Transcript
Jack Schell (00:00) yeah. Hi, Kelly every.
Kelly Martinelli (00:04) day. Huh? Every day. So we were on a call today with Lindsay and we were going over the functions of the medallion system and what we didn’t have access to. And she was showing us screens that I don’t have access to certain fields. And maybe that’s half the problem. I don’t know… I have administrator rights, but, you know, the questions I had like she had them on her screen. I’m like why can’t I see all that stuff, but.
Jack Schell (00:34) Such as?
Kelly Martinelli (00:37) It was like follow ups and stuff like that and notes and stuff because people like people have called me like three times today and asked me where are we at in this process? So while we were in there… Kat was talking about, you know, the provider, you… know, you’ve got your payers and then you have, what do you call them? The ones below that you have them, where they’re linked, but I can’t I gotta think about what they’re called. That just escaped me.
Jack Schell (01:12) When you go to the, when you go to the provider profile.
Kelly Martinelli (01:17) When you go to the provider profile, you know, how you have a list of payers and it says Aetna has blue cross blue shield, but it just says blue cross blue shield of Texas. It doesn’t tell you the contracted payers underneath, who we’re in network with. So that was one of the things Doug wanted… remember?
Jack Schell (01:38) Sorry. So you can, sorry. So when you go to a provider profile, you go to their payers, you can see all the payers that they’re enrolled with, or that there’s open requests with correct. And then under each payer, there’s specific indications of lines of business. It’s.
Kelly Martinelli (01:56) the product names.
Jack Schell (02:00) Product names, okay? Such as, okay?
Kelly Martinelli (02:04) So like blue cross blue shield of Texas has gold and silver and something else. I don’t know. Okay, we’re not on plan with all of those. So when you credential… those with blue cross blue shield of Texas, we don’t know what plans we’re in network with. And so when I said, well, I asked about the report, she’s like, yeah, but it’s still not going to show the product names.
Jack Schell (02:34) So, you need specific product names beyond just like this is the commercial plan. This is the.
Kelly Martinelli (02:42) Yeah. And I said, well, you must not have any big clients because I would, I mean, everywhere I’ve worked credentialing has been in contact with operations scheduling. I mean, that part, I know 100 percent because we always had something to look at that showed, okay, this doctor was on plan with a managed care and managed plan. I mean, it gave me the exact name effective date. Was this because they knew that they could schedule with them but not with the other one because we don’t have a contract that we’re in network with?
Jack Schell (03:12) Yeah. So you’re not seeing… I’m going to open up medallion?
Kelly Martinelli (03:25) I’ve got all my asc stuff. I’ve got a mess going on over here.
Jack Schell (03:29) Go to, I just select a random provider.
Jack Schell (03:39) Let’s go with this one. I go to a provider. I go to payers. Okay?
Kelly Martinelli (04:00) The thing about it, I’m getting really used to this software.
Jack Schell (04:04) That’s a positive. Yeah, whoops.
Kelly Martinelli (04:11) Okay. So you can see my screen, I go to providers and then let’s just type in meta… because I know he’s got a bunch underneath him. Yeah.
Kelly Martinelli (04:31) Okay. So you see how it has this right here? This doesn’t yeah.
Jack Schell (04:35) Yeah. You’re saying it does nothing for you? No.
Kelly Martinelli (04:41) Because it’s like we don’t know we have plans underneath there.
Jack Schell (04:47) So, looking.
Kelly Martinelli (04:48) For that, we’re not in network with, so.
Jack Schell (04:49) A level further down?
Kelly Martinelli (04:51) Yeah, we’re not contracted with some of those. And then it’s kind of different because we have different tins like meta’s in multiple tins. And so we don’t know what plans by tin he’s underneath as well as the actual name of the contract that we have. So what’ll happen is this front desk scheduling won’t know, and we’ll get somebody that we’re out of network. We’re not contracted with. And then we’ve got issues with the sunshine act because we didn’t provide them with a good faith estimate, you know, we now we’re in and out of network situation where we may not get paid at all. Okay?
Jack Schell (05:35) I’m pulling up this provider on my side just to look at exactly what you’re looking at. And so you spoke with Lindsay, you spoke with Lindsay about this. Okay? It.
Kelly Martinelli (05:50) Was just one of the things she had as a takeaway.
Jack Schell (05:54) Okay.
Kelly Martinelli (05:57) And that’s what Doug is like. He just, he really upset with that.
Jack Schell (06:03) Okay. Because of specifically, I just want to make sure I’m summarizing it correctly. So when I talk to Lindsay, I have it, it’s like you need to see a level of more detail below like commercial. So like I need,
Kelly Martinelli (06:18) to know what commercial the actual names of those plans are. Okay?
Jack Schell (06:25) Okay. The.
Kelly Martinelli (06:26) Product name underneath there.
Jack Schell (06:31) I’m just doing a little more digging into the details here. You can see the practice details and the providers there.
Kelly Martinelli (06:44) The other thing I asked her was… so in modio, they actually have a way that they can store privileging documents as well. So, like for our ascs, we have outside providers coming into our ascs and we can’t put them in there to store privileging documents, correct?
Jack Schell (07:06) So, folks that are getting privileged with your locations?
Kelly Martinelli (07:12) Yeah, we can’t just have like dr Burrus, he’s coming in for an example. Like, okay. So here’s what actually happened when we did a aaa inspection just recently. Okay? They used modio. Well, they didn’t have all the forms in one place and they couldn’t find the forms. So they got, you know, strike on the you.
Jack Schell (07:35) Know.
Kelly Martinelli (07:35) On the audit. So that’s like a remediation that we have to do, they were in files on a shared file somewhere. Okay? So I’m trying to do the privileging where if they have access to medallion for our own providers, why can I have a special? I mean, can I just add them with no enrollments or anything and just upload all the documents in there? I didn’t know if that was a good idea.
Jack Schell (08:02) Let me ask if that would cause any issues for any reason?
Kelly Martinelli (08:07) I’m just trying to simplify things, you know, yeah of.
Jack Schell (08:09) Course. And to use medallion as a source of truth, which it should be… let me ask about that example. If, because… we support actually a lot of clients with their hospital applications. So we actually support a lot of clients with getting providers privileged at hospitals or at ascs, so let me see if we can support the reverse… and kind of thinking the same as you like. Can you create a provider profile where maybe they’re not necessarily invited to the platform? But you’re managing details about a provider in medallion. I just want to make sure that it wouldn’t cause any complications or confusion for you and your team, but I’ll ask about that example.
Kelly Martinelli (08:56) All right. And I did ask, I did ask Lindsay like other than just enrollments, what can I, you know what I’m asking, right? What can I send your way? And I said, you know, and Kat and Sonia were on the phone and I said, you know, they’ve got a lot of stuff on their plate and they’re a little overwhelmed. What else other than enrollments can you handle? And she told me to ask you, so.
Jack Schell (09:20) Well, well, yeah, that’s just because so currently, like what we are set up for work to do, and the work that we’ll complete for paying specialists is pay enrollments. Okay? We do offer other services. I just mentioned one, like we do privileging for some clients and then we do licensing. So we do handle licensing. So if you have a lot of renewals in a particular year that you want to manage, then we can manage that. And then we do also support clients with getting delegated with payers and getting delegated credentialing stood up. So if you do have any delegated agreements that come about, then we can support with delegated agreements and delegated credentialing.
Kelly Martinelli (10:10) Because I can understand right now why Angela said we can’t terminate anybody because I mean you’re just taking the enrollment stuff off, but there’s all this other stuff that’s going on. They have asc privileging, they have primary source verification. They have revalidations, they have, you know, they’re doing stuff with the Ra and eft enrollments into waystar. Well, we are, yeah.
Jack Schell (10:34) We are doing, let’s see real quickly.
Kelly Martinelli (10:39) And Doug and I keep telling Doug that and he’s like, well, why are we paying all this money? I’m like,
Jack Schell (10:45) no. So we are doing some monitoring, some primary source verification monitoring for you. You are, I can send you which ones we’re doing.
Kelly Martinelli (10:59) Okay.
Jack Schell (11:02) But,
Kelly Martinelli (11:02) I wonder if Kat just doesn’t know that.
Jack Schell (11:08) We’re also doing caqh management for you, which means that caqh profiles are being synced like between medallion and caqh. So if something is updated within medallion, it’s like a bidirectional sync to caqh where that profile is also updated. Okay? So… the bulk of the work that we’re completing is the support with higher enrollments, which includes revalidations, and also includes any demographic updates required.
Kelly Martinelli (11:40) We’re doing caqh, that’s what I need to know because right now, she’s doing revalidation with medicare. And if you’re doing that, I mean, why is it? She pushing that over to you? If you’re doing revalidation?
Jack Schell (11:54) Revalidation? Like, so people are, you know, at the two year mark or three year mark, whatever it is and they need to just revalidate their enrollments?
Kelly Martinelli (12:02) Yeah.
Jack Schell (12:03) Yeah. So you do have that started with us where if they’re in system and they’re coming up for revalidation, then the request should kick off and our team should work that.
Kelly Martinelli (12:15) Okay. So I’m going to tell them they should be, you guys should be doing the revalidations for medicare. Okay? Yeah.
Jack Schell (12:22) We’re not just doing new enrollments, we’re doing like we can handle revalidations.
Kelly Martinelli (12:28) So, I think that’s the problem.
Jack Schell (12:29) A lot of the volume that’s been purchased has been with like revalidations. So let me show you this. We reviewed this in the executive sync that we have. Do you mind if you stop sharing your screen so I can share? Yeah. So we review this on a monthly basis in our executive sync. This is consumption.
Kelly Martinelli (12:52) Yeah. And.
Jack Schell (12:53) Like, so this is the volume purchased. So for payer enrollments on an annual basis, 845 new that’s for new enrollments. Okay. Revalidations got a lot of revalidations volume and coming up that we can use and then demographic updates. So if there’s information of course, that needs to be changed demographically, then we would handle those as well. You would submit a demographic update request via medallion. So kind of like we talked about before, like maybe two weeks ago or a week ago. What we… need your team to do is to submit requests for these things. And then once you submit the request for these things, our team takes over the work. If there’s something that’s missing that is required to complete this work, then we will ask your team for it and we’ll task it out via the medallion platform and we’ll say, hey, you made this request, we’re working on it, but we need this additional information and that’s how the back and forth should and will work. So if Pat has a revalidation coming up and she wants to get familiar with the revalidation process through medallion, she should initiate that revalidation through medallion and start to get familiar with that kind.
Kelly Martinelli (14:13) Of process. What’s the monitoring thing?
Jack Schell (14:16) Monitoring is the primary source for applications. So we do some ongoing monitoring for your providers. Let me, I think right now we’re doing license expiration monitoring.
Kelly Martinelli (14:36) I know you are because I saw that in there. I thought with the license.
Jack Schell (14:42) Yeah. So we’re doing continuous checks on state licenses, Dea licenses, CSR licenses.
Kelly Martinelli (14:49) Okay.
Jack Schell (14:56) So, we do offer various primary source verification monitoring products and there are some that offer additional monitoring. So, like we have sanction monitoring, we have ncqa compliant monitoring. We have comprehensive monitoring, and each one of these monitoring packages comes with specific pscs.
Kelly Martinelli (15:18) Okay. So I do the exclusion monitoring with my compliance software.
Jack Schell (15:25) Okay. The medicaid exclusions?
Kelly Martinelli (15:28) Yeah, all states all?
Jack Schell (15:30) States? Okay. Yeah.
Kelly Martinelli (15:32) It’s all states, LEIE o, IG gsa, Sam.
Jack Schell (15:38) Sam. Okay. Yeah, I was going to say because since you have our license expiration monitoring package, the other one that is really common that I see is just sanction monitoring, which is Sam o, IG medicare opt out and mpdb.
Kelly Martinelli (15:52) Yeah. We have all those, but we also do state individual states because you’d be surprised how, because I found that like when I came, we had a provider that was excluded in the state of New York. Oh, wow. Okay. Lost their license in New York and I had that when I worked it and that’s.
Jack Schell (16:08) fine. Yeah, because.
Kelly Martinelli (16:09) We’re in 14 states. So like somebody would end up in trouble in Texas. That’s what happened? Somebody was in trouble in Texas, but they could go practice in another state, but Pennsylvania, they actually monitored all of those, they monitored that pretty close. So, if there’s a physician in another state, they’ll ban them from their state as well.
Jack Schell (16:29) Got it. Okay. Let’s see. Alright. So, there’s two items that you brought up with me. There’s the line of business detail which you’re… hoping for detail that’s a step further. Then there’s the item with, can you use provider profiles to store privileging documents and just make sure that won’t kind of create any hiccups or barriers within the platform?
Jack Schell (17:14) I’ll get with Lindsay and the team. Okay. I’m… sure she has all the information from your call earlier today, right? You guys met this morning?
Kelly Martinelli (17:24) Yeah, she’s got a lot that she took back from today’s, call.
Jack Schell (17:28) Okay. And I know that we identified the discrepancy with the enrollments on those providers. We were looking at. It looked like one provider was initially imported to our system with a different email and then deactivated. Huh. And so when that was deactivated, all the existing enrollments that were uploaded were deactivated with it. So, I know that she was working on like merging those profiles or like providing a solution.
Kelly Martinelli (17:53) I think it got fixed because I looked at it and I could see stuff in there. So it looked like it got.
Jack Schell (17:57) Fixed. Yeah, there you go. And then those two other providers were new after implementation. So, their existing enrollments if any were not imported, but the team can put the details of those existing enrollments into medallion. Okay? If there are any, but I can see that there were also enrollments already completed for them, which is great.
Kelly Martinelli (18:20) All right. And I got to say, I’m really nervous about them firing caqh in the next couple of weeks because I just, I don’t have a handle on this and I don’t have the time to do credentialing on top of my compliance stuff. I haven’t even touched compliance all week. It’s like I’ve been, oh, wow. Yeah. Okay. I’ve been dealing with all of this. Yeah, because there was a big, there was a big to do yesterday over Jessica garou. Yeah. And it was, what did she credentialed with because she was hired eight months ago and I don’t my, and your system only showed three.
Jack Schell (18:56) The three that were requested and.
Kelly Martinelli (18:58) Modio had other ones in there. And then there was other stuff that Kat had that wasn’t even uploaded in any system. Well, Kat didn’t know how to upload in medallion. She was never explained or taught how to update stuff in there. And Lizzie couldn’t figure it out. So she had to go back to medallion?
Jack Schell (19:17) I know Naomi did a number of trainings though on that.
Kelly Martinelli (19:21) I don’t remember, I don’t remember that being in that training though, either.
Jack Schell (19:25) What specifically it?
Kelly Martinelli (19:28) Was, how to update? Like.
Jack Schell (19:31) How to add an existing enrollment?
Kelly Martinelli (19:34) No, it was. Well, yeah, I think that’s what it is because if they’re already enrolled, how do you upload it? How do you put the notes in the system and stuff like that? I don’t know if it was under a new task or, and she didn’t know either. So she was going to take that back to Naomi. So Doug was like flipping out because he thought he had this provider with nobody enrolled in credentialing, he was ready to fire everybody on the spot yesterday.
Jack Schell (19:59) Yeah. You can just add the existing enrollments to the profile. You just click add enrollment.
Kelly Martinelli (20:06) Okay. Let me see because I don’t know if she has that again like her and I are like looking at stuff going. I don’t have that same field. So it’s under payers, right? Yeah, they go under Jessica. It’s under payers under enrollments. Oh, add enrollment. Okay? And then you just upload it, right? You.
Jack Schell (20:29) Complete the fields or you can upload. And then there’s a document upload file.
Kelly Martinelli (20:34) Oh, okay. I see that. Oh, that says… export payment. Yeah, it says I can export it. You can’t upload a file and it just says bookmarks or, well, let’s see, add enrollment. Yeah, you have to do it individually online.
Jack Schell (20:59) Yeah. Well, so you do that enrollment and then there’s a couple enrollment, details based on line of business. And then if there’s a particular file to upload for the enrollment, you can upload the file attachment.
Kelly Martinelli (21:15) Okay.
Jack Schell (21:17) So, you know, as you have new providers start and we handle all of the enrollments you’ll see like with Jessica grau, how there were three enrollments there. Those were three enrollments that we completed for her. And then they’re right there we completed it. They’re right there in the profile. So she must have started at an interesting time where like we were just starting to take over work for you, but there was already work being done too. So this should only be, this should likely be one of the few instances where you have to add the enrollment if we are handling all enrollments for you. If there’s enrollments being handled outside of medallion, then you will need to add them in that way you’ll need to go and you’ll need to add enrollment. So it’s another reason to encourage cat to like submit the request through us and have us do all the work.
Kelly Martinelli (22:09) Well, going forward, they’re all getting submitted to you. The problem is Angela went ahead as we were in the middle of things and had them go ahead and start the applications.
Jack Schell (22:21) Okay. And so then that’s why there’s information living outside of medallion. Yeah. So, at this point, we think she.
Kelly Martinelli (22:27) sabotaged us honestly.
Jack Schell (22:31) I know that she was resistant to providing a lot of information to us at one point, but after we met in January, I know me, you and Julie met and we reviewed like the need to know things. We started getting more ground, but it’s hard to see from your side of things. It’s hard to like know exactly what was going on. But… yeah, it does seem like there were a couple of delays when we were promised things before, and so we can make it all right. We can get all the information into medallion. And like, as you see, when you submit requests to get enrolled, you tell us it’s priority. Our team hustles on it. So like fully confident we can handle the enrollments for you. Unfortunately, it sounds like there’s some things some specific things to work out the kinks for. Yeah.
Kelly Martinelli (23:26) I got a lot of kinks, I gotta work out and I gotta, I wanna try to push as much to you as possible.
Jack Schell (23:34) That’s that’s my goal. I’ll get with Lindsay on the item that you had initially reached out about the visibility to like the specific plans transparently. I haven’t seen that with the clients that I have. So, I need her expertise and I need her team’s expertise on how, we’ve handled this when it’s come up in the past.
Kelly Martinelli (23:59) Okay. But,
Jack Schell (24:01) I, but like I’m working on it and I’m sure Lindsay is too, and we’ll, continue to provide those updates. And then, I know you mentioned Doug is out of going out of the country. When is he back?
Kelly Martinelli (24:13) He’s in Texas. We’re all in Texas next week.
Jack Schell (24:17) He’s back next week. Yeah, quick trip out of the country. Huh? Yeah.
Kelly Martinelli (24:22) His wife’s birthday. Then I think they’re going to cabo or something. Okay?
Jack Schell (24:26) All right. So, let me get with the team. I know you asked for the sales team. I’m curious if there was something that.
Kelly Martinelli (24:33) He’s just gonna be, he’s gonna be hot on this, but if we can get this straightened out then we don’t have to have a call. You… know what I mean? Okay. Yeah, we can get it. If we can get it worked out, then, I can back him off. Was.
Jack Schell (24:49) There, is there, but is there something specific that the, that you were looking for that the sales team needed to speak to? No?
Kelly Martinelli (24:57) Because when we were in the sales team, he’s like you get everybody on the call? Okay. I will do that. That’s that’s how he, when he’s angry about because we were told in the sales process that our staff could get in there and see those plans and maybe they didn’t understand what we needed and we didn’t understand that you only had it at a high level because he would have never signed a, he would never signed a contract got.
Jack Schell (25:26) It. Okay. All right. I appreciate the clarity on that. Ask. All right. Let me get with Lindsay. Let me take some time to like assess and figure out what the recommend recommended path forward is. And in the meantime, we’ll continue working on the other items too, like making sure that you have the reports that you need and, you know, if you do find other providers where you’re like they should have existing enrollments. Like, I know you’re checking with Kat on what she has in her hands, but we can also double check like again, maybe there’s another situation where a provider was deactivated from an email perspective. What have you like? Just let us know what you need us to check on and we’ll keep doing it. Okay?
Kelly Martinelli (26:10) Sounds good. Thank you so much. Yeah.
Jack Schell (26:13) Of course. All.
Kelly Martinelli (26:14) Right. Bye bye.