Transcript
Kristen Hanly (00:00) oh, my mom, mute. Hi. How are you? Good. How are you? Doing? Good. Thanks, Jeanette’s. Coming. We just, we were on a call and we looked at the time and we’re like, my God, we’re late. So, I apologize.
Amy Barfield (00:10) No, you’re fine. I understand. I was coming off of a meeting myself. I feel like that’s all I do is I’m in meetings all day.
Kristen Hanly (00:18) Yeah. Seriously, that’s how last week was like that this week. It’s like, how are you supposed to get anything done? I.
Amy Barfield (00:25) know, I know, I’m working like 10 12 hour days. It seems like.
Kristen Hanly (00:30) Yeah, I’m in the same boat.
Amy Barfield (00:31) Yeah. So I saw your email about John Hopkins and I don’t have any requests for priority partners. So, is that what that’s through?
Kristen Hanly (00:45) So, we.
Janette (00:46) I.
Kristen Hanly (00:46) was always told that priority. So, MD priority partners is the medicaid of johns Hopkins. So, and then, so when we request johns Hopkins, it’s for like everything.
Amy Barfield (01:00) Medicaid line of business. Yeah, or it’s, for everything.
Kristen Hanly (01:05) It’s for everything. Okay? Like we’re supposed to. I think it’s like Jeanette would know more because for the medicaid portion, we had to request for each of the unique npi numbers, like the individual npi numbers for the group, like linking the providers to each of the facility ones.
Janette (01:28) And we.
Kristen Hanly (01:29) had to like do that differently… but I’m pretty sure that that’s what that is.
Amy Barfield (01:39) So, I have, let me see where she is. You don’t do medicaid. So they’re only medicaid and medicare. Is this for this is for Delaware Maryland?
Kristen Hanly (01:57) This is Maryland.
Amy Barfield (01:58) Maryland.
Amy Barfield (02:04) I don’t have any matches here… priority partners?
Amy Barfield (02:19) I’m just trying to get it to where… Maryland our team is requesting the right… based on your request. Yeah, it does say John Hopkins health news. Okay. She’s joining now.
Amy Barfield (02:47) Hey, Amy. Hey, how’s it going good?
Janette (02:50) I’m so sorry, we were late.
Amy Barfield (02:52) Oh, you’re good? You’re good?
Janette (02:53) I wasn’t you know, I clicked on the other one and it kept saying that meeting was at on Friday. It was so weird it wouldn’t pop up.
Amy Barfield (03:02) I mean, we’ve had one before on Friday, but not that one.
Janette (03:06) Yeah, I don’t know why I was doing that. I don’t know. Okay, it’s hard sometimes.
Amy Barfield (03:11) What can medicaid do for business? Okay? I was just talking to Kristen about John Hopkins, how those are the medicaid lines of business, gets you approved for the priority partners mco… so that I can direct that to my team appropriately. Okay? So, we have a few things to review today. We were going to talk about sunshine health and the five locations needed for providers that are against your Ar. And you had mentioned something about, you have 98 percent approved on your roster, let?
Janette (03:52) Me send you that. Did I send you the sunshine roster? I?
Amy Barfield (03:56) Thought you did let me double check because I don’t want to lie to you.
Kristen Hanly (04:01) And I’m just letting you guys know. I do have to hop at two 30 because I have another call, so.
Janette (04:05) I’m just letting you guys know, okay?
Amy Barfield (04:07) Is that that’s in eight minutes my time or our time? Okay?
Amy Barfield (04:18) I’m pulling up the rosters right now that you sent me?
Janette (04:28) And you just needed that, why can’t I open any of my files? I don’t know what’s going on here.
Amy Barfield (04:35) Sunshine? Okay. Sunshine, Florida, yes, you sent me… is.
Janette (04:45) It, are we talking about PMP of Florida or is it nightlight? I can’t recall now?
Amy Barfield (04:53) It looks like nightlight is the only one that’s on this roster.
Janette (04:59) Because you need both.
Amy Barfield (05:01) I only have nightlight.
Janette (05:05) Okay. So, let me send you, the PMP one, hold on.
Amy Barfield (05:38) I’m sure he’s fine now. Yeah, that’s wonderful. Wait.
Amy Barfield (06:03) Okay. You’re going to send me that roster… and then, the second part of that question is location. So they only, they will only put five locations in the directory. So we can only request five and I think with one and that I think that’s overall between the two tax id numbers. So, are they practicing at all locations or are there not?
Janette (06:33) But it’s always safe for us to credential them at all the locations because we don’t know if they’ll do the, you know, telemed visits or anything like that?
Amy Barfield (06:45) Yeah. But.
Janette (06:48) There’s some providers that won’t ever travel, to a different location. So, yeah.
Amy Barfield (06:53) They won’t see more than five. So I have to, I want to be able to narrow it down like when you’re making those requests that you’re only requesting your top five because, they just send it back that they want to prove it. Because we need to know which five of the ones that we’ve requested. And I don’t want to make assumptions on those locations. And then that provider doesn’t even practice there, you know, So if you want, I can send you a list of what providers we have requested or you can review.
Janette (07:42) I just sent you the PMP, the south Florida one. Okay. And you said you had the nightlight one, right?
Amy Barfield (07:49) I have the nightlight. Yeah, they block him. Oh, man. This is… thank you. Trying to open and see what I have for them right now.
Amy Barfield (08:31) So, I’ve got ambetter from sunshine and then I have sunshine health. Yeah.
Janette (08:37) So, ambetter, there’s no product in nightlight for that. So that won’t apply to them.
Amy Barfield (08:45) Okay. So any, that might have those requested, we can stop.
Janette (08:51) For nightlight, we shouldn’t have any. Okay?
Amy Barfield (08:55) I’m just asking if I find them or run across.
Janette (08:57) Yeah, no. If you do. Yeah, absolutely. We shouldn’t have any.
Amy Barfield (09:03) Sunshine. And… then.
Amy Barfield (09:12) Let me just look report.
Amy Barfield (09:21) What we have total. So we have a 64 requests total, and it looks like we’ve got some client needs attention. Oh, those look like they’re in the intake. So those are probably recently requested, but on those locations… double check… no… they’ve moved things around on me. So, a lot of them have three locations, but there are some that say 10 locations, nine locations on any of those that have like Nina Fitzgerald is a prime example.
Amy Barfield (10:05) She has sunshine health and Anne better from sunshine. She’s got nine locations with one and three with the other. We would need to know the,
Janette (10:13) five locations. Can I see your screen? Yeah. All right, guys. I’m going to hop Amy. It was nice seeing you. Yes, good to see you. I’ll see you next.
Amy Barfield (10:23) Week, I’ll see you next week. All right. Bye talk.
Janette (10:25) Later, bye.
Amy Barfield (10:26) Okay. Bye. We share screen. This is my view, but you’ll be able to see the same thing under practice locations, you can see. Can you see my screen?
Janette (10:41) Not yet. Okay. Now, I can. Yeah. Okay. So under.
Amy Barfield (10:46) Practice locations, you can see like nine, three, three, three. And so like Nina here has these two and there’s nine and three, we would only be able to request five.
Janette (11:06) One of the locations lists away, go back over there, hover over it.
Janette (11:14) So, you see all the ones there’s like three offices that have closed there too.
Amy Barfield (11:21) Okay. Is that reflected on your practices? I see this one shows closed, but you can, these are coming over from the group. So if they’re closed practices, we need to.
Janette (11:32) No, no, no, those are fine. Okay. The oak ridge location, I don’t see it requested there. So that’s good. So there should only be eight, okay?
Amy Barfield (11:43) Right. So, if we eliminate this one, let’s see. That was March the third 20 26. So, I think this request was done prior to that. So we would think, oh, we still need to add this location, but you’re saying we don’t… because I wouldn’t know if there’s any open Ar with this location.
Janette (12:08) So… which, so I’m trying to figure out because for nightlight, those… providers should already be on the roster… except Nina Fitzgerald. I don’t even think she worked ever worked at, nightlight before… unless she did telemedicine. Okay. So I.
Amy Barfield (12:34) mean, these are the types of things we would need to know because we don’t want to waste our efforts enrolling them if they’re not even practicing at those locations or under the group level, that would help us clear out a lot of these aging requests. Okay. Yeah. All right.
Janette (12:51) So, I’ll send an email now to have, Renee work on it. She’s the one in charge of that location. Let me just put that, okay? Locations?
Janette (13:05) Can you hear me to hear the nlp… locations? And so.
Amy Barfield (13:16) I have… and we’re going to stop.
Janette (13:27) Also.
Janette (13:36) Patience.
Janette (13:42) at any time… so… and,
Amy Barfield (14:23) said only sunshine hell. So we have this and better under nightlight right here.
Janette (14:32) You have and better requests on the nightlight. We.
Amy Barfield (14:35) Have one, I’m checking the other page to see if there’s another one anymore. So we just, we have two and betters under nightlight.
Amy Barfield (14:54) So, you’re good for me to stop those? Yep? Okay… one and two.
Janette (15:19) Work management task. Okay. All right. Done. I just took care of it. Okay?
Amy Barfield (15:26) Let me see if I can stop these.
Janette (15:54) There was one I sent you this morning that I thought you took care of and it came back and recircled. So I,
Amy Barfield (16:00) said asking you excuse?
Janette (16:02) Me about it. Okay. Look at that here in a second.
Amy Barfield (16:24) Oh, my system’s been so slow. Okay? There’s that one and then this one.
Janette (16:31) So, where are you staying when you go next week? I’m staying near laguardia airport.
Amy Barfield (16:36) Okay. We’re staying at? Oh… it’s a weird name. I’ll have to look it up.
Janette (16:47) Yeah, I finally booked it, and I’m staying at this hotel that my son stayed in when he goes to New York called aloft.
Amy Barfield (16:56) Okay. I’ve heard of that, but that’s not the one that we’re staying at. Yeah, how long are you staying? Just the two days? Yeah, same, we’ll leave Thursday morning. So… yeah… okay. Those are stopped. Do you know if ficus will be joining us or he lives in that area? Doesn’t he?
Janette (17:20) I don’t know. I honestly don’t know where he lives. Okay? But I think he may be, yeah, because he asked me if I was still going and I said, yeah, I just booked everything. It’s pretty expensive to go out there. Holy cow. Yeah, we.
Amy Barfield (17:38) were able to find a pretty good deal with our flight and hotel. I found something for under 800 altogether. Yeah.
Janette (17:48) See, mine was 1,100. Oh, my.
Amy Barfield (17:50) Goodness. Yeah, yeah.
Janette (17:52) And that was through jetblue. Oh, man. And that was without the car. The car’s another 200.
Amy Barfield (18:01) Yeah, we’re just gonna Uber… but are.
Janette (18:06) you staying in laguardia or are you flying into the smaller airport we’re.
Amy Barfield (18:10) flying into? Let me, let me pull it up here. I think I got it… in my… saying… I think it was expedia is what we did it on expedia.
Amy Barfield (18:38) We’re flying. Yeah, we’re flying into laguardia… she’s coming from Minnesota, and then we’re staying at in, at great neck.
Janette (18:49) Oh, so you’re staying in long island? Yeah.
Amy Barfield (18:52) It’s not far from the… office. Yeah.
Janette (19:03) So, yeah, that’s where we’ll be and.
Amy Barfield (19:07) We’ll be hustle and bustle? And then we’re right back out.
Amy Barfield (19:11) Let’s see. Okay. So you’re going to get that, we closed those that’s the roster that you provided me. And then you said you just email me the new roster?
Janette (19:25) Yes. And I tell you that I did a big project on that. So, when I tell you, it’s probably 99 percent complete. If you find one that’s not on there, it must be new hires. Just let me know. She’s been, really good about working with me and she’s going to reprocess all our claims.
Amy Barfield (19:47) Okay. What? Okay. Let me know if there are any providers not listed on the roster, would you say like prior to the last 30 days or 60 days?
Janette (20:08) Well, I mean, I added the last of the providers to her a couple of weeks ago, but like I said, if there’s any new hires, they probably may not be included in on there. Okay? I’ll say.
Amy Barfield (20:22) 14 days. I can actually.
Janette (20:26) Tell you when I sent her the spreadsheet and that may help to reduce. I probably go back to maybe the last quarter just to double check. Okay? I don’t think it has higher dates on it if you want to look at the roster. But, okay.
Amy Barfield (20:48) I got let’s see higher dates, 10. Okay?
Janette (20:54) Not for nightlife for the other ones, right? I’m just.
Amy Barfield (20:57) But the roster looks the same. I’m just wondering if it has that on here. Yeah. Where’s the effective date network effective date? Okay. Recent effective dates here’s, the start date and the network effective date. They look the same. Oh, some of them are a little bit different.
Amy Barfield (21:30) Okay. So, for, and I don’t even think this abbreviation is correct. This is the health care services of DC.
Amy Barfield (21:46) I think there was a confusion about that. I can find it on him.
Amy Barfield (22:01) Oh, my gosh. Come on.
Janette (22:16) So, before you’re doing that, we had a meeting with ibx today, oh,
Amy Barfield (22:21) perfect. What did they say?
Janette (22:22) Yeah. So I’m going to send you the meeting notes of what we found out and basically to view the providers, the way that you guys want to. Yes, that is that’s still down, they have no idea when it’s going up. The payr portal is still actively working if you want to look at like claims or eligibility and benefits and things like that. So let me send you the notes before I forget.
Amy Barfield (22:52) This.
Janette (22:52) way we, you’ll have it of what I, she had an ask and this may help us because… IBX, maybe IBX?
Janette (23:46) I just sent it to you. Okay?
Janette (24:09) So, she gave us two different links and she said that one of them, you can get the forms if you just want to link a provider that’s actively enrolled with the plan. And then if you do a brand new credentialing, then you would do the other email. Then she said that medallion normally, what they do is they kind of save their contacts and they reach out to the same person. And she said that they don’t do, that their structure is whatever comes into that inbox email. They take the first come first serve kind of a thing. And to that digresses the thing because they’re not going to go back. Whoever’s looking at it. The rep is going to go and… start a brand new research kind of a thing. They open a brand new ticket. They said to make sure that you copy the tickets. So, for the ones that have been pending, when you get the email, if you look at the bottom that list, I sent her, she said that you should not have anything pending over 120 days. If you do, then it has to be escalated to them, and that they would take care of it nothing.
Amy Barfield (25:24) Should be… over 120 days… escalate to who to,
Janette (25:33) my, I didn’t send you the email address. Her name is Lorraine and hold.
Amy Barfield (25:43) On a second. Why is this email not coming through yet?
Janette (25:53) Lorraine Stewart, I’ll throw it in the chat so you can have it. Hold on. Yeah, your.
Amy Barfield (25:57) email with your meeting notes hasn’t come through yet either. Oh, there it is. I spoke too soon.
Janette (26:10) Lorraine Stewart and who’s the other one? Karen… but she, they’re just to be included after, you know, they’ve exhausted their efforts with the customer service.
Janette (26:29) and she couldn’t promise when the thing was going to be fixed. So for now, we have to do it unfortunately that way.
Amy Barfield (26:35) Yeah. I mean, unfortunately, it’s been going on since 20 24. Yeah.
Janette (26:40) She said they don’t know when it’s going to be fixed. What is her name? Karen?
Janette (26:55) Karen, she’s not coming up, but I’ll get you the other one… but she said it delays the process not to have them reach out to the same person that they just have to just create a whole new email thread for it.
Amy Barfield (27:11) Did you get it? Yes. Okay. But she,
Janette (27:16) said that for the ones that are pending, we need the email trail for those specific providers and that she would consider paying us for those claims because they’re, really old. So she escalated it to the director. So, I need those email threads of them reaching out with no answers because I know they did. We’ve done the same thing and it’s just been a chronic problem with them. And she said it’s not just happening to us as well. You know, that it’s down. It’s down across the board. Okay?
Amy Barfield (27:55) So, she’ll work with, to get them approved.
Janette (28:02) Okay. If I could provide her with the email addresses for those specific providers, if you go to my notes all the way at the bottom, I took a snippet of the providers that… I’ve been pending and those are the ones that she’ll put on project. Okay?
Amy Barfield (28:20) I’ll open it back up for some reason. It’s freezing up on me. Come on.
Amy Barfield (28:33) These right here. Yep those providers. You need email communication. I,
Janette (28:39) need the proof of email communication. She has the application submission date. She’s like, I can’t believe, that they kept saying that it’s processing. I said, yeah, that’s all they say.
Amy Barfield (28:51) I.
Janette (28:51) said if you go back to the notes that’s listed, I said including us that we’ve called for status and they just say it’s in process. I said it’s just frustrating that you have something for over a year sitting there and it’s just in process. So she said if we can provide proof that she’ll and there’s a lot of money out there. So this would be a kudos if we can get that money in, okay. Okay. Email.
Janette (29:48) Fucking get her name from the… that’s well, point. Okay?
Amy Barfield (30:09) All right.
Amy Barfield (30:19) Yeah.
Amy Barfield (30:27) Let me get my calendar just in case we go a little bit over. Do you have a,
Janette (30:29) hard stop today? No, they’re my last fee for the day.
Amy Barfield (30:34) Okay. Lucky you.
Janette (30:36) I’ve been in meetings all day today. I’m just like, you know, you’re trying to get work done, and then you’ve got people asking you for stuff. You’re like my God, I know. When do you have time?
Amy Barfield (30:46) I had a gap?
Janette (30:47) Her name is, yeah, go ahead. I don’t know why I thought it was Karen, but I’m sending it to you now. Hold on.
Amy Barfield (30:52) Okay.
Janette (30:56) I just found it.
Amy Barfield (30:57) In chat, you’re going to add it?
Janette (30:59) Yeah, it’s you now. So both of them are high up there with high BX. But if we’ve exhausted our efforts, these are who the people that we see them in the email thread.
Janette (31:25) I don’t know if I told you that we did mail the New York medicaid application. So it’s been mailed, David mailed it.
Amy Barfield (31:34) Okay. Wanted to let.
Janette (31:35) You know that before I forgot. Yeah, he mailed it out on Monday.
Amy Barfield (31:44) Okay. So on that, let me make a note here. Eton was mailed out on Monday. Okay, our director of enrollment is having us close out or approve anything that’s been approved with provider… enrollment because it is a separate issue. And like I told you before, this isn’t something we normally manage. So, how did you guys?
Janette (32:14) Start managing it? Is this something Danielle implemented? Maybe?
Amy Barfield (32:18) I think she… I don’t want to speak ill will, but I think there was a bit of manipulation on her request with the demographic updates as this was like a revalve for Eton. And so our team and this is probably why it elongated because there was a confusion of like what an actual revalve for the provider versus Eton? Because we don’t do Eton stuff. Yeah, you.
Janette (32:43) know they expired back in may when she was here. So I.
Amy Barfield (32:46) don’t know. Yeah, and we didn’t get requests until like late July or August.
Janette (32:51) Yep. I know, I’m well aware. Yeah. So I don’t.
Amy Barfield (32:56) know if she was covering up or what, and that’s exactly.
Janette (33:00) What happened actually?
Amy Barfield (33:01) And I think that’s also like the whole facility approvals where she was like approve these with the facility approval dates. I think that was a way to cover up making these erroneous requests. You know, it didn’t show that she cost the company money, but these are all my assumptions, no.
Janette (33:23) Your assumptions are right?
Amy Barfield (33:25) Yeah. So, so anyways, this isn’t something we typically manage. And so moving forward since you have what you need, our director of peer enrollment has said we’re going to approve, what is our responsibility? And then moving forward, you’ll… be responsible for making sure that the E 10 is approved moving forward. So how do we do?
Janette (33:53) That if we’re we just do it internally? Yeah, so.
Amy Barfield (34:00) You had all the forms. I think I submitted you just a little snippet of like requirements, making sure you review that everything’s there… and then just follow up with the payer on what is needed and what needs to be, if anything is needed and follow up on the status of it. You have the copy of the shipping label. So you should be able to go into usps and confirm that they received it when they received it so that, you know, when.
Janette (34:31) to, so will you guys still create the shipping label for us?
Amy Barfield (34:35) For the E 10, you shouldn’t need to as long as they approve this next, this last one that you submitted… no?
Janette (34:43) No, no. I mean, moving forward that you’re saying, so, I mean, we have so many, oh.
Amy Barfield (34:46) Yeah, for anything payer enrollment related. Yes. But the E 10 issue for us, that responsibility we’re handing back to you… so.
Janette (34:57) And that’s what I, that’s what I’m I just want clarity on a full ownership of it so we can’t put anything inside of medallion to,
Amy Barfield (35:06) request.
Janette (35:06) like I’m just trying to think about the thought process for it because I kind of came in the middle of, you know, when you guys were already doing it, right? Yeah, it’s kind of like this super fidelis thing that I got stuck doing that. She never gave me any guidance on. Yeah. But, so,
Amy Barfield (35:23) we look for.
Janette (35:24) An effective day because we have so many things pending with etns right now and.
Amy Barfield (35:29) Then no new.
Janette (35:29) Etn request. And then we need to create a protocol for it.
Amy Barfield (35:34) Yes, internally… yeah, because we have no way to like manage it track it and our teams don’t submit anything. It’s just like we don’t submit for Edis or eras. The etn is kind of that same thing. It falls in line with that same category.
Janette (35:58) Know when he said it’s going to be effective.
Amy Barfield (36:03) The, the Etan. Yeah, I mean, I think they requested as far back.
Amy Barfield (36:16) Can, I don’t know that was communicated when it would be effective? I just know that we had to resubmit for it because of, the transpose numbers?
Amy Barfield (36:29) Yeah.
Amy Barfield (36:35) I’m.
Amy Barfield (36:53) then trying to pull up… what is that?
Janette (37:00) So, do you think that if I talk to Vikas about incorporating that? I don’t know if there’s any additional charge for that or not because I guess there wasn’t right? Since she just manipulated the whole thing. I.
Amy Barfield (37:12) mean, she, there was a charge… because it was a demographic update… but, it was slid in with change of ownership revalidation for the group, you know, so work was done and completed on each of those lines, but she kind of slid that in with the request… and we just started, we started handling it all a bit because our production team didn’t they just assumed it had to do with the revalidation.
Amy Barfield (37:54) If the enrollment is approved, then those lines will be approved and closed with an effective date of the enrollment. It will have nothing to do with the etin. So… it’s just.
Janette (38:06) a revalidation and then the medicaid applications yep.
Amy Barfield (38:22) I’m trying to remember what this pair is called. It’s like health, it’s a really long name health services… something. DC, it’s a medicaid program. My gosh.
Amy Barfield (38:42) Weren’t sure if they were automatically enrolled. If we made the request on the medicaid side, it’s an mco program. Do you know what I’m talking about with Maryland? Hold on?
Amy Barfield (39:01) Services for children?
Amy Barfield (39:10) CSN? What’s.
Janette (39:15) your question? I’m sorry?
Amy Barfield (39:15) We were going to review like if you had any opening or maybe this is a Christian, Kristen question, I think.
Janette (39:25) Kristen was supposed to look.
Amy Barfield (39:27) into that. Yeah. So.
Janette (39:30) I can, what’s it called health services for children?
Amy Barfield (39:33) Yes, it’s HS.
Amy Barfield (39:42) CSM is the abbreviation for it, it’s… a medicaid program and… I think… there’s we’re trying to figure out if a separate application is needed or not.
Janette (39:57) We haven’t got a.
Amy Barfield (39:58) Response back from the payer. And I think we’ve asked a couple times and not getting clear. And so, we’re wondering if it’s if, when we’re doing medicaid enrollment and it’s enrolling them in this mco, or if it, if there’s like an additional step that we have to do to make sure that they’re on this network like this… HS CSN. And so, if I knew that you didn’t have any open Ar, that you’re getting paid on those claims that would tell me like we wouldn’t need to follow through or these are approved with medicaid?
Janette (40:35) We need to ask her because, I have no idea. I just did.
Amy Barfield (40:39) Though. Okay.
Amy Barfield (40:53) Amerihealth stopped line. So, I got Spencer’s getting really frustrated. I can tell in his support request. He had… requested this one right here and you may have responded. I don’t know. I… know he’s tagging you, but that’s not, following up on your approval. Thank you… approved. Okay. So, he’s telling me that you’re approved. But when they make these requests with our support to stop lines, they either need to come from you or we need to see the approval from you because we have strict orders to only stop lines based on your, because history has shown like they request to stop lines and they didn’t need to be stopped. So, yeah, if Spencer’s confirmed as somebody who can make those decisions, like just let me know. Yeah, no.
Janette (41:55) I’m the only one that’s still approving right now. And, if I don’t respond to it quickly, it’s because I’m researching.
Amy Barfield (42:02) To.
Janette (42:02) make sure that, you know, I kind of just spot check here and there, that there’s no active claims or nothing can happen. You know, with that after the fact that I approve it, but for the most part, I don’t know why they CC everybody on there. I mean, I don’t know if they doing that just to keep a paper trail?
Amy Barfield (42:22) I don’t know. But like this is communicated, it looks like probably via teams or something, or an email, private email, but that’s not.
Janette (42:32) No, it’s an email that they’re sending to support.
Amy Barfield (42:35) Okay. I don’t have you attached to this at all from support. Oh, geez on the first one, this one, that he sent today that I saw, let’s see. He might let me see if he’s got you on this one… on this support ticket?
Janette (43:02) Yeah, I’ll send a reminder out. Yeah. All right.
Amy Barfield (43:05) Okay. So basically, I can close these three. All right. Okay. So, basically, I can close these three… Elizabeth Carey or… Marilyn? Oh, he just took like three different screenshots for these locations. Okay? So, is it your internal process now that you’re only requesting these five locations? So we’re not making these enrollment requests for others, which one I?
Janette (43:37) Can’t see it? Make it a little bigger?
Amy Barfield (43:43) Too big.
Amy Barfield (43:48) Amrara, hell, DC… only the following locations can be enrolled these five locations. But then he’s asking me to close out nine locations for this particular provider.
Janette (44:05) I didn’t approve that, did I?
Amy Barfield (44:10) Let’s see. He sent this as the approval… approved. Thanks, but it doesn’t like specify following up on your approval, and… then it just says you replied or I guess he replied that’s… old though.
Janette (44:35) Let me double check on that to make sure.
Amy Barfield (44:37) Okay. I’m just gonna respond to him. Yeah, he may be.
Janette (44:45) Right. But I’ll double check because.
Amy Barfield (44:49) I know that I.
Janette (44:50) thought for DC was just DC providers that needed to have an active Dea medical state license and a medicaid as well. If they didn’t have one, we didn’t have to do it.
Amy Barfield (44:59) Okay. So… let me ask him, but it’s also just five locations that are, yeah.
Janette (45:07) That’s what I’m asking him now just to double check.
Amy Barfield (45:19) And you are on this email, so send, I just don’t want support to go in and close it based on that.
Amy Barfield (45:32) Okay. All… right. I just.
Janette (45:37) sent it to him and.
Amy Barfield (45:40) Reconfirming, and we’ll notify.
Amy Barfield (45:51) where do we want to move forward with the anthem facility group enrollments? I think… I know we got rosters, but that doesn’t tell us like how you’re enrolled, so.
Janette (46:02) I did get a response from them. Hold on a second, because I’ve been going back.
Amy Barfield (46:08) And forth with them.
Janette (46:12) You know, they, it’s like you ask them five questions that come back with one answer.
Amy Barfield (46:17) I know it’s so annoying you’re like, can you please read the rest of the email?
Janette (46:27) Pnpediatrics of bayside is configured as a mixed billable group, tin group is par.
Janette (46:38) Hold on.
Janette (46:53) The next one was.
Janette (47:01) Ask them another question about this. Hold on, yeah.
Amy Barfield (47:04) I mean, they’re telling us they’re par, but they’re not telling us how like is it facility or group?
Amy Barfield (47:21) Submitting enrollments? They’re telling us that it’s not needed because it’s facility. Yeah, that was my question.
Janette (47:29) On the description need to verify if individual enrollment is required or ancillary contract. And then their response was.
Janette (47:43) Is configured as a mixed billable group tin, slash group is par?
Janette (47:54) Went again on Monday, and it said thanks for the update. Can you also advise if it requires individual enrollment or facility based contract?
Amy Barfield (48:03) Individual enrollment? And which one is that for?
Janette (48:07) Anthem? I’ll send you the, yeah.
Amy Barfield (48:10) But what state New York?
Amy Barfield (48:18) Okay.
Janette (48:27) Ask them to make sure that we were, are with medicaid and we are okay.
Amy Barfield (48:40) Now, for the other states, have you got anything back from them? No. Okay. Do you want to submit par analysis and let us handle that piece or do you want to continue?
Janette (48:55) As long as it’s okay. It’s just one, one answer for them. I mean, yeah, I know. Help me, okay?
Amy Barfield (49:03) If you’ll submit par analysis for the other states that we’ve mentioned prior… then we can get that rolling because I mean, they’re just chomping at the bit they ask me every week. Did you get an update? Did you get an update? So if I have that in there, then they could start running with it themselves. You know, yeah… states again. Yeah… hold on a second.
Janette (49:29) Let me go into this chat really quick and say.
Amy Barfield (49:44) Go ahead. Do you need the?
Janette (49:46) Additional states? Yeah, I don’t need New York since we just confirmed, okay.
Amy Barfield (49:50) Trying to find which ones I may have to email them to you. Hold on. Let me check my email. I know I have an email.
Amy Barfield (50:03) Okay. So.
Janette (50:07) Spencer did reply. Yes, those are the only locations for a myrahoff that will credential other locations are out of the service area.
Amy Barfield (50:20) So, we’re good to stop this.
Janette (50:30) Just that doesn’t help you need to know again if it’s just individual and facility.
Amy Barfield (50:39) Yeah, I need.
Janette (50:40) To know.
Amy Barfield (50:41) So here’s the, do you want me to re, send you this email that’s Virginia, Connecticut, New York. You just gave me Texas and New Jersey, New York, Texas, and I think I already have one for Connecticut. So I just need Virginia, Texas and New Jersey. Okay? And then I’ll let them know about New York today.
Amy Barfield (51:16) Yeah. Okay. For get back up here.
Amy Barfield (51:35) Texas.
Amy Barfield (51:41) Forgot, New… Jersey, Virginia, cal, California was another one Virginia… and.
Janette (51:49) California on my list though.
Janette (51:54) New Jersey?
Amy Barfield (51:57) Texas, New Jersey, Virginia, California. You gave me New York?
Janette (52:01) Virginia, Connecticut?
Amy Barfield (52:03) California.
Janette (52:05) Texas, New Jersey… in the meantime, I’ll open the other tickets like I did with the amount of air, let’s see and see if that.
Amy Barfield (52:13) Helps. Okay. New Jersey, Virginia, California, New Jersey, Virginia… California, New Jersey, Virginia and California.
Amy Barfield (52:29) That is already your question. Okay? Tell me more about this California team deleted. I saw your support tickets and I’m frustrated myself that they’re not giving you what you need. So, was it like an entire team that was deleted from median?
Janette (52:47) So, he’s the one that you helped me with?
Amy Barfield (52:51) Remember the video you,
Janette (52:53) sent me and how you showed me how to do it. Yeah.
Amy Barfield (52:56) Well,
Janette (52:57) he then he was deleted and he was so upset and I’m just like I swear to God, I did it like, I don’t understand. I was the first one that I learned how to do. And anybody else I go back to the video and I watched the video.
Amy Barfield (53:10) Yeah. And so this man?
Janette (53:11) Was just like, you know, he had cc’d like the big guys that I didn’t respond to his request and I’m like, no, I took care of it. So, you know, when I went in there, he was not in there. He was not linked to the group at all. So, I’m just like, okay, well, who went back and deleted it? Because I have so many people that have admin access. I can’t keep track of who’s making all these huge mistakes.
Amy Barfield (53:38) Yeah. I wish we had a better way.
Janette (53:40) And to be honest, you literally have to go in there and remove the. Yeah, it’s like a two or three step process.
Amy Barfield (53:50) Did you create a new team for him? No. What was his name again? David walker?
Janette (54:04) Thing was the other one that they changed the state I’m like who on earth did that?
Janette (54:14) And I really think it’s the access team that’s doing it because I don’t think there’s only three of us left on our side, you know, since Danielle left, it’s Diana, myself and Ashley, and then there’s 16 of them on their side. Yeah. Okay. Let me see. I’ll.
Amy Barfield (54:34) send a support ticket and see if I can, because I can’t even tell if they not a support ticket, a tech support ticket. Okay? And see if they can tell me what… was the team called? Originally Los Angeles?
Janette (54:51) It’s there now, oh,
Amy Barfield (54:52) it’s there now.
Janette (54:52) Yeah… but this is not the original this.
Amy Barfield (54:57) Is.
Janette (54:58) no, that is the original. Oh, it is what they did was deleted him.
Amy Barfield (55:04) Got it. They just went in right here.
Janette (55:06) And went trash, right?
Amy Barfield (55:09) Gotcha. Yeah, because we don’t even get into teams. This is all for you guys?
Janette (55:16) Yeah, whatever. And I mean, I know I did it because I followed the directions. I added it. I was so excited after I did it and, you know, I’ve been doing it ever since you’re like I did something. Yes, you did. I don’t have to go back and ask you anymore. I love those little video stuff that you do.
Amy Barfield (55:31) Oh, I still owe you a video. What was the video that I owed you? Let me see. Okay?
Amy Barfield (55:42) There was a video I was supposed to provide you?
Janette (55:44) Was it there?
Janette (55:53) They also had a, deactivate providers?
Amy Barfield (55:57) Oh, yeah. That’s another big.
Janette (55:59) problem that we have. I don’t that whole thing that happened with CD, New York with them sending all those duplicates. I don’t know how that happened. I went and looked, I have a draft there to send you because I started to look at the providers. I don’t have an answer how they got requested. Amy, I really don’t there’s like, I don’t see a request other than reopening resending, and I don’t know, I just don’t know what else to look for it.
Amy Barfield (56:29) Okay. So, I,
Janette (56:31) think part of the problem is that you,
Amy Barfield (56:34) know, we’re.
Janette (56:35) putting terminated on there, but I don’t know if it just generates a request when it expires or, you know, I,
Amy Barfield (56:46) don’t know.
Janette (56:47) I don’t know what else.
Amy Barfield (56:48) Happened.
Amy Barfield (56:54) They’re getting.
Janette (56:59) We’re getting providers that are terminated for enrollment, but the provider’s already terminated. So, so, rule of thumb when a provider terminates rule of thumb, should be that the first thing we need to do if they’re terminated, is to go back and stop the lines for those providers.
Amy Barfield (57:16) If they don’t have.
Janette (57:17) a plan, right? But if they’re already in process, we can’t stop them.
Amy Barfield (57:23) No, you have to, well, we can stop them… we can stop them in medallion, but we can’t stop them with the payr.
Janette (57:31) Right. So there’s no processing. And then what’s the worst case scenario if we deactivate all these terms, providers like, I know that we keep them there for claims purposes, but, and then Kristen wants them there. But my concern is that a lot of these things are happening is because they’re still not deactivated even though they have a term date on there. Can this rejuvenate? Can this generate requests for licensing requests from the providers? Because I see a lot of automation going out.
Amy Barfield (58:05) Right.
Janette (58:07) It can be for Dea state license. Like I had one doctor that reached out and said, I haven’t worked in Arkansas for, I don’t know how long are they asking me for a license? I said, I don’t know. And then when I sent support a ticket, they said, I don’t see any requests. I said, so where is this coming from? That? They’re asking this doctor for this? Because he reached out to me and said, hey, I haven’t worked in Arkansas and New Jersey for a while, but I’m getting a request.
Amy Barfield (58:31) For it.
Janette (58:32) And I said, I don’t know. So I just opened a ticket with support and support. Said, I don’t find a request. I’m like, okay, I leave it to, I don’t know, what to, you know, what to do here. So, I’m really thinking that it’s because these doctors are not terminated. They’re still showing up active and maybe if we just deactivate all of them, and when we need them, we can reactivate them.
Amy Barfield (58:58) Have.
Janette (58:58) them access because active because they’re processing payr and stuff.
Amy Barfield (59:02) Yeah, they have to be active for us to one receive emails for them, link them to the requests that they’re related to. So like when they’re deactivated, we can’t search the provider at all, even if it’s like, so like, you know, you can go and see like what’s blocking or pending a provider. You can see where there was a line and it’ll say stopped if I click on it and it’s a provider that’s deactivated it’ll come back as an empty field because they’ve been deactivated. It’s no longer in the system.
Janette (59:35) So,
Amy Barfield (59:36) if you fully deactivate a provider, it’s as if they never existed in medallion. So, and nothing will proceed forward. So, is.
Janette (59:48) there any way that they can do?
Amy Barfield (59:55) That.
Janette (59:55) triggers them that, you know, like an audit report that triggers them that they can’t request anything for this provider because they have a termination date on there. Yeah, I don’t know. I’m.
Amy Barfield (60:07) just thinking out loud. Yeah, I need to ask if there is a term date if provider is active in or not… deactivated but has a term date… automations… correct? Yes.
Janette (60:35) Them emails providers.
Amy Barfield (60:39) Are still getting emails and auto other… are there other automations happening? Like probably like profile updates and things like that?
Amy Barfield (61:00) And then, it should also take away the option to task the provider and… only admin when they’re termed. Yeah, because I think, you know, if they’re termed, they’re not going to be able to sign for anything unless you physically reach out to them. They’re not going to be using this portal anymore. They’re not going to be getting notifications. So like really everything should come through you if anything’s yeah.
Janette (61:33) I think that’s probably why Danielle put the little asterisk and the star in front of the providers because they were not able to identify it. Yeah.
Amy Barfield (61:42) And I will say that our epd, our product team is working because we’ve had a request from other clients to show in medallion somewhere like if you go into your payers to have some kind of like indication that this is a term provider because.
Janette (62:04) We had to remove all.
Amy Barfield (62:05) those stars because it was messing with automation. It was, it was sending requests with that T star. Yeah.
Janette (62:13) And it was getting, it was going that way to the payers as well.
Amy Barfield (62:17) Yeah. So, so they are working on a way to identify like, yes, this provider has a request but they are termed… I don’t know how they’re doing that, but it is something that’s in the works. So, okay. That all that sounds like that. Yeah. And also another ad I wanted to, I don’t know if you noticed this, but in request status, you can see partially completed enrollments now. No… I didn’t know that. Yeah. So if you click partially completed, that’ll show you. So you can notify Kristen or Ar, hey, these are, and if it’s partially completed, it’ll generate in the existing enrollment section, what is completed? So say you have nine locations but only five of them were approved. It’ll generate in your enrollments that those five are approved, but it doesn’t complete the line. Totally that way. It doesn’t hold up you… being able to submit claims on those that are completed and approved.
Amy Barfield (63:26) So, that’s a newer feature. Like in the last couple weeks, I think it will be helpful for you guys too… just to recognize what’s approved and what’s not okay?
Amy Barfield (63:42) Covered everything. I’ll get some tech support tickets out on the California issue, the la, Los… Angeles team… manager deleted. And… then I’ll get a tech support ticket to see if we can do something about these terminated providers.
Amy Barfield (64:13) With the team, okay communication, we’ll stop those. You said, we can go ahead and stop those.
Janette (64:22) Yes, only those five are needed.
Amy Barfield (64:25) Stop enrollments… across the board that have anything outside of those five locations? Well?
Janette (64:36) For that specific state? Yeah.
Amy Barfield (64:38) Okay. But the okay.
Amy Barfield (64:48) You’ll put in a request for Texas, New Jersey, Virginia and California for anthem… Kristen on this health services for children, special needs. Yep… I already.
Janette (65:04) Asked Kristen and I already sent for, the other one. Okay? John Hopkins, the other thing I had was that there?
Amy Barfield (65:15) Was a medicaid?
Janette (65:16) Person that reached out.
Amy Barfield (65:18) Regarding.
Janette (65:21) automated from medallion. And I told her, I wasn’t aware that this was being done if it is.
Amy Barfield (65:27) But,
Janette (65:28) she says she’s getting inundated with calls and that her representative are live. So they need to take like information down. And by the time that happens, they’re already hung up.
Amy Barfield (65:44) Explaining?
Janette (65:44) But if you go back to the email that I sent you, she was pretty, she’s already asked me twice, and I told her that I would follow up with you today about this automation of calling. So, I don’t know. I mean, this was new news to me. I said, I didn’t know that they were even doing that.
Amy Barfield (66:00) Yeah, we do have, I don’t know if it’s 100 percent. It’s not 100 percent. But I think certain payers, we do have our automation do follow up. Do you know what specific medicaid this is for? Yeah.
Janette (66:13) Hold on a second. Let me go in there.
Amy Barfield (66:28) What was it?
Janette (66:42) She had to follow up with me again this week. I told her I’d get back to her, yeah.
Amy Barfield (66:48) Because I can reach out to our automation team and see if they can just stop doing that for that one particular payer?
Janette (66:53) Yeah.
Amy Barfield (66:55) My God, what?
Janette (66:57) Is her name?
Janette (67:10) Okay.
Janette (67:28) The topic is called concerns regarding AI generated calls to the Maximus provider enrollment call center.
Amy Barfield (67:35) Oh, is this mass medicaid then?
Janette (67:39) Maximus?
Amy Barfield (67:42) How come it doesn’t.
Janette (67:43) say what state she is with?
Amy Barfield (67:49) Maximus.
Janette (67:55) Let me read forward, yeah.
Amy Barfield (67:58) See if she’ll I know that mass medicaid uses Maximus. So… if we can just confirm it’s I mean, I can, yeah, let me confirm with.
Janette (68:10) Her, I don’t want her to have your email, so.
Amy Barfield (68:13) I appreciate that because then, you know.
Janette (68:16) You give them your emails and they just start I.
Amy Barfield (68:18) Know, we try to protect each other. We’re like, what do you mean?
Janette (68:21) Okay. Hi, Martha, I just, we need to confirm what state this?
Amy Barfield (68:29) Is.
Janette (68:30) in, so we can,
Janette (68:37) automation, I’m going to blind CC you on it. Okay?
Amy Barfield (68:40) Okay. That works.
Amy Barfield (68:58) Summer. Okay.
Amy Barfield (69:05) That’s all I got.
Amy Barfield (69:11) I think we have enough to work with today and I’ll… be sending out on Friday an update on where we’re at with the 90 plus aging. And then, and I’ll CC you and Kristen on it too, just so you’re you have visibility. Okay? And then I think you’re on the Monday calls too.
Janette (69:36) Including me on that one. Okay?
Amy Barfield (69:37) Okay. So we’ll see you on Monday.
Janette (69:39) Then, all right, thank you. Have a good.
Amy Barfield (69:41) Day. You too. Okay?
Janette (69:43) Bye.