Transcript
Rheta Larson (00:00) hello?
Malia Emberson-Lafoa’i (00:03) Right off, Amy… I can’t hear you.
Rheta Larson (00:08) Sorry, I was on mute. Hello.
Malia Emberson-Lafoa’i (00:10) How are you? I’m.
Rheta Larson (00:12) well, how are you doing?
Malia Emberson-Lafoa’i (00:14) I’m good. How’s my audio?
Rheta Larson (00:16) It’s okay. I can hear you. Fine. Fabulous. Great. All is well on my end. Hello, Salma team. Happy Friday.
Malia Emberson-Lafoa’i (00:29) Happy Friday to you.
Rheta Larson (00:33) Yeah, I hope y’all, I don’t know if anyone’s doing anything for Easter weekend, but I hope y’all, get some nice relaxing time in.
Malia Emberson-Lafoa’i (00:42) Yeah, it’s so crazy that America doesn’t celebrate Easter in Australia. This is a four day weekend, like no one works like the whole country shuts down literally just to confirm.
Niki Ohmer (00:55) What you’re saying? I didn’t even realize it was Easter weekend.
Karissa Weight (00:58) It’s good.
Malia Emberson-Lafoa’i (00:59) Friday. I hope no one’s eating meat… Fish only today.
Rheta Larson (01:06) You’re unmuted, but we can’t hear you. So I don’t know. Oh, yeah.
Malia Emberson-Lafoa’i (01:12) We can’t hear you just.
Karissa Weight (01:14) Bear with.
Malia Emberson-Lafoa’i (01:15) Can you hear me now? Yeah, I can hear you now. I think it’s geographic.
Karissa Weight (01:20) So, this is my theory… in Michigan regular like this is, it is a four day weekend for most, right? But I think as you like maybe are in different regions of the country, it’s different. So, not sure. Not sure why that is.
Niki Ohmer (01:39) No, I like, I grew up in the south, it was definitely a bigger like celebration.
Malia Emberson-Lafoa’i (01:45) Yeah, also.
Niki Ohmer (01:47) When I was young when I was in school, my spring break always coincided with Easter like it was always it.
Karissa Weight (01:52) Changes a lot now.
Niki Ohmer (01:53) Yeah, yeah, it was a long time ago that I was getting things like spring break, I think.
Karissa Weight (01:59) It maybe is related like, you know, religion is just not what it was in the past. So, I think maybe that is a part of it, but we have, really big Polish community. So like really big Polish catholic community. So it was always a big deal where we were so… well.
Rheta Larson (02:17) Whatever y’all, end up doing, I hope it’s lovely. And I know I really appreciate y’all’s, flexibility on moving this to a Friday. So we’ll try and get through the agenda. I know we have a few action items at least from last week. So, I’ll share my screen and I really wanted to start with the medi, cal, group enrollment denial, but if there’s anywhere in particular, you want to start, let me know. Let.
Malia Emberson-Lafoa’i (02:42) Me, no, I think that’s good. Can raunaq not join this one? Did I miss that? I think raunaq can join? Let me just message him.
Rheta Larson (02:53) Okay.
Malia Emberson-Lafoa’i (02:54) Sorry. Hey, mate. Oh, he’s just got another meeting. Hey, mate. Where are you? Are you joining? Sorry. Okay. But either way, I agree, let’s jump in. Okay? So, yeah, I,
Rheta Larson (03:15) don’t know if you’ve had a chance to review the review that we got back with the root cause. But essentially our next steps to getting this corrected is of course resubmission. So, I just want to clarify a few things that we do need in order for this to be properly submitted. The payer is asking for a tax document showing the correct name and address, which I think you all had. But they had said that address was not provided that wasn’t matching the business address. And the same with the Coi, I think the Coi had a 400 car long.
Malia Emberson-Lafoa’i (03:57) Car drive. Yeah. So this one, let me just go. I think the business tax license. Let me just pull up the one that I sent back to you just so you guys can like confirm for me that I’m not going crazy because I think what could be the issue here? Oh, sorry. I’m, just going to share my screen, Rheta, if that’s cool. Yes. So, let’s have a look here. So, this is the business license I sent to you. And I think like I can see the name and I can see the address. I’m just wondering whether the issue for them is that it doesn’t say suite 240 dash 250.
Rheta Larson (04:46) Let me see that’s. A good question. I don’t know why they didn’t accept it the first time. Let me pull what they said, a business license matching the name Salma as a sale application. We got that the tax document listing the correct name and address was not provided. This was not requested in the initial 116 deficiency. But, yeah, four one eight, zero, la jolla village drive. It’s going to have to be whatever was placed on the application. So, I’m assuming if there is a dash in it, maybe they’re being mad and picky about it.
Malia Emberson-Lafoa’i (05:26) Yeah, it could be the dash 250, in which case, I’ll just have to call. I’ll call the city of San Diego and see if I can fix it with them. I know our lease is for 242 50. So I’m hopeful that it won’t be a problem. But otherwise, I feel like let me just see where I get to with the city of San Diego on it. But like it seems to me to be pretty insane that medi, cal wouldn’t accept this given that like the majority of the like all of the addresses there, I don’t know. Yeah, we.
Rheta Larson (06:08) can also submit like a rebuttal to the payer just to see like if that was in fact the case, but I know initially, they had said the lease agreement that was submitted, which I don’t know if that’s different than this tax.
Malia Emberson-Lafoa’i (06:23) Nah, it wouldn’t be.
Rheta Larson (06:24) Okay. So at least we have that part which if you can get the dash incorporated, that should be fine. But then the Coi was in the same boat. Yeah. So let’s.
Malia Emberson-Lafoa’i (06:37) go to the Coi. So the Coi, so with the Coi, it does say here insured summer health and affiliates, or 100 con car drive, et cetera. Now, that is who is insured and that’s who holds our insurance. But if you scroll down, I went back and I requested from our insurer to make the certificate holder who’s the person that like that’s the address in the business that then holds that insurance is center for neurohealth with that address. So I can ask, I can ask my broker. I actually don’t know whether my broker will allow me to put it there to put the address there. I can, obviously, I can ask, but every time I’ve done any of these cois to indicate an entity or a property that has that is insured, that information always goes there in the certificate holder section.
Rheta Larson (07:36) Okay. And I see we have the workers comp Coi with that address listed, which I think we also submitted because that one has the four one eight zero, la jolla village drive 240, but are those one in the same? Are they they’re different policies, right?
Malia Emberson-Lafoa’i (07:57) For workers comp, maybe it was workers comp, that was the issue. This is.
Rheta Larson (08:04) The one that was submitted that got denied because they’re saying the address is different. So, they are asking that the 41 80 la jolla village drive be listed on the top here. I know you said you’re going to ask and see if that’s feasible on y’all’s end. But we do have a second certificate of liability insurance that was sent for automatic data processing insurance agency. And it’s titled workers comp in our notes. So I don’t know if this is a separate policy you’ll hold or the same one?
Malia Emberson-Lafoa’i (08:33) Do you mind sharing your screen and just showing me what that policy is?
Rheta Larson (08:38) Yes, it’s centered for neuro health as the insured automatic processing, let’s see… it was this one. So I see this one has dba Salma, the address is listed there as well as listed here, but this is qwc this.
Malia Emberson-Lafoa’i (09:01) Is adp. Okay. Yes, just scroll down. Okay. Oh, weird.
Malia Emberson-Lafoa’i (09:15) Okay. And.
Rheta Larson (09:17) I know this was attached here to the group external documents and our team did submit most of these and I think we even put here like they’re pretty firm with some of these items but.
Malia Emberson-Lafoa’i (09:29) Yeah, I know. Yeah. And I remember at that time, we were like we’ll risk it because at that time, we didn’t have at… that time, I don’t know our assurances basically like the issue has just been that we’ve been moving all of our insurance over to our mso entity. So, the workers’ comp was still in centre for neurohealth but all of the medmail and the commercial general lib has moved over to Salma, but I can let me get in touch with my broker and see what I can do. Slash, I think the other part that I can ask them for is like clear language that you guys can maybe go back to medi cal with and just say back to HHS and say, you know, this is the situation with our insurance… because I think me explaining my, our insurance policy is probably not going to be as convincing. Hello, raunaq, how are you? Hi?
Raunaq Singh (10:29) Sorry, I’m good. I was, I got due to another meeting, apologies.
Malia Emberson-Lafoa’i (10:36) That’s okay. We’re just going through the medi cal issues. So, see… workers’ comp isn’t even listed there like it’s.
Rheta Larson (10:48) just, no, it’s the Coi that we submitted with the, I mean, we have both of them. I wasn’t sure it’s the, and they want that to have the suite. So, I’m assuming what we discussed is correct in those, the Coi will be updated with the correct… address, and then the tax document as well with the correct business address that was listed on the application, which is this one.
Malia Emberson-Lafoa’i (11:18) Oh… I feel confident that the, I feel confident that the business tax registration certificate is correct. I just think that there’s I mean, I know like can we confirm that they’ve rejected that one? The one that I sent?
Rheta Larson (11:36) Yeah, let me see if the team can input this and I’ll see if they can just pull like whoever sent the denial, if they can review the document that we had sent. And just if they are nitpicking about the suite portion, and then that will trigger you to see if you can get it updated with San Diego. But I mean, just based off of the denial that’s what our team obtained. And to answer your question, I know you had asked like why wasn’t this flagged sooner? We were checking on the specific follow up cadence as expected. And the payer didn’t actually come back with the denial until the 20 third. So during that time, we didn’t have any sort of notice from them that was even an issue. But at least in terms of steps, we can definitely promptly resubmit, do you all want us to go ahead and start that process or do you want us to? Yeah. Okay.
Malia Emberson-Lafoa’i (12:34) I don’t I mean, unless raunaq, you think it’s I mean, I guess maybe Rheta, could you tell us whether you think it’s better for us to appeal?
Raunaq Singh (12:41) My, my, before we get there, did you guys discuss what went wrong? Because like, yeah, whose fault is it? Is it our fault? I.
Malia Emberson-Lafoa’i (12:52) No, it’s medi cal’s, fault kind of because medi cal, basically what Rheta was just saying was that medi cal, they checked it every two weeks, but medi cal didn’t say that there was anything wrong? Like medi cal, didn’t say the Coi is incorrect, or that the business tax registration certificate that you’ve submitted is incorrect. So, I guess like the question is Rheta, whether there was anything further aside from checking the pay of portal? Was there anything further the team could have done to check the sufficiency of the documentation that was submitted? I.
Rheta Larson (13:24) Think the one thing that, yeah, the one thing that we flagged was that the Coi that was uploaded was a, we saw, that was the address, and we used that same one regardless because it had the, so that’s the only thing that I notated here with the team and we did specifically get with that agent and like obviously let them know if you see any sort of discrepancies between the address, like flag them to the admin. So, you all know, you can make that final decision if you need to update the Coi or not. But I mean to be fair, the address was listed on there. So I think it’s just the nuance with the payer and they didn’t explain that to us during this time. It wasn’t noted until the denial came in. Essentially if… that makes sense from the January.
Raunaq Singh (14:10) Did we submit all the documents that we were supposed to submit? Yes?
Rheta Larson (14:14) Everything was submitted correctly. It’s just the payer is asking specifically for a tax document reflecting the correct business and address name that was tied to the application, which we had. The only thing that we found is that the address doesn’t have the additional suite listed. So maybe that’s why they’re being a little strict with that portion. And then the Coi on the one attached has the 400 concar drive in the insured portion. And they’re asking that to also match the 41 eight la jolla which was on the application. So that needs to get updated on the certificate of insurance if.
Raunaq Singh (14:57) they have a helpline or a phone number we can call.
Rheta Larson (15:00) Yes. So there is in the letter, you can submit like a rebuttal or an appeal here. I don’t think it provides the direct number other than this one. So they may be able to route you appropriately. But look here’s, the paranormal message center, the 801. So you all are more than welcome to reach out as well. We can also submit the appeal if you want us to. But I think just based off of our findings, the next approach would be try for the resubmission, see if you can get the Coi updated with the correct address. And then potentially we can explore further if we need that tax certificate to also be updated with the suite.
Raunaq Singh (15:41) Okay. So what are your proposed next steps?
Rheta Larson (15:46) I just need y’all’s, permission to determine if you want to or permission to proceed with the next steps for resubmission. We’re waiting to see if y’all, can, I wanted to confirm with you first if you can get that Coi updated or if it was just like a hard no?
Raunaq Singh (16:00) Can we first call them to figure out exactly what was the reason for denial? Because a lot of that, a lot of what we’re kind of what I’m understanding at least seems to be an inference. And we still think that our documentation is correct. Yeah. So we don’t fully understand why this was denied. Is that true Leda?
Malia Emberson-Lafoa’i (16:23) I think, well, sorry, I think medallion understand it to be true. I don’t personally, I think on the Selma side, we have justification for our, the documentation that we’ve submitted. So I think it, sorry to like put words in your mouth about it, but I think like from the medallion side, I think they, they’re aligned on why it was denied, but I still have, so this one, so, sorry, if you just go back, sorry, Dan. So this one is wrong. Like this one, 100 percent, this one was incorrect, right? You guys told me this one was incorrect because it says Kaizen on it. And so I went and I changed it and then I resubmitted it with Selma health in January. So if you go keep going, well, like this is for a different one. So, like this was the initial application, then we got the initial rejection saying the Coi and the business registration was incorrect. And then that happened in January. So then in late January, Samira and I uploaded the new documentation, told Rheta that we’d uploaded the new documentation and then that was submitted. But like the thing that I, I’m going to talk to my insurer, but like I told my insurer all of these requirements and this is what I got back. So I guess like for me, I’m a bit worried that I won’t be able to kind of move the needle anymore on the Coi. But on… the business on both of them? Yeah, I would basically run like I would like to call and I would like to kind of explain the documentation on my end to them as my next.
Rheta Larson (18:12) step.
Raunaq Singh (18:16) Okay… sure.
Rheta Larson (18:22) Do you want me to hold up on resubmission until you get clarity back from the payer or… no, just proceed. I.
Malia Emberson-Lafoa’i (18:36) Think just proceed just for the sake of pace. I think regardless, you know, like if we get to somewhere with them, then great. But.
Raunaq Singh (18:45) Malia, when are you planning to call?
Malia Emberson-Lafoa’i (18:48) We’ll call them today?
Raunaq Singh (18:49) Today?
Rheta Larson (18:50) Yeah. Okay.
Raunaq Singh (18:52) So, Rheta, then wait for Malia’s, response because I do think like this seems to be, this is an organization that’s pretty opaque usually. So let’s like see if we can get some transparency and then if we need to change something on our documentation, we’ll have to push our insurance company because pushing medi cal is not an option.
Rheta Larson (19:13) Okay. Gotcha. Okay. So in terms of next steps, Salma… will call… I’m.
Malia Emberson-Lafoa’i (19:23) going to call my broker first, and then I’ll just so I can like understand exactly why our Coi is formatted that way. And then I’ll call medi cal after that.
Raunaq Singh (19:35) That’s fine. On the call with medi cal like Rheta, do you typically do calls where someone from your team can initiate the call? And then once they have medi cal online bridge and connect a patch in Malia as well from our team, is that an option we?
Rheta Larson (19:54) Don’t but we can coordinate some time on the calendar to help support that. If you all decide you need to go that route.
Raunaq Singh (20:03) Okay. No, that’s fine. I was wondering if you do it already that way we can kind of have… someone from medallion on as well because they probably have more context on what’s in the application than us.
Malia Emberson-Lafoa’i (20:16) Yeah, I.
Rheta Larson (20:17) Am I’m happy to make that intro? I guess after you all talk to them, if you think it would be beneficial for medallion to seek, then we can do together.
Raunaq Singh (20:31) Malia, what do you think? Will you be able to answer questions or do you have full context about the application? Or do you need someone from medallion to be on there with you?
Malia Emberson-Lafoa’i (20:39) I don’t think so. I think like this is like, I know like the context of their, I know the context of their denial, which is the only thing I’m asking about with like those two specific sets of docs. So I think that’s fine.
Raunaq Singh (20:55) Okay. Good. Let’s do that then. Okay.
Rheta Larson (20:59) I will wait to hear back from you all there. And then I’ll give the team a heads up as well, but let me know if anything changes between now and whenever you hear back from them. Yeah… any other questions on the medi cal group enrollment?
Malia Emberson-Lafoa’i (21:20) No, okay.
Rheta Larson (21:22) Good news. I just wanted to shout this out here. Follow up is on track. And it looks like the 13 tricare that we flagged last time we pivoted and made phone calls for all of those. We’re now down to five. So 11 in total have been completed and I think the method of the phone outreach has been very successful there. The five remaining. It looked like the notes they had stated that they are still continuing to follow up via phone. And then like most of the notes just reflect need more time for processing after they got off the phone call with the processor representative, but we will continue to follow up on the tricare west applications via phone.
Rheta Larson (22:06) So those are moving. And then last week we discussed that you all are going to be doing the bulk import for the 32 existing providers. And then I know adding the new group for ocean psychiatry. I have looped in our technical team because I know we need to determine if there’s a cost associated with this which I don’t think there will be. I just need to set up time with the technical managers. They will be the ones who kind of help implement that once you all are ready to pull the trigger there, which if you have an et on that, I know you said it was going to be in the next couple of weeks, but we can get that kind of started and on the calendars.
Malia Emberson-Lafoa’i (22:46) Cool. We can let our leadership know that that’s pretty much ready to go.
Rheta Larson (22:51) Yep. I’ll let you know once we have further information as well via email.
Malia Emberson-Lafoa’i (22:55) Wait. Yeah. Sorry. Yeah, we’re waiting for them all to sign their leases.
Rheta Larson (22:59) So, yes. Okay.
Malia Emberson-Lafoa’i (23:01) We should be ready to go next week, I think. Okay, next.
Rheta Larson (23:06) Week.
Malia Emberson-Lafoa’i (23:08) What do you think, Karissa? Do you know where the leases are at?
Rheta Larson (23:13) No, I don’t know where those are at presently. Okay. I’ll just put potential that’d be good. Thank you. That’s fine. We can carve out time there. Great. And then lastly, I think just the only pending thing on our end for medallion anyways, Carissa and Nikki just setting up additional time for you all.
Rheta Larson (23:35) So we can do really like a big deep dive into the platform. I don’t know if y’all had more hands on experience now and getting more familiar. I know we covered some of that last week but if you still find it beneficial to set aside separate time async we can do that and I can coordinate schedules for next week. I can send some availability elsewhere. Okay? Yeah.
Karissa Weight (23:56) I think that would be helpful. And then if we could free Malia and raunaq from that one less thing they don’t have to participate in. But if you could give us a crash course, I think that would be greatly appreciated.
Rheta Larson (24:08) Okay. I’ll put that on the calendar and then give you some time slots to, does there, is there a preference? Is there a preference for y’all, in terms of day?
Karissa Weight (24:18) Or time not ideally, not in the evening. I am Eastern Time, so that will put me at bedtime.
Rheta Larson (24:27) Okay. Gotcha. I’ll send some availability for Tuesday through the seventh through the tenth of next week.
Karissa Weight (24:33) Let’s be serious. It’s not bedtime it’s more like cat herding time. I have two preteen girls. So everything is, you know, centric around them.
Rheta Larson (24:40) Gotcha. No worries. We’ll make it. We’ll make it fit. Thank you. Okay. Anything else? Y’all want to flag here or address in the sync while we’re live?
Raunaq Singh (24:52) Where are we on the response from Jake?
Rheta Larson (24:57) I did follow up with Jake today and I know finance and accounting is really the pending and the pending one here. So he is going to ping them again just to make sure we get some sort of resolution to you. As far as an eta is concerned. I don’t have that, but he is aware that we owe you all a response there.
Raunaq Singh (25:20) It’s just been forever. We need an answer either way. Like I just feel like it’s… not let’s close it out, please?
Rheta Larson (25:33) Okay. Let me just tell him if we don’t hear back what his like next steps are for closing the loop there with you all. And then we can just like knock that off our plates. But yeah, I apologize. It’s not necessarily coming from me or Jake. We just need to wait for our financing and accounting support teams to confirm or approve the next steps there… but I’ll loop in, I’ll see if we can get it escalated to their direct manager.
Rheta Larson (26:05) Okay. I think we have a good action plan in place for the medi, cal group enrollment. Please let me know if you need any support there, any help there. And then if you just give me the green light, we can go ahead and proceed with resubmission and promptly upload everything in one go. And if you can get the Coi, great if not, also, let me know so we can submit, maybe that appeal. Sounds good?
Raunaq Singh (26:29) Thank you. Awesome. Thanks.
Rheta Larson (26:31) No problem. I hope you all have a lovely Easter weekend, thank.
Karissa Weight (26:35) you too. Bye bye.