Transcript
Vanessa Persha (00:00) hi, Sarah. Good morning. Hello. How are you? Doing? Good? How are you? Oh, I’m doing all right. Hanging in there. My coffee maker broke over the weekend and I just work so much that I don’t even grocery shop like I have not stepped foot in a grocery store and I can’t tell you how long I order my groceries and have them delivered. And so the thought of even going to the store to buy a new coffee pot has been just order on Amazon. You can get it tomorrow. That’s what I, you know, I’m like this weird. I like to see it, touch it, feel it, whatever. Oh, yeah. And you know, so I’m like I should just order it but anywho, I’ve been going to starbucks and then just ordering a venti, like black coffee, coming home, adding my creamer to it.
Vanessa Persha (00:52) I’m like this is going to work for now. Well, you get off the courage to go into society. I know I don’t like doing it either. I hate it. Yeah, it’s too people y out there. All righty. Hi, Deanna. Hi. Oh goodness. So before we get started, I’d like to jump into the escalation overview. From your four two email, Sarah. That’s a good place to start. Yep. All right. Let me go ahead. I put a presentation together and we’ll go through that. Perfect. You can see my screen. And before we dive in, I do want to acknowledge the email that you had sent over the recent one.
Vanessa Persha (01:37) We did receive it definitely understand the seriousness there with the concerns that you’ve raised. And that being said, one item we acted on immediately was stopping the AI calling activity that has been removed from your account. And then we’ll come back with a structured response and corrective action plan with clear timelines. Once our review is complete of those other items, okay. All right. So jumping in here, we’re going to talk about our areas of opportunity. We identified trends solutions, some of the audit findings, our quality program overview. I’m going to skip the contract and consumption updates because Derek is going to use this same deck later for his executive touch base with cortica. So I’ll skip over that one. All right. So enrollment delays, what we’ve seen across your escalations is not random. It clusters really into three core themes with an isolated support incident. The good news here is that these are systematic issues which means they’re solvable. So delays are largely about visibility and control. And our focus is tightening our SLA management, improving visibility into in flight work and ensuring nothing stalls without being flagged. We’re also seeing preventative errors like missing required steps or incomplete submissions. And so we’re strengthening our upfront checks and ensuring every application meets requirements before it moves forward. Of course, I’m aware of the support related issues but important to call out that this was an isolated incident. It’s been investigated and addressed. And we’re putting additional safeguards in place to ensure reliability going forward. So while this definitely impacted the experience, it’s not representative of a broader support model. Deanna, I did see some of your emails coming in that you flagged for support. And I’m seeing those responses with ticket numbers just wanted to make sure that there’s no other issues that you’re seeing still. Okay. Perfect. All right. So trends and proposed solutions with North Carolina medicaid here, obviously required training tasks weren’t consistently created which led to application rejections. We’ve done a comprehensive audit on all of the North Carolina medicaid enrollments and we’ll share the findings later in this meeting. And going forward, we’re prioritizing automated application submissions and validation to ensure nothing is missed at the point of submission… independence blue cross. In this case applications appeared submitted, but we’re actually sitting in an automation work queue for over 30 days. So we’re fixing this with actually we’ve already fixed this with better tracking, clearer status definitions and alerts when work exceeds SLA. So again, at the end of January, early February which is right around when these independence blue cross applications were impacted. We put in those system controls to prevent that from happening going forward. Arizona medicaid. This was an execution issue. We missed follow ups. There was delays on action being taken. We’re addressing this with stronger queue management, daily workflow discipline and clearer accountability across the board… cigna, Arizona here on hold applications were not actively managed. And that points to both a process and capacity gaps. So we’re implementing defined ownership, regular reviews and better resource alignment. Additionally, we’ve completed a full audit on hold lines and have outcomes to share later on. And then the support workflow, we identified that very specific issue where the inbound emails were not being reliably received from an action standpoint. We’ve already partnered closely with the technical team to investigate and resolve the email delivery issue. Excuse me, sorry. I’m like all congested this morning. So as part of this process, we didn’t just identify issues. We validated them through a structured audit. We conducted a full review of impacted lines across the key areas including North Carolina medicaid and your on hold enrollments. To understand both the scope and root causes. So what this showed us is that while there were real gaps particularly around the training compliance and the on hold visibility, we now have a clear handle on where those breakdowns occurred. More importantly, we’ve already taken action. So applications were resubmitted that needed to be resubmitted. We’ve created any provider tasks that were missing. And then for your on hold lines, we have moved a significant number of lines back into a workable or completed state. So we’ve made progress here and it just gives us a strong foundation to measure improvement going forward. Any questions on this before I move forward?
Sarah Aloisi (07:06) So, I think a lot of what you said was about process. And when I looked into.
Vanessa Persha (07:13) the blue.
Sarah Aloisi (07:16) Cross and the cigna… I almost said claims enrollment. I saw errors in the applications. So I saw one of them said fill out this page for group, fill out this page for individual and they filled out. Both. One of them said the providers are PCPS. One of them had a, the W9 isn’t going to get, isn’t going to have a problem, but it’s a problem because it’s I mean, it’s not like fraud to be signing somebody’s name.
Vanessa Persha (07:53) Are you referring to, the new email you just sent?
Sarah Aloisi (07:58) Yeah. So, if the process is good but the applications are incorrect, then it doesn’t really matter. Yeah.
Vanessa Persha (08:07) Nope. That’s a great point. The next slide. We’re going to jump into our quality program overview. So we’ll touch on that.
Sarah Aloisi (08:13) Okay. Any.
Vanessa Persha (08:14) Other questions though on these two audits specifically.
Sarah Aloisi (08:18) Okay. No, perfect. All.
Vanessa Persha (08:21) Right. So strengthening our quality and proactive oversight on the quality side, we’ve put a much more structured approach in place to strengthen oversight and catch issues earlier. So today, we have full coverage across the highest risk areas including medicaid lines, new hires and all application resubmissions at the same time. We’re evolving our QA to be more proactive. So moving towards daily sampling of production across all lines. And our overall goal here is to identify trends earlier, address issues upstream. I’m so sorry, excuse me, and drive more consistent quality across the board. So where I would like to partner with you all with is identifying those high risk payers, where we’re seeing the quality trends. We’re seeing the issues and we can roll those over into 100 percent quality control. So we can flag those to our QC team to ensure before that application ever reaches the payer, it’s going through a full QC.
Sarah Aloisi (09:29) So, are the, are… some of these people from this country? I feel like a lot of it is like perhaps… language like offshore confusion. So.
Vanessa Persha (09:44) Our quality team, both the QC and QA teams are 100 percent onshore staff.
Sarah Aloisi (09:50) Okay.
Vanessa Persha (09:54) But I do understand your concerns there. So I think like this quality program is necessary because it allows us to track and trend on those issues. And if we’re seeing individuals that are particularly struggling, we can take action on that. If we’re seeing that it’s a payer across the board or a specific state that’s challenging, we can create action plans around those trends. So.
Sarah Aloisi (10:20) How do you? Well, let me say what I saw and then try to articulate a question. So I was looking at the medicaid Arizona applications and I saw one person was listed as an LLC, another person was listed as a corporation, and a third person was listed as a person. So I would think that if it’s going wrong, it would at least be consistently wrong. Like wouldn’t there be an sop that says this is what the application looks like. And you check this box and if it’s wrong, it would be the same kind of wrong?
Vanessa Persha (11:00) Yeah. So particularly around Arizona medicaid, that’s what I wanted to understand like those errors that you were seeing and we, I don’t know when we did you happen to change the password to the Arizona? Okay? Because they were having trouble getting in. And I said, hold on, let me just see if they had to do a password reset. Okay? So I wanted to see like where you were looking, where you were finding those issues, because I did take that back to the ops team. And what they were saying is the Arizona medicaid application goes through in phases. So initially we do the domain transfer request that gets approved, then we can go in and do the request to link the provider to a group or address. Once that’s done, then it unlocks the full provider profile for us to make changes. So what the agents were saying is that they may not have necessarily seen what was in that provider’s, full profile where you could have identified the errors. But until I look at them deeper, I can’t say for sure that is exactly what happened. I thought there were only.
Sarah Aloisi (12:12) two steps, the domain transfer and then I thought you could do all of the steps together. Okay? Not two pieces, yeah.
Vanessa Persha (12:23) So, from what the team had shared, they do the address linking group linkage, then it will allow them to view the full profile. So things like one of the things you called that was like end dating previous employment. They had shared that they don’t have the visibility to that when they’re submitting the profile, the location ads or the group ads.
Sarah Aloisi (12:46) Oh, interesting. Yeah. I didn’t do any. I was just looking at the existing ones. So that, so then that means you ask for the domain transfer, you wait for medicaid to get back to you. You do steps one and two, you wait for medicaid to get back to you. Then you do the rest of the steps and wait for medicaid to get back to you a third time.
Vanessa Persha (13:06) What are they doing down there? She said it’s a very convoluted process yeah.
Sarah Aloisi (13:12) And their website, did you see their website? Like two point font? Oh.
Vanessa Persha (13:16) No, I hadn’t looked at their full website.
Sarah Aloisi (13:19) And.
Vanessa Persha (13:19) she was saying that it’s like they have two different portals. Like the domain transfer part is one portal. The application linkage part is a different portal. And then the follow up is in one of the two portals, but they’re not the same. So, she said it is, very convoluted. So.
Sarah Aloisi (13:39) I’m working on, so Arizona is like the top focus at cortica. So I’m calling the new hires and asking them to do the domain transfer. I emailed like the old job?
Vanessa Persha (13:55) And I.
Sarah Aloisi (13:57) said, can you like give me the password because you’re losing her and we’re getting her. It was very awkward. You know, I’m hoping to avoid that step by getting it just directly from the person from the old job. So, yeah.
Vanessa Persha (14:11) That’s a, that’s probably a great practice, right? Like get that domain transfer letter signed by the provider before? Like during their onboarding, so, that gets started right away. Yeah. And I do believe it was Ronan Raneen who changed her name because it.
Sarah Aloisi (14:31) Was Ronan, and it was Raneen the.
Vanessa Persha (14:35) Team was like, I can’t find this provider. Now, what happened? And I was like there was a name change. Yeah. So we had success getting that domain transfer for them, stating on the domain transfer letter that we attempted to identify who the previous domain transfer holder was, and we were unable to determine that. So on line H of the domain transfer, we put some verbiage like that in there. So if you do have struggles figuring out who that person was, they approved it with that verbiage.
Sarah Aloisi (15:08) Okay. So I think it’s not going to go through. I didn’t stop it before they picked it up, but I think because the license doesn’t match the name, I think it’s going to get rejected. I don’t think there’s anything I can do about it.
Vanessa Persha (15:25) Okay. I’m going to skip over that side there. So in closing, we’ve identified the gaps. We have a clear plan to addressing them and we’re committed to executing alongside you. So at this point, I’d like to just open it up for discussion. And my goal here is just to make sure we’re fully aligned on the path forward.
Sarah Aloisi (15:53) I think so. I’m trying to address some of it on a higher level. So, I’ve been trying to get in touch with cigna slash… evernorth, to figure out how many applications were… done as individual contracts instead of sucked up under cortica’s contracts. And it looks like some people may have been set up as PCPS. So I’m trying to get a list from them so that I can tackle that one broad pig. Yes, and they seem to be taken forever and it looks like they’ve been submitted and cigna’s just sitting on them. So we have a new contract in North Carolina with cigna.
Vanessa Persha (16:45) November.
Sarah Aloisi (16:46) First. Okay. One. No like this past November first. Oh, okay. One out of the 19 providers is enrolled. So we got this contract signed in November and it still isn’t active… wow.
Vanessa Persha (17:05) This was cigna New Jersey.
Sarah Aloisi (17:08) North Carolina because it was like a new market for us, so everybody was all excited that they can take cigna patients. Yeah. And there’s one provider… are?
Vanessa Persha (17:22) We managing that enrollment for you?
Sarah Aloisi (17:24) Yes. Okay. Good luck. And I think I’m… hoping that they can help me, but they haven’t gotten back to me.
Vanessa Persha (17:39) I wonder if we have a contact that we can, and it’s for cigna. Is it cigna or evernorth? North Carolina?
Sarah Aloisi (17:48) They seem to be in mixed in medallion. I can’t figure out like I can click cigna and I can click evernorth, but they like they come.
Vanessa Persha (17:59) Together.
Sarah Aloisi (18:00) Yeah. I think it’s both and, the behavioral health providers, I don’t know whether they go with cigna or evernorth. They.
Vanessa Persha (18:14) Go to evernorth. Well.
Sarah Aloisi (18:15) The problem is they’re in our cigna contract. Oh… we’re not contracted with evernorth, for behavioral health. So they negotiated them inside of the cigna contract.
Vanessa Persha (18:29) Okay. So.
Sarah Aloisi (18:32) That’s ridiculous. Yeah. So I think, we may have sent them previously… to cigna, but I don’t know if they get automatically routed to evernorth. So, I think the point is that we need to talk to them, yeah, to figure out the big picture. And I think that would be a big, I think there’s a lot of those that medallion is working on. So if we could take those out, it would be nice to pull them off of medallion’s… to do list.
Vanessa Persha (19:12) Let’s see. So we have 18… that are processing… total.
Sarah Aloisi (19:22) Or in North Carolina, I think there’s 18.
Vanessa Persha (19:25) In North Carolina, and then there’s.
Sarah Aloisi (19:26) the whole rest of the country, too.
Vanessa Persha (19:28) Right. How weird. Laura, burek of all people was the one completed for North Carolina? Yeah. Look at all of your cigna lines here.
Vanessa Persha (19:42) So, your cigna contract was a multi state contract. Yes. Okay. Yeah, we have 74 processing seven in needs client attention.
Sarah Aloisi (19:54) And so we had, so we have a brand new national cigna national evernorth, and we were already contracted in some of the markets.
Vanessa Persha (20:04) But.
Sarah Aloisi (20:05) not all. So, there was like a, you know, a huge North Carolina enrollment, but then the other states, it’s just normal with a different contract underneath. Okay. But the fact that it switched from state specific to national, I think, is messing up the way that they’re doing the enrollments. I don’t think they’re like acknowledging the new contract when they’re doing it so that it could be causing problems?
Vanessa Persha (20:38) When you received the national contract, did they provide you a specific process like a dedicated rep that you should be submitting to or was everything still supposed to go through the website?
Sarah Aloisi (20:53) Website? Okay. Yeah. Interesting. But I think we sent a, we sent a roster? I’ve been trying to ask them about it since February and nothing… just go.
Vanessa Persha (21:08) Look and see, I don’t think cigna was one of the payers we reviewed a couple months ago when we were looking at payers… but let me just see.
Sarah Aloisi (21:19) I don’t think we did because it was just a normal.
Vanessa Persha (21:21) Yeah, the normal process,
Vanessa Persha (21:31) Yeah. So we call cigna to initiate the enrollment over the phone. If they redirect us to ash, we go to ash.
Sarah Aloisi (21:41) We definitely should not be going to ash.
Vanessa Persha (21:44) Okay. I can take that out of there because I think didn’t you flag in your most recent email that there was some issues with apps going to ash.
Deanna Purchiaroni (21:59) Yeah. And that should have been on the instructions that we’ve never gone through ash and ash, or I think it was a call that they said Medellin is trying to enroll a provider with ash, but they need to go through cigna, which that’s always been the case. We shouldn’t be submitting to ash. Okay?
Vanessa Persha (22:17) I can remove that language from the project plan and actually specifically say, do not send any apps to ash.
Deanna Purchiaroni (22:25) Yeah. And I know when we used to do enrollment, when we would call, they would try to direct us to ash, but if we just like really explain, we’re a multi specialty group, we always go through cigna, then you’ll be transferred to cigna.
Vanessa Persha (22:38) Okay. And I’m going to take a look at what our normal payr directory process is just to see if anything’s changed there.
Vanessa Persha (22:54) That’s the same standard process you call cigna choose the credentialing option, national contracts.
Vanessa Persha (23:06) Oh, interesting. Okay. So, national contracts… when calling to initiate an application, tell rep, other states to enroll in and request a note be added asking for a national contract… join our site. Interesting.
Sarah Aloisi (23:27) It seems like the.
Deanna Purchiaroni (23:31) I.
Sarah Aloisi (23:31) think signal reps make a lot of mistakes and medallion isn’t pushing back on them.
Deanna Purchiaroni (23:40) So, if.
Sarah Aloisi (23:41) cigna says call ash, then medallion will just call ash or fill out an individual contract. Then medallion will do it instead of pushing back and saying, you know, I don’t think you have the right information Cigna. Yeah.
Vanessa Persha (23:57) So, I see here like for a large group joining with five or more providers, submit a group roster first, do not initiate credentialing.
Vanessa Persha (24:12) Okay. Yeah. Let me, I’m going to use the information from the payr directory we have for our standard process and make some tweaks to the project… plan specific to cortica, just to make sure it calls out like for five or more providers, we can submit a roster and then also to link an in network provider to an in network group. So, if they’re already credentialed, we just send the link letter to intake underscore, pdm. Okay. Yeah. Let me, do, I’m going to do a revision of your cigna project plan… and then do you feel it would be worth it? I mean, I don’t mind giving them a call and just try to see like, can I get a full roster? Ask if I can get somebody to send me one? Oh, you’re on mute, Sarah. I,
Sarah Aloisi (25:18) said sure it’s worth a shot. I’m not having any luck. Maybe you are.
Vanessa Persha (25:22) All right. Yeah. We’ll do some outreach. I’ll try to get a full roster here. If I don’t have any success there and you guys decide you want to take those enrollments in house, I can certainly switch those to client owned. Okay. All right. And then let me pull open your, our… agenda… and share my screen here.
Vanessa Persha (25:57) So, I’m going to start down at the bottom here. Deanna, I wanted to flag this one for you just because I know you’ve most recently taken over some licensing while. Forgive me pronounce her name again. Cecile, okay? While she was out or is out, so, Sahana, padmanban, her evernorth, New Jersey enrollment is pending her BA or bcba license for New Jersey since like mid and 20 25, I believe. And.
Deanna Purchiaroni (26:36) What’s the name?
Vanessa Persha (26:38) Sahana, padmanabhan. Padmanabhan.
Deanna Purchiaroni (26:48) She’s been here a while.
Vanessa Persha (26:57) So, the application was put on hold pending her New Jersey license, but I don’t see that there was ever a request put in for her full… license.
Deanna Purchiaroni (27:17) New Jersey requires a state license for bcbas? Correct?
Vanessa Persha (27:22) Yes.
Deanna Purchiaroni (27:23) I see that she has her board certification. And under request there’s a permanent New Jersey license?
Vanessa Persha (27:31) Let me go see.
Deanna Purchiaroni (27:33) It’s under needs client attention intake.
Vanessa Persha (27:36) Sorry. Yes, that’s what it was. It’s the request is there, but it’s in, needs client attention, and it’s been sitting in there for a little while. I think there’s three tasks associated with it.
Vanessa Persha (27:58) So, anyway, I just really wanted to flag it to your attention just because it may not have been something you were historically looking for, but it is a blocker for her New Jersey enrollment.
Deanna Purchiaroni (28:09) Okay. And then also, I know Paige had New Jersey. So I’m just not as familiar. Is New Jersey, one of the ones that they, it’s like a new requirement to have a state license? So she was previously able to be enrolled with a, with her bcba certification?
Vanessa Persha (28:28) That I don’t know because.
Deanna Purchiaroni (28:31) it looks like she has enrollments that have been completed, but how is that, if she doesn’t have a license?
Vanessa Persha (29:25) That’s interesting. So, the payr is the one that stopped her credentialing due to her license?
Deanna Purchiaroni (29:35) For which payer? Evernorth?
Vanessa Persha (29:36) Evernorth. Yep. Evernorth, sent a letter stating the provider application was denied due to provider not having a valid license for the state of New Jersey, valid license type is lba and provider has bcba.
Deanna Purchiaroni (29:56) You think that would be the requirement across all payers then?
Vanessa Persha (30:01) You would think so. Evernorth?
Vanessa Persha (30:09) Yeah. So back in October, Paige said to put the line on hold until the license comes through. How the heck did these other payers process these?
Deanna Purchiaroni (30:31) So, this provider has been with us since December… of 20 24 and doesn’t have a license?
Deanna Purchiaroni (30:46) Something seems odd.
Vanessa Persha (30:50) She has other licenses. It’s.
Sarah Aloisi (30:52) just New Jersey that’s missing.
Deanna Purchiaroni (30:54) She only… has her bcba certification. She’s only linked to New Jersey. So she’s not even like enrolled with her bcba to California locations. Oh.
Sarah Aloisi (31:05) My God. Yeah, that’s not good.
Deanna Purchiaroni (31:14) I’ll email her… S, a H a.
Vanessa Persha (31:44) So, we did also task, let me see. This could be a profile issue because we tasked and said, please review the existing license section to make sure to include any and all licenses you’ve held both active and expired. So, I wonder if we identified… yeah, there was another one, if you have licenses in process, please add them to medallion. I wonder if she does have other licenses that we flagged from somewhere and we’re asking for them to be put in medallion? Like if they found them in caqh… well, that doesn’t make sense because we do your caqh management. So, why did they?
Deanna Purchiaroni (32:37) I looked her up on the licensing board and doesn’t look like she has a New Jersey license?
Sarah Aloisi (32:46) So, I’m looking at the claims, horizon claims are paying… and optum claims are paying. And.
Sarah Aloisi (33:02) One cigna claim paid.
Deanna Purchiaroni (33:07) Which is the one that she’s not even enrolled with. They denied her because she didn’t have a license.
Vanessa Persha (33:16) This is very odd. They may have paid like an out of network claim.
Sarah Aloisi (33:29) Here’s, another one, the supervision paid, the supervision is paying, but the direct therapy is not paying.
Deanna Purchiaroni (34:02) Okay. Well, I’ll email the provider, and I’ll ask.
Deanna Purchiaroni (34:09) Her to look at those tasks too. Okay?
Vanessa Persha (34:13) I mean, oh, you said you already looked on the board and she doesn’t have one, right? I was saying maybe she just did it on her own, and that’s why the other payers are picking it up through a verification somewhere, but, okay.
Deanna Purchiaroni (34:25) Yeah, yeah. She’s not looking up all.
Vanessa Persha (34:27) Right. And then if you guys want, I’ll keep monitoring it, I can keep this one open just so that as soon as that license comes through, we can unlock that evernorth New Jersey enrollment? Okay. Oh, here’s on the agenda. This is where I saw something about ash. You had mentioned that. Okay. Trying to enroll through ash for this provider. Okay? I’ll take that back and look at the process with them. Michael stortz, I had this on here. I haven’t had a chance to check yet and see if you all had responded, but I think this was missing a copy of his board certification. We should be.
Sarah Aloisi (35:09) Enrolling with New Jersey medicaid.
Vanessa Persha (35:13) Say that again?
Sarah Aloisi (35:17) We shouldn’t be enrolling with New Jersey medicaid.
Vanessa Persha (35:20) I’m so sorry, North Carolina medicaid. Oh, okay. Apologies. Yeah. I hadn’t flagged on here for that as well, but wasn’t sure. Let’s see. Oh, it’s a Dea. Sorry, let me go check.
Vanessa Persha (35:54) He’s for, so he’s both because he’s an NP. So we need the supervising Dea for Suzanne gohadengadi, and then we need his board certification.
Deanna Purchiaroni (36:06) Yeah. And I believe all those with the orange highlight.
Deanna Purchiaroni (36:16) Are going to be on hold because dr go does not have a North Carolina Dea and it’s requested in medallion. Yes. So.
Vanessa Persha (36:24) But if you guys can simultaneously grab the copy of his board cert and attach it in there when her Dea is issued, then his board cert copy won’t be a blocker to submitting his application. Okay?
Deanna Purchiaroni (36:39) Are you asking for like the, his pediatric nursing, his most?
Vanessa Persha (36:46) Relevant certification?
Deanna Purchiaroni (36:49) It looks like that’s in there under his certification section.
Vanessa Persha (36:54) With a copy of it.
Vanessa Persha (37:03) Oh, yes. It was looks like it was just added at the end of March. Okay. I will tell them to mark that test complete. Actually, I will mark it, complete myself while I’m in here.
Vanessa Persha (37:39) It’s the PC. What is it? Pcnb?
Deanna Purchiaroni (37:47) Encb. Okay.
Vanessa Persha (38:04) Okay. I closed the task and then you’ll get another task for the Dea, but we’ll at least know that. So those applications cannot be submitted without the supervising Dea. So I don’t want you guys to worry about the trainings expiring because the training task won’t come until we actually submit the application. So there’s no concerns there with the training tasks expiring… all right? For.
Deanna Purchiaroni (38:36) The other providers, I know I was going to send out. I keep getting mixed up between all the medicates. Sarah, we are still needing to mass email all North Carolina providers that a training task is going to be assigned to them, correct?
Vanessa Persha (38:57) I, it’s too late because.
Deanna Purchiaroni (39:01) they only have two weeks.
Vanessa Persha (39:02) To complete the training. And I,
Deanna Purchiaroni (39:04) think, did we talk about last week? Vanessa, those providers were then going to get the task again and you were going to let me know, so I could give providers a heads up.
Vanessa Persha (39:14) Yes. So, let me go. Look. There were eight providers in total, which these ones here that I flagged for you. Let me go. I think they just resubmitted those apps, but let me go, look really quickly.
Deanna Purchiaroni (39:48) I have an email drafted, but it’s for 11 providers.
Vanessa Persha (39:58) So, just, okay.
Deanna Purchiaroni (40:00) So just left with real.
Vanessa Persha (40:02) Yeah.
Vanessa Persha (40:33) Actually looks like… these were just resubmitted two days ago. The tasks, let me see. No. The application itself. Let me see here. Did we get that email yet?
Vanessa Persha (41:04) Looks like we haven’t received the email yet for the training tasks or for us to create the training tasks. So, we’ve just gotten the confirmation that the application has been resubmitted. So as soon as those emails start coming back from North Carolina medicaid, we can create the tasks for them. But if you do want to send a proactive email to those eight providers and just let them know a task will be coming. Okay? So.
Deanna Purchiaroni (41:35) I can just send that today and just tell them heads up,
Vanessa Persha (41:38) Okay. Yeah.
Vanessa Persha (41:47) And then I’ll do another column here and update where we are as of today on all these providers. I think we’ve had a couple move through to a completed status since last week. So I’ll update that there. Okay? And then go back up. Where were we here? Cigna, New Jersey. We’re going to take a look at that one for Laura burek. I wanted to confirm. I remember you said Laura burek specifically was going to be used in that dual capacity for multiple states. Did you have any other providers that were going to be in that same category… where they’re an SLP for some groups and a bcba for others… there is?
Deanna Purchiaroni (42:41) Another provider?
Deanna Purchiaroni (42:46) Oh, gosh. I can’t think of who it is. I know that dr Goh has bcba and MD. Okay. So… yeah, I’ll have to think of the other provider.
Vanessa Persha (43:03) Okay.
Vanessa Persha (43:11) So what I did was I opened a request with our epd team to update our request modal, so that it offers an option for you to input specialty that you’re requesting. I asked for them to put primary secondary, and then like alternate specialty like some way to designate because I’ve shared like this isn’t just a unique issue to cortica. Like, right? We have providers that may operate in a PCP status at one group as an internal medicine. And then they’re a cardiologist under another group as a specialist. And so that’s not a problem that’s unique to cortica. It impacts all customers. So I did ask if they can put that on their roadmap as like an expedited enhancement to the platform so that you don’t have to manually track it in tasks. And the agents are very clear how they should be enrolling those providers. So that would be our solution there rather than creating unique payer directory and project plans and all of that. So I’ll keep you posted on where epd is on rolling out that enhancement.
Deanna Purchiaroni (44:24) Okay. Yeah. But hopefully that can be done soon because I know Laura is in process for licensing for bcba and SLP in every single state that we’re in. So there’s going to be many more requests that.
Vanessa Persha (44:39) Are using?
Deanna Purchiaroni (44:40) Both licenses. Yeah, all.
Vanessa Persha (44:42) Right. I’ll see how quickly we can get that expedited in the meantime, just keep doing what you’re doing in the comment section, just stating to enroll her as bcba instead of SLP. Okay. Amy provenzano. Actually, we can cancel this one. This was Sarah. You went through and stopped her lines. They did advise that for North Carolina medicaid… they won’t support a Dea waiver for Suzanne Goh, until her actual Dea comes in. So there is no need for a template per SE. There. We just have to wait until she gets her Dea.
Vanessa Persha (45:38) The cortica healthcare group demo update for California medicaid. I clarified with the team that there actually is not an email they’ve been trying to send you. Deanna, the task was a little bit confusing. They were stating that there was a portal created utilizing your email address. And so they, I think it’s the pave portal. And so there’s action that they’re asking for you to take in that task, using your email as the login. And we can look at… that in real time. Let me just go.
Deanna Purchiaroni (46:21) So, I already have a login using my own email. Are you saying that they also created a login with my email? I?
Vanessa Persha (46:28) Don’t think so. I think they were just directing you to use that. Like they identified that was the email address associated with the account and they were asking you to log in and take some kind of action there. Let me just go look and see if I can pull it… group.
Vanessa Persha (47:24) Okay. So, application atn number, basically, it’s saying it’s pending an admin signature. So they’re asking you to log into the portal and sign off on that application?
Deanna Purchiaroni (47:50) Okay. I can go in and look at that.
Vanessa Persha (47:53) Is that something we ought to be doing?
Deanna Purchiaroni (47:56) Yeah. Sarah didn’t you give access to Brianna to the pave portal to sign off on things Brianna?
Vanessa Persha (48:03) Signed.
Deanna Purchiaroni (48:03) Cbhi.
Sarah Aloisi (48:08) And chi… I think I sent to her to sign, but she did… not receive it. I don’t think I followed up with her. So, yeah.
Deanna Purchiaroni (48:24) It looks like this is for chi… let’s.
Sarah Aloisi (48:29) Look at it together. Next time we talk… okay?
Vanessa Persha (48:37) Do you want me to take that one off of our agenda and you guys will take a look at it or just leave it on here?
Deanna Purchiaroni (48:43) Leave it on there, just so I can remember to do it. Okay. It’s a, sorry, it’s a group application that needs to be signed.
Vanessa Persha (48:53) It’s a group demographic update, but for some reason, it looks like it’s asking for like an attestation or a sign off on ownership information. So, I don’t know if it’s this is just something that they’re doing as like a hey, confirm that this is still accurate because it’s all it’s.
Sarah Aloisi (49:12) all messed up in there. Okay?
Deanna Purchiaroni (49:14) It’s really bad. I’m not finding it, Sarah, maybe we can look at it together.
Sarah Aloisi (49:17) Yeah. Let’s look at it together because I, we might have to call. Okay? And then.
Vanessa Persha (49:23) I’m going to add the application number in here for you so that you can reference that without digging through medallion. Okay. Marley chang, I marked that complete. We confirmed last week. She does have a compact license doesn’t need anything there. Fallon caqh emails, Sarah and Deanna, you guys were going to work on that one kind of offline to investigate? Do you want me to mark it complete until you figure out if it, if there is something we need to action?
Sarah Aloisi (50:02) Can you keep it so we can remember? I did email them yesterday?
Vanessa Persha (50:05) Okay. Sure. Not a problem. Your caqh updates for your Coi, renewals are complete. So, I marked that one complete… gainwell application denials. This was another one you ladies were going to look at together. Yeah.
Sarah Aloisi (50:22) I emailed them also yesterday. Okay?
Vanessa Persha (50:26) Perfect. I’ll leave that one on there as well. Brenda. Rodriguez. I did see that the team submitted a specialty update to the payer on 415, so we can try to get that specialty updated and stop those billing issues you guys are having… the support at medallion co, closed that out but just wanted to confirm or clarify the support at medallion co email is no longer being used. So, all of your support emails should go through that help at medallion co… North Carolina medicating training task. I marked this complete on our agenda since we’re tracking it on the separate tab there, so we can continue to monitor those for those eight providers when they come due the ever north Arizona three on hold lines. I was going to mark this complete because we have taken action on it, but let me know if you want me to just leave this open… broadly until we get that full audit or able to resolve what’s going on with ever north and cigna?
Sarah Aloisi (51:44) Yeah, I think we should keep, we should just,
Vanessa Persha (51:46) keep it open. Keep it. Yeah. Okay. Arizona medicaid domain transfers. I think we can, you guys have taken ownership of all of those at this point. We can go ahead and cancel that one out. Mariah Baldwin, uhc enrollment. Let me go, take a look at the incident. I apologize. I didn’t grab the update on this one before our call.
Deanna Purchiaroni (52:13) I do believe that it is in process finally. Oh.
Vanessa Persha (52:17) Perfect. Okay.
Vanessa Persha (52:24) Let me lay my eyes on it because I trust but verify lately. Oh, okay.
Deanna Purchiaroni (52:35) Oh, they made a note on April ninth saying that it needs to be resubmitted. It doesn’t look like they’ve shown that they have.
Vanessa Persha (52:45) Actually submitted it. Okay. I know that they are onboarding additional resources. As I mentioned in the cap discussion, like we’ve identified some capacity constraints there. So, they are actively onboarding new agents to help support your account. They did share. We may see a slight dip in movement for a little while they’re onboarding, but reassuring that we are pulling in resources to help get you guys caught up.
Vanessa Persha (53:22) Okay. Haley masterson. Her app was resubmitted. Let me just see where she’s at.
Vanessa Persha (53:43) This is her, uhc… or something. Looks like that one’s been completed. It was completed on four six.
Vanessa Persha (54:08) And then I’m… going to close this one out for the North Carolina medicaid?
Vanessa Persha (54:17) Provider email preferences. Did I, we didn’t actually speak to this during this particular meeting. When I put the update on here, have you had a chance to review that? Our TSM team confirmed? They cannot do a bulk update to… give specific email preferences. It’s like an all or nothing. So they either turn them all off or they turn them all on. They can’t do a bulk update where we specify specific alerts to keep on. So.
Deanna Purchiaroni (54:50) Unfortunately, it?
Vanessa Persha (54:52) Would have to be manual at this point, but we did submit an enhancement request to epd to see if this was a future enhancement. They can roll out. Okay? And then, uhc enrollments, we’re continuing to monitor those. I think you and I have a tab here. I need to update some notes. Oh, I did add some notes here. So, revalidation line has been reopened for dr Sarabi koul, and the app is being resubmitted. Mark barros, I flagged here. There’s. Actually not a PE request in medallion for him for uhc?
Deanna Purchiaroni (55:37) Okay. I’ll go through and look at your notes and I can add to it. Okay, perfect. Really quickly before I know we only have a couple minutes left. I wanted to bring up. I know, I believe Sarah emailed you about this, but for pccn… enrollment, it’s not good. Yeah, medallion just continues to email the wrong person. They follow up with the wrong person specifically provider, Deborah, rosenzwig.
Deanna Purchiaroni (56:11) like they’re just straight up, not even following the enrollment steps. They’re emailing the wrong person at pccn and saying like this is a request to enroll the provider, and they’re not even including any of the application that like or W9 like not including any of the enrollment items that they need. And then… Deborah at pccn will respond saying like, I don’t have, this is not the provider type that I work on. And the medallion updates the note saying this is still in process in progress. It’s like, no, it’s not. The pccn said that they, you’re submitting it to the wrong person. It’s not truly in progress. This has been requested. I believe it was August and it still has not been sent to the correct person. When Deborah has responded multiple times saying you’re not submitting it to the right contact?
Vanessa Persha (57:06) Yeah, no, I totally understand your frustration there. I mean, she asked me to do it. Okay. Do you want me to flip Deborah’s into client owned so you can maintain at least? Yeah, I.
Deanna Purchiaroni (57:22) think for this provider, I’ll just submit all the info. But, okay, I mean, ccn has reached out to us saying just how like fed up they are that medallion continues like it’s like they’re sending follow ups to the same person when that person responded saying you haven’t even submitted the.
Vanessa Persha (57:39) Application?
Deanna Purchiaroni (57:41) Yeah. And then two weeks later, medallion will be like following up on this and she’s like again, you haven’t even submitted the application? Yeah. So then they’re getting frustrated. Yeah, yeah.
Vanessa Persha (57:50) I totally understand that frustration there even, you know, both on your side and the payr side, you know, I’ve gone through that process with them. I can’t even tell you how many times every time I get an email, I’m like let’s revisit this so we can understand what’s happening here. We have already flagged pccn. Like once you shared that email with us, we’ve now flagged pccn to go through 100 percent QC. So now, any enrollments before they’re submitted or anything that’s been resubmitted is going to go through QC and QA. So let me partner with the quality team to understand if they’ve started that yet, where they are with it, what the findings are. But just to give you reassurance that this payr has been flagged for 100 percent audit moving forward. So we won’t see the ongoing issues with sending emails to the incorrect rep at pccn. Okay. Yeah, I.
Deanna Purchiaroni (58:51) Think for pccn, it really needs to be checked. The enrollment is being done correctly. But also just like a second thing is I feel like that’s something that we see constantly is medallion sending that follow up email, the payer responding to that email. And then two weeks later medallion sending another follow up email and not even looking at or reading or responding to what the payer replied to medallion.
Vanessa Persha (59:14) Yeah. And I.
Deanna Purchiaroni (59:15) feel like that would also have like fixed the situation if they saw pccn responding saying what was needed instead of just following up?
Vanessa Persha (59:25) Again, yep. So part of our QC program, both QC and QA, is that the agents who are working on the QC and QA? They’re going through the mailbox and they’re looking to see, has the payer reached out about this? Have they, you know, provided some type of response? And the agent just is like not even acknowledging. And so those are things that are being addressed and captured in those qas and QCS. So we shouldn’t see that moving forward especially for pccn. Okay. I’m going to just flipping this to client owned before I forget.
Vanessa Persha (60:16) And then I will add a tab here for us, Deanna, to monitor your pccn so we can keep track of where we’re at with the quality, review any new apps that come through and we can keep tabs on those. Okay? And then I know we are over time here, but I will do another check in on Laura burek’s enrollments and put some updates here.
Vanessa Persha (60:38) I think we’ve had a few things move through as approved in the last week. So I’ll go in and update that tab there. But anything else you ladies want to address really quickly before we wrap up?
Deanna Purchiaroni (60:51) I don’t have anything.
Vanessa Persha (60:53) Okay, great. Well, I just want to thank you both for your partnership here. I know we’re riding the struggle bus. It seems a lot lately but I do appreciate your patience and providing honest feedback so that we can make those corrections internally. So, thank you.
Deanna Purchiaroni (61:08) Okay. Thank you. Have a good day, you.
Vanessa Persha (61:11) Too. Ladies. Bye bye bye.