Transcript
Svetlana Vinokur (00:00) thank you. Hi. How are you?
Amy Barfield (00:04) I’m good. How about yourself?
Svetlana Vinokur (00:07) Today was not a good day. Yeah, but tomorrow will be different days.
Amy Barfield (00:13) Right? It’s a new day every day, right?
Svetlana Vinokur (00:17) Yeah. So here’s kind of what I want to go through. I want to go through medicaid, blue cross, blue shield, united, Michigan, and then talk about Georgia Theoria, Georgia medicaid, Theoria. Because my exchanges with Derek yesterday really upset me because I know my stuff and my facts and he’s just fed wrong information. Okay? And I called him out on that.
Amy Barfield (00:46) Okay. I do have a few things just to review based on emails. Yeah, if you don’t mind just to give you a quick update. Yes. Yep. Okay. Let me share my screen real quick. Always have to find it on teams.
Svetlana Vinokur (01:08) It’s on top. Yeah, it’s.
Amy Barfield (01:11) just taking a minute here. Okay. You had an email about midwest H, that was a notice for eft?
Svetlana Vinokur (01:26) Yeah. What happened there? Actually? Amy? Because I, so I had to call medicare today because ecw said that basically our payments are on hold and it looks like medicaid put our payments on hold.
Amy Barfield (01:43) Yeah. It was, that same thing that happened where they deactivated, because when they submit payments, they go through. So medicare team reached out to the director of CMS and she confirmed that everything was fine, that it’s good. Yeah.
Svetlana Vinokur (01:58) But it’s still like, on their records, it’s on hold. So they’re not releasing. So I opened the case number and they’re supposed to call me back in September. It’s up to 10 days, but they told me if I don’t get a call by Monday, I should call them back because they’re not going to release payments because it says hold right now. Okay. And I have a case number. It’s two six, one zero, five, zero, four seven, three two six, one zero five to six one zero five zero 473.
Amy Barfield (02:51) Okay. The enrollment and report, I, for some reason, I reached out to Mitch and was like, why aren’t they getting it for some reason? I don’t know if it just auto quit or there was like some timeline or something, but I just want to confirm anyone who needs to be on that. So those can start getting to you automatically again. Yeah. Okay. So, Carrie, Lori and Jacqueline, who else needs to be on that email?
Svetlana Vinokur (03:19) Tejas? I think he’s copied on the.
Svetlana Vinokur (03:30) T a TTEJS.
Amy Barfield (03:37) Hey TEJS. Okay. J.
Svetlana Vinokur (03:41) A. S, sorry. Okay. Yeah. And I put Julie as well. Okay?
Amy Barfield (03:50) Okay. Brandy, add in north. Yeah, medicaid New Hampshire needs enrollment for Theoria. I flagged that to the team today, so.
Svetlana Vinokur (04:03) Okay.
Amy Barfield (04:07) And then Anna, kavitt… for… blue cross blue shield of Massachusetts is now partially completed. So that is done.
Svetlana Vinokur (04:20) Medicaid. There’s one more that I just sent Amy that I got a welcome letter that they need to update.
Amy Barfield (04:29) That you sent me I,
Svetlana Vinokur (04:31) sent to help when I copied you as well.
Amy Barfield (04:34) Do you know the name? Yeah.
Svetlana Vinokur (04:37) It was Nana.
Svetlana Vinokur (04:45) Last name?
Svetlana Vinokur (04:51) Nana N a N a… first name, Emelda… EMELD a. So she is, yeah, there’s a welcome letter as well that I forwarded.
Amy Barfield (05:08) for blue cross blue shield in Massachusetts.
Svetlana Vinokur (05:14) Okay. I also sent out kind of the so on the provider partners. I also signed the amendment to add Missouri and end complex cares. I think I copied you guys as well on that.
Amy Barfield (05:28) Yeah. I did see that.
Svetlana Vinokur (05:30) That needs to be updated. So, I don’t know how to like medallion, really needs to kind of update that timely, right? So then, what was it? It’s? Provider partners, right? Provider partners? Yeah.
Amy Barfield (05:48) I did get that. It is updated now. I think I sent Carrie an email because I know she was trying to make those requests. Did you get that? Carrie? I did, and I sent it out to the team also. So, yeah. But Carrie.
Svetlana Vinokur (05:59) Why are we going to do all this requests? If we don’t have Ar, on that? Like why do we need to do that?
Brittany Dees (06:05) I don’t know Lori had originally requested that I add them into medallion as client owned.
Carrie Reding (06:12) And we didn’t have access to do that. So she opened it up for all the states that it can be in. We’re only going to use it for the states that we have Ar.
Svetlana Vinokur (06:19) In? Okay. So, because right now, the contract, okay? Just to be clear, I have a contract for Indiana and for Missouri.
Brittany Dees (06:28) Yes. So, the only two states that I have originally?
Svetlana Vinokur (06:30) Requested for? Okay. If we are entering into more states then we need to reach out to them and they just do an amendment. It was actually very easy to deal with them. So, yeah.
Brittany Dees (06:39) Only Indiana and Missouri are the ones I have.
Svetlana Vinokur (06:42) Correct. Okay. So the next thing on your list medicaid Illinois, but Amy, when I went into medicaid Illinois, I saw them all stopped, not processed but stopped… and it says per client stop everything. So, they stopped it. Everything. Like I almost had a heart attack when I looked at it today. Okay. Well, when we go through medicaid, I’ll show you, yeah, all of them are stopped.
Amy Barfield (07:17) Yeah. Okay. That’s alarming. I will. Yeah, we can look at that today. Okay?
Svetlana Vinokur (07:22) And then we’ll look at it at H, I don’t understand this. So, if M was approved why H is rejected now because of some ownership stuff. So, but we can look at it… you know? And then the same for, Georgia had been rejected, but we can go through medicaid’s when we’re done here. Okay?
Amy Barfield (07:44) Babaca, font. Yeah, the reason why I know you put that she’s been outstanding since June. It didn’t get submitted until this year because the group was still processing. So that’s why hers took so long, but it is in process submitted in process for medicare.
Svetlana Vinokur (08:04) Is that because midwest age?
Amy Barfield (08:07) I believe, so, let me check this real.
Svetlana Vinokur (08:11) Quick, the issue is like, I have tons of Ar on her.
Amy Barfield (08:15) Sure. This is for complex care age. Yeah, midwest age.
Svetlana Vinokur (08:22) Okay. But I don’t know why we were holding it like because right now, they’re not going to honor the one 126, right?
Amy Barfield (08:33) They may be able to go back at least 60 days, yeah.
Svetlana Vinokur (08:38) But that’s what I don’t understand why we’re holding it if we knew that there was a mistake on them.
Amy Barfield (08:44) On the group?
Svetlana Vinokur (08:45) Yeah. Okay. It’s the same issue. I mean, that I’m going to go back to medicaid, Georgia Theoria, medallion.
Svetlana Vinokur (08:56) I don’t know what medallion was doing holding or not submitting retros like, but it’s medallion who messed up on those?
Amy Barfield (09:05) Okay. We can review those.
Svetlana Vinokur (09:07) Yeah, like, I don’t know like, but I need to on the Rebecca fund. And there is a, another one presley… it was presley, right? Wasn’t it presley that we… Whitney Preston for… medicare is not done. And I’m… she’s midwest, M, and she’s been outstanding since January.
Amy Barfield (09:44) Medicare, Michigan. Okay. I’ll flag this one… what’s going on and,
Svetlana Vinokur (09:52) I have an hour on that. That should not be taking that long.
Amy Barfield (10:09) That’s from midwestern, right?
Amy Barfield (10:29) thank you. Okay. You needed a partial completion for unitedhealthcarerequest to be released for Chandra and that’s been completed. Okay? Today, midwest and anthem, Missouri two.
Svetlana Vinokur (10:47) Networks were added. No, I just sent the email I.
Amy Barfield (10:49) Just sent the email. Okay. Yeah, they weren’t added. So I moved that to our PE team to submit that change form. Okay? So they’ll work on that complex care medical group, midwest, M, lines of business request for paramount. They’re reviewing this. I don’t it showed, I think it showed some of them requesting medicaid. So, yeah, but.
Svetlana Vinokur (11:16) That’s done… that line for paramount Ohio, and we are, Carrie, aren’t we, the ones we are the ones that are processing the, yes, the enrollments, so we are entering them. Yeah, I think they go ahead.
Carrie Reding (11:36) Oh, no. We sent in a roster they made. I think we just need to get the, actually, Sheila was working on updating the effective dates for those and making sure the enrollments are in place for paramount, but I have seen a,
Svetlana Vinokur (11:50) bunch of paramount Ohio enrollments come through already. Like, no, like I don’t know who is doing them.
Carrie Reding (11:59) Are they as client owned or?
Amy Barfield (12:01) Theoria?
Carrie Reding (12:03) Because they should be client owned. Let me look here because I want to say, I put it on the spreadsheet that way, the master payer list.
Amy Barfield (12:21) Yeah, Ohio is client owned. It looks, yeah.
Carrie Reding (12:26) And I have that any new requests need to be put in as client owned. So there shouldn’t be anything else coming in, but if we.
Svetlana Vinokur (12:32) add, hold on, why do we have stopped? What are they doing? Amy? Look at this?
Carrie Reding (12:42) For Michigan? That’s Michigan?
Svetlana Vinokur (12:44) Yeah. Oh, that’s Michigan.
Carrie Reding (12:46) Okay. Yeah, we only did Ohio for paramount, but why?
Svetlana Vinokur (12:48) Do we need to stop? We don’t stop because we actually paramount Michigan. I actually requested that. So it’s not stopped. It needs to be, can you actually make it client owned and unstop it? Because we actually submitted the request, remember Carrie for one location and three providers?
Carrie Reding (13:14) Yes, I forgot about that. Yeah. Okay. But it’s not going to be all those providers, so we should.
Svetlana Vinokur (13:21) We don’t want that. Yeah, but we’ll just update that if you switch them to client owned and not request owned, but.
Carrie Reding (13:30) Do we want to review those first? Because it may not be.
Svetlana Vinokur (13:34) What review first?
Carrie Reding (13:35) Well, are those I want to make sure because if we only, did those three providers for Michigan, we don’t want to do.
Svetlana Vinokur (13:43) Well, I am talking about the group. I’m talking about the group.
Amy Barfield (13:48) So, do you want me to just reopen the group?
Svetlana Vinokur (13:52) Reopen the group and there was three providers? Yeah.
Carrie Reding (13:58) This?
Svetlana Vinokur (13:58) Is part of Ohio?
Carrie Reding (13:59) Let me see if I.
Amy Barfield (14:00) have it.
Amy Barfield (14:05) So, yeah, I only have an Ohio group… enrollment for, well.
Svetlana Vinokur (14:14) Because it says stopped here, see, so we need to reverse those from stopped… okay? And put in client owned. And then for providers, let me see who the providers are.
Svetlana Vinokur (14:37) Paramount health is?
Lori Durkin (14:39) Paramount still in Ohio or they exited this year or is it just Michigan?
Svetlana Vinokur (14:44) No, no, no, they’re bigger in Ohio, Lori, don’t spread rumors.
Amy Barfield (14:50) One.
Svetlana Vinokur (14:50) Of them was going away.
Carrie Reding (14:52) No.
Svetlana Vinokur (14:53) That’s Aetna better health Lori?
Lori Durkin (14:55) Yeah, yeah, yeah, you’re. right? You’re right. Okay.
Svetlana Vinokur (14:57) So, this is the only three providers, Amy, can you just move them from stopped to client owned?
Amy Barfield (15:06) Hold on. Keep that screen for me.
Carrie Reding (15:14) Yeah, it was one location and, they, those were the only three providers that actually go to that location. So.
Amy Barfield (15:26) Okay. So, just to clarify, you want midwest H and M reopened to client owned?
Svetlana Vinokur (15:34) Well, actually, Carrie, we only are going to do H, so just H, because, we, we’re not doing. M, okay. So, just H, and then those three providers.
Svetlana Vinokur (15:53) And you can have the screen back?
Amy Barfield (15:57) Okay.
Amy Barfield (16:05) All right. Blue cross blue shield in North Carolina is being updated with the contract approvals. You sent me a list of those, and you mentioned something about healthy blue requests… when you’re going to put those in?
Svetlana Vinokur (16:18) Yeah. So that has not been done. It has not been done. I don’t know Laura, Carrie, do we know if we’ll find out tomorrow? If Latoya did it or not, if she didn’t we’re going to put that in as a request, Amy into medallion because right now, I don’t know I.
Amy Barfield (16:33) Did check before our call? I didn’t see them in there, yeah.
Svetlana Vinokur (16:36) Yeah. It’s not there. Okay. Yeah, I know. Okay. So, but we need to get rosters for North Carolina like, I don’t know if there’s a way to pull it from, ability.
Amy Barfield (16:50) I did ask the team to work on that this week. I just don’t have an update on it yet. So I’ll get that. I do have rosters.
Carrie Reding (16:58) I do have a North Carolina roster from something else that we worked on if that would be helpful? No?
Svetlana Vinokur (17:03) No, no, Carrie, it’s not our roster. It’s the roster. Oh,
Carrie Reding (17:07) it’s theirs. Never mind. Yeah, that’s the one we couldn’t okay. Yeah.
Svetlana Vinokur (17:10) Exactly.
Carrie Reding (17:11) Ability. Yeah. Okay.
Amy Barfield (17:16) Uhc is approved for complex cares. Brittany did send out an appeal for medicare and medicaid lines of business because some of those states were closed networks. So, she is working on an appeal for those lines of business. She asked if you consider doing a national contract with unitedhealthcare. Absolutely. Okay. She said I just go ahead and request it, but I want to ask her, so.
Svetlana Vinokur (17:43) Oh, 100 percent 100 percent. Okay. You know what? I have a few united contracts that came in and I don’t know what they are for, like I will show you and I ask, so I have this one midwest age, okay? But I would just not know what is it for at all. Let’s see if it’s.
Svetlana Vinokur (18:09) so, see, it says for midwest age, but like, I don’t know what state it is. And then if I go and I need to sign for it, right? It’s a community health plan. So that’s a medicaid plan, right? And then it asked me to do the roster. And so, I don’t know like what is it all for?
Amy Barfield (18:38) Okay. This one’s for, okay, let me write that number down.
Svetlana Vinokur (18:43) GD.
Amy Barfield (18:44) Yeah, GD.
Svetlana Vinokur (18:46) 45 eight, zero one, four, eight four.
Svetlana Vinokur (18:55) And I need a roster for that. Like, so I can actually.
Svetlana Vinokur (19:03) And then I have another one. So this is that united?
Svetlana Vinokur (19:16) I just thought there was another one.
Svetlana Vinokur (19:28) This one. They keep sending it to me for dr Matthew.
Amy Barfield (19:43) What is the number on that one? GD? So.
Svetlana Vinokur (19:47) 46, zero, seven, nine, four, four, three. Let me see. GD. Okay. GD. Let me see. So I did get this that one as well. And I ask me daily, like what the heck is that state? Because I have no idea what is it for? Let me see… because dr Matthew is in a bunch of states, but let me see if this contract works. So, if I can sign it. So it’s just for dr Matthew. And if I do that, I need like his… roster for facilities, right?
Amy Barfield (20:27) Yeah.
Svetlana Vinokur (20:27) So, I couldn’t sign that?
Svetlana Vinokur (20:34) That’s coming to him though, you shouldn’t have to sign individually on them, do we, Amy, or do we?
Amy Barfield (20:41) Sign?
Svetlana Vinokur (20:43) For the group that’s interesting, I know it’s actually like we have received a lot of them already, kind of right? So, I think it’s like when you enroll the group, but then you enroll the provider. So, when you enroll the provider, that’s the contract.
Amy Barfield (20:57) Yeah. Like if they weren’t credentialed initially with uhc, yeah.
Svetlana Vinokur (21:02) Okay. So, did I give you this one, right? Four, four, five, eight… four, 1,484. Yes, that was the first one. Okay? So that’s the first one then is Stanley, then I have this one… 46, 73 nine nine three that’s for Sarah Maria Garcia.
Amy Barfield (21:28) 46, 73 nine nine, three four. Sarah Maria Garcia.
Svetlana Vinokur (21:34) If that’s Kansas.
Svetlana Vinokur (21:42) Then I have this one, I also ask Medellin, for… the roster. It’s four, six, zero eight, zero eight three one. But that’s midwest M.
Amy Barfield (21:55) Four, six zero eight.
Svetlana Vinokur (21:57) Zero eight three one.
Amy Barfield (22:01) For midwest M, you just don’t know what state?
Svetlana Vinokur (22:04) Yeah. And see like I sent it on 317 and nothing.
Svetlana Vinokur (22:14) So, well, that’s at least some of it that we can probably… what is this… or? Yeah. Okay. You know, you can have the screen back… okay?
Amy Barfield (22:39) Melina, midwest and Brittany, I saw the email. Were you able to get those forms back to them?
Svetlana Vinokur (22:44) She’s still here. I sent it on Monday. Okay? Which one? Is it the one that we’ve been discussing Svetlana about? Remember the Ohio license? Yeah. By the way, meridian, Illinois reached out to me, they were all confused about like what the heck is happening? And all of that.
Svetlana Vinokur (23:06) So, and they, and he told me to send everything to him. So, I’m waiting for Carrie to get me the roster so that I can submit everything to him directly. Okay? So you can put it right now and that’s only midwestm because they apparently work on different things, so you can put that midwestm client… only… midwestm only.
Svetlana Vinokur (23:42) Talk to you.
Amy Barfield (23:46) Okay. New Hampshire medicaid, the W9 was submitted and the apis processing for northeast H and midwest M is approved.
Svetlana Vinokur (23:57) So, Amy, it took them 10 days to submit the W9. Yeah. You know, I mean, that’s all I know to submit the W9, yeah.
Amy Barfield (24:13) Yeah. I don’t know what to really say about that. I’m just glad it’s finally submitted. And I did kind of get on to them last week about like any time you’re submitting a group enrollment, you have to submit a W9. I don’t care if it requested or not. So hopefully it got through to them. I.
Svetlana Vinokur (24:29) Talked today to your product team, right? And I basically told them that there has to be something kind of when they submit initial enrollments almost like a checklist, a standard checklist that they have, to go through. And I also want, I think it’s a good idea for them to load in medallion the whole package that they are sending out. So then everyone knows what application was submitted with what, and how, yeah, yeah,
Amy Barfield (25:03) Yeah, I don’t know what that entails for them to do that. I know we’ve got our internal payer directory that has that. But to that point, they would have to look in it to know that so, but.
Svetlana Vinokur (25:16) No, I’m so one thing that is missing from your list, kind of just that you owe me priority health, right? The roster updates in… medallion. Yeah.
Amy Barfield (25:27) Those haven’t, those aren’t updated yet?
Svetlana Vinokur (25:32) I would have seen if they would update it. It would have come to me as approved enrollment, right? But I don’t think.
Amy Barfield (25:41) Yeah. Let me see here.
Svetlana Vinokur (25:47) Nope. It’s on hold.
Amy Barfield (25:49) Okay. Well… I will flag that. Yeah.
Amy Barfield (26:20) Okay. Hap, we, that is reopened and a reconsideration letter was submitted for midwest M, on the thirteenth… provider partners is updated. We discussed that.
Svetlana Vinokur (26:35) Why only midwest M? Because we need both M and H.
Amy Barfield (26:38) I think that is all I have in here. Let me double check, you know, feel like there’s more than one name in here. Perhaps maybe I just missed it.
Amy Barfield (26:57) Let me just do this.
Svetlana Vinokur (27:00) Might be a health, whatever kind of cool.
Amy Barfield (27:08) Midwest, and… yeah, she did do it for both. I just didn’t put both, let me just put that on here, midwest H, and.
Svetlana Vinokur (27:23) Okay. All.
Amy Barfield (27:24) Right. Do you want to share your screen with me? And we’ll go through your items, yeah.
Svetlana Vinokur (27:29) Okay. So medicaid, I guess we have a little bit of progress. So now we’re 30 percent missing. So, but, I really need that to be done by five seven, right? When I go to the board meeting, I need to be able to tell that we are done with medicaid billing under the Gloria. Okay? So taxes, it looks like it’s still in that, which is, I have a little bit of more room with taxes because we’re not starting them probably till like June. So we’re not billing now, but that’s something we need to keep, right? Like Amy, like, I cannot be in June and not have enrollment. It was Texas medicaid.
Svetlana Vinokur (28:26) Okay. Georgia, look at this. They rejected again.
Svetlana Vinokur (28:36) Denied… due to business license. Hence they need business license. What the heck again? Why are we back to business licenses again?
Amy Barfield (28:53) I don’t know because we submitted the medical license. Like they asked what day was that on four?
Svetlana Vinokur (28:59) Six. And then they resubmit something, for… the facility. Like I don’t understand what’s happening? Like they’re talking about submitting for the facility that was… Gary, do you have access to medicaid? Georgia now? No?
Carrie Reding (29:24) I have to call because I have a login but it’s locked up. I do. So you do have access. Okay? Do.
Svetlana Vinokur (29:33) You have access to complex care under that?
Lori Durkin (29:35) Let me double check. Latoya was logging in as me. Let me, let me double check that. It might just be teoria.
Svetlana Vinokur (29:41) Okay. But, but like emu, like we, I feel like we just, I don’t know what’s going on with Georgia. And this one is according to the grant application still in review, the same status reflected in the portal.
Svetlana Vinokur (30:00) Like really on 318, we resubmitted application again.
Svetlana Vinokur (30:10) And in four six, something again was all rejected. I don’t understand like why was the secretary of state certificate again? Rejected? And a lot like what is happening?
Svetlana Vinokur (30:29) Like we’re nowhere like we made zero progress in?
Amy Barfield (30:35) Georgia secretary of state bank letter and what else was rejected?
Svetlana Vinokur (30:41) Like right here, I see four things who rejected. Then they after then recently submitted it again. So… they submitted everything again. So we’re like trying, we’re hitting the wall and then trying hoping for this for a different result. How many more times can we do that?
Svetlana Vinokur (31:09) Okay. So then for Illinois, I guess I’m confused. So, they gave us enrollment but only with one location.
Svetlana Vinokur (31:21) Is that how I should look at it? And then it looks like we have some location spending, but we have 23. So I’m not sure and… like why even this one, Carl and Mel read this one? It was not even on the list.
Amy Barfield (31:44) So, is the question why?
Svetlana Vinokur (31:46) Only one right here. So why is it yellow? If it’s if it’s been done?
Amy Barfield (31:56) Right.
Svetlana Vinokur (32:00) Like right here, why is it not green?
Amy Barfield (32:04) Great question. If.
Svetlana Vinokur (32:08) it’s here, it says that it’s done.
Svetlana Vinokur (32:15) And then who is requesting like look at this lobs, look at this for medicaid. Look at all this lobs… you think it was automatically requested, by medallion. But like look at this. And that’s why it’s for they’re probably not closing because they think that there is all this lobs that needs to be done.
Amy Barfield (32:40) I mean, hopefully, they would see this as traditional medicaid and they, that’s not possible. Do… you see who requested it to see if this is?
Svetlana Vinokur (32:59) Okay. And then I look at the other medicaid and it… says during review process of your application and I notice an error with the ownership staff because your group is certified with the controller as a corporation. The board of directors must also be listed in the owners. So.
Amy Barfield (33:20) What?
Svetlana Vinokur (33:21) Are they doing? Can they forward me this email? And I will respond to that to like explaining that it’s 100 percent owned by this person. And for tax purposes, it’s selected to be corporation. So there’s no board. The board is one person who 100 percent owns it. Yeah.
Amy Barfield (33:46) But.
Svetlana Vinokur (33:46) like it was done. It was the email came on April nines if that one came to me, I would have responded immediately and been done with it. We are on 950, so 50. Like we’re still not making any progress.
Amy Barfield (34:10) Okay. Illinois medicaid, which one was that for midwest? That’s.
Svetlana Vinokur (34:14) H midwest?
Svetlana Vinokur (34:21) So then medicaid’s, Indiana been on the partial complete, like forever? Like I don’t know why they’re not moving at all. Like if someone can looking at that.
Svetlana Vinokur (34:38) Okay. Medicaid, Kansas, the same partial complete been for a while, Kansas for, in this age.
Svetlana Vinokur (34:49) So then Kentucky was resubmitted.
Amy Barfield (34:52) I saw that today.
Svetlana Vinokur (34:58) Yeah, but I don’t understand like Kentucky is midwest, M, what is happening with Kentucky, midwest? H, do we not… to see if it’s done Minneapolis?
Svetlana Vinokur (35:14) Like… unable to reach, look at that? Like there’s like every it’s like if I go back… since February, just the follow ups, unable to reach.
Svetlana Vinokur (35:47) Yeah. On both. Actually, Missouri is the issue on.
Amy Barfield (35:57) Yeah. I know we had to resubmit, but at the same time, like they’re just so slow, well.
Svetlana Vinokur (36:05) We have to resubmit again on three point eight, six and four seven.
Svetlana Vinokur (36:12) Yeah. So, New Hampshire that’s the W9 one, which?
Amy Barfield (36:21) Took.
Svetlana Vinokur (36:23) 10 days to send medicaid, Wisconsin. Carrie, have we figured out what’s going on with medicaid Wisconsin, which?
Carrie Reding (36:32) Part complex care this?
Svetlana Vinokur (36:34) Is midwest, M, that’s.
Carrie Reding (36:38) the one we are not, which one are we enrolled with hang?
Svetlana Vinokur (36:42) On H, I guess, yeah.
Carrie Reding (36:44) We’re enrolled with H. M, I went in and requested, I did a demographic update. One of them, they didn’t request the physician group. And one of them, they didn’t request the NP group. So, all those requests have been put in it.
Svetlana Vinokur (37:00) Says all other locations like, so the following locations are not enrolled under physician group, all other locations… I need to submit new enroll application for, to add three locations. So, if it’s partially done, why there’s why this is not saying that it’s partially done?
Amy Barfield (37:25) I will have them partially completed. Okay?
Svetlana Vinokur (37:27) And then how does it make sense that they put revalidation date like a week after the effective day?
Amy Barfield (37:38) Okay. Validate.
Amy Barfield (37:58) And that one’s for midwest end, correct?
Svetlana Vinokur (38:01) Correct. Okay. So that’s our medicaid’s.
Lori Durkin (38:08) real quick team. Before we go, I can see the contract status for M, there’s an effective date of four one, but it’s showing inactive.
Lori Durkin (38:22) So, just to confirm… it’s only southeast H and midwest M in Georgia medicaid?
Svetlana Vinokur (38:29) Right. No, H.
Amy Barfield (38:32) Oh, the effective date’s for one, but it’s inactive for.
Lori Durkin (38:35) Georgia medicaid? Yeah. There’s an effective date there. I mean, all I can see is contract status, but,
Svetlana Vinokur (38:44) yeah, it says it was denied, see, right? On four six.
Amy Barfield (38:49) Not for midwest M.
Lori Durkin (38:53) And then nothing’s pulling up for southeast H.
Svetlana Vinokur (38:55) They received a denial letter from medicaid. Georgia. Okay. So, if they received a denial letter from medicaid, Georgia. Where is the denial letter? Let’s see if I can.
Svetlana Vinokur (39:15) Eft, business affair, doc, old appian council, the rap has escalated 325, well approved termed.
Amy Barfield (39:29) Okay.
Svetlana Vinokur (39:33) So, it says Terrell payr because it was denied linked to the payr in application because application was denied to close in 25.
Lori Durkin (39:56) When was it denied? It says.
Svetlana Vinokur (40:01) Well, they say right here received a denial letter from medicaid. Georgia. I don’t know if you see it on your end being submitted somewhere, but it’s like it’s unreal kind of like, I don’t know.
Amy Barfield (40:17) Yeah, I don’t know if that’s shown through the portal. I’d have to look up the.
Lori Durkin (40:21) Email, and then just yesterday, their note says it’s processing, but I’m just not seeing that.
Svetlana Vinokur (40:29) How about anything on southeast street?
Lori Durkin (40:33) No, I see. I can’t even pull up the atn on that. Like I… can’t pull up. I can’t locate anything under southeast H.
Svetlana Vinokur (40:45) Okay. So medicaid, I have 15, probably like five of them partially completed, right? 10, completely kind of, and the partially completed one. Let’s look at this. Like this is what I’m kind of look at the Illinois. This is what I saw.
Amy Barfield (41:04) Okay. Illinois.
Svetlana Vinokur (41:18) Okay. And then I was told that all the Indiana will be released. And look at this. I still have pending.
Svetlana Vinokur (41:30) Still have a bunch of pending. Okay?
Svetlana Vinokur (41:44) They’re still pending.
Amy Barfield (41:50) Like why is still?
Svetlana Vinokur (41:52) Pending? Yeah, why is he still pending? Remember, I told you it just.
Amy Barfield (42:01) Means it hasn’t been submitted yet. They, in their reporting, it flags that whenever it’s partially completed, they don’t flip it to release. They just submit it. And so it just hasn’t been submitted yet based on their cues, but I will ask them to release them.
Svetlana Vinokur (42:23) Okay. It just takes them some time. Carrie. Like, I don’t know, I’m just going to like today. Is that like why would we be submitting application with only one practice location? And that’s… what they are holding? Because that location has not been rolled but we need to have all locations for him… that.
Carrie Reding (42:48) May have been part of the well, one she’s not here anymore, but that may have been part of the project where if they were missing locations, they were supposed to make sure that they were tied to medicaid?
Svetlana Vinokur (42:59) And blue cross. So, here is the, okay, hold on.
Svetlana Vinokur (43:12) Okay. So, it looks like at least this one is going, okay?
Lori Durkin (43:22) Amy, southeast Asia is pending documentation still.
Amy Barfield (43:28) For Georgia medicaid?
Lori Durkin (43:32) The team’s last note, medicare. I’m sorry, medicare, my dad’s last note says it’s just all pending, but they need receipt of info.
Amy Barfield (43:41) For Georgia medicaid.
Lori Durkin (43:43) I will put a screenshot in here of what I can see.
Amy Barfield (43:48) Lori, is that for Georgia medicaid? Oh?
Lori Durkin (43:50) Sorry. Am I on mute? No, yes, it is.
Amy Barfield (43:53) For Georgia medicaid, no, I can hear you. Can you hear me?
Lori Durkin (43:55) Yes. Sorry, the words are not coming out. Yes, yes, Georgia medicaid. Yes, they need additional info, but they’re not telling me what they need here that’s southeast. H. Okay.
Lori Durkin (44:11) Got it. It’s got an effective date of three, one of 26 though, but it’s pending, so maybe they intend to go backwards. That’d be fantastic.
Amy Barfield (44:22) That would be awesome. Yeah.
Svetlana Vinokur (44:32) I’m really confused like on this one, Mimi, look at this. So I look at all the Kansas people and look again like so many pending dependencies… but this one is… pending dependency because location is not enrolled, fine, but all the others are, so, wouldn’t you put it that partially completed?
Amy Barfield (44:59) Yeah.
Svetlana Vinokur (45:06) Like look at this shouldn’t that be partially completed on the grade level, no, on his level on the provider, on the provider. And then because of that shouldn’t be an unhealthy blues released.
Amy Barfield (45:22) Yes, which providers is Justin? Is it obermiller?
Svetlana Vinokur (45:27) Obermiller? But all of them are the same kind of like look at, there are a bunch of them and I can guarantee it’s the same issue that it’s that one location is probably… on hold. So, you see it’s not enrolled. The location is not enrolled with the group. So all the others are right, and that we are holding healthy blues because of it.
Svetlana Vinokur (45:56) Okay.
Svetlana Vinokur (46:09) I will look at that.
Amy Barfield (46:18) Yeah. My team lead today. She said she’s working through trying to get things released when it’s requested. It just takes a lot of time because we have to do it one by one… so I just wanted to let you know that. So it does take time away from her to do that… but it is reported in sigma for them to flip them. So, I think, you know?
Svetlana Vinokur (46:45) If we see them sitting there for a long time, those group, those locations enroll quickly. So then the entire thing will flip, right? Like I don’t know.
Amy Barfield (46:54) Well, and I think another thing I can point out is like we’re seeing there are partial completions, but those are not always being done. And so that has to be at the very least done for it to flag in our reporting. So.
Svetlana Vinokur (47:09) Yeah.
Amy Barfield (47:13) Okay.
Svetlana Vinokur (47:13) Well, we have only 10 minutes left and I have so much kind of read. We just went through medicaid, blue cross blue shield. There has been like no movement and, you know, Amy, I read your explanations on blue cross blue shield in Michigan and I wanted to cry to tell you the truth, right? Because in the six months, basically, nothing was done… like, I don’t know. So I finally got the contact. I mean, I.
Amy Barfield (47:40) wouldn’t.
Svetlana Vinokur (47:40) say that.
Amy Barfield (47:40) Nothing was done. I do agree that it has been slow and there has been some hiccups, but I wouldn’t say nothing is.
Svetlana Vinokur (47:48) Done like so just now, like on one of them, nothing was done at all. And on the other one, it was requested in the.
Svetlana Vinokur (48:04) I mean, I think like on age, nothing been done… on M, right? On M, we made progress in February on H, nothing been done since December. Yeah.
Amy Barfield (48:25) Did you get the communication from Amanda about that additional BCN? She said, I think she got that other one submitted and I think I’m trying to recall because it’s all kind of jumbled together for me.
Svetlana Vinokur (48:44) I signed.
Amy Barfield (48:45) Whatever.
Svetlana Vinokur (48:45) They asked me to sign. So I signed, yeah, I signed immediately and I responded to her. I’m four seven like I did the media, right? Thanks. But then nothing kind of right? I sent an email to our contract, but just.
Svetlana Vinokur (49:12) I mean, that to me, is nothing been done since November to now kind of since December to now.
Amy Barfield (49:20) Amanda’s got her eyes on it. She’s pretty much the only one handling it at this point. So, I’m confident in her abilities and we do talk about it frequently. So I know she’ll keep up on it… okay?
Svetlana Vinokur (49:37) But I’m just so confused like, and in theory, we enroll with everything, why do I have so many provider? Like, why do I have half a 1,000,000 dollars of provider issues?
Amy Barfield (49:52) Is that even with your like for what you’ve submitted on BCN networks and stuff like that, are you do?
Svetlana Vinokur (49:57) You still have things like that? Well, BCN is right here, right? Nine one. Yeah, right? Like, so where is the like… look at that? They said that it’s all done with up to 2018… like, I don’t I like, I really don’t understand.
Svetlana Vinokur (50:16) Like I want someone to, like look at the providers and like why I don’t get paid?
Amy Barfield (50:22) Yeah. Amanda is looking at those providers. I created a separate list of just those providers for blue cross blue shield of Michigan for her and she’s reviewing those.
Svetlana Vinokur (50:33) Okay. So if I look at blue cross like, I mean, like Illinois… I don’t know how to tell my people that we don’t have a single provider enrolled in blue cross blue shield of Illinois. Like like I can’t operate without that and it’s been for a year now. Okay?
Svetlana Vinokur (51:03) Like, I don’t understand like what’s happening with Theoria, or… with complex cares, right? And, and if I look at my blue cross blue shield, I have so many kind of, I have a bunch of them still even on hold like, see, like, why do I have healthy blues on hold… right? We talked about it. Healthy blues should not be on hold, right?
Amy Barfield (51:37) I have that noted to release those.
Svetlana Vinokur (51:39) Yeah, like, this should not be on hold, right? Like, so, so that should be, North Carolina should be fixed because they shouldn’t be on hold, right? I have that noted. So, so like what’s going on with Louisiana?
Svetlana Vinokur (52:08) What does that mean?
Svetlana Vinokur (52:17) We received, signature, completed agreements through mail, where is that signature? Completed agreements through mail?
Svetlana Vinokur (52:42) Like, I don’t understand this Guy that’s like.
Svetlana Vinokur (52:56) And I don’t know why medallion sings and sending emails like that is actually like productive.
Svetlana Vinokur (53:17) And if they say that they received something shouldn’t they be attaching it?
Svetlana Vinokur (53:24) Person. So I need to understand from them, like what’s happening with the new boss and I think it’s possible because apparently, that’s holding the Louisiana.
Svetlana Vinokur (53:49) Medicaid it’s holding great. Okay. So that’s seven on hold. But then 20 I have… being processed.
Svetlana Vinokur (54:07) Look at this follow up. So just every two weeks, just us sending an email.
Svetlana Vinokur (54:19) Look at this. So, basically, since we submitted every submitted application, we don’t know what’s going on.
Amy Barfield (54:28) Okay. I’ll have them make a phone call.
Svetlana Vinokur (54:47) We’re currently par with commercial only reconsideration is not on file for medicaid advantage and all that because we need to resubmit appeal reconsideration. So, but why doesn’t say that we are partially?
Svetlana Vinokur (55:09) Like I really struggle?
Svetlana Vinokur (55:15) Do I read it correctly? So, we are.
Svetlana Vinokur (55:21) Well, right here, look at this, Lori, until processed and additional of these are par payment will continue to issue to Miles Greenberg.
Svetlana Vinokur (55:37) What the heck? Isn’t that the one that you?
Amy Barfield (55:40) Flagged to me Lori?
Lori Durkin (55:43) Yeah, sorry, say that one again?
Svetlana Vinokur (55:45) Until.
Svetlana Vinokur (55:50) don’t process which ones, but.
Lori Durkin (55:51) It’s our part?
Lori Durkin (55:57) That, yeah, this is one of the ones that, I flagged to you. I went in and updated.
Lori Durkin (56:17) I went up and updated some things to get it switched over to eft. And then I emailed W nines and all sorts of things over to them. But I mean, it doesn’t make sense that with a group contract commercial or not? Yeah.
Svetlana Vinokur (56:28) So, Amy, but like, this retro letter, like if I received this, I would reject, it doesn’t tell you anything about our… who we are? Why are we asking? What are we doing? Like it just says that we asked me for the additional lines of business and that’s it.
Amy Barfield (56:51) Okay. I wonder if this was attached to something else that would. Okay. Well.
Svetlana Vinokur (56:58) If there was, I, they don’t have it in here.
Svetlana Vinokur (57:11) And then I guess why is it anthem, what is anthem blue cross, blue shield versus blue cross, blue shield of Georgia?
Svetlana Vinokur (57:37) And, and Amy, when they submit this, like we’re not transitioning the warrior just to midwest. M, it needs to be both southeast age, and then what are we going to do with southeast age?
Amy Barfield (57:59) Okay. And it’s supposed to be just anthem, blue cross, blue shield of Georgia. I.
Svetlana Vinokur (58:05) Don’t know. Yeah, I don’t understand mercy submitted that. I… don’t understand, that was submitted by medallions, blue cross and then mercy submitted on.
Svetlana Vinokur (58:22) What is mercy doing? Submitting this?
Svetlana Vinokur (58:33) Not sure unless there’s a.
Svetlana Vinokur (58:38) Task or something. I don’t know, I’ll have to go back and look. Okay. So like look at this. So, while the group is listed in the roster, it was only one service location and the one, it would be blue cross community health plans was actually what we need because it’s the medicare plan. Send the email to the payer to get the par roster. So that was, but why wouldn’t you put it as a partially completed if you were?
Amy Barfield (59:14) Which one is that for Illinois… which group midwest?
Amy Barfield (59:28) Okay. We’re at time and I do have a hard stop at five o’clock.
Svetlana Vinokur (59:39) I asked two weeks ago to focus on Michigan, right? There’s. A priority kind of, so I look today and I still have three enrollments. Okay?
Svetlana Vinokur (59:57) I just don’t know what to do like, you know, like I think medallion is failing. My team is failing like this is like, I mean, it’s unreal, like I just, I don’t know, I just don’t see like I don’t see progress.
Amy Barfield (60:15) Yeah, I mean to get approvals in a two week period when we weren’t… when things are processing with the payer, I mean, I wasn’t expecting to get a bunch of approvals, but to your point, I understand the frustration of only having three at this point.
Svetlana Vinokur (60:33) Well, we’ve been at this for a year now, right? I.
Amy Barfield (60:36) Know, I know. Yeah. So, I am meeting with the team weekly on the midwest M, priorities with Kelsey leaving that kind of put a hiccup in things. So we’re looking to add another person to the team. So… do we need.
Lori Durkin (60:57) to get a task force on blue cross, blue shields? I can pull some folks?
Svetlana Vinokur (61:01) I don’t know what task force like what is the task force will do? Like Laurie, like I.
Lori Durkin (61:05) don’t know at.
Svetlana Vinokur (61:06) this point, I don’t understand like kind of like.
Lori Durkin (61:09) Pick up the phone. I don’t know either. I’m just trying to say, I mean,
Svetlana Vinokur (61:15) I don’t know like I do need to, I need to, on Theoria, like what you said, Amanda is going through my providers, why? Like I need to have the meeting to talk about that, to understand what’s going on, right? Kind of with those providers? Because I do not understand like why my medicare lines are all like why I have half a 1,000,000 dollars right on that. Yeah, right? And that’s.
Amy Barfield (61:43) what I’ve asked is for her to go through each of those and make sure that we realize that some providers have to… like those lines of business have to be under the providers. I want her to confirm with each provider that they have been added to the lines of business that they qualify for one and two, that they are linked to the group to.
Svetlana Vinokur (62:02) The networks.
Amy Barfield (62:03) That are under the group. So she is looking through those eta and when that’ll be done, I’m not sure but I’ll reach out to her by the end of the week and see where she’s at.
Svetlana Vinokur (62:14) Okay. And, and Amy on medicaid, Georgia retros… I… sent Derek like he clearly got it from you or someone else all this kind of that, it was us and I just want to show you because I sent back to him facts and… I’m rarely wrong. Okay. Because, I really check, my facts. So, so on this.
Amy Barfield (62:51) One, can we possibly do? I’m at time right now and I have a hard stop at five if you want. I can schedule some time with you tomorrow and we can review just the Georgia medicaid or we can pick it up on our Friday call.
Svetlana Vinokur (63:05) I’ll pick it up on Friday because tomorrow, I have 20 meetings. I understand. Because as I see you both, this is not the only thing I’m doing unfortunately, I.
Amy Barfield (63:14) understand. Yeah. Okay. Thank you for understanding. I will work on getting these pushed out. Thank you. Bye.
Svetlana Vinokur (63:21) Bye.