Transcript
James Donachie (00:00) hey, Jessica. Hey, Sabrina, how are you… doing well, good? How are you surviving the week yep?
Eveli Flores (00:10) Almost done.
James Donachie (00:15) Yeah, it’s officially the second half of the week. It’s been a long week. I, my gosh, yeah, I’ve had like all sorts of fun stuff happening with like the start of the new month and I don’t know it’s like a tidal wave of activity. But Jessica, I don’t know what I saw our support team responded and resolved that thing. I don’t know what happened.
Eveli Flores (00:49) Yeah, they said they have a duplicate for Jacques and then they’ve closed them both off out, I thought, but it’s still sitting in my like request page even though everything’s marked off like everything’s been verified. It just has not moved to ready.
James Donachie (01:09) Okay. I was just pulling up your guys’ account.
Eveli Flores (01:16) Because I know they were doing working on our stuff today because I’ve had a wave of providers get ready. I’m like, okay, it’s still stuck like at least on my end, everything looks like it’s green to good to go. I don’t know what it looks like on y’all’s, end, but.
James Donachie (01:32) Yeah, I wonder why it’s not.
Eveli Flores (01:35) Yeah, like they’re like we’re still waiting on verification. I’m like, yeah, the verification’s in there. It’s I see it like it’s done.
James Donachie (01:43) Let me just, I’m just gonna, why did this just so that it’s on… verification looks… to be complete in platform, please update?
James Donachie (02:10) And then I’ll just follow up once I get off this call, and then I, what was the other one? The?
Eveli Flores (02:18) Other one was like an old one. I’m like guys that’s been cleared and approved like a week ago, like that one was done?
James Donachie (02:30) Okay. Let’s see…
James Donachie (02:43) I’m gonna send that. And then… yeah, well, I’m just.
Eveli Flores (02:51) Yeah, the, Kristen gearhart one was the one where I’m like, nope, that one’s she’s been approved. That one was done. It was just… yeah, the two for Jacques Bogdan.
James Donachie (03:05) Okay.
Eveli Flores (03:05) Yeah.
James Donachie (03:07) Okay. That one’s resolved. Okay, technical issues. The file is not saving marked as complete despite being signed. Yeah, I don’t like that. They didn’t alright. I’m also gonna follow up on that because I’m like, why did that happen? Like what’s the, why, what or?
Eveli Flores (03:29) The, oh, yeah. The ones where like they were, yeah, was it, yeah, that was Jessica davis reported that because I had three like side packed providers. Yeah. And unfortunately for Jacques, she was the first one and she’s still stuck. The other two have cleared out and passed along so like it got worked out, but I think they were figuring out how they wanted to enter the side packed. And, yeah, Jessica davis was the one that flagged. She was like, hey, I can’t sign it’s giving me this error message. Yeah. But then I guess it took whatever she had submitted and cleared it. So that one, like I said, the two that were submitted after Jacques are fine. Those have all been submitted and resolved. And hers is still sitting in my request field for some reason even though it’s… all been like, I’ve got little check marks across the board when I’m looking at her and, yeah, the little green shield, everything’s good. No issues. But yeah… it’s just not.
James Donachie (04:36) Okay. I, well, I just pinged and then I’ll also ping on our internal slack just to find out what’s going on that one. I think it’s like pretty, it should be pretty cool. Yeah, I’m like just, I don’t know why it’s not. Yeah.
Eveli Flores (04:57) And then I don’t think I’ve gotten a reply yet as far as like, hey, should all scipack license be given this designation? Does it matter? What state I do? Yeah.
James Donachie (05:08) I include, I just include that on my update too because I’m just waiting to, for the, like what… what to be said there, but it’s on my, it’s on my thing. Okay?
Eveli Flores (05:20) Yeah, because we have had a problem in the past where, when we had both the state license and the scipack when it came to renewals, if we weren’t keeping a close eye on it, sometimes someone on your team would like delete it out or change it to the home state. Again. We’re like, no, no, this was a completely different license. Like it’s a scipack. It’s a, yeah. Yeah. So I would just like to have what we should be, the format and record and change that to avoid that ever happening again.
James Donachie (05:52) Yeah, I want to memorialize it so that we can also point back if they ever say like you’re doing it wrong? I’ll be like, no, no, we had this conversation… but yeah, I am tracking that one down. Okay?
Eveli Flores (06:12) That’s really all I have from like the credentialing world. I actually let me check. I have not followed up on licenses lately. I know I submitted… a few more for dr malamba… and nirubashki was the other one. If I’ve honestly that’s probably on me. I’ve not followed up with her to see how things are moving along. There… looks like mwambas are also in intake… and Nero’s… looks like it’s been submitted.
James Donachie (06:54) OK.
Eveli Flores (06:55) OK, cool. I don’t know why it’s got a little exclamation mark by her, but.
Sabrina Liu (07:03) Let me, let me pull up. Did anything happen with Stacey lear? I think our team was… asking for an update. Are we still working on that one? I assume.
James Donachie (07:24) Stacey lear, let me,
Sabrina Liu (07:28) I know from your email, I think you were still, she was on the email, yeah, but I don’t know if you heard anything, jess or seen?
Eveli Flores (07:40) Anything I have not seen anything?
James Donachie (07:57) OK. Let’s see if we can get an update… on Stacey… for horizon because I have that on here.
Eveli Flores (08:09) Yeah. My last email from them was on March 20 seventh. So nothing recent. OK. I think Eileen did like show me. Hey, look. She’s in network. I’m like that was from a year prior to us asking you to link her to our group. So I don’t think that was for making sure she’s linked to us. I think someone saw that she was credentialed and closed it out when they should have submit like a link letter or something. So, but they’ve got access to like a portal that they’re pulling it from that I don’t have access to or I’m not sure where because like if we have a login or something for like I can start investigating but it seems like you guys had more visibility onto, into it than I did.
James Donachie (08:55) Let’s let me see if I can get you because the payers should have gave you guys also access to any portals that they’re using. I don’t know we.
Eveli Flores (09:08) Could have, but that was like three people in my position ago. I’ve only been here since November and anything historical that wasn’t saved down a medallion somewhere might as well be in the winds like.
James Donachie (09:23) Okay. Let me, let me see if I have a, oh, yeah. Here we are right here. Oh.
Sabrina Liu (09:41) OK. Where is it? I’m gonna chat.
James Donachie (09:56) My font is like comically large for zoom and I don’t know why it’s probably not showing up on your guys screen like that, but on mine, it looks like I tried to zoom in and it didn’t work at some point and then.
James Donachie (10:12) Status? Okay.
James Donachie (10:19) So, looks like there should be, you should have, I don’t know if these urls are different. Let me.
James Donachie (10:32) Yeah. So this is the sign in… you guys as headspace. Should also have access to this… as well. So, I wonder, well, it sounds like someone might have, at some point. I can see if there’s a, let me look on our… on my document here.
James Donachie (11:07) If there’s a like a point of contact… well, that’s no… you guys don’t want, you don’t want to call an 800 number. Do you?
Eveli Flores (11:23) I mean, if I have to, I can.
James Donachie (11:25) Yeah, there has to be like another.
James Donachie (11:38) This is what is like our generic information just like about the plan says, but which they might just not have it a support email address.
James Donachie (11:53) That’s a really big promise for you.
James Donachie (12:19) Do they really only have a?
James Donachie (12:28) They don’t have an email address on their contact? I’m on this like contact page because I’m like, I imagine if you hit… forgot, like I like… oh, maybe.
James Donachie (12:45) I don’t know if this is going to be right?
James Donachie (13:02) But there is, this is listed too. I don’t know if they would be able to help you guys get your.
James Donachie (13:14) Get your login because like I feel like the forgot login and forgot password isn’t going to help you if we don’t if you’re not the person?
Eveli Flores (13:23) Yeah, because it’s like asking for a person, last name. I’m hoping they use credentialing, but I can make some guesses possibly as to who this might have been.
James Donachie (13:35) Well, I wonder… but.
Eveli Flores (13:40) For a lot of these, like if it wasn’t if we didn’t have like a group contract, it’s not really been… like because I’ve seen that like Rhode Island and some of these other states where we’ve just had individual contracts. I’m like cool. Do we have access to the portal or anything and haven’t found anything? So I don’t even know if they do… or if it’s all through just the individual provider or if you can even have like a group login and associate people that are with your tax id.
James Donachie (14:14) Well, I wonder for, I wonder if we, if you email that PCS credentialing box, if we would get a, if it’s just going to, I know the blues are difficult to get a hold of. But, if that would work for you to like get someone to find out if you guys had a login, if we could get it switched over to.
James Donachie (14:48) But then I will, I’ll also, I’ll there should have been a note that’s so frustrating on my end.
Eveli Flores (14:55) Yeah, that’s what I kept getting confused like I’ve got screenshots of they submitted in the portal. I’m like how did y’all get access to the portal? Did you have one that you guys were using? And if so, can you get back in and see what was going on with her or were you using ours?
James Donachie (15:10) So, yeah. Okay. Let me see if I can just like give, ask the question even more pointed. This is part of my back and forth I have. Okay.
James Donachie (15:30) And then, for, there was one for Montana as well. And there’s a task open for a DocuSign signature regarding or… I don’t know why I put Montana. I think, I meant Massachusetts… niru, batski, there was a DocuSign signature that was like pending for them to sign.
Eveli Flores (16:07) Interesting. I don’t have it in just admin tasks. Maybe it was, oh, these are provider tasks. It was assigned to her.
James Donachie (16:19) So, that one is just that one’s just being held up because of that.
James Donachie (16:44) And then the other ones that were on here was the walmart, Iowa. There’s a client input, the medallion task and it’s for you guys to reach out to the provider directly to share credentialing details as the payer will not release them to medallion. I don’t know if we’re able to do that, but that seems to be the holdup there.
Eveli Flores (17:15) Okay. I’ll dig into Iowa or that walmart thing later.
James Donachie (17:19) Okay. And then ambetter Illinois, the application was canceled due to missed Coi deadline, and then the re, submission requires the group to be accredited for the Illinois marketplace. I.
Sabrina Liu (17:33) don’t think we were pursuing ambetter Illinois.
James Donachie (17:37) Okay. So maybe that was, it, is that one just on hold? I just asked them for an update on your guys’. No.
Sabrina Liu (17:44) I think the confusion we were doing, we had a request for Aetna Illinois, not ambetter Illinois… but we resolved the Aetna Illinois one. We, I don’t remember anything about ambetter Illinois. Okay. Do you remember anything? Jess? Did we have anything?
Eveli Flores (18:08) Ambetter Texas and Pennsylvania? I remember. Yeah, I thought.
James Donachie (18:12) We got them. Did they get that?
Sabrina Liu (18:13) Okay. So, nothing about ambetter Illinois?
Eveli Flores (18:16) Okay. Not that I’m aware of.
Sabrina Liu (18:18) Yeah, not that I’m aware of either.
James Donachie (18:21) I, all right. I don’t know this is, I… guess you live and you learn, I have another client and we are going through implementation right now and we’re working on our like setting up our life process for enrollment and then they give me a grade based off of like the questions the operations team asks them of like what they think I’m going to have to give that, this group an F for putting the wrong provider on my update… but she’ll be like,
Sabrina Liu (19:02) those are because I was like, we have ambetter and we have Aetna Illinois. So I think it’s just.
James Donachie (19:07) They are just, yeah, they combined them and I’m like, I also, I want to know where they got that update from. Like I.
Sabrina Liu (19:14) know, I was like.
James Donachie (19:15) Should that go out of place? Yeah, it sounds like someone should follow up on that, not you guys obviously. Yeah… but yeah.
Sabrina Liu (19:27) We are following up about the other ones in the agenda. So, blue cross blue shield, what is WI, Wisconsin? Yeah, yes. And then ambetter pa, ambetter Texas?
James Donachie (19:39) Yep. Yeah.
Sabrina Liu (19:48) Yeah, like based on the agenda, last update from Janine, like for Wisconsin medallion reopened something. So I don’t I am hoping there’s like requests open for these because it seems like Janine was actively working on these cool.
James Donachie (20:09) Yeah, like.
Sabrina Liu (20:11) There’s like some kind of tickets open or something. Yeah.
James Donachie (20:19) Let me, this is where, okay, let me follow up on the like, why can’t they, this is, I guess this is why I’m here, but it, but I want to see where, like why aren’t these? Like why aren’t these notes making it back into the platform for visibility? There seems to be a missing step here. I will find out what’s going on because it shouldn’t be… it shouldn’t be this buried, in the platform or backend. I know there aren’t always updates like every it’s like every few days, sometimes the payers are a little bit slow, but I’m going to just give feedback around to… see if we can get some updates in here. But, okay. Okay. Sounds good. I have some work. I have some work to do on my end. Sorry, I,
Sabrina Liu (21:25) don’t think we went over grace trueblood. I saw the support ticket and that was completed. It’s just weird because I, we had some recent claims for grace that were processing incorrectly… but yeah, it looks like medallion was able to call and then we’re effective. So I’m thinking if I just see more of those claims that are more recent, I’ll just send them over. So, when medallion’s calling, are you just reaching out to the credentialing department?
James Donachie (21:58) I believe so. Okay. So all.
Sabrina Liu (22:01) Right.
James Donachie (22:01) What, what was the, who… is the, who I can look up? Let me look up on my just as.
Sabrina Liu (22:12) a summary like I called on grace trueblood, like two weeks ago, and then her, like recent, I think it was like December. So her December claim processed at some random Florida rate. So the rep told me that she wasn’t linked correctly. So that’s why I opened up this case.
James Donachie (22:30) And, which payr is this? Let me see where, oh.
Sabrina Liu (22:33) For Aetna?
James Donachie (22:34) Okay. Aetna.
Sabrina Liu (22:35) And then Asia from medallion, she said she called and then we were linked correctly, or we’re just linked as of 20 24, but I’m like I saw some 20 25 claims just getting processed at weird rates. But I’m like if you guys don’t do the claims part of it then.
James Donachie (22:54) Yeah, but I can give you, where they’re I should have access to see where they’re reaching out to. It looks like they call… one… 800 and I could put this in the chat, three five, three, one, two, three two… as the number that… they’re contacting.
Sabrina Liu (23:29) 25? Okay. Sounds good. I will. Well, if I see more claims processing, yes. I suppose I’ll just call back and confirm, but yeah, I, if Aetna confirmed it, it’s effective. We’ll see.
James Donachie (23:46) Yeah. And then all that looks like the, that looks like this is… the main number that they use to, why isn’t this copying for me… here? It is that’s the aet that’s the Aetna number that, they call.
Sabrina Liu (24:08) Okay.
James Donachie (24:11) And I’m sure like anything that’s probably just a starting point and who knows how you get routed from there, but yeah, let me know for that one. If Aetna if Aetna called, I’m sure she did. She’s on our support team. She’s pretty good. But if it does pop up again, just like, I can loop her in to just be like, what did you do? Yeah?
Sabrina Liu (24:43) I trust her but it’s just weird because like the, I mean, the reps sometimes give you incorrect information or incomplete information, but it’s just like effective from 24 and I was like, but I saw these issues in 20 25, but.
James Donachie (24:55) we’ll see. Okay, yeah, cool. Awesome. Well, all right. Well, I owe you guys some follow ups and some clarity here. Let me see what, I can figure out on those. And for jock, I just, I put the note in there as well. So, let me go. Let me go knock on some office doors and see who who’s going to answer me today. Cool. Thank you. Bye bye.
Sabrina Liu (25:24) All right. Later, James.