Weekly Notes

SFCASE: 01525969
Facility Name:Hayward Convalescent Hospital

Invoice Number: 173557
Billing Period: 07/09/2023 - 07/15/2023
Disputed Within Terms (Yes/No): YES
Total Invoice Adjustments:-$248.00
Total Disputed Amount (ABV):$248.00
Findings (list per disputed shift):
07/09/2023, CNA Lisette Manzambi,PM

Reason : HCF Disputed this shift because of missing CDPH530.
07/09/2023, CNA Veronica Louise Branch, NOC

Reason: SLD
Shift ID:64a737ab5bacb101b8c8076d
07/13/2023, CNA Minette Lang, PM
Reason: SLD
Shift ID:649a1d655dda0501b84445fd
07/14/2023, CNA Deanna Markel, NOC
Reason: SLD
Shift ID : 649a1d727eefbe01b7f94b4d
HCF ID : 60073758bab29a00165bcbcf
Conclusion:
Actioned on CBH App (Yes/No):
Charge Breakdown (N/A if retracted or rejected for handling):
https://docs.google.com/spreadsheets/d/1ZiV4XYvKEjZzfmUZo553JKFyJiy5PfAzQGyxtq_4WZc
/edit?usp=sharing
Invoice Regenerated (Yes/No): YES |173995 07/19/23 10:05:08 am
Informed Customer (Yes/No/Auto): YES
HCF(Hayward Convalescent Hospital) disputed this shift and provided work hours,
Since this is AAD im resolving this in favor of the HCF.
24.64
16
14.08
_________________________________________
Facility Name: Whittier Pacific Care Center
Billing Period:04/23/2023 - 04/29/2023
Disputed Within Terms (Yes/No): NO
Total Invoice Adjustments:
Total Disputed Amount (ABV):
HCF file a dispute for these shift
04/28/2023, CNA Karina Pacheco, AM

04/28/2023, CNA Letresa Young, NOC
Upon checking both disputed shift provided CDPH530 with signed, HCF did not clarify
if the signatory was unauthorized.
For confirmation is this for rejection or i will approve in favor of HCF?
Conclusion:
Actioned on CBH App (Yes/No): YES
Invoice Regenerated (Yes/No):YES |
Informed Customer (Yes/No/Auto):YES
___________________________________________
sf 01526870
Facility Name:Whittier Pacific Care Center

Invoice Number:147462
Billing Period:04/23/2023 - 04/29/2023
Disputed Within Terms (Yes/No):NO

HCF Disputed these shifts due to no signature in their TS .
04/28/2023, CNA Karina Pacheco, AM
04/28/2023, CNA Letresa Young, NOC
Conclusion:
Zero out the charge for both disputed shifts via CBH app
AAD Eligible
Regenerate Invoice
Actioned on CBH App (Yes/No):YES
Charge Breakdown (N/A if retracted or rejected for
handling):https://docs.google.com/spreadsheets/d/1msVZpTEnuE2ld6NL-
kcUGV2jT60UrrrqvYJp9sXKs8Q/edit?usp=sharing
Invoice Regenerated (Yes/No): YES |174094
174094
07/19/23 4:07:30 pm
___________________________________________
SFCASE:
01527128
Facility Name: Marina Garden Nursing Center (bellaken Grp)

Billing Period:07/09/2023 - 07/15/2023
07/10/2023, CNA Diane Wilson, PM

Facility disputed this shift's request for a handwritten CDPH530; however, HCP did
have one that day that was digitally signed. Since the facility is on our list of
HCF Preference Facilities, HCF does not accept CDPH530 Forms that have been
digitally signed.
ZD Related Ticket #5637194
07/10/2023, CNA Mujidat Majasan, AM

Reason: SLD
07/10/2023, LVN / LPN Porshia Wynne, PM

Reason: SLD
07/15/2023, CNA Pamela Anne Estiaga, AM

Reason: SLD
Upon checking with the work hours that these three HCP work that day, Facility
billed correctly, However this case fall under AAD. will resolve in favor of the
Facility.
Conclusion:
AAD ELIGIBLE
Approve the disputes on BillTerms
Adjust the shift lengths on the calendar.
Zero out the charges for one disputed shift that does not have handwritten CDPH 530
on the calendar
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1BCec078blvtHFOke_daXyKxx4qd0tO9OR
JxbUaoVAUc/edit?usp=sharing
Invoice Regenerated (Yes/No):YES | 174115
HCF provided work hours.
Bonus Description: SLD

Bonus Reason : Upon checking the billed hours is correct, but the facility disputed
this case without any clarification in notes. this case falls under AAD resolved in
favor of facility.
Complete Shift Details: 07/15/2023, CNA Pamela Anne Estiaga, AM
Facility Name: Marina Garden Nursing Center (bellaken Grp)
Date: 07/15/2023
Type: SLD
___________________________________________
REGEN TIME : 07/20/23 2:52:21 pm

SFCASE: 01527513
Facility Name: Excel At Woodbury For Rehab And Nursing
Billing Period: 05/14/2023 - 05/20/2023
HCF disputes shifts
Upon checking the HCF billed correctly, HCF is also listed on our HCF Preference
list. They only pay in Increment of .25 to .75.
no zd related ticket.
since this case fall under AAD will resolve in favor of HCF.
05/16/2023, LVN / LPN Summer Williams, AM

05/19/2023, LVN / LPN Shanta Craig, PM
05/19/2023, LVN / LPN Nikeitha James, PM
Conclusion:
AAD Eligible
Regenerate Invoice
File Bonus Request 2023 Form
Adjust the shift length on the calendar.
handling):https://docs.google.com/spreadsheets/d/1A43WTJYqFfqTC7Ve3idfNbGP0XaXg8_wl
24ODa_b1vE/edit?usp=sharing
Invoice Regenerated (Yes/No): YES | 174129
Informed Customer (Yes/No/Auto): AUTO
___________________________________________
Template Bonus Request Excel At Woodbury For Rehab And Nursing | 06/03/2023, LVN /
LPN Miriam Marseille, AM | Shift Length Adjustment.
SFCASE: 01527518
Facility Name:Excel At Woodbury For Rehab And Nursing

Billing Period: 05/28/2023 - 06/03/2023
HCF dispute regarding
06/03/2023, LVN / LPN Miriam Marseille, AM
Upon checking the HCF billed correctly, Since this is AAD i will resolve this case
in favor of HCF .
Conclusion:
AAD Eligible
Regenerate Invoice
File Bonus Request 2023 Form
Actioned on CBH App (Yes/No):Yes
https://docs.google.com/spreadsheets/d/1KcFRjzjXnHSYPC-
Iil6VAkGBHuxcU_OmVIhvogBcxRk/edit?usp=sharing
Informed Customer (Yes/No/Auto): AUTO
07/20/23 5:02:47 pm
___________________________________________
Disputed invoice #171943 | Sutton Park Ctr For Nursing & Rehab
The facility provided timecards, corrected the shift length that is provided by the
facility.
Template Bonus Request 2023

Marina Garden Nursing Center (bellaken Grp)| 07/15/2023, CNA Pamela Anne Estiaga,
AM | Shift length adjustment
"07/14/2023, CNA Deanna Markel, NOC

HCF (Hayward Convalescent Hospital) disputed this shift and provided work hours,
since this is AAD I'm resolving this in favor of the HCF."
Adjusted Shift Pay (Billing Disputed Hours)

HCF Will not pay exceeding to 8hrs work shift.
Facility Name: Sutton Park Ctr For Nursing & Rehab

Billing Period: 07/02/2023 - 07/08/2023
HCF disputed these shifts upon checking the HCF provided employee time cards. the
time cards were adjusted to the correct shift length.
No ZD Related Ticket
07/02/2023, LVN / LPN Jasmine Livingston-still, AM

07/02/2023, LVN / LPN Monique Nation, AM
07/03/2023, LVN / LPN Marlyne Salomon, NOC
07/04/2023, LVN / LPN Christina Andreadis-romero, PM
07/04/2023, LVN / LPN Adewale Oladipo, PM
07/04/2023, LVN / LPN Monique Nation, NOC
07/05/2023, LVN / LPN Kahlia Hylton, AM
07/07/2023, LVN / LPN Christina Andreadis-romero, AM
For this HCP it is already corrected upon checking the time card provided by the
Facility.
07/05/2023, LVN / LPN Eleize Joyner, NOC
Conclusion:
AAD Eligible
Adjust the correct shift lenght on the calendar.
Approve Dispute on BT.
Submit Bonus Request 2023 Form
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1X6wiELrV7e9M8O7l9FyHHggYURLxP0nqf
r2dDzD_qrA/edit?usp=sharing
Invoice Regenerated (Yes/No):YES | 174167
SFCASE: 01526298
Template Bonus Request Excel At Woodbury For Rehab And Nursing | 06/03/2023, LVN /
LPN Miriam Marseille, AM | Shift Length Adjustment.
TIME OF REGEN: 07/21/23 12:32:22 pm
ALL LATE DISPUTE MUST BE REJECTED
___________________________________________
SF CASE: 01528240
Regen Time: 07/21/23 3:38:01 pm
Facility Name: Ark Healthcare And Rehabilitation At Branford Hills

Billing Period: 06/25/2023 - 07/01/2023
Total Invoice Adjustments: -$155.85
According to the facility, the worker had the opportunity to work; instead, the
worker wasted 4 hours and demanded a higher rate.
06/27/2023, CNA Keavon Rochester, AM, (Sent Home Charge)
Conclusion:
AAD Eligible
Regenerate Invoice
Toggle off the billable button of the late cancel on the calendar.

https://docs.google.com/spreadsheets/d/1tgD3oWB2ocxohZggRRNK7gjEOgbYHrCiKpebEdq5sy8
/edit?usp=sharing
___________________________________________
Facility Name:
Invoice Number:
Billing Period:
Disputed Within Terms (Yes/No):
Conclusion:
Invoice Regenerated (Yes/No):
Informed Customer (Yes/No/Auto):
___________________________________________
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
___________________________________________
Facility Name: San Leandro Healthcare Center

Billing Period: 07/09/2023 - 07/15/2023
Total Invoice Adjustments:0
Total Disputed Amount (ABV):0
07/14/2023, LVN / LPN Lanitra Chatman, NOC
Upon checking there is no clear provided clock in/out of this Professional.
Conclusion:
We tried reaching the facility via email and voice mail. Facilities don't respond.
In this case, we would reject it. EOD.
Actioned on CBH App (Yes/No): NO

https://docs.google.com/spreadsheets/d/1nPWooGpw1_H__IQQoLr8cimKx7ywWejFWaytyeLBQ-
s/edit?usp=sharing
Invoice Regenerated (Yes/No): NO
___________________________________________
Time of regene : 07/24/23 10:30:07 am
Facility Name: New Orange Hills

Billing Period: 05/01/2023 - 05/31/2023
Findings (list per disputed
The facility disputed this shift because there was no record of this HCP being sent
home.
Upon checking, HCP is not on our calendar to toggle of the billable button. Deleted
the line of the disputed shift on regeneration.
No zd related ticket
Resolved in favor of the facility.
shift):05/26/2023 LVN/LPN, Laquiesha Greene-topper, AM, (Sent Home, 56.00 x 4

hours)
Conclusion:
AAD Eligible
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1uKwoya_pb6RdFs1cwEDMbrVpqwopBFIWe
1FfrqjBGFI/edit?usp=sharing
Informed Customer (Yes/No/Auto): Yes
___________________________________________
SF CASE: 01529166
Facility Name:Paul House & Health Cr Center

Invoice Number: 06/11/2023 - 06/17/2023
Billing Period: 165050
Total Invoice Adjustments: -$2,682.34
Total Disputed Amount (ABV):$2,682.34
Facility disputed these shifts because these workers do unauthorized early clock-
ins and late punches,facility provided clock - in / out for the disputed shift,
checked if the facility was listed in our HCF preference list, the facility was
listed there, but there are no notes there. ,
No related ticket
DONE ADJUST SHIFT LENGTH

6474da2179e75701bb3c7706
06/11/2023, CNA Deja Dorsey, AM
13.09 TO 11.5
Done Adjust Shift Length

6474da37bb241201bc71996b
06/12/2023, CNA Briana Gordon, PM
13.09 TO 11.5

6474da3879e75701bb3c7eaf
06/12/2023, CNA Deja Dorsey, PM
13.07 TO 11.5

64809e978a927001b839bae7
06/12/2023, CNA T’shonda Davis, AM
12.67 TO 11.5

6480a06472d29601b98985b1
06/13/2023, CNA Alisa Robinson, AM
11.74 TO 11.5

64887f4510a4ee01be4db47b
06/13/2023, CNA Ifeanyi Chukwu, PM
13.65 TO 11.5

6474da745f0e2a01bcb0def4
12.74 TO 11.5

64887f701d080b01b71ece29
13.87 TO 11.5

6474da88bb241201bc71a9b3
06/15/2023, CNA Briana Gordon, AM
12.95 TO 11.5

64887f9167955901b7cd93a8
13.4 TO 11.5

648b1bc20218f001b882f835
13.01 TO 11.5

648768c038874e01b94b2eb0
06/16/2023, CNA Myeisha Potts, PM
12.49 TO 11.5

6487693aa3bb3401b60773b1
13.02 TO 11.5
Conclusion:
Approve the disputes on BillTerms.
Regenerate invoice
Adjust the shift lengths on the calendar
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1me2sZClLife0VFmscxeWAO4vKmP5YDN6C
ZsERqbmf_M/edit?usp=sharing
Invoice Regenerated (Yes/No): YES
sorry for late response i just take my 1hr break. it is now corrected ms jie. it is
___________________________________________
___________________________________________
Failed to provide CDPH530Form that the facility requires.
Ms. Jie can i resolved this in favor of the facility? if the professionals fail to
provide the CDPH530 that the facility requiring, also it is been 24hrs. SVT created
a ticket via zendesk trying to reach these professionals. found out they reply to
the thread but they did not send the CDPH530 Form.
153678
Please cc RegistryInvoiceSubmissions@rockporthc.com in any dispute emails.
Need to remind the facility about this dispute regarding these 3 professionals that
dont have CDPH530 Form
Facility Name: Burlingame Long Term Care

Billing Period:07/09/2023 - 07/15/2023
Total Invoice Adjustments: -$1,053.35
07/12/2023, LVN / LPN Olawunmi Dawodu, AM
07/14/2023, CNA Brianna Recinos, AM
07/15/2023, LVN / LPN Catherine Ortaleza, NOC
Reason : Missing CDPH530Form.
Upon checking, these two professionals do have CDPH530 attached. Also, this
facility is listed in our HCF Preference Under Rockport Child Facility.
This Professional does not have CDPH530.

07/12/2023, LVN / LPN Olawunmi Dawodu, AM
Seeking your assistance to email the facility if the provided CDPH530 of these
professionals are valid or not.
Conclusion:
Approve the disputes on BillTerms
Zero out the charge on the calendar
Submit Bonus request 2023 form
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1JTVunAkhGa9s_gUfUk4rR27C2Ld61VM7HFgh2r3BwMw
/edit?usp=sharing
___________________________________________
01529779
time of regen: 07/25/23 9:47:02 am
Facility Name: Claridge Operations Llc

Billing Period: 07/09/2023 - 07/15/2023
Total Disputed Amount (ABV): $1.20
Facility Disputed this shift and provided correct work hours of this Profesionals.
07/11/2023, CNA Jacqueline Gonzalez, AM
Since this is AAD resolved in favor of the facility.
Conclusion:
AAD Eligible
Regenerate Invoice
File bonus request 2023 Form
Approve the dispute on BillTerms
Adjust the shift length on the calendar

https://docs.google.com/spreadsheets/d/
1LOWRaI0LITaQl2z2cO4JE6tHiqH93idSBLb3hNIMTW4/edit?usp=sharing
_________________________________________
01529780
time of regen: 07/25/23 11:06:37 am
Facility Name: Heritage of Edina - Non Clinical

Billing Period: 07/16/2023 - 07/22/2023
07/18/2023, HOUSEKEEPER Vanessa Brannon, AM

07/19/2023, HOUSEKEEPER Vanessa Brannon, AM
Reason : SLD
The facility provided a clock in/out for this professional. Upon checking was no
timesheet available for the professional, I tried checking the zendesk and found
out that HCP provided a clock in / out.
ZD related ticket NO #5730348 / 5731821 / 5731942
since this is AAD , Resolved in favor of the facility.
Conclusion:
AAD Eligible
Approve the dispute on Billterms
File bonus request 2023 Form
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1FlUW0re6ubJW2oMuyv7uUEfBySvwfpJZj3E7UhYG9ms
/edit?usp=sharing
___________________________________________
Facility Name: Cupertino Healthcare & Wellness Center
Billing Period: 07/09/2023 - 07/15/2023
Disputed Within Terms (Yes/No): Yes
07/12/2023, LVN / LPN Tylette Cull, NOC

07/14/2023, LVN / LPN Jay Yoo, NOC
07/14/2023, RN Anthony Pippen Jr, NOC
Reason: Missing CDPH530 / Base Rate
Facility disputed these shifts upon checking

07/14/2023, LVN / LPN Jay Yoo, NOC
07/14/2023, RN Anthony Pippen Jr, NOC
No Zendesk Related Ticket
Conclusion:

Regenerate Invoice
Adjust the base charge based on faci
https://docs.google.com/spreadsheets/d/1STHenHsXlqGcrCUY0mqH5XQzKgAdBxBwRaClwf11PPg
/edit?usp=sharing
Invoice Regenerated (Yes/No): YES |
___________________________________________
The facility is already included in the bulk dispute that was sent July 7 credit
notes The amount to $45,838.66. the facility billed correctly for this.
Facility Name: Paul House & Health Cr Center

Billing Period: 06/18/2023 - 06/24/2023
Total Invoice Adjustments:0
Total Disputed Amount (ABV):00
06/18/2023, LVN / LPN Latasha Smith, AM

06/18/2023, CNA Briana Gordon, PM
06/18/2023, CNA T’shonda Davis, PM
06/20/2023, CNA Kala Johnson, PM
06/21/2023, CNA T’shonda Davis, AM
06/23/2023, CNA Gregory Wade, AM
Conclusion:
The facility is already included in the bulk dispute that was sent July 7 credit
notes The amount to $45,838.66. the facility billed correctly for this.
Actioned on CBH App (Yes/No): NO

https://docs.google.com/spreadsheets/d/1JLm-9ptPNNgZV4_NGzs1uzcw1XQLLHxj28Nv1J-
5Two/edit?usp=sharing
Invoice Regenerated (Yes/No): NO
Informed Customer (Yes/No/Auto):Yes
_________________________________________
01530271
Time of regen: 07/25/23 4:39:30 pm
Facility Name: Michealsen Health Center

Billing Period: 07/16/2023 - 07/22/2023
Total Invoice Adjustments:-$396
Total Disputed Amount (ABV):$396
07/22/2023, LVN / LPN Royalle Brown, AM
Reason: Sent Home
The facility disputed this shift because the professional sent home there is
ZD Related ticket 5778985 / 5778985 / 5778985 . since this is AAD resolved in
favor of the facility.
Conclusion:
AAD ELIGIBLE
REGENERATE INVOICE

https://docs.google.com/spreadsheets/d/11RIrGGFate5IM1MmVjr-
YAlNfXwohQCCY9Z6r556nEA/edit?usp=sharing
_______________________________________
SF:
TOR:
Facility Name: Cambridge Place

Billing Period: 07/16/2023 - 07/22/2023
07/22/2023, CNA Elaina Armstrong, PM

Facility disputed this shift because the Professional did not use the time keeping
system of the facility.
also upon checking this HCP is under training. Since this is AAD Will resolve in
favor of the Facility.
There is no zd related ticket
Conclusion:
AAD Eligible
Zero out the charge on the calendar.
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1KBVHg0ueBCm-
WDgAXVA6eqBPa629J59MUzHKCH6M7dw/edit?usp=sharing
_______________________________________
Facility provided work hours.
SF 01531024
TOR : 07/27/23 9:55:24 am
Facility Name: South Pasadena Care Center

Billing Period: 05/07/2023 - 05/13/2023
05/07/2023, CNA Charday Johnson, AM

05/07/2023, CNA Ana Osorio, AM
05/07/2023, CNA Arienne Holland, PM
05/07/2023, CNA Destinee Floyd, PM
05/07/2023, CNA Chiterra Palmer, PM
05/07/2023, CNA Destinee Floyd, NOC
05/07/2023, CNA Patricia Hernandez, NOC
05/07/2023, CNA Altesha Wright, NOC
05/08/2023, CNA David Hernandez, AM
05/08/2023, CNA Bianca Dolphin, AM
05/08/2023, CNA Veronica Aldama, AM
05/08/2023, CNA Mirleydis Rodriguez, AM
05/08/2023, CNA Altesha Wright, PM
05/08/2023, CNA Gilbert Guillen, NOC
05/08/2023, CNA Sook Kim, NOC
05/08/2023, CNA Javonne A. Beans, NOC
05/09/2023, LVN / LPN Alexandra Sanchez, AM
05/09/2023, CNA Shouna Love, PM
05/09/2023, CNA Wen Qing Cai, PM
05/09/2023, CNA Kimberly Sells, NOC
05/10/2023, CNA Maria Martinez, NOC
05/10/2023, CNA Yamileth Cortez, NOC
05/11/2023, CNA Altesha Wright, PM
05/11/2023, CNA Gideon Boakye, NOC
05/12/2023, CNA Tamisha Boyd, NOC
05/12/2023, CNA David Hernandez, NOC
05/13/2023, CNA Destany Thomas, AM
Reason: SLD
Facility Disputed these shifts and provided work hours for these professionals.
Upon checking the Facility Listed on our HCF Preference list, the facility will not
pay for unauthorized OT.
No Zendesk Related Ticket.
Additional info. There is a parent case for this case, so im not the one who will
email the facility thankyou.
Conclusion:
AAD Eligible
Adjust shift lenghts on the calendar
Regenerate Invoice
handling):https://docs.google.com/spreadsheets/d/1wjnqe2k10SVLVWvYFZavLcbUzGv0ljtKQ
UKgqhSR_f0/edit?usp=sharing
___________________________________________
These Professionals exceeded 8hrs work hrs.
05/07/2023, CNA Charday Johnson, AM

05/07/2023, CNA Ana Osorio, AM
05/07/2023, CNA Destinee Floyd, PM
05/07/2023, CNA Chiterra Palmer, PM
05/07/2023, CNA Patricia Hernandez, NOC
05/08/2023, CNA David Hernandez, AM
05/08/2023, CNA Bianca Dolphin, AM
05/08/2023, CNA Veronica Aldama, AM
05/08/2023, CNA Mirleydis Rodriguez, AM
05/08/2023, CNA Sook Kim, NOC
05/08/2023, CNA Javonne A. Beans, NOC
05/09/2023, LVN / LPN Alexandra Sanchez, AM
05/09/2023, CNA Kimberly Sells, NOC
05/10/2023, CNA Maria Martinez, NOC
05/10/2023, CNA Yamileth Cortez, NOC
05/11/2023, CNA Gideon Boakye, NOC
05/12/2023, CNA Tamisha Boyd, NOC
05/12/2023, CNA David Hernandez, NOC
05/13/2023, CNA Destany Thomas, AM
upon checking the timesheet of these HCPs, it is accurate and correct. Also this
case in under AAD .
175505
172835
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
___________________________________________
sf 01531657
07/27/23 5:03:53 pm
Facility Name: Homestead Living Inc

Billing Period:07/02/2023 - 07/08/2023
07/02/2023, CNA Eboni Williams, PM

The facility disputed this modification, seeking that the basic rate for this HCP
be reduced from $42 to $338. They charged $38 for CNAs after inspecting the
facility drawer looking for this disputed shift. The increase was from a rush fee.
will adjust the base rate of this HCP back to $32. Resolved in favor of the
Facility since this is AAD.
Conclusion:
AAD Eligible
Adjust the base charge of the disputed shift.
Approved the dispute on BT
Regenerate Invoice
https://docs.google.com/spreadsheets/d/1zAk1hbpO9qKBt4W0cPTsVnQ9TDDoj7WizQqSeHsyVyA
/edit?usp=sharing
___________________________________________
TOR : 07/28/23 9:42:00 am
01531677
Facility Name: Mervyn Sharp Bennion Central Utah Veterans Home

Billing Period: 06/18/2023 - 06/24/2023
06/23/2023, CNA Kade Moore, PM

Facility disputed this shift one of the CNAs duty dated june 23/2023, Upon checking
the facility wanted to zero out the charge for this HCP because the HCP did not
work that day as per CNA supervisor of the Facility that day confirmed this.
However HCP provided timesheet with clock in/out that day (zendesk ticket #
5447985) . will resolved in favor in the facility
Conclusion:
AAD Eligible
Zero out the charge for this HCP
Submit TSF Form
Regenerate Invoice.

https://docs.google.com/spreadsheets/d/1VbkwDFbvjlR327b36Qjp5yHALvhYt5J2ve9uUkwC25E
/edit?usp=sharing
___________________________________________
FACILITY 10 DAYS DISPUTE TERMS

TOR 07/31/23 9:55:38 am
Facility Name:San Francisco Health Care And Rehab

Billing Period: 07/16/2023 - 07/22/2023

07/22/2023, CNA Tynisha Milton, PM

Upon Checking, the Facility disputed this shift because the professional did not
leave a copy of the original CDPH530 in the Facility blackbox. It is also required
by the facility.

No Zendesk related ticket.
Conclusion:
AAD Eligible
Approve dispute on Billterms
Zero out the charge in Facility Drawer
Regenerate Invoice
handling):https://docs.google.com/spreadsheets/d/1A-
w0IUTzuD14Y00Dc1gjU6NK6y6dLdJWyxE1n-vGkP8/edit?usp=sharing
___________________________________________
5 days from the receipt
37 Disputed shifts
Facility Provided correct work hours.
01532500
tor : 07/31/23 1:04:17 pm
Facility Name: Freeburg Care Center

Billing Period: 07/16/2023 - 07/22/2023
Disputed Within Terms (Yes/No):Yes
07/16/2023, CNA Skyler Lawrence, PM

07/17/2023, CNA Jewell Bismillah, AM
07/17/2023, CNA Alexis Dean, AM
07/17/2023, CNA Latisha George, AM
07/17/2023, CNA Marryn Madrigal-kaltenbronn, PM
07/17/2023, CNA Morgan Jones, PM
07/17/2023, CNA Amanda Patterson, NOC
07/17/2023, CNA Morgan Jones, NOC
07/17/2023, CNA Jesmine Myers, NOC
07/17/2023, CNA Tiffany Lowery, NOC
07/18/2023, CNA Brittany Winters, AM
07/18/2023, CNA Francesca Robinson, AM
07/18/2023, CNA Jasmine Fair, PM
07/18/2023, CNA Lequitta Alexander, PM
07/19/2023, CNA Sharlynthia Chatt, AM
07/19/2023, CNA Danielle Reid, PM
07/20/2023, CNA Shonvondelique Lopez, AM
07/20/2023, CNA Shuronda Thomas, AM
07/20/2023, CNA Latisha George, AM
07/20/2023, CNA Stephany Plummer, AM
07/20/2023, CNA Danielle Reid, PM
07/20/2023, CNA Marryn Madrigal-kaltenbronn, PM
07/21/2023, CNA Lauren Wilson, AM
07/21/2023, CNA Kawonica Jefferson, AM
07/21/2023, CNA Esther Wheeler, AM
07/21/2023, CNA Nicole House, AM
07/21/2023, CNA Cresanta Warren, AM
07/21/2023, CNA Tiffany Lowery, NOC
07/21/2023, CNA Lauren Wilson, NOC
07/22/2023, CNA Zeira Ransom, AM
07/22/2023, CNA Chassity Williams, NOC
07/22/2023, CNA Kaila Belle, NOC
07/22/2023, CNA Nyosha Thomas, NOC
Reason: SLDs
Facility disputed these shifts according to facility it is incorrect, Upon

investagating this facility listed in our HCF Preference they did not allow early
clock in. there is no related zd ticket for this . Resolved in favor of the
facility.
Conclusion:
AAD Eligible
Adjust Shift lengths on the calendar
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1xpzygj-SLSspQhHuaqj5GfQWBdutya7vLrqO-
ApVoHc/edit?usp=sharing
___________________________________________
TOR: 08/01/23 11:43:06 am
sf 01533221
Facility Name: Manokin Center For Rehabilitation And Healthcare

Billing Period: 06/01/2023 - 06/30/2023
Total Invoice Adjustments:-$480
Total Disputed Amount (ABV): $480
06/09/2023, CNA Kizzy James, PM

06/10/2023, LVN / LPN Nyola Shaw, AM, (Sent Home Charge)
Upon checking the rates for this facility should be set to Baltimore which is the
land territory of Manokin Center For Rehabilitation And Healthcare. did checked the
facility drawer it is not updated,
All the base charge in facility drawer is wrong due to the reason it is using
washington DC rates, it should be Baltimore rates .
Conclusion:
AAD Eligible
Toggled off billable button on the facility drawer
Adjusted to correct shift pay rate. Facility did used other state rates, it is now
corrected.
handling):https://docs.google.com/spreadsheets/d/1ZQeQRku-SXALW_6vs-
u8LAFK75SHZdpPGrq86FNDGcw/edit?usp=sharing
Informed Customer (Yes/No/Auto):Yes
___________________________________________
TOR: 08/01/23 10:03:19 am
SF : 01533852
175423
Facility Name: Stonebridge At Montgomery Health Care Center

Billing Period: 07/16/2023 - 07/22/2023
07/22/2023, CNA Chanelle Dale, AM

Upon checking, the facility disputed this shift because this professional provided
poor service and claimed that this professional took a break. Upon checking, this
professional took a 30mins break only. Is this a valid reason to zero out the
charge one of our CNAs duted that day?
Conclusion:
AAD Eligible
Zero out the charge on facility drawer
Approve the dispute on BT
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1jGVqjIIhRv4yM02aOBqlVnfiifNYdXYfy
0fem3b_6nE/edit?usp=sharing
___________________________________________
SF 01533854
5d9de8850928040016e7cdac
TOR : 08/01/23 3:42:59 pm
Facility Name: Willow Pass Healthcare Center

Billing Period: 07/23/2023 - 07/29/2023
Disputed Within Terms (Yes/No): Yes
07/29/2023, LVN / LPN Ariel Xu, AM

07/28/2023, LVN / LPN Shiela Erestain, NOC
07/28/2023, LVN / LPN Catherine Ortaleza, PM
Facility disputed these shifts because of unauthorized overtime, also this facility
listed in our HCF Preference list. Facility provided authorized overtime.
For
07/28/2023, LVN / LPN Catherine Ortaleza, PM
Facility disputed this because professional worked 8hours as per facility but
billed 5.14 only, did check the zendesk Ticket # 5859763 and the professional did
doubled press in the clipboardhealth app that is the reason why the professioanl
billed 5.14 only.
Conclusion:
AAD Eligible
Adjust shift lengths on the calendar
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1itemC-
xx6K9PQnoDGG3OHoxvJbpUfGGki6edoh1ZkMA/edit?usp=sharing
Invoice Regenerated (Yes/No): YES |178113
___________________________________________
TOR : 08/02/23 12:20:11 pm

This facility has 5 days
SF CASE : 1533963
ETP error facility are not paying for single shifts over 8hours.
Facility Name: Divine Rehabilitation And Nursing At Shane Hill

Billing Period: 07/23/2023 - 07/29/2023
07/23/2023, CNA Cornaejah Pettigrew, AM
07/23/2023, CNA Tanikka Harris, AM
07/23/2023, CNA Aubree Middendorf, AM
07/23/2023, CNA Davia Alexander, AM
07/25/2023, CNA Aubree Middendorf, PM
Reason : Extra Time Pay
Facility disputed this Overtime of our Professionals,

Upon checking the facility drawer, Back to back shifts and single shifts are
toggled off. Found out these shifts that facility disputed mostly are single
shifts. resolved in favor of the Facility since this is valid dispute and it is
indicated in their contract .
Conclusion:
AAD Eligible
Submit Bonus Request Form
Regenerate Invoice
https://docs.google.com/spreadsheets/d/1AwE_-
EhTERJe5HT6UW2BUqQNRxvxS50MWzvFO6aNLG8/edit?usp=sharing
___________________________________________
TOR : 08/02/23 3:00:44 pm
Facility Name:Barnes-jewish Extended Care

Billing Period: 07/23/2023 - 07/29/2023
07/24/2023, CNA George Odhiambo, AM

Facility disputed this shift of our Professional as per facility this HCP did not
work that day , He does`nt have any clock in / out in their kronos also the
signatory of the Timesheet did not recognize by the facility . Resolved in favor of
the facility . No zendesk related ticket. Resolved in favor of the facility.
Conclusion:
AAD Eligible
Zero out the charge in the facility drawer
Regenerate Invoice
Actioned on CBH App (Yes/No): Yes
https://docs.google.com/spreadsheets/d/1rteBxAkE1Kk-Mj2w5sTE8xcWpz-jgDtkhGmOQfgzs-
U/edit?usp=sharing
___________________________________________
>>>>>>>>STILL PENDING
01534844
Facility Name:Country Villa Belmont Heights Healthcare Center

Billing Period:07/09/2023 - 07/15/2023
Total Invoice Adjustments:-$2,289.30
Facility disputed these shifts upon checking this facility is listed on our
rockport child facilities, Upon checking on the disputed shifts
07/09/2023, CNA Mariah Bell, AM

07/09/2023, CNA Kevin Lamdul, PM
07/09/2023, CNA Jazmen Baldwin, NOC
07/09/2023, CNA Donesha Collins, NOC
07/10/2023, CNA Karaphine Ouch, NOC
07/10/2023, CNA Isabel Soria, NOC
07/10/2023, LVN / LPN Rodge Vernick Pruna, NOC, (Late Cancel)
07/11/2023, CNA Summer Harris, AM
07/11/2023, LVN / LPN Ebony Keishawn Watson Davis, AM
07/11/2023, CNA Rosemary Aceves, PM, (Late Cancel)
07/14/2023, CNA Jazmine Flores, AM
07/15/2023, CNA Wanda Jones, AM
07/11/2023 Mariah Acosta Duran NOC (regular urgent shift charge 6.24* $34)
The facility is disputing regarding a missing DON signature on the CDPH530 forms as
well as a missing CDPH530 form and Missing Date on 530Form. They also want to
verify the validity of the late cancellation.
Conclusion:
Reject the disputes on BillTerms because the late cancelled was valid .
Zero out the charges on the calendar
Regenerate the invoice
Zero out the charges on the calendar

handling):https://docs.google.com/spreadsheets/d/12ftFGPIREazkyPbyfU5gYubR4ionp-
0NjYx9Je5WV_4/edit?usp=sharing
Invoice Regenerated (Yes/No):YES
___________________________________________
TOR : 08/03/23 10:38:44 am
Facility Name: Palm Springs Healthcare Center

Billing Period: 07/23/2023 - 07/29/2023
07/29/2023, LVN / LPN Anita Arias, AM
Facility disputed this shift of our Professional, upon checking the Professional
decided to go home that day due to overstaffed that day,
Conclusion:
AAD Eligible.
Approve the dispute on BillTerms.
Adjust the shift length on the facility calendar.
Submit bonus request.
Regenerate the invoice.

https://docs.google.com/spreadsheets/d/1Jv78Fug9SH_KR-
zA5ocG00pAQRZcGHYdxEdbtV2H1wc/edit?usp=sharing
___________________________________________
Pendish case 01534876 Y/N=Y
01534876
Facility Name: Country Villa Los Feliz Nursing Center

Billing Period: 07/09/2023 - 07/15/2023
Total Disputed Amount (ABV): $2,936.69
Upon checking these are the Professionals that did not submit the CDPH530 Form
07/09/2023, RN Ama Addo, AM
07/09/2023, RN Channing Francis, PM
07/09/2023, RN Channing Francis, PM
07/12/2023, LVN / LPN Norma Macias, PM
07/15/2023, CNA Kathy Duran, AM
These two professionals did submit the CDPH530 Form, However the facility requires
the Signature of DON.
07/15/2023, RN Janel Arnold, PM
07/15/2023, CNA Imari Harrison, AM
The facility disputed these shifts.Upon checking on the disputed shifts that the
facility is disputing, professionals did not submit the CDPH530 that this facility
requires. Also, this facility is listed on Rockport Child facilities. No zendesk
ticket for this. Will zero out all the charges for these disputed shifts if the
Professionals failed to submit their CDPH530.
Conclusion:
Will request retrieval of CDPH530 Form to our SVT Team.
Zero out the charges on the calendar to professionals that will not submit their
CDPH530
Approved the Disputes on Billterms.
Reject the disputes on BillTerms for those professionals that will submit their
CDPH530 .

https://docs.google.com/spreadsheets/d/10dnMzGA3GvF-
ug4YArLdh4W0fGcREFhZ34iACCrlMDw/edit?usp=sharing
Invoice Regenerated (Yes/No): YES
Informed Customer YES(Yes/No/Auto):
___________________________________________
PENDING CASE Y/N=Y
01534875
Facility Name: Cupertino Healthcare and Wellness (Rockport)

Billing Period:07/09/2023 - 07/15/2023
Total Disputed Amount (ABV): $3,586.66
07/09/2023, CNA Camila Gonzalez, AM

07/09/2023, RN Dami Smith-kayode, PM
07/11/2023, RN Lydia Muzota, PM
07/11/2023, RN Onon Harris, PM
07/13/2023, RN Carlton Petties Ii, AM
07/13/2023, RN Lydia Muzota, NOC
07/13/2023, RN Darnella Crowder, NOC
07/15/2023, RN Dara Johnston, PM
The facility disputed these shifts.Upon checking on the disputed shifts that the
facility is disputing, professionals did not submit the CDPH530 that this facility
requires. Also, this facility is listed on Rockport Child facilities. No zendesk
ticket for this. Will zero out all the charges for these disputed shifts if the
Professionals failed to submit their CDPH530.
These professionals did not submit the CDPH530.

07/09/2023, CNA Camila Gonzalez, AM
07/09/2023, RN Dami Smith-kayode, PM
07/11/2023, RN Onon Harris, PM
These are the professionals did submit the CDPH530 Form, However the facility
requires the Signature of DON.
07/13/2023, RN Carlton Petties Ii, AM
07/11/2023, RN Lydia Muzota, PM
07/13/2023, RN Darnella Crowder, NOC
Conclusion:
Will request retrieval of CDPH530 Form to our Customer care channel.
Zero out the charges on the calendar to professionals that will not submit their
CDPH530
Approved the Disputes on Billterms.
Reject the disputes on BillTerms for those professionals that will submit their
CDPH530 .
Actioned on CBH App (Yes/No): Yes

https://docs.google.com/spreadsheets/d/1V_6sMa5WxNS1KOGsLDXpQDDF58dBQPXuFW7ahXk70ys
/edit?usp=sharing
Invoice Regenerated (Yes/No): YES |
_________________________________________
Disputed invoices should not be regenerated but a credit note is preferred.
@cash-ops-team Can you please issue a credit note for:

HCF - Trustwell Living at Clyde Gardens
HCF ID - 64b045c40f255e01b8b8cd63
Credit Amount - $90.92
Description - reimbursement for inappropriate behavior by CBH CNA Ya ' Vontae Hood,
(edited)
Facility Name: Carecore at Westmoreland

Facility Contact: Yehuda Kramer and Sam Katz
Related Shift(s): All sent home charges
Billing Period: 07/01/2023 - 07/31/2023
Disputed Within Terms (Yes/No): Y
The facility disputed these two shifts upon checking the facility contract. The
sent home charge should not have been paid, and the dispute is valid according the
terms of the contract.
07/08/2023, CNA Lydia Jallah, AM, (Sent Home Charge)

07/30/2023, LVN / LPN Furaha Kaporoma, AM, (Sent Home Charge)
Facility
Conclusion:
Toggle off the billable button of sent home charge on the calendar.
Submit bonus request 2023
Issue Credit note
handling):https://docs.google.com/spreadsheets/d/1XxQXdJg1xciyu9CXLtVBd3oleznP8adVI
u2-wnM46lI/edit?usp=sharing
Invoice Regenerated (Yes/No):NO
Notes: Please remove all sent home charges on the invoice. HCF should have no sent
home fee as per the contract/amendment. Thank you
Please refer to slack message in #new-invoice-disputes for more information.
Reach out to CBH and/or HCF contact if you have additional questions.
___________________________________________
SF: 01535671
BS : brenda.samonteza
TOR : 08/04/23 9:55:01 am
Facility Name: Village Manor

Billing Period: 07/01/2023 - 07/31/2023
Disputed Within Terms (Yes/No):Y
The facility disputed this shift because this Professional was sent home due to
(Overstaffing that day), as per the facility will reduce the shift length of our,
Professional to 4hours, since, as per contract/amendment, this facility will be
billed for 4hours when the facility approves the worker to be sent home,This shift
was verified via SSCP
Zendesk Ticket # 3489615. Resolved in favor of the Facility.
07/30/2023, CNA Keala Nachelle Loving, PM

Reason: Sent Home
Conclusion:
AAD Eligible
Reject the dispute on BillTerms to make the necessary corrections.
Bonus Request Form
Regenerate Invoice
Actioned on CBH App (Yes/No): Y

https://docs.google.com/spreadsheets/d/1kqc31ZFut4Vh-
DWKPvkQDH5eU62bVkutbLW032gddis/edit?usp=sharing
Informed Customer(Yes/No/Auto):Y
___________________________________________
TOR: 08/04/23 11:10:07 am
SF : 01535706
BS : c.ramos_io@clipboardhealth.com
Facility Name: A Grace Sub Acute & Skilled Care

Billing Period:07/23/2023 - 07/29/2023
The facility disputed this shift because Clipboard did not advice that there will
be a replacement for the CNA who left this shift originally.
07/27/2023, CNA Shatearia Williams, AM, (Sent Home Charge)

Reason: Sent home
Conclusion:
AAD Eligible
Toggle off the billable button of the sent home charge on the late cancel.
Regenerate Invoice
Actioned on CBH App (Yes/No):Y

handling):https://docs.google.com/spreadsheets/d/18TEcj_RIKtvH3vbxl1rPuVTja4X8w661M
9rX0ZYr4NE/edit?usp=sharing
Invoice Regenerated (Yes/No):Y | 180024
Informed Customer (Yes/No/Auto):Y
___________________________________________
TOR : 08/04/23 11:47:24 am

BS: jonathan.macaraeg@clipboardhealth.com
SF : 01536092
Facility Name: Brookdale Emerson

Billing Period: 07/09/2023 - 07/15/2023
Disputed Within Terms (Yes/No):N
Facility Disputed this shift because this facility does not allow early clock-in
and unauthorize Overtime. Also upon checking this facility listed in our HCF
Preference List, This facility included in Brookdale Senior Living
Solutions(Parent)
07/10/2023, CNA Kichema Johnson, PM
Conclusion:
AAD Eligible
Approve dispute on Billterms
Adjust the shift length on the facility calendar
Submit Bonus Request
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1LOQEyFyS6QuPrILjFrxSP0sKT2KBMV6oP
0aP9a9SHBE/edit?usp=sharing
___________________________________________
sf 01536189
rhocanne.villasin@
Facility Name:The Lakes Assisted Living

Billing Period:07/02/2023 - 07/08/2023
07/04/2023, CNA Nancy Garcia Mendez, PM

07/04/2023, CNA Lisa Goss, PM
Reason: Base charge
The shifts were opened as CAREGIVER shifts, hence the $28/hour base rate, + the
$20/hour holiday diff which puts the hourly charge at $48/hour. This is valid
charge
Conclusion:
Rejected Valid charge
Send Rejection email
Actioned on CBH App (Yes/No):N
handling):https://docs.google.com/spreadsheets/d/1HchhiAVTcKWVc1oW-zZ1S7MI1OLOx2-
wjSCxdtlVuXo/edit?usp=sharing
Invoice Regenerated (Yes/No):N
___________________________________________
ivy briones
TBielinki@EmpireCareCenters.com
Buckhead Center For Nursing And Healing -- TERENCE
01535941
161557
06/04/2023 - 06/10/2023
160095
05/28/2023 - 06/03/2023
Facility Name: Buckhead Center For Nursing And Healing

Billing Period: 06/04/2023 - 06/10/2023
06/07/2023, CNA Sonya Garrett, PM

06/08/2023, LVN / LPN Tamesha Jackson, PM
06/09/2023, CNA Shanquanna Thurman, PM
Facility provided correct work hours for these two professionals,
This facility wants credit note instead of new invoice. no need to file Bonus
request for this.
Conclusion:
AAD Eligible
Issue Credit Note
https://docs.google.com/spreadsheets/d/1C4Qqdl0M9FCh4cB0Md4bPxVkhX1GpbTHpZoEIyoJtNw
/edit?usp=sharing
01524354
___________________________________________
TOR: 08/07/23 11:56:06 am

SF 01536297
BS: marelyn.benial
Facility Name: Carnegie Post Acute Of Princeton

Billing Period:06/11/2023 - 06/17/2023
Facility provided correct clock in for this professional.

Facility provided work hours for these three professionals regarding their clock in
time.
06/11/2023, CNA Latraya Robinson, NOC
06/12/2023, CNA Latraya Robinson, NOC
06/12/2023, CNA Sarah Kabineh, PM
06/14/2023, CNA Shakeira Turner, AM
As per facility this Professional did clock in that day however Professional walked
out after 1hour of clocking in, this professional wasn`t sent home and as per
facility he spoke with the name terry, upon checking in Zendesk there is no related
ticket for this.
06/17/2023, CNA Latraya Robinson, AM
Conclusion:
AAD Eligible
Reject the dispute on BillTerms to make necessary correction.
Zero out the charge on the calendar for the Professional that walked out of their
work hours.
Submit Bonus Request Form.
Regenerate Invoice.
handling):https://docs.google.com/spreadsheets/d/1epz3TkM6rgeTAgpqyjwh46fY-
PQwPS8kB3MtUHfcMJI/edit?usp=sharing
Invoice Regenerated (Yes/No): Y | 180086
___________________________________________
SF : 01537143
BS : jenny.isidro
Facility Name: Complete Care at Cedar Grove
Invoice Number: 06/01/2023 - 06/30/2023
Billing Period: 169456
Total Invoice Adjustments: 0
Total Disputed Amount (ABV): 0
06/25/2023, CNA Kathia Fontin, PM

06/25/2023, CNA Kathia Fontin, NOC
Upon investagating this dispute is not valid, as per facility the shift of kathia
fontin which is noc and pm shift dated 6/25/23. in their timesheet database there
is only one clock in/ out for both shift that is why the facility disputed these
two shifts and claiming that they are double billed,I emailed the facility and
submitted the professional timesheet.
Conclusion:
Rejected Invalid dispute
handling):https://docs.google.com/spreadsheets/d/13phFRpAH6nstNBHNYDtumnh6xeLzGdvgn
tIztbeut2o/edit?usp=sharing
___________________________________________
01537452
BS: jenny.isidro
Facility Name: Complete Care at Green Knoll

Billing Period:07/01/2023 - 07/31/2023
Facility provided correct work hours

07/30/2023, CNA Sarah Amolegbe, NOC 7.38 Adjusted to 7.5
Conclusion:
AAD Eligible
Regenerate Invoice.
handling):https://docs.google.com/spreadsheets/d/1l-
Z2cQeGyw3e5qQmkW_E0mruh5WXm88fMcyaAXechTw/edit?usp=sharing
Informed Customer (Yes/No/Auto): Y
___________________________________________
Facility Name:
Billing Period:
Conclusion:
___________________________________________
08/08/23 10:13:40 am
BS: c.ramos_io@clipboardhealth.com
Facility Name:Asbury Towers Retirement Community

Billing Period:07/30/2023 - 08/05/2023
As per facility this professional was sent home because he did not know how to
administer some insulin shots
there is no zd related ticket. resolved in favor of the facility
08/04/2023, RN Mohammed Awladmohammed, AM
Conclusion:
AAD Eligible
Zero out the charge on the facility calendar.
Regenerate Invoice.
handling):https://docs.google.com/spreadsheets/d/1CCObjqSXrNIOFZh3H6rKe1Umnt7R-
8TFDDIpuuP_9lw/edit?usp=sharing
Invoice Regenerated (Yes/No): Y| 181807
___________________________________________
01537988
BS : marelyn.benial
08/08/23 12:17:10 pm
Facility Name: Stonebridge At Montgomery Health Care Center
Billing Period:07/30/2023 - 08/05/2023
08/01/2023, RN Naylah Scott, PM

Reason: Shift Length Adjustmetn
from 7.59 reduced to 7.13
Conclusion:
AAD Eligible
Reject the dispute on BillTerms because the disputed shift is incorrect; it should
be PM shift instead of noc shift.
File Bonus Request.
Regenerate Invoice.
https://docs.google.com/spreadsheets/d/1ITaiGvUmUum1R_fgUsSuuWEh5KDFfElVL3-
dmxM6g0I/edit?usp=sharing
___________________________________________
08/08/23 1:59:07 pm
01538103
w.delacruz_io@clipboardhealth.com
Facility Name: Rembrandt Assisted Living, Llc

Billing Period: 07/30/2023 - 08/05/2023
Regarding the late cancellation, the facility disputed to make adjustments to this
invoice. According to the Facility, this employee did not adhere to the work hours
that she had signed up for.
there is no linked ticket.
08/05/2023, CNA Hajlyn Kamara, PM, (Late Cancel)
Resolve in favor of the facility
Conclusion:
AAD Eligible
Toggle off the billable button of the late cancel on the calendar.
Reject the dispute on BillTerms to make correction.
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1HxSm_RLC3rYv_tC-
4VhL6PZwtigQJeReH133XQSbI20/edit?usp=sharing
___________________________________________
Facility requested to deduct the lunch break for this shift.
01538269
171958
mylene.reyes@clipboardhealth.com
08/08/23 4:50:37 pm
Facility Name: Verrazano Nursing And Post-acute Center

Billing Period: 07/02/2023 - 07/08/2023
Disputed Within Terms (Yes/No): N
Facility provided work hours for these Professionals.

Facility disputed these shift regarding shift length adjustments requesting to
deduc the lunch break in their work hours . Resolve in favor of the facility.
There is no related ticket
07/08/2023, CNA Yvonne Mckreth-edmonson, AM

07/09/2023, CNA Johnetta Togba, NOC
07/09/2023, CNA Angel Greenland, AM
07/09/2023, CNA Shawn Richardson, AM
07/09/2023, CNA Latasha James, AM
Conclusion:
AAD Eligible.
Adjust the shift lengths on the facility calendar.
Submit Bonus Request.
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1zfFeXgI86EJ_eXENm1Kba6pXtE9H-
KXJghWmC9ABZFE/edit?usp=sharing
___________________________________________
SF 01538694
08/09/23 10:22:33 am
r.francisco_io@clipboardhealth.com
Facility Name: The Inn at Deerfield

Billing Period: 07/01/2023 - 07/31/2023
Upon checking on the facility disputed shift the facility based on their amendment
contract the facility does pay sent home charges. but this disputed shift the sent
home charge is not approved due to the reason the facility did not need the service
of this professional.
Zendesk Related Ticket
07/31/2023, CNA Ann Lady Kayee, AM,
Reason : Sent Home Charge
Conclusion:
AAD Eligible.
Toggle off billable button.
Regenerate Invoice

https://docs.google.com/spreadsheets/d/1uW37Pf0gOZR9epK3XfXg8nNOfTSnha-
68ZvgjblRitg/edit?usp=sharing
___________________________________________
08/09/23 11:36:34 am
01538737
a.verana_io@clipboardhealth.com
Facility Name:El Encanto Healthcare & Habilitation Center

Billing Period: 07/23/2023 - 07/29/2023
Facility provided work hours claiming this professional did late clocking in.
resolved in favor of the facility
07/29/2023, CNA Rosemarie Hernandez, NOC
from 7.2 to 6.43 upon calculating the work hours provided by the facility.
There is no zendesk related ticket.
Conclusion:
AAD Eligible
Reject the dispute on Billterms to make necessary correction.
Adjust the shift length on facility calendar.
Submit bonus request.
Regenerate invoice.

handling):https://docs.google.com/spreadsheets/d/1WvWxG2WCQF_sJ1lMcWrs_asmRqw_odYO1
LsAXO65Ndo/edit?usp=sharing
___________________________________________
01538206
08/09/23 12:21:05 pm
jonathan.macaraeg@clipboardhealth.com
Facility Name: Bayshire Carlsbad Senior Living Alf

Billing Period: 07/16/2023 - 07/22/2023
Facility disputed this Professional Overtime claiming this professional doing

unauthorized overtime without approval or authorization. this professional did
clocking in early and clocking out late accruing overtime facility claiming that
this professional did overtime but not actually working for the Overtime. resolved
in favor of the facility, reduced this professional working hours from 8.75 to 8.
07/20/2023, CAREGIVER Daniel Partida, NOC
Conclusion:
AAD Eligible.
Reject the dispute on BillTerms to make correction.
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1C40pNmUgsBU3NCXCbmgiwezN52XNnNW3G
x9H-aqSMLE/edit?usp=sharing
___________________________________________
NAME:Terence Earhl Gammad

DATE :August 14, 2023
Employee ID:5441
Reason: the reason why i need this leave is because my grandma is sick in province
of laguna we need to visit her our grandma.
01538825
08/09/23 5:27:35 pm
c.ramos_io
Facility Name: Masonic Home For Adults Union City

Billing Period: 07/30/2023 - 08/05/2023
Facility provided work hours for these Professionals.

08/01/2023, CNA Lilia De Leon, NOC
08/04/2023, CNA Solange Aboke, NOC
08/04/2023, CNA Marvalynn Washington, NOC
Reason: Shift Length Adjustments
Conclusion:
AAD Eligible
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1EzErbZvkkq4LQOEjAuQXNWbBtp0rXvVIN
efdHwcPF3g/edit?usp=sharing
___________________________________________
08/09/23 5:42:35 pm
01538917
r.francisco_io
Facility Name: Amy Johnson Residence

Billing Period: 07/23/2023 - 07/29/2023
Facility disputed this shift claiming that this Professional under tim
07/28/2023, CNA Amir Buckingham, PM
Zendesk Related Ticket 5856027
Conclusion:
AAD Eligible
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1PsEaLPyMhv1Brjghf1UqxuIrHAqjufnMq
xX2Pa9YTUc/edit?usp=sharing
___________________________________________
Facility Name: Cedarwood Plaza

Billing Period: 07/01/2023 - 07/31/2023
Facility disputed these shifts regarding sent home charges and shift length
adjustments. Facility claiming that these Professional did not work that day. Also
this Facility included in our HCF Preference List.
07/31/2023, CNA Shaqweta Coleman, PM
07/31/2023, CNA Kiana Williams, AM
07/30/2023, LVN / LPN Jamie Beduhn, PM
07/30/2023, CNA Nicole Spencer, PM
07/24/2023, CNA Kayla Mcwilson, PM
07/11/2023, LVN / LPN Sharonda Smith, AM
07/02/2023, CNA Arianna Peck, AM

07/11/2023, LVN / LPN Sharonda Smith, AM
07/15/2023, LVN / LPN Katrina Tuggle, AM, (Sent Home Charge)
07/22/2023, LVN / LPN Kiana Jones, AM, (Sent Home Charge)
07/24/2023, CNA Kayla Mcwilson, PM
07/25/2023, CNA Melody Ford, PM, (Sent Home Charge)
07/26/2023, CNA Melody Ford, PM, (Sent Home Charge)
07/26/2023, LVN / LPN Shaunte Conwell, PM, (Sent Home Charge)
07/30/2023, CNA Nicole Spencer, PM
07/30/2023, LVN / LPN Jamie Beduhn, PM
07/31/2023, CNA Kiana Williams, AM
07/31/2023, CNA Shaqweta Coleman, PM
Reason: Sent home charges / shift length adjustments
Conclusion:
Approve the disputes on billterms
Reject the disputes on BillTerms to make corrections.
Adjust the shift lengths on the facility calendar.
Zero out the charges on the calendar.
Toggle off the billable button for sent home charges.
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1DrC7h_2pE5bUMvVBDOMyWVhJoiYRdZISb
CRgvKC3IDE/edit?usp=sharing
Invoice Regenerated (Yes/No):Y |
Sorry for 07/02/2023, CNA Arianna Peck, AM

___________________________________________
SF Case: 01539564
BS:zendie.bukid@clipboardhealth.com |
08/11/23 9:57:43 am
Facility Name: Mckendree Village - Healthcare

Billing Period: 07/01/2023 - 07/31/2023
Facility disputed this shift and provided clock in for this Professional.
07/31/2023, LVN / LPN Shana Myers, AM
Found zendesk ticket 5890847. providing signed timesheet regarding this shift .
Reason : Shift Length Adjustment
Conclusion:
AAD Eligible.
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1E1b78FVK2_6fHWNshx_DHvf2LqyRKCQdj
XjZcrTKIS8/edit?usp=sharing
___________________________________________
BS: jenny.isidro
Facility Name: Driftwood Healthcare & Rehabilitation Center

Billing Period:07/23/2023 - 07/29/2023
Facility disputed this case regarding shift length of this professional claiming
this professional did 3hours and 31mins break, provided clock in. this facility is
included in our hcf preferences under rockport child. did checked the timesheet
CDPH530 forms of this professional and it is digitally signed. resolved in favor of
the facility. Found zendesk ticket 5802448 regarding this shift .
07/24/2023, CNA Amber Martinez, AM
Conclusion:
AAD Eligible.
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1fZ49sT_sM6S8vOIqxwz9d2gT8Hl2gHUUW
LL0zlXyD9I/edit?usp=sharing
___________________________________________
BS : j.zorilla_io
08/15/23 10:40:52 am
Facility Name: Westwood Post Acute

Billing Period:08/06/2023 - 08/12/2023
The facility disputed this shift regarding, missing CDPH530 of this Professional as
per facility claiming that they repeatedly contacted the professional to complete
her charting and documentation as well. despite of repeated attempts still no
response from this professional. Resolved in favor of the facility.
08/07/2023, LVN / LPN Valisa Nash, NOC
Conclusion:
AAD Eligible
Regenerate Invoice.

https://docs.google.com/spreadsheets/d/19oAP_bB7vutvJ-OfGTnR-
MY1iD7MXZDxEZT_dhQvmuc/edit?usp=sharing
___________________________________________
08/15/23 12:10:57 pm
j.zorilla_io
10days
01541725
Facility Name: Westbury Center of McDonough for Nursing and Healing

Billing Period: 07/23/2023 - 07/29/2023
facility disputed this shift and upon checking this professional already DNR at
this facility.
07/29/2023, CNA Florine Lee, AM

found zendesk ticket #5509096 facility already DNR this Professional in their
Facility.
Conclusion:
AAD Eligible
Regenerate Invoice.

handling):https://docs.google.com/spreadsheets/d/1LjML6A66_I4KiFjBHnGudtXbVYlihLkLJ
V_hqtI3Wao/edit?usp=sharing
___________________________________________
29 DISPUTED SHIFTS IN BILLTERMS

37 DISPUTED SHIFTS
Total Disputed Amount $2,479.78 %15 of total invoice amount $16,458.19
Margin of the invoice $2920.21
01541962
Facility Name: Delmar Gardens West

Billing Period: 08/06/2023 - 08/12/2023
Ralated slack thread :

https://clipboardhealth.slack.com/archives/C02N0BF2E9E/p1691658898685339
The facility disputed all of these shifts regarding ETPs, checked the contract for
this facility to check if this dispute is valid. According to the facility
contract, it does not cover all 3 forms of ETPs. Just today the ETPs for this
facility turned off, and kindly checked the attached photo.
08/06/2023, LVN Lindsay Thompson, NOC
08/06/2023, LVN Marissa Hogan, NOC
08/06/2023, RN Deborah Arnold, NOC
08/07/2023, CNA, Aria Tovan, PM
08/07/2023, CNA, Aria Tovan, PM
08/07/2023, CNA Daijana Leonard, AM
08/07/2023, CNA Danielle Denise Davis, AM
08/07/2023, CNA Shontisia Fields, AM
08/07/2023, CNA, Yolonda Hicks, PM
08/07/2023, CNA, Yolonda Hicks, PM
08/07/2023, LVN Angela Sumlin, PM
08/07/2023, LVN Jamera Howard, PM

08/07/2023, LVN Mackenzie Berry, PM
08/07/2023, LVN Shanaye Walker, AM
08/08/2023, LVN, Ariauna Chase, NOC
08/08/2023, LVN, Ariauna Chase, NOC
08/08/2023, LVN Lindsay Thompson, PM
08/08/2023, LVN Mackenzie Berry, NOC
08/10/2023, LVN Amanda Payne, NOC
08/10/2023, LVN Dana Roberts, NOC
08/10/2023, LVN Leteisha Devrouax, NOC
08/10/2023, LVN Michelle Galuszka, NOC
08/11/2023, LVN, Leteisha Devrouax, NOC
08/11/2023, LVN Natasha Curlee, NOC
08/11/2023, LVN Tiffany Warren, AM
Reason: ETPs facility does not pay 3 kinds of ETP.
Conclusion:

request turn on ETP of the facility drawer and make necessary adjustment.
after adjustment request to turn off the etp, adjust to correct hours to remove the
ETP in the invoice.
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1b7_KcXy6aDuyxGlR9qu70tR-
piHCaqfb0EDqPzoiY3o/edit?usp=sharing
Invoice Regenerated (Yes/No):Y |
___________________________________________
jenny.isidro@clipboardhealth.com
the facility has 10days to dispute
01541483
Facility Name: Burlingame Long Term Care

Billing Period: 07/01/2023 - 07/31/2023
No zendesk related ticket.

07/01/2023, CNA Tungamirirai Muzota, NOC
Facility disputed this shift regarding wrong date on CDPH530Form that this
professional submitted, based on the facility dispute the date on CDPH530 Form
should be 7/01/23 not 7/02/23 did checked the CDPH530 form of this Professional
upon checking the day on the CDPH530 Form for this professional is not clear please
see the attached CDPH530 Form for this professional. Additional information this
facility is under rockport child.
Conclusion:
AAD Eligible.
Request the correct and has clear date on CDPH530 to our customer care and send T2
Escalation Request.
Approve the dispute on Billterms.
Zero out the charge under the facility calendar.
Since this is under rockport child will not regen the invoice.
Track this under Rockport Disputes

handling):https://docs.google.com/spreadsheets/d/1PwF8Jzm6WWgThFw-
jHwG8ztKaVo33PaNsUjXfZnEEIM/edit?usp=sharing
Invoice Regenerated (Yes/No):NO
___________________________________________
08/16/23 1:24:13 pm
5days
isun.veloz
60385.91 60397
$1,903.67
01542501
64c6955b757126d0bef81ae8
Facility Name: Sunny Acres Nursing

Billing Period: 07/01/2023 - 07/31/2023
Facility claiming that this professional did not work the shift.
07/31/2023, CNA Brittany Richard, AM
Conclusion:
AAD Eligible
Submit Time sheet fraud.
Regenerate invoice

handling):https://docs.google.com/spreadsheets/d/1U7kA-
riivQ3HMTzd6ohwd0VmAhtKLYkACvJvcH73PHs/edit?usp=sharing
___________________________________________
closed
01542426
Has 10 days
alyanna.chan
08/16/23 2:24:29 pm
Facility Name: Harmony Palos Heights

Billing Period: 07/30/2023 - 08/05/2023
As per facility the professional voluntered to go home, Because they were

overstaffed at the facility.
08/03/2023, CNA Brenilya Shepherd-gregory, AM, (Sent Home Charge)
Zendesk Ticket #5925411
Conclusion:
AAD Eligible.
Toggle off billable button.
Regenerate Invoice

handling):https://docs.google.com/spreadsheets/d/1-
DWD7zGzQgnbq5f8rpcFIuFE1dQToF1BQC9xrXiyRZo/edit?usp=sharing
___________________________________________
15days
jonathan.macaraeg
08/16/23 4:59:00 pm
01542685
Facility Name: Santa Monica Healthcare Center
Billing Period: 08/06/2023 - 08/12/2023
Facility provided work hours for these professionals.

08/06/2023, CNA Maharlika Williams, NOC
From 3.9 to 7.38
zendesk ticket 5936409 / 5966361
08/06/2023, CNA Lavern Simpson, NOC

From 8.07 to 7.67
No zd ticket
08/09/2023, LVN / LPN Kingsley Ukonu, NOC

From 7.99 to 7.83
No zd ticket
Conclusion:
AAD Eligible.
Approve the dispute on Billterms.
File bonus request with the new process.
Regenerate Invoice.

https://docs.google.com/spreadsheets/d/1w5It_djudQAtiGPxWG44KKq5DuhQrXp1sETux8__Ygk
/edit?usp=sharing
___________________________________________
08/17/23 10:18:09 am
01543113
jenny.isidro
Facility Name: Kensington Care And Rehab

Billing Period: 08/06/2023 - 08/12/2023
facility provided clock - in / out for the disputed shift,
08/06/2023, LVN / LPN Tamara Marshall, AM

From 7.55 to 7.5
08/06/2023, LVN / LPN Tamara Marshall, PM
From 8.45 to 8.42
08/12/2023, RN Khalilah Biloche, AM
7.75 to 7.72
Conclusion:
AAD Eligible.
Submit Bonus request Using the new process.
Regenerate Invoice.
Actioned on CBH App (Yes/No): Y

https://docs.google.com/spreadsheets/d/1VL1biIoxj7ZgJiwZ26tBvV3v0X5U0BRKzVdT0fL0Ufk
/edit?usp=sharing
Done with my SLD Adjustments Tab.
Shift id
08/06/2023, LVN / LPN Tamara Marshall
64b6828734d68a01b6fcc17c
08/06/2023, LVN / LPN Tamara Marshall, PM

64b6828d538a1101b7d13eb3
08/12/2023, RN Khalilah Biloche

64b68170538a1101b7d12e3e
___________________________________________
01543192
rhoxanne.villasin
08/17/23 12:00:54 pm
Facility Name: Bryn Mawr Village

Billing Period: 08/06/2023 - 08/12/2023
Facility provided work hours for this professional.

08/07/2023, RN Laura Ciobanu, PM
From 7.32 to 4
Reason: Shift Length Adjustment
Conclusion:
AAD Eligible
Approve the dispute on billterms.
Submit bonus request using new process.

https://docs.google.com/spreadsheets/d/115RZmBC10pFoSXqFENIQ-
wqXi_C7rLt_GnIfsyFqSaI/edit?usp=sharing
___________________________________________
jonathan.macaraeg@clipboardhealth.com
5
Facility Name: Bancroft Healthcare Center (bellaken Grp)

Billing Period: 07/16/2023 - 07/22/2023
Conclusion:
___________________________________________
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Informed Customer (Yes/No/Auto):___________________________________________
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Informed Customer (Yes/No/Auto):__________________________________________
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Facility Name:
Invoice Number:
Billing Period:
Conclusion:
Facility Name:
Invoice Number:
Billing Period:
Conclusion:

Weekly Notes

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SFCASE: 01525969

Facility Name:Hayward Convalescent Hospital

07/09/2023, CNA Lisette Manzambi,PM

07/09/2023, CNA Veronica Louise Branch, NOC

Informed Customer (Yes/No/Auto): YES

04/28/2023, CNA Karina Pacheco, AM

For confirmation is this for rejection or i will approve in favor of HCF?

Facility Name:Whittier Pacific Care Center

Disputed Within Terms (Yes/No):NO

Facility Name: Marina Garden Nursing Center (bellaken Grp)

Invoice Number: 172760

07/10/2023, CNA Diane Wilson, PM

07/10/2023, CNA Mujidat Majasan, AM

07/10/2023, LVN / LPN Porshia Wynne, PM

07/15/2023, CNA Pamela Anne Estiaga, AM

Actioned on CBH App (Yes/No): YES

HCF provided work hours.

Bonus Description: SLD

REGEN TIME : 07/20/23 2:52:21 pm

05/16/2023, LVN / LPN Summer Williams, AM

Facility Name:Excel At Woodbury For Rehab And Nursing

Template Bonus Request 2023

"07/14/2023, CNA Deanna Markel, NOC

Adjusted Shift Pay (Billing Disputed Hours)

Facility Name: Sutton Park Ctr For Nursing & Rehab

07/02/2023, LVN / LPN Jasmine Livingston-still, AM

Actioned on CBH App (Yes/No):YES

TIME OF REGEN: 07/21/23 12:32:22 pm

ALL LATE DISPUTE MUST BE REJECTED

Facility Name: Ark Healthcare And Rehabilitation At Branford Hills

06/27/2023, CNA Keavon Rochester, AM, (Sent Home Charge)

Actioned on CBH App (Yes/No): YES

Facility Name: San Leandro Healthcare Center

07/14/2023, LVN / LPN Lanitra Chatman, NOC

Upon checking there is no clear provided clock in/out of this Professional.

Actioned on CBH App (Yes/No): NO

Time of regene : 07/24/23 10:30:07 am

Facility Name: New Orange Hills

shift):05/26/2023 LVN/LPN, Laquiesha Greene-topper, AM, (Sent Home, 56.00 x 4

Actioned on CBH App (Yes/No): YES

Informed Customer (Yes/No/Auto): Yes

Facility Name:Paul House & Health Cr Center

DONE ADJUST SHIFT LENGTH

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Done Adjust Shift Length

Actioned on CBH App (Yes/No): YES

Failed to provide CDPH530Form that the facility requires.

Please cc RegistryInvoiceSubmissions@rockporthc.com in any dispute emails.

Facility Name: Burlingame Long Term Care

This Professional does not have CDPH530.

Actioned on CBH App (Yes/No): YES

Facility Name: Claridge Operations Llc

Actioned on CBH App (Yes/No): YES