Transcript
Naomi Denson (00:00) hello? Welcome back. Thank you. Let’s see Melissa’s waiting room… thank you.
Naomi Denson (00:25) Hi, Melissa. Oh, she’s still joining?
Naomi Denson (00:35) Hi, Melissa.
Melissa Mendez (00:36) Hey, good morning. Good.
Naomi Denson (00:38) Morning. How are you?
Melissa Mendez (00:40) Doing well. How are you?
Naomi Denson (00:42) Doing good. All right. Let’s see. How did I saw the email about baptist setting up credentialing committees early? So, did Teresa have a chance to go through their provider data and confirm that was all of their providers? And that was everyone that should be loaded?
Melissa Mendez (01:06) I think they probably do need to make some tweaks at least add those couple of providers that she said are new, but she hasn’t gotten back to me with the updated template. So, I’ll check in with her again to get that correct list.
Naomi Denson (01:25) Okay. Yeah. And then for their, if they’re going to start credentialing ahead of, you know, on their own to, for the urgent needs, do they have a separate set of policies and procedures that we should be going by? Or are we going by just the lpca policies… that you sent us?
Melissa Mendez (01:52) I guess if they’re just doing their internal review for now, I… mean, it sounds like we should use, we should look at their policies and procedures. Right. Does that make sense? I mean, I think, yeah.
Naomi Denson (02:10) I mean, if they’re going to put them back through credentialing under lpca later, then they’re only, what is the purpose of, the… credentialing file for baptist, is it just onboarding hiring new providers or is it like an actual like ncqa requirement for compliance? I.
Melissa Mendez (02:32) think it’s a hrsa requirement for health centers. Like, I know that health centers regardless have to do like they have to maintain privileging to approve the services the provider can perform at their specific health center?
Naomi Denson (02:50) Okay. Yeah. So, let me know about their data. And so we can get that loaded. And then I would reach out to them and ask them for their policies, so we can make sure that they’re set up correctly before they start making requests. And then also, we just need to identify who would be on their committees as users of medallion to vote and close out the files.
Melissa Mendez (03:14) Okay. And so, I do know with health centers, like sometimes they do, when they do their internal review, sometimes they do have like a small internal committee, but a lot of the times it’s also like board ratification or like medical director sign off. So in those cases where it’s a reviewer or sometimes it’s like medical director sign off and then the CEO sign off. So like if it’s a reviewer, like the CEO, do we, is it kind of like, is it the same process of setting up those reviewers? Like setting up a committee even though it’s not, you know, technically like a credentialing committee in the way that we’ve been thinking about it. Like I don’t think that, you know, like because I know with the provider credentialing committee, we needed them to vote on each other’s files before they could vote on, yeah other credentialing files. But if it’s something like board ratification or medical director signing off or the CEO signing off, then do we still set them up in the same way and just not have to do the reviewing of each other’s as?
Naomi Denson (04:21) Long as they’ve already credentialed their medical director, then I think would be fine and they have that documented internally that he’s cleared and, you know, good to go. But I think it would just be helpful to see their committee set up and their policies and how that workflow goes and get a better understanding on, you know, the purpose.
Melissa Mendez (04:45) Okay. I’ll ask for those.
Naomi Denson (04:50) Perfect. And then let’s see… southwest and peace. We’re working on existing enrollment data, yeah.
Melissa Mendez (05:07) Yeah, they just said that they’re going to start working on it, but they don’t have any updates for me.
Naomi Denson (05:15) Okay, perfect. Well, we’ll get there and then the sub license agreements for the other health centers. I know you said last time Andy had received approval, it was under review to execute any update there on, you know, who those centers are going to be, and when we can expect data to come in.
Melissa Mendez (05:35) I’m not sure. I don’t have an update on those contracts. So, I’m not sure when we can expect them to come in but, okay, I know. Yeah.
Naomi Denson (05:49) Okay. Just let me know when you know, and I know you have the import templates that you’re going to share with them. So as we start getting data, I just want to know so I can get their platform built and we have somewhere for that data to go when it does start coming in. And then still no progress on the lpca committee. I know you guys were meeting with some people internally to try to get volunteers to be on the committee and you didn’t have any, and Andy was going to have one on one conversations.
Melissa Mendez (06:21) Yeah, I know the Andy and the network directory that are having those conversations still, but I don’t think we’ve gotten anything, okay?
Naomi Denson (06:40) Perfect. Right? And then, so because we don’t have committee, we don’t have answers to these questions yet. The ofac, I do proxies.
Melissa Mendez (06:50) Okay.
Naomi Denson (06:53) And then I can’t remember if I, this was on our agenda last week and I can’t remember if I already addressed it with you about the peer references. We didn’t see anything in it’s not typically part of the ncqa credentialing. And we didn’t see any call outs to it in the policies and procedures that it’s needed. So we were just wanting to circle back on that because that was a question that you had had on… how, yeah, you managed you?
Melissa Mendez (07:21) Had mentioned it to me. And so, yeah, I’m it’s like something that I have on the agenda to make the committee aware of when we are able to set up that governance committee. But because I’m I need to, I’m assuming it’s maybe I don’t know where that requirement had come from. And so, I want to better understand from them. If it’s not ncqa, then, you know, how are we going to handle that? If the health centers have to maintain that process, but yeah, it’s something that.
Naomi Denson (07:54) It’s on your radar. Yeah. Okay. And then the only other thing was the npdb any update from southwest or priority health, on getting those over any other questions that they have around the authorization not.
Melissa Mendez (08:09) From those two baptist was saying that they run npdb pre hire and so they wanted to see if they could keep that in house so that they could do it before beforehand because, you know, they don’t want to have to do it immediately and then have medallion completed again and have to pay for it twice. Yeah.
Naomi Denson (08:32) I think the only thing there would be because npdb is a requirement of us to monitor and run as a cvo, like for the purposes of future delegated agreements, we would have to be monitoring that. It sounds like maybe they’re doing a one time query, when they hire a provider and they’re not continuously monitoring. And… without us being it having the access, it would not pull those queries into the credentialing packet. We would have to task out to pull a new one time query regardless. So, but with onboarding new providers, they set up the continuous queries as soon as they, if they just added the provider to the platform, like created their profile and provided the data points needed, it would automatically start running those for them. So they could do that before they hired the provider, it could still go into through medallion. Does that make sense? I?
Melissa Mendez (09:30) Think so. So.
Melissa Mendez (09:38) They could pre hire, put the data in medallion just… to like just enough. Yeah. What exactly do they need in medallion to do the ncqa? Or to run it? Sorry to run npdb like because if they don’t have yet all the provider information, so.
Naomi Denson (10:02) Right here, I have a sheet that outlines the requirements for each of the checks. So for npdb be first name, last name, date of birth, profession, type, social security, npi, gender and address, or either, or social security or npi. So for the npdb queries, these would be, the requirements that we would need in the provider’s profile at a minimum. And then those verifications would kick off and start running.
Melissa Mendez (10:35) Okay. So as long as they have that information and they plug it into medallion before the provider gets hired, they could, that would trigger npdb that medallion could run. Yeah.
Naomi Denson (10:55) We would run it through their npdb org registration as a, the authorized agent. And then they would get the results in the platform directly once we have all of those features. And then of course, the authorized agent access with the dbid setup. So any provider that has these fields in, once we get the dbid and enable the auto enrollment as soon as the provider’s profile is created, has the minimum requirements needed. They’ll start going through those verifications automatically. And then if they run it and they’re like we’re not going to move forward and hire them, they just disable the provider’s profile, deactivate it. They never even have to invite the provider.
Naomi Denson (11:39) Okay. And then they free up that core seat.
Melissa Mendez (11:46) Okay. And so they could still do it pre hire if medallion maintains the process and medallion has to do it regardless on an ongoing basis because it’s part of your.
Naomi Denson (12:08) role as a cbo. Yeah. Okay. For ncqa standards, there has to be some sort of ongoing monitoring. And if they’re not, if they’re not doing the ongoing monitoring piece and they’re just checking one time at time of hire, that’s.
Melissa Mendez (12:22) not technically.
Naomi Denson (12:23) Sufficient for cbo compliance. Yeah.
Melissa Mendez (12:26) I can’t imagine that would be the case. I am sure that they are doing the ongoing monitoring.
Naomi Denson (12:32) For the continuous queries, it’s the same price per provider per year that it is to do that one time pool. So they would just be paying. I want to say it’s like two or three dollars or something per year per provider. I can’t remember the exact amount, but they’re probably paying that… already if they’re pulling them versus just reaching out to the provider and asking them to pull it. Okay… it just depends on what their onboarding requirements are. So, if they have anything also in addition to the credentialing policies and procedures about their HR onboarding processes or requirements, workflows, things like that they could share, we could definitely look at it and see what kind of checks they’re doing and how they’re obtaining them if it’s through them pulling one time or they’re asking the providers to provide it. Okay?
Naomi Denson (13:32) Yeah, because I mean they could be asking the providers to provide it and making them pay for it, having them pay for it or they’re paying for the one time pull or they’re monitoring. Yeah, it would just depend on what their process is.
Melissa Mendez (13:48) Okay. I’ll ask for more information around that then, and I will let you know what they say.
Naomi Denson (13:52) Okay. Any other questions that have come up?
Melissa Mendez (13:57) So, there was another question and I know that we had talked about this a while back and so I need a refresher on because medallion was asking if there was a limitation on the number of payers, and, you know, because I, you know, with their current vendor, I know that like they’re they only handle like a certain number.
Naomi Denson (14:20) Of you said medallion was asking? Yeah.
Melissa Mendez (14:23) Oh, sorry. Baptist was asking. Oh, okay. Yeah. Baptist, I know has a current vendor and they like only have them handle, you know, a portion of the insurers because they need to pay for each one. And so they were wondering like is there a limitation on the number of payer companies? And I think that you had mentioned like there is no limitation on medallion’s end, but we, you know, the network internally might want to cap that for each health center, but I can’t remember why.
Naomi Denson (14:58) We had talked about that. Yeah, in your contract currently, like for year one, you have payer enrollments that includes new group enrollments, new provider enrollments, a 1,000 quantity, and then provider group enrollment revalidations for 1,400 and then demographic updates for 140. So that’s in your contract for, across all of your organizations. So it really just depends on what you want to allow them to utilize as far as consumption, okay, towards the contract in medallion, they have, they’re not going to be limited on which payers they can select. They can select any payers that they need. It’s. Just that how… many are they using? Are they enrolling one provider and 30 payers? And they have 20 providers? So, are they going to use 600 enrollments? It just depends on what they’re utilizing and what you want to allow to make sure that everybody has access to utilize it without over consuming?
Melissa Mendez (16:01) Okay. Got it. So it’s not about the number of payers, it’s about just the number of enrollments.
Naomi Denson (16:06) That we have across.
Melissa Mendez (16:08) Yeah. Okay.
Naomi Denson (16:08) So, it’s typically per provider per group, per state, per payer, could be one request. And then depending on how they’re if they have multiple practice locations, if they’re set up and, you know, they need each npi enrolled separately, that would be a separate request for each practice npi. If it’s a different submission. Does that make sense? Okay.
Melissa Mendez (16:36) Yeah. I’ll talk to Andy then and see if, yeah. Okay. Yeah, yeah.
Naomi Denson (16:42) And then they did build in and it probably doesn’t look like much. But in your login when you go into lpca, let me just make sure that it’s there. I saw the flag that it was there lpca?
Naomi Denson (17:02) Yeah. So they built in the roll up reporting. So as we start going live, these… custom reports here are going to be for every different health center that has their separate medallion instance. They’re going to roll up into combined reporting so that you and Andy or whomever is only having to look for reports and analytics in one place. The requests still have to be made individually in each platform. But all of the reporting for your purposes will roll up into this. And then you can monitor your usage here as well to see what’s been consumed, how many aromas you have left, how many have they used? How many are pending? So you’ll have access to all of that in one platform versus having to pull from different health centers, oh.
Melissa Mendez (17:49) Cool. Okay. That’s super helpful. Yep.
Naomi Denson (17:51) So all of that is built. I got the confirmation while I was out of office that was ready to go for you. So once we start really rolling it’s these custom reports down here that are collaborative of all centers so far. Okay?
Melissa Mendez (18:06) Okay. Cool. That’s that’s super helpful.
Naomi Denson (18:10) Anything else that’s come up?
Melissa Mendez (18:13) There was just one other question about and I’m sorry, I’m sure we’ve like discussed this as well before, but for the caqh reattestation, is that part of the expirables report for that gets sent out with, to each health center? Or like, is there a process for medallion informing providers or admins of upcoming caqh reattestation? Yeah?
Naomi Denson (18:41) And we had talked about this before. That’s only an option and included if you have caqh management in your contract, which you don’t the caqh management is where we’re managing the provider’s caqh profiles, where they would, if they were enabled, it would automatically pull in their latest attestation date and when their next reattestation is due, but that’s not currently in scope. Okay. Thank you. Yeah, no problem.
Melissa Mendez (19:13) Anything else? Those were all the questions that came up recently?
Naomi Denson (19:19) Okay. Well, perfect. Just let me know if you hear back from Teresa on either any data or the credentialing policies and how we want to set up those committees for that initial push and we’ll get all of it set up for you.
Melissa Mendez (19:35) Okay. Appreciate it. No.
Naomi Denson (19:37) Problem. You have a great rest of your week.
Melissa Mendez (19:40) Thanks you too. Thank you. Bye bye.