Transcript
Shannon Costine (00:00) oh, hey girl. Hey girl. So they have all.
Nichole Walker (00:04) of their implementation right now. They’re.
Shannon Costine (00:07) technically get out of implementation, but it’s been pretty effed up, so, right? Exactly. So I wasn’t on the last call because I had my surgery appointment, but they were telling me that, I guess their internal person messed it up. All their current dates and enrollments that are in the system are wrong. And he was asking if we could just submit everything. And I was like, I don’t think that’s how it works.
Nichole Walker (00:34) Like, no, he could do, he could put the request in for us to do a par analysis, which is where we contact the payers and say, are they enrolled? Are they not enrolled? If they’re enrolled, then of course, we add the information in the system to say they’re enrolled and we close the task out. If they’re not enrolled, then we test the client back saying a full enrollment is needed. I.
Shannon Costine (00:57) Think from my understanding and, we can get him to re, summarize that. But from my understanding, his concern was they don’t have time like time. But if you’re going to submit enrollments that don’t need to be enrolled, you’re wasting time, right?
Nichole Walker (01:10) Well, and they could depending on what payer it is, you know, that could cause just a shit show down the line, they could deactivate both your enrollments, right? Because you’re duplicating the work for them. Yeah. So I also don’t think that’s the smartest thing to do is because I mean we could probably have a team, I mean, depending on how many lines it is like a part analysis isn’t as hard as, you know what I mean? A full enrollment?
Shannon Costine (01:36) And they have no dates, like to be able to know like, okay, re, enrollment is today, they don’t know when it’s supposed to be re enrolled, so that’s what they wanted us to check. It sounds like he’s willing to pay for whatever.
Nichole Walker (01:50) Yeah.
Shannon Costine (01:51) But I think you’re right? I think part analysis is probably going to be the best thing at this point, right?
Nichole Walker (01:56) Well, yeah, because if not, then what happens is, then you take the risk is if we do unnecessary enrollment, some payers, Florida medicaid, and blue cross being ones they’re just going to. I mean, they’ll deactivate you.
Shannon Costine (02:09) And I think they are in Florida. Yeah, it’s Florida digestive duh, yeah. Okay. Well, that’s what Connor and Jack wanted was someone just to explain that to him. Like I said, he’s super nice. He’s just, he’s seeing people getting terminated and he’s stressing.
Nichole Walker (02:28) Yeah, I mean, and rightfully so, but, you know what I mean? Yeah, I also think that, I mean, depends on, I guess we can ask and maybe it can give me a better understanding like how many lines is it like? Is it something that, you know, we could pull a tiger team to together and, you know what I mean? Like there’s ways around it.
Shannon Costine (02:46) And that’s the other thing is, I don’t know Connor was struggling to get them to upload their information. So, I don’t know what’s in there is current to be able to say, you know, we have this many lines that we need to get through. Yeah, I don’t know that he’s even joining, but he made it sound like he was.
Nichole Walker (03:11) If not, then I’ll let Connor and them know and then they can take it back to him and, you know, but I think the part analysis is going to be the best way because if not, then he’s going to end up causing more havoc for himself.
Shannon Costine (03:22) I’ve got 177 total.
Nichole Walker (03:26) Lines. Yeah. Oh, that’s not very much at all.
Shannon Costine (03:30) Okay. In.
Nichole Walker (03:32) Florida medicaid. If we have the provider’s npi number, I mean, that shit can be done in… like minutes. Do you know what I mean? Are you doing it? Yeah?
Shannon Costine (03:44) Medicare too, right?
Nichole Walker (03:45) Yeah, same thing. So, look and see how many of them are Florida medicaid and medicare?
Shannon Costine (03:53) Probably a lot. Aetna is a big one. How do you do Aetna? I don’t remember.
Shannon Costine (04:08) They’re not even in the waiting room yet girl, you know, how, on the shot, if you eat too much, I told you that’s where I’m at today. I’m like, yeah.
Nichole Walker (04:20) Every little, yeah, every little thing I just ordered mcdonald’s chicken nuggets because it’s just been a day. I’m sure that’s about this damn trip to India. Like no one can even tell me. I just booked, my hotel for Chennai because I, everyone else that’s going because, you know, we’re going to Hyderabad first and we’re flying to Chennai. So, no one bothered to tell me that they’re all flying. They’re leaving, they’re going to be in the Chennai office for like three hours, then they’re all going to the airport and leaving. So, I’m going to be in fucking Chennai by myself. No, yeah, no one told me that no one can tell how we’re getting from the airport to the hotel. Nothing. No one fucking knows anything. This shit has me stressed out.
Shannon Costine (05:02) I’d be puking over that. Yeah, girl. Yeah. Where the heck are these people?
Nichole Walker (05:12) Yeah, it’s 11.
Shannon Costine (05:16) Let me make sure. Yeah, I don’t have anybody in the… is this Connor’s meeting, if it’s Connor’s meeting? I’m not going to see it, right?
Nichole Walker (05:27) Yeah. If they’re in the waiting room, it won’t not until he joins.
Shannon Costine (05:30) Yeah. Who’s the host?
Nichole Walker (05:32) Is he joining?
Shannon Costine (05:34) I’m going to ask him?
Shannon Costine (05:40) Are you joining us… now that I?
Shannon Costine (05:55) He said he’s jumping on now… he did send me the transfer and I didn’t take it. So, will it update while we’re on… hey, Connor? Hey, everyone. I just realized I didn’t take the transfer over. Are they in the waiting room? Yeah, I’m letting them in right now. Okay. Thanks. Sarah’s. On our team, right?
Rick Vance (06:21) Yep. She’s the manager for PE.
Shannon Costine (06:23) Oh, she’s in the waiting room. Yeah.
Connor Morley (06:25) Why is she in the waiting room? That’s weird.
Rick Vance (06:29) That is kind of weird.
Shannon Costine (06:32) Sarah, we’re going to have to update your settings friend.
Connor Morley (06:38) Yeah, Sarah, I don’t know why you were in the waiting room?
Sarah (06:41) I don’t know either. It always happens to me.
Connor Morley (06:44) That was a weird one. Hey, Rick. Hey, Nikki.
Rick Vance (06:46) Hey, good morning, good.
Shannon Costine (06:47) Morning, guys.
Sarah (06:48) Morning.
Connor Morley (06:50) Hey, team, Rick, Nikki, we’ve got a couple guests on the call right now. So I want to introduce you to Nicole walker and Sarah. You know, we hear you loud and clear on this issue with the existing enrollments and we want to like, I wanted to loop them in because they are our PE operations experts as well to help us kind of figure out and to really think through like the best strategy going forward because just… to set the scene, you know, you have these existing enrollments that we don’t know, we’re not confident in the actual revalidation dates in the past, right?
Connor Morley (07:33) For them and we want to get them either re enrolled. We want to understand like are they still enrolled with the current payers? And then there are a couple handful of providers that you had mentioned like Carolina and Anthony ditomaso that we want to just get them re, enrolled as quickly as possible. So a couple of things for Carolina and for Anthony ditomaso, I can’t submit. We can’t submit new requests for them unless we delete the existing enrollments. I can pull that information out of medallion just so we have a source of truth and submit the new request. Is that okay with you? Because I know you want to get moving on those as soon as possible.
Rick Vance (08:15) Yeah. I think that’s how your system works and then it’ll dump into let’s… see what’s the here. I’ll just bring this one up. I go to payers, then it’ll dump into the enrollment requests bucket, right?
Connor Morley (08:32) Correct. Yeah.
Rick Vance (08:33) Yeah. Now, we don’t want to mess up medicare and ambetter because that looks actually let me go to him. Let.
Shannon Costine (08:41) me ask you though, Rick, because I was given, Nicole is our director of PE and I was giving her a little summary before the call. Are you, do you feel like those providers are not enrolled at all? Or is that something that you want us to check?
Rick Vance (08:54) So here’s what happened. I think to really kind of raise this up on our consciousness last week is dr ditomaso and the other person is her last name is difficult to pronounce but it’s Karolina sobkovic or something like that. They report their office reported that they were getting out of network messages from Aetna and so by a patient particular patient actually. And so I called Aetna and they verified that they were out of the network. And as you know, most of these payers renew every three years, we have poor data as of at least six months ago as to renewal dates for enrollment. So we’re fearful, right? Because we don’t have good data at our hands, right? Like Connor was saying. So we have been lagging on getting the payer information into your system because it’s taking us an inordinate amount of time to get it into that spreadsheet format. And so what we decided last week is Nikki and I and missy, our practice operations manager. We basically pounded out for a day and a half, all most of the payer information that we have into the system by physicians. So you’ll see you, look at Anthony ditomaso, you’ll see now a ton of those payers are in there, right? We entered that in mostly on Friday. So I think what Connor is saying is we’re going to take all that. We’re going to send out enrollments for him and Carolina… requests for all of those because we don’t know the data situation and try and make sure that they didn’t fall off enrollments. And a lot of these enrollments might be at the same time because they might’ve been originally enrolled at the same time. So our thinking is for 150 dollars a pop. Let’s just send all of these out for these two positions to make sure that they are enrolled. And then look at what information we get back. If they send back, hey, you’re already enrolled? What are you doing? And fine, right? We covered ourselves. But if we’re not like Aetna then they’ll start the re enrollment process which it sounds like might be from start because we might have missed the re enrollment period. So that’s our thinking at the moment. And it’s only those two that we’re hearing about right now. But we’re just skeptical. And just as a side note, dr ditomaso is the chairman of the group. So, I mean if you wanted to pick the worst one for this to happen to it’s him. So we want to cover ourselves, right? And at least get him back on board with everybody that might be falling off. But hopefully that describes our situation and our level of concern.
Shannon Costine (11:56) Now, Nicola brought up a good point about medicare and medicaid. Do you feel like those are terminated as well or they didn’t make it for those?
Rick Vance (12:04) We don’t think so. So we have a contact and I don’t know if you guys can do this through avality, but we have a contact that I need to give a phone call to. We’re playing phone tag from blue cross blue shield, who can show us in avality, how to check enrollment eligibility. Now, that might just be for blue cross blue shield. But if we could do every payer.
Nichole Walker (12:30) It’s going to be just for blue cross blue shield on avality, your Aetna you can also do on avality, okay? For Florida medicaid, it’s probably one of the easiest payers I’m in Florida. So I only say that because that’s the only one that I know the best. Okay, but Florida medicaid, I can look at super easy and tell you what location they’re at, if they’re enrolled, if they’re due for revalidation, and when next revalidation is due, same thing with medicare. Okay? So, them payers, I’m not as worried about what I did tell Shannon though is if there’s some… payers as an Aetna and blue cross for Florida, if they’re already enrolled, and this would be my dilemma on us just randomly going and submitting without doing like a par analysis to see if they are enrolled. Florida medicaid will deactivate them as a whole. If you submit a new enrollment for a provider that’s already enrolled. So then we would have a bigger issue, right? Because if dr walker’s enrolled, but we do a new enrollment and say dr walker’s been enrolled for 10 years, we’re going to lose that effective date from 10 years ago, right? And that’s what we don’t want to do. We want to make sure that we can go back and bill for whatever reason if we need to.
Rick Vance (13:47) So that was recommended kind of brought that up on our phone call last week, but we were told that the par analysis could take four to six weeks yeah.
Nichole Walker (13:56) So, you don’t have that many providers and I told Shannon like Florida medicaid, medicare. I mean, I can jump in and help. I mean, them two payers, I could probably have done in an hour. You have, what would you say like 140 something providers Shannon?
Rick Vance (14:11) We have 80.
Shannon Costine (14:13) Yeah, they only have 80 providers. I’m seeing 177 lines Nicole.
Nichole Walker (14:17) Oh, Jesus, take the wheel. No, sir. We can commit to having that done pretty quickly.
Rick Vance (14:23) Okay. We just need to get the par analysis and contract.
Nichole Walker (14:27) That, okay, right? So once that’s done, I just feel like if we don’t do it this way, then we could set you up for bigger failure, right? Understood. Because we surely don’t want any providers deactivated from any locations, understood. But it’s not that many providers. And like I said, if I need to jump in and help personally on medicare and medicaid, I can do that for sure.
Rick Vance (14:48) Okay. That would be helpful go.
Shannon Costine (14:51) In that route, Rick, because then you’ll know for everybody, not just those.
Rick Vance (14:54) Two, I think that’s the way.
Nichole Walker (14:57) To go. Yeah. And so what we do for part analysis, we find out are they enrolled, is there a revalidation coming up? Medicare only releases them within 90 days of revalidation being done, but for medicare, their enrollment’s good for five years and medicaid is three years. So, if you say that they’re enrolled today, you know, right off the bat five years from yesterday is going to be the revalidation date, right? So there’s some, we could actually provide you with upcoming revalidations, you know, just be mindful about it again. I just don’t want you to get in a bigger pickle, right? If we could just go start submitting all these enrollments. A, you’re going to pay for them and you don’t need to, and B, you have a good chance of deactivating your current providers.
Rick Vance (15:43) That’s great. Now, you’re going to update your system after you do that par analysis with all those enrollment dates. So that’s great. We’ll catch that rolling forward. But one other thing you were also going to do as I guess plan B is update your email addresses with as many payers or payer portals so that you’re getting some of that communication as well as to when that 90 days kicks in that.
Nichole Walker (16:05) Is exactly right. And then for medicare, once we get which Shannon, you can tell me if we already have it. Once we get surrogacy to the group, there is a revalidation tool in CMS that we pull every single month that tells us from the medicare standpoint and medicaid is, I mean, it’s 80 providers. They are literally three years to the date. And like there’s no going past, go, never any exceptions. So, as we do this part analysis, we’ll be able to pull revalidation dates for every provider for medicare and medicaid.
Rick Vance (16:39) That’s beautiful. Okay. That is really good news on a Monday morning.
Nichole Walker (16:44) And what will happen is, so if we do the part analysis and say dr walker is not enrolled with Aetna or we get confirmation that they’re out of network, then we would let you know, hey, a new enrollment is needed. We need you to put this request in. So it’s not a guessing game and you’re not paying for unnecessary enrollments that the providers already have. We would let you know going into it. We do need an enrollment for dr walker for Aetna because they’re out of network and.
Rick Vance (17:11) So, if you could check D, Tommaso and Carolina just put them at the top of the list, if any enrollments are needed, we should submit those today.
Shannon Costine (17:21) Jack, is that something you have to take first on your end to get it started?
Jack Schell (17:26) Yeah. We need to look at how many providers, and if we’re doing groups and facilities for par analysis as well too, so that I can quantify that and put that in an order form for those work we were going to do on par analysis, okay?
Shannon Costine (17:37) Do you need anything from PE ops on that?
Jack Schell (17:42) We’ll just notify you once we get the par analysis through with signatures so that we can get started on the work. I can look at total providers we’re going to need. Are we going to be doing par analysis at the group level as well?
Shannon Costine (17:59) Rick, do you have group level enrollments or facility enrollments?
Rick Vance (18:04) We’re all one tax id number. I will have to double check that.
Shannon Costine (18:10) I would say no, but I’m not going to.
Rick Vance (18:12) I would say no too, but.
Nichole Walker (18:14) Well, I would say no, but with the caveat if you guys don’t have when your facility is due for revalidation, then that’s something that you’re definitely going to want to do because if good point again, Florida medicaid’s the only one that I can tell you everything about. If you term with Florida medicaid, it will automatically term all your providers also. So then you would have to go back and do a re enrollment for all ad providers. And that’s something we definitely don’t want to do. So, just with that caveat, we just need to be mindful is, you know, yes, providers have to be revalidated, but so does your organization.
Shannon Costine (18:50) Great point. Nicole. So, yes, Jack, one facility? Okay?
Rick Vance (18:54) Yeah.
Jack Schell (18:56) All right. Are we going to assume moving forward, Rick, that we’re going to do this for all of your providers? I think so, because something that we just need to associate with the order is the specific list of providers for our team. So if we go into medallion and we look at your list of providers, is that everybody? Yep? Okay. All right. So I will get this going on my end so that the team can we’ll send it to you for a quick review. We’re just going to add this to the contract. I’ve.
Shannon Costine (19:34) got 79 in medallion, Rick, you were saying 80. So that should be accurate, right?
Rick Vance (19:39) Yeah, I think that’s right? It’s like 47 docs and like 30 apps. It’s pretty close 32 apps.
Nichole Walker (19:49) Where are you guys at Rick in Florida?
Rick Vance (19:53) We’re mostly from Tampa to port Charlotte. We’ve got five on the space coast in Brevard county. That’s why that first health is for them only, you know, and we should probably think about, we… just credentialed a bunch of docs and maybe I need to take them off the list. So probably the new docs from October of last year to current, we know all of those are fine. And then the new payers that we just signed up for, we’re not going to need to do those either.
Nichole Walker (20:36) Right. Because if they’re new, then you would know right off the bat that enrollment hasn’t been done.
Rick Vance (20:41) Exactly. Yeah… I.
Nichole Walker (20:44) asked if Shannon and I are both in Lakeland. So when we hear Florida, we’re both like where?
Rick Vance (20:49) We’re at in Florida, you’re not far from us? Yeah, not far.
Nichole Walker (20:53) At all. Nope.
Rick Vance (20:54) Yeah… all.
Shannon Costine (20:57) right. So, as far as next steps Jack, that would come from you, and then, do you, in the meantime, Rick, you go through that list, Jack, are you going to pull anything, pull a report for him to go through?
Jack Schell (21:11) In terms of the providers?
Rick Vance (21:13) Yeah, yeah.
Jack Schell (21:15) I’m not sure that we would have that report to pull in terms of those that started with you in October, I’m just saying, can.
Shannon Costine (21:26) we export, well, you guys can do it on your end. You could export the list if you need to Rick, and then just take off the ones that you don’t want.
Rick Vance (21:33) Yeah. Okay. Let me work on that and.
Shannon Costine (21:36) Then you could send that over to Jack. Does that work, Jack? Yeah.
Jack Schell (21:39) Do you know about? Is that, is that like a large volume of providers that will be excluded from the 79?
Rick Vance (21:46) One, five, six. No, no, I mean, might not even be 10. All right. Good to know. Is that in the report builder?
Jack Schell (22:04) No, if you just go to your providers tab and you should be able to export the provider data from the directory directly.
Rick Vance (22:12) That says download export providers into a CVS, but I, can, I manipulate a CVS file or what if I just sent you a list via email? Sure. Is that fine? Yeah.
Jack Schell (22:26) If you know who the providers are that started that you don’t need part analysis for, then we’ll assume all providers except for those.
Rick Vance (22:37) Okay.
Shannon Costine (22:42) Anything else you guys were thinking about or want to cover in the meantime while we’re all together?
Rick Vance (22:50) Nikki, are you on? She is, yeah, anything from your perspective, Nikki? No.
Shannon Costine (22:59) No. Okay. Nicole, Sarah, thank you guys so much for joining from the PE side. Appreciate you.
Rick Vance (23:05) Guys. Yeah, thank you of.
Nichole Walker (23:06) Course, don’t let me know if y’all, need anything else from us.
Shannon Costine (23:09) Appreciate you prioritizing that. Thank you. Yeah. All right, guys. Thank you so much. Appreciate it, and we will talk to you soon.
Rick Vance (23:16) Yeah, stay in touch. Thank you. Thanks.
Jack Schell (23:18) Everybody. Rick. I’ll be reaching out later, okay?
Rick Vance (23:21) I’ll send you an email, Jack. Thank you. Bye.