Transcript
Leigh Howle (00:00) hello? Hello? Hi, Laura. Hi, Michelle. Hello? Hi, Carol.
Carol (00:09) Hi, Leigh. How are you?
Leigh Howle (00:12) Doing good. How are you? I’m.
Carol (00:14) doing good. Thank you.
Leigh Howle (00:16) Good, Michelle. You sound so much better. Are you feeling better? I?
Michelle Jared (00:21) Am I’m still a little? I still have some sneezing head congestion, a little cough, but I am way better than I was last week. Thank you.
Leigh Howle (00:37) Well, I’m glad you’re feeling better.
Michelle Jared (00:40) Me too. That was not fun.
Leigh Howle (00:46) Yeah. Especially before vacation. I mean, that just even makes.
Michelle Jared (00:51) it, yeah, that really was a bummer.
Michelle Jared (00:57) Yeah.
Leigh Howle (00:59) Let me just see if Ken accepted he declined today. So I’ll go ahead and share my screen.
Michelle Jared (01:08) Linda should probably be along any minute.
Michelle Jared (01:13) Okay? Should we wait for? Well, what’s the first thing on the list here? No, we can go ahead and get started.
Leigh Howle (01:22) Okay. I know.
Michelle Jared (01:23) We have quite a few things on here today.
Leigh Howle (01:25) Yeah. So on that first section there for payer requests, so I just added this on here to go over the requests that are coming in and just make sure that the final payer name listed matches what’s being requested, you know, for what’s active enrollments. So for keystone, we’re getting requests and I mean, the team knows that if it’s a demographic update, it’s client owned. So they’re stopping those requests. Is there a different workflow that you all would prefer on those?
Michelle Jared (02:11) So let me just make sure I’m following and Linda said she’s having a hard time getting in. I’m going to re, forward the invite to her? She said she’s getting a meeting error message. Okay. Let me try to forward it to her. Okay? Sorry, one second.
Leigh Howle (02:28) Yeah, no problem. So, I guess Carol, maybe I could ask you on this. So for keystone demographic updates, do you want to request that as client owned? Yeah. And you track it in the platform and just, you know, complete that line or do you prefer?
Michelle Jared (02:48) Well, let me just, can I just ask a quick question? So there’s two paths for keystone enrollments. Yes, and discovery has to be done. So, if you guys call and find out that the provider was enrolled before then that’s when Carol has to do it. But if the provider’s never been enrolled with them before, then your team can submit the enrollment. Do I have that right? Carol?
Carol (03:17) Yes, that’s correct?
Michelle Jared (03:19) Yeah, because keystone won’t work with… vendors for demographic updates, correct? So.
Michelle Jared (03:33) I agree that we need to have a workflow for this. So like if your team does the discovery and they find out… the provider had been enrolled before, would they be able to put like a note on the enrollment and change it to client owned? Yeah. Okay. It.
Leigh Howle (03:58) Can be changed to client owned. So, I get it would be if they identify the like if it’s a new enrollment request, we’ve seen a few of these come through where it’s a new enrollment. And then keystone says the provider’s already credentialed, you just need to submit a demographic update. So the team usually will task out and just let Carol know that would be a demographic update. Instead. I think it’s a great idea to also just make that client owned for follow up even though it says new enrollment when it’s truly just a demographic update.
Carol (04:35) Yeah. Like, yeah, if they could just note the line of the findings if the provider’s already enrolled with keystone first, that helps a lot.
Carol (05:11) And you said they would notify me, is that like through the task?
Leigh Howle (05:15) Or, yeah, in a task? Okay. Yeah. I thought there were keystone demographic updates that were recently requested… and that’s why they.
Carol (05:31) Yeah. I think for the new location for Pennsylvania for Chester county.
Carol (05:42) Is it for Chester? Yeah… I requested those?
Leigh Howle (05:53) Do I need to make them client owned? Yes. Okay. I think they were stopped. So, I guess that’s a second piece to that question. So if a demo update is… accidentally requested… instead of stopping it, you want us just to automatically make it client?
Carol (06:20) Owned, which is to client.
Leigh Howle (06:22) Okay. So if I.
Carol (06:28) know it’s a demographic update. So I don’t have to request that as a demographic update. Would medallion just do it for Axia? Is that how I?
Leigh Howle (06:43) Would do it? Yeah. So when you go to make a single demographic update up here, when it says who should work on their request, you could make it Axia. Okay?
Carol (06:56) Okay. And.
Leigh Howle (06:57) then it’ll just be it’s automatically client owned.
Carol (07:01) Oh, okay. Okay. Great.
Leigh Howle (07:04) It gets tricky because, when you bulk request clients a demographic update, you would have to separate out keystone. So that would be like you’d have to do all the other payers, you know, Aetna humana… cigna, under the bulk and then you’d have to go back in and make that one keystone as client owned. Oh,
Carol (07:26) okay.
Leigh Howle (07:28) Yeah, but I think doing it that way and then I’ll also tell the team that if it does, if there’s one that accidentally comes through, just don’t stop it, make it client owned.
Carol (07:39) Yeah. Okay. Yeah.
Leigh Howle (07:42) Thank you. So, for the ones that were stopped.
Michelle Jared (07:47) We probably.
Leigh Howle (07:49) Should make those client.
Carol (07:52) Yes. Okay. So, I know in the future not to do that. Just request Axia?
Leigh Howle (08:05) Okay. So, we have these looks… like 14?
Carol (08:11) About 14 or 15, I believe.
Leigh Howle (08:14) Yeah.
Leigh Howle (08:20) Some of these go back to 24.
Michelle Jared (08:23) I want to restart though. Who are the providers? Let me look at those. Oh,
Michelle Jared (08:36) those are all from 20, wait, no. What ones are from 20 24 or are they all from 20 24?
Leigh Howle (08:46) It’s like just the ones down here at the bottom. Yeah, just the last.
Michelle Jared (08:50) Three. So, who are the providers? The last three providers on that list?
Leigh Howle (08:58) Oh, last three… Deborah, kopit, Michelle, singleton, and Eric Carlson.
Carol (09:06) I didn’t request those is.
Michelle Jared (09:10) Michelle singleton? Still here?
Carol (09:13) She is, I think so.
Carol (09:27) Let’s see this?
Michelle Jared (09:31) Is for Pennsylvania, And this is keystone, right? Yes.
Michelle Jared (09:42) So, she’s… showing, yeah, non par. So that one needs to be restarted. Yeah. Or will that… reset the… or… is that going to age back to 20 24?
Leigh Howle (10:04) It ages back, it doesn’t reset.
Michelle Jared (10:07) Yeah. Let’s Carol, let’s request a new enrollment for that one? Okay? Debra kopit?
Carol (10:19) She’s a radiologist? Okay? So, keystone first, they don’t enroll radiologists or behavior health providers that’s why they were stopped?
Leigh Howle (10:34) Yeah, I.
Michelle Jared (10:34) know. I was like, why are they stopped?
Carol (10:36) Yep.
Carol (10:43) So, the ones that I requested was March the 20 third of this year. And, yeah.
Michelle Jared (10:53) So, those, sorry, it was Michelle singleton, Debra kopit, and who was the other one?
Leigh Howle (10:59) Eric Carlson?
Michelle Jared (11:01) He’s mfm isn’t he, yeah, he is.
Carol (11:05) Yes.
Michelle Jared (11:06) So,
Michelle Jared (11:11) why was that one? Stopped?
Michelle Jared (11:25) And he’s not a new provider either,
Michelle Jared (11:33) He’s already got like he’s got keystone… first. He’s… active… for market street and crescent boulevard and mainline perinatal?
Leigh Howle (11:55) Okay. So, this one’s fine.
Michelle Jared (11:56) Well, who? Yeah. Yep. Yeah. So, don’t restart those three bottom ones, just all the ones up above it.
Leigh Howle (12:08) These go back to July 25, I think.
Carol (12:12) Those were duplicates… that we had to stop for cling, because I remember that one?
Leigh Howle (12:24) Okay. There’s three for her, keystone first, CHC, and then keystone first managed medicare medicaid.
Carol (12:34) Yeah.
Leigh Howle (12:37) There was a ticket. We.
Carol (12:39) had to stop them. They were duplicates because I did a buck demographic. Okay.
Leigh Howle (12:46) Let me look at these 23 processing. Are these demo? Okay. These are, and these are all client owned? Oh, good. Okay. Yep.
Carol (12:54) That’s the one I requested this month?
Leigh Howle (13:00) Yes, March here, they are, And there’s a March twentieth. Okay. And you’re putting notes. So it looks like this is already… a workflow that’s in process because there’s 23 lines you’re already working and there’s one on hold. What’s this one? Ashley powers… sure. It’s blocked by keystone first pa,
Leigh Howle (13:46) Looks like there’s a medicare advantage line… of business… and… keystone first is blocked by keystone first.
Leigh Howle (14:04) This is medallion owned… is she enrolled?
Carol (14:11) She should?
Leigh Howle (14:19) Sorry, I didn’t mean to spend as much time on keystone. So, yeah… it does show her enrolled 11, 325 with medicare medicaid. And she’s got several… practices here. So, three four.
Michelle Jared (14:39) She’s probably missing a location. If you open up the one with four there’s. The eagle view. Yep. That’s a new location. So, I bet that’s what those were for is to add eagle view.
Leigh Howle (14:56) Okay. So, then, do you want me to make this one client owned? Yep.
Leigh Howle (15:08) This has add downington, Chester county,
Carol (15:13) That’s that new location?
Leigh Howle (15:15) Oh, the new one got it. Okay. And,
Michelle Jared (15:17) I think they need eagle view on one of those lines of business too… or two of them actually, because it’s only showing.
Carol (15:28) Medicare.
Linda Lipschutz (15:30) Oh my goodness.
Carol (15:33) I know.
Michelle Jared (15:34) Well, how did you finally get it to work? Linda I.
Linda Lipschutz (15:37) went online and looked and it said don’t join like put the web address… into the, into your browser that’s what I did. Oh.
Michelle Jared (15:50) My goodness. Oh,
Linda Lipschutz (15:51) wow. And it worked. I don’t know. So I googled it because I was like, what is,
Leigh Howle (15:55) this error… that is, sorry, guys. So, sorry. Oh, that’s okay. We’ve been talking about keystone first. So, no problem. Okay. So Carol, when I make this client owned?
Carol (16:10) Right.
Leigh Howle (16:11) Here, there may be an option where you can update the location and… because it hasn’t been submitted yet, I know. Oh,
Carol (16:22) okay. On.
Leigh Howle (16:23) Medallion’s side that account managers can make updates to locations and lines of business pre submission. So you might can add it. If not, then you would, you know, request a demographic update, okay?
Carol (16:36) Under Axia, okay?
Leigh Howle (16:39) Yeah. Okay. All right. So, let me add this to the agenda. Okay?
Leigh Howle (17:02) All right. And then for intergroup in New Jersey and Pennsylvania, there have been some requests, and there is a task note that says to stop those enrollments, the payer isn’t listed on the final payer list. So, I was just wondering if intergroup is a… payer that Axia is considering getting a network with or if this just should not have been requested.
Michelle Jared (17:38) So, intergroup is no more, there is no such thing anymore. It was an older payer… and some of our, I think some of these came in from modio.
Michelle Jared (17:57) And I don’t know if, like when we’re like adding new practices, if it just got selected by accident, you know, by doing all by… doing the bulk demographic update.
Michelle Jared (18:12) It would be like a provider probably.
Carol (18:21) Yep.
Michelle Jared (18:22) And I don’t know, see if there’s any information out on dr… Google.
Leigh Howle (18:34) Intergroup robot.
Michelle Jared (18:46) Prime health services. Okay. That is good.
Leigh Howle (18:52) Because prime is already requested. So, I guess when there’s a bulk demographic update for providers, does it give the option to deselect intergroup services? Well, what I’m.
Michelle Jared (19:13) wondering is if we need to go in and change all of these to prime health services?
Leigh Howle (19:22) That could be done with the payr mapping… exercise… because it would match what’s in the directory and the directory would have prime. Yeah.
Michelle Jared (19:36) And there’s 101 existing enrollments. So… okay. So, Carol, if you could just put a note when you go to work on that project that anything with intergroup… needs to be changed to prime health services?
Carol (19:57) Okay. And that.
Michelle Jared (19:59) Way, like if we have to do like add a new location for people you won’t accidentally like pick intergroup?
Carol (20:05) Okay.
Michelle Jared (20:07) Because I think that’s what was happening?
Carol (20:09) Yeah.
Leigh Howle (20:13) Okay. Have you all heard iu health that Greg is saying as of one, 125, they’re not adding providers to the group contracts. They’re only processing demographic update… yes.
Michelle Jared (20:29) Yes. Okay.
Leigh Howle (20:30) Okay. We.
Linda Lipschutz (20:31) gotta, we gotta have a notice from them?
Leigh Howle (20:35) Okay. So then I think the final payer list should be updated for iu health demos only. Maybe what do you all think about that?
Carol (20:47) Yeah, that makes sense. I do too. Yeah. Okay. Yeah.
Linda Lipschutz (20:51) That definitely makes sense. Because sometimes you don’t remember?
Carol (20:57) So, they’re going through anthem now?
Leigh Howle (21:00) Yes, with.
Carol (21:02) elevant, right? Okay.
Leigh Howle (21:18) Carol, where do you want this added?
Leigh Howle (21:29) Do you want a payer specific note?
Carol (21:36) Yeah, that way and you can, if you could put something in the little, the box over there, see like… K for demo… something like that. Okay?
Carol (22:04) Column K for demo updates.
Leigh Howle (22:07) Okay. Go over a little more. Which one I did add this to? Kay? Okay.
Carol (22:20) I’m sorry, in the box over there… an, a, okay. Do not request demos for yet. Okay?
Leigh Howle (22:36) Oh, let’s just put request demo only. Okay?
Michelle Jared (22:45) But that’s not. Should we put that under the other column because that is not a column we should be looking at typically the medallion, the column C. Sorry?
Leigh Howle (22:57) Oh, you’re right? Yeah.
Carol (22:59) Yeah.
Leigh Howle (23:01) Sure. Already. That’ll work.
Michelle Jared (23:04) Yeah, put it there. Yeah.
Leigh Howle (23:07) Alrighty.
Leigh Howle (23:14) And I, yep, that’s all. Okay.
Carol (23:16) Thank you.
Leigh Howle (23:17) Thank you. Oh, amerihealth so, amerihealth caritas, medicare, I get so mixed up on this because some of the state has a split amerihealth caritas processes medicare in certain counties, and then ibc processes medicare in other counties. Okay? And do you have like a practice location list by county to show which ones should go through amerihealth caritas, versus which ones should go through ibc?
Leigh Howle (24:02) I.
Linda Lipschutz (24:03) don’t we.
Michelle Jared (24:03) don’t, have I’m, not familiar with that at all? Yeah, we.
Carol (24:05) don’t I don’t see any… America?
Leigh Howle (24:26) Okay. Here’s, ibc. They are saying care centers located in breast hill, Sewell, cherry hill, garden state. So, these are the care centers that are going to process ibc medicare?
Laura Savage (24:44) That’s New Jersey? Oh,
Leigh Howle (24:47) thank you. Yeah. Here’s, pa. Okay. Medicaid there’s, the counties for medicaid, a mayor health care toss only requested for solo or counties listed in column B. No behavioral health payr uses magellan. We talked about that one should enroll with magellan?
Leigh Howle (25:18) I will try… to list the medicare, so, Lee.
Linda Lipschutz (25:24) I’m sorry. So, you’re trying to determine medicare products in which counties in Pennsylvania, yes?
Leigh Howle (25:35) For a mayor health care toss, right?
Linda Lipschutz (25:37) Okay.
Leigh Howle (25:41) Bucks this.
Linda Lipschutz (25:43) Says bucks, Chester, Delaware, Montgomery and Philadelphia.
Linda Lipschutz (25:51) Okay. Thank you. I’m looking online now.
Linda Lipschutz (25:59) So, like different plans are offered in different county. You know what I mean?
Linda Lipschutz (26:07) Like the dual eligible special needs plan is like in the Philadelphia area, the bucks, Chester Montgomery.
Linda Lipschutz (26:27) That’s what I’m seeing here. Okay? And I’m thinking.
Leigh Howle (26:38) Denise, is,
Linda Lipschutz (26:40) it Denise that helps us with that. Carol… doesn’t she also, Denise montalva, doesn’t she also do a mayor health care toss?
Michelle Jared (26:50) No, that’s Angela williams?
Leigh Howle (26:52) Oh,
Linda Lipschutz (26:53) okay. They should be able to tell us to confirm it, right?
Leigh Howle (26:59) They should, yeah.
Laura Savage (27:03) Angela does care toss too. Huh? No. I was just thinking I didn’t know. She did care toss if you too, I.
Linda Lipschutz (27:11) Didn’t think so. Either. I thought it was Denise montalva.
Leigh Howle (27:15) But Denise is… let… me look at that. I.
Linda Lipschutz (27:21) Know, I know she is.
Leigh Howle (27:23) He’s done first.
Linda Lipschutz (27:25) Yeah, but she sends messages from a mayor health care toss. So I think we should confirm.
Leigh Howle (27:32) She does. Yep. You’re right? She?
Linda Lipschutz (27:34) Does send messages from them. Yeah. And I thought, I remember her saying she handles that also. Yeah, I could be wrong, but I’m just, no, you’re right? Because they, yep.
Leigh Howle (27:46) Because they do respond to my emails.
Linda Lipschutz (27:48) They do, and they send secure emails from a mayor health care toss. Yeah. So, I think because it’s a medicaid managed, medicare product, I think that’s why, for the chip. Yeah. Yep. So yeah, we can confirm, we can ask, but that’s what I’m seeing online. It’s probably accurate, you know, but always good to confirm.
Leigh Howle (28:13) Okay.
Laura Savage (28:14) So, Carol.
Leigh Howle (28:15) Would you mind to email Denise montalvo and just confirm which medicare counties and medicaid counties they serve. And then once this is confirmed, we can list the practice locations that are in those counties. So that when you make the request, it will be specific to those locations. Okay. Working on it right now?
Leigh Howle (28:55) Okay. Geisinger is only in pa, for Helen furio with the payer, there were some geisinger requests for New Jersey… and she said they’re only in pa… so these lines were stopped. So any, I guess that’s kind of where this came up pay a request with stopped lines or tasks questioning… requests.
Leigh Howle (29:33) So… geisinger only in pa?
Leigh Howle (29:48) It does have it in. So the final payer list does have geisinger in New Jersey… right?
Laura Savage (29:57) But I think we only request by like for a special request unless there was a demographic update for one that was already existing. I’m trying to think because it’s only Rei? Providers.
Linda Lipschutz (30:10) yeah, no, you’re right? Laura.
Leigh Howle (30:21) So, who was this for the team? Just told me that Helen furio with the payer had emailed back and said that geisinger is only operating in pa, and so there would have been a task out on this to stop those lines.
Leigh Howle (31:05) Yeah. Here’s, 14 stopped 12 completed.
Leigh Howle (31:13) These go back to 20 I’m.
Michelle Jared (31:15) looking on our old documents, like why do we have this listed?
Laura Savage (31:25) And I’m trying to recall because I do remember recently seeing a provider that did have geisinger. So, I was like, there it is because I never see it. You know, I’ve never really had to request it or I don’t receive anything from them, but I did come across a provider and so I was like there is an enrollment for geisinger?
Michelle Jared (31:46) Yeah, we have a New Jersey contact too, Melanie, bojakowski.
Leigh Howle (32:03) Yeah. I do see her contact information on the project plan and it is listed in New Jersey under commercial and medicare. Did they change their coverage… area and have they exited? It almost seems like they’ve exited New Jersey and they’re only operating in pa now.
Michelle Jared (32:47) It says it’s not primarily available as a standard commercial insurance option in New Jersey because it’s based in Pennsylvania. However geisinger provides coverage in New Jersey through specific channels. So, medicare.
Leigh Howle (33:04) Aco, some.
Michelle Jared (33:08) Geisinger plans offer coverage for care through affiliated regional campus providers in southern New Jersey. And sometimes they partner with cigna for coverage outside their primary service area.
Leigh Howle (33:28) Laura, would you mind?
Michelle Jared (33:29) So it covers counties in northeastern and central Pennsylvania and southern New Jersey. So.
Laura Savage (33:36) I think that’s where we have the south fertility because it’s Lauren weissman, Omar kuzbari, Peter van deerlin, Stephen son, all of our fertility providers in the south are showing par with geisinger.
Michelle Jared (33:51) How about dr, o’flynn, she’s in south jersey.
Laura Savage (33:56) Let’s see. I see the radiologists, I see a couple radiologists, no, no, that’s Flynn, but I think it’s only fertility.
Michelle Jared (34:09) Yeah, it does have that note on here. Only Rei, providers are linked. We can link others by request.
Laura Savage (34:17) So.
Michelle Jared (34:18) Rei, is the reproductive endocrinologists.
Michelle Jared (34:27) So, this should only be… for fertility… and southern, I would put a note in there too about southern jersey… seems to be.
Michelle Jared (34:48) Like an area specified… or something?
Leigh Howle (34:57) Okay.
Michelle Jared (34:59) So, I guess.
Leigh Howle (35:01) Then they are in New Jersey, but only in the certain region.
Michelle Jared (35:06) Yep. So if you go back to what’s been, are they on hold or what were they? Well, these, are they’re.
Leigh Howle (35:15) unstopped. Yeah, there’s this goes back to October. These are stopped. Well completed. So, if.
Michelle Jared (35:22) we look at the names though, I just want to make sure they’re not any of the fertility providers.
Leigh Howle (35:28) Sarah pacman, yeah.
Laura Savage (35:31) She’s on FM, yeah.
Michelle Jared (35:34) Rupa, Patel’s, radiology… haslett, she’s at isn’t she at premier?
Laura Savage (35:42) She’s at premier, yeah.
Michelle Jared (35:44) Oh, no, riverview, oh, riverview, Ellie, Donovan, yeah, I think everybody else is okay?
Michelle Jared (36:01) She’s onecare which closed?
Laura Savage (36:03) She’s returning, yeah.
Michelle Jared (36:07) Yeah, but I don’t think she’s going to be in the southern, oh, no, no, region. Yeah. No.
Leigh Howle (36:14) Okay. All right. So, this is good.
Laura Savage (36:33) Quest. Requested?
Leigh Howle (36:35) In Pennsylvania, the payer isn’t listed on the final payer list. Network is closed.
Michelle Jared (36:41) Quest, it’s behavioral health. I think they’re the ones that, are they the ones that are stopping?
Linda Lipschutz (36:52) Yeah.
Michelle Jared (36:53) Yeah. So they’re as of December, they’re no longer going to be providing behavioral health benefits. Yeah.
Linda Lipschutz (37:06) Yeah. And I think, Michelle, like, I think something was processing, but other there?
Leigh Howle (37:12) Was maybe?
Linda Lipschutz (37:14) I don’t remember. We looked at a couple of providers. There was some differences like, I don’t think, I don’t know if they’re really going to process or not.
Leigh Howle (37:31) Bye. Here we go here’s. Three, Lauren montalvo, Tiffany, Russell, and Shamika, roan, two have client tasks.
Leigh Howle (37:51) These go back to… December and February… should these be stopped?
Michelle Jared (38:05) So, you guys called and confirmed they’re no longer enrolling providers?
Leigh Howle (38:13) Payr isn’t network is closed. Is what we’re being told?
Michelle Jared (38:18) Okay. Yeah, I would stop the three of them and I’ll just put a note that I need to just let them know that we can’t enroll anybody. So hopefully they’re… do we have anybody who is enrolled? Did we get anybody through?
Leigh Howle (38:45) let’s go to enrollment and look under existing link care as.
Leigh Howle (38:55) Yeah. What is this one too? It looks like eight or nine providers under link care?
Leigh Howle (39:14) Do they individually contract providers?
Michelle Jared (39:20) Yeah, because we don’t have a contract. Yeah, yet. We were working on that. And then we got the notification that they’re completely stopping operations. So I’ll just let link care know that the providers who are in, is it we?
Leigh Howle (39:36) Can’t enroll?
Michelle Jared (39:38) Anybody else and I’ll let them know that. Okay. So, yeah, the ones that are in progress should be stopped, okay?
Leigh Howle (39:59) Thank you. Let me just say the network is closed.
Leigh Howle (40:22) Oh, I can definitely get in touch with merit and ask… her to send the credentialing audit over to you the template.
Michelle Jared (40:33) Yeah, that would be great. And we did have our first, we had our kickoff meeting with horizon. So they’re going to be sending the pre delegated audit… requirements and what we need to do by the end of next week. So we’ll be getting that started.
Leigh Howle (40:56) Awesome. So do.
Michelle Jared (40:58) we need to meet with merit or anything or what? Like, what is the process?
Leigh Howle (41:04) Yeah. So if you, just, if you email me everything over that they’re sending you, I’ll send it over or you could, you know, CC her and I’ll send it into, the Axia, we have like a communication channel that every so Molly’s in the loop and everybody’s aware of what’s going on with this and the progress that gets made on it. So if you’ll just email everything to me, I’ll get it to her, find out what is needed and send it back to you. And, yeah… and I’ll ask her to send over the audit template. I’ll let her know the pre delegated audit information is coming next week. Okay?
Leigh Howle (41:54) And this kind of is a really good flow into George Spencer, Selena, bartleson, Andros for the two providers that have a financial info section under their profile. So, you know, how we talked about quest individually contracting providers earlier. So this is a new field and the section is only visible for providers who have a PE service request to enroll as an individual without group affiliation.
Michelle Jared (42:22) Why would we ever do that? I went?
Leigh Howle (42:26) Through all of George Spencer’s enrollment requests. And I cannot find any indication on the payers of how this request is in the platform… and.
Michelle Jared (42:41) Selena bartleson is also, we would never enroll individually.
Linda Lipschutz (42:46) Right. We wouldn’t do that.
Leigh Howle (42:48) I know. So I got in touch with our tech team and said, like, how is a payer identified? That has a request as provider without a group? I’m trying to identify if like prime in our directory or in the enrollment request itself, there is not an option because when you go in to put that request, it has, you know, the tax id for the group, it’s got the group npi number, the group location. So I’m trying to just get a little more information on these two providers. Okay? I just, so this is kind of the why behind, the field here.
Michelle Jared (43:42) Okay. So more to come on that?
Leigh Howle (43:45) Yes.
Leigh Howle (43:58) And on Lauren montalvo, the Aetna medicare for New Jersey is also pending the Aetna commercial line. So the commercial line is still in process. I checked the following… yeah, all.
Laura Savage (44:14) Right. Let me see. Yeah, because I looked and I, they did release the hold for the other medicare’s but that one wasn’t I thought maybe it was because it wasn’t a standard payer name, like there was an issue with that. Ah, the Aetna is still on hold. Okay?
Leigh Howle (44:29) Yeah. And, I checked her caqh, it has the medicare ptan listed in there, you know, and Aetna, I checked the Aetna application. There’s not an option for lines of business on the Aetna application, the online submission. So, you know, it’s if they do add the medicare line of business, then the line will just be completed. But if they don’t then an Loi will be submitted requesting that it be added. Okay. Ibc, that one should have gotten put back into process, that’s what I thought too. So I did request the team to go ahead and move forward with ibc. And then same thing that Aetna That’s kind of commercial… thank you for the crystal Coleman heads up. So I did request that these lines get stopped. The team reached out to me and they were starting to work them and I was like, you know, I thought because she was reactivated her, I thought most of those enrollments would be completed if she were credentialed or, you know, under her previous tax id. So I did let them know to go ahead and stop those lines. And if you need to make any new requests, that should be fine.
Michelle Jared (45:52) Okay.
Leigh Howle (45:57) Oh, my goodness. Yes. What? Yep. So if.
Michelle Jared (46:02) you go to like our group… our practices and click on like click on groups and then click on New Jersey.
Michelle Jared (46:28) And go to practices. They’re all intermixed again. I fixed them all before and now they’re all mixed up again.
Leigh Howle (46:38) Okay. I’ll revive that tech support ticket where this was submitted a couple of months ago and just tell them they’re back again and they were removed. So there needs to be an investigation on why these keep getting added back in and then some type of solution to… that root cause.
Leigh Howle (47:11) So, weird. I don’t know if it has anything to do with providers with requests, but even though… it’s the same tax id, it’s a different npi number. This is very strange.
Leigh Howle (47:58) Sorry about that. Michelle.
Michelle Jared (48:00) That’s okay. Just need to have it stop happening and figure out, yeah, what’s going on with that?
Leigh Howle (48:09) Yeah, for sure. I know we saw, yeah, go ahead. No.
Linda Lipschutz (48:14) I just had something that waivered prescription med that’s… showing up as overview tasks. And I thought that your email said that we weren’t we wouldn’t have to worry about those.
Leigh Howle (48:33) Yes. So, so.
Linda Lipschutz (48:36) There’s a bunch of overview tasks for providers with those. Wow. I’m sorry, not overviews. There’s a bunch of profiles. My mistake. There’s a bunch of profiles that are now listed as incomplete, citing that as I don’t know if there’s related overviews to be honest with you, I didn’t look, but I know for sure that there’s providers. Okay? I think Spencer might be one of them. But, yeah. So we started going through it because we keep seeing the incomplete profiles growing and I’m like why is that? So then when we looked, we’re seeing this is an issue.
Leigh Howle (49:22) Yes. So, I spearheaded an initiative with our epd team on having almost all of my clients are the ones that have talked to me about this and said we don’t offer mat, we don’t offer gender affirming treatment. This is not, this should not be a requirement for any of our providers. So now.
Linda Lipschutz (49:44) It’s.
Leigh Howle (49:46) kind of grown into all engagement managers would ask all clients to determine who offers this versus who doesn’t so I did put in a request for Axia and other of my clients not to have this activated. So, I think that epd is wanting to do it like in a bulk like… functionality update so that it would encompass all clients. So you can just like for now, you know, if you want to go in and mark it, no, that’s fine. You can, it’s an automatic no, if it’s not answered. But until the end update gets made in the system by engineering, it is going to show up for providers. And I’m still trying to kind of work through our can. Axia and my other clients just go ahead and have this activated as like removed from the org. And this… was, yeah. So I’m still working on this one. Does that help answer your question? Linda? So not.
Linda Lipschutz (51:05) Exactly. So what should we do nothing until we hear from you?
Leigh Howle (51:09) Yeah, it’s totally up to you. So if you want to go in and have it be 100 percent, it can be, no, you can just mark it as, no. I am working on like a broader fix.
Linda Lipschutz (51:20) What do you mean? Mark it as? No? I just want to make sure I understand.
Leigh Howle (51:30) So in, I’m looking at Sarah Spencer right now under her provider professional information, under the provider profile, when you go down to the bottom, it has the two questions that have now been asked and it says one missing field, it blocks one enrollment. So if you just click the little pencil and go in and do, are you a waivered prescriber for mat, treatment for opioid use disorders, you could just mark it as no save. Oh, okay. Yeah. Same thing on the gender affirming treatment. So this is like a workaround to move these forward and like for broader a broader fix, you all are on the list to have this turned off at the org level?
Linda Lipschutz (52:19) Okay.
Leigh Howle (52:21) And I don’t know the timeline on when that will be implemented. I’m working on it. Okay.
Linda Lipschutz (52:29) Yes, that answers my question. Then I’ll go in and mark them as no. So at least they fall off our list.
Leigh Howle (52:36) Okay. Thank you.
Leigh Howle (53:09) I will update you on the chat. Okay? All right. So.
Laura Savage (53:13) I know we.
Leigh Howle (53:14) Have a few minutes. I do have the opsync deck and I’ll email this out as well.
Leigh Howle (53:27) So consistently seeing a decrease in the outstanding enrollments which is great. Last week, it was at one three this week, it’s 98. Same thing with the 90 to 120 decreased by seven this week and client tasks are going down. So those went down by about three. So this is really good. We have 576 that are processing in the zero to one 30, zero to 30 day and these are qc’d. So I would anticipate these if they’re new enrollments to be completed before it gets too far into the 90 to 121 50 status time frames.
Laura Savage (54:16) Do you know what the 78 are still in… that bucket? I think wellcare is in there?
Leigh Howle (54:23) I do. Yeah.
Laura Savage (54:25) Actually, Leah, I had a question for you on wellcare. I was, I wanted to set up that, talk to Yvette and Joyce about setting up a meeting, like we talked about, our last meeting. But so when I was going to, I was going to reply to Joyce’s email. She said that she would love to set up a time to set up a meeting for any new requests, but anything before one one would be handled by Yvette. But since then we did submit, resubmit all of the… older applications to Joyce, right? Because she requested that they be submitted as a different way. Like before, I think it was on PDF. Yvette had everybody do PDF, but then they had them switch over to the rosters, right? So Joyce would essentially be the one to handle all of them at this point because they were all resubmitted to Joyce the way Joyce requested I.
Leigh Howle (55:26) Don’t know if we could say, all, okay, there, there may be some that were processing… that.
Laura Savage (55:37) Are in process? Yes?
Leigh Howle (55:39) Because I know Yvette had given us status updates for enrollments in. So I’m.
Laura Savage (55:50) not.
Leigh Howle (55:50) sure how, they may have some type of internal reporting that would separate out which providers are theirs? Okay? If Joyce, if we could just get some kind of meeting on the books and then just ask her, but yes, I would say the majority of those are under Joyce? Okay?
Laura Savage (56:09) Okay. So, I’ll just, I’m gonna email the both of them, for them to, because the way Joyce put it was like for all new requests. So I was like, well, I think she’s okay. Yeah.
Leigh Howle (56:21) They were new. They were considered new on the roster. Okay. Yeah, perfect. That will knock out a good portion of these. So the 46 for the well care community health direct is four. There’s some smaller ones that come in that count in that total 90. Was it 98?
Leigh Howle (56:43) So… abh, New Jersey and better through buckeye. So this is the list of those payers. I do have a hard stop here in just a minute. So I will send this deck out. This was another good news for the follow.
Michelle Jared (57:13) up. So.
Leigh Howle (57:14) Everything is current. This is the lowest it’s been in the last few weeks.
Leigh Howle (57:19) It’s 12 at zero to seven that are overdue. But everything else is current. So 890 lines are current.
Leigh Howle (57:30) It’s great. Yeah, yeah, awesome. All right. Well, ladies, I appreciate your time today and I will send the deck out and a recap, and yeah, just keep me updated, Michelle. I’ll look for the delegated information coming over from horizon and I’ll get in touch with merit about sending over that audit preview sounds.
Michelle Jared (57:54) Good, and add Signa to the list too. We just got word that kickoff meeting’s being worked on as well. Okay?
Leigh Howle (58:03) Awesome. I will put that on the list and let her know. Fantastic good news. Have a great week. Everybody. Thank you.
Michelle Jared (58:11) So much for being flexible with rescheduling. Yes.
Leigh Howle (58:14) You’re welcome. Yes. Totally. All right. Bye bye.