Transcript
Amy Barfield (00:00) hi. How look we match today. Oh, look at us. When are you supposed to leave for India?
Nichole Walker (00:07) I leave Sunday… and you’re gone. Yeah, I’m a little stressed. It’s like no one, it’s… just the most unorganized thing. First of all, I’m just stressed about going, you know, there’s a lot going on over there. And like no one is we’re going to Hyderabad then to Chennai, no one else is going to Chennai with me. They’re all leaving. So, I’m going to be there like two days by myself. So it’s just,
Amy Barfield (00:34) is nerve wracking? Yeah.
Nichole Walker (00:35) It’s a lot and that far away from, you know, like I scheduled a call on Friday because I’m like I need to know like who’s picking us up from the airport? Who’s driving me to the airport? Like it’s a culture shock when you get off the plane and, yeah.
Amy Barfield (00:50) Yeah, it’s not like they have Uber and all those other things.
Nichole Walker (00:53) No. Well, girl, and I can. Yeah. And the hotel was like an hour from the airport. Yeah. So like I want to make sure that I’m safe getting in a car with somebody, you know?
Amy Barfield (01:05) Yeah, for sure. Yeah. Are you riding with anyone from our team there?
Nichole Walker (01:09) So that’s what I scheduled a call for Friday because like everyone’s coming in at different times, I don’t think anyone lands like the time that I do. So, you know, just trying to figure all that out on who’s where, when all the things.
Amy Barfield (01:25) For sure. Hello, Kate. Hello?
Amy Barfield (01:58) Did everyone have a good Easter at least? Yeah. Okay. I did. I didn’t have to cook this year, so I was happy about.
Nichole Walker (02:07) that. Heck, yeah… it’s weird because, you know, we’re a blended family, but it’s in the divorce papers. Easter’s never on there, which I think is extremely weird. So it’s like we never have our kids on Easter like ever. So, you know, we always have to celebrate these early, but on the upside, I did play golf with my husband yesterday, and I beat him by six points like that. Framing it. I took a picture holding my scorecard. This picture. I was so excited like legit. That was the highlight of my day. So I’ll take it. Hi. Hello. How?
Amy Barfield (02:46) Are you good? How are you doing good? We were just talking about our weekends. Sounds like wonderful. Yeah. Do you have a good holiday weekend?
Vikas Bhalla (02:58) Indeed, we did. It was beautiful weather here in Houston.
Amy Barfield (03:03) Oh, you’re in Houston? I didn’t realize that. So, will you be in New York next week when we visit, I.
Vikas Bhalla (03:09) Will be in New Jersey. I will not be in New York. So we have our leadership meeting in New Jersey, but I know our team is excited to meet.
Amy Barfield (03:19) Yeah. We’re going to nail out some things for sure. I’m excited about it. So are we waiting on anyone else? Derek from our team? No, will Kristen and Jeanette be joining us today?
Vikas Bhalla (03:32) Kristen is out. I want to make sure if Jeanette is maybe like, you know, it was probably my bad when I forwarded the invite. I only invited forwarded one week. So let’s go ahead and proceed.
Amy Barfield (03:48) Okay. You want us to add her to the invite moving forward?
Vikas Bhalla (03:50) Yeah, you can add both of them?
Amy Barfield (03:53) Okay. We’ll do that after today’s. Call. Okay, perfect today. I’m sharing my screen and this is just a little presentation I put together for you visually. We’ll talk about the 90 plus breakout where we’re at with the four states and then just overview any like open items or where we’re at with certain payers.
Amy Barfield (04:13) So these are this week’s numbers. I pulled these this morning and we are at 621 from the original 892 from beginning of March. And so we are working to burn these numbers down. That brings us down to let’s go to the next slide here. And this will be week over week. So I’ll just continue to add these week over week so you can see those numbers drop. So we’re down 271 from the original March third date of those numbers and we were, oh, I forgot to put a number here last week. I think we’re in the 700. So we’ve dropped down even from then.
Vikas Bhalla (04:49) So, Amy, I’m sorry, just trying to. So when you said drop to this number, like does it mean you have submitted something you’re waiting for payr to accept and it might come back and add to this or are we 100 percent sure these things are confirmed and it’s not going to you’re? Not going to see this issue again?
Amy Barfield (05:08) Yeah. No, these are 100 percent confirmed either approved or we stopped enrollments. We’ve reviewed a lot of the payrs with Jeanette or we got rosters. So those are completed. So the ones that are still open in that 621 are either processing or we’re working those lines. Still. Yeah. And then for the four states we have these broke out, we started at 177 from last week when you started requesting those and those are down by 10. Maryland did creep up by three. I think that’s just because some have moved from that, you know, under 90 days to over the 90 day bucket. So, but overall we’re down by 10. Okay. And then some of those payr items, we completed 77 of the New York medicaid they’re reviewing an additional 27 today that were in client input requested. So your team did get this task completed. They’re reviewing those to see if we can close any of those out or if they need to continue to move forward for independence blue cross blue shield.
Amy Barfield (06:17) We’re working with, we did get and I think this might have been related to you already. But we did get two contacts from independence which is really great. So we are working with that with Jeanette to get the correspondence that they need to show that we’ve had no response from the payr and that representative we’re working with is going to work to push the 21 providers that we have been trying to get a response from and not getting. So hopefully we’ll get some approvals in there pretty soon. I don’t know the turnaround time once she receives that documentation, but the team’s working to get that documentation together this week… for sunshine health, Florida. We received two rosters from Jeanette. There’s a few things on the rosters. We had questions about that didn’t completely allow us to complete all these lines. Some of them we could, because it did say like an effective date and the lines of business that were included. But there were a lot of providers on the rosters that didn’t confirm both medicaid and commercial. So we’re confirming that this week and you have two tax ids. So there’s two different rosters. So we’re working to make sure those are confirmed… for MVP. I wanted to confirm with Jeanette and maybe I thought she might be on this call today, but, and I did send her an email on this waiting on her to confirm for the behavioral health. Are they telehealth? Only, I don’t know if you know that offhand.
Vikas Bhalla (07:48) Yeah. So, well, our providers are currently telehealth only, but we do have a couple of locations that we see in person and we are adding more. But like I don’t think for behavioral health, there’s a restriction in terms of the locations or facilities. You know, you can provide the same telehealth services to any location as long as it’s in New York, okay?
Amy Barfield (08:16) So they just wanted to confirm that we could complete those lines. They’re on the roster, but they’re on the roster as telehealth only for those locations that are outside of the state. Basically, so we’ll get those completed this week. Anthem, I did talk to Jeanette last week about anthem. We’re still waiting on par analysis results or requests for these four states. I think she was trying to handle it on her own so she didn’t have to make the request, but she realized it was becoming very timely for her. So she’s supposed to make those requests last week, but I haven’t seen those come through today. Once she makes those requests, we can confirm in those states if your group or facility and that’ll help us know how we need to move forward because we’re getting conflicting information from the payer when we’re submitting for individual enrollments. So I’ll push that with her again today. And if she can’t get it by this week, we’ll get it done at least by Wednesday. When we see her. Amerihealth caritas, and I did relay this to her, Jeanette as well. They only accept five locations that are eligible for enrollment. So, a lot of those requests are going to be stopped that are outside of those five locations. So that’s going to reduce some of your 90 plus as well. And it’ll say in medallion request denied because we did submit, they denied for those locations moving forward. If the team requests locations outside of those five locations, they’ll just be automatically stopped. Jeanette confirmed that was fine. If they didn’t have anything submitted, it’ll just say stopped. Otherwise, it’ll say request denied if they’re approved for those locations or there’s a mix of locations, it will say completed. But in the line, it’ll show that those other locations are denied because they’re not within the region for, amerihealth, credis, for DC. Does that make sense? Yeah cool for term providers? Jeanette and Kristen are currently reviewing the providers that you have in medallion with request to make sure that we’re not submitting requests for providers that don’t have any open Ar or need to be deactivated within medallion. So they’re working on that as of last week. And so just waiting to get confirmation on those… group profiles we need updated. This is kind of outside but still kind of works with this whole thing. We need the emails updated for each of the groups. So that any correspondent that is coming through from the payer that it’s going to the right email right now. We have some groups that have no email, or we have some groups that aren’t behavioral health and have the mental health email listed in the group profile. So we just need those group profiles accurate, so that all correspondence is being received to the right area. We do have a meeting with cdphp today to strategize on how we can get those providers approved. I know one of the biggest factors is getting signatures… from the providers. They only will allow us to email the provider for a signature. So we can’t put like an admin email and then do DocuSign, they want it to come from the provider. So that’s one of the hurdles that we’re going through with cdphp. The other one that we hope to clarify today is you have two mpis, we were submitting two applications for each mpi. So we just need to clarify that we can submit that on one because they had a lot of duplicate applications that were coming back and rejected. So that’s probably another one that’s showing high because I believe there are two separate requests in medallion. So we’ll be able to resolve those simultaneously once those are approved. And that’s pretty much all that I have. Do you have any follow up questions?
Vikas Bhalla (12:22) Yeah, quite a few. Okay. So one thing you know, just to be mindful of, you know, there are a lot of things you are saying here, it stopped enrollment which is the right thing to do from housekeeping perspective, but it’s not going to reduce my denials, you know, because if those are the things which is not needed for those location claims are not getting denied today.
Vikas Bhalla (12:44) So I just want, I’m just cautioning all of you to not look at, you know, the number of aged people here backlog reduced by 202 50. And then you figure out half of it is because you just stopped it. You know, it may reduce your number, but it’s not going to help me at all in reducing the denial claims because, you know, those like if the provider is termed already and we haven’t given you update information, yes, we should take them out but I’m not getting denied claim today, right?
Vikas Bhalla (13:19) So maybe one thing I mean, when you meet with Janet and Kristen next week, you should figure out a way is because I get a weekly bi weekly report on all the denied claims, how to integrate those with your report, so that you can prioritize the stuff with the filter of a denied report… because your time is valuable and I want to make sure we are prioritizing that is, you know, that is critical for us because, you know, these things, you know, as I said, it’s good for house kitting, but at the end of the day, it doesn’t help me.
Amy Barfield (13:57) Sure. Totally understandable. Yes. When we meet on Wednesday, I’ll put that on our priorities to kind of review your Ar against what’s requested in medallion to make sure that we’re aligned. And I believe you work with ecw correct? Yeah. And they may provide some type of reporting as far as Ar goes. And we can review that with Kristen. But, yes, housekeeping good. So we’re not wasting efforts, but also want to make sure that we’re reflecting what you need enrolled based on your Ar. Yeah.
Vikas Bhalla (14:37) And make sure that we have… like you all have some process, you know, which is, and if it’s not happening, we can use this meeting to escalate to me like a monthly process to get the termed report weekly process to get the denial report, whatever you need to keep this up to date. It should be here. And if you’re not getting it, we should have a mechanism for you to, you know, escalate and let me know or if at all, because if I don’t hear anything, I’m assuming that’s happening. And then I don’t want to wait till these meetings to find out it is not happening or happening in different frequency. Yeah.
Amy Barfield (15:17) Currently, that’s not something that’s happening. We can definitely include that in our calls and review how we’ll proceed forward with doing that when I meet with them on Wednesday, yeah.
Vikas Bhalla (15:31) Yeah, but this should be part of the standard operating procedure, right? Like what’s the frequency, what report do you need? And what we need to have from the report, right? So, the second comment I have was if you go back to slide six, I think, which is by state you said or seven, one of the two seven, right?
Amy Barfield (15:53) So.
Vikas Bhalla (15:53) By state, like I would like to see for these states also, you know, the payor priority list, like how you have for eight, Which are the top payors for this? And what are some of the key actions you’re taking? Like for those for the payors? Like because there are top… two or three payors in these locations that is driving significant volume as per the report I sent you.
Amy Barfield (16:17) Yeah, I think for just basically based on this morning, when I was looking, I think for DC, it’s amerihealth, yeah, which we’re working to resolve that, but is the top, but yeah, I’ll look through that and get you some top payors.
Vikas Bhalla (16:31) Just add additional roles in slide eight. You know, if there are any payors that’s affecting these enrollments and not captured in your slide eight, just add it so that you can track them? Okay?
Amy Barfield (16:49) And then,
Vikas Bhalla (16:49) I was looking through your spreadsheet that we sent, you know, is there a way I don’t want us to go through like a 800 lines every time, but I want to figure out a way for us to track that at a line level, not at a payor level. So what is the best way to do that?
Amy Barfield (17:13) Track it? Like at the request late, yeah. And.
Vikas Bhalla (17:16) Then, like I want to see that, you know, for all these enrollment lines, you all have had an action covered last week and what was the response for each of those at a enrollment line level?
Amy Barfield (17:28) Okay. We can, I think find figure out a way to do that internally to provide to you? Yeah.
Vikas Bhalla (17:37) Like, let me make this maybe specific. Like you have about 600 lines. I don’t want to have a spreadsheet with we go through each 600 lines. But what I’m trying to solve is as we discussed and Derek and you agreed, I think we need to update it on weekly basis and make sure that we are touching those each of those lines on weekly basis. So when there’s an email, when there’s a call, when there’s an update from payor, you know, what is happening and it is there in your spreadsheet. But again, and I want to make sure we discuss it so that we can be on top of, you know, like what we said, we’re going to do every week?
Amy Frana (18:15) So, I guess just real quick and chiming in. Is there something that?
Amy Barfield (18:21) Was.
Amy Frana (18:21) on the update Friday that was sent out with the spreadsheet that was missing? So we can make sure from your perspective, we’re incorporating it. I.
Vikas Bhalla (18:31) don’t think anything was missing. I mean, I think the comment is like, you know, I think the slide eight is at a payor level and I think it’s still at a too high level. I think we are in a like for I’m like frankly little anxious and frustrated we have gone through these payor level issues. And then I still have those lines. So we are, you know, so this is a good place to start. It’s ad 20, you know, but I want to make sure every line which is more than 90 days we talk about it on these calls. So you tell us what’s a better way to do that? Short of reviewing 600 lines every week? Yeah. And I think.
Amy Frana (19:12) What we, because what Amy and I have been working on is figuring out the right way in terms of and she kind of broke it out here. But just the buckets right of here’s ones that we know we are continuing to monitor, we can watch.
Vikas Bhalla (19:26) We are.
Amy Frana (19:27) Checking on follow ups and all that stuff here’s. Ones, I know Amy and I plan to talk with Kristen and Jeanette on Wednesday. Here’s. The list of the grouping of ones that we need action from pmps and why are some of them still sitting? And so I think we can definitely bring that forward and just make sure you can see what action is being taken across the board because some will require additional audit that didn’t get done previously, but we can bring that for you.
Vikas Bhalla (20:00) Yeah, yes. I think that’s fine. Another way to do that is add the number of lines in this table, what I see and keep on going and, you know, like till you can have all the lines that adds up to your 600 enrollment lines, right? So that, all right. So we know New York medicaid is 77 line. This is covered there. But, and… I don’t know today right now, I don’t know when these slides eight and nine, how many out of those lines that we talked about today, we discussed or not. So I want the total in these tables to add to those slide five. Anything above 90 days. Gotcha. All right. And then, and then the last another thing or maybe a couple more… is there a report that you all get, you know, for every new enrollment or declines that happen today? Like how we talked about term provider? Do you get a, is it like maybe it’s already there in medallion is like how many of them are for new providers or how many of them are for existing? Whether it’s recredentialing or something that we might have missed. So if I want to say last 30 days last 60 days, whenever you get an enrollment request or, you know, can I simply break down by new provider versus existing?
Amy Barfield (21:29) Kate, do you have some insight on how to break that down? I mean, other than, yeah, yeah. When you’re.
Nichole Walker (21:35) saying new versus existing, do you mean existing? Like we’ve already done work at medallion or they’re existing with pmps versus a brand new hire? I mean.
Vikas Bhalla (21:44) Yeah, existing at PMP versus brand new hire. So, I know like for we have new providers, we are hiring continuously and, you know, and sometimes that new hire takes 60 days, 90 days. You know, what I also want to figure out, is there at our end, is there a leaky bucket where we are? Like, I realize going for assuming we solve this, what is in front of us then… my expectation is the only providers we should have here is either new providers or where the credit recredentialing is required. I just want to see. Is there anything else at least in the last 60 days? Yeah, I.
Nichole Walker (22:26) think there may be something in the overview or in your analytics tab that you can pull. But, let me go look and see like where that lives. If not Amy, you and I could manipulate using provider start date, export it and then map it together. But, we can connect offline by kiss and then send it to you. Okay?
Vikas Bhalla (22:42) Thank you. Yeah. And something that it can be the appendix here so that we keep a track on that. And this will also, I know Derek we never talked live but we exchanged email. This helps us forecast the volume because if I can see the volume of new provider enrollment separately from existing recredentialing, I know what to expect because of my hiring plan and other stuff. So, okay. And then the last question I had the one I asked last time was like, you know, what’s this is the aging report and the audit report we are working off was done in January. I think… you know… I don’t see Nate on the call but like I think one of the questions I had was what’s the process or assurance that anything that’s happening today… you know, we are not making same issues so that we find out in order three months from now?
Amy Barfield (23:44) I mean, I think some of it we’re resolving here, updating our internal project plans for PMP so that we’re not running into these issues again. Like for independence. Now we have a contact so we can’t we won’t be running into this issue where we run into like follow up with no action because now we can flag it or escalate it to a person. So I think resolving a lot of these are going to prevent that from happening with future requests or current requests? Yeah, no.
Vikas Bhalla (24:18) I don’t think that completely answered my question. I think there are two parts to what we see. One was what you said, which is, you know, is the follow up happening, but you take one example of payr but it happens with every payr that’s why there are a lot of examples even in your audit sheet where you know, like it was a very general update, you know, somebody called into no answer, right? You know, so we need to, while you’re doing this, we need to see some process to make sure you know, how that gets addressed almost on a real time basis. And second, you know, which is again, in your audit report, there were a lot of errors in the applications which were submitted and then we had to resubmit it a couple of times and it will be lost six to nine months and you were waiting for your audit report to figure that out, you know? So my two question is how can we ensure that any application you submit is 100 percent accurate? Like literally 100 percent, you know, 99 percent is not an option here because once you submit an application and it waits for six months and it gets denied, and then the clock starts again. And second is how to make sure when, you know, when we have issues where payers are not responding, it gets properly tracked and reported. So if you’re not ready to answer this question, I see a direct message that it is out of office. I’m happy to, we can talk about this next week, but I need a plan. I need a plan which is where I can confidently say that you have a process that is… effective in real time, both in terms of accuracy of application and second is in terms of turnaround and response time of payers. Sure.
Amy Barfield (26:07) Yeah. I think internally between myself, Nichole and the PE team bringing Nate in, we’ll put something together. Yeah, I’m.
Vikas Bhalla (26:18) looking for the process, sure process map with owners who gets reported, what’s your operating plan, you know? So who is responsible, who is reviewing? Who is accountable? Like I’m looking for some sort of details around that. Sure, definitely Derek, does it make sense? Or am I like is, yeah.
Amy Barfield (26:42) Yeah, absolutely. Sorry. I’m just recovering from a bit of a cold, but yes, yeah, definitely everything you said makes sense. We can come back with more details on that.
Vikas Bhalla (26:51) Yeah, because right now, our process is, which is, you know, as we all know, it’s not good. What our process is. You all do audit three to six months, you find these errors. Then I get frustrated. I send a mail to Derek and then we come back to these calls every three months. You know, I’m sure none of you enjoy this. I don’t enjoy it for sure. And it has a lot of financial implications for us. So, and I have zero assurance right now that what we are discussing today is not going to happen again.
Nichole Walker (27:24) Yeah. I do think one thing that’s changed is we have audited even everything that’s not aged and we will continue to audit those. But I think to your point, we can write it down what those milestones are and then give that back to you. If.
Vikas Bhalla (27:37) you tell me that I’m going to audit everything within 24 hours. And there’s a report that comes to somebody on the team that would tell that, okay, this was audited here is a QA done. Somebody signs off on it. It is accurate every 24 hours after the application is submitted, that’s a good answer. But I’m looking for that. Yeah. And one thing.
Nichole Walker (27:57) we have done is we are qcing. So even before they hit the button, submit, someone else reviews it before they submit the application to make sure there’s no errors on it. Once it’s submitted, sometimes we have to get it pulled back if there’s an error. So we are qcing up front and then qaing after just to make sure all documents were uploaded kind of we can lay all that out for you. We have like a QA checklist.
Vikas Bhalla (28:20) Yeah. And.
Nichole Walker (28:21) then we do have a corrections tracker team as well where if any error is found, it goes to a different team to make the correction. They sign off when they did it. And then it is re audited again to make sure the corrections were done correctly. So now.
Vikas Bhalla (28:33) That’s another example of good report. I would like to know what’s the percentage of volume you QC. You know, when you find an error, do you reject that particular enrollment or do you reject the entire batch? And, you know, so I would like to understand that because if you tell me you QC five percent and you only reject what you find error, then I wish you with that because you know, when you QC a small sample, then you actually are supposed to reject the entire batch.
Vikas Bhalla (29:01) So again, you know, you probably have all some of that so, and I can’t react on it till I see that. Sure. Awesome. Okay. All right. Good. All.
Amy Barfield (29:14) Right. Appreciate it. Thank.
Vikas Bhalla (29:15) You. Thank you and let’s talk next week, and I’m sure you the next week meeting will be helpful if there’s anything you all need from me or from my team, you know, feel free to reach out directly because Janet is doing her best. She’s she, she’s you know, picked up things pretty fast. And, but sometimes, you know, if you think anything it is critical that needs to be prioritized, just feel free to ping me directly. Okay? I will. Thank you all. Bye bye.
Amy Barfield (29:44) Bye bye.