Transcript
Rae Tompkins (00:00) hey, Sherry, how’s she now? Hello?
Rae Tompkins (00:09) How is everyone… I’m doing? Okay? How are you?
Rae Tompkins (01:18) Just waiting on val?
Rae Tompkins (01:36) Hey, guys. Just waiting on val to get started.
Rae Tompkins (02:09) Will Nico be on the call? You know, right? Yes, he will. Okay.
Sheri Prouty (02:14) Because I have some more information on the files. Okay? We can’t split it comes. I mean, we can’t split them from downloading on from medallion either. So, I’m not sure what happened, but… seriously?
Rae Tompkins (02:39) Thank you. Do you want to go ahead and get started? We can fill in, val?
Sheri Prouty (02:52) Yeah, that’s fine. She said she wasn’t going to be, she said she wasn’t going to be on the 30 minutes of this meeting. I tried to clarify. It was the first 30 minutes or the last 30 minutes. So, yeah, we can go ahead and get started. That’s fine. Hey.
Rae Tompkins (03:06) Perfect. This isn’t on our agenda but something that was just, oh, there she is something that our analytics team was actually just able to create and something that we’re going to embed in platform for caresource. So, one of the things flagged was just more visibility into missing items. So our analytics team was able to create a report. And again, this will be embedded in platform for viewability at any time. But you’re able to filter the status. So any of the providers that are falling in the request queue, what type of provider type there is. And then it has this column here application missing information that gives you the exact reason why a file is sitting in the request queue. So whether that be, the import was not successfully completed, the attestation is outdated.
Valerie Lewis (03:53) Again.
Rae Tompkins (03:54) I hope this sheds a little bit more visibility into all of the files sitting in the request queue and what exactly is preventing the file from moving to the ready queue?
Rae Tompkins (04:09) You can also filter by recred, deadline and I can definitely shoot over an email once this is live.
Sheri Prouty (04:16) Is that going to be on the analytics… page?
Rae Tompkins (04:21) Yes, it will be.
Sheri Prouty (04:25) Speaking of reports and that the one that I built to pull specialties, the specialties are still not populating on that report that I built from report builder when we were trying to see what specialties you guys are using or credding the providers for. Okay. Yeah. So you’re going in platform and I created that report and created a report. And… although specialty, is there, it doesn’t populate?
Rae Tompkins (04:58) Okay. Yeah. Let me, thank you for flagging. That. Let me look into that directly and see if I can figure out what’s preventing it from being pulled over.
Sheri Prouty (05:09) Thanks. Appreciate it. Yeah.
Rae Tompkins (05:14) Alrighty. So one of, the main topics today, and as you know, can we continue our own conversation is just a clear alignment of if a re, cred license is… imported over by caresource but doesn’t match what’s you know, utilizing the caqh. So we’re outreaching to the provider. They’re stating I’m not licensed in these states. The current plan was to archive the file, notify caresource that it needs to be re imported with correct states. That way our team can successfully process, we know that has caused some abrasion as we’re utilizing caresource to have to re import the files. So I want to discuss today kind of a clear alignment on what exactly the caresource team would expect when an outcome is that the provider is not licensed in that state. So, current state we’re archiving a partial package generated with any of the work that was kicked off with the automation? Can we kind… of understand from the caresource side, would you expect it to be sent over on the CDT file? Maybe marked incomplete or just kind of continue our conversations there?
Valerie Lewis (06:31) Sent over as incomplete, run all the verifications that you can add the note, right? As to why it’s incomplete, unable to verify whatever state we sent you license, send it back over as incomplete as an issue file. So.
Rae Tompkins (06:48) Just to reiterate that the caresource team would expect everything to be ran and psv’d with the exception of the incorrect license and then sent over as incorrect or incomplete.
Valerie Lewis (07:01) Correct. Yes, that.
Sheri Prouty (07:03) Is correct.
Rae Tompkins (07:06) Okay.
Valerie Lewis (07:07) We take a look at that. We identify if it’s incomplete or not, if you run the verification on the license, then we can flip that automatically quickly to committee review. No, it’s no longer incomplete based on caresource’s requirements. And then we take it and we submit it. Just like when you send over an incomplete now, right? We do reveal it. We don’t just close it because you decide it’s incomplete. We do review it to determine if we need to run a verification. If whatever it is that you deemed it incomplete, was the reason? Is it truly incomplete? If not, then we’re flipping it and sending it to medical director for review. So same way with any of the files that you’re unable to verify a license state based on what we’re sending you?
Sheri Prouty (07:56) Okay. So, is the expectation that those requests get marked as ready or is having them archived the okay?
Valerie Lewis (08:07) Say one more thing? Say one more time? Yenny?
Yenny Zhang (08:10) For those credentialing files in which we’re you know, you’re asking us to do all psvs except for maybe a license because maybe the provider doesn’t have a license. Would you expect that to come back to you as like an archived file or as a file that’s marked as ready with an incomplete verification?
Valerie Lewis (08:29) Marked as ready, incomplete verification. I see… from an ncqa perspective, you’re verifying license is just not the state that we’re wanting, right? Because you’re looking at caqh and determining right that he has a license here. So I’m verifying it, is that correct? You’re verifying all licenses. So from an ncqa perspective, you’re completing the file, it’s just coming back as incomplete because that is not what we requested.
Valerie Lewis (09:00) That’s what we’re asking for. I see.
Rae Tompkins (09:05) Okay. I appreciate the conversation here. That’ll definitely be something that we need to scope out internally as, you know, it’s outside of our current workflow, but definitely something that we can, you know, work to see what that process will look like. Hi jumping ahead here to the priority list. I know we went over on our last meeting, the tracker and outlining a priority list as far as specialty, missing information and packet size in regards to what was just discussed, and just reiterating that the… expectation is that the file be processed, everything that we can process, with the exception of the license, moving it to the ready queue with an incomplete status. Would caresource say that takes priority over importing their own specialty? Or would that just be number four in our list of priorities? We just want to make sure that we’re kind of focusing on the most important asks from caresource so that we can scope out feasibility and product enhancements.
Valerie Lewis (10:13) We would say this is moved to number one because the amount of files you’re sending back as archived, is it’s really creating some backlog for us. So I would say that is number one specialty moved down to number two and Sherry and Yenny, you can jump in. If you don’t agree, I’m okay with that too?
Sheri Prouty (10:29) No, I agree.
Sheena L. Swihart (10:31) Yeah, Sherry and I agree considering we’re working files right now, right?
Rae Tompkins (10:37) Yeah.
Yenny Zhang (10:38) And.
Sheri Prouty (10:39) the number of files that I have to go find because they’re incomplete for an archive is pretty high as well. Yes.
Rae Tompkins (10:46) Yes. Okay. Perfect. Yeah, thank you for confirming that we’ll continue conversations as a team. The best solution for getting those files ready to the ready queue with an incomplete status and with verifying all the information that’s presented in the packet with the exception of the requested state by caresource. And I can definitely follow up once I connect with operations to see if that’s something that we’re able to do and kind of a game plan moving forward. But for now, I’ll have support, stop archiving files until we can come up with a solution. And then we can go from there with the exception. If we do stop archiving files, outreach will still take place. So there may be some provider abrasion there as we’re continuously going to outreach and they’re going to say, I’m not licensed in this state, which was why we were, but.
Valerie Lewis (11:36) They’re not licensed Ray. Why do you continue outreaching? Well, we don’t it should be well done, right?
Rae Tompkins (11:43) That’s when we’re archiving the file, right?
Valerie Lewis (11:45) But instead of archiving, can you update your system so you don’t continue outreaching for that license when they’ve already told you they’re not licensed in that state? Is what I’m asking… if you leave it open and you process it for the other things, then outreach continues, is that what you’re saying? Yeah.
Yenny Zhang (12:06) I think we may be able to explore a process on our end where we, you know, can stop the ceqh import if the license is the only thing that’s missing and probably manually move a file forward. But I think we can take this back internally to figure out a solution that reduces the provider abrasion in these situations?
Rae Tompkins (12:33) Okay. Wanting to jump ahead to the recred universe if possible. Can we receive that by end of week just to make sure they’re able… to be processed with any further delays, we’ll just have a higher number of incomplete files sent to caresource.
Valerie Lewis (12:50) Shayna.
Sheena L. Swihart (12:52) Yeah, we can work on that… today’s. Wednesday.
Sheena L. Swihart (13:00) Probably, it’s I don’t want to say by end of week because I’m out half a day tomorrow and Friday. So it’ll… probably be early to mid next week, but we can definitely get that within the week.
Rae Tompkins (13:18) Yeah, that would be greatly appreciated. Whenever you’re able to send it. It’ll. Just reduce the number of incomplete files to ensure we have enough time for processing.
Rae Tompkins (13:31) And then wanted to kind of get a rough estimate with the new states that are incoming that we discussed previously, if we had a rough estimate of expected volume?
Valerie Lewis (13:41) Not yet. Okay?
Rae Tompkins (13:46) Are you able to provide that as soon as you kind of have an estimate just so we can game plan operationally?
Valerie Lewis (13:53) Yeah. I mean, I got a rough number. They say they only receive about, you know, 20 requests a week, but I don’t that was low to me, right? And I questioned that. So I don’t really want to because that’s just really low. I don’t… I’m not sure they’re one state though, right? And I don’t know how big the state is, but, you know, how big they are. So I just let me ask real quick. Yep, I should have that to you. Let me ask somebody else.
Rae Tompkins (14:27) And then I flagged to the team, the collab agreement, not populating in the caqh application or file and I will definitely provide an update as soon as possible. I know that was flagged on our last call. But our main conversation topic today was just understanding the expectations of the state flips for re creds and how we can kind of work together to make sure that that’s handled… internally. Were there any additional things on the caresource side that we can assist with?
Valerie Lewis (15:01) I don’t have anything else right now… all.
Rae Tompkins (15:06) Right. Well, I appreciate everyone’s time and thanks so much for working with us as we. Oh, I’m sorry, Sherry, you wanted to speak to Niko, well?
Sheri Prouty (15:12) And I also have a question. So you were talking about the collab and including it with the packets. Where are we on? Including all the outreaches that’s made as well in the packets? Because that’s something we’re required to do as well as partisan cqa which is in the phone call. Is that part of the same thing? No?
Rae Tompkins (15:32) I’ve submitted that to our product team and they’re currently investigating feasibility to see if that’s something that we can start putting directly in the packet?
Sheri Prouty (15:44) Okay. And something we need. So hopefully they can do that… absolutely.
Sheri Prouty (15:53) And then, yeah, Nico, so I was working on packets today and how… we have to split them in the new process. And it’s like mid February, right? So I actually found a mid February one that came to us and we got the file three different times.
Sheri Prouty (16:11) It was sent three different ways in the same CDT file. One of them had a period, an underscore. And when I hover over, it has mac OS X in it. The second one, it had additional naming convention. I couldn’t open it. And then the third one I finally was able to open. And this was on February twelfth is when this came in and that’s about the time we started having problems with being able to print and split and we do that, you know, every one of them, every page gets its own document kind of issue that we were going through. You. And Sheena and I went through. I also have the same problems when we download from medallion. So I tried that today to directly download from medallion and save it and we can’t split it from there. Either, it does the exact same thing. I have to print to Adobe PDF before we can actually split them properly by size.
Niko Byron (17:15) Yeah. Do you mind? I think those are probably two separate issues. Do you mind? Was that February twelfth? Was that in the clean or the risc file this?
Sheri Prouty (17:24) Was risc file? Yeah. Let me, I’ll put a snapshot in the chat of the file that I found?
Sheri Prouty (17:45) And I’m still trying to get with my, it to see what if it’s on our side… somewhere somehow.
Niko Byron (17:55) I’m not seeing. I’m only seeing one PDF for that provider.
Sheri Prouty (18:03) When I search my archive, I get it three times for the same date, same file name.
Niko Byron (18:09) See if something happened in the compression. I mean, I’ll uncompress it really quick and see what that looks like. Okay?
Niko Byron (18:32) February twelfth risk.
Niko Byron (18:55) Weird. I’m not seeing the February twelfth file in here. Let me see like the compressed version, but I might have already pulled it out to investigate. Okay, let me just see if it’s in here.
Niko Byron (19:29) We can keep talking about other things. Sorry, I’m trying to look at it right now, but if there’s any other issues we want to talk about, I don’t want to hold us up here.
Niko Byron (19:43) Okay. Here we go.
Rae Tompkins (19:47) All on you, Nico. I think we were good.
Niko Byron (19:50) Okay. On.
Rae Tompkins (19:51) Our end.
Niko Byron (19:53) Gotcha.
Sheri Prouty (20:02) Hey, Nico, I guess you and I and Sheena can figure this out if everybody else wanted to drop.
Niko Byron (20:08) No worries.
Sheri Prouty (20:09) I mean, that’s up to you guys, right?
Valerie Lewis (20:12) Well, I’m going to drop, so, let me know the outcome already. Thanks everybody.
Rae Tompkins (20:17) Thank you. Yeah.
Niko Byron (20:20) I should be able to find it here.
Niko Byron (20:21) I just found it. It was like my finder window is having a little bit of issues finding it. So I just paste it here.
Sheri Prouty (20:30) I understand that.
Niko Byron (20:32) I.
Sheri Prouty (20:32) have the same problem. So.
Niko Byron (20:35) I’m unzipping it now just to verify that we have… everything in here, sort by name. And then it was Kiara robinson.
Sheri Prouty (21:08) And I don’t know if somebody on our team unzipped it and stuck them in the same folder they shouldn’t be. But I don’t think any of our team uses macos, and I think I recall you saying you guys use mac?
Niko Byron (21:19) Yeah, I do specifically or you do. Yeah.
Niko Byron (21:32) Okay. There she is, Kiara. Robinson. Yeah, I wonder if it’s the way that it was being unzipped or something that caused the issue, but I only see, I just pulled the exact file we sent you and unzipped it. And I’m only seeing the one PDF for that provider. I’m not seeing multiple. Weird. Okay. I’d be curious to see if your it team could track like track anything down with it. Like if they received it as if they could go to like if they could pull up the original that it was received as, and if it’s they’re seeing three there. If it had to do with something that when it was being uncompressed, something happened wrong… I’m not sure.
Sheri Prouty (22:19) Yeah, it’s really odd. Like I said, and one of them’s like 163 bytes. The other one’s four point three, four megabytes.
Niko Byron (22:26) Yeah. The one I’m seeing is four point six megabytes. So I think that’s good. Okay. The right one.
Sheri Prouty (22:35) So, how are they saved? I’m sorry, I’m just quite curious. How are they saved on the platform? Because like I said, we have the same problems downloading them on the platform. If we go and pull up on download. They’re.
Niko Byron (22:49) hosted on a like third party like secure obviously, like document hosting platform. It’s called Cloudinary. So, it’s the same way we retrieve them. If you press the download button, we just perform like an API request to like download that file essentially to your machine or in my case, I’ll download it to this directory before I zip it up and send it to caresource.
Sheri Prouty (23:21) Okay. I was just wondering if it was, they’ve changed something on their side too that might be causing the problem. I’m just trying to figure it out because it’s taken an immense amount of time for our team to have to download, then print and save it and then split it versus just being able to split it from what we download especially… when they’re really large and some of these can be quite large as you guys know, files. So, and what’s really odd like we were talking when we print to PDF, it shrinks it and puts it in. The majority of them are less than 10 MBS once we print it to Adobe PDF. But when we download them, they’re like 17… 1,000 KBS. So I’m not sure. I’m just at this point lost as to what could be causing it… but I will try to get with the, it and see if they.
Niko Byron (24:20) can figure it out. I’m not seeing any Cloudinary media flows, release notes. I’m trying to find like looking at Cloudinary’s release notes, if they even had like a change that went out in February. And I’m not seeing anything from what I can tell, but I’m kind of scrounging around a lot of different things. Yeah, I’m kind of perplexed on it as well. I don’t have Adobe, so I can’t really test the same flow on my end unfortunately.
Sheri Prouty (24:48) Right. It works. It does the same thing in foxit pro. So it’s a similar program as Adobe, but we have the same issue in it as we do Adobe pro. That’s another reason I’m not sure. I’m not thinking it’s Adobe the program if you will as much as it is the file because it acts the same way in two different programs… because I downloaded foxit pro to check it to see if it would do the same thing. And it does… so.
Sheri Prouty (25:29) Yeah.
Niko Byron (25:30) I wonder if I can get access if we have like product keys that I can get access to through medallia and see if I can mess around with it on our end. But… yeah, unfortunately, I don’t think I have a resolution just now. I think we would have to do some further investigation and see what we can find out.
Sheri Prouty (25:50) Then, again, like I said, I’ll see if I can go through our helpdesk or it, which is our it people and see if they can come up with any other thing because the only thing they gave us was a workaround which is causing a lot of time. So, I’ll try again from my phone and see if I can get any further as well. Okay. Yeah, I just might ask.
Niko Byron (26:15) Yeah, it’s also just weird that the printing as a PDF works because like that should be doing nothing to the file and yet it’s working after that’s done. So, I’m yeah… it’s very strange.
Sheri Prouty (26:27) Yeah, agreed. And it.
Niko Byron (26:29) Opens as a PDF and it’s like visible. So like, I don’t really know what like… if it was like a corrupt file or something like that would kind of make sense. But then you wouldn’t be able to look at the file at all, right?
Sheri Prouty (26:43) It wouldn’t even load it.
Niko Byron (26:44) Exactly. So that’s what’s very confusing for me and I’m sure you as well, but.
Sheri Prouty (26:49) Correct. Yeah. Okay. Well, I decided to bring it up again and see if we can brainstorm and figure it out especially since it comes down off of medallion’s website the same way. Yeah, the platform. So. Okay. Well, that’s all I had Rae, sorry took up so much time. Oh, no.
Rae Tompkins (27:10) That’s what these calls are for. Yeah. So we’ll stay in touch regarding that. And then I’ll circle back once we sync internally, the best solution for the state flips, and if anything else comes up via email, just let me know and I’ll let you know as soon as that report is embedded in platform.
Sheri Prouty (27:27) Okay. I appreciate it. Thank you.
Rae Tompkins (27:29) You’re welcome. Bye. All.
Sheri Prouty (27:30) Right. Bye bye. See ya.