Transcript
Dawn Candia (00:00) good morning. Good morning, Tanisha.
Jason Zednick (00:05) How are y’all,
Dawn Candia (00:06) all right.
Jason Zednick (00:10) Good… Dawn. I would like to start today by following up on.
Jason Zednick (00:24) The 20 first century cares act piece. Let me pull up your email.
Jason Zednick (00:50) Okay. So… so my team was under the impression that they were supposed or should be applying for both for all providers, but it sounds like… you can’t so, if that’s the case and it’s one or the other, then I think my team really just needs to know which when they’re doing an enrollment, which it… should be for.
Dawn Candia (01:35) What they need that to know that from us, they don’t they can’t you know, I don’t know why can’t they determine which one it should be?
Jason Zednick (01:46) Well, what criteria would they use to determine that?
Dawn Candia (02:00) And see, I think there needs to be, there probably needs to be a little bit more clarity because who told you guys to? Like? What was you said? The impression was to submit both, where did that come from?
Jason Zednick (02:16) Well, that was from me based on conversations from before. Now, it may be the case that I misunderstood what was being told to me at the time. And that’s why.
Dawn Candia (02:29) That I thought I heard that come from horizon. I thought that it was Jill that said that.
Jason Zednick (02:34) That, that is why the conversation came up because… horizon was saying, if I’m remembering right? That, like that, they had to have the first century cares act. And so we talked about it and it was like, okay, well, when we do New Jersey medicaid, we’ll also make sure to do the 20 first century cares act as well. And we’re now and that’s I, right? That’s what I communicated to them. And now we’re learning that you can’t do both.
Dawn Candia (03:12) Yeah. Well, the group app is a fee for service. It’s it’s saying, you know, you want to enroll this provider and link them to a group. So that’s like an application you do. If you want the provider to be fee for service, a billing provider that’s the normal app. The 20 first century app is if, and any provider can do a 20 first century cares act application if they want to be non billing, if they want to be set up with medicaid as non billing because being set up with medicaid as non billing will also, even though they won’t be able to accept, you know, payments and that kind of thing won’t be able to bill. They’ll still be enrolled to the degree where, they can enroll with the managed medicaid… you know, it’s like they don’t want to accept straight medicaid, but they enroll as non billing, so that they can accept the managed medicaid. So that’s the difference in the two applications. But according to like I said, like what that development letter said, you can’t submit both to medicaid… right?
Jason Zednick (04:35) So that’s where I’m a little stuck because… I assume you need. And I’m making an assumption, I don’t actually know that you need your providers to be fee for service, but horizon is telling you they also have to be.
Dawn Candia (04:58) Fee for service with medicaid. And Duane might need to get involved in this because unfortunately, that’s been, that whole horizon thing has been an issue for a long time. We’ve been fighting back and forth with them over the years about why they would be asking for the 20 first century cures act application. If the provider is going to be fee for service, why do they still need the 20 first century? And I went on their website and it does say that they still want the provider to be registered with 20 first century. Now, I think that they have a way that they separate it, but they just want it on file. They just want it on record that the provider is registered with 20 first century, but in their system, they still have a way to separate it out like this provider is billing, but we do still have the registration for 20 first century. I don’t know why they need it, but horizon is horizon and, you know, they won’t process something. You know, how Jill was on that call. She was like, well, you’re going to have it. So, I don’t know a way around that.
Jason Zednick (06:06) Is there, and I’m grasping at straws? I don’t know, is there some like on file with cares but not enrolled? Is there like just some like, hey, we have your data but you’re not enrolled? And.
Dawn Candia (06:22) I think it may be. I don’t know about the application. Like I haven’t pulled the application to see what it says, but yeah, yeah, I think it’s something along those lines. Yeah.
Jason Zednick (06:33) Yeah. Here’s the way now… hey, Dwayne. Hey.
Dawn Candia (06:40) Sorry, I’m late. I was on another call.
Jason Zednick (06:42) No worries. So, we’re talking about the 20 first century cares act. So, Don confirmed sort of what… the state told us about the… 20 first century cares act. It’s either or you’re either fee for service at the group level or you enroll in 20 first century cares, you know, for the managed medicaid, the mcos… you can’t do both. So originally when… horizon, so I’ve been telling my team like my instructions to the team are enroll in both. I did not know that you cannot do both. And that is because horizon is saying when we were talking to them about horizon, they were saying that providers have to have the 20 first century cares act enrollment. And so we sort of made the decision. Okay? We’ll do them both at the same time. That’s fine. We don’t mind. But now we’re learning that we can’t… and we’re just not sure where to go from here because you need your providers billing for fee for service, but horizon needs the 20 first century cares act and those things are in conflict.
DeWayne Hiebert (08:13) So,
DeWayne Hiebert (08:31) does horizon New Jersey health need the 20 first century cares act or they just need the medicaid approval letter if it’s a medicaid provider, right? I mean, Dawn we provide those approval letters, right? Those aren’t necessarily 20 first century cares act. So, right?
Dawn Candia (08:50) We’re just, yeah, you’re right? And I thought that because I asked Jason, where did that come from? And we both recall on the call, when we had Jill on the call and her team, we thought we recalled her saying or pushing back saying you got to submit that 20 first century, you got to have that, remember? I thought, do you remember her saying, that we had to, that they had to register with 20 first century cures?
DeWayne Hiebert (09:20) Yeah, I mean, she may have said that, but I mean, like I said, we were talking, you know, via email yesterday, right? About dr… nihani, right? So, she was recently approved by horizon New Jersey health. I don’t believe she had a 20 first century cures act letter, right? She just had the medicaid approval letter.
Dawn Candia (09:44) I.
DeWayne Hiebert (09:44) mean, if you can’t have both, you can’t have both. You can’t have both, right?
Dawn Candia (09:48) Right, right.
DeWayne Hiebert (09:51) So, I think either what Jill said was incorrect or, you know, our interpretation of what she meant was.
Dawn Candia (10:00) Incorrect. Yeah.
DeWayne Hiebert (10:01) Was off. So, okay, I think we have to work under the assumption that you have to have one or the other, right, right? But since you can’t have both, there’s no way you can have both, right? So, right? They’ve got to accept. They’ve got to accept.
Dawn Candia (10:21) You know, medicaid approval, right? Or the, yeah, okay.
Jason Zednick (10:26) Well, that’s simple enough on our side. We just, we just do the fee for service enrollment, and that’s it. Yeah.
DeWayne Hiebert (10:34) And then once we have that approval letter, right? We should be good. And if they don’t want to be a billing physician and we submit.
Dawn Candia (10:40) The wow.
DeWayne Hiebert (10:41) The 20 first century cures act, then we need that letter to provide to them.
Jason Zednick (10:46) Okay. So, I’ll.
Jason Zednick (10:54) update my team and we’ll resubmit the ones that were bounced and that’ll be that?
Dawn Candia (11:01) Yeah, good. Okay.
Jason Zednick (11:04) All right. Okay. So, Duane the licenses, yeah. Did you get my email? Yeah.
DeWayne Hiebert (11:15) I did, I was just looking to see which ones were… the profile was complete, and which ones they’re not. So, I guess when I want to make sure, do you agree that the list of licenses for fourthirty… is limited to the group I sent you or are you seeing others? I just want to make sure I’m not missing anybody.
Jason Zednick (11:47) Let me look.
Jason Zednick (12:25) So, I have a longer list.
Jason Zednick (12:35) But.
DeWayne Hiebert (12:42) yeah, I filtered out deas, and RNS.
Jason Zednick (12:53) Yeah, I’m just pulling from the full. Okay. So, filtering out deas and RNS. Let me find your email.
Jason Zednick (13:31) There’s a better way to… all right. So, let’s take out deas. It’s my nest… our end.
Jason Zednick (14:20) All right. So, faucet.
Jason Zednick (14:37) It’s not on your list that’s been requested already. Kariana… also a compact.
Jason Zednick (14:58) Johnson.
Jason Zednick (15:05) yerkes… it’s an apn?
Jason Zednick (15:16) Marco… this is a Connecticut license. I assume you don’t care about that… and Tulsi?
Jason Zednick (15:32) So, there’s a few but not that many that were not on your list.
DeWayne Hiebert (15:40) So, if.
Jason Zednick (15:41) I’m reading that, right?
DeWayne Hiebert (15:42) Six more in addition to the ones that I had?
Jason Zednick (15:50) Yeah, something like that.
DeWayne Hiebert (16:03) So, why did I not get those when I did this?
Jason Zednick (17:20) So,
Jason Zednick (17:25) it’s the tenth now.
Jason Zednick (17:31) I asked sort of my team. I was like, hey, like do we think that this is possible in the time given? And they were like, yeah, it’s like possible. Like you can still get it. We can still get it done… but we… need the requests to be in. I can have my intake team expedite the intake process. We will still need the two or two known. We can check the others, the new ones, the profiles to be done like, that will still need to happen. And then I can ask my licensing team to… add it to their queue and work it as quick as I can… but it is nearing the end of the month. So, I just, I mean, would you like to put them through and give it a shot?
DeWayne Hiebert (18:36) Well, giving it a shot isn’t an option. We’ve got to get it done. So, you know, I think.
DeWayne Hiebert (18:56) I would like to know why my, what I pulled didn’t have all of them, what?
Jason Zednick (19:02) Did you pull from? What did you?
DeWayne Hiebert (19:07) Well, when I pulled it, I went to existing licenses, right? With an expiration date between four one and four 30. Yeah.
Jason Zednick (19:18) I mean, that’s exactly what I did. I’m not sure why.
DeWayne Hiebert (19:24) So, and I guess if we take out… the New York ones, if you just.
Jason Zednick (19:36) You know, I just look at, yeah.
DeWayne Hiebert (19:37) Just look at Delaware… pa, and New Jersey. I don’t know if there were any delawares there, but I.
Jason Zednick (19:45) don’t think so, but Delaware.
Jason Zednick (19:51) New Jersey and Pennsylvania.
DeWayne Hiebert (20:02) So, you have 10… and I had six?
Jason Zednick (20:09) Yeah. So, fawcett… Kariana, johnson.
Jason Zednick (20:22) Marco, yerkes, tolsi.
DeWayne Hiebert (20:31) Fawcett, Kariana, johnson, yerkes, Marco, Tulsi. Okay?
DeWayne Hiebert (20:39) And if I take out this one. All right, then I, with those six, so we have 10… and I guess the first one, fawcett, that is in process, yeah.
Jason Zednick (20:58) That’s.
DeWayne Hiebert (20:58) been requested. What status… is that in? I mean, is that since that one is already happening? Is that one that you guys can?
DeWayne Hiebert (21:16) For sure complete? Although it says need client’s attention… to our task.
Jason Zednick (21:37) We need CE certificates.
DeWayne Hiebert (21:48) No problem. And she hasn’t returned that and it says for one. So we’re already passed on that. So I think.
DeWayne Hiebert (22:04) we’ve got to assume that’s not going to be done. Okay? So, I think we need to look at all 10 of them. So… that’s good.
Jason Zednick (22:47) So, let’s do this. Go ahead. I’m sorry, no.
DeWayne Hiebert (22:51) I was just going to say Jason, we’ll discuss internally, but I think we’re probably going to have to identify somebody who can focus on this internally to make sure this is, they’re done by four 30.
Jason Zednick (23:03) Yeah, that makes sense. Let me know if you decide to kick any of these to us, that’s fine. Put the request in and let me know and I’ll like flag it right away to my intake team, be like, hey, push this through. If we need something… they’ll still create a task for it, but I’ll ask them to ping me and I can reach out directly and let you know at the time and that’s sort of, I think the only sort of thing I can think to help then go faster. But if you decide to do it internally, I totally understand that. So just let me know.
DeWayne Hiebert (23:54) Okay.
Jason Zednick (23:57) All right. OK.
Jason Zednick (24:13) And then, of course. Well, we’ll worry about that later horizon and Bethany, so my team five o’clock is just a bad time for my team. We can’t do five, if we can do earlier. I can… if we can do four, I can get my people if Bethany can’t do four. I understand, you know, she has another job that’s totally reasonable. If she can’t do four. What I think we should do is if she can walk… through an application and record it. And like I can hop on a call with her, we can do that together and just sort of go step by step and talk through it. I can share that with my team and we can sort of do an async thing with questions and that can happen just whenever she… has an opportunity. And if she comes in at five, I’m around at five. I can meet with her to record that if that’s helpful?
DeWayne Hiebert (25:28) Okay. Well, we’ll start, I’ll see if.
DeWayne Hiebert (25:43) She can make four PM work. Let’s start there. Yeah.
Jason Zednick (25:53) All right. That is it on my side. Were there any other topics from the advocare team?
Jason Zednick (26:07) No, I’m good.
Dawn Candia (26:14) Amelia macaray, that’s the just… want to make sure that your team is following up on that because they’re really care… center is really pushing about that one… and they get a chance to look at the follow up, but they had sent an email that there was follow up due that wasn’t done. So, I’m not sure if maybe it was done late yesterday and they just didn’t know or didn’t see it?
Jason Zednick (26:48) Do you remember what… payers? Yeah.
Dawn Candia (26:55) I know tricare was one of them. Amerihealth was one of them horizon were doing internally?
Dawn Candia (27:06) Tanisha confirmed, uhc, is par… and I think medicaid was the other one that they were concerned about.
Jason Zednick (27:24) So, tricare, we did check yesterday. It’s still processing… amerihealth.
Jason Zednick (27:46) We reached out on March eighteenth. So, it was a while ago, but that was submitted February 20 third… and.
Jason Zednick (28:04) that is a 90 day window that Tammy. Communicated.
Jason Zednick (28:17) This is it?
Jason Zednick (28:22) Yeah, no provider enrollment. Now, let me check medicaid.
Jason Zednick (28:43) Medicaid was submitted on the eighth. So, it is with the state now.
Jason Zednick (28:57) Although it’s going to.
Dawn Candia (28:58) On, April eighth?
Dawn Candia (29:13) I’m just curious why it was just submitted. April eighth. I see the note above. It says task with test out for W9, mpi, W9 mpi, when I looked in the notes, the W9 looked like it was already there way… back.
Dawn Candia (29:42) When I looked in the documents?
Jason Zednick (29:46) Yeah. So the task was closed, you did the task on the seventh… I can’t speak to the W9… when you say in the documents in the for?
Dawn Candia (30:02) Amelia Mcelroy. Her documents section.
Jason Zednick (30:06) Was it in the Google drive? Do you know?
Dawn Candia (30:16) No, I don’t know if it was in Google drive. I was looking back to it because I don’t even know if we were doing it then.
Jason Zednick (30:23) Yeah, because they don’t check the documents for W9 to check them. Wait, am I thinking about the right thing?
Jason Zednick (30:47) Next three? Yeah, yeah, they check the drive for the, okay… but good news is they’re all out with the payers. So we just have to tighten… once we know more, we know more.
DeWayne Hiebert (31:16) Hey, Jason. Sorry to backtrack here, but on the licenses I.
Dawn Candia (31:26) saw.
DeWayne Hiebert (31:27) Another one that you didn’t mention?
DeWayne Hiebert (31:39) Majerak, Tulsi, majerak, Was she on your list? She was, yeah.
Jason Zednick (31:49) She was on the ones that I pulled earlier?
DeWayne Hiebert (31:54) All right. So, she’s one of the 10, yes.
DeWayne Hiebert (32:03) Okay.
Jason Zednick (32:08) All right. Okay. Hey.
Dawn Candia (32:12) Jason, just a quick question is Satish Kumar. Is that one of your people?
Jason Zednick (32:17) I wouldn’t know by name. Okay? What, how… did that come across? Your, I,
Dawn Candia (32:28) was just seeing that something was uploaded by that person. I just didn’t know who that was.
Jason Zednick (32:32) It probably is. Yeah. I mean, yeah. Okay. Talk internally about the licenses if you want any, that you want us to do. Very, happy to push that internally as best as I can. You just got to let me know even if it’s a split or something like that. I don’t know what the answer there is, but just move me in and I’ll expedite that. Duane, talk to Bethany, let me know where she’s at.
Dawn Candia (33:14) If it.
Jason Zednick (33:15) Needs to just be me, I can meet her at five. That’s no problem at all. I won’t have the like questions that my team will have, but I can at least record it, put it in front of my team and then we can see what next steps are there. And then I’m going to instruct my team to drop the 20 first century cares act applications. We’ll process medicaid, just the group enrollment fee for service and deal with horizon. When it comes up. Anything else, could?
DeWayne Hiebert (33:54) You just resend me Monday’s, invite. I’m going to be out and so I had declined it, but I’m going to try and work it out so that I can be on the call Monday.
Jason Zednick (34:08) Yeah, I can… I’ll do that now. Okay. All right. Thank you all for your time. If you need anything. Shoot me an email otherwise, have a great weekend and I’ll speak with you Monday.
DeWayne Hiebert (34:25) Thank you. All right?
Dawn Candia (34:27) Thank.
Jason Zednick (34:27) you.