Transcript
Jason Zednick (00:00) hey, Kristen. Good.
Crystal Eligon (00:01) Morning.
Jason Zednick (00:02) Good morning. How are you? Good?
Crystal Eligon (00:05) Hey, I wanted to pop on. I was trying to get on a few minutes early, but today is my last day with SPC. So I’m sure Diego and Gina are going to let you know, but today is my last day. So I’m moving on to.
Jason Zednick (00:18) Another organization.
Jason Zednick (00:24) Oh, nice. Okay. Well, congratulations. Thank you. I’m sorry to see you go though. Hopefully, it’s like, you know, like a really good opportunity for you and a step up, you know?
Crystal Eligon (00:38) Yep, I’m just taking that next step up. So crystal’s still here. She’ll be on in a few minutes, but she’ll still be working in the medallion system, and then eventually they’ll get another, just strictly credentialing specialist?
Jason Zednick (00:52) Yeah, yeah, great. Well, thank you for letting me know and congrats.
Crystal Eligon (00:56) Thank you. Yeah.
Jason Zednick (00:58) All right. Looks like they’re in the waiting room. So I’ll let them in. Okay. Yeah.
Jason Zednick (01:18) Okay. Good morning. Hello, everyone. How are you today? Good morning.
Jason Zednick (01:30) So, Kristen, let me know that she’s leaving. So, did you say today is?
Crystal Eligon (01:37) Yes, today?
Jason Zednick (01:39) Today is your last day, okay?
Crystal Eligon (01:40) That’s why I wanted to say, goodbye. Yeah.
Jason Zednick (01:42) Sad day for us. Yeah.
Jason Zednick (01:54) I guess like I am sort of only coming in with one major item. Oh, it’s weird. I can see my reflection in your window, Kristen. Yeah. Can you? Yeah, I can see the monitor with my head moving that’s so funny. Do?
Crystal Eligon (02:12) I need to.
Jason Zednick (02:13) No, no, no. Don’t do anything. It’s just amusing that’s all. Okay. So, the one thing I sort of wanted to follow up on… crystal is what we spoke about last week with psychhouston. The medicare mapping. Have you had the opportunity to like review that at all? Or look at it? Or if not, did you have any questions about it?
Crystal Eligon (02:45) Just because this whole week has been a little hectic. Sure. Yeah, yeah, I would be a little bit better for next week since we’re doing a lot of training.
Jason Zednick (02:57) Yeah, totally. Totally fine. No worries. But did you have any questions? Is there anything that you were uncertain about? No?
Crystal Eligon (03:06) Not really. I did take a glimpse at it, and it seemed pretty self explanatory.
Jason Zednick (03:10) Good, good, great. Yeah. So, yeah, you know, if you find a moment next week, take a look. If you do have questions, just reach out. We can chat perfect. Okay. I think that is like the major, oh… I responded to your email yesterday crystal. I forget it was one of the Louisiana pieces. It was about setting up the onboarding time with their rep. That is something that SPC would need to sort… of… manage and find time with her. I don’t know if you got my email or not. Yes.
Crystal Eligon (03:58) Thank you for that.
Jason Zednick (04:00) Yeah, yeah, no, of course. Okay. So that’s really? I think all I have on my list. Let me just double check.
Jason Zednick (04:19) Yeah. All right. What is top of mind from the senior psych team? Thank you.
Crystal Eligon (04:31) I know Dave, you might want to know if there’s any updates with the optum issue with the Cheryl Lucas situation?
Jason Zednick (04:39) Yeah, no. Amy had… reached out to her contact at optum. She did let me know earlier this week that she has not heard back yet. So we don’t really know more. I was supposed to meet with her this morning and I was going to follow up again, but she’s ill today. So we’re not meeting again until Monday. So I’ll ask, but last I heard, she just hadn’t heard back. Have you all tried or spoken with like your reps over there? Like maybe in contracting to sort of ask what… their perspective is?
Crystal Eligon (05:23) Diego hasn’t disclosed any information to me at least?
Gina Myers (05:26) What’s the issue with all this? I’m sorry, what’s the issue with it? Crystal?
Crystal Eligon (05:33) It’s mainly that we were trying to figure out if to do if we did an individual contract for our, Jason… what type of providers were there again? I’m trying to remember?
Jason Zednick (05:46) It’s like nurses that are not it’s.
Crystal Eligon (05:52) the fnp issue basically, yeah.
Jason Zednick (05:54) Like the gerontology, and there’s another common one.
Crystal Eligon (05:59) Fnp. And then agnps, but we only have two or three of those, Cheryl Lucas being one.
Crystal Eligon (06:05) Yeah, yeah. So we basically wanted to know if we can get her credentials with uhc but, right, because.
Gina Myers (06:15) Chris turner has it, right? And his claims were getting paid. There was a few that weren’t and I think Alicia y’all… didn’t know the reason for the few that weren’t correct. It’d have to be like a project to drill down and figure it out… Alicia.
Crystal Eligon (06:42) I don’t know if she can hear us, Alicia? She, oh,
Gina Myers (06:50) I think I.
Crystal Eligon (06:52) don’t know if she knows, she’s on mute.
Alewis (06:54) I’m sorry. Oh, there you go. Hi, what’s going on? Okay?
Gina Myers (06:58) So, remember, we were talking about, they were asking about Cheryl Lucas and applying for uhc or whatever. Yes. And remember, Chris… turner, I’d asked y’all about him because he’s in network with uhc and we were paid on some claims and there were a few claims that we weren’t but did we ever figure out what the reason was for the denied claim?
Alewis (07:23) If you give me one second, I can let you know, okay, let’s see.
Alewis (07:33) let’s see Chris turner?
Alewis (07:47) Oh, Chris has quite a few. All right. The majority of his denials are not due to enrollment. They’re due to a misrouting issue with unitedhealthcare. So, it’s due to wellmed, being the medical portion in unitedhealthcare handling the behavioral health and them just seeing the claim back and forth due to our diagnosis codes, the provider’s credentials and things of that nature. But it’s not because he’s not enrolled.
Crystal Eligon (08:25) But when you say credentials, you mean because he’s an fnp?
Alewis (08:28) Yes. So, he’s an fnp. But we are a mental health company. So, what ends up happening is based on the diagnosis code and the provider’s credentials and the CPT code. We’re billing. They want to send our claims to wellmed. The medical side, however wellmed gets, it, looks at the fact that our taxonomy for our company and our I’m, sorry, our mpi number for our company is behavioral health. And then they kick it back over to unitedhealthcare.
Gina Myers (08:55) Not though it’s multi specialty grade.
Alewis (09:01) Yes, but we bill mental health claims. So they end up kicking it back over to unitedhealthcare. And then we go back and forth that’s why I’m working with Dorita.
Gina Myers (09:13) Okay. So you are working with Dorita? Yes, with the optum?
Alewis (09:18) Yes. Do you want me to look up Cheryl Lucas?
Gina Myers (09:21) Well, she’s not enrolled, right? Is that the case, she doesn’t have anything. So, they’re wondering what to do with her. So, what exactly can y’all, look up at Chris and see exactly what he is enrolled in?
Alewis (09:51) Yeah, she’s got 135 B 11 denials. This claim has been transferred to the proper payer claim not claim service, not covered for this payer processor.
Gina Myers (10:06) And that’s from.
Alewis (10:08) that’s for Cheryl. So, Cheryl has with unitedhealthcare say that again? What?
Gina Myers (10:13) Payer did that?
Alewis (10:14) Unitedhealthcare. So, for unitedhealthcare, she has a total of give me one second. Let me get her pull back up.
Alewis (10:26) 704 denials across 41 patients, primary pain, primary denials.
Gina Myers (10:33) Yeah, she, for uhc, or where?
Alewis (10:39) Just, uhc,
Gina Myers (10:40) She doesn’t have any. She has wellcare, and wellpoint, she doesn’t have so… right?
Alewis (10:50) She, so she, that’s how we’re getting the denials, for wellpoint, she only has 16 denials across five patients. And then let me see. What if that was this year or last year?
Alewis (11:08) And that was for last year… so far this year, Cheryl, Lucas’s, denials are basically, she’s got 62 denials for unitedhealthcare across eight patients… and then medicare part a denials. And then she’s got six medicaid denials. Let me see what’s.
Gina Myers (11:30) going on. So, couldn’t we just enroll Cheryl, the same way they enrolled… Chris… because when you look at his medallion, it says optum?
Crystal Eligon (11:42) Yes, I was just about to say, I only see that he’s in network with optum?
Gina Myers (11:52) Yeah, it says commercial managed medicaid medicare advantage.
Gina Myers (12:16) Oh… feeling spreadsheet if you want. So, do you know how that, who else has gotten optum? Recently? That’s a, that’s a non pmhmp. Do we know, is there a way to run a report Jason?
Jason Zednick (12:40) Yeah. I mean, you could… run a report of enrollment requests and look at sort of the completion… date and then put that up against the specialty or the taxonomy when.
Gina Myers (12:56) You look at him, it says direct enrollment. So it’s direct meaning that Kristen did it.
Jason Zednick (13:05) No, I think direct enrollment. I… don’t think that’s a useful data point. Oh, here. Did we, I mean, look.
Crystal Eligon (13:21) I’m looking at my emails from medallion and the last enrollment, but it’s for unitedhealthcare is mark,
Gina Myers (13:29) Yeah, but he’s therapy. Oh, okay. Okay.
Jason Zednick (13:34) So, I don’t know if this is the difference or not. I mean, the only thing I see sort of difference between Chris and Cheryl is that Chris has a… primary specialty of psychiatry. The taxonomy is NP family, but, I don’t.
Alewis (13:57) so, Chris, his denials total, give me one second.
Alewis (14:17) For unitedhealthcare, he has 430 denials across 16 patients.
Alewis (14:29) So, what could be happening is, sorry, are.
Gina Myers (14:32) they on unitedhealthcare?
Alewis (14:34) Yes, that’s just unitedhealthcare. He’s got 177 misrouted 134. Actually. Let me just do primary, give me one second. So, I just want to focus on primary with just primary. He has 366. So he’s got 177, misrouted 134, a claim not covered by this payor contractor, which is basically the misrouted 53. The claim service has been transferred to the proper payer for processing, and then two that are for hospice. So the majority 3,364 of his claims are due to misrouting. So, what I’m wondering is, are they saying that it’s due to misrouting? But it’s actually due to credentialing because he’s not credentialed with either side… because sometimes that happens with us. I would have to have someone call, I was looking for this spreadsheet because we usually track this with providers, but everyone’s out today. What I’m wondering, is if the denial just isn’t clear, but he’s not getting paid either. Let me check. Give me one second. I’m going to check the ledger to see if we’ve gotten paid on any of his unitedhealthcare claims.
Gina Myers (15:47) Yeah, somebody I can’t remember who I asked, what was it? Let me see. I think Jennifer had come back and said, yeah, there were some paid.
Gina Myers (16:03) And a few not, but they didn’t know exactly what the reason was.
Alewis (16:10) Yes, paid. Thanks.
Alewis (17:20) All right. Let’s see if these are actually paid by unitedhealthcare. I see some claims at a zero balance, but I need to see if they were actually, I’m sorry, paid by unitedhealthcare.
Alewis (18:49) I’m not pulling that, but this report is also pulling a little wonky. So I’m not sure I can’t say that we have been paid by him. I’m going to continue looking being paid.
Gina Myers (19:12) Yeah. So what she told me was since Danielle said that Jennifer showed her the paid one, she said since 11 four of last year, there were 73 claims billed and paid by united.
Alewis (19:46) So, I’m going to share my screen?
Alewis (20:01) So, I’m going to reset this. I am pulling is the claim paid, yes… insurance. We just want unitedhealthcare… that’s Louisiana.
Alewis (20:47) And then I’m going to pull it for turn. Okay, there we go. So this is what I’m showing for him from two six of 24 to 211.
Gina Myers (21:17) And what is this name?
Alewis (21:19) I’m going to move this over so you can see it. I need to pull it up so you guys can see it this way. No, I just had to, I needed to identify the patients and pull them up and ims.
Gina Myers (21:31) So,
Alewis (21:31) yes, we are getting paid for some, no, yes. In 20 25. We’re going to pay for some. So some of his claims are paying. But if you’re if you look at it… let me draw this back up.
Alewis (21:54) I’ve got 188 claims that I’ve paid out of his denials were hold on.
Alewis (22:36) So, 430 denials and 188 claims paid.
Alewis (22:49) So we do have a few, there are a few paying, but not many.
Alewis (23:03) But from my end, I’m handling it with Doritha, I don’t know what, as far as what you guys need to do for credentialing? Yeah.
Gina Myers (23:13) So, with Doritha, can you find out like what’s our best plan of action here? Especially since we’re billing E, M codes for the most part, which aren’t so.
Alewis (23:23) That’s what Doritha and I have been going back and forth with for about a year and a half. We’ve been sending her over reports of all of our denied claims. So, she told us to bill everything to unitedhealthcare for the initial rejection. If they reject it, they send it over to wellmed. Wellmed. Is supposed to process it. If they still deny it, then we pull a report and we send it to her, and then they’re supposed to reprocess it and pay it. That has not occurred yet. So, I’m still working with her?
Gina Myers (23:51) Yeah, because we need to know how to credential these other fnps.
Alewis (23:57) So, you want me to discuss? So I’m not discussing credentialing with her. I’m just discussing claims. So, you want me to ask her about credentialing?
Alewis (24:08) Our last conversation with her was 324.
Gina Myers (24:14) Yeah. I mean, what’s the best course of action for our non… pmhnps to get in okay, network? I will ask her, I mean to have claims played because like and what’s the rhyme or reason on the claims that are being paid for Chris turner and, you know, versus the rejected. So.
Alewis (24:34) That’s going to be the miswriting issue that’s an actual unitedhealthcare issue. So, that is an issue that unitedhealthcare and a lot of other payers that have gone into business with wellmed. Have we’re having that issue with superior as well as wellpoint superior and humana? They’re bouncing our claims back and forth. So, we’re trying to get it together with her. And then I think Kristen gave me a gentleman Jason who actually messaged me back yesterday. We’re trying to work that out with them, but it’s not, I can’t say that it’s credentialing it’s their system and how they’re classifying us…
Gina Myers (25:19) Okay. So, basically, we don’t know what to do with them. So.
Alewis (25:32) I’m including you on the email I’m about to send to her.
Gina Myers (26:06) Okay. And then,
Gina Myers (26:15) do y’all, have Jason, do y’all, have customers in Louisiana that’s real familiar with the medicaid process?
Jason Zednick (26:25) I don’t know, I think y’all, are, my only client in Louisiana. I’d have to ask, and find out and.
Gina Myers (26:34) Same for Oklahoma. You don’t have any Oklahoma,
Jason Zednick (26:38) I think y’all, are my only in Oklahoma as well. But that’s just me, that’s not like everyone else. Yeah. What specifically is the?
Gina Myers (26:49) It’s just setting up the group for therapy,
Gina Myers (26:59) Because what we did, what they instructed us to do was through that portal was just mco portion. And when I called to ask questions, she told me that we needed to do this group, the group enrollment for medicaid. But then there was all these other… like… the, there’s the specialty ones that were separate like each, it looked like each like a psychologist has to do their initial by themselves or individual by themselves. Etc, lpcs has a different form, blah blah. So that’s what it looked like. But even the medicaid lady didn’t really know.
Jason Zednick (27:48) Like they have to like enroll as an individual before.
Gina Myers (27:50) Yeah, the way, and, it was just the way the group, it didn’t even give like a behavioral… health group. It was mental health clinic, it, you know, so that was the closest.
Gina Myers (28:10) I just need to call back and just verify for sure which one. We picked. The only one on the list looked like it was just mental health clinic. I think.
Crystal Eligon (28:22) That was the one we tried initially and they rejected it. Because, yeah, that is the closest.
Gina Myers (28:29) Right. Do you remember why they rejected it?
Crystal Eligon (28:32) Yeah, they said they don’t do, they don’t do our group, our multi specialty group groups in Louisiana,
Crystal Eligon (28:47) They said we, they could do a, they could do the psychiatry group, like if we had an MD in that group, that was what they kept trying to push us towards,
Gina Myers (28:59) Do they were trying to push us to put in do with the psychological group and just enroll an MD in it?
Crystal Eligon (29:07) No, it would technically be a psychiatry group, but they said you could probably put the therapist in the group with that.
Gina Myers (29:13) MD, yeah.
Crystal Eligon (29:16) But I think there was a reason why we said we couldn’t do that. I just, that was so long ago.
Gina Myers (29:25) Yeah, it would help if somebody, if y’all, had… you know, experience dealing with Louisiana medicaid and Oklahoma medicaid?
Jason Zednick (29:35) Yeah. Let me, let me do some taking asking around.
Gina Myers (29:39) Okay.
Gina Myers (29:44) Where, what states do you handle primarily?
Jason Zednick (29:50) Me personally? Yeah. Texas, Pennsylvania, New Jersey, a little bit Delaware… some… others, but those are sort of like the big, okay. Yeah.
Jason Zednick (30:09) A little bit of Georgia medicaid, which is also, oh, okay. Yeah. And that’s just entirely based on like… on, my particular clients. Yeah.
Gina Myers (30:27) Does anybody else have anything else?
Crystal Eligon (30:33) I don’t have anything?
Gina Myers (30:35) All right, great.
Jason Zednick (30:38) Well, I’ll follow up with Amy and see if she has her back from her contact at optum if there’s any news there. And then, otherwise, you know, reach out, shoot me an email and we’ll keep working through some of this. Yeah, thank you all. Appreciate your time. Thank you, Kristen. It’s very nice working with you. Good luck work.
Crystal Eligon (31:08) With you too. Thank you. Yeah, best.
Jason Zednick (31:10) Of luck. All right. Everyone. Have a good weekend. Okay, you too.
Gina Myers (31:15) Yes. Bye, bye. Take.
Jason Zednick (31:16) Care. Bye.