Transcript
Mira Guha (00:43) hi, Tyler. How are you having some zoom issues this morning? It looks like for me… I might need to turn my camera off if it gets a little wonky. By the way. I think you’re muted?
Christina Oneil (00:59) Yeah, sorry all.
Mira Guha (01:01) Good. How are you doing today? Not?
Christina Oneil (01:03) Bad. How are you?
Mira Guha (01:04) Doing all right. It’s Wednesday. I’m halfway there. Not really close.
Christina Oneil (01:12) Yeah, almost.
Mira Guha (01:19) I’m guessing it’s gonna be the usual dream team today… Tyler Innis, Christina, anybody else? I’m guessing that’s all of us. Hi, everyone. How are we doing today?
Mira Guha (01:35) No worries.
Innis Barton (01:36) Good, good.
Mira Guha (01:38) I was telling Tyler I was having some wonkiness, when I joined there’s. A chance. I’ll have to turn off my camera… I,
Innis Barton (01:44) have a new computer, so I could also have wonkiness. I.
Mira Guha (01:48) Know you were having some camera issues, I think on our last call. So I’m glad to try you a new one. Yeah. My sister works in healthcare and she was at a meeting and someone spilled an entire iced coffee on her laptop and they didn’t even replace it. They just fixed it. I was like, I hope they fixed it, right?
Innis Barton (02:03) Wow. Okay. At.
Mira Guha (02:06) Least it wasn’t that, hi, Christina. How are you?
Christina Oneil (02:09) I’m all right. How are you?
Mira Guha (02:11) Doing all right. I realize we budgeted 30 minutes for this call. If we need another one, we can do that, but I know everyone’s time is really precious. I put together kind of our standard deck but with a huge priority right now on just kind of the hot topic items right now being the parent enrollment pieces. Obviously, I wanted to just kind of address the feedback. I know the thread’s been ongoing for a while kind of do a review of everything medallion has done, credits that have been issued, review of lines and hopefully puts us in a good place. We’re focusing on moving forward. I understand progress is going pretty well in the current meetings. And then of course, address the current consumption as it stands right now. Any other major questions before I just go ahead and jump in… hoping we’ll cover everything we can in this time? Yep. So even if we don’t get to some of the other pieces, I did just include them in here especially kind of just current operational metrics, overview of how certain processes are going, licensing, enrollment, credentialing, and then consumption as it stands today. Wanted to start by addressing any of the kind of questions hopefully Innis and team got to see the email yesterday from our leadership and sent by me regarding just how the pending dependencies line works. Just wanted to flag anything in pending dependencies does not factor into the SLA timeline that is considered a non working status. So just wanted to refresh on the msa language here and just confirm or clarify anything as it relates to slas which we have been monitoring can go over that as well. But just see if there’s any further questions here.
Innis Barton (03:51) In my comments though, I wasn’t referring to items that were in a pending dependencies status. And Christina can correct me if I’m wrong, but my understanding is these items are never in the pending dependencies status and they were being submitted. They should have been in a pending dependencies. But they were being submitted knowing that they would be rejected anyway. And the act of submission was then what was saying, okay, hit the SLA even though they would be rejected.
Mira Guha (04:28) Okay. I think that might have been a misunderstanding. Then on our end, was this specifically for wellcare wellpoint this?
Christina Oneil (04:36) Is specifically for all of the managed medicare managed medicaid plans. They were not being mapped to pending dependencies. The applications were being submitted and they didn’t have a medicare id. They didn’t have a medicaid id. They didn’t have the criteria that they need to actually check off the boxes for each line of business, which caused if you look at the notes. And I specifically call it wellcare because I looked and that’s just our biggest payer but it’s all of them. Anything that has multiple lines of business were being rejected and going in circles because there’s no medicare id and no medicaid id.
Mira Guha (05:18) Okay. I can check on that. My understanding was our team did an audit of the wellcare, well point lines and was not seeing that. I will review that again with our team. But as of right now, that was not something that they were seeing. So we’ll follow up there, but that.
Innis Barton (05:30) was historical like it was fixed, what like a week ago Christina two weeks ago, it?
Christina Oneil (05:34) Hasn’t technically, well, it was on a call that we had that they like flipped the switch to say pending dependencies for wellcare now and Shannon had submitted a ticket to it to verify that it’s all been done and that’s where the historical information is the part where it’s not, it’s it wasn’t happening the, in the order that, which it was being requested. And that’s what prompted my meeting with Shannon is to be like, what are we doing wrong? What are we, what step can we take to make sure that the medicare and medicaid business lines are not being delayed? Because like I feel like I went into the call. Like I wasn’t about talking about consumption or anything like that. It’s what can we do to improve the process going forward for our new hires, right?
Mira Guha (06:27) And I do know that our team was aligned on those pieces. There, there have been multiple conversations internally with our payor enrollment, operations, team, director of operations, as well as Shannon regarding the go forward plan. So they’re definitely aware of that piece. It was my understanding that had been fixed going forward and that any that were out of SLA that warranted credits at least for one care at one point were provided? But are you saying that you said all managed matter? Could you provide some more examples and I can check internally with the team?
Christina Oneil (06:59) So, if you, and this is, it’s kind of… when you, when I download the report for the enrollments within, sorry, I was gonna say lightning step within medallion it, I can filter by the ones that say multiple service lines, says medicare medicaid commercial. And that’s the way that I was able to kind of do a spot check of the other lines of this, of the other insurances to… get a better idea of like, what is the issue, see what the trend was? And that’s what it was is that those multiple lines of business were not being reviewed.
Christina Oneil (07:50) So, I mean, I still go back to like we’re asking for an audit, right? Like we’re that’s all we’re asking for. It’s not specific examples. It’s looking at the data and saying, okay, this does not make sense. You know what I mean? So, like,
Innis Barton (08:10) and I can’t I was going to say separately, I do not know if we have the credits you speak of specific to the SLA issue. So, it would have been a prior issue. I don’t know that we have any credits for any of the instances where the SLA actually wasn’t met because nothing was being coded as the dependency. Okay?
Mira Guha (08:35) Yeah. So as far as the pending dependency lines from what I understand from the audit that our team did for a number of those requests, the ones that were in request stopped that we had to address those. Either, you know, we did the SLA track here. This was from late March and confirmed if there were any outside of SLA to be credited or they did not complete intake complete. So platform logic, they would not have been consumed against your contract. That is my understanding as of where we are right now. In addition, hopefully, Shannon shared with you yesterday, the two requests that should have been put in pending dependencies that weren’t were still within SLA, so technically didn’t warrant credit necessarily, but we credited those back to your account anyhow so those will be seen as a consumption credit to get back against your account. But as far as I’m seeing, we did that audit here, just checking my notes here. And then we did share the report of any of the lines that were moved to request, stopped based on what your team provided to ask us to stop those requests. And then similarly any of those lines moved to request stop that hadn’t completed intake did not count against your consumption. That is what I understood to be kind of the big highlights discussed yesterday that we wanted feedback on were wellcare wellpoint which our team reviewed requests, stopped being a big one and then just kind of SLA pending dependencies pieces, which is what our team reviewed as the priority status there.
Innis Barton (10:00) My understanding that was you only reviewed the items that Christina had brought up, correct?
Mira Guha (10:06) That’s how our auditing process works. We do need examples that’s just how that’s not acceptable. Like you guys need to be auditing everything.
Innis Barton (10:16) Because we’re saying like, this is, I think where the miscommunication is happening. We are saying that in a very small audit of this essentially one two payers… instances where we got a credit were found. So in… a small sample, if there is this, we are assuming it means in the much larger sample that is our book of business, there’s other credits out there, but we shouldn’t be the ones looking for them to prove to you that we’re being over billed. Now, it’s a wait. You’ve been over billing us?
Mira Guha (11:05) Like I mentioned?
Innis Barton (11:06) The two that.
Mira Guha (11:07) we credited, were credited as a courtesy. Those weren’t actually out of SLA. Generally, our credit system will be based on those, any of those requests out of SLA per the msa. So that’s why I was just letting you know given some of the concerns and feedback given our team agreed to credit those two back, but they technically didn’t require credit. Again being a courtesy, I thought.
Innis Barton (11:26) The credit wasn’t for the SLA piece. It was for the fact that we were charged for consumption for something we asked to be stopped before intake was completed.
Mira Guha (11:36) That’s not my understanding here. My understanding is that we completed intake on these, they were within SLA, but then they were moved to request stopped. This is not.
Christina Oneil (11:47) What Shannon shared on the audio.
Innis Barton (11:49) That was not what the powerpoint was. Yesterday. It was two separate items. One was the SLA piece, which was just, it was more of a, yes. This happened because there was no dependency. It wasn’t a, I don’t want to say it wasn’t a huge issue, that was a different word, but it wasn’t considered a critical item. In addition, there were instances… where there was no, the dependency item wasn’t set up. Sorry, we asked for something to be stopped prior to the intake being completed and those we are getting credit for.
Mira Guha (12:35) Okay. I think there might be some miscommunication there because if it was stopped before intake completed, it shouldn’t be getting credited because it shouldn’t need to. It wouldn’t have been consumed against your contract, anything that does not have.
Innis Barton (12:46) But it was that’s what we want checked because we think it is showing up as consumed it is.
Christina Oneil (12:50) It did. And that’s where I went back to the consumption report that you all sent. And the examples that I provided were off of the consumption report and the report that when you pull the report for intake complete date, it does not show up on any downloadable version. And so you have to manually go in and look at the consumption data to then go into medallion and see where the actual intake was completed or not. And that’s what I did in order to provide my examples. So.
Mira Guha (13:30) Those examples being the wellpoint wellcare, you’re saying our team provided that report that said that they were consumed, but you’re not actually seeing intake completed dates in platform. Sorry, I’m just trying to, there were items.
Christina Oneil (13:43) Yes, there were items that were not intake complete that were on the consumption data.
Mira Guha (13:48) Okay. I will take a look at those wellcare wellpoint lines myself to confirm intake, completed dates. That consumption report that our team shared was based on the logic within our platform. Anything that was marked consumed would have an intake completed date. So I will need to check that because if so, that is a huge discrepancy. But my understanding is that is not possible through our system to be marked as consumed. If intake’s not completed, I’ll go ahead and look at the wellcare wellpoint lines after this call and I’ll see if there are any that were consumed. I’ll do a cross reference between the two and let you know… any other questions about consumption.
Innis Barton (14:31) Not at this time. Okay?
Mira Guha (14:34) So just to confirm as far as what was credited through our SLA check per the number of misses that we are, you know, the 95 percent that we need to be on SLA, we did confirm credits for 34 of those misses, 2000, 640 in credits and then the additional two enrollments this week that we credited as a courtesy.
Mira Guha (14:54) Any additional questions there? Okay. I believe I have my feedback and action items to take back. It sounds like if that is the main issue is that you were seeing a discrepancy between what we’re showing as consumed and intake completed in the platform. I will go ahead and check that back with our team. This was just information I think to help kind of clarify any other consumption terminology msa items that was shared by head of our am team. I’ll just unless we have questions to go over here. I’ll just go ahead and share it after the call for your reference. But any questions there? I don’t okay. Got it. So I think I have my new feedback here being the biggest point being the intake and completed sorry intake and consumed. Any other requested action items. I will say as of right now we have completed and this is coming from our leadership as well. We have completed audits. Wherever we have seen feedback requiring or suggesting an audit is needed. As of right now, our team is not going to conduct any more audits except for this one mentioned today where I’m going to be auditing the consumed versus intake completed here. As of right now, we are seeing a lot of progress against your current enrollment work, current turnaround time. I’m seeing in platform and that’s in here from submitted to enrollment completed is 50 calendar days. Rather understand, we want to fix up any of the SLA credit issues. Historically. My understanding is that has really been addressed as much as possible. With the potential exception being this piece here today with the consumption and intake completed. But I just want to let you know we are seeing progress. We want to continue making that progress. We do need to, of course, follow up on that action item. But we do also really need to address the consumption which I’ll talk about in a moment. But I wanted to provide that message from our team and make sure just anything else related to SLA msa, consumption is cleared up.
Tyler Countie (16:50) So I just want to be clear. We’ve repeatedly asked for you guys to just audit everything. And your response is that you’re just not going to do that.
Mira Guha (16:58) We’ve gone ahead and prioritized the items that you’ve given us. We do request examples.
Tyler Countie (17:03) Okay. That’s not what I asked.
Mira Guha (17:06) I’ll take your feedback back to leadership but again, this is their standpoint here.
Innis Barton (17:14) Okay. I mean, I am going to ask that you tell leadership we are accusing you of fraud and inaccurate billing and your response is we’re not going to audit it to tell you if that’s true, and that our attorney and chief of compliance, chief compliance officer is asking if you are outright refusing to provide us audited billing documentation and that medallion’s response is, yes, we are refusing. If you could bring those specific words back to them, so that we get a response from them. And I don’t want you to tell you what to do as an employee. I would tell them that they have to have that response and they should stop making you be the person who has to tell us because they’re putting you in the middle and that’s not fair. I’ll.
Mira Guha (18:08) relay that. I know one of the things they will say is that we’ve provided the consumption reporting, we’ve provided the data on the requested items as well as the pending dependency items and the request stopped. I will of course, take that feedback back to leadership. I will relay the severity of that concern. I will use that verbiage. This call is recorded, of course, so they will see that as well. But again, their highlights are current state of work is positive. We have done the reporting and sorry overview of those requested lines. I will get back to you with their feedback.
Innis Barton (18:40) Thank you. Of course.
Mira Guha (18:43) Okay. Let me go ahead and do we want to go ahead and look at any of the other operational metrics here can also fast forward to the consumption. Sure. Perfect. So not a lot happening with licensing. This is really just kind of a quick overview.
Mira Guha (18:57) Really only these six in process. Most of these are ones we’re not putting in working process right now because renewal window is not open or there’s some sort of pending dependency, but looks like for the most part, we’re seeing pretty good turnaround times here, processing with application team just as far as some kind of success metrics for the current calendar year for sorry last 12 months, 14 new state licenses issued, 12 renewals completed. There are 81 licenses expiring in the next 81 months. I’m guessing y’all, are still kind of working on some of those internally, having your own folks renew those. Otherwise we’re happy to do those. And as of right now, seeing 65 days from license requested to license issued, does not include time to submission as well. So seeing pretty good turnaround times there. Any questions on the licensing piece?
Innis Barton (19:49) I don’t have any. Okay. Perfect.
Mira Guha (19:51) As far as just where we are a quick overview, a number of requests, quite a few processing with our team right now, of course, any of that feedback that’s been discussed with Shannon and the team is being taken to any requests moving forward. It sounds like we’re seeing that progress. Just a couple in needs client attention. I’m not seeing anything really jarring there. And then a number that are on hold. Most of these are pending dependencies. A few are on hold per client request. Did want to highlight again that 50 day turnaround from submitted to being par and in network is 58 days. We usually see closer to 91 20. So did really want to flag just, you know, how low that turnaround time is. And as of today, full time you’ve been with medallion just over a year. We’ve completed 177 enrollments. Okay. Cred files. Again, not a ton going on there. Similar to licensing. Seven files were completed in 20 26. There are nine files currently in process. Four are being put together, might be waiting on some profile pieces to get the application completed. All our credentials have been completed on time and total files. All time is 13… quick task overview. There are not too many open tasks right now, only nine which is quite low for the number of requests you have open. I wanted to flag. Four of those are provider and five are admin. If you ever have feedback on how we are tasking, provider versus admin, any things that should go to certain folks, Shannon can work on your project plan with you to customize that. Average task. Completed time is 16 days. I’d say that’s pretty low actually compared to what I’m seeing for other clients across the board, an average task age being eight days and kudos to you for having no tasks right now, over 30 days in age. So again a big priority here being the current consumption which I know has kind of sparked this whole conversation as of right now we are, you know, in the second year of the contract, we were 53,000 dollars over annual contract value in year one, which has been kind of that is part of our policy is once we reach 120 percent of the annual contract amount we do need to address via addendum. So did want to flag that at about 50 percent through your two year agreement. We’re about 80 percent through the total contract value. This should take into account any of the consumption credits so far that have been applied to your account. I can check to see if the two we submitted this week have already been applied with our accounting team, just to see, make sure that is applying here and we do have 18,000 dollars in upcoming requests.
Mira Guha (22:27) These are queued up but intake has not been complete. So that is 80 enrollments into new state licenses just to flag there. That another reason we need this addendum is to factor in the overconsumption from year one as well as those upcoming requests. So again just wanted to remind you that we have this addendum out to your team. Of course, we’ll continue working through the big takeaway items I have today and the action item I have for the intake completed versus consume date. But we will again need that addendum signed wherever we land with total credits and overage amount. We will, I don’t have a timeline for you right now as far as a deadline for signature, but we’ll send over this addendum again for your team to review once we’ve addressed the feedback items today. Great, any remaining questions for me?
Innis Barton (23:16) I don’t know about Tyler, no, I don’t sorry. Okay.
Mira Guha (23:20) Well, thank you so much. I appreciate your time. I do want to make sure you know, I am prioritizing that feedback as much as possible. I apologize if I misunderstood that issue being the intake completed versus consumed. So I’ll go ahead and bring that back internally. I’ll go ahead and do a cross reference and I will let you know our findings.
Innis Barton (23:40) Okay. Thank you. Thank.
Mira Guha (23:41) you so much. You two have a great rest of your day. I’ll go ahead and send this back for your review and let me know if you have questions. Thanks, thank you. Bye.