Transcript
Amy Barfield (00:00) good morning.
Amy Barfield (00:09) Good morning. Oh, I can’t hear you. Oh, can you hear me now? I can hear you now. Okay, good. I was like, please don’t let it be a speaker issue. I thought I got that fixed. No worries. Good.
Amy Barfield (00:29) We found a few more people here.
Amy Barfield (00:37) I’ve been out for the last three days. So, we’ll tell you if you sent me any emails or Daniel working through them, I’ve got about 80 plus emails from your team. So, in the last three days, so, working, yeah, working through that, and I’ll be working on an update from our Monday call, Friday, Monday call. I have a question though.
Daniel Dominic Roxas (01:05) Regarding provider, Jana Houston. She has a task regarding cigna, Illinois complex care about the effective date mentioned in the documentation in the source. Loi, we… I think the team is confused where to get this information?
Amy Barfield (01:27) Okay. What is the payer again?
Daniel Dominic Roxas (01:30) Cigna Illinois for… Jana Houston?
Amy Barfield (01:35) Jenna… we look her up while we’re waiting on everyone. Oh, hi, Carrie. Hi.
Svetlana Vinokur (01:43) Good.
Daniel Dominic Roxas (01:44) Morning, Carrie. Good.
Svetlana Vinokur (01:45) Morning. Happy Friday.
Amy Barfield (01:47) Good morning. Bye Houston.
Amy Barfield (01:59) Cigna. Illinois.
Amy Barfield (02:05) And you have a task? You said yep?
Daniel Dominic Roxas (02:10) It says here that the effective date does not match the email, effective date that they received?
Amy Barfield (02:41) I’m confused. Let’s see… kindly confirm, correct, effective date in the source, allow effective date given in no contact. Okay? So, which one do you need? I assume the September one, right?
Daniel Dominic Roxas (03:01) Yes, probably. But the team is confused who will do the follow up or where to confirm date?
Amy Barfield (03:15) We have that here.
Amy Barfield (03:22) Hi, Svetlana. Hi, everyone. Good?
Daniel Dominic Roxas (03:25) Morning.
Amy Barfield (03:27) Good morning…
Svetlana Vinokur (03:34) So, Amy, I sent the email yesterday on hallelujah. We got Illinois medicaid, kind of at least partially kind of right? But we now need to get providers released and get all the locations added. And so, can we get the team kind of going on this ASAP? Please?
Amy Barfield (03:57) Yes, which one did you say for? Q?
Svetlana Vinokur (04:00) It’s midwest, M, medicaid Illinois?
Svetlana Vinokur (04:08) We got the group enrolled with one location.
Amy Barfield (04:15) So, additional locations and providers?
Svetlana Vinokur (04:17) Yeah, we need to release ASAP. Okay? I also sent an email. I think it was New Hampshire medicaid. I sent it to Nicole and you’re like they’re asking for W9 after all this months, and it’s been nine days and we still haven’t sent them W9, like how difficult it is to send W9 immediately for anthem it was, I think it was medicaid actually.
Amy Barfield (04:44) Oh, for medicaid? Yeah.
Svetlana Vinokur (04:51) It’s just my overall concern is like we are racing against time and like on this basic things, it takes forever.
Amy Barfield (05:00) Sure. Yeah. I’ll find out what happened there because I’ve told our medicaid team. Like all group applications. I mean, it doesn’t matter. Always send it, just send everything, send a W9, send everything. So I’ll find out what’s happening there.
Svetlana Vinokur (05:17) Okay. And then I want to have someone go through comprehensive. Like, I know I already raised that, medicaid, Georgia, what the heck is happening there? Because it’s a mess right now. Amy. Yeah. With Theoria, it’s a mess. Yeah.
Amy Barfield (05:38) I know the one that was recently rejected was because of a signature.
Amy Barfield (05:42) They wanted a wet signature on the eft. And they only allowed like 10 days to get that. So that’s why once we got the signature, but it’s.
Svetlana Vinokur (05:54) retro. So it has nothing to do with eft. They already kind of, I don’t know what that was, but it’s just, we asked for retros a long time ago. I don’t know something was not done. And now they’re coming back to us and just saying we can’t get retros. I have 100 plus K on medicaid Georgia. Okay. Like I need someone to take all the like, not even outstanding Amy from medallion because medallion closed the tasks without actually getting retros. So it’s almost like they need to take our credit report. And so maybe juvie, if you can provide Amy, it was medicaid, Georgia, outstanding, Ar… for people, which location and what’s the earliest date of service. And they need like medallion needs to go through and like we… need to clean this up. Yeah, I will do that. I will send you a listing.
Amy Barfield (07:13) Okay. Thank you, juvie.
Svetlana Vinokur (07:17) So, and I signed whatever, something came to me from Michigan to sign. I signed it, some person, Brittany was copied on it from blue cross blue shield. So I don’t know Amy what’s happening there? Did we finally found the contact that is going to help us? Or like what is happening?
Amy Barfield (07:39) Yeah. Let me get that information for you. So for… complex care, midwest N, we have an effective date of 12 till for traditional only for BCN bcna, it was denied on 1,124. Due to not receiving signed contracts back. They were sent back to… us. The payer did confirm nothing was ever received. I think that’s what the signature was for this time. The group changed form to add those was sent on four eight. And then for midwest H, you have an effective date for traditional for 1,117. The bcna contract was signed on 225. The BCN contract is still not signed and required before bcna can be processed. Once the BCN is received, processing time should be minimal. A confirmation and executed contract will be mailed once complete. And it looks like you signed that on four seven. And it’s processing… for nurse practitioners. They are in network for medicare blue plus ppo, traditional lines of business. Only, they’re not eligible for the other lines of business for MDS, medicare blue plus, ppo, trust, traditional and preferred plus, they’re eligible for, but they have to be linked to the BCN bcna plans at the individual level… and I think those have been sent, but I’ll confirm that they’ve been sent for those individual providers.
Svetlana Vinokur (09:33) So great… that we make the progress. But somehow the contract was sent in November and only now in April, we are learning that it wasn’t signed.
Amy Barfield (09:50) From what I get from the team, correct? Yeah.
Svetlana Vinokur (09:53) Yeah, it’s just, do you see how ridiculous that is? Okay. So, so that means that all this, all these contracts that we need right now are signed for midwest MH?
Amy Barfield (10:07) I believe. So I’m going to double check today.
Svetlana Vinokur (10:11) Okay. To.
Amy Barfield (10:11) Make sure those are all processing in the way that they should, that everything is set. Okay?
Svetlana Vinokur (10:17) And then when you, when we’re saying that stuff needs to be at the individual provider level, so does that mean we need to be submitting individual providers’ applications right now?
Amy Barfield (10:30) Yeah. And those have been submitted. I believe… I just want to confirm that the BCN part is also being submitted with it like at the same time. So we’re not running into this, you know, three, four months from now where that’s the one thing?
Svetlana Vinokur (10:45) Exactly. Okay. And then what does that mean for Theoria? Because again, I have almost.
Amy Barfield (10:55) seven.
Svetlana Vinokur (10:57) 100… Ar for my blue cross blue shield and it’s becoming like the largest, right? I now… have all the top 15 people. It’s probably at least half of them are… my bluegrass blue shield.
Amy Barfield (11:25) For those that are complete?
Amy Barfield (11:32) So, those that are partially complete that they’re just missing that BCN nurse practitioners should have medicare blue plus ppo and traditional, which I know that doesn’t mean and then your MDS are on medicare blue plus, ppo, trust and blue preferred trust or blue preferred. Plus. So all those plus plans, if you have a partial completion on those, you should be able to bill for those, but.
Svetlana Vinokur (11:59) We look at this. Okay. So I need like I need an Italian review of this. Look at, this blue plus, right? Look at this dollar amounts I have right now sitting on people. So, Peter, Ladonna, Patricia, we can look at them like, I think.
Svetlana Vinokur (12:40) So, I have nothing… her checking in portal, the found application is not reflecting. So hands need to allow more time. Like I just, how is this is okay full up if we’ve been at it since February 20 25, sure.
Amy Barfield (13:03) I can have the account specialist look more into the providers this coming week. She was really focused on the group, making sure that we had everything for the group this week.
Svetlana Vinokur (13:20) So, but Amy, I’m challenging because I kind of like, right? If if is like one contract and she focused on it the whole week.
Amy Barfield (13:32) No, it’s not the only thing she focused on. But as far as like blue cross blue shield in Michigan, she wanted to make sure that because you still have to be enrolled under the group. And I know that was, yeah, I.
Svetlana Vinokur (13:44) Understand. But like look at this like, right? This is, this is just my, the blue plus and then I have this Michigan blue care network… and then I have that.
Amy Barfield (14:01) Falls under the BCM?
Svetlana Vinokur (14:03) And then I have this Guy, blue cross blue shield of Michigan.
Svetlana Vinokur (14:12) So, if I and is.
Amy Barfield (14:15) that just traditional or is that like the other lines of business for those that just say blue cross blue shield of Michigan?
Svetlana Vinokur (14:23) That’s a good question. Let’s see who that is.
Svetlana Vinokur (14:30) So, the top Guy it says pending dependency on hold, let’s see.
Amy Barfield (14:38) And who is this for?
Svetlana Vinokur (14:41) Okay. Let’s see. Yeah, I’ll go for it then.
Svetlana Vinokur (14:48) Do we want Brittany?
Svetlana Vinokur (14:57) This was spending since 24. Okay. So hold on. So if it says here… upon reviewing the providers enrolled in service facility, 86, 33 was effective day one 30 26, the lines of businesses enrollment, government. Okay. Do we, what facility do we need for him? But also they would clearly need retros, but all of this is blocked, right? So we have like such a mess here because like here, right? We clearly… like I don’t need 103 facilities here for sure. Like we don’t care about Theoria, any 103 facilities. So that needs to be gone. We just need to have exactly which facilities he needs kind of and make sure we add that. So, Joey, what facility does he need? But also like if this one is, why is it not markets partially completed? Then if this was indeed the case, right? Sure. And then,
Svetlana Vinokur (16:17) and then like… I don’t know, look at how many are pending on this one?
Svetlana Vinokur (16:31) And then look at this is checking in with B. Medical commercial is added to effective 319. Still exchange? Okay, this is very confusing. So this one is saying effective date 319. This one is saying effective date one 30… and nothing is completed under enrollment, right? Shouldn’t that be kind of in here?
Svetlana Vinokur (16:58) So, I need someone to look to like go through like, we send this right information, and understand like what, what’s happening? But we need to have also right away ask for retros. So it’s almost like Amy, like there needs to be right now a process like to figure out because all of those are going to be like… it’s useless for us to get a Theoria enrolled if we cannot get retros?
Amy Barfield (17:27) Sure. Okay. I’ll make note of that. Yeah.
Svetlana Vinokur (17:32) Like look at this. So let’s look at it’s just so Julie tafo, like what’s her story here?
Svetlana Vinokur (17:45) Hey, peoria, since… 24.
Svetlana Vinokur (17:54) What we submitted since 24, we submitted application on three four.
Svetlana Vinokur (18:02) This is real. So after a month year and a half plus we are just submitted the application.
Amy Barfield (18:14) I’m looking at hers… here.
Svetlana Vinokur (18:17) At the station form and the board certification, we’re missing from initial application. How can you submit application without, the board certification?
Svetlana Vinokur (18:41) I don’t know how not to get upset when you read those notes. Paulson.
Svetlana Vinokur (18:59) Like I want to go through every single person I want to like we like, when do we meet? When we meet next Tuesday? I want to go through every single person. What’s going on?
Amy Frana (19:09) Like,
Amy Barfield (19:15) Amy, do you think it would be worth having QA do an audit? Just a blue cross Fish shield of Michigan?
Amy Frana (19:24) Yeah. I would prefer we do it that way and then that then Svetlana, we would have the full breakdown per person that we’d be able to review.
Svetlana Vinokur (19:40) Okay. So look at this. So here’s what we need to change the process here. So pending… dependency. So on this one on the polson, I’m… confident I need retro. So like we need to review. So polson claims going back to 924 to five. So I see that she has something enrolled… effective 1,219 five. Can you see her if, like we need to. So someone needs to on our side to go through because like I don’t know if we can release anything on this, but also, we need to ask for retros, but the retro needs to be entered because right now, the retro will be sitting on the… because this is only partially completed.
Svetlana Vinokur (20:51) So we need to have a rule that like retro, we need to work on the retro. And then, and then Julie, we need to go through and see like, do we really need this request? Like if she’s only has one facility that we have, like I would rather like stop all this nonsense, right? I will go through them and we’ll request to stop. Well, if we need to like, right? It’s just, I think we need to just also because there is, there has been so many layers added because I mean, this is going since 20, yeah, may 25, right? Kind of, so… but this is my Michigan. And then I have… where’s the other one, what is this Michigan blue care network that’s the one that we are trying, to get right to what blue care?
Amy Barfield (21:49) Network is BCN. Okay?
Svetlana Vinokur (21:51) Okay.
Lori Durkin (21:54) So, Michigan blue care network, so.
Svetlana Vinokur (21:57) That’s the one we’re not even enrolled with Theoria, either, right? No.
Amy Barfield (22:02) Theoria, you are enrolled? Okay?
Svetlana Vinokur (22:05) So, then why are we having, then? Why do I have so many kind of again? So it’s Julie taffo? Yeah.
Amy Barfield (22:14) That’s why I want to do an audit to see which providers are enrolled with BCN and make sure that those applications were submitted. Yeah.
Svetlana Vinokur (22:23) So, and kind of Amy, when you do the audit, like stuff, this needs to be updated in the right way, right? Yeah.
Amy Barfield (22:32) Typically, when an audit is done, they will make the… correction there. Okay?
Svetlana Vinokur (22:41) Yeah. Okay. But like look at this Patricia.
Carrie Reding (22:49) But that blue care network is part of the actual blue cross blue shield of Michigan or the blue cross complete of Michigan.
Svetlana Vinokur (22:57) It’s the blue.
Amy Barfield (22:59) Cross blue shield of?
Svetlana Vinokur (23:00) Michigan. Yeah, complete is a medicaid line, right? Like, so, if I, okay. So I’m just making notes for master.
Carrie Reding (23:08) Pairless. Yeah.
Svetlana Vinokur (23:10) Yeah.
Svetlana Vinokur (23:15) So, it’s showing nothing. I mean, she’d been at it… since August and we showed nothing… and look at this follow ups basically like… all the follow ups is just, I checked the valid, it doesn’t show anything.
Svetlana Vinokur (23:43) So, for the last three months, they just check your Valerie and they chose nothing since December.
Svetlana Vinokur (24:07) So, and I saw that the audit on the Michigan was already done. Like I saw that was, I.
Amy Barfield (24:16) Don’t know we haven’t done a recent one.
Svetlana Vinokur (24:20) Okay. Yeah. So, but, this… is more than 50 percent of my, the whole thing, and then medicaid of Georgia is my other big one, right? Right? So we’re… going to take priority health.
Lori Durkin (24:40) On our own… have.
Svetlana Vinokur (24:44) We figured out what’s going on with blue cross blue shield of Indiana that this plan?
Lori Durkin (24:58) This plan… you can do books?
Lori Durkin (25:21) Okay. Let’s see.
Lori Durkin (25:47) Please enroll provider with medicaid?
Svetlana Vinokur (25:49) Plan that’s a medicaid plan. Right there. It goes back to day location.
Lori Durkin (25:53) For, for brickyard?
Lori Durkin (25:59) So,
Lori Durkin (26:06) portal press for LinkedIn location. However, the effective day still not updated, submit… it. There are three error in the roster hands need to resubmit the roster, so.
Svetlana Vinokur (26:20) Help me understand like, so on 325, they were, they said they know that they need to resubmit the roster. Okay? So, I’m at 410. Did that actually happen?
Amy Barfield (26:33) If you click on those, if it’s listed below, I think, is that second one or either of those rosters? Yeah. So they uploaded the roster, okay?
Svetlana Vinokur (26:48) So, then why can’t they just say, then say roster has been uploaded or something kind of that indicates that it’s actually been done, right? Right? Because as I read it here, it just says it needs to be done, but I don’t know if it was done or not bless.
Svetlana Vinokur (27:09) You bless you. Thank you. Sorry?
Carrie Reding (27:11) I’m gonna hit mute fast enough. Yeah.
Svetlana Vinokur (27:14) No. Okay. So.
Lori Durkin (27:23) Okay. So, I think we kind of maybe release some of that. Okay?
Svetlana Vinokur (27:31) So, I guess blue cross blue shield and Michigan audit that’s what we’re doing, yes.
Amy Barfield (27:37) I’ll request that today and find out how long it’ll take for them to… get that done.
Svetlana Vinokur (27:48) Okay. Amy, any update on like when and who is gonna do that update on the priority health roster that we actually received with all the enrollments?
Amy Barfield (28:03) No, but I can get an update today. Since I was out the last three days. I’m playing catch up on updates. So I’m hoping to have an update on the things that we discussed on Monday for you. Okay? Either today or early Monday, okay?
Svetlana Vinokur (28:18) Because I did see that they did updated paramount Ohio, at least, kind of right? The only items I want to flag and I don’t know how we’re going to adjust that in the system. So, the original enrollments for paramount, right? Ohio were both for midwest M and midwest H, for the providers depending kind of what they. But paramount, Ohio only said that they will enroll only one one entity. And so we enrolled everyone with midwest M. And so there’s almost needs to be note of something saying there, hey, because paramount only allowed one one entity. Everyone is rolled enrolled under midwest M, you?
Amy Barfield (29:05) Mean, based on the request for midwest H, right?
Svetlana Vinokur (29:10) So, right now, in medallion, what happens is your team went and updated that the enrollment was done, but it says midwest H, because that was the original request was for midwest H, right? Kind of, so, yeah, the.
Amy Barfield (29:24) Only problem with that is it’s not going to provide a source of truth in your existing enrollments because if we complete it with midwest H, saying just documenting that it was completed under midwest M. So.
Svetlana Vinokur (29:37) My question, is it possible to switch the entity? Like is it possible to go back and switch the entity?
Amy Barfield (29:46) Not within the request line. No, once it’s submitted, we can’t switch it. So what we can do is stop all those for midwest H?
Svetlana Vinokur (29:55) Yeah. I don’t want to do that, and.
Amy Barfield (29:57) Then you would just, you would update the existing record to reflect midwest M. Yeah, but that’s like stopping.
Svetlana Vinokur (30:05) And then entering new ones, God, it’s even worse. No, no, no.
Amy Barfield (30:08) You’re not submitting new requests. You’re just updating the existing record like you’re just updating the existing enrollment, so you can add enrollments that are already existing in the existing enrollment section. And it doesn’t cost against your consumption because you’re just adding a record?
Carrie Reding (30:28) Yeah, but it shows as midwest M. And then there’s another line for midwest H, right?
Svetlana Vinokur (30:33) That will be stopped. No.
Amy Barfield (30:36) That one would be stopped. So it won’t update the existing record.
Svetlana Vinokur (30:39) Okay. So we’ll need to think kind of through, right? But that’s what I want to flag right now. And also, Amy, can you mark paramount Michigan? I actually went ahead and submitted the enrollments for that because that was actually very few providers and only one location. So you can make it client owned.
Amy Barfield (31:07) For providers and group, yeah.
Svetlana Vinokur (31:09) It’s only like three providers actually. Okay?
Carrie Reding (31:12) Let me.
Svetlana Vinokur (31:14) just check, but I’m working on that. Oh,
Amy Barfield (31:19) since midwest, just bouncing back to paramount, Ohio, since midwest H is not going to get an enrollment, we should stop those lines. Well?
Carrie Reding (31:31) Hold on just a second because I feel like this one, we’re getting confused because when we sent the roster in, we did note midwest M and midwest H on here.
Svetlana Vinokur (31:39) No, Carrie. No, paramount only allowed midwest. M. Okay. Paramount only is to, we put everything under one.
Carrie Reding (31:50) Oh, we did, I see that now. Okay.
Amy Barfield (31:56) So, are we good to stop those? Because there’s no action that we can do on our side if they’re not going to honor a contract, let.
Svetlana Vinokur (32:03) Me, think about it kind of. So right now, your team just entered them as if?
Carrie Reding (32:10) Well, that was not necessarily medallion we were working on that. Sheila was working on that because there was missing enrollments we didn’t even have an enrollment for them.
Svetlana Vinokur (32:20) Okay. But did she, is she enrolling them all under midwest M? She?
Carrie Reding (32:24) Put them as client owned under paramount for Ohio. So, and they were, yeah, some of them do show as midwest H. So that was my bad. Yeah. So I.
Brittany Dees (32:36) took the, for paramount, I took out those midwest H and I sent that over to Melina. Is that still accurate?
Carrie Reding (32:46) So there’s two things on that list that you’re looking at, I’ll show you there’s I forgot to denote this, but, so if you look at what we pulled it pulls, let me share this real quick. It shows this, which is the NT that they’re in. But if you scroll over here.
Amy Barfield (33:05) This.
Carrie Reding (33:06) is what we asked them? I think we took this out on the roster. We sent, this is our records. This is what we sent everything was midwest M. So I forgot about that. Okay?
Brittany Dees (33:17) Okay.
Carrie Reding (33:17) I need to put a note on my own spreadsheet. What we did.
Brittany Dees (33:21) Okay. So the roster I have for Molina, I just need to update to H then right there on those.
Svetlana Vinokur (33:27) You can use, yeah, everyone else is just because they were, they didn’t want to add two entities. We kind of were forced.
Amy Barfield (33:34) Yeah, got it. Yep. Okay.
Carrie Reding (33:35) Okay. That was, I, yeah, I’ll make a note of that on here. So, for future reference because this is done, we’ve got this.
Svetlana Vinokur (33:43) Is only paramount. So we, but we need to make sure that we enrolled everyone, right? Yeah. Okay. So, priority, so paramount Michigan. So I guess you can mark this one as client owned.
Amy Barfield (34:01) Okay. For midwestm?
Svetlana Vinokur (34:05) Hold, on, hold on what?
Lori Durkin (34:08) This says… received an email from the confirming. The group is effective 120. However, only commercial line and business mentioned. The remaining lines are not specified.
Svetlana Vinokur (34:20) Oh, my God.
Carrie Reding (34:23) What are you looking at? I’m.
Svetlana Vinokur (34:25) sorry, I’m looking at the Michigan because I.
Svetlana Vinokur (34:44) so, I mean, but when they send this, none of this is talking about whether it’s Michigan or Ohio… and I can guarantee you that this is all for Ohio.
Amy Barfield (35:02) do you?
Svetlana Vinokur (35:02) See anywhere where they ask, is it the same people… right?
Svetlana Vinokur (35:19) So, see.
Amy Barfield (35:20) Ohio, is this for medical mutual or is this for?
Svetlana Vinokur (35:25) No, it’s paramount. It’s.
Amy Barfield (35:26) paramount. Okay. I just saw medical mutual. So, yeah.
Svetlana Vinokur (35:29) It’s the same company. They are, it’s the same company, kind of, right? But see how sloppy it is. She’s looking at Ohio and he’s putting this under Michigan?
Amy Barfield (35:38) Right. Which provider is that for?
Svetlana Vinokur (35:43) It’s the group, oh,
Amy Barfield (35:44) for the group, okay?
Svetlana Vinokur (35:46) So, can you just make this client known? And, they need to delete, this message and they need to stop contacting paramount, right?
Svetlana Vinokur (36:03) And yeah, I don’t know why this request was stopped. Oh, all of them, oh,
Svetlana Vinokur (36:14) so, midwest and we decided to do midwest H, right? Carrie, because we have, more providers, yeah. So, so question for you when you make, yeah. So see like why this request is stopped. I don’t know.
Amy Barfield (36:37) So, you’re not doing midwest H for Michigan? No?
Svetlana Vinokur (36:41) We’re not doing, M, we’re doing H?
Amy Barfield (36:44) You are doing H and M… no?
Svetlana Vinokur (36:48) We are only doing H, because there’s only like four providers and all of them are H. So this group needs to be not stopped. I don’t know why it was stopped. Can you make it client owned, so we can make changes, right? Can we make it, or how does it?
Amy Barfield (37:07) Yeah, paramount, Michigan for the group, for midwest H, I can make client owned, okay?
Svetlana Vinokur (37:15) Well, I see right now that it was stopped.
Amy Barfield (37:21) Is there a note that says why it was stopped?
Svetlana Vinokur (37:23) I don’t know. They say that they’re not operating. They’re not licensed in the area, which is not true.
Svetlana Vinokur (37:31) We, we learned that it is, and there’s one facility and they agreed with it. So we are working on kind of getting that enrollment.
Amy Barfield (37:39) Okay. Let me bounce back because we’re kind of bouncing around here for paramount Michigan, midwest. H, I show that there are 86 requests… and you’re saying there’s only three or four?
Svetlana Vinokur (37:54) Right. So, paramount Michigan services only one small area. And in that area, we only have one location that we learned. Okay. And in that one location, we have four providers and that’s what we’re going to enroll. And so we send the enrollment request to paramount and I’m working with them on it.
Amy Barfield (38:18) Okay. So what do we do with these other?
Svetlana Vinokur (38:21) So they all stopped, look at this like, right? They all stopped. I,
Amy Barfield (38:26) think I should now I show pending dependency. I’m not even, okay. So.
Svetlana Vinokur (38:31) So, hold on. I think I copied you on the email. And if I didn’t.
Svetlana Vinokur (38:55) okay. So, Amy, you were copied the email on Tuesday four seven? Okay. It’s called paramount Michigan. So you will see in the roster. There’s only like three providers. So that’s the only three providers that we need to have outstanding enrollments for midwest age. It’s only also only one location… that the.
Amy Barfield (39:23) 41 800 you’ll.
Svetlana Vinokur (39:26) go around a hickory ridge. Yeah, hickory ridge of tampons, okay?
Amy Barfield (39:33) So of the other ones, those can be stopped, correct?
Svetlana Vinokur (39:38) And midwest am completely stopped. Everything stopped for midwest. M.
Amy Barfield (39:50) Okay. I think I’m following now. Okay? So.
Svetlana Vinokur (39:54) It’s kind of like paramount Ohio. We have midwest M, for everyone, paramount, Michigan, we have midwest H for those for one location. Yeah. Sure. Okay. Got it. Okay.
Svetlana Vinokur (40:12) So, hold on. I wanted to look, my friends in North Carolina.
Svetlana Vinokur (40:23) Have we figured out if we can log into availability and look up for the rosters for North Carolina?
Amy Barfield (40:32) I can find out?
Svetlana Vinokur (40:39) Because I know we are enrolled. I want to see the groups.
Amy Barfield (40:46) And you’re talking about for blue cross official, north?
Svetlana Vinokur (40:49) Carolina, North Carolina?
Svetlana Vinokur (40:57) Atlantic, and also in midwest now. Okay. So… but what I also wanted to see is hold on North Carolina.
Svetlana Vinokur (41:13) Okay. I, so this too right now, see comp, mid atlantic at midwest. M, it says that they are on hold… but I sent an email to medallion, I think last week saying that the groups are enrolled… and this needs to be updated. So.
Amy Barfield (41:40) Yeah. I saw that and we don’t see that done yet. Nope.
Svetlana Vinokur (41:44) No, it’s like, I need to ask and then I need to audit, I need to ask and then I need to audit and maybe in three times it’s gonna get done. So, so this needs to be updated, right? That it was enrolled effective four one and four, four. So there’s one of them four, one, one of them, four, four. And then I need, to make sure that all the providers are kind of enrolled as well. The question I have is I don’t see healthy blue of North Carolina enrollments, and that’s the medicaid line. So, Latoya, have you done that?
Amy Barfield (42:32) The medicaid, healthy blue? Yeah.
Svetlana Vinokur (42:35) In North Carolina, I’m working on that. Okay? So that needs to go into medallion, right? As a new group enrollment, right? And then all the providers need to be entered in medallion for it. So, but what I don’t understand is how was that missed to begin with? Why was not? That was not done? Because with Theoria?
Svetlana Vinokur (43:09) We do have healthy blue of North Carolina.
Svetlana Vinokur (43:16) So, and I think it’s maybe because it was entered only in October and we pulled all the group enrollments in July. I think that’s probably why. So that was missed. So Kerry, can you make sure that it’s on the master data list? And like we… need to get the healthy blue of North Carolina. The two complex groups enroll ASAP.
Amy Barfield (43:48) Yeah. I have healthy blue on the master pair list already.
Svetlana Vinokur (43:53) So that’s.
Amy Barfield (43:56) the one we did the roster too, isn’t it?
Svetlana Vinokur (43:58) Yes. No, no. Okay. That’s the one we haven’t enrolled. We haven’t done anything on it. So, Amy, for North Carolina, blue cross blue shield update medallion that the groups are enrolled, check evalid on the providers, right? Yes. And then we in Theoria, need to take care of healthy blue, North Carolina. Okay. And enter that in medallion as client owned?
Amy Barfield (44:33) Okay. So, healthy blue will be client owned? Yeah.
Svetlana Vinokur (44:38) It’s not even there. So we need to create it, right? Okay.
Svetlana Vinokur (44:50) Okay. I wanted to look at my favorite Wisconsin.
Svetlana Vinokur (45:06) Theoria?
Svetlana Vinokur (45:11) And while I’m looking back, Amy, you owe me the hop for Michigan? Yes?
Svetlana Vinokur (45:29) Okay. So, this… one was partially enrolled, but we don’t know what the heck is happening then. So we send the email, we need to get a contact with blue cross blue shield of Wisconsin. Like, yeah.
Amy Barfield (45:45) It’s been something I know that Kelsey was working on before she left, I will ask the account specialist to,
Svetlana Vinokur (45:56) yeah. Look at this fall off attempted to contact attempted to contact.
Svetlana Vinokur (46:04) They do not. And like, I mean,
Svetlana Vinokur (46:13) yeah. Like, so it’s bad.
Svetlana Vinokur (46:20) And… there’s no moment on that or even like knowing what’s going on in Kansas?
Svetlana Vinokur (46:41) Okay. So, Kansas.
Svetlana Vinokur (46:53) So, the same, like just a bunch of emails without any reproducing… yeah.
Svetlana Vinokur (47:37) Okay. So, they just sent an email to this person saying, okay. So, I’m looking at those because they’re the ones in my, they’re still pretty high on my list. And what is it? Why he’ll see blue Kansas is the issue. I say, okay, but he’ll see blue Kansas.
Svetlana Vinokur (48:20) Why is that not done? Okay?
Svetlana Vinokur (48:34) Why? So we have a healthy blue Kansas with M and H, I think done.
Svetlana Vinokur (48:49) And I think I asked, do we didn’t I ask you guys to rebuild under complex care because… we have that done?
Juvy Patal (49:01) When I checked that, when I checked medallion, showing that for complex care is on hold what?
Svetlana Vinokur (49:11) Do you mean on hold the?
Juvy Patal (49:13) Healthy blue, healthy blue, Kansas. I don’t see.
Svetlana Vinokur (49:18) The.
Juvy Patal (49:18) payer as well. Well. Where?
Svetlana Vinokur (49:20) Isn’t this on hold? I don’t see it on hold. I see partially completed.
Juvy Patal (49:27) Okay. I’m gonna call back. I’m gonna.
Svetlana Vinokur (49:29) Call it’s on the whole Kansas age, hold on.
Juvy Patal (49:37) I did call them and they said the provider is enrolled but not linked to the location. So, and then when I checked that, I saw it’s on hold. Okay?
Svetlana Vinokur (49:47) So, why this one is like, yeah, this one needs to be really healthy, blue needs to be released. Okay? It needs to be released ASAP probably.
Amy Barfield (49:58) Blue for the, for which time Kansas?
Svetlana Vinokur (50:01) H, so everything needs to be released because the medicaid is partially completed. And so everything that is holding that needs to be released, okay? But… I think Kelsey Atkins was the one that was, and it says it’s complete… but this needs to be like all of this needs to be released ASAP.
Svetlana Vinokur (50:49) Nicole again promised a lot of things on the call on Monday with Derek. I, other… than I think a little bit of movement was Michigan? I guess that I signed the contract. I haven’t seen a lot of movement at all. Okay?
Amy Barfield (51:05) Is there anything particular that you want me to check up with her for an update?
Svetlana Vinokur (51:11) Well, I, so here’s the thing, I have a board meeting right on may seventh and that board meeting, Justin and argamon are gonna press me in front of everyone why I’m still building billing on this, the warrior. Okay. So I need to be out of billing medicaid. Sure by that time… because… I haven’t updated medicaid records with them being out. So I’ll have no excuse and it’s going to be really bad. So, I need medicaid’s to be done. And if I look at my medicaid’s.
Svetlana Vinokur (52:31) okay. So I still have 25, right? It says 25… 16. Okay. I have 16 that I’m still. So if it goes through Texas, it’s been followed up, it’s… still in process and we are going into Texas very soon. So I really need Amy that one. Okay? So Minneapolis.
Svetlana Vinokur (53:10) Location currently pending Georgia?
Svetlana Vinokur (53:20) So, when I look at this like, I don’t know what’s online enrollment application received… not verified. So, what the heck is, like, what is happening? Like, why the letters like this is like so easy? Why, why are we? Why are they rejected? What happened that? What we loaded on 313 has been rejected again?
Amy Barfield (53:51) Which one? Is this? It’s.
Svetlana Vinokur (53:53) medicaid Georgia?
Amy Barfield (53:56) That one was the eft, they wanted a wet signature.
Svetlana Vinokur (54:05) Secretary of this bank?
Svetlana Vinokur (54:11) Well, I don’t see eft. So this is says bank letter and secretary of state of existence, and they loaded the same probably stuff again.
Svetlana Vinokur (54:25) So, and the electronic fund transfer form, this is verified on four six.
Amy Barfield (54:38) Okay. I’ll check with the medicaid specialist.
Svetlana Vinokur (54:45) Okay. Illinois.
Svetlana Vinokur (54:53) Okay. So, I guess we’re waiting on Illinois, New Hampshire.
Svetlana Vinokur (55:02) Okay. This is the one that really pissed me off. Quite honestly, right? Four one, again, they need W9. I’m at 410. Was it done? Was it not done? Like I sent the email on that to Nicole?
Amy Barfield (55:15) This is for Illinois. This is for New Hampshire.
Svetlana Vinokur (55:18) No, this is for New Hampshire.
Amy Barfield (55:20) Yeah, I have that noted to check to see what’s going on there?
Svetlana Vinokur (55:25) Missouri.
Svetlana Vinokur (55:42) like all of this and I don’t know if they partially completed if we can get to the, yeah. So this is the Illinois… anyway, Carrie, we, you and I need to talk about Wisconsin when we connect today, right?
Amy Barfield (55:57) Yeah, with medicaid or medicaid?
Svetlana Vinokur (56:00) Yeah, we need to kind of, so, but if I look here, right? Amy, we have a few states that we really need to kind of… Georgia continues to be an issue, Georgia.
Amy Barfield (56:14) Michigan, New Hampshire. No.
Svetlana Vinokur (56:16) Michigan is okay. Oh, I’m not you’re talking.
Amy Barfield (56:20) About medicaid particularly, yeah, medicaid particularly, Georgia, Illinois, New Hampshire.
Svetlana Vinokur (56:26) And then, and then Texas and Missouri, Texas and Missouri. And, yeah, I don’t have Kentucky, like I see. And then there’s some partial that we need to complete… right?
Amy Barfield (56:47) Yes. And we,
Svetlana Vinokur (56:50) need to make sure that all the partials are actually.
Svetlana Vinokur (56:59) I actually, we have everything else released. Just look at that like Illinois that’s what I, the one I told you like look 66 are dependent on it. So we need to release.
Amy Barfield (57:14) Or Illinois medicaid. Yeah.
Svetlana Vinokur (57:16) It’s it’s for midwest. M, H is still pending, but at least M is done.
Brittany Dees (57:28) You know, for New Hampshire medicaid, Amy, I think one of the delays is kind of the missing… information or wrong information that is putting being put on an application. Like for instance, this morning, I just received an email from New Hampshire medicaid and they’re saying that, I guess that there’s a ppa form and the ppa form submitted does not match the address does not match what’s on the application. So that’s kind of what’s delaying a lot of, I haven’t seen a lot of that or just a lot of misinformation being submitted to New Hampshire or these signatures. The signatures are in wet ink, that like they’re requesting and that’s where the delay is there.
Amy Barfield (58:18) Okay. Thank you. Wanting me to know. Do you have like a particular provider I can reference?
Brittany Dees (58:26) Yeah. So this one, this provider is Barrett L Chapin.
Brittany Dees (58:37) And he’s gonna, he needs a whole new ppa form with the correct address.
Brittany Dees (58:47) Match the application… and it’s so small and it’s a tiny thing. It just looks like medallion put an X after 30 county drive and they want the X removed?
Amy Barfield (59:06) I wonder, okay, I’ll look into this. I know some of our medicaid applications are automated. I’m not sure if New Hampshire is one of them, but I’ll check and see if that is an issue. Then I’ll get with automation and have them look into that. Yeah. Okay. Yeah.
Svetlana Vinokur (59:31) Okay. So, medicare, I’m looking at medicare’s provider holds, let me see like I… have 72 processing. Why do I have 70 on hold… for which payer?
Amy Barfield (59:51) I’m.
Svetlana Vinokur (59:52) just looking at medicare’s to make sure that we don’t you know, that medicare’s are shoot. I have another call I need to go to. Oh, yeah, I’m sorry. All right. I think you have plenty of lists, right? But like I want to have a blue cross blue shield audited, and when I have a review discuss every provider, what’s going on?
Amy Barfield (60:14) Okay. I’ll try to have an update over these and what we went through on Monday and get with Nicole. If not today, it’ll be early on Monday.
Svetlana Vinokur (60:23) Okay. Sounds good. Thank you. Bye.
Amy Barfield (60:25) Bye. Yes. Hey, can you send me the notes from today’s? Call? I don’t know who else is taking notes, but, yeah, I’m taking notes. I see a scratch pad and a medallion. I’m trying to keep up. And so, I was like, okay, I’ll clean these up and put them into our agenda, so they’re legible. But yes, I will. Can you send that to me? Because we covered a lot today. Sure. You have access to the agenda? Yes. Oh, Amy, if not, I’ll give it to you in an email and I’ll get you today’s, notes?
Brittany Dees (60:57) Is it on the invite? Sure?
Amy Barfield (61:00) Yes, yeah.
Brittany Dees (61:01) Okay. Oh, then.
Amy Barfield (61:02) I have it. Yeah, if it’s on the invite, I’ve got it.
Svetlana Vinokur (61:05) So, okay.
Amy Barfield (61:06) I’ll send it to you in a separate email anyway. So, okay. Okay. All right. A lot going on. All right. Thanks. Bye, bye, bye bye.