Transcript
Jack Schell (00:00) you’re done. Hey?
Genevieve Seney (00:01) How are you?
Jack Schell (00:03) I’m okay. A lot of client calls today, so a lot of follow up to take care of too. And then… it’s just excited for Sean one.
Genevieve Seney (00:18) Of those days. Yeah. Also, you were out Monday, so short weeks, I feel like always. Yeah, yeah, you were out Monday, right? Yeah.
Jack Schell (00:26) Yeah. I mean, I was there was a travel day, so I was kind of doing things anyway like, but yeah, all right. He’s here.
Genevieve Seney (00:36) Sounds good.
Jack Schell (00:37) I’m gonna let him in. Yeah. Oh… it said he was here and then it dropped. Okay. Here we go.
Jack Schell (00:57) Hey, Sean. Hi there, hey.
Genevieve Seney (01:00) Hey, good afternoon, Sean. How are you?
Sean Mercado (01:03) Hey, I’m doing all right. Sorry, I’m kind of in transit, but I… was also having a little difficulty getting on the zoom. So, no.
Jack Schell (01:14) Worries. Yeah, I saw you were in the waiting room and then went to let you in and you dropped and then you came back. So, apologies for that. Okay. No worries. Yeah, no worries. All right. How are you all doing? Doing? All right. Apologies for having to reschedule from last week. I just unexpectedly was out but yeah, doing well, hope you’re doing.
Sean Mercado (01:36) Well, are you doing okay, Jay?
Jack Schell (01:38) Yeah, no, I’m fine. It was just a funny story for another time but not really funny because it sent me to urgent care. So anyway, yes, I hope that you’re doing well. I know that I don’t think that you and Jed have connected live before and I know that you’ve connected with our head of, yeah, I know you’ve connected with our head of account management, gabby, but I actually directly report to Jen and then gabby obviously oversees all of account management. So Jen was able to join today and Jen, I’ll let you introduce yourself.
Genevieve Seney (02:16) Yeah, yeah, it’s good to meet you, Sean. Apologies you’re in transit. Hopefully, we’re not catching you at a bad time, but it’s a pleasure to meet you as Jack mentioned. I am a manager on the account management side, work very closely with gab. So, yeah, just here to support any way I can and again, good to meet you.
Jack Schell (02:34) Great. Yeah, nice.
Sean Mercado (02:36) To meet you too, Jen. You know, just a way introduction. I lead all the managed care and credentialing efforts at afc.
Genevieve Seney (02:44) Perfect. Great.
Sean Mercado (02:46) Awesome.
Jack Schell (02:47) And so Sean, I know that you had raised to me wanting to talk more specifically about the Mckenna smith… enrollment and, you know, I caught Jen up to speed on that.
Jack Schell (03:01) I know I let you know that I would go back to our team and kind of like do a bit of an investigation on like what the history with that request was that’s right? Yeah. And I can share with you our findings and just like the status and like the timeline, do you want to start there? Yeah, we can start there. Okay. All right. So when we went back and we looked at the history of the enrollment. Well, first of all, this issue is that Mckenna smith was enrolled with medicaid at Massachusetts as orp led to denials on your end and an inability to bill. So then, you know, now current state after resolution, Mckenna’s properly enrolled as fee for service, which hopefully would ensure no future denials. You can bill appropriately. When we went back. And we looked at the Mckenna smith record, it looks like Mckenna smith joined medallion as an afc urgent care provider in July of 20 24. Their mass medicaid enrollment was linked to afc urgent care, and that existing enrollment was as orp. And then it was in December when Aiden raised to us that Mckenna was enrolled as orp with mass medicaid and asked that we get a new enrollment going to correct it. An application was submitted the next day. And then we went through and completed the new enrollment to ensure that Mckenna was enrolled as fee for service. So as far as the correction, we handled the new enrollment request and correctly enrolled Mckenna as fee for service. And ultimately, it seems that the originating mass medicaid enrollment was as orp when initially brought over to medallion, which is something which is ultimately what needed to be corrected. Okay. Yes. Okay. So this was the timeline and we made the correction, curious questions and put.
Jack Schell (05:28) together just the timeline for the Alabama medicaid, if we wanted to talk about that too. Yeah.
Sean Mercado (05:32) Yeah. I mean, we don’t get that too. Okay. I mean, really, you know, I have a little different history on this, okay? And, you know, I’ll just put up kind of like, I think we just put up both histories and just kind of like work through this just from like a workflow perspective. How does this go back and forth? Like, I mean, like I’m sure this happens, you know, like it’s human error sometimes. So just walk me through kind of like what the workflow is when there is like some sort of resolution that’s needed, and like let’s just say medallion, you know, screwed up, right? How do you work with clients to resolve that? Because I mean, this is like the first time that I’m you know, working on this with y’all, so I just want to make sure that, you know, we’re working together and solving this.
Jack Schell (06:25) Yeah. Well, so, in this scenario, of course, it was raised to our team by your team that there was, there must have been some error because of denials and it was identified. And so once the issue was brought to us, obviously, we proposed the resolution which was to submit a new enrollment in order to move them to fee for service, that was per mass medicaid. And that was the work that Amy led. And so in this scenario, it was reactive to denials that you were receiving. And typically, I mean that’s how, I mean that unfortunately was how we were notified that this was not enrolled correctly from the start. In other scenarios, you know, we do have a specialist team that will be working on active enrollment requests and we’ll enroll based on the project plan that we have in place for afc. So our specialist team references specific parameters or processes that you might have in place for different payers or known processes to follow. If the project plan doesn’t have specific like specific unique processes or nuances from your team, then we will follow like standard application processes for a pair. But yeah, does that answer your question?
Sean Mercado (07:52) Kind of Jen, did you, were you gonna say something too?
Genevieve Seney (07:57) No. Well, I was just gonna say like, I think, you know, I obviously, in the event that, right? Like if there is a consumption request, if we process something incorrectly, if we, for whatever reason didn’t submit an application on time, like you guys have obviously slas in your contract, right? The 10 day business submission, things like that we’re adhered to, then we would talk through like things like consumption credit or if we had to obviously give you guys back credit on a request that was processed incorrectly. So, those conversations like we’re more than happy to talk through and look at if there’s anything like outside of SLA, I think like in this example, right? Like the provider was already previously enrolled under orp, and we will just process requests as they come in. So the fact that the request was submitted and we went ahead and processed it, like we don’t have any insight obviously into your billing and how you guys are billing. So that is like completely separate from us.
Sean Mercado (08:56) Okay. So so just, I mean let’s just play, you know, hypothetical. So if you have a client and, you know, enrolled a provider incorrectly, there’s all these denials and it’s stacked up over time and then it’s fixed, but they can’t rebuild y’all, don’t work with a client to like help them out with that monetary loss.
Genevieve Seney (09:23) No, no, we don’t do any, anything related to like denials or claims. There’s a lot of factors that go into that in terms of your billing. So we don’t have anything tying it to us, right? Like we’re just a service that we’re processing your requests, but we don’t do any monetary sort of like damages in terms of your billing or your claims denials. Did?
Sean Mercado (09:41) You guys not like carry like errors and omissions, insurance or anything?
Genevieve Seney (09:47) That, that’s definitely above my pay grade, but we, everything in terms of like liability and things like that can be found in the msa.
Sean Mercado (10:02) So, I mean, obviously, you know, the issue with Mckenna smith is like there’s all this money, all right. And it’s lost due to an, you know, an enrollment issue, and let’s say, you know, well, I mean, if she was orp, and then you guys just, you know, loaded it again, you.
Jack Schell (10:27) Know.
Sean Mercado (10:28) And, and maybe someone should have rang the alarm sooner that we were experiencing that, but.
Sean Mercado (10:42) You know… we entrust that medallion will load the providers appropriately that we can bill appropriately. I mean, that’s why we guys use you as a, as our credentialing vendor, right? So this is just, I mean, it’s a big mess, right? So, you know, I want to work with y’all because, you know, on like a resolution here because, you know, at the end of the day, it was a credentialing error.
Genevieve Seney (11:19) So, I mean, if.
Sean Mercado (11:21) you don’t have a resolution today, that’s fine, but, you know, it’s… a monetary loss of the practice, right? And it’s a monetary loss to aoc, right? So, and it was something that we couldn’t control.
Genevieve Seney (11:39) Yeah, I think like from our standpoint, since it was a linkage, we don’t have, there was no reason for us to change that from orp to fee for service.
Genevieve Seney (11:47) We were just linking it to the enrollment that already existed. And so I think like that’s the disconnect maybe from our side and I maybe just want to be clear on that point, well.
Sean Mercado (11:59) I would just if you wouldn’t mind, you know, when you send this slide deck out, put that in writing, yep, because, you know, it’s just like I, you know, everyone’s got a boss. I got a, you know, I got a, she has my boss, right? And, you know, he’s a big numbers Guy and he wants to understand exactly, you know, what happened. So, you know, I appreciate that. And then, you know, I would just like to kind of like, you know, we’ll go back through, we’ll you know, get our notes and then we’ll compare maybe in the next meeting and we can have that deeper discussion there.
Genevieve Seney (12:40) Yeah, absolutely. We welcome that. Agreed. Like we’re not trying to hide anything. Everything is in the notes and if there’s anything else we need to talk through, we’re definitely happy to do it.
Sean Mercado (12:51) Great, great. Awesome. And then you want to do Alabama medicaid then?
Jack Schell (12:56) Yeah. I wasn’t sure if you wanted to talk about that too, but I just know that Amy’s been working on it.
Jack Schell (13:03) So, I just summarized what you likely already know in this slide which was that, you know, the Alabama medicaid enrollments were being completed under multiple group medicaid ids and for your processes, sounds like they need to be rolled under just one. Ultimately, that was at the direction of Alabama medicaid, that was created. But once we, once it was raised to us, obviously, we put in to plan that what Amy’s worked on and with regard to the relevant demographic updates to get them all linked under, the single group id. So I.
Sean Mercado (13:45) just.
Jack Schell (13:46) summarized that here for you in terms of like the action that we took collaboratively to, correct that. Yeah, I.
Sean Mercado (13:56) don’t see a timeline on this and I don’t know if this has been completed by Amy. Has,, it, has all of, this whole issue resolved now?
Jack Schell (14:06) Well, all of the corrections, all of the demographic updates that were required were requested pretty immediately. And then she was just following up on them to make sure that they were going through process. She told me… the end of last week, there were only three providers that were still processing for this.
Sean Mercado (14:31) It’d be helpful to kind of like understand, you know, the different challenges of providers and how, you know, quickly they were switched.
Genevieve Seney (14:41) Yeah, we could get your readout on that, that’d.
Sean Mercado (14:44) be helpful. Just, I need to compare it to what we’re seeing… on the RCM side. Yeah, absolutely.
Jack Schell (14:59) But as far as the Alabama medicaid? Yeah, I, in terms of how we originated there, again, we look to the project plan first for any specific nuance or requirements that afc might have for specific types of enrollments, we followed the standard medicaid practice there that we were communicated, but I understand that for your billing purposes, it was required to be under one, so that’s where we started and set forth that plan for the updates. And I’ll touch base with Amy to see if those three have wrapped up since the end of last week?
Sean Mercado (15:37) Yeah. And it’d be just great to kind of detail that out that thought process and that workflow for us. Okay? So, and then in that communication.
Jack Schell (15:49) Like how the corrections were made?
Sean Mercado (15:52) Yeah. Okay.
Sean Mercado (15:59) Great. And then, Jack, I know we haven’t talked about consumption yet, but kind of where are we right now? Do you have that like ready or can you just kind of give me like, are we on track or? Yeah?
Jack Schell (16:15) I did. Let me, I just let me look in this deck because I know I had prepared for us to have a call but we still have to schedule that.
Sean Mercado (16:23) Yeah.
Jack Schell (16:26) So, as of two Ish, weeks ago, you were about 50 percent consumed. I can pull up your usage report, which just as a reminder you do, you can also review the consumption in your account… if so that you’re not waiting on me, but in our meetings, our monthly meetings.
Sean Mercado (16:49) Yeah, yeah, yeah. But Jack, I spend all my time in the medallion platform because I just got time like that. Well.
Jack Schell (16:58) Yeah, I’m happy to have a monthly touchpoint with you and would love to get that set up so that I can do a regular consumption readout for you. Yeah. Maybe anyway, you have about like 40 percent, you’ve got 107,107, 834 dollars remaining in consumption. So you’re over 50 percent consumed.
Sean Mercado (17:25) Okay. And then is, as part of that consumption, did you guys apply like Alabama medicaid and the Mckenna smith efforts within that 50 percent?
Jack Schell (17:38) The Mckenna smith request went through in December. So that would not be a part of this current term. And then the request required for the Alabama medicaid updates would be demographic updates, which are part of this consumption.
Sean Mercado (18:00) Okay. And then I would just like to know how, like what percentage of the like, how, like if you could just, you know, detail the consumption that was allocated for these initiatives? Sure. Yeah, I’m just trying to understand like how big like, you know, we have a lot of providers in Alabama, right? So, you know, is, you know, was it 30 percent of that 50 percent consumption? Just this initiative?
Jack Schell (18:31) No. So, I’m just trying to understand based on quick math, no, but I can break it down for you.
Sean Mercado (18:37) Okay. So, let’s get the consumption meeting scheduled. Do you have your calendar in front of you? Yep. Okay. Cool. My Wednesday, next Wednesday. The 20 second is wide open in the afternoon. Okay?
Jack Schell (18:58) Okay. You’re still in mountain right now or are you traveling?
Sean Mercado (19:05) Still in mountain? Okay?
Jack Schell (19:15) Can you do three… PM mountain? You said afternoon, correct?
Sean Mercado (19:24) Yeah, yeah. Three PM mountain. I can do that. Okay? So.
Jack Schell (19:35) And we’ll use the time to walk through consumption specifically, I will break out the requests that were required for the Alabama medicaid corrections. Yeah.
Sean Mercado (19:49) And then I would just what I would like. I think what’s going to be helpful to me is just going to be, you know, like based on kind of the monthly consumption. And I would, you know, just like, you know, initiatives aside, kind of like how are we trending? You know, for, you know, kind of the middle of the year, you know, when either, you know, we buy more consumption… I just want to understand kind of like where we’re at today, so we can plan for like kind of the rest of the year?
Jack Schell (20:22) Yeah, definitely want to support you with planning for that. I know when we went into this next term, the idea was to have enough volume to get through June and that you’d be making a decision by June as to whether to continue with medallion or not. Like, is there additional information you need from us or conversations we should be having to support that? Well?
Sean Mercado (20:45) I got two issues with Mckenna smith and this whole Alabama medicaid thing. First, I’d like to get past us and then, you know, then… I think it’s probably appropriate to talk if, you know, if we’re still happy. So let’s… focus on those two first and then go from there.
Jack Schell (21:09) Sounds good. Jen’s out next week. So it’ll just be you and I on Wednesday. Okay? Hopefully.
Sean Mercado (21:17) Jen’s, doing some fun… yes.
Genevieve Seney (21:21) I’m going to Hawaii for the first time super excited. Oh, which island… everyone keeps asking this? I think oahu and Maui.
Jack Schell (21:30) Nice. Oh, you’re doing both? I didn’t realize you were doing both. Yeah.
Genevieve Seney (21:33) I have a friend that lives out there been trying to get to. So, yeah, hopefully we can.
Sean Mercado (21:39) Enjoy it. Maui’s amazing. Walea is, really, fun. So, there’s a lot of, really nice hotels and there’s like an outdoor shopping area that’s, really nice. Oh, cool. How.
Genevieve Seney (21:54) Do I spell walea?
Sean Mercado (21:57) Walea? I got it. I got it.
Genevieve Seney (22:00) Googled it. We’re good, awesome.
Sean Mercado (22:02) And then there’s mama’s Fish house. You got to go hit that up, but you need a res, and I don’t know usually they book out once in advance, but, you know, if it’s just two of y’all, you know, maybe you guys can slip in or, you know, a local. So maybe they can, you know, fix?
Genevieve Seney (22:21) You up backroads, yeah, for sure. I appreciate the recommendation. Thank you. It was great meeting you.
Sean Mercado (22:27) Yeah. Well, safe travels. Thanks Jack. Thanks Jim. You guys have a good one. All right. Bye bye.