Transcript
Shannon Costine (00:00) hey, Stephanie. How are you? Good? How are you? Good?
Shannon Costine (00:08) Just waiting on the others.
Shannon Costine (02:37) I just saw… what in the world? I could have sworn I just saw Christina in the waiting room… and it’s not showing her.
Shannon Costine (02:56) Oh, my gosh. Can you shoot her message and let her know if you don’t mind… or ask her if she could. I hate to ask her. This. Does she mind like leaving and coming back? I don’t know what happened unless she did leave.
Stephanie Alcena (03:19) Messaging her right now.
Shannon Costine (03:25) Oh, this is so annoying. This has never happened… unless she joined the wrong meeting.
Stephanie Alcena (03:34) We only had one. I did notice that we used to meet at one before, right? One P. M eastern.
Shannon Costine (03:43) Yes, ma’am, I bet we changed it last week.
Stephanie Alcena (03:48) I’m waiting for her to.
Shannon Costine (03:49) Reply, let’s see.
Shannon Costine (04:27) Oh, there it is.
Shannon Costine (04:32) Innis is here, but I don’t see Christina.
Shannon Costine (04:51) Hello? Hey, Innis. How are you?
Innis Barton (04:53) I am good. How are you? Good?
Shannon Costine (04:56) I could have sworn I saw Christina come in and then maybe she left. So, I was like, I felt like I was searching for an Easter egg. Oh, how weird. I know, I was like, I swear, I saw her and then I couldn’t find her. I was very concerned she.
Innis Barton (05:11) Gets lost what’s going on?
Shannon Costine (05:14) Oh, sure. I’m like maybe I did something Christina because I could have sworn I saw you come in, well.
Christina Oneil (05:22) Yeah, and it just was sitting there spinning and I was like, I don’t know what’s going on.
Shannon Costine (05:28) Sorry, of course. Okay. So I had the team perform an audit based on our conversation last week.
Shannon Costine (05:40) So I will share these results with you. And then I believe there’s an executive meeting tomorrow with Mira where she’ll get more into the contractual stuff that I don’t do. Okay, let me share my screen and it’s a very simple quick slide that I want to go over the results. So I will go, I’ll pause on each section. But first area I want to go over is the enrollment stopped lines. Now, let me preface this by saying the audit that they did was only on the two wellcare wellpoint because those were the payers that were identified. So there was eight lines that were stopped. All were confirmed by client to move to request. Stopped. Two lines were moved incorrectly. I can tell you that those lines will be reimbursed to you. That will be a credit back to you all because they were stopped incorrectly. Incorrect, client task stated. Wellcare, West Virginia does not offer PE, client approved closure, but that is still an error on our part. So, you know, we’re taking accountability for that and giving you that credit back flag to production lines, reopened for processing. Anytime something’s closed incorrectly, they should always reopen it. You should never have to put a line back through because that’s where you get charged, remaining lines correctly stopped in intake pending provider. And that was requested by Christina. I’m going to pause there. Any questions so far?
Innis Barton (07:18) Yes. So, were we charged for the remaining lines correctly stopped? Yes, you were. Yeah, but didn’t we agree that we aren’t supposed to be.
Shannon Costine (07:29) Any lines that are put in intake complete, then you’ll be charged for those. That is my understanding. If you have continued questions on that though, Innis, I will flag that to Mira and ask her to make sure she covers that. Will you be in the meeting tomorrow?
Innis Barton (07:47) Probably. Okay.
Shannon Costine (07:49) I’ll make sure that she covers that peace on what you’re charged for consumption on that. My biggest concern to be honest was making sure that obviously I don’t want you guys being overcharged. Of course, you know, that, but I want to make sure that they’re processing the way that they should be because they should always be paused on pending dependencies and they should not be completely stopped, which was what Christina’s concerns was legitimate concerns, which is pending dependencies. We had 16 lines total, 14 correctly moved from intake one submitted then moved on first follow up. One sat in follow up for three months before moving. So that was discussed with the team. The two were submitted within SLA, no major impact. So that one was our biggest concern which is why was it sitting there for three months which is what they’re looking into, does that so.
Innis Barton (08:51) Secondary to the billing? Does?
Shannon Costine (08:54) That include that?
Innis Barton (08:56) We, that medallion… is getting credit for hitting the SLA, even though something is submitted that’s never going to be approved because it’s not the dependencies aren’t being taken into account.
Shannon Costine (09:11) Yes, they are okay. That’s what I’ll just leave that there app submitted, follow up. There was seven lines, five correctly moved to pending dependencies before processing. And then two flagged production for review. Oh, sorry. So there was one recently submitted on 325 and there’s one sitting in follow up. So the two that were within SLA, there was no major impact, but they will update the status accordingly. So I will follow up on those two that were flagged to production to make sure that those are moving. Any questions on that part… Mira will cover anything about consumption or what we found in the audit making sure you get those two lines back and any additional questions that you have in that area?
Innis Barton (10:04) Is there.
Christina Oneil (10:04) a reason why the full audit wasn’t completed?
Shannon Costine (10:10) Why we didn’t do all lines? Yeah… no, because the wellcare and wellpoint were the two insurance companies that were brought up that’s why they did.
Innis Barton (10:22) Are you on tomorrow’s meeting or are you not on tomorrow’s meeting?
Shannon Costine (10:26) I am not okay.
Innis Barton (10:28) Can I be, I’m going to be blunt. So I mean, that’s why I’m going to ask?
Shannon Costine (10:32) I love it.
Innis Barton (10:35) I don’t want to speak for Christina, but I think I am speaking for Christina because I’m about to say stuff that isn’t actually about you. And I want to be clear that it’s not.
Shannon Costine (10:45) About you, I don’t take it personal. Okay? I promise. Okay.
Innis Barton (10:52) We have now asked multiple times sometimes… rudely on my part for a full reconciliation that is the responsibility of medallium okay. So if Mira shows up to tomorrow’s, meeting with only a reconciliation of like the examples that Christina gave, it is not going to be a good meeting. Okay? And I might not have to say a word. It’s not going to be a good meeting because the CEO is going to be really angry. I feel like she gets a heads up on that. If you want to give her a heads up on that, I feel like you’re her co worker, maybe she should know that this is not going to fly for tomorrow.
Shannon Costine (11:40) She,
Innis Barton (11:41) will also need to address conceptually that medallion is getting credit for meeting an SLA, which in fact, they are not meeting because they are submitting without the dependencies being addressed, which means it looks like on paper, they’re meeting the SLA, but they’re just submitting something that’s going to be rejected anyway. So that is in not good faith meeting the SLA… which again, would indicate a floor in the foundation of how medallion is set up and how they contract and bill. Again, this isn’t you and I need to make that clear because you have been nothing but above board with us. And you’ve paid attention to the questions we ask and you’re trying to do your best. And I will state that on our side with executive leadership, I have also made that clear that the issue is not with our, now, I can’t remember your official title?
Shannon Costine (12:41) Engagement manager engagement.
Innis Barton (12:42) Manager. Thank you. It’s not with our current engagement manager. But yeah, tomorrow’s, meeting is not going to go well if that’s all she has. And all she’s going to say is, well, we can’t do anything without examples because it’s now on like look, we’re being, we’re being billed under the assumption you’re meeting in SLA, that you’re not actually meeting as intended. And we came up with things that we’ve been billed for now that we shouldn’t have been. So now, it’s on medallion to actually prove that everything’s legit. Yeah. That’s do.
Shannon Costine (13:24) You feel like all payers and lines should be audited?
Innis Barton (13:29) The bitchy part of me says, yes.
Christina Oneil (13:32) Yeah. Well, I do. Yeah, no, I agree. Like, I do feel those were just specific examples because those are our top payers, you know? So that’s where I, why I provided those two. But considering most of, our highest payers that we have are managed care plans, then, yes, all payers should be audited. And that’s kind of what I was trying to get at the last email that I sent whenever that was. And so, you know, we continue to still see things not saying, pending dependencies. I sent, I got another request today that I forwarded to you and it’s just like as an fyi, of, hey, they stopped this or, they put this on hold now because of the fact that they realized that, it needed the medicaid number, you know? So, I mean, I don’t know. I like, I, again, Shannon, you’ve been incredibly helpful. Thank you. And I appreciate you listening to me, and the call that I, that we went into was not supposed to really be about consumption. It was mostly just to be about the fact that I have questions and I want to understand like what processes do I need to make sure that we’re following? And in order for both sides to not have, be overburdened with, you know, additional tasks or additional steps in the process, right? And I, it kind of was frustrating to me that Myra said you can’t be discussing this. That’s not why we were there. You know what I mean? Like that’s? That was not the purpose of the call at all. It was simply to understand, okay, how can help me help you? Right? Like I don’t know.
Shannon Costine (15:26) Right. I.
Christina Oneil (15:28) Don’t know what I don’t know and I wasn’t part of the initial implementation. Like I said, on that call, I wasn’t I was, I got thrown into it like end of August and early September and just started noticing stuff that didn’t seem to be going the way that I was under the impression it was, yes, I was involved in some of, the calls and discussions, you… know, but not all of them and not all of the information as far as getting the data loaded into medallion. What did that look like? I don’t like there was a bunch of stuff I wasn’t involved in because the original, like the implementation started. I think it was March April. It started with Melissa, then went from Melissa then to Teresa, and then kind of landed in Stephanie and I’s hands. So, yeah… so long winded of, I don’t know what’s going on but, and while things are going, what looked to be better now with the new hires that I have currently in process, I just feel like all of the lines that we had that we’ve been billed for and all that need to be reviewed and Innis, I don’t I mean, it doesn’t feel like medallion… is willing to do that. And I don’t understand why, like is it a data issue or what? And when I look at the request lines stopped, there’s more than that. There’s 186. And so that’s where I’m like, okay, well, I know I did request some, but the ones that I identified in my email were ones where it was clearly not me stopping, the request and it was because we needed the medicaid id, you know, sure.
Shannon Costine (17:28) Yeah, absolutely. And, the two payers that they found, I mean, obviously as I showed you two lines were not done correctly, but I can take it. What I’ll do is take it back to her now or when we get done here and say we want everything reviewed, all payers with all stopped lines. Is that a fair request?
Christina Oneil (17:51) I believe so. Yeah.
Shannon Costine (17:54) Or what I guess I should say, what you’re asking for? Yes. It’s better to say it that way. Yes, we’ll say all payers and then all stopped lines… if they agree to that. And I’m not, I don’t know what they will agree to being Frank with you guys. If they agree to that, it’s probably going to be a couple days. Normally, I see about two to three days. I would expect by end of week for the audit team to get through that. So I will take it back to them, take it back to the audit team and find out what they can and can’t do and then send you guys an email and let you know.
Shannon Costine (18:33) But Mira can also bring that information to the executive meeting. Will Nick be in that meeting? He’s supposed to be? Yes. Hopefully he won’t be… okay. So… I’ll take that part back. Is there anything that you feel like you are having issues with? Currently, the only provider that I see currently that I’m concerned with is Nicole. We talked about last time because I know you had that issue with her license, but she should be moving. The other one I see is Catherine. Have you seen issues with her?
Christina Oneil (19:12) Yeah, she, Catherine rattlin. And this.
Shannon Costine (19:16) Is for deep theory, I was going to say which Catherine, because we have more than one and I will get lost otherwise fair, totally fair.
Christina Oneil (19:26) So she’s she was one of the ones that I called out in my email. It’s her.
Shannon Costine (19:32) Her enrollments.
Christina Oneil (19:34) Have kind of been all over the place and having a lot of issues with them. Okay?
Shannon Costine (19:40) And.
Christina Oneil (19:42) it’s her, Tabitha Hawkins, dr rattlin. And the other part is with crystal ratcliffe, Nicole smith, and we have Christine mons, who are our new hires.
Christina Oneil (19:58) Those are the ones that I’m just we’re tracking to hopefully have a good onboarding experience. But the part that I had Stephanie do specifically was I was trying to make it so that we wouldn’t have those hiccups with the pending dependencies while the it team was like working through that. Did anything happen with that by the way? Like did they look at the, how it’s mapped?
Shannon Costine (20:29) No, not yet. I do have a ticket in but not yet. Okay?
Christina Oneil (20:33) So, what I had Stephanie do specifically? Like I said for Christine because I was trying to be mindful is I only had her request the medicare and medicaid for?
Shannon Costine (20:46) Her as.
Christina Oneil (20:47) a first pass before entering in the additional… enrollment request. Okay? So.
Shannon Costine (20:57) You did put, you’re saying you did put those through. I.
Christina Oneil (21:00) Put only those two or Stephanie put only those two through, but I just, I was just curious if the it part of the, of this is was addressed yet not.
Shannon Costine (21:14) Yet, I’m curious to see if we can look at all lines, what that’s going to entail or what comes out of that because they’re saying 14 were moved correctly with the pending dependencies. So I need a bigger view to see, but it is in it like there is a ticket out there for them to fix it. Okay? Let me make sure there’s no other ones that are sitting out here. I see your needs client attention went down quite a bit… and completed went from 158 to 177. So they’ve completed some lines, but we went up on hold quite a bit. So there was 114 on hold as of 324. And now we have 132 on hold. I haven’t had a chance to review those. Do you feel like those are the pending dependencies that they put on hold?
Christina Oneil (22:16) Those are for the new hires. Yeah, that move to pending dependencies. And that kind of goes back to my point like if we’re not looking at all the lines from the audit perspective, you can see that the time frame at which the application was submitted to, how many times it was rejected and all that, then it’s you know, it doesn’t line up. And without looking at the full scope of kind of where we were to where we are, you know, like that to me is the biggest red flag. Yeah, an.
Shannon Costine (22:55) Issue. Yeah, for sure. Okay. Do you have any other questions or Stephanie? Any other issues that you wanted to address?
Stephanie Alcena (23:05) We received a few enrollments that were partially completed. Would those still be under processing or are they being moved to on hold?
Shannon Costine (23:18) What were they like? Were they commercials that were complete and then you still need medicare medicaid? Yes, those should always move to pending dependencies. So on hold to answer your question, that’s the process that it should follow. I should say, okay, so if you see otherwise, flag them to support or let me know. And I’ll flag it over to the team. But I’m going to take a look at these as well to see what’s out there while I look at it with QA. But like I said, if you see issues, flag them, let us know and we’ll look at it.
Shannon Costine (23:56) Okay. Anything else? I know we don’t have all the answers today, apologies, but hopefully I will get something by end of day to let you guys know where we’re going to go with it. Okay. All right. Well, that’s what I had for you guys. Like I said, I’ll follow up with you and if not, Mira should bring that to your meeting. Okay? Appreciate it. Are there any questions we should be asking that? We’re not asking? No, you’re asking all the right things to be honest with you. Okay. Thank you. All right. Thank you guys. I appreciate it. I’ll talk to you soon. Okay. Bye. Thanks, Shannon. Bye.