Transcript
Dreama Hembree (00:00) hey, Dreama. Hey, max. How are you?
Max McGlothin (00:04) Doing well. How are you?
Dreama Hembree (00:06) Doing well, almost Friday.
Max McGlothin (00:09) Almost, we’re getting there.
Dreama Hembree (00:11) I feel like this week has been a little bit crazy.
Max McGlothin (00:17) Yeah. It has been absolutely.
Dreama Hembree (00:20) Let me go ahead. I’ve been having so many issues with this with my computer today. Like my buttons are gone, like my share button is gone. Okay. There we go.
Max McGlothin (00:42) Hey, Dreama. Do you guys go by first layer AI at all?
Dreama Hembree (00:46) Yes. Okay.
Max McGlothin (00:54) Okay. I, we have a, we have a serious escalated client. I sent you the details yesterday. It’s neighborhood NP, with Tanisha Harrison. Yeah.
Dreama Hembree (01:08) I got that one as the top topic there, on the agenda. With the medicare surrogacy, yes, that one was carried over from last week too. She’s struggling. I go ahead well.
Max McGlothin (01:24) It, it looks like, well, now, I’m even more concerned because it does look like there was a task for them to add medicare surrogacy, But the medallion rep indicated this would be for first layer approval is pending. And then, but it looks like she sent a screenshot that says that neighborhood has authorized the following surrogacies and first layer AI is in there. So, it looks like surrogacy had been established… and… she just very escalated like she needs somebody to walk her through what the next steps are, where in the process, she truly is, and like there’s no enrollments that have been completed at this point in time. And then it looks like most of them are in client needs attention, but she doesn’t know what she needs because she’s being told that surrogacy, like all the medicare stuff is stopped for surrogacy, but it seems that surrogacy was established previously.
Dreama Hembree (02:39) So, this is the last screenshot that I see in there. Can you see that I just drug it over? So this is what we sent to her, correct? So it’s still showing pending and this was on 327.
Max McGlothin (02:56) Yeah, and she had the requested date of 325, but then she also sent one that it was approved. I don’t know when that one was sent. Like, I don’t know when she approved it.
Dreama Hembree (03:12) Okay. Let me tap, let me get with my medicare person on the medicare team to have her go in there and look. I also have them granting me access under our Pecos account, so I can go in there and look at this stuff, just kind of like as a staff end user, like a view only type of thing for anybody on our account. So, I should be able to look at those like going forward. So I don’t have to like depend on somebody else to look at them. So Pecos for neighborhood, let me check on that. If it is not approved, I will reach out to her directly, but, yeah, all of our requests are gonna come under first layer AI. So we’re first layer AI, dba medallion.
Max McGlothin (04:06) Okay. I don’t know if this is gonna come through. It looks like it’s coming through. This is a screenshot that she had sent to us. Are you sending it in the email, from her or?
Dreama Hembree (04:19) In the in?
Max McGlothin (04:19) The chat in?
Dreama Hembree (04:20) The chat? Okay. Yeah.
Max McGlothin (04:23) There’s no details here other than npi. So… let me look at it. But basically her, like her biggest concern right now is number one, she cannot, she wants to speak to somebody at medallion. And I mean, same thing, right? She’s like I’m trying to understand, you know, I don’t understand where the delays are. You… know, this has been weeks and no one has, you know, essentially reached out, you know, she’s essentially reaching out. None of the asynchronous messages are making any sense. The support chat is not, you know, they’re basically stating the exact same things, but she’s doing those tasks. I, you know, we’ve told, we’ve, worked with her multiple times on tasking, and… but at this point, she’s extremely escalated, so.
Dreama Hembree (05:32) Okay. When did she send you this screenshot?
Max McGlothin (05:38) It was sent to this morning like, okay. So maybe she minutes ago, so she might have just, but she’s indicated.
Dreama Hembree (05:45) She might have just done it. Okay?
Max McGlothin (05:47) Well, she indicated that there’s so many emails from her. I’m trying to get the correct information. Okay? Here here is the original email about the surrogate information I’m on the phone with them now. Yeah, connection request was made by Jill Gardner at first layer inc.
Dreama Hembree (06:12) Yeah. And the task we tell her it’s under first layer AI. So, okay. So, maybe that was what was confusing.
Dreama Hembree (06:30) Yeah. We, we told her on 326, this would be for first layer approval is pending. And then, you know, to call medicare to she’s,
Max McGlothin (06:41) saying that she said the surrogacy was completed on 318 and communicated as well. I… don’t know which where… that was, you know, done. But basically, she’s stating that she approved Pecos on as a 318. I don’t know if there’s a group and I don’t I mean, I know about Pecos, but I don’t know if there’s a potential group and provider because, this practice had two different states involved. So this.
Dreama Hembree (07:22) was the one where she put in the wrong tin and the tin was for that, dr, Jerry, T, Jerry NP, which I don’t understand. How are those two related in some way?
Max McGlothin (07:41) I believe so. Okay.
Dreama Hembree (07:43) So, Nick got involved on this one back on 313 and he said the tin that was entered incorrectly, it should now reflect neighborhood instead of T, Jerry MP. So, the tin was incorrect. So we tasked out for the wrong surrogacy under the wrong, you know, organization. So then Nick went in there and corrected it and then we sent out an updated request. And then that brought us to, you know, today. So the last correspondence on there to her was 327 saying, you know, it’s been corrected now to the correct organization. Call medicare to help, you know, get this approved because she was struggling. So that’s originally what happened there?
Max McGlothin (08:32) Yeah. So.
Dreama Hembree (08:33) What confused me as I was like, how did she put a wrong tin number in? So it had to have been, you know, those organizations have to be related in some way. Yeah.
Max McGlothin (08:42) I think so. So.
Dreama Hembree (08:45) I will have them check this to make sure and if it’s approved, I will have them expedite this and get this like out the door. She’s gonna have to go in there and sign off, but we’ll task out for signatures. So she uses that same, you know, username and password for Pecos to go in there and sign as she did to give us access in Ina. So I can send her an email and let her know that, but I’ll get on this one as soon, as soon as we’re done here. Okay?
Max McGlothin (09:14) Yeah. And again, I, you know, we’re emailing, you know, as much as possible. You know, we’ve gotten on the phones with her, but at this point, we don’t have the information she’s needing. Yeah. And so I, like I said, she is adamant she wants somebody on the phone with her. Yeah, that’s, I, there’s only so much that we can work through and tell her on our end. But like I said, I think she’s pretty much done with the chat support at this point.
Dreama Hembree (09:49) Okay. I’ll intervene and see if I can get this expedited, and get her calmed down a little bit. So, okay.
Max McGlothin (09:58) I.
Dreama Hembree (09:58) got that one on top of the list. The other one I had was small town medical for blue cross blue shield of Tennessee. They’re having claims denials even though it’s showing approved in the platform. So, I’m having the team research that one. I’m not sure where the disconnect is on there, but I’m, trying to figure it out. Okay? And then matriarch medical for anthem blue cross, I did file an escalation to the team on that one. That one was re, it doesn’t say in the platform why it was resubmitted, which is obviously frustrating for all parties involved. So, I have filed that as an escalation. So I’ve got that one as urgent with the team as well. What, what?
Max McGlothin (10:48) Would be the cause for? Like just in general?
Dreama Hembree (10:55) Let me pull that one up because I don’t want to misspeak because I looked at it and then, but I’ve looked at a bunch since then, so I need to go back in there and look. Okay. Got it.
Dreama Hembree (11:29) Okay. So it’s saying that the application was submitted under an existing group contract, but blue cross came back and said there, no contract could be late relocated for the tax id. So… I’m guessing that they probably submitted the request incorrectly under like, you know, to link a provider instead of a new enrollment indicating that there was an existing contract already. And blue cross is saying there is not, okay.
Max McGlothin (12:03) Okay. I gotcha. So.
Dreama Hembree (12:06) That is that’s so.
Max McGlothin (12:07) It was a, it was an intake. More than likely, it’s an intake error on the providers. And okay, yes.
Dreama Hembree (12:15) Yeah. When they’re requesting, you know, the enrollments, it’s obviously important that, you know, if they’re indicating that it’s an existing contract and we’re just linking, then we’re going to go off of that. I’m looking at the enrollment section of the.
Dreama Hembree (12:51) Yeah, that’s what lacrosse came back and said, there’s no existing contract. So we do have it keyed to go out again, but that is the initial thing, but I’ll mark that one as urgent as well, so we can try to get that one expedited because I know that they’re angry. Okay?
Max McGlothin (13:23) Do we have?
Max McGlothin (13:29) Do we have payor like… average turnaround time, days from medallion? Like what they’re seeing from various payors? I’m calculating this on my end. And what I’m trying to determine is, are we essentially… in line with the overall medallion aspect? Like, for example, there was, you know, I had to, we had a humana issue this week. There is another client that’s escalated with humana. I had to call humana as well this week because it… showed the panel was closed. Or at least there was a notification, the panel was closed and this was for R iii diagnostics. When I reviewed this, it looked like we had originally submitted an application to humana in August and then… there throughout follow up processes for two months. It was indicated that there was no application received. So they were following up. The payer was informing them that the provider application it’s for it’s a provider enrollment for brookray. They already have group enrollment, but essentially, we submitted the original application.
Max McGlothin (15:05) August nineteenth. We did follow ups for over two months on… 10 29. It was discovered that an application had not been received. So they did a resubmission. Again, that was October 20 ninth and then again all throughout November, December, January, February, there’s follow ups happening. But just indicating that needs more time for processing. And then the provider kept adding notes into here. Like I spoke with humana, she’s saying something does not or they’re not able to be credentialed there’s issues. But all the notes just indicate follow ups. And then all of a sudden on March thirtieth there was an indication that the panel was closed for that area. So I did call humana… and, they indicated, you know, yes, it does look like the panel’s closed, but can’t give me any information on an application that was submitted? And so I started digging into, trying to dig into the data points of, okay, how long… you know, are we seeing payr applications being open and something for like Florida healthcare plans? I have three… enrollments there. And the average days of those three enrollments are like 286 days. I have some that are, yeah, no.
Dreama Hembree (16:41) That, that does not sound accurate. That to me anything, I mean, obviously enrollments can stretch, you know, 120 past depending on the payr, but on, in general, if something, is creeping up to that 120 mark, I’m starting to like really question, is something wrong? You know, on the back, on the back side, is there something missing? What’s delayed? It, obviously, there can be delays, you know, as we go along, but in general, a clean application at the 120 mark, that’s more. It’s not the norm. Usually, you know, we’re usually getting approvals before that. So to me, that indicates that there’s something wrong.
Max McGlothin (17:25) Yeah. Well, I said I have three that are showing as open right now. Can you send me them? Well, there’s a couple of them that say like enrollment denied and enrollment stopped. But, but again, that’s where I’m running into like I don’t I’m just working off the reports that I have. And so, my question was, do we have like… just so you’re aware, like from my, our previous vendor, we could see what the average turnaround time was for humana and, it would show like 180 days, right? Just, we know humana is takes forever, but this information is stuff that we’re trying to get to these providers to say, hey here’s.
Dreama Hembree (18:17) what you should expect? Yeah.
Max McGlothin (18:19) Correct like these, this is how long this is taking. This is our norm. This is a, you know, usual time for this payer and so that’s kind of where, my question is coming from is I can view this at a, at an enrollment level, but I can’t I don’t know what it is from like a payer level.
Dreama Hembree (18:37) Yeah. Okay. Let me see if I can pull something just across all platforms, you know, all orgs, all payers to get an average turnaround time in general. So, and hopefully, that will help, you know, give them some sort of expectations you know, and what to expect turnaround times. So, I have that as a takeaway. So, for, I’m looking at the R3 diagnostic for.
Max McGlothin (19:10) Yeah.
Dreama Hembree (19:11) For humana, now, the one thing that I’m noticing like right off is you’re correct? They’re kicking back and saying panel closed, but we have a wait, I can’t see but we have a group enrollment, correct? So… right away my brain goes to, you can’t if we have a group enrollment, you can’t come back with a panel closed because we already have a contract for the group. You know what I mean? They don’t they can’t deny that. So, I’m gonna go flag this one to the team, so we can push back on humana on that one. So the other thing that, I am seeing is that she put notes, on the enrollment line itself. A lot of times those aren’t seen if the line is closed like that one has is it says request stopped. And then there’s a note on there. So the rep is not gonna see that on that line. So I would not encourage them to leave notes on there. I mean, they’ll see it once we go back in there, but it’s not flagging anybody. It’s not throwing up a notification that there’s been a note left. What?
Max McGlothin (20:27) Is the workaround?
Dreama Hembree (20:29) I would open a ticket on that or reach out to support on that because then that’s right away, we have eyes on it. We know that there’s something going on I would reach out to support on that.
Max McGlothin (20:42) Okay. Well… I did and they like they came back and just said the panel’s closed like that’s. That’s where, I think that’s where like we’re also running into this issue with the asynchronous chat is number one. The, the chat bot is not helpful. I just my feedback to you guys. The chat bot is not helpful. It takes I would say several… or more minutes to get a live person. Frequently, it’s up to an hour. So by the time you know, somebody like me who is trying to send in a support ticket, I have a 1,000 other things that’s going on by the time a live rep actually reaches me, they open the ticket and it’s closed. They just say this is this panel’s being closed. It’s already done or, you know, we’ve reviewed this and the status is accurate. And then again, I can’t like I can’t reach out somebody. For example, I submitted a support ticket because we have a report that’s not generating right now. I have, I tagged Jack on. It looks like Jack’s out of the office until sometime next week. Now, he had not responded. But, you know, I submitted this ticket in. And then… it basically, the day later the, there was a live person that reviewed it, but basically just stated that, yeah, we don’t see any providers in this report, the report. So I’ve resolved this ticket. Well, that’s not the case. The, the, this report was working as of last week. It’s not working this week. There’s never been any providers in this report. And and again, I don’t have a way of like, I can reach out to you but like nobody else can, right? So, you know, that’s where like a lot of the frustrations come in. I have a significant concern right now with the changeover from the email system because we have a lot of, a lot of email automation built. We’re trying to get all that updated right now. But like again, what I’m finding is there’s a lot of delay between support tickets and live representatives being available because the asynchronous chat is just not cutting it for the vast majority of the requests that we’re putting in because they don’t really fall in line with a, you know, a single from an RCM organization.
Max McGlothin (23:28) We don’t have a singular client, right? I have 150, some odd clients that I’m over. And so trying to do this from a support perspective at a singular level is not in scope of what we’re actually trying to do, no.
Dreama Hembree (23:46) I get that. I get that. And I will take that feedback back to them because that’s not like you said that’s not, it’s not scalable. It’s not conducive to your time, you know, an hour wait time for one one off issue. When you have 150, you know, child orgs that you’re dealing with is not ideal. So I get that. But I will open a ticket on brook for the humana because the panel closed should not apply. They already have a group contract. So we need to push back on that one. Yeah. And then the email change. I did figure it was going to cause a significant amount of work on your end, but the being able to route the tickets more efficiently is the why behind that change. And so I did call out to them, you know, that you guys use practice fusion domain that it’s going to be multiple domains that there’s already an issue with visibility ticket wise on your end. So they’re aware of that. Okay? So I want to make sure that it doesn’t a, get worse obviously. And then B, we’re being proactive to make sure that you can see all of those tickets going forward.
Max McGlothin (25:02) Okay. And then from the you’d mentioned the 120 plus being sent over and that you’re reviewing those, what was the analysis from the last report that was sent? Like is it was that accurate? Was the… I guess again, I’m trying to figure out like where we are in the entire scope of the process? Because I’m struggling figuring out how many applications are out… there that are, you know, accurately status and that are being escalated at 120 days or what that process looks like of escalation over 120 days. Because again, I do have some that are, you know, like we’re looking at 200 plus days at this point. And again, some of these are, you know, they might be sitting with the client level. They might be sitting in a like now there’s a new status called terminal. I’m assuming those are just active ones, but like I have an active enrollment, that is it. I don’t know if this is… one that is, oh, give me just a second.
Max McGlothin (26:32) All right. It was there. We go. Okay, 267 days. But some of these are like with medallion, some of them are with the client. These are American house call ones, but they’re pending dependencies or intakes, pending providers. We’re submitting out requests, but some of these don’t have notes on them. Some of them do some of them don’t. I just want to make sure that somebody’s actually like reviewing our over 120, yes. And that those are being escalated up because I’m not seeing movement on them.
Dreama Hembree (27:09) Yeah, I did flag those to the team last week and said, you know, we need to get some additional eyes on these because they’re aging out. And so they are working them. Like I said, you do have a dedicated PE team just for veridigm that I send that stuff to. So it’s not just getting, you know, thrown into a queue to be worked whenever it gets to. So yeah, we have a dedicated channel just for veridigm and so all of that goes in there. So it’s trackable. And there’s you know, set eyes on it. So I will follow up back with them to see if they can pull an additional report to see if there’s been any movement or changes in that and then see if I can get that shared out with you. Okay?
Max McGlothin (28:01) And then there was a request. It falls back in line with the neighborhood NP health service account. There was an email sent from mintu previously that I just didn’t have any. I didn’t know the answer to this just from a credentialing perspective. And I didn’t see a response on that. So I just wanted you to, before you like go back to the client that… you reviewed. That one too is from mintu regarding something to do with billing on the before… payers… are credentialed. Okay?
Dreama Hembree (28:41) Let me circle back and look at that one. And if I missed that one, I apologize but I’ll get a response out to her on that one. It’s for neighborhood. Okay. Got that one on my to do list? Okay?
Max McGlothin (28:56) And then just again, for my, like, I have to relay this up through my leadership team too because of this client’s escalation point is the plan to contact them today?
Dreama Hembree (29:09) Yes, I will reach out to the medicare team right now to verify if surrogacy has been established and if that is the case, then I will urge them to get that application out if not today by first thing in the morning so we can get that submitted to medicare. I will send her an email to let her know the outcome of the surrogacy review just to make sure, yes we have it. This is the plan be looking out for this application to be coming over for signatures. So I will touch base with her today.
Max McGlothin (29:45) Okay. Excellent. And I did get the we do you do checklist. So we’ve given that back to our sales team again to try and just reiterate what the expectations are. We had one, we, you know, I validated it’s the same as yours. So, you know, this is what was drawn up in the beginning… when we initially were launching this deal back early in 20 25. So it’s all still shows the same. So hopefully we’ll our sales team will get that out and have a little bit less of these concerns moving forward. Okay?
Dreama Hembree (30:26) One of the other changes that they deployed this week was surrounding tasks. So, in the past, I think I had indicated like if you’re leaving a note on a task, mark it complete, otherwise, you know, it doesn’t go back into the bucket for urgent review. So, they’ve updated that internally that anytime a note is left on a task and it’s still open, that it kind of goes into the reps like critical bucket for them to review. So, regardless if it’s closed out or not now, the rep is getting flagged that there’s a note and it needs to be responded to. So if the provider forgets to close out a task, that note won’t get overlooked. Okay?
Max McGlothin (31:16) Okay. That’s yeah, that’ll help. I think that’ll definitely help.
Dreama Hembree (31:18) out. Yeah, I’m hoping that will help. Yeah. Okay. What else do we have? Oh the outstanding payer names for the mapping? Just so I can understand what you’re needing there in column D, are you wanting me just to verify like a payer id or just what is it? If you have anything?
Max McGlothin (31:40) Else? Like I have the name, right? And that’s it that’s all I can go off of. Okay. And so like when you have like ma blue cross blue shield down there, I have no idea what those are.
Dreama Hembree (31:50) Okay. And then these are, do we have these tied to a group? No, we don’t do we, okay.
Max McGlothin (32:02) Yeah. I just, I don’t have access. I don’t think I have access to like look up the medallion payer id guids. If I do like, I would, I’ll go through that, but I could not… get a correlation between medallion payer id guids and what these are. This, this report is out of my internal system by the way. Okay, this is based on your, this is what we pulled from your apis… and that’s but that’s the only information we get.
Dreama Hembree (32:32) Okay. Let me go back to the technical support team and see what I can get for you on there. I just wanted to make sure that I was clear on what you were asking. So just any identifying information for the payer I don’t under, and then I’ll get back with you on that. Okay. And then these are the, this payer id is the API key for the group, right? Yeah.
Max McGlothin (33:03) I don’t know. It’s, the, all we get is the payer name and your medallion payer id. Okay? So that’s for that’s just for, what you guys have your payer list loaded as. So it’s an individual guid number for your payer lists. Okay? All right.
Dreama Hembree (33:23) Let me get with the team on that, and then hopefully, I can get you, some additional information on that. Okay?
Max McGlothin (33:31) When does the, when does the pass not needing to be completed? When does that take into effect?
Dreama Hembree (33:38) It’s already in effect. Okay. Yeah, they did that. I think it was Monday, it went into effect, but it’s already up and going. I mean, you can, whether they close it out or not, we’ll get notified of it, but obviously, best practices is, if it’s complete, close it out, right? So it moves into that review bucket. But what we were trying to do is if somebody went in there and left a note like, you know, help me on this. I need, I don’t understand something to that effect that wasn’t getting missed, right? So… continue, if the task has been completed, continue closing it out. So it does close out and moves out of that bucket. But if there’s a note on there or a question or something like, that was the intent. So that was being captured. Okay. What else I think that’s all I had?
Max McGlothin (34:34) Yeah, that’s it. Okay, awesome. I.
Dreama Hembree (34:38) Appreciate your time. I know I have some stuff that I owe to you. Let me get working on it. And then as I get updates, I will be reaching out.
Max McGlothin (34:47) Okay. Excellent. Thanks. Shreema.
Dreama Hembree (34:48) Thanks, max. Have a great day.
Max McGlothin (34:50) You as well. Bye bye.