Transcript
Janette (00:00) recording in progress.
Janette (00:22) Hello. How are you?
Kateland Sanders (00:24) Good. How are you?
Janette (00:26) Good. Trying to test my video here for some look. See, I’m logged in twice and I don’t know… why is it two in there?
Kateland Sanders (00:36) Yeah. And one is your full name, and then the other one is just your first name.
Kateland Sanders (00:43) I don’t think I can, I was gonna say like maybe I could try to kick one out but I don’t think I can, I think Amy has to do it.
Janette (00:52) And then he has me on scratchpad. I don’t know what all of it says.
Janette (01:08) Oh, I think you do remove me.
Kateland Sanders (01:12) On this side, there’s still two of you?
Janette (01:15) Really?
Kateland Sanders (01:16) Yeah.
Amy Barfield (01:18) Hi, Amy. Hi. How are you? Good?
Janette (01:21) I’m trying to figure out why I’m logged in twice. Can you remove one of them?
Amy Barfield (01:27) Oh, I don’t know which one you’re on. Let’s see. I.
Kateland Sanders (01:33) Think she’s on the one with her full name, and then the one with just her first name. I think you can try to remove. I just can’t do it because I’m not the admin or the owner.
Amy Barfield (01:45) It doesn’t let me give me an option to remove.
Kateland Sanders (01:49) Oh, sorry. Derek is the host. Oh, okay. Derek, can you try to remove Jeanette? Just the one that says her first name, not her full name. She doesn’t know why it’s logging her in us twice when she joins calls?
Amy Barfield (02:03) Yeah, I just did. Okay, cool. Thank you. Yeah, of course. I think we just lost Vikas though too. I don’t know why.
Kateland Sanders (02:12) Yeah, I know. I saw that he joined and then it dropped.
Amy Barfield (02:22) Do you make it back? Okay? Jeanette.
Janette (02:24) I did, the flight was delayed coming back because it was a full flight, but it wasn’t too bad. Just an hour.
Amy Barfield (02:33) That’s good… there he is.
Amy Barfield (02:41) Hi, Vikas. Hello? All right. Let’s get started here. Let me share my screen.
Amy Barfield (02:56) All right. Okay. So let’s jump in. These are our numbers for this week. This is pulled from this morning. So the numbers did spike a little bit, but that is because we’ve got some holds and dependencies that are releasing from medicaid MVP and anthem New York. So those were expected to spike. Okay. And then we have our overall counts here. So we’re at 780 at 150 75 at 120 to 150 and 93 at 90 to 120. And if you notice these are going down, but that’s probably another reason why these are coming up is because of those were just moving into the year. So some of those are moving into the next buckets… let’s see. And yeah, we have an increase because of medicaid approvals with New York, anthem holds that we had for New York and then MVP, New York. We had a few that were released there. And then here’s your breakdowns per the four top states, we did go down by 10. Nothing rising there. We did find out which I’ll go over amerihealth with DC. We have to have a Maryland and… DC medicaid approval and we were submitting with only one medicaid approval. And so some of those did get resubmitted. So you might see some of those spike a little bit this week, but we’ll keep an eye on it and make sure we try to keep those down… based on our call. Last week. You asked for a state breakdown of top payers. So I’ve listed those here in slide eight for your requests. And I do have a report to share that matches this, which I’ll show once we go through here. So for California, if it was like one or two applications, I didn’t list them here. But if it was like five or more, then I listed it here in the top three. So for California, your highest was regal medical group and blue cross blue shield of California with a total of all payers of 36. Connecticut had a total of 11 with connecticare as your top one, DC, the majority of them are here with health service hscsn.
Amy Barfield (05:22) And then of course, amerihealth creatus DC with a total of payers of 36, Delaware, 28 with amerihealth, we’re going to see amerihealth come up several times here in independence, Florida, sunshine health, which we expect those to go down once we get confirmation about if the medicaid lines of business were approved on those rosters. So those should get down this week. And then we had simply healthcare which I’ll have to look in to see what the issue is with those. But we have a total of 65.
Janette (05:51) Hey, Amy, I’m sorry, but if my memory serves me correct for Florida simply does not require individual enrollment.
Amy Barfield (06:01) Okay. It’s a.
Janette (06:01) Facility based concept.
Amy Barfield (06:04) Okay. Let me make a note of that. Okay? So if you can add that to your internal processes on requesting per provider, then we won’t have those fall into that bucket or fall into our workloads. See simply is facility.
Amy Barfield (06:30) All right. Illinois, Aetna and tricare west. I think tricare west was higher than Aetna but we had a total of 26… Massachusetts, blue cross blue shield of Massachusetts and. Fallon health only had like maybe… four I think, and the other, but we only have a total of eight in Massachusetts, Maryland, amerihealth caritas, DC, John Hopkins, which we realized that we do need to do individual enrollments there. So that’s why that number’s high and then carefirst with a total of 115. The majority of those are amerihealth DC… North Carolina. We had seven total with the high with blue cross blue shield of North Carolina. I think there was only like five total for blue cross blue shield of North Carolina, New Jersey, amerihealth still in here and independence, and then Aetna with a total of 175, New York was medicaid New York MVP and cdphp which I’ve been working closely with Jeanette on those payers to get this down. But we have a total of 354. I could probably add a couple more high payers on this New York list, but we were just doing top three… Pennsylvania, amerihealth independence with a total of 41, Texas is blue cross blue shield of Texas and medicaid and carillon for your behavioral health groups with a total of 31 Virginia, carefirst multi plan, clarity as it’s known now and centara, with a total of eight. So this is my state by state report which I shared this deck with you and you can pull this report. But here it is state by state and what status they’re in as far as like if it’s submitted, resubmitted, if it’s in a follow up process broken down by… 90 to 120, 120 to 240 and 240 plus here. And then that brings us to our totals that match that first slide of seven, 80 75 and 92 with a total of 947 that are in the 90 plus.
Derek Lo (08:49) Amy, I think that, yeah, we didn’t pull this exactly right? I’m seeing a much different number that’s closer to what we’ve been presenting, which is 612. Okay. Yeah. Sorry if I let me go, re, pull this with the team and we’ll send the accurate report in a couple hours.
Amy Barfield (09:12) Okay. So here’s what we reviewed last week, there’s a couple updates here, New York, medicaid, we released pending dependencies for those that were approved. So you see a spike in those… independence. We’re still working with the team to get those communications for those 21 providers. Hope to have that this week that we can provide to Jeanette and the representative… sunshine health. We discussed the medicaid roster, just waiting for approval or confirmation from sunshine health that medicaid is a line of business. And then we can close those out. Anthem we released holds for New York… Jeanette. Were you able to get those prior analysis requests for those four states that were pending? I didn’t see them on Friday. I.
Janette (10:04) Believe the staff did do it. So I’ll double check them.
Amy Barfield (10:07) Okay. Thank you, amerihealth caritas, again, they required both medicaid’s for DC and Maryland. We had originally only did based on one medicaid enrollment approval. And then they just updated their provider data intake form. So that was updated with our team. And so they’ll start submitting it on the new form. And then MBP, we can only enroll one tax id number at a time. Once it’s approved. Then we can submit for the additional tax id numbers. So that’s what’s holding that one up. I’m still going through that list of payers in your top ones with the team this week to see where we can nail down where some of the lag in time is happening and where we can remedy those situations to bring those numbers down. Do you have any questions about any of those? I?
Janette (11:09) Do Amy, so I know that I don’t know if you’ve had time to do debrief with the team yet, but to go back to term providers just wanted to know. So the workflow that we currently have, we don’t deactivate them if they’re in process or in a denial status. But I think what’s continuing to happen is that it’s doing outreach to… one to the providers and two for recredentialing. And I wasn’t sure if there was any way possible if, when they see terminated providers that it, you know, it’s like extracted from an archive. I don’t know what’s the best method to do that, but it’s creating a lot of redundancy work for both sides for medallion and for us as well because it’s doing outreach to providers that are no longer employed with us. So I just wanted to make sure that we brought that up independently. We’ll be doing a cross check with these providers to ensure that if there’s no active payer processing or no claims attached that we’ll deactivate it. It’s going to be a lengthy process for us because we have to have someone assigned to do that as well.
Amy Barfield (12:24) Yeah. I know we talked about that last week and Kristen was going to work on getting me that based on what you had open in Ar, as far as like the term providers in our team… Kate, and help me recall, maybe I don’t know, but there’s no like quick like view to see if our providers terms, like if they’re working a line other than going into profile and checking every single provider before they even do anything correct? Yeah, that’s correct. Yeah, I think our epd team like our product team is working on having a visibility of like seeing like this provider’s termed on a line. But I don’t know where it is in their queues to do that so that we can flag those appropriately. Right now. I think the only process would be since admin has the ability to look at both admin and provider task is just to keep an eye on any providers that may have termed with pmps? That if they have open provider tasks that they’re addressed by the admin team?
Amy Barfield (13:39) Do you think that’s doable in the interim… Jeanette?
Janette (13:44) I’m not sure, Amy, I’d have to go back and just think about what’s best practice because like I said, it’s very time consuming and tedious for us to go through every single line item… in essence for you guys as well because, you know, part of the problem we had with that group cvphp was that it was terminated, doctors that were terminated and we were resubmitting applications, right? So, and it created chaos for us and for the payers. So that’s why I’m trying to figure out if there’s any way that can be streamlined with medallion as well as having a term provider status?
Vikas Bhalla (14:21) Yeah, I’m surprised this seems like a pretty basic thing. I’m sure all your clients should have the same issue because providers get termed and we don’t want to remove them because there are pending claims, but we also don’t want to, you know, continue the process of payer follow ups and create extra work for both teams.
Amy Barfield (14:45) So, yeah, I think and correct me if I’m wrong, Jeanette, this is like if we’re tasking a provider for something that’s needed on the provider side and you don’t have a provider there to task anymore, right? Yeah.
Janette (14:56) It’s both. It may be a provider that they’re tasking, but most recently was the example I’m using is the cdphp payer that we met with last week that terminated providers were resubmitted. The applications were resubmitted, unbeknownst to me because we were trying to figure out why they were resubmitted. I still have no idea why it was resubmitted but I sent you a few examples of one and did an audit trail on it. I don’t know if you had a chance to look at it, but I think that basically just the resubmission of applications and if it’s a provider that’s termed, we don’t need to do or go that route. So I don’t know if it’s just a rule or search engine that can be put in place. I don’t know. I’m not an expert in that matter, but for us internally, it’s just causing a lot of conflict.
Amy Barfield (15:48) Sure. I think we can discuss further on our Wednesday call like how to navigate that. Okay, as far as like the duplicates, I think there was, you know, we were trying to navigate like how can we get these signed? So we did the group email and then we, you know, they said they wouldn’t take it. And so there was a resubmission with a different email and then, you know, the two mpis, so there was a lot of different factors there on the duplicate, but definitely want to stream like that better. And then you and I can… discuss what we do with term providers when we need provider interaction.
Janette (16:24) Okay. Yeah. And then the last piece is the email inbox again that Amy, you came up with a great idea of having a dedicated team to focusing in inbox emails because some of these are time sensitive and require a three to five day follow up from the medallion team. And if there’s no response, then they close the case, and then we have to reapply again. So I mean, I really want to emphasize how important it is to have the medallion team responding to those emails within that timeframe. I think again putting a rule in place with some of these and I’ll work with my team to see if we can give you some of the payers that are requesting a response within three to five or seven, 10 business days so that, you know, they’re responding to timely. So, you know, I’ll try to assist with that aspect. But I think having a dedicated team for emails and allocating them to the prospective person that’s going to be responsible. But I think that’s imperative that, you know, we have emails, a lot of them are saying that no one’s responding timely. And so the case was closed.
Amy Barfield (17:40) Sure. I haven’t got a chance to talk with Nicole. She’s actually out of pocket for at least for the next week that I know of. But once she returns, I’ll be able to kind of talk to her and see how we can navigate that with our production teams. I did speak with the team that handles PMP specifically and our account specialist is trying to keep an eye on those that are coming through or even the emails that may not get tagged to a specific request to try to catch them before they fall into this, you know, chain of no response. So she is keeping up with the team. It is one of her priorities until we can find out another way, to resolve that issue. Okay, perfect. Okay. I did want a clarification on because on our last call, you asked for a provider breakdown of like new… providers versus existing providers, Vikas.
Amy Barfield (18:51) Yeah. How do you want that broke down? Like are you wanting that broke down by start date? And then if that’s the case, like what is a date range that’s considered a new provider versus an existing provider?
Vikas Bhalla (19:06) Well, typically I would have said 90 days because most of the time I would expect the enrollment to be completed in 90 days. But here, we have an issue, right? So we are dealing with enrollments that’s much longer than 90 days. So, yeah, let’s start with, you know, because I’m actually looking for to see the difference between if it’s a like what’s the frequency of our submission or percentage of submission between the two categories. So maybe I mean you can look at, you know, like your, most of the enrollment once for the new providers, how long does it take to get the providers approved? And if you say more than 90 95 percent of them get approved within 90 days, then use 90 days. If it is 120 days, then use 120 days.
Amy Barfield (20:11) Okay. I understand the reason for 90 days, there are some payers that push out and say, don’t even ask us for a follow up to 120 days because their process is 120 days. I think we can maybe nail down some of those payers that are at that 120. But we did discuss on when we had our onsite last week of onboarding, and I wanted to tell you Jeanette, we just updated that platform because I know originally we were looking at it and it looked like a turnaround time for a provider to be onboarded into medallion was like 57 days and then it goes into the submission. So we weren’t even getting to submission until close to 60 days from the time the provider was started with PMP. So, or invited to medallion, I should say, and they did update that it was an average over all time. And now I think like the end of last week, Jeanette, they updated that analytics and we, I can go over that with you on Wednesday. Okay. So now the numbers you can sort it by like last 12 months or last six months to kind of see like is this being resolved or are they happening faster? So… that’s something we discussed because it’s like how can we streamline the onboarding so that your providers are getting into medallion quicker?
Amy Barfield (21:39) So we can start submitting those requests? And then I think another call out when I met with Mitch was, we had noticed like some providers might have been invited, but then there were no requests for like a certain timeline. So even though they had a, been in medallion or started in medallion, we didn’t have any requests for like a gap of time. So, so… we can go off that start date as long as it’s in line with the actual start date of the provider and not just the start date of when they were added to medallion, I guess is what I’m getting at,
Vikas Bhalla (22:17) Yeah. No, that’s good. I was gonna ask that maybe anybody sent the reports, send it to me and Janet, I would like to understand this better also because we are increasing our recruitment and I want to make sure our time for a complete application submission to medallion is within the benchmark. So, so I know initially last year we had the challenges, but so, Amy, the like if you look at 20 26, if you can just show me the view of 26 or maybe last six months, what has been our average been? And, and then Janet, we should look into that and see where is the gap? Is the gap in a submission from providers or is there a gap from our onboarding team?
Amy Barfield (23:01) Okay. All right. So.
Vikas Bhalla (23:05) Let’s let’s do that on the earlier question about new versus existing. Is it, will it be better? Maybe you all can take this off on your call? Like, you know, we can submit the list, right? So it’s like every week, Janet, like how you submit term provider list or you have a storm provider list, we can submit the new provider list and then just use that to show split in your reporting.
Derek Lo (23:36) That, that should, yeah, you mean like you send us a list of providers, we can then tell you like what the excuse me, like average or median turnaround time is for enrollment for that cohort exactly?
Vikas Bhalla (23:49) So then, yeah, then you can just say the rest is, you know, not nil, right? So we can every week, every month, whatever frequency I mean, you need it, we can submit that, that’s some kind of report because, you know, we track it internally, every new provider gets paid, right? So we know those people, yeah.
Derek Lo (24:09) We should, I mean absolutely, we can do that. So, yeah, yeah, if you can tell me, I’m sure we can work on that.
Vikas Bhalla (24:15) Yeah. So maybe Janet also for, as part of this follow up on that process. So like maybe start with, you know, then submit the list of new providers in last 12 months and then at every frequency within six months or sorry, a week or monthly, you can update that. So that should be a pretty straightforward file from HR? Okay?
Derek Lo (24:40) We, we, the other way we could do it because if you want is just thinking about it is like, I think what would get the same thing probably is if we looked at the average or median turnaround time… basically like on a cohort basis, you know, so like for things that were submitted in, for everything submitted in January. Well, yeah, for everything that was submitted for the first time, maybe in January, like, you know, what are we seeing the turn on time be now? So, that might be another way to get at it, but this also works too.
Vikas Bhalla (25:16) Yeah, because I think that, you know, if you did the recredentialing or if you all have had error that we submitted before, and that becomes a bit complicated because I’m trying to understand what’s our time to revenue for every new provider we hire at.
Derek Lo (25:33) a provider level? Yeah. Right. And,
Vikas Bhalla (25:35) what, as Amy is saying that’s one of the data I want. I’m curious about how long we take to submit to you and then how long you take to submit to, you know, meta suppliers and how long they approve and what’s the average time? Right now, I get overall, I want to separate new versus everything else. So.
Derek Lo (25:53) Right, right. Right. Okay. Got it. Yeah, that makes sense. I do.
Janette (25:58) Have a question to build on Vic’s response for the submissions. When you guys do resubmission of applications. Does that re, age the application or does it keep the original date on there? So, you know, like I said case is closed and you have to redo a submission of an application. Is it starting from day one again? Because it’s a new submitted application? Or how is that identified with you guys as far as the average and the analytics report? Yeah.
Derek Lo (26:26) We track both. We track both of those things but it can be tricky… because there’s different cases like one case obviously is like, you know, submitted, there was an error either like on our side or maybe on the payor payer side, we have to resubmit, and in that case, you know, like the clock shouldn’t really reset. The other case though is if say something was submitted incorrectly, say by our team, but that line actually should have been say like pending another line anyway, you know, that line will potentially look aged but actually, you know, when it does get submitted, that really should be treated as like the first submission time because it was pending another line anyway. So there’s like a couple of different cases. And so, yeah, right now, the reporting that we’re showing is showing you everything from the last time it was submitted so that, you know, we can kind of get an accurate view of like of when the actual issue date, you know, we think should be for these enrollment lines essentially. I mean,
Janette (27:39) ideally, we should see how many times the application was resubmitted, right? So we have a first, you know, third, can we have them in that category as well? You know, per provider? And possibly we?
Derek Lo (27:52) Should be able to do that. I think, yeah, yep. Yeah. Let us maybe talk to our analytics team to see if we can cut that by provider, but I think that should be possible.
Amy Barfield (28:11) The other part, you had some additional questions on how we were, you… know, we’re doing 100 percent on medicaid applications, quality QA… and of all new employees with medallion, we’re doing QC on all of their applications. You had some additional requests there. And I didn’t know Kate, can you speak on that on? Because this additional request? Yeah.
Kateland Sanders (28:42) So, I know one of the things you asked for was for all applications prior to, I think it was prior to April to.
Amy Barfield (28:48) Be checked.
Kateland Sanders (28:49) Qa’d… Jen is working, Jen runs our quality team. She’s actually working on pulling what that number is. It should be a very small amount that have not been checked because we have qa’d pretty much everything on your account. There may be a sub small set from the last two to three weeks when we finished the last audit that would not be included. And so we’re working to see what that number is and then provide a timeline on those. And then we are working internally to align what the ongoing outside of what we already provided different from what you wanted. The problem with QC, the way the random QC works is it is by payer. There’s not a way that we can just pull five percent per payer, two percent per payer. It is, that part would be manual. And so we’re working with the team to figure out how we can give you that, but there is a percentage overall that is being pulled currently for QC.
Vikas Bhalla (29:43) All right. And if you can just add me to there, whatever reports you get internally in terms of what is selected. So, so, so yeah, if you can answer both like one confirming that all the enrollments before April has been qc’d and second, going forward, what is the process and how we are tracking that?
Kateland Sanders (30:03) Yeah, we can provide that. Okay?
Janette (30:06) The only thing that I add for medicaid is to make sure that they’re using all the recent forms that they need to upload. I’ve seen in multiple states where they use an old form. It can be a collab form or something else that’s not up to date, that they just periodically go on the website and make sure they’re using the most recent forms, I know they may save them and the form was modified and then it gets rejected again. So if they can just be mindful of that, yeah.
Kateland Sanders (30:37) And our medicaid is 100 percent QC. So no matter what state it is all of the QC or all of medicaid’s get qc’d regardless of the client. And then what’s happening during that QC, Jeanette. Is if they find a form that is one of the old versions. Our quality team is actually going in and updating anywhere where that form would be housed to make sure it is the most up to date one as well.
Janette (31:00) Perfect. Thank you.
Kateland Sanders (31:03) Thank you. Is there anything else? Yeah?
Vikas Bhalla (31:07) I think one more quick follow up thing like, you know, and… you all did this for me before.
Vikas Bhalla (31:14) So if you need to, if you take your current pace… of enrollment completion and look at slide five, then I would like to know like, you know, by, when do you expect, you know, these, whatever the right number after you review with Derek? Like, you know, pick add the last, you know, three bars or maybe in fact, perhaps the four bars because 60 will be close to soon going to 90. So if I assume this is correct, that’s like 1,200 enrollments, you know, to give me some sort of estimate in terms of what’s your projection when you expect this to be completed? Yeah.
Derek Lo (31:54) We can definitely look at that like I said, then, yeah, before this call, I was just looking at overall completions. And so, yeah, it seems like, you know, March was fairly healthy just pulling it back up. I think it was around 800.
Vikas Bhalla (32:13) So.
Derek Lo (32:20) Yeah, we will pull that and.
Vikas Bhalla (32:23) Have that. Yeah. And I would like to start because there’s always going to be add new ads. I want to just keep, you know, if you will the cohort of everything 60 plus right now, you know, so that because when you say it’s enrollment completed, you know, some pair may complete in five days, right? When we submit them, right? So I just want to track a cohort of 60 plus what is today 60 plus and say, okay, 1,000 enrollment is in 60 plus bucket. And when do they go? And if you know, if there are new, which comes in, let’s track them separately and others, but let’s track this 1,000 which is, let’s wind that down. Yeah, yeah, makes sense.
Derek Lo (33:05) Okay.
Vikas Bhalla (33:06) Thank you all.
Derek Lo (33:07) Okay. Thank you.
Vikas Bhalla (33:08) Bye bye.