Transcript
Niccole Russell (00:00) good morning. Good morning. How are you?
Nancy Rodriguez (00:03) Good. And you, I’m.
Niccole Russell (00:05) doing well. Thank you. Are we waiting on chendel.
Nancy Rodriguez (00:10) yes, yes, he’s going to join in one second. Okay? Yep. No problem. There he is.
Nancy Rodriguez (00:50) Okay. Nicole… can we start first because we have noticed some discrepancies in medallion that we need your help in correcting these things?
Niccole Russell (01:09) Okay. Let me go over the agenda, and then we’ll look at that stuff because that’s probably.
Nancy Rodriguez (01:13) Going to be, but we just want to make sure that we’re going to have enough time.
Niccole Russell (01:16) Yeah, we should, this agenda is pretty short so.
Nancy Rodriguez (01:20) Okay. Because going forward, we would like to have at least 45 minutes instead of 30 minutes because it’s a lot. It’s a lot going on right now.
Niccole Russell (01:31) I’m going to have to change our date then because I have calls directly after this.
Niccole Russell (01:35) So I’ll have to look to see where I have 45 minutes. All right. So just starting out with the overall task, we have 33 provider. We have 15 admin. We have 18 for board cert, expirables, we don’t have any expiring within the next 30 days, pay your enrollment request. There are zero out there right now. Processing are 178 and then needs client attention, are 68 outstanding task. We do have. This is for just the provider’s profile alone. Outstanding tasks are 12 profile action required. Are three, there are showing additional ones there. I took the ones out with the birth city and state. They will automatically show just because the profile’s not at 100 percent. Do still have that ticket in. So just wanted to let you know that. But the three that are showing outside of the birth city and state are Lindsay March, Sonia, Gaffney, and kosser, Alvey, and then profile zero to 84 percent. I have zero. The providers that have not signed into medallion right now are Verlene Carter, Laura Ennis and Ken lamb. And they were all invited on January 20 eighth and then just to go over the provider supervision tab, we had talked about that because it wasn’t populating it’s. Not going to populate for you because the supervising tab is intended for providers with state mandate collaborative agreements tied to their licenses. So that’s the big thing. It’s tied to their licenses. I do know you have three MPS, it’s showing there. So for provider enrollment, they will still see that information. It’s just not going to fall under that separate tab. So that’s all that I have. Would you like me to quit sharing? And then you go over it or would you like me to look at something?
Nancy Rodriguez (03:31) Well, no, yeah. Actually I can share my screen.
Niccole Russell (03:35) Okay. I’ll stop sharing. Okay?
Nancy Rodriguez (03:43) So we were, Jasmine and I, we were working on the medicaid applications that it was submitted through medallion. And we noticed that there are several mistakes and that we cannot process. Okay. So, can you see my screen? Yes. Okay. So this one is for Shelly. Okay? If you look at here. Okay? The first error is this is the wrong application. This was dated 10 20. There is one that is dated 1,125. So they need to use an updated application. Okay?
Nancy Rodriguez (04:38) Number two… you see the category of service, it says enter four codes. They’re using zero two seven zero.
Nancy Rodriguez (04:51) It’s actually a revenue code. It’s not a category of service. The code for a social worker, which is that’s our title. It should be zero five six, zero. Okay. So that’s number two, number three, you see how they put her. It says here, last name, first name, middle, you put letter, no comma, and then they put an apostrophe S… they need to put like the whole name based on their registration. Okay? Fax number?
Niccole Russell (05:33) Well, it’s middle initial. It’s not full name, so, no.
Nancy Rodriguez (05:37) But you see the apostrophe that’s not her name?
Niccole Russell (05:40) No, they just, yeah, that’s just a typo, they would still process it, but that’s just a.
Nancy Rodriguez (05:45) Typo. No, not medicaid. If there is typo, medicaid is going to return it, believe me, I know medicaid. Let me give you an example. We sent a voided check, right? And we made a copy of our original check and we put voided for a facility application. Medicaid returned it back because they needed an original check to make sure it was voided. So, they’re, very, yeah.
Niccole Russell (06:14) Yeah, I know that. Yeah, absolutely.
Nancy Rodriguez (06:17) Npi. I mean, npi is fine. Social security number. It should be like zero nine, one dash 54 dash 69 17, right? That’s the way your social security is, all right. Fax number. I know that this, we would look at the profile for the correspondence… there’s. No, you didn’t ask for the fax number, but is there a way that they can add the fax number, which is nine one four, nine, four, one, eight, six, two six.
Niccole Russell (06:48) Oh, let’s see. I don’t know if.
Nancy Rodriguez (06:49) that’s a possibility. Okay?
Niccole Russell (06:53) Let’s go to groups and look at that real quick. No.
Nancy Rodriguez (06:57) Let’s continue with this. You can review it later. Page three. Okay. Over here. It says we’re not a private office. We’re a freestanding clinic. So they need to correct that. So, out of that nine applications, we’re sending it back to medallion?
Niccole Russell (07:22) Okay. Just state what the corrections state where the issues are. Oh, yeah, we’re first exactly the.
Nancy Rodriguez (07:28) Way, I’m telling you that’s the way we’re doing it.
Niccole Russell (07:31) Okay, perfect. And then you can just copy and paste that within the task itself. Oh.
Nancy Rodriguez (07:36) Yes, we’re doing that. Page four. Okay. This is four. Okay. You see where it says city and state, they put brioclick manor and New York. It should be copy New York that’s zip code. Okay? It should have a zip plus the four format use. Look at how they put it in here.
Niccole Russell (08:05) Yeah. New York medicaid, they are specific, but I mean, we do this across the board for many and they don’t say anything about it.
Nancy Rodriguez (08:13) They need to fix it. I’m sorry, they need to fix it. They’re putting our name on it. Okay? Number five, this needs to be left blank.
Jfeliz (08:27) Nancy, I’m sorry to interrupt you. Also on page four, the social was also not formatted correctly. Okay. I’m sorry to interrupt.
Nancy Rodriguez (08:37) Okay. The social. So number five, this needs to be left blank. It says here, managing employees aging and those within control. Medicaid doesn’t require like the same as medicare. So they need to remove this. This needs to be blank. Okay? In addition to that, remember, we had a meeting with you, Jasmine, chendel and Naomi about the process of how we want medicaid to come to us. They sent, this is the message that they have basically says, let me see where.
Nancy Rodriguez (09:25) Go here on the tasks, right? So if we go here and we put medicaid and we look at the instructions, it’s very confusing. Okay. So it’s telling them, okay, here’s, the touch application. I have placed a sign which is perfect. But then it says once notarized, please upload the completed application. We can follow up with emed, right? And then it says, please mail to emed, po box. All right? And then they have this usps, you’re telling them to mail it. And then you’re putting here a label, it says to Jasmine, please that’s not what we agree on. You see there is like discrepancy. We had agreed that they need to sign it and send it to Jasmine. We are going to notarize it in house. Remember that conversation Nicole?
Niccole Russell (10:29) Yeah, it’s on your project plan. Yeah.
Nancy Rodriguez (10:31) They’re not following that.
Niccole Russell (10:34) Okay. I’ll let their supervisor, their director know that.
Nancy Rodriguez (10:38) Maybe we should have a meeting with the supervisor, maybe next meeting so they can.
Niccole Russell (10:44) They don’t join client calls. Oh, okay. But I can take that in house and have that, I’ll bring that to her attention to follow up with her staff.
Nancy Rodriguez (10:52) Okay. So that’s that anything else I missed on the medicaid application for providers? Jasmine, I think that’s about it. Yeah, I.
Jfeliz (11:04) started, I’m sorry, Nancy, I did start reviewing another provider and it’s kind of more or less the similar errors. They’re using apostrophes along with their name and.
Jfeliz (11:21) It’s pretty much along the lines the same, all.
Nancy Rodriguez (11:24) Right? The facility application, I had mentioned to you before that they are using the wrong application and I had sent you an email and you were supposed to follow up. Do you have any update on that for me?
Niccole Russell (11:39) I reached out to the rep and she said she was going to have it corrected. Okay?
Nancy Rodriguez (11:43) So, it has been 12 days already, and you said usually they will reply within at least three days, they haven’t replied?
Niccole Russell (11:53) Replied to the task to the task, correct?
Nancy Rodriguez (11:57) So, I sent the task. Let me show you this is the medicaid.
Niccole Russell (12:03) So three days is for our support team. Okay? So, what happens when you send a task here? So that was you last commented on the 30 first?
Nancy Rodriguez (12:14) Right. I sent it on March the twentieth. Well.
Niccole Russell (12:19) That’s let’s see, scroll down just a little bit on that task. So we’re not changing. We haven’t received updated, miss. Okay. So you stated there, you weren’t changing it, but then you said you haven’t received the updated one on three 31, which was just yesterday.
Nancy Rodriguez (12:33) They don’t reply it.
Niccole Russell (12:36) Falls into their follow up bucket and, they will reply to these.
Nancy Rodriguez (12:41) But medicaid, like I mentioned to you, Niccole, medicaid is our number one.
Niccole Russell (12:45) Yeah. I get that. Medicaid and medicare are number one for across the board for every client. I get it. Medicaid.
Nancy Rodriguez (12:51) Is number one? And, we have other providers that are coming on board. Actually in March, we probably need to tell them don’t come because we are, we’re in the same boat we haven’t moved. And now with all these mistakes on the medicaid application, I don’t know. I really don’t know.
Niccole Russell (13:17) Anyway, so I mean, the formatting is not necessarily a mistake. It’s the way you prefer it to be completed, but it’s not really a mistake. Now, the label that’s a mistake, you know, the code. If you say that’s supposed to be different, that’s really a mistake, but the formatting is not really a mistake for the application.
Nancy Rodriguez (13:39) If they’re going to be doing updated new applications, I think they need to do it correctly because they’re using the wrong application, they’re using the wrong code. Yeah.
Niccole Russell (13:51) Yeah. I can, I mean, definitely, they need to know about the updated application kind of, I… would have to look to see where they got that one. But the facility application, yeah, I did let them know that needs to be updated and they did have a sample application. So it was referred to the team where they should be looking for that. On the PE side. They house their own stuff separately. So, it was advised where that needed to be found. And I will follow up back with her on that to see if those were submitted, which by your comment there, it doesn’t look like it’s been resubmitted, but I… will kind of see where we are with those facility applications. We.
Nancy Rodriguez (14:36) Also asked you last Wednesday about nosacena NP, the pediatric nurse, pediatric provider, that she… has a medicaid, and is non billable. She has Oprah, and they need to submit an enrollment change form to compare.
Niccole Russell (15:01) Yeah. I responded back to that email.
Nancy Rodriguez (15:03) Meforservice. I.
Niccole Russell (15:05) responded back to that email stating you needed to request a demographic update for enrollment to be started there.
Nancy Rodriguez (15:13) So, it’s a new application?
Niccole Russell (15:15) It’s a demographic update. So it would be to… make her participating. So it’s not really a new request per SE. You would go under a new request, but it’s a demo update. Okay?
Nancy Rodriguez (15:32) Can we do it right now? So providers, right? Do I come here or the payers?
Niccole Russell (15:41) Payers… over on the top, right?
Nancy Rodriguez (15:47) It’s for medicaid, right?
Niccole Russell (15:49) It’s over on the top, right? You’re going to request?
Nancy Rodriguez (15:53) But I need to find her first, right? No. Oh, so just do a request here. Yeah.
Niccole Russell (15:59) It’s a single demographic update?
Nancy Rodriguez (16:06) I see your email. I’m sorry, I did not see that email.
Niccole Russell (16:10) That’s okay.
Nancy Rodriguez (16:12) When did you send it?
Niccole Russell (16:15) I think the same day maybe the day after you asked, okay?
Nancy Rodriguez (16:21) So, this is for medallion provider, and then it’s the medicaid… it says pending new enrollments… it won’t let me.
Niccole Russell (16:40) You have you have a medicaid enrollment for her already?
Nancy Rodriguez (16:46) We ask, this is one of the persons that I don’t know. Can we check to see?
Nancy Rodriguez (17:01) So we’re going to a romans or requests.
Niccole Russell (17:06) Requests… if you want to search her specifically, you can just go up to payers. Let’s just look at what she’s got. So you’re not looking at all that information, just go up to provider tab… the provider tab on the far left. We.
Chendel Hooks (17:24) Got one pending for medicaid for her?
Niccole Russell (17:25) Right here. What? Oh.
Niccole Russell (17:33) You can type in her name, and we can just look at her.
Niccole Russell (17:40) Their process.
Niccole Russell (17:45) Yeah, go to payers up at the top. There you go enrollment requests.
Niccole Russell (17:55) That’s fine. You can go that way. Either way is fine.
Nancy Rodriguez (18:02) Previously in network?
Niccole Russell (18:04) Okay. So.
Nancy Rodriguez (18:06) Needs to be linked to the group. How do you link it?
Niccole Russell (18:17) Give me just a second.
Chendel Hooks (18:44) Send request for enrollment.
Chendel Hooks (18:53) It looks like I see something saying that medicaid that sent request for enrollment. So.
Niccole Russell (18:59) You created a line? Yeah, you created a line for medicaid to be completed. So they’re showing it’s pending with the payer?
Nancy Rodriguez (19:12) So, they are enrolling her, then they’re doing it from scratch then. So we don’t have to worry about it.
Niccole Russell (19:22) It looks like you already added the line. So they’re working it. Okay. You just didn’t do it as a demographic update. You did it as a, just… a regular line. Okay? It’s showing it’s processing with the payer.
Nancy Rodriguez (19:40) Okay, perfect. So, now, this is our confusion about… this and I told you I was going to show you. So for example, we are on the payers, right? You say to make sure we come here and check, right? And the payers and the overview tasks, they don’t match some of them, they do, but some of them, they don’t yeah.
Niccole Russell (20:08) They’re not going to, they’re not going to match it’s. Two separate things some, again, like you say, some will, some won’t, okay?
Nancy Rodriguez (20:15) So, we wanted, to see exactly what we need to focus on. Because if we’re looking at here, you see here, they’re all green. Does that mean that’s the.
Niccole Russell (20:26) profile, it has nothing to do.
Nancy Rodriguez (20:28) With, oh, okay.
Niccole Russell (20:30) Correct. That’s. Just showing the profile status all.
Nancy Rodriguez (20:33) Right. So, for example, we look at March last name, March… because we want to understand it. So we know, and we don’t waste time because right now we feel like we’re going here. We’re going over there, we’re going here, we’re like, okay, so.
Niccole Russell (20:53) To be fair, you were kind of to be fair, you were kind of rushed through implementation because you wanted to rush through. So we didn’t take the amount of steps we normally do because you wanted to get out and start enrolling. So to be fair, we normally do things in a very standardized slow motion to make sure that everything is understood and to be worked. And so it was very rushed. So that’s why I don’t think that the… full knowledge is there. I’ve had several trainings. So I’m not understanding, I guess where the disconnect is… but we can definitely review it.
Nancy Rodriguez (21:36) I think it will be great. I didn’t know that I rushed because I thought that’s the way you have your template. And then they told us no, no, no.
Niccole Russell (21:47) When you got Maria on the phone and you were saying, you know, we need to rush through this, we need to get this done. We got you out of implementation per your request as quickly as possible, which hinders really the whole process. But we can take a look, I can, you know, walk through this with you, but, oh.
Nancy Rodriguez (22:10) Yeah, that would be great if you can walk us through the process because I thought that the whole implementation was done. I didn’t know that well.
Niccole Russell (22:19) It is done. It is done, but it was done in a very rushed format which I don’t think you’re retaining the information because it was so fast.
Nancy Rodriguez (22:30) Oh, okay. I see how you see it. Okay. I didn’t see it that way, but definitely, yes, let’s review it. Okay. So this person, right? It says needs attention, right? Yes. And then it says here, medicare, right? So we come here, we go into it says they need professional history, they need residency, right? NPS do not have residency. Well?
Niccole Russell (23:00) So the profile’s at 95 percent. You’re really focused on the profile which is good. You need to look at that, but what is that task asking for? So click on that one outstanding task.
Nancy Rodriguez (23:13) They’re asking for a residency. She doesn’t have a residency, so.
Niccole Russell (23:18) Did you go to the task because you clicked on professional history, I just want to see what the task. Nope, nope. Just go.
Nancy Rodriguez (23:24) I was going back so you want me to go to the task? Yeah. But if you look at here and what it just says outstanding?
Niccole Russell (23:34) So right here, what is this Pecos follow up submission? So this is for medicare, right? This is what needs attention.
Nancy Rodriguez (23:46) Yeah. And this actually matches the other one which is good because I know that she’s missing the Pecos application.
Niccole Russell (23:57) Right. That’s what needs attention. It has nothing to do with what’s missing on the profile. Yes, that stuff is missing. And if we needed that for enrollment, we would task for that. So it’s showing that her profile is at 95 percent. So stop right here for just a second. So just to show you’re at 95 percent here. So these are still the two outstanding things to get you to 100 percent. Doesn’t mean it’s needed. It’s just advising you that’s what is there that’s what is still missing from the provider profile to make it 100 percent. However for the task, there are several tasks here. So if you’re looking, you know, you’ve got your payco one here. And one of these is probably for you saying, hey, we need access to their surrogacy and still don’t have it. And then they have their medicaid, which was not in regard to that. The only one that was pulling up was this paycos one right here.
Nancy Rodriguez (24:58) So you send it to the organization and you send it to the provider. So you’re sending two tasks?
Niccole Russell (25:08) Yes. So it is for the ao, gets one for the admin, and then the provider gets one.
Nancy Rodriguez (25:15) Oh, okay. Because we didn’t have that before. We noticed just recently.
Niccole Russell (25:20) Yeah. So anytime an application is completed or let’s see this looks like that’s E signature. So that’s not even just E signature. If it’s let’s see if it’s just for the access for the surrogacy, then the provider should receive that. But since this is for an application for medicare, the provider has to sign and the authorized official has to sign. So the admin will get one for the ao, and the provider will get one for one of them. You’re just saying both tasks listed here, but one’s for you and one’s for them.
Nancy Rodriguez (25:55) Oh, OK. Yeah. Actually, that was one of my other questions, but we want to fix this profile. We want to fix it. They are asking for required training. They’re asking for the license which this person does not have a training. And this person, the license is already on file. So why is it here? Can they fix that? See here?
Niccole Russell (26:35) So the training, let’s see.
Niccole Russell (26:49) Let me just see. And you said there is no training for this, no?
Nancy Rodriguez (26:54) She’s again about lmhc, they don’t have residency only physicians and they’re asking for the license and the license is already there.
Niccole Russell (27:12) Let’s see license.
Nancy Rodriguez (27:34) Chendel, while she’s looking into that, do you want to add anything else?
Chendel Hooks (27:41) Well, I was looking at the payers, just the ones that have already gone out. It looks like our providers are looks like they’re in processing. But I guess one of the questions though, I think, you know, that we really need to know though if, since the application is incorrect and this is for basically, I guess everyone we set up so far, how long was what’s the turnaround time on correcting this? Because we’re already now significantly kind of behind on a lot of this. And as you know, as Nancy’s been saying, and as, you know, medicaid is really super important to us revenue wise. So what’s our turnaround on this? And I know also that, you know, we pointed out a couple of things that, you know, that, you know, Nancy and Jasmine saw as far as, you know, some of the inconsistencies and I know some of it seems minor but, you know, we’ve had a lot of experiences. And just as Nancy quoted that, you know, a lot of these coming back and we just don’t have that time in order to have something come back. So, I know it’s something that seems small, but if it is something that we’re asking it’s important only because really we, this everything is so time sensitive especially for the fact that we’re no, I.
Niccole Russell (28:54) get that. I understand that. And I will say, for the most part for most payers. And New York medicaid is one of those once you submit, even if they send something back, if there’s a discrepancy a dependency as it’s called, they will still give you that favorable effective date. So just because they’re requesting more information doesn’t mean that it’s starting all over. Yes, if things need to be fixed here, we definitely need to get that fixed before it’s sent to the payer that’s why it’s sent to you for, you know, for review. So as far as timeline, what I can say is if you are putting in the task, you know, and you can copy and paste, you can do it on one and then copy and paste it for the others. The corrections that need to be made. Once all of those have been put into a task. If you’ll send me an email and let me know. I can advise the team lead over there or the account specialist and let them know, hey these need corrected. We need to fix this up.
Chendel Hooks (29:57) So, but question I’m, sorry, Jasmine, real quick, I’m.
Nancy Rodriguez (30:01) sorry, excuse me, no.
Chendel Hooks (30:02) No, no, it’s fine. So real quick though. So, all right. And I understand that these are things that we’re asking for, but, you know, the way that the way that city and state were done, that’s it is a typo. But we, you know, these are things we expect you have that kind of accuracy because that’s really what we’re paying the company for. So, I mean, these things, the dashes, stuff like that, I know it seems minor, but it is, we are looking for that kind of accuracy in this stuff. So, I mean, can, you know, and it’s great that we’ll be able to put tasks in, but there’s also additional work that we’re having to do for things that we feel need to be corrected. So, no, what we’re hoping for here is that, you know, an email can go out to the teams and say, hey, look, you know what? We understand you’re doing it, but one form is wrong. Two, these minor things, are seen minor and seem like typos, but they need to look out for it. We need that accuracy because that’s literally what we’re paying the professionals for, you know, so, we, these are things that we do really need. So, I mean, it’s great that we’re going to do tasks but we shouldn’t be expected to have to say this is this typo. This here, I mean, there’s going to be errors, but these are things that are pretty basic. So we do expect that this will be done and done correctly. So, I mean, if we need to send an email out a blast to the team, you’re a supervisor, whoever needs to get it. But this is stuff that we do expect. So and, you know, yeah, and.
Niccole Russell (31:21) I will relay that to the team absolutely. Yeah.
Chendel Hooks (31:24) So, and that’s what I’m saying? I mean, we will do as much as possible but, you know, we, it’s not that we have a huge team doing this. So, you know, a lot of time is put to kind of take these second looks and of course, we’re going to do, you know, as much as possible, but we really do need it out as accurate as possible the first time.
Niccole Russell (31:43) Yeah, I do understand that. And I plan on communicating that to the team. I will say, I don’t know that that’s a standard process putting dashes in a secure in a social security number or in a zip code.
Chendel Hooks (31:56) And I, and I understand that, but maybe how you guys do it, which would be strange to me because that is most businesses that I’ve worked with that is standard. But even if it’s not, it is for us. So these are things that we do expect and we do need so, and, you know, and you can’t tell me that putting an inside, for a comma should be something that is normal. We really know, no, I.
Niccole Russell (32:17) Agree there? Not saying that. I.
Chendel Hooks (32:19) mean, we’re on a time crunch and, it’s not just us, we have our executive team that is on this and we really need stuff done as accurate as possible and as least amount of having to rework as possible. So, I totally get it and I know it’s you know, we’re coming to you because you are a liaison on this and I know it’s not just you handling it but we really need as much, you know, really assistance with making sure that we’re getting this out as accurate as possible the first time. You know what I mean? Yeah.
Niccole Russell (32:48) I get it. I understand it will be communicated what?
Jfeliz (32:52) I wanted to add into what chendel is saying in regards to the accuracy is that now reviewing all of these applications because not all of them have the same errors. I’m only now on reviewing the second application. And now I’m finding additional errors that wasn’t on the first application that are now on another application. So it’s okay. It’s going to be repetitive in some actions but also not.
Niccole Russell (33:20) That’s fine. I understand completely. I will have the team review those and see what’s going on there. I do have to jump to another call I’m already but yeah, okay. Okay. Sounds good. Thank you. Bye.