for example, I’m looking at provider, Nicole smith, she has two wellcare requests both for managed medicaid and medicare advantage. So this would be two consumptions. One for the Pai medical, West Virginia group, and one for pursuecare LLC. That’s how I’m looking at that. So those would be two consumptions not four, right? And.
Christina Oneil (15:21) that’s where I think that’s what I was assuming too. But that’s where I think if we can get some clarity on that to ensure that we’re all on the same page because I’d like to be able to go back and be like, okay, either we were, we had a process that was wrong on our end and we were assuming too much or like, you know, I mean, we just need to the consumption thing just needs to be figured out because it’s very hot topic right now. But also like if we were to say if I go, we have another provider that’s starting soon and I want to be able to go to Stephanie and be like, okay here’s your process going forward, just submit the medicare medicaid applications, just do that, wait for everything else because everything else is dependent on those. And so, and that’s where like again, we say the slas are all in line but none of them are really truly in line because of that.
Vanessa Persha (16:19) They’re prematurely submitting those applications. Yeah.
Christina Oneil (16:24) I.
Shannon Costine (16:24) mean, that’s what I would suggest is holding on those until you submit them or until they’re done. What, what do you think, Vanessa holding on the plans until medicare medicaid is done?
Vanessa Persha (16:35) I mean, this should be like we should be able to, this could be just a like a technical glitch in that line like that payor, allowing for our ops team to even see it before those medicare medicaid requests come through because our system should be able to recognize that specific payer and that request requires medicare medicaid. So it shouldn’t even appear on our agent’s dashboard as a workable line. So I, well, yes, that would work. Having them hold it. It does put an extra administrative burden on them to have to monitor when the medicare medicaid’s are approved and know to go back and submit those. So let’s take that back to, I think that would probably be our epd team Shannon to find out why those lines are not properly dropping to a pending dependency status, okay?
Shannon Costine (17:36) Then I guess my other question is Pai and pursuecare. They’re definitely two separate groups, right?
Christina Oneil (17:43) Yeah. I’m not worried about those. They’re two different tox ids we’re just, we’re trying to, so while we’re getting the Pai, Ohio kind of ramped up because all the contracting that we’ve been asking for, you know, with the medicare, we didn’t have medicare for a long time. So I do know that there’s always going to be like if we’re enrolling Nicole in both Ohio or in LLC, and then the Pai Ohio, like those will be distinct, but that three underneath wellcare, like being three separate ones that’s where it’s.
Shannon Costine (18:16) concerned. Okay. Let me, yeah, let me take that back. Like Vanessa was saying. And then once I get a response, which I should this afternoon, what I can do is schedule another. I hate to do another meeting, but I can schedule another meeting for Monday or Tuesday morning if that works for you. And then we can go over it, but let me make sure I have my response or answer for you back first. Yeah. And then we can jump on a call with you. Yeah.
Christina Oneil (18:42) Sounds great. I really appreciate the time and Tuesday would be better for me just a side note. But, okay.
Shannon Costine (18:49) I’ll shoot for Tuesday, Vanessa, were you going to ask something?
Vanessa Persha (18:52) I’m sorry. Yeah, I wanted to ask. So just, I know one of your concerns is overall consumption. And I did notice that almost 25 percent of all the requests that you guys have put into the platform have moved into a stopped status. Is that something that you guys requested? And then if so, is there a reason behind why so many were stopped?
Christina Oneil (19:19) So, I know that I did that this morning too. There were several that were requested that were actually not needed. And I had asked prior to Shannon, if depending on where they’re at in the process, does it matter? Like I was told that unless the provider had met or let me choose my words wisely, unless the payer line for the provider had been prior… to intake complete… that we could stop it without charge?
Vanessa Persha (20:00) Yes, that is correct. I’m still looking, I’m pulling all your data into a pivot table to understand how many of those lines cleared intake, because that will tell us a little bit better like how much of an impact those stop lines had on your consumption. But yeah, I just wanted to call that out and see if you guys were aware that the volume was that high number one. And then number two, find out like if it was, you know, if you guys were just not seeing success on the medallion side or if it was an internal reason that Drew you to stop those lines.
Christina Oneil (20:38) It was kind of a mixture of like both. Well, mostly it was mostly just internal processes or providers terming frankly. And so that was something that kind of came to play where we just didn’t know the provider was going to be terming, and then it looked like they were. So do I have, and I was looking for that exact data too. Like is there any field on the reports that show… like intake day? Is there any report? Oh, there is. Yeah.
Vanessa Persha (21:17) So let me go. I want to, actually before I say that, let me not jump the gun. Let me toggle to admin view. So I can see your view in the platform… and just confirm that… enrollment requests. Yes. So in your enrollment requests, section of your payers, tab, there is an intake complete date listed towards the very last few columns. And so you can download, click?
Christina Oneil (21:54) Export results. Yep. And.
Vanessa Persha (21:57) So that will tell you like you can filter it to all of your stopped requests…
Christina Oneil (22:08) Bye. Downloaded. I did the stop request application. Can I share my screen? Because that’s what I was looking for?
Christina Oneil (22:24) So I downloaded it and I literally had it open too because I was looking at it, but I don’t see.
Christina Oneil (22:39) Practice id, group, id enrollment. Oh.
Vanessa Persha (22:43) That’s weird. The downloaded version looks very different than the way it actually looks in the platform?
Christina Oneil (22:53) Is there a.
Shannon Costine (22:53) different way to pull it like there is in sgma reporting? Vanessa?
Shannon Costine (23:05) How bizarre? Is that? No, it does not look like it? And you?
Vanessa Persha (23:09) Were under the enrollment request tab when you downloaded it, right? Yeah.
Christina Oneil (23:15) I went here. I always use this report and I just downloaded it, but… okay. So, oh… and to complete it, you’re right? Okay. Well, I mean, that helps me out a little bit though. I didn’t know. Yeah.
Vanessa Persha (23:34) So, you can apply filters like, you can just look at the stopped ones up at the top. There should be a bucket of platform groupings. You see, it’s actually scroll up a little bit more.
Christina Oneil (23:49) I was trying to get over there, no.
Vanessa Persha (23:52) You’re okay. So all the way to the right, you can see the stopped bucket has 112 in it. Yeah, if you click on that, it will filter the report to only show you your stopped lines. Oh, okay. And then you can scroll over to the intake complete column and look at how many actually cleared intake. And if you do a sort on, it should bring… your one. Yeah, all the ones with dates in it are there.
Shannon Costine (24:30) So, it looks like some did clear.
Vanessa Persha (24:33) Yeah, it looks like quite a few did.
Christina Oneil (24:37) Well, then.
Stephanie Alcena (24:50) I know for dr Wilmore, he was one of our providers who originally termed. So, when we deactivated his medallion account, all his enrollment requests went into a stop, but when he returned, like shortly after, so we put in new requests for him. So I’m just wondering down the line, should we be, is there a different way we should be doing that? That way we don’t get twice. Yeah, yes.
Vanessa Persha (25:22) So, there are situations where it would be advisable to just reinstate the line versus requesting new. So, if a provider, like if they were, you know, gone less than 30 days, and if they were returning back to all the same practice locations on the original requests, it would be safe to say, okay, we could probably reinstate these enrollments without any issues… which you can request through support. You could send support a request and say, hey, this provider, you know, came back, we want to go ahead and continue with his enrollments. Can you please reinstate his service requests? Like all service requests or tell them the specific ones you want to reinstate and they can move those back into the last status that they were in before we moved them to stopped.
Christina Oneil (26:26) Gotcha. Okay.
Shannon Costine (26:29) Christina, were you going to ask something?
Christina Oneil (26:32) I don’t even think, did I term him officially in medallion at some point Stephanie?
Stephanie Alcena (26:38) Yeah. So the one we had for him, they all went into request stopped. So when he came back, we submitted, I submitted a new one for him. So he might, I don’t know if they were already went through the intake process. So that might be why the numbers are behind.
Shannon Costine (26:58) Yeah.
Christina Oneil (27:00) Well, and that’s weird too, because well, that part doesn’t make sense. Then even more to me, just a side note is because all… of… his enrollments were done by our previous, he was gone less than two weeks like he was termed for less than two weeks or something like that, and they were all done by the internal people then. So, I mean, I don’t know.
Vanessa Persha (27:28) Who is the provider’s name?
Christina Oneil (27:30) It was dr. Wilmore. There was a bunch of client owned tasks that were completed.
Shannon Costine (27:39) Can you spell that?
Stephanie Alcena (27:42) W, ILM o RE, I did.
Shannon Costine (27:48) See his name pop up?
Stephanie Alcena (27:51) There’s a feeling, so.
Vanessa Persha (27:54) It looks like we stopped eight enrollment requests for him. And then we have.
Vanessa Persha (28:08) 15 in processing, 16 needs client attention. And this is the last time the data was pulled that I looked at… one, two, three, four, five, six, seven. Yeah, it looks like there was a stop for seven of the payer requests… caresource. There were two requests. All the other payers were one request… anthem blue shield Kentucky, which I see you did request another line for that buckeye health plan. I see that one’s yeah. Yeah, I mean, I would say definitely like in this scenario, if you have stuff that was in process previously, take a look at the data that’s in the request if it matches what, you know, where the provider is at and everything, when they come back, you can request through support to have that line reopened.
Shannon Costine (29:15) And that’ll definitely help with your consumption.
Vanessa Persha (29:18) Yep. Absolutely.
Shannon Costine (29:22) Christina, did you have a question? You look like you’re deep in thought, no.
Christina Oneil (29:27) I’m my thought and, you know, I always wanted to be very candid is just that like when it comes to a new hire or a rehire in general, like, I guess it… doesn’t seem like there’s that great. I mean. And this is, like I said, I’m not an enrollment specialist. This is me talking to a, like being a system person and just looking at data and stuff like that, right? Like, and so like in my mind, if I had a provider that was with us and we termed, and then we were like… we like activated it, there would be some kind of it, some like magic, right? Like that would say, hey, this person was termed within the last 30 days or whatever. And we don’t like we just do this like, you know what I mean? I’m just a tech person, so that’s how I think of things. But because we wouldn’t like Stephanie didn’t know, that like that mattered. You know what I mean? Like, so it’s kind of hard for, it’s hard for me to wrap my head around something and, you know, I’m not being, I’m not trying to be nitpicky, but like I don’t know, Vanessa, but this kind of got thrown at my lap. And so now I’m kind of,, like, okay, what don’t I know to now like to put a process in place to be like, okay, this is how this will work better and this is how this will, this makes sense. You know what I mean? Because I wasn’t part of the implementation. So I’m kind of just like we’re… kind of guessing on what are the right ways to do it. So, I appreciate you going back to it and going back and saying, hey, why isn’t this payer putting it in pending dependencies? That’s my kind of thinking. And so I would also request like the care source is the same way, like anything with the multiple lines of business, if we can make sure that they kind of look at those because I don’t see it consistently going into a pending dependencies.
Vanessa Persha (31:35) Yeah. So what we’ll do is we’ll look at all of your group contracts that have medicare medicaid lines of business on there. And then we’ll take that back to make sure that those lines truly fall into the correct status of pending dependencies until there is an enrollment with medicare medicaid listed either in the request and it’s completed or it’s already listed in the existing enrollments. That should be the two parameters we’re looking at before it clears dependencies. And to your point, you know, I definitely agree with you like it’s not you’re not being nitpicky and we appreciate the feedback about like the system not having a blocker or like even a banner or something to say, hey, you’re reactivating a provider? Are there any enrollment requests that you would like to reinstate or something like that that’s great feedback? And that’s something that Shannon and I can submit to our product team to see if that’s something they could put on a future roadmap? Of course, no guarantees on whether they will even do it or how long it would take them to do it, but we definitely rely on feedback from our customers to give that to them. So don’t ever hesitate to share that with us?
Christina Oneil (32:52) No, I appreciate it. I appreciate the time absolutely.
Shannon Costine (32:56) All right. Well, I’ll take all this back. Thank you Vanessa for joining. You always have good thoughts and take all this back. And then I’ll shoot you an email, Christina and Stephanie when we can meet it’ll. Probably be Tuesday.
Christina Oneil (33:07) Sounds good all.
Shannon Costine (33:08) Right. Thanks, guys. Have a good weekend. All right?
Vanessa Persha (33:10) Thanks, everyone. Bye bye.