Transcript
Vanessa Persha (00:00) hi, Sarah. Good morning.
Sarah Aloisi (00:01) Hello. How are you?
Vanessa Persha (00:03) I’m doing well. Thanks. How are you? I’m good. Awesome. How was your Easter?
Sarah Aloisi (00:10) It was fun. My daughter just came home from college, oh, nice. And my four nephews were home also. So we had all seven kids.
Vanessa Persha (00:23) Fun.
Sarah Aloisi (00:24) Yes. How about you?
Vanessa Persha (00:26) It was good. We just did super low key. I made just a small dinner. My oldest was sick, and then my boyfriend was sick too. So we were just, you know, I was like, well, I mean, I’m kind of glad I don’t have to make a huge dinner, but it was a nice low key weekend. So that was good. Hi, Deanna.
Deanna Purchiaroni (00:50) Hello?
Vanessa Persha (00:52) Are you back home now?
Deanna Purchiaroni (00:54) I am. Yeah, good.
Sarah Aloisi (00:56) Did you make it home? Okay?
Deanna Purchiaroni (00:59) My flight home got delayed two hours. So I got home at three totally in the morning. Oh my gosh. You know, I did not have good luck with flights. I don’t know, Vanessa, I can’t remember when we last saw you, but I spent the night in the Denver airport, going to San Diego. My flight was delayed and so I was there for like nine or 10 hours. Oh my gosh. This is my good luck with traveling this trip.
Vanessa Persha (01:24) Well, I’m glad you’re back home now and hopefully relaxing a little bit.
Deanna Purchiaroni (01:29) Yes, all.
Vanessa Persha (01:31) Right. Let me go ahead and jump into our agenda here.
Vanessa Persha (01:41) I’ll start at the bottom if that’s okay. Unless there’s anything urgent you guys want to review. I do have a hard stop. I added an extra 30 minutes to our series going forward, but today, I do actually have a hard stop at 10 30.
Deanna Purchiaroni (01:57) Okay.
Vanessa Persha (01:59) So if you guys are okay for me to start at the bottom, I did flag for our payer research team, the SLP bcba stuff we talked about last week with Laura burek, they are trying to, we’re trying to determine like what’s the best way to document this for the PE team? Since it will require a little bit of research for all payers to the ones that use caqh just to make sure that we’re submitting the correct application if it’s going to be something outside of the caqh. So they’re still investigating like what’s the best way we document that for our teams. And I’ll keep you posted there… Amy provenzano. We didn’t get to talk about her last week, but we have several lines for her that are on hold. Our PE team is now going through and like every five days, anything that’s on hold, they’re creating tasks for the customers just to see if those lines should remain on hold or what we should be doing with those.
Vanessa Persha (03:05) So I wanted to just flag for you guys that so that we can, I would like their focus to be on submitting the apps and following up on apps rather than checking in on hold lines.
Sarah Aloisi (03:17) Yeah. I canceled a whole mess of them over the weekend actually for that same reason. Okay. Funny that you should say that.
Vanessa Persha (03:26) Okay.
Deanna Purchiaroni (03:27) It looks like there’s only one on hold. Now, it’s for medicaid North Carolina.
Vanessa Persha (03:31) Okay.
Deanna Purchiaroni (03:33) Which also, I was going to bring this up. I know we typically used to have Cecile who would handle licensing. So I just want to confirm and maybe this is a dumb question. But I have seen a lot of provider tasks for NPS saying that for enrollment, they need a Dea license. Is that accurate that we should, that… NPS need to have deas in all states that they have a license in.
Vanessa Persha (04:00) So NPS can prescribe but they’re not required to. So, but the payers will ask for prescribing coverage if they don’t hold a Dea. So we would just need to have whatever like if there’s a supervising physician or another physician in the practice that will prescribe on their behalf. We would just need something in writing that states that.
Deanna Purchiaroni (04:25) Okay. Because typically, like the tasks said that before and we have cpas that we will upload and send to them. But lately the tasks have been saying specifically that they need the Dea. And I feel like there was one task like closed out saying that they didn’t have one to use a supervising physician on file. And it like reopened?
Vanessa Persha (04:43) Yeah. So I was.
Deanna Purchiaroni (04:44) Like, I don’t think that they’ve ever needed a Dea in the past. Yeah.
Vanessa Persha (04:48) I actually flagged that one. I forgot which provider it was, but I know they were like asking for Suzanne gohadengadi’s like Dea information. And I was like it’s in the platform. Why are we tasking the customer for this? Like just go grab it from there. So I did ask them to be mindful of the tasks and make sure they’re asking specifically for what we need. If Dea arrangements are acceptable, then they should be offering that as a solution. And then putting a copy of the letter for signature in there.
Deanna Purchiaroni (05:21) Okay. Yep.
Vanessa Persha (05:24) And then the cortica healthcare, your California medicaid group demographic update. Can I go back to Amy? Oh, yeah. Sure. All right.
Sarah Aloisi (05:33) Okay. So she has an, so we’re talking about a Dea license in North Carolina. She has an NP license in North Carolina that says rxauth included. Is that different from Dea? Yes?
Vanessa Persha (05:51) So, her, that’s her CSR for the state of North Carolina. She would need something at the federal level. So if she doesn’t prescribe or doesn’t hold a Dea, then she would need prescribing arrangements.
Sarah Aloisi (06:06) Okay. But you said federal level, but you still need a Dea for each state.
Vanessa Persha (06:11) Yeah. So the Dea is a federal program, but the deas have to have the state specific on the.
Sarah Aloisi (06:17) State. Got it. Okay. So then we need to either get one which we’re probably not going to do or write a letter and the letter goes to the payer. Yes. Dear. So, and so this is the person who’s going to be prescribing for me.
Vanessa Persha (06:33) Correct. Yep. And I believe we already have a template for that. So if her task doesn’t have a template attached, I’ll ask the team to go back and put the template in there.
Deanna Purchiaroni (06:45) I think in the past, we’ve just responded to the, those tasks saying that we have like a cpa agreement with whatever doctor. Okay? So we don’t typically have to like fill out the letter, correct? We just let you guys know which supervisor. Yeah.
Vanessa Persha (07:00) I want to, I think it depends. I’m trying to remember depending on the guidelines for the payer because ncqa has specific requirements about what has to be in that letter and I do believe it has to be signed by the prescribing physician. So, I think it’ll depend on the credentialing guidelines for the payer.
Deanna Purchiaroni (07:23) Okay.
Vanessa Persha (07:25) Okay. Anything else for Amy before we move on to the next one?
Sarah Aloisi (07:30) So, so just to confirm you’ll send the template?
Vanessa Persha (07:35) Yes. Yep. Let me, I’m going to add my note here. So I don’t forget VP to.
Vanessa Persha (07:50) Okay. All right. I’m going to mark that one in progress. Okay? And then the California medicaid group demo update for cortica healthcare. Did they resent the email? Did you end up receiving it yet? Deanna?
Deanna Purchiaroni (08:10) No, I got that one email from, I don’t remember the Guy’s name that I forwarded you?
Vanessa Persha (08:17) Oh, Patrick, I,
Deanna Purchiaroni (08:18) don’t know if that was like him testing to see if I received it, but I haven’t received anything else.
Vanessa Persha (08:23) Okay. Let me, have… I’m going to ask them to forward it to me and I’ll send it to you since we don’t you receive all my responses just fine. So I’ll ask them to just forward the email to me and I’ll send it to you. Okay?
Vanessa Persha (08:47) Did you have a chance to respond to Patrick’s email?
Deanna Purchiaroni (08:51) Yes. And I see that he just responded back again with like steps that he wants me to do. Awesome. Okay. Perfect.
Vanessa Persha (09:01) Marley chang’s, Connecticut RN license renewal. So I escalated again because, and it could just be me not understanding the platform, but they are saying that, yes, for sure. Her Connecticut RN license is tied to her compact license for Florida. So her Florida renewal, like it’s all part of the compact licensure, where I am not clear on what our platform looks like is that I don’t see the Connecticut license like highlighted as part of the compact licensure. And then I see that the Connecticut RN license still shows as expired in our platform. So, I’m asking the team like, okay. So if this is truly part of the Connecticut or the Florida compact, like why is the expiration date not being updated? And who’s expect? Like where does the expectation fall for? Who updates that expiration date? So still working with them on it, but I will get that figured out for you guys.
Deanna Purchiaroni (10:03) Okay. I did confirm with Marlee chang. I emailed her and she said that seemed correct. And that she didn’t need to renew, and I also had that same talk with medallion support saying then can we update that expiration date to the Florida expiration?
Vanessa Persha (10:21) Date, yes. And.
Deanna Purchiaroni (10:22) He said that wasn’t how that worked. So I didn’t understand either.
Vanessa Persha (10:25) That is so weird. All right. I will keep working with them because like the whole licensing thing for me, like how it sits in our platform is still like I got PE down now, but the licensing is still a little, I need to dig in a little bit more on that one, but I will, I’ll keep you posted. Okay? The Fallon caqh emails. So, Deanna, I know you were going to reach out to Sarah and find out. Let me look at our last notes here.
Deanna Purchiaroni (11:02) Yeah. And I don’t think I have them dead.
Vanessa Persha (11:03) Yeah. So the, this, the team confirmed like we didn’t submit any recent enrollment requests for Fallon on those examples that you had sent over. So we weren’t really sure like where those emails were even stemming from, but they did confirm in the examples you sent that their caqh was updated with all the correct cortica information.
Deanna Purchiaroni (11:27) Okay. Sarah, do you know what state Fallon is? And we don’t request Fallon enrollment anymore? No?
Sarah Aloisi (11:39) They’re all yunked up. I think the Fallon stuff. Okay? We do. Well. We should be in requesting enrollments, what’s… the status? I don’t know what this means?
Vanessa Persha (11:55) You guys may still be requesting new ones. It was just for the example ones that Sarah or that Deanna had sent over? We hadn’t submitted any requests for those providers anytime recently.
Sarah Aloisi (12:10) Okay. Can you send them to me, Deanna? Are you the one you have them? Yeah?
Deanna Purchiaroni (12:15) Is Fallon possibly point 32 or is that different? Nope? I don’t see Fallon, Sarah, honors players by state sheet.
Sarah Aloisi (12:25) Huh. Look at that. All right. Well, then we.
Deanna Purchiaroni (12:31) Can chat about it outside of this, but yeah, I’ll send you, Sarah, okay?
Sarah Aloisi (12:36) Let’s talk about it after, okay?
Vanessa Persha (12:39) Your Coi, renewals, thank you for submitting those to support the caqh team, confirms that they will have all of your provider caqhs updated by the end of day tomorrow.
Sarah Aloisi (12:52) I think I closed most of those tasks. Okay?
Vanessa Persha (12:57) Except.
Sarah Aloisi (12:58) I did not close Deanna, the organization and,
Deanna Purchiaroni (13:03) I uploaded those. So those ones are not closed. Okay?
Sarah Aloisi (13:06) Did you close them or should I go in here and close them? I,
Deanna Purchiaroni (13:10) closed them? Okay?
Vanessa Persha (13:15) I have some exciting updates. Don’t let me forget to share with you guys before we wrap up if we have time, but I remember a few months ago, we were talking about like closing your practice locations, like how to mark end dates or archive them. We do have an enhancement rolling out this week that will allow us to do that. So we’ll go through and we’ll talk about that if we have some time… the gainwell application denials. So, I think last week, Deanna, I was saying… you know, if you could bulk email me those like put them all together in some bulk emails and send them to me. I can forward those to support to you so that they don’t continue to sit without action. Did you have a chance to send those to me yet? No?
Deanna Purchiaroni (14:04) And I was going to, after a meeting, but the tricky thing is that I can’t like search gainwell in our email and just like find all of them because they’re all faxed to us. So it’s like a document. And if I search gainwell, it doesn’t pop up, but I do know I have been forwarded to support. I.
Sarah Aloisi (14:25) Have a person there. Why don’t we, Deanna, if you can find one or two, maybe we should talk to these people. I got some people.
Deanna Purchiaroni (14:37) Okay. So I can forward you an example of the denials that we’re getting. Yeah.
Vanessa Persha (14:45) Okay, perfect. Okay.
Sarah Aloisi (14:47) So Deanna will send Sarah and then Sarah will call gainwell. Yeah.
Deanna Purchiaroni (14:53) It’s saying that like a full completed enrollment application wasn’t submitted. So maybe it’s just something that we need to like talk to gainwell to see what is continuously missed in enrollments, then we can communicate it to medallion.
Vanessa Persha (15:08) Yeah, I know their letters in the past have been very vague about what’s missing. Like they’ll just say.
Deanna Purchiaroni (15:12) They’re.
Vanessa Persha (15:15) not easy.
Sarah Aloisi (15:16) To work with, yeah, on the paperwork department, they’re nice people they’re like easy to, work with, but they’re not, yeah, a lot of requirements, a lot of rules.
Vanessa Persha (15:27) All right, Brenda, rodriguez, healthnet. You guys were having some billing issues for the Aba codes. I submitted an incident for this one because I haven’t received a response from our ops team. So I submitted that and they’re expected to give me some kind of update by end of day. So I should hopefully have an answer there for you. The support email. You let me know. Patrick sent Deanna action items.
Vanessa Persha (16:05) Okay. And then if you wouldn’t mind just letting me know when you respond to him just so I can coordinate and make sure he received your email.
Vanessa Persha (16:15) All right, North Carolina medicaid training tasks. So I have, I updated the tab here, with all the updates for your providers, minus the last two. I have to go in and update those. We, as part of the escalation email that you had sent over to us, Sarah, I’m doing a full deep dive on all of these. Like I opened a corrective action plan internally with our PE ops team, not just on your North Carolina medicaid but everything where we’re seeing delays in the agents taking action. So I don’t have a summary pulled together for you just yet because it’s been a little like I am being, I am being very thorough with them. Anything they send me that doesn’t make sense? I’m pushing back and saying this is not acceptable. I need more. So it’s taking a little bit to get the full details out. But I do have at least the North Carolina medicaid’s updated. Where they are. There are a handful that are going to require resubmission, and I am identifying all the lines that are, that require resubmission because of medallion error. And then I’m flagging those to Molly so that she can work through a solution on those additional application fees that would be passed through. So we’re going to work through that with her.
Sarah Aloisi (17:33) Okay. And so the resubmission, so… the people have 14 days to complete the training. Is that right? Correct? And then the resubmission is required because the 14 days has passed. Yes. Okay. So then I think what we need to do is, tell these people to… wait… and then they’re going to get another email for training. Yeah.
Vanessa Persha (18:02) So, what I’m finding is that most of the providers that require resubmission, it doesn’t appear that we ever attached the appropriate task link to the task. So they may have never even received the actual, the correct link to complete the training. Okay? But they will get an updated task or a task that actually has the details in there.
Sarah Aloisi (18:26) Okay. And then it’s these red people. These were, that need to.
Vanessa Persha (18:32) So, these are Deanna’s notes where she went through to identify. Oh, okay. This column right here, let me app requires, I can highlight these in red for you. Okay?
Sarah Aloisi (18:45) Because I think Deanna or I should also email these people and tell them that they’re going to get a task and they have to do it quickly because sometimes the tasks from medallion get lost in.
Vanessa Persha (18:59) In the shuffle, yeah, a big.
Sarah Aloisi (19:01) Group of medallion emails. Yep. Okay. So, I think Deanna, we should just send one mass email and say you guys are going to like pay attention to medallion and you’re going to see a request to complete a training and you only have 14 days to do it. But really, they have potentially less than 14 days if it takes one day to get them the task, they have 13. So we should stay, yeah, tell people to like do it in a week. Yeah.
Vanessa Persha (19:34) I was going to say, yep, give them a week. Yeah, but the agents have been instructed and their, you know, their sops have been updated that as soon as they hit submit, they are to monitor the medallion mailbox for that email and update the task as soon as it’s received. Yeah.
Deanna Purchiaroni (19:53) So, and so, when are those? Sorry, did you say when those tasks are going to be updated? Like when should I send out that email?
Vanessa Persha (20:01) Let me go check because I flagged them yesterday to the team. I said, you know, get these apps resubmitted ASAP. So, let me check on the ones that I’ve highlighted in red here to see if they’ve already been resubmitted. And then I’ll update the notes here and let you know if the task has been created and app has been resubmitted.
Sarah Aloisi (20:23) Okay. And.
Vanessa Persha (20:24) Then I’m just going to check on these last two here for you and update that because I didn’t get to those two just yet. And then I did answer here. Anybody who’s already par and doesn’t require any training, I put that on there. And if we’ve completed their enrollment since the full application was submitted, I flagged those as complete. All right. Let’s jump back over here. Evernorth, Arizona three lines on hold. So I want to look into this one a little bit deeper because I have this on my agenda as cigna Arizona in some places and then evernorth Arizona in other places. So I want to make sure that I’m aligned with my PE team on or with our PE team on which lines they’re investigating here because there’s three evernorth lines that say the panel is closed. And then there’s three cigna lines that say it’s pending a group contract. And I don’t think either of those are necessarily accurate… right? Because if you hold a group agreement, they shouldn’t be denying providers for closed panels, yes.
Sarah Aloisi (21:40) And I got another cigna thing just this morning from one of our providers that she was asked to sign an individual contract… yeah.
Vanessa Persha (21:50) Okay. For.
Sarah Aloisi (21:51) Cigna. So cigna and evernorth are the, I guess they’re not the same but their own. So if it’s a bcba, it’s evernorth. If it’s not a bcba, it’s cigna. So if we have a list of these people and some documentation, I can send it to cigna… to say what the heck. And I also have an email from our ops team that says get our contracting status resolved with cigna out of network in New Jersey. So we got a problem in New Jersey too.
Vanessa Persha (22:35) Okay. Let me flag that right here. Cigna, New Jersey.
Sarah Aloisi (22:41) I don’t know if it’s a medallion thing or a cigna thing. So I have to, I… have to wrap all of these up. Okay?
Vanessa Persha (22:53) What I can do is run a report on all of your cigna New Jersey requests and see if there’s anything that’s still sitting out there or if we’ve had successful completions?
Sarah Aloisi (23:03) Oh, I can do that. In one second. I’m already in the platform, but do we have the documentation? What does this say? It should be? I’ll look while we keep talking, I just want to be able to send cigna and evernorth, a copy of a document, an example that says, what happened? Okay? So hopefully, there’s something attached in here.
Sarah Aloisi (23:44) Okay. And it’s wait, what state did you say you said Arizona?
Vanessa Persha (23:49) Yeah.
Sarah Aloisi (23:50) This, how come sometimes it works because this one worked… evernorth, Arizona, mark violetti, his worked?
Vanessa Persha (23:59) Yep. And that’s what I told the pef team. I said we have successful enrollments in that with these payers, like why are these an issue? And we need to push back on the payer because they shouldn’t if there’s a group agreement in place, they shouldn’t be denying providers for panel closures number one. And then for the other payer, they’re saying there’s no group agreement in place, but we have successfully linked other providers to your group agreement. So, yeah, okay.
Sarah Aloisi (24:29) Well, do we know that because people could have just signed the independent agreement and not realized, right?
Vanessa Persha (24:38) That’s an interesting, okay.
Sarah Aloisi (24:40) But this one, mark violetti looks like the note says linked to group, right? So, I think he is, I think mark did not sign an individual contract but he was already contracted with evernorth from his old job. So maybe that’s the difference. I’ll.
Vanessa Persha (25:04) dig into it. I’ll look at some of your successful completions and see what documents are attached to the lines. And then I’ll kind of provide a summary and let you know what I find, okay? Because.
Sarah Aloisi (25:15) it’s the, it’s helpful to me to have like a roll up of everything so that then I can send an email to evernorth with everything because they’re more likely to respond if it’s like a comprehensive email. Do you?
Vanessa Persha (25:32) Want me to review any other states? I can do just a full cigna review?
Sarah Aloisi (25:43) Deanna, do we have a cigna login where we can check evernorth? We can check… who’s in our roster, and then we’ll know who’s in and who’s out. We can cross check it against medallion. So, if medallion says this provider was successful, but the evernorth… roster says they’re not successful, then we know… yeah, we do have a login I’m checking right… now what I have. So maybe I should just send evernorth an email and say, give me a list of everybody who’s attached. Okay. Maybe. Okay. So what are we going to do for the next step? Vanessa, if you can research… get me some examples of some of these problems, like the document that says the panel’s closed. And then the other document that says there’s no group contract. Okay? I can send that over. Okay?
Vanessa Persha (26:52) I will do that. Okay? Thank you. Arizona. Let me see. Hold on Mariah Baldwin’s uhc enrollment. I flagged to the team again, Deanna, I know you ended up updating her license in, I think it was in caqh or in the uhc portal, but I’m still having them confirm that it’s actually been updated with uhc, okay. Haley masterson, uhc, Arizona… her app was resubmitted. I think that one’s still in process. I’ll double check because I haven’t checked on that one in a minute. North Carolina medicaid, that’s a duplicate line. Oh, I think I skipped one. Sorry, Arizona medicaid. So mark violetti’s app has been submitted, and it is just a group linkage. They’re adding the addresses and the tax id, his domain transfer was approved. This one is also under the microscope again, you know, you escalated it. I’ve been singing from the rooftops that this has been an issue for a long time. And so, the particular agent who’s responsible for working on these is being closely monitored to ensure that she’s not overlooking these applications and your weekly follow ups on them. Okay? Thank you. Yeah, no problem. This is our most, probably our single most important contract right now. Yes, this is Arizona medicaid. I have a dedicated like every week when I meet with them. Now, I have a dedicated section on our agenda for Arizona medicaid. And I’m flagging, I’m like, hey, your note says this, but this needs this and so, we’re keeping a close eye on those.
Vanessa Persha (28:42) Okay. And I know we are at time, so I do apologize. We didn’t get to go over the rest of these items here. I can update, I can give you updates on all of these in the notes here. And then if we need some more time, Deanna, if you need an extra like 30 minutes, I can look to see what I have either later today or tomorrow, even early next week, whatever. If you want to email me and let me know we need some extra time. Okay? Thank you. Awesome. No problem. Well, thank you ladies. So much, I appreciate the time and I will… Sarah and Deanna, I’ll send you an email on a time. We can connect on those escalation items that you sent in the email, Sarah. I’m just, I want to put together a little deck of a full analysis, that we’ve done and where we’re going on that one. Okay. Great. Thank you. Awesome. Thank you ladies. I appreciate you have a great. Day you too. Bye, bye bye.