Transcript
Shannon Costine (00:00) that was so weird. Everything like froze. And then my screen went big. Oh, I thought I wasn’t gonna be able to get in.
Vanessa Persha (00:05) Oh, no.
Shannon Costine (00:07) Okay. Let me, let Colleen in.
Shannon Costine (00:17) Good morning. How are you?
Colleen Simpson (00:22) Good morning, it.
Shannon Costine (00:24) Is good Friday. We should not be working.
TamraOhnesorge (00:27) Right. We.
Shannon Costine (00:29) Should be enjoying this day.
Colleen Simpson (00:31) Definitely.
Colleen Simpson (00:41) We will wait. Shannon. I just sent you that list that you had requested for the groups on which should be enrolled with just optum and which one should be enrolled with optum and uhc, so you should be getting that shortly. That was one thing I’m going.
Shannon Costine (00:55) To go over today was just making sure that moving forward, whatever you file, just make sure you do the one or the other. We just need to take a look at the requests from prior to see if we truly need to remove them or reopen them.
Shannon Costine (01:14) Zoom is on the struggle bus. Today. There we go. I’m like it’s not letting Tamara in. What is happening? Hi, Tamara. Good morning. How are y’all, I just was telling them it’s good Friday and we should not be here. I am tired. Is Amanda joining I?
TamraOhnesorge (01:38) Think so. Yes, Colleen should join as well?
Shannon Costine (01:40) She’s here. Oh, okay.
Shannon Costine (02:01) While we’re waiting, Vanessa, do you think we should put that in their project plan or what would you recommend?
Vanessa Persha (02:10) What?
Shannon Costine (02:10) Would be optimal and then which one should be united?
Vanessa Persha (02:15) Yeah. If it’s a pretty clear distinction like specific provider types or npis or something like that, we can certainly call that out in the project plan.
Shannon Costine (02:28) It’s specific locations, oh,
Colleen Simpson (02:31) yeah, it’s just, it’s group specific to those groups, so that hopefully that’s helpful.
Vanessa Persha (02:36) Yes. So, Shannon, when, we can add there’s like a drop down field in the project plan where you can select specific groups that it applies to. So we could essentially create additional groups, optum united lines in their project plan that are specific to those groups, okay?
Shannon Costine (03:00) Perfect.
TamraOhnesorge (03:16) Let me reach out to you.
Shannon Costine (03:18) No worries.
TamraOhnesorge (03:23) Okay. She’s traveling. She texted me. So we’re good.
Shannon Costine (03:29) She’s not joining. Okay. No worries. Manpreet was removed off of your account. I’ve got an audit in progress. There’s 263 lines that he was assigned to. So he, they’re going through those. They were hoping to start it by today. If not, it’ll be done by next week for sure. And then I’ll give you guys the results of the audit, whether we had to undo anything that he did, which was my concern. And I know Tamara, that was your concern as well. Uhc… access, I think was the next item on the list. Do you guys, have you guys gotten the request from them for the access? Yes?
TamraOhnesorge (04:15) And I approved those, you?
Shannon Costine (04:16) Approved it. Okay. Let me make sure that they received that.
Colleen Simpson (04:20) I have seen some tasks too, where they’re asking for access.
Shannon Costine (04:25) Yeah, they put a lot of tasks and so, I’m going to let them know that those have been the request has been approved. You.
TamraOhnesorge (04:33) Need to log in really quick to make sure there’s nothing new that’s popped up.
Shannon Costine (04:45) And I’ll tag them now just to make sure.
Shannon Costine (05:02) Well.
Shannon Costine (05:13) I just tagged them on that. Okay, we got the list from Lindsay for keeping lines open and keeping lines closed. We only had about 166 to move to open, and we closed out 239. So, if you see any of those that’s where that came from, she’s still going through the list. She has about 500 left to go through. So just wanted to give you that information. Okay? Tamara, on a few of your email issues wanted to go over those. So let’s cover the first one where you sent it to support and they never resolved it. I would, if you’re going to send anything to support that has an attachment. I would use the email and send it that way, but you did it. I mean, you should be sending it to support and they should have resolved it to answer your first question. But I would, if you don’t have an attachment, you can do it through the three little dots. Is that correct? Vanessa? She can submit it that way?
Vanessa Persha (06:22) Yeah. And I just want, like, so there’s you can add a note in the line which is different than going to support. So when you add a note, the expectation of course, is that our agents review notes that you add when they go to do their follow ups, but they don’t actually get a notification if somebody adds a note to the line, so, and.
TamraOhnesorge (06:45) we were told that they don’t review the notes that they, that’s it and that’s so we click the, provide an update option and then I get a notification with the attachment.
Vanessa Persha (06:56) Oh, you can attach.
Shannon Costine (06:58) Yeah.
Vanessa Persha (06:59) Okay. And.
TamraOhnesorge (07:00) So, that’s what I used and you can see my attachment and note that says the provider’s been approved. And then they continued to follow up. So,
Vanessa Persha (07:09) that’s I see the note that you made, but I didn’t see the support resolution. So it almost looks like support didn’t ever get involved in adding anything there. They.
TamraOhnesorge (07:21) Did send me a request saying to provide they left the Kentucky market on 12 31, can we close this line? And I told them at that point in time? Yeah, but I didn’t realize the approval was never entered.
Vanessa Persha (07:35) Never even entered. Okay. So I did fix the line for you. I went through and showed the timeline where she was par from 10 28 to 12 31. The line is now marked complete. And then if you go to her existing enrollment, it will say inactive, but it will have the timeline of when she was approved. And I attached the approval letter. And then I gave that feedback to our PE team. I said here’s where we dropped the ball on several instances. You know, I noticed they didn’t follow up timely. They didn’t look at your notes like there were just a lot of opportunities here for them to catch this. So we did give them the feedback and I did update the line, but I wasn’t under the impression you could attach documents with the three little dots. So that’s interesting. I’m going to take a look into that. But if you ever do the three little dots and you’re not getting somewhere, let us know so that we can, yeah.
TamraOhnesorge (08:35) I think the problem with that is, I mean, you literally have two people trying to manage over a 1,000 providers in almost 400 locations when I submit something, I don’t have the bandwidth to follow up to.
Vanessa Persha (08:47) Make clients.
TamraOhnesorge (08:48) Following up on that, I just,
Vanessa Persha (08:50) totally understand. Yep, totally understand. Shannon. Let’s talk to Courtney… and see if we can pull the history of all the submissions that have come through for H ii and see if there’s any that are still sitting out there unresolved. So we can try to push those along.
Shannon Costine (09:12) From support. Yep. Okay. That’s a good idea.
Shannon Costine (09:23) Okay? On your duplicate request. Vanessa, do you want to share your screen? Do you think that would make it easier?
Vanessa Persha (09:31) Yeah, to.
Shannon Costine (09:31) Tell her.
Vanessa Persha (09:32) What?
Shannon Costine (09:32) We were looking at?
Vanessa Persha (09:34) Remind me which provider this was.
Shannon Costine (09:36) That was Amy borland. Amy.
Vanessa Persha (09:37) Borland. Okay. Let me get her pulled up one second… while she’s doing?
Shannon Costine (09:44) That Tamara, do you want me to send a note to Amanda and let her know that, you know, we’re doing the audit?
Vanessa Persha (09:51) Yes, please. Okay. Yeah.
TamraOhnesorge (09:53) No problem. Let.
Vanessa Persha (09:55) Me share my screen here.
Shannon Costine (09:57) That was for blue cross, Vanessa? Sorry?
Vanessa Persha (10:00) Yep. I remembered, I was looking at it. I was like, I think this is what I was looking at this morning. Okay? So, Tamara, you received a notice that one of your lines was stopped for Amy borland’s blue cross blue shield Texas lines because it was a duplicate. And I looked at both requests and I honestly could not find a distinction between the two requests like what the ask was here. So to my eye, these did look like a true duplicate, but I wanted to run through them with you and just make sure that we’re looking at it correctly. So, the first one here, I’m going to open up the request is for blue cross blue shield Texas and it’s a demographic update to add.
Vanessa Persha (11:01) I’m guessing the effective date that was requested, that’s at the very least the date they started at the practice… then when, and the lobs are for this one are medicare advantage and commercial. The second request, same payer is… also for 61 41 McPherson boulevard, suite 151. Same medicare advantage and commercial lobs.
Vanessa Persha (11:36) Is there, yeah. Was there some kind of difference in these requests that you were trying to submit? I.
Colleen Simpson (11:47) Submitted those there’s not a difference. I’m wondering if maybe it was some kind of glitch in the system because it doesn’t allow us to submit. Like if there’s already a demographic update out there for one location, I can’t submit another for the same location for the same payer. But this happened with this provider. And then another provider, Matthew dobbins, and they were both submitted on the same day. So I’m just wondering if maybe there was a glitch in medallion where it sent out two requests. Somehow? I don’t know it’s very strange.
Vanessa Persha (12:14) Okay. So this one, let me just see.
Shannon Costine (12:19) Was that the other one we were going to look at?
Vanessa Persha (12:21) They were submitted the same day, cleared intake, the same day. Okay. Let’s for this one and the other provider that Colleen just mentioned, Shannon, let’s take that back to Peter and let him know that it appears it might be a glitch because we want to see what he can do about consumption on these since they cleared intake. Good.
Shannon Costine (12:49) Idea, Adrienne… Colleen, can you give me that other name again? Sorry?
Colleen Simpson (12:56) Yes, it’s Matthew dobbins.
Vanessa Persha (12:58) Matthew dobbins. Got it.
Shannon Costine (13:02) And Vanessa, while you’re there, you want to look at Brandon or did we clear that one that was the one with optum and the provider id and effective date we just need to get with the team?
Shannon Costine (13:24) Oh, her headset must have died. Oh, no.
Shannon Costine (13:32) While she’s getting back on Tamara, those were the three main issues that I had from you, which was the stopped request. Brandon was the one that they did not enter all the information correctly? And then the, is there another one? I think that was, I think that was everything.
Vanessa Persha (13:56) Can you hear me? Yes, yeah.
Shannon Costine (13:58) I just told him. I said, I think her headset died. I.
Vanessa Persha (14:02) Zoom did something. It completely disconnected my audio and then it wouldn’t let me reconnect. No. Sorry about that.
Shannon Costine (14:12) Emily was the other one that we just talked about. So it was Emily, Brandon.
Vanessa Persha (14:16) Okay. Brandon was the last one. Oh, that one. So, for Brandon, we noticed that what they did, what our agents did was they marked the unitedhealthcare line complete with all of those effective dates instead of marking the optum physical health line complete. So, we’ve already flagged this that they need to… put the unitedhealthcare one back in processing and complete the optum physical health line with all those effective dates that you shared in the email.
Shannon Costine (14:52) And just to confirm Tamara, the united is still pending, right? For Brandon?
TamraOhnesorge (14:56) I don’t know. I just, when I’m looking at it and it says what bothers me is when they send a notification that it’s been completed. And then it says not provided by the payor not provided by the payor not, and that’s.
Shannon Costine (15:09) a lot.
TamraOhnesorge (15:11) And so I thought this can optum usually gives an effective date and I looked through the correspondence that was in the enrollment and found that in the email, it gave them dates that, and which one was for which location. So, I don’t know if that wasn’t entered in the provider’s record, why it says nothing was provided by the payor. I’m.
Vanessa Persha (15:36) curious if they entered all of that in after they marked it complete because the dates are in the platform but they’re under the wrong payor, they’re under the unitedhealthcare line. I did open it and I looked at each line, it has the specific effective dates that were put in that letter. But again, it went out for the wrong payor. So, but they are in there just for if it, you know, helps they’re in there now, yeah.
TamraOhnesorge (16:08) The overwhelming concern for us is if they don’t put an effective date and a revalidation date, we have no idea how to maintain revalidations that are due.
Vanessa Persha (16:22) Remind me for optum, have you, is that something that you guys requested specifically to put in your project plan? Like if optum or any payor does not give a revalidation date on the approval letter, do you have a standard date you want us to input in the system?
TamraOhnesorge (16:43) Most payors are three years, but we have some that are five, right? I mean, I would say whatever the industry is for that payor, we need at least that information because we can’t keep track of all of it.
Vanessa Persha (17:01) There’s issues. I.
Colleen Simpson (17:03) Would also say if they don’t provide an effective date, and they’re not seeking that out at the very least the date they’re notified of the approval could be the effective date. Does that sound right? Tamara? Yeah.
TamraOhnesorge (17:14) I mean, any kind of date any?
Colleen Simpson (17:16) Date? Yeah, we.
TamraOhnesorge (17:17) just, we have to know, we have to have an idea a timeline because when we run a report and there’s no revalidation dates on there, we’re just again… we need medallion to do as much for us as possible because we are a team too.
Vanessa Persha (17:37) Absolutely. So Shannon, maybe, so I caution against filling in revalidation dates that are dummy dates because only, because certain… payers like let’s say you get, you see that a revalidation is due three years out and you submit the request to medallion to initiate the revalidation, we start working on it and the payer says, no, we pushed their revalidation date out to X date. Our internal team’s process is to stop that line, will update the revalidation due date in the platform. And then you would have to submit another request when that actual revalidation is due. And so that can lead to increased consumption because you’re submitting requests prematurely. And then we have to stop the line.
Vanessa Persha (18:33) So I would prefer that we have our agents push the payer for an actual revalidation due date and put that in the system rather than putting a dummy date of three years out, if that makes sense. And we can put that in your project plan to have them push for those actual dates.
TamraOhnesorge (18:54) Yes. So they, I mean, payor knowledge in medallion, there’s not anything that lets them know if you don’t receive a revalidation for X payer, their revalidation timeline is three years or five years or you just have to, I mean, there’s nothing in the payer table that tells them that.
Vanessa Persha (19:12) So for payers that do have very clear defined revalidation due dates, we have that like united, we know is every three years, the medicades are a little tricky depending on state. And then… I’d have to check, we can certainly check for your payers, like we’ll pull the list of all your payers you guys have requested.
Vanessa Persha (19:35) We can check to see if the payer directory has a standard revalidation turnaround time and then use that as our guidance for updating your project plan. So anywhere we don’t have a defined one, we can specify to the team like you need to push for a revalidation date.
TamraOhnesorge (19:55) And right now, we’re managing all the medicare and medicaid. So that’s a non issue. I mean, we would love to hand it off but that’s we can’t afford to lose those people.
Vanessa Persha (20:05) Yeah, sure.
TamraOhnesorge (20:07) That’s fair understood.
Shannon Costine (20:09) Okay. I can take that back to them and see what we can do and we’ll take a look at the project plan, Vanessa.
Vanessa Persha (20:17) Yep. Sounds good. Was.
Shannon Costine (20:20) there anything else? Tamara, Colleen that you guys had?
TamraOhnesorge (20:23) I do have one and it’s.
Vanessa Persha (20:25) I do as well.
TamraOhnesorge (20:29) You know, when they imported things, they took addresses KP did to try to match and map to providers. But we have like a new Smyrna beach that is under H ii Florida, which is our adult outpatient and we have a new Smyrna beach under our great strides Rehab, that’s just pediatrics. And we have providers that are H ii Florida only that have the great strides new Smyrna beach listed under their locations. And I have someone that’s trying to assist us with medicaid enrollments. She has no knowledge of what’s true and not true. And it’s difficult at best because this is our whole system wide. We have wrong locations attached to providers for naming conventions. And I need to, because that’s a big difference. It’s a totally different tax id. So I need to clean that up.
Shannon Costine (21:32) Vanessa, do you have any idea how that would have happened on the import?
TamraOhnesorge (21:39) Some of it is because they mapped it to the main location. The problem is great strides and H ii Florida should have never, so I think when they couldn’t match on other numbers, they just matched on address.
Shannon Costine (21:56) Can you send me an example? Would you mind? I know that’s a pain, but.
Vanessa Persha (22:01) I’m so sorry. I was talking on mute this whole time. I’m looking at the provider summary, which has practice ids like our back end practice id information. We can probably export this, look at those two locations specifically and track down like we’ll have to do an exercise with you like tell us where this provider should actually be at, and then we can get them moved in the platform.
TamraOhnesorge (22:39) Shannon is Seely last name CEEL y Christine. Okay?
Vanessa Persha (22:50) Shannon, it may be something we need to get epd pulled into because the downstream impact of the enrollment data, if there’s any existing enrollments today that are tied to that group and practice location, like it’s going to need to be changed over to the correct one, providing that is actually how they were enrolled. So, and,
TamraOhnesorge (23:14) this provider does have existing enrollments under the GSR, okay? And it should be the H ii Florida.
Vanessa Persha (23:22) Okay. Sorry.
Shannon Costine (23:25) H ii Florida Riverside is correct. Well.
TamraOhnesorge (23:29) That’s the one, if the payer enrollment didn’t have a specific location attached, they just mapped it to the main location. So that one is not where she practices, but it’s fine. It’s the main location, but the great strides, new Smyrna beach is not, it should be H ii Florida. New Smyrna beach. Okay?
Shannon Costine (23:48) So, GSR is incorrect, it should be H ii Florida.
TamraOhnesorge (23:53) But if you look under the locations listed under H ii, Florida, it should be GSR new Smyrna beach.
Vanessa Persha (24:04) Yep. So we’ll have to run a report Shannon identify all the providers that are listed under both practices, make sure that they’re tied correctly. We’ll have to work with Tamara on that one. And then at the very least, we can add the correct practice location under that group, if it’s not there yet, and then look at existing enrollments. Move those over to the correct practice name. Any new enrollment requests? If they’re still in process, we’re probably going to have to send a notice to the payers to say, stop this and resubmit the updates to the correct practice npi tin combo. And then same thing for completed enrollments. We would have to re, request those under the correct tin npi combo.
Shannon Costine (25:06) Okay. All right. Let’s see what we can pull first. And then we’ll go from there. Colleen. What was your question? Okay?
Colleen Simpson (25:18) My question is we have with our endeavor Rehab group, we have a couple, well, there’s a bunch of locations that opened, but there were four that opened at the same time, and they’re all under a group that we acquired. So I submitted a location enrollment for medrisk for all of those four locations. And then at the same time, I submitted for individual providers for medrisk, and I received a task and they’re saying that the four locations are not a network provider request, has to submit a separate application form for each location. Well, I’ve already done that, and I guess my question is just when these agents are reviewing these requests that we send, do they ever refer back to the group to see if an enrollment has been submitted? Or do they just send a task?
Vanessa Persha (26:01) They’re supposed to look okay?
Colleen Simpson (26:04) And I just, I mean, I didn’t know if that was the process or how that works, but they sent me the application to fill out and asked me to fill it out. So that’s just a.
TamraOhnesorge (26:13) And we get asked to do rosters pretty often.
Colleen Simpson (26:16) Yeah, quite often. And it’s just if they’re looking at the practice location, you can see, well, I don’t know if it shows, it does show the providers tied to the location. So that’s just a, you know, I don’t know how to manage these tasks. Yeah.
Vanessa Persha (26:32) That is extremely frustrating. And, I am so sorry, I don’t even know what to say. Oh,
Colleen Simpson (26:40) my God, that’s kind of our calls when I call Tamara and say, hey, do you get tasks like these? Because I don’t I’m not quite sure, what to make of this.
Vanessa Persha (26:49) Do you have, an example task that, yes, asked you to fill out?
Colleen Simpson (26:57) Yeah, it’s going to be for provider, Kelly chance. Okay. And I think there’s more out there, Kelly chance, Stephen Cole. Those are, those are two that are coming up with the same issue.
Vanessa Persha (27:12) I was just in a test environment and I was like, what are all these tasks that just have random characters? I got really scared for a second.
Colleen Simpson (27:22) Like,
Shannon Costine (27:22) that is not accurate. Oh.
Vanessa Persha (27:25) My goodness, Kel, what was that name again?
Colleen Simpson (27:30) Kelly chance?
Shannon Costine (27:51) You said this was for which network?
Vanessa Persha (27:57) It’s, medrisk, I’m looking at it right now, this is ridiculous. Who is this shika Sharma? Is the specialist on this one? Let’s take this one back internally, Shannon. Okay. Do you have another example of one where they’re asking you to fill out a roster?
Colleen Simpson (28:26) I don’t remember what provider that was for Tamara. Do you have an example of one?
TamraOhnesorge (28:31) Just me. I’m going.
Vanessa Persha (28:33) To try searching, oh, nothing roster came up.
TamraOhnesorge (28:36) Back and said the providers, the provider information is listed under the group and locations. I was like, I don’t have time to fill out rosters?
Shannon Costine (28:49) That’s why you hired us?
Shannon Costine (28:55) Stephen Cole was the same situation Colleen.
Colleen Simpson (28:58) Yes, he was okay.
Shannon Costine (29:05) Oh, yeah. It’s still a needs client attention.
Colleen Simpson (29:10) Yeah, and it’s because it’s asking for, that form to be filled out. I was looking at that too because I thought, well, maybe, let me make sure I actually sent the request to medrisk for that one. But, yeah.
Shannon Costine (29:20) It’s the same agent. Vanessa… it’s one.
Vanessa Persha (29:25) Thing to ask for the information needed to complete the application. It’s a completely other thing to ask for the application to be filled out. And that information that they were looking for, is that standard information that would be applied for all the medrisk applications? Okay? Once we have that information, Shannon, let’s put that in the project plan for the medrisk, that way they don’t ever have to task for it again. Okay?
TamraOhnesorge (30:01) Last one I had for roster?
Vanessa Persha (30:10) You said you found it?
Colleen Simpson (30:11) Not, oh, no. So.
TamraOhnesorge (30:13) If I run across it, I’ll okay.
Shannon Costine (30:16) You can just email it to us and we’ll add it to your, yeah, issues list.
Vanessa Persha (30:25) I’m honestly baffled and just, I don’t even know what to say other than the speech list. I’m so sorry that this is happening to you guys and we are going to work to figure this out.
Shannon Costine (30:40) Anything else you guys have?
Colleen Simpson (30:45) That’s all I have at the moment, okay?
Shannon Costine (30:49) Maybe a steak dinner, edible arrangements, like?
Colleen Simpson (30:52) I.
Vanessa Persha (30:54) feel so bad all?
Shannon Costine (30:57) Right. Well, we will work through these issues and provide you guys an update. And then what, Tamara, once you find that, just send it over and we’ll take a look.
Vanessa Persha (31:06) All right, Tamara and Colleen, are you both in Florida?
TamraOhnesorge (31:10) We’re in Texas? We’re.
Colleen Simpson (31:11) in Texas?
Vanessa Persha (31:12) We’re in Texas, Lubbock, how far is that from San Antonio?
Colleen Simpson (31:18) A long way, oh, so far?
Vanessa Persha (31:21) Darn I was going to say I have family out there. We’ll just arrange it where I go on vacation and we meet up and we’ll go for dinner and wine.
TamraOhnesorge (31:30) So, let me know when you’re going.
Vanessa Persha (31:33) The riverwalk, I mean, my gosh. I fell in love.
TamraOhnesorge (31:39) They like drained it and cleaned it and redid it. It’s beautiful.
Colleen Simpson (31:44) I actually got married on the riverwalk in San Antonio. Did you, I did, oh, my gosh.
Vanessa Persha (31:49) It’s so beautiful, Shannon, I don’t know if you’ve ever been, but it is like we did the little boat tour. So, they went through and did the history and talked about, you know, the movie, Selena, and like just my gosh, it was amazing. I loved it. I took all my kids. We all, you know, it was a great time.
Colleen Simpson (32:08) Best food.
Vanessa Persha (32:10) Really? Yes, it’s so good for.
Shannon Costine (32:14) A place with some good food.
Vanessa Persha (32:16) And you can drink while you’re outside walking there, which I was like, can I walk around with this? And everybody was doing it. I was like, okay?
Shannon Costine (32:28) That’s amazing.
Vanessa Persha (32:29) Yeah, it was a good time. Well.
Shannon Costine (32:32) Thank you guys. So much. I hope you have a great Easter and enjoy your time off.
TamraOhnesorge (32:36) Thanks, you too. Thanks.
Vanessa Persha (32:38) Ladies. Bye bye.