Transcript
Amy Barfield (00:00) good morning. Hey, good morning. How?
Brittany Dees (00:03) Was your vacation?
Amy Barfield (00:06) Oh, it was not a vacation. Oh… I had to do an on site with one of my other clients. And so, yeah, not a vacation. And then at the end of the month, I’ll be off that last week of the month because I have to go to some conference for CE. So I’m like when can I take some time off that’s like for me?
Carrie Reding (00:35) Actual.
Amy Barfield (00:35) time off, right? Yes, actual time off. I was telling my boss, I said, I feel like I’ve been gone a lot but it hasn’t been anything that I want to do, you know, I,
Brittany Dees (00:46) know. So I had back surgery the end of January and I was out for like three weeks and I’m like, but I still haven’t like gone out, you know, right?
Brittany Dees (00:56) I haven’t taken a vacation or anything. But now I feel like I can’t because I’m like I was just out for three weeks. So, when do, I know?
Amy Barfield (01:04) Yeah, balance that out.
Brittany Dees (01:09) So, I, just before everyone joins, I have a couple things. Okay? So, I submitted quite a few revalidations and we received back… like tasks on every single one of the revalidations. So, I’m not sure if you received that email. Oh, am I frozen? Oh, okay.
Amy Barfield (01:31) No, you’re good. I have… and I’m not even kidding. Let me see… 96 emails from you guys, right?
Brittany Dees (01:42) Now, so it was before you left on before you went out of office, but anyhow, what’s happening is they were sending back tasks stating that we did not attach locations to the request. However, there’s nowhere to even add locations to the request for revals and whatnot. And so it was, so it was, I sent all those tasks back. I haven’t seen them come back but I’m not sure if there’s someone new that’s completing revalidation requests and maybe they just aren’t you know, very familiar with it, but I can’t even submit a location with it, so.
Carrie Reding (02:24) Okay.
Amy Barfield (02:27) Yeah. Was it a particular payer?
Brittany Dees (02:31) No, no particular payer, just several. Okay. It was just several different, yeah, several different ones. My other thing is.
Amy Barfield (02:41) Darn.
Brittany Dees (02:42) it, I already had, I had it in my head and now it’s gone. Oh, the, yeah, I forgot the name santander or something like that. They continue to… santandra. Santandra continues to email the RCM cred email requesting for an update for a payer?
Amy Barfield (03:09) RCM cred?
Brittany Dees (03:13) So, and,
Amy Barfield (03:15) then, do you have an example? Yeah.
Brittany Dees (03:19) I, I’ve sent you, I sent you a couple emails already on it. Okay? So you’ll probably get to it. Yeah, you’ll probably get to it then. And then there was another email. So, our payer with Molina healthcare, they are saying that, yeah, medallion is emailing the to follow up. They said medallion is sending emails to the contracts email. So, and that email’s for only for like new, you know, a new contract request. And then that’s what they’re sending like, you know, requesting for updates and they requested that like if medallion can please stop doing that, and if they can, you know, I, I’ve sent you an email on this as well, if they can just pause because the group is in, you know, process of being contracted.
Amy Barfield (04:23) Pause, follow up.
Brittany Dees (04:25) Yep. Yeah. It just, I sent you the email, but they’re sending it to Ohio contract requests and it’s just that’s just for new contract requests only. Okay? So.
Amy Barfield (04:45) Yeah. I mean, I actually have a big gap of time today where I’m going to start going through you guys’ emails. So, to catch up from last week, I’m sending to Ohio… and,
Carrie Reding (04:59) Amy, I’m getting some stuff in here for confirmation of effective dates and all of them are.
Brittany Dees (05:06) For.
Carrie Reding (05:08) complex care. Okay? So, they’re saying that I think they’re and it may be how we’re requesting it because we’re asking them to go back to the provider’s hire date, but do they know if it’s complex care? Like they can just do like one?
Amy Barfield (05:24) One four one or one one or?
Carrie Reding (05:25) Four, one. Well, one, one four, one. Whatever, you know what I mean? Yeah. I’ve closed out probably like six requests where they’ve asked for the dates.
Amy Barfield (05:33) And when you say request, you’re saying you mean task?
Carrie Reding (05:37) It’s a task? Yeah. Okay.
Amy Barfield (05:38) Just want to make sure. Yeah… I was looking to see if I had, I.
Carrie Reding (05:44) Don’t know if I have an example, but just if you look at the payers, they’re all for complex care.
Lori Durkin (05:49) So,
Amy Barfield (05:51) OK. And.
Carrie Reding (05:53) I can address that with our team too. I think maybe we need to put in our own a different date too for complex care. So, I’ll address that on my side too. OK? So, with my team, OK?
Amy Barfield (06:09) Anything else? I think Judy and Lori are on here now.
Lori Durkin (06:17) Oh, yeah. I guess you.
Carrie Reding (06:19) talk… about credential or cred holds.
Lori Durkin (06:24) Yeah. I guess, like is medallion still getting that cred hold report? And?
Amy Barfield (06:30) Yeah. And today I’ve got our account specialist is reviewing those blue cross blue shield in Michigan. Those top six, I think it’s… I’ll tell you specifically.
Lori Durkin (06:47) Yeah.
Amy Barfield (06:52) Top six… Ladonna, peters, Patricia blank, miller, Claudia, romo, Ashley poulos, Julie tuffo, and Melissa miller. So she’s digging into those. I think the top ones are from blue plus. And so hopefully I’ll have an update by the end of the week on those.
Lori Durkin (07:19) Okay. I’m sorry, you said my bad, let me share my screen. It’s these guys on the right here?
Amy Barfield (07:26) Okay.
Lori Durkin (07:26) Yeah, I gotcha. Blank peters, Paulos, romo, that’s who you said, right? Yes, yes. Okay. Cool. Yep.
Amy Barfield (07:34) Yep. She’s looking at those this morning. We had a little chitty chat about it already got.
Lori Durkin (07:39) It, yeah. And those are all blue cross blue shield.
Amy Barfield (07:43) Those are all.
Carrie Reding (07:46) those the.
Amy Barfield (07:47) highest ones for those are blue plus for Michigan, the blue plus plan for Michigan, which I think we determined that has to be enrolled on the individual level, not the group level. And so, she’s confirming whether they’re enrolled with those plans on the individual level.
Lori Durkin (08:13) Holy moly.
Amy Barfield (08:15) Yeah, it’s real wonky. Like some of the plan, they’ll only do like a couple plans on the group level. And then there’s like a handful that have to be only on the individual level. And then… there’s a difference between if they’re a nurse practitioner versus a medical doctor. And it’s she finally, she nailed down like who needs to be with what? And so now she’s confirming with those enrollments to make sure that they’re enrolled appropriately on those lines of business that they qualify for.
Lori Durkin (08:53) Is this new? I mean, I’m just curious why this is just now coming up.
Amy Barfield (09:01) Let me see. I think I did discuss it with Svetlana, I think last week or the week before, and then I sent her an additional update last night just.
Amy Barfield (09:16) Just to reiterate, yeah, I was.
Lori Durkin (09:18) Going to say blue plus. Is that the medicare line of business or what exactly is blue plus? I?
Amy Barfield (09:24) Think it’s a medicare line of business. It might be like a dual plan. I’m not sure. Let me see.
Lori Durkin (09:31) All right. I mean, I know there’s always been.
Amy Barfield (09:34) Or what state is that… Michigan?
Lori Durkin (09:38) Oh, Michigan, I mean, the xyl or, you know, the medicare advantage plan has like always been an issue. I mean, obviously, that’s you know, half a 1,000,000 dollars sitting there, but,
Amy Barfield (09:57) I don’t know. I’m just.
Amy Barfield (10:04) It’s basically a ppo that combines hmo and ppo features. I don’t know… how that’s possible.
Lori Durkin (10:20) See the details on this? Of course, not.
Amy Barfield (10:25) It’s a commercial plan. It’s.
Lori Durkin (10:29) a commercial plan. So, I was gonna say, so, I’m not fully convinced that that’s all this. I’m.
Amy Barfield (10:37) I… can’t see no, I’m looking at the detailed, the cred hold and I filtered out by anything Michigan blue cross, blue shield. And then filtered to the top highest balances… and it gave me those names. So I didn’t take it from this list. And so those top balances. Yeah, that’s fine. I’m just saying, I mean,
Lori Durkin (11:03) we got like let’s still drown to her. And we got 140 K sitting here and I have a feeling it’s probably a big chunk of this.
Amy Barfield (11:13) Yeah, yeah, which?
Lori Durkin (11:14) Is not a commercial plan?
Amy Barfield (11:18) Yeah, that says medicare advantage,
Amy Barfield (11:25) See… what I… super? Oh, I have one here. Yeah, I can see her working in the spreadsheet now. So, she’s looking at each of those providers to see all the networks that they need.
Lori Durkin (11:49) Yeah. And she’s working on one that has 4,800 when we got 100 grand sitting out to, the medicare line of business.
Amy Barfield (11:56) Yeah, and the medicare ppo, they should be in network with. But if that blue plus, I don’t think the blue plus falls under BCN. So, BCN is the one that we, yeah.
Lori Durkin (12:12) But where are we with this one?
Amy Barfield (12:14) That’s what she’s checking.
Lori Durkin (12:16) That’s not blue plus though.
Amy Barfield (12:19) That top one, it says blue plus xyl… so.
Lori Durkin (12:24) It’s the medicare line of business. This is indeed a medicare line of business right here.
Amy Barfield (12:29) Okay.
Lori Durkin (12:29) I thought she was referring to this one here for the 4,800? Okay. All right. So, she’s gelling down, okay? And I’m sorry, let me go back here. So, what were those providers again they are working on?
Amy Barfield (12:42) It’s it’s those top five right there. And then there was one that had like 12,000 in blue. I think her name was. Melissa. Miller was another one that I added to the list. And, yeah, those, and then Melissa miller, I had her checked too because she had some pretty high too.
Lori Durkin (13:07) All right. And juvie, you got line of sight on these?
Juvy Patal (13:12) Yeah, I’m currently reviewing them.
Lori Durkin (13:14) Okay. I was going to say if it’s blue cross blue shield, we just need to punt it over to the woman that’s working on that, those are some pretty hefty numbers there. Yeah. Okay.
Juvy Patal (13:27) Okay. Yep. Oh, sorry. Sorry. I was just going to say I reviewed the enrollment for the blue plus and I found out that some of them like Peter’s madonna, they are in network under the complex care, so, but the date of service are like 20 26. So, we requested for, we requested ecw to bill under, the complex care. But for Theoria, we need, we definitely need the retroactive.
Lori Durkin (14:03) Right. Gotcha. Okay.
Amy Barfield (14:05) Yeah. And she’s just, she’s looking at this for Theoria only today. Okay. Yeah.
Lori Durkin (14:15) Right. Okay. I do know that Svetlana asked me about, I just sent an email now, Amy, it comes back to that Jessica deal. She… said that Nicole or somebody may be able to escalate this with some kind of contact that she has or something. I don’t know, let me pull up her message here. Oh.
Amy Barfield (14:42) Was it a medicare issue? Yeah.
Lori Durkin (14:45) So, it’s deal. What happened was they came back and yanked like 30 40 grand from us on take backs. Something… about her license. They had her RN license on file or something, and then we needed to send in the NP license, something to that effect? Yeah, I sent.
Amy Barfield (15:09) You didn’t you, I sent you the, yeah, but the,
Lori Durkin (15:12) problem is, the problem, is that medicare… is not reprocessing these claims. So, yes, on the enrollment file, she went with no lapse, however they’re hitting us with timely filing on everything. So, there’s this massive process that’s involved. We have to like print a paper claim, send in. I mean, the only piece of documentation I have is a one liner from that email that says, you know, hey, they’re you know, whatever, but, I attached, my phone call to them going, hey, medicare can’t we do like a special project on this, you know, let me send you a spreadsheet of the open Ar and, you know, work through it that way like some type of special project and it was a hard, no. Svetlana said she wants Nicole… to try to escalate it within CMS because… it was their error. Was it really their error?
Amy Barfield (16:21) I mean, they didn’t yeah, I mean, if they, you verify based on… it’s, not her name didn’t change with the license. It was, she changed her license like it wasn’t.
Lori Durkin (16:36) a right? No, I remember that. Yeah. So they should have.
Amy Barfield (16:41) Been able to verify that.
Lori Durkin (16:43) No. And, they did, and she has no lapse in medicare enrollment. The problem, is they’re not repaying us.
Amy Barfield (16:51) Right. I’m saying they should have been able to verify that at the time of enrollment or whenever before they even recouped these claims, right? Because that’s what they recouped claims, right?
Lori Durkin (17:02) Yeah, to like the tune of 40 grand. I think we have a little bit more open at this point, but I.
Amy Barfield (17:07) mean, isn’t that the proof of timely filing?
Lori Durkin (17:10) Well, we’re going to try it, but we’ve got, I mean, you’re talking a paper claim and an individual appeal on thousands of claims? Yeah, for sure. So, what Svetlana is asking is, can Nicole escalate this with CMS and go CMS? We need a special project and not individual timely filing appeals on, you… know, 7,000 claims. Like, I guess what she’s asking is, can Nicole escalate this within CMS somewhere to say we’re not, we shouldn’t have to send seven… 1,000 timely filing individual appeals. Can they approach this as a special project and just go in and reprocess them off of a spreadsheet we send them or if they can run a claims thing, something, does that make sense?
Amy Barfield (18:07) Yeah, it makes total sense. Do you know the specific number of claims?
Lori Durkin (18:13) I can, I will get that. I will get that.
Amy Barfield (18:16) If you can get me that and like a date range of when you’ve got these denials like whatever detail you can give me to put because Nicole is out, okay for the next week and I don’t think Svetlana would want to wait that long for us to do that. And so I can email the director at CMS, but she is just on the provider enrollment side. So I’m not sure what she can do, but maybe she can get us in contact with someone somebody.
Lori Durkin (18:47) That might be able to help to go. Hey, this is like a, you know, an issue on your part and, you know, we just, we need your help. I mean, this is a massive administrative lift on something that should have never happened, you know, right? Okay. So yes, I’ll get a report of everything that I can see. I’ll get the original take back letters and I think Svetlana’s just asking, can you help us escalate this or loop us in and we’ll talk? I don’t know if you’re able to do that, but if you got a contact, we need your help, I guess that’s what she’s saying. Yeah.
Amy Barfield (19:17) I mean, it’s not going to hurt me to send an email for you.
Brittany Dees (19:20) Okay, cool. And.
Amy Frana (19:22) Amy, just real quick because even though Nicole is out, we can try and so team, Nicole is overseas right now taking some time and she did respond last night. So if we need to message her, Amy, we can figure out who she would reach out to and see if we can use that person too.
Lori Durkin (19:45) Great, greatly appreciate that.
Brittany Dees (19:50) So, I have a list of providers I need to add into medallion as a client owned. But the payr provider partners is not listed in medallion. Are we, it’s for Indiana? How do I go about requesting that they get added into medallion? So I can have these providers… what?
Amy Barfield (20:20) Is it, it’s called payr partners?
Brittany Dees (20:22) No, it’s called provider partners. It’s in Indiana and Missouri.
Amy Barfield (20:32) Let me see here.
Amy Barfield (20:40) I’ll have to reach out. I’ll research that and find out because we don’t do custom payr names. So I’m wondering if it’s like… a line of business plan or something like a tpa plan or something like that, but I can definitely find out and let you know how to get that in medallion.
Brittany Dees (20:59) Okay. And so Fareed Ahmad, he is in Wisconsin… and we received a task yesterday for his anthem blue cross blue shield. They’re saying that they do not want to enroll him because of a general practitioner. They’re not looking for a general practitioner within his geographical like in his area. I plan on calling. I don’t know what happened to this. I had the task open. I don’t know what happened to it. Someone must have closed it. I think… anyhow, so board certified, either, I think is the provider, yeah, but it didn’t have anything to do with his board. So they’re just saying that first, it was three things. First, it said that he didn’t have, he either had to have one year of U. S training, which he did. He had to have 10 years of his clinical, at least 10 years of clinical experience, which he does. And then the third one was, you know, blue cross blue shield. We aren’t enrolling general practitioners in your geographical area.
Amy Barfield (22:18) Which state is this for?
Brittany Dees (22:20) Wisconsin?
Brittany Dees (22:27) So, yeah, I didn’t mention anything about not being board certified or anything like that. So, he’s already emailed if the email attachment that medallion sent dr Ahmad has already emailed and said that he qualifies for, you know, it sounds like he qualifies for all of those. So he’s confused. So, I’m thinking I’m wondering if like they’re just, they, you know, because he is family medicine. So, I’m wondering if maybe they put him in as a general practitioner. I don’t know if there’s something that we can do or we can call and let them know that he’s a medical director at this facility and that like we have.
Brittany Dees (23:10) To get him enrolled. Well?
Amy Barfield (23:13) And my thing, is like, even if you didn’t need that in the area, there’s a group contract that exists that you would just link him to. So, okay, we’ll research that.
Brittany Dees (23:23) And a very, I mean, and if it is, I mean, I guess if it was board certification, I’m going to assume that they would have specifically sent, you are not board certified, but.
Amy Barfield (23:36) I.
Brittany Dees (23:38) don’t.
Amy Barfield (23:38) know it’s hit or miss, you know, with.
Brittany Dees (23:41) Whoever’s processing it.
Amy Barfield (23:42) You know, if they’re like specific direct and why, you know, yeah, so.
Brittany Dees (23:49) So, yeah, I mean, we, so then there I, we did have a task out. I don’t know what happened to it. I’ll have to go and look for it. But here it is right here. I know… that’s that wasn’t it anyways. Yeah. So it’s somewhere there’s a task out somewhere. It looks like it may have gotten completed out or something like that. But if we can look into that because… we have to get him, yeah.
Amy Barfield (24:21) We might have to do like a reconsideration letter or something or find out why he’s just not being linked to an existing group enrollment. Okay. All right. Anything else? Yeah, I’ve.
Carrie Reding (24:35) got this is blue cross blue shield Illinois. I love Illinois. So, dr, Islam, it looks like.
Juvy Patal (24:44) they,
Carrie Reding (24:45) for some reason, his application just, they closed it out back on the 20 seventh. He’s been open since may and they had to resubmit. And I’ve got the facilities asking me where we’re at in credentialing, but there’s nothing saying why it closed.
Amy Barfield (25:03) Which payers is blue?
Carrie Reding (25:05) Cross blue shield of Illinois, and they closed it out on several of our Illinois providers. Islam, I want to say haji was another one.
Amy Barfield (25:16) Yeah, I sent, I actually just sent an update. Let’s see, give me just a second… because we talked about that last week.
Carrie Reding (25:31) And I see that, they worked it, but I don’t see why it actually closed. And now, are we going to have to wait the full… time frame to get them enrolled again? And actually, they haven’t even submitted in haji’s yet. It’s.
Amy Barfield (25:51) so, for Islam, they, he was enrolled as telehealth only. So, the, our team, is submitting a demo update to remove telehealth and to link him to the requested locations? But I’ll look at it and make sure that it didn’t close haji, was he listed?
Carrie Reding (26:10) As telehealth in the in medallion?
Amy Barfield (26:13) I don’t know, I know he was with the payer from what they told me, I’d have to look at his profile.
Carrie Reding (26:22) But.
Amy Barfield (26:22) Haji has been flagged for resubmission because the application was originally denied. So that’s probably why it was closed. But that’s what I have as… of yesterday, and the group the.
Carrie Reding (26:41) Group enrollment’s done now, right? For Illinois, right? I think that’s what I saw. Yeah.
Amy Barfield (26:47) I believe. So. Okay. Well.
Carrie Reding (26:51) I’ve got, and then I guess basically all of those providers that are in Illinois, blue cross, they need to be Stanley, Matthew, dr. Sarpong, fergani is another one. We just need to kind of make sure that we get those through if it’s not Illinois. I’m getting emails on it’s Massachusetts. So, cause it’s all stern. Okay?
Carrie Reding (27:19) And I get asked pretty much weekly on this, so.
Amy Barfield (27:22) Sure. Okay. Got that added. What’s another one?
Carrie Reding (27:42) Anyone else? I think, no, I think I’m okay. Let me actually, let me have, I have one more provider, just want to see if she’s been updated. It’s Jennifer hall. We’ve been waiting on her Ohio medicaid and I just want to see if there’s any updates.
Carrie Reding (28:20) She has two new provider enrollments out, which I’m not sure why one’s on hold pinning dependencies, and the other one is in process. So, I.
Amy Barfield (28:31) don’t know for Ohio medicaid. Let’s see, new provider on hold. Yeah. Both for Theoria. So I.
Carrie Reding (28:45) think that one, the other one can be stopped. I don’t know why that’s.
Amy Barfield (28:48) open. Oh, because one has zero practice locations. The other one has 24 practice locations. Oh, so the one that says it’s processing, has the practice locations. The other one doesn’t so let me flag. I’ll flag this to the team. Okay? And if it’s been submitted, then we just need to… combine somehow, but it’s been submitted and yeah… I’ll have them look at it because we don’t need to submit it twice. Okay? Two.
Amy Barfield (29:50) Okay. Anyone else I?
Carrie Reding (29:54) Think, did you see the email?
Juvy Patal (29:57) I sent you for medicaid of Georgia, those providers and locations that we need retro.
Amy Barfield (30:05) Yes. And I sent it to our medicaid specialist and asked him to pay special attention to those. And so he is, he hasn’t provided me an update yet, but I did because I wanted him to kind of audit through those and find out what’s going on.
Amy Barfield (30:21) I will say with Georgia medicaid retros. So what was happening is we submitted a request for retros? Some of those retros were denied saying we didn’t submit them timely, but what actually happened is we did submit timely. But when we submitted them, we requested more than six months of a retro date and they only go back six months. So instead of giving us six months, they just denied it altogether. And so when we went back and they tell us we only go six months back, it’s been denied. We go back and we submit a new request for at least six months prior to effective date and they deny it for not filing it timely within the two month period from effective date.
Amy Barfield (31:04) So now our team is going back and looking at each of those and they’re going to be kind of like you do with claims like this is my proof of timely filing and say we did request it. You denied it. You didn’t honor it at six months then. So we’re requesting that you at least honor the six months. Now, we did do it within your requested timeline. So that’s what we’re doing right now with Georgia medicaid. Retros. Okay. Thank you for the update.
Amy Barfield (31:38) All right. Anything else? I think I’m good for now. Okay, perfect. I will be you’ll get a lot of response from me today. I’m going to get through your emails.
Carrie Reding (31:51) Enjoy. Yeah.
Amy Barfield (31:53) I know. So Lana told me yesterday, she goes, Amy, I’m going to be on a plane for four hours and, you know what I like to do on the plane? I said, I do, I fully expect emails from you. So I’ve got a lot to do with you guys today. So appreciate your patience in getting a response to you and I will push these items to the team and try to get that medicare email out. Once Lori, you give me like a timeline of Jessica deal rice. Is she still on? Yeah, yes, thank you so much, Amy. I’ll get that over to you. Okay? And then I’ll get that out today. So, all right. Thank you guys for meeting with me today. Have a great week. Thank you.
Carrie Reding (32:35) Bye bye.