Transcript
Rheta Larson (00:00) hello? Hello, Mellon team.
Lisa Frank (00:02) Hello? How?
Rheta Larson (00:04) Are y all doing today?
Lisa Frank (00:07) Good. Thank you.
Rheta Larson (00:09) Doing well. Thank you for asking… great. Let me see. It looks like we have Jay Kenneth. Is there anyone else from the magellan side joining nope? Okay. And I think you will just have myself and Nick today. So… I’d like to open the floor. I know we’ve had several conversations and then we had a slightly smaller conversation with fletcher and the team, but let me share my screen and I first wanted to kick it off with asking about the file from the thirteenth. I know we received the file or we sent the file with the expectation that it was going to be the full universe of licenses again. So I just wanted to see if you all had any questions. There. Is there anything you want us to dig into flag in this call that we can help support?
Jason R. Hough (01:02) I didn’t even open it. I’m waiting for the updated file.
Rheta Larson (01:07) The updated file on the twentieth, correct? Okay.
Rheta Larson (01:11) Gotcha. That makes sense. If there is anything in particular that you see, if you happen to glance at it and you see anything that’s funky or you want us to cover, let me know and I can explore the license further with you.
Lisa Frank (01:24) Okay. But.
Rheta Larson (01:25) Like I mentioned in the email, it looks like we are on track for the twentieth to have the correct filter set for the licenses expiring in 30 days or expired within the past 30 days. So you should receive that smaller list of licenses… question?
Lisa Frank (01:40) About that. I’m just processing that and thinking out loud. So if you filter, which is what we requested, I just want to make sure that we’re not missing any potential impact there. If you filter for that, I guess it would be a 60 day window right? 30 days before to 30 days after. Is there any possibility that?
Lisa Frank (02:09) Can we, can, we assume, and I guess Jay, you’ll be able to have visibility to this tomorrow that anyone who expired previous to that, you’ve already attempted to verify. So it’s either been updated or there’s a need attention alert on there or, you know, some comment on it that would indicate that you have worked that license. We’re not going to end up with like a gap of months that just haven’t been interrogated because they’re falling out of the new filter.
Rheta Larson (02:47) That is correct. These licenses are ones that we’ve already validated whether that was ran through the automatic validation or it failed in some capacity and kicked to our manual team. So that’s not to say that it will 100 percent of the time be in needs attention, but if it is in an expired status or there was something we couldn’t validate, you would have visibility into that in the platform to review and kind of back them. So.
Lisa Frank (03:13) Jay, when you get the file tomorrow, which should be, you know, reflective of these new rules and of the March second file that we sent over, if… you find that there’s like a subset of providers that… you feel didn’t reach some kind of a final status, whether that’s because we have a mismatch on the license appropriately or, you know, they have whatever might have caused that, then we may need to send like that delta file back to medallion. I think to just investigate what you’re seeing. If I’m thinking about this correctly, what are your thoughts Jay?
Lisa Frank (04:12) I can’t hear you if you’re talking.
Jason R. Hough (04:17) So, let me see what comes back. So the file that we sent them went out at the beginning of this month. We’ve updated thousands of licenses already on that file. So I’m going to have to run a disruption on what we sent them, what comes back and what we’ve already worked in the meantime. So, but yes, if I find anomalies, I will make people aware.
Lisa Frank (04:46) Okay. Hopefully this will bring us a lot closer to, you know, where we’re really just receiving updates on that, those providers in that 60 day window and any cleanup that needs to be done outside of that can really be easily identified or not easily, but can be identified.
Rheta Larson (05:11) Yeah, definitely. Looking forward to any feedback that you all have when you receive the file, and we will action appropriately from there.
Lisa Frank (05:21) Okay. Ken and Kenny are, I guess Kenny, you’re Ken’s, not with us anymore, but Kenny, from your perspective, the work on this is done, right? Like you don’t have any concerns about inbound or outbound processing. At this point, there isn’t anything that like anything new that we’re going to be receiving that we don’t have rules for. So as far as you’re concerned, we’re in steady state, right?
Lisa Frank (06:02) Kenny… he may be doing more than this thing right now. I’ll follow up with him after the meeting. I’m inclined to just let him decline. He and Ken Moreland just decline this meeting moving forward. I think their piece of this is probably done. And if we find that something’s not processing, right? On our end, it’s probably an internal issue from an it perspective. Jay, do you agree with that? Yeah. Okay. So we may, you know, we may let them off the hook moving.
Rheta Larson (06:45) Forward. Do you want me to remove from, the scheduled calendar invite or do you just mark as optional?
Lisa Frank (06:53) Yeah, you can mark as optional, but I’ll.
Rheta Larson (06:58) huh. Okay. So.
Lisa Frank (07:02) I’ll double check with them to just make sure that he’s comfortable with that before you remove them from the invitation.
Lisa Frank (07:09) But either way, I think they’ll probably stop showing up unless they have concerns that I’m just not, I’m just not aware of at this point… okay? Sounds.
Rheta Larson (07:23) Good, perfect. Any other questions on the inbound outbound files? Anything else you’d like to discuss there? No. All right. My next talking point is a corrective action plan. Given we’ve had, you know, extensive months of ongoing issues with the files that majone is receiving. I just want to let you all know that we did create a corrective action plan. It will have an overview. It will also list the incidents that had occurred. So kind of like what medallion had reviewed, and then a root cause analysis and corrective action measures. So we’re in the final stages of validating and finalizing that. And then once I do have that, I plan to share it with you via email and we can discuss it live during our next sync. But I just wanted to make you all aware we did put in long term preventative measures. So this does not continuously occur. I.
Lisa Frank (08:26) Appreciate that. That seems like a great next step. So, thanks for, you know, making the decision to do that on your own. Yep, of course.
Rheta Larson (08:40) All right. And then lastly, as far as an eta is concerned, I should be able to get it to you this week via email if not, I’ll be early next week just a heads up there.
Rheta Larson (08:52) All right. And then lastly, I wanted to go over the licenses that are now falling or to the client that needs client attention, which is that needs attentions verified column. I think I’ve quickly. Glad ran through this with you at one point. But as administrators. Now when you navigate to licenses and then navigate to the existing licenses, what I’m essentially doing here is about or filtering by needs attention. And then that’s going to pull the list of any licenses that medallion has touched but wasn’t able to either verify because of a data mismatch, or another scenario where the license has expired, which I don’t think there’s too many in that bucket since y all are scrubbing those as well. But I can run through a few of these and just show you how we would basically correct the action or validate the license. I’m trying to find. Let me do an MD one because that might be a bit easier than… some of those lpcs or lmfts. Okay. I’ll use Regina as the example. Here. She’s a do so essentially what I would do in this case, if it does fall to you, all that needs attention. The first thing I would look at is a note just to see if anything in particular had been flagged by medallion. If not, then what we would do is look to see what the issue could be by actually exploring the verification through the board portal. So in this case, it’s for California. Do I’m gonna pull by the license number? But in this case, what I typically do is I try and pull by the provider’s first and last name just in the event that there was a mismatch. So I’m just pulling up the dca search, let’s… do the license number. Okay? And then you can see there’s several of the same license number tied to California because they use the profession. They use license numbers for different professions. So in this case, I want to narrow into the board which would be either medicine or osteopathic medical board because they’re a do. So, then I would narrow that in further. And… then there’s two hits here. So I see one same name. Then there’s another one with a previous name. So I’m going to utilize this one to validate the license.
Rheta Larson (11:35) And then I’m going to pull the record just to make sure we have the same info. So give me one second.
Rheta Larson (11:47) So here on Regina, I’m just going to isolate her. So we’re not looking at any other noise.
Rheta Larson (11:57) Okay. And then I’m going to go ahead and hit the verify manually button. This is essentially how the team reruns the validation. And this is what you all, as admins should do in the case that you receive a license that is in fact in this needs attention status. So you hit verify manually. And then you’re basically just cross comparing with what is in the board portal to what is in medallion. So I’m just going to take this information and input it into the system. Can you give me one second? I’m just going to open the door really quickly for my dog. Excuse me.
Rheta Larson (12:43) Sorry, I don’t know if you can hear the barking but it drives me nuts. So thanks for y all’s patience. Okay. So this is for Regina. Like I said, and I do see her name as Regina baton or baton, which her middle name is the citus S, we’re not validating the middle name. So it looks like that’s a match there, first name, and last name. She’s a do so that matches based off of what I’m seeing in the portal. I haven’t pulled up another screen, the license number one, zero one, two four also matches. And then I am looking for that expiration date which.
Rheta Larson (13:22) I am not seeing… I do see it March 30 first 20 27. So everything that I’m seeing here does in fact match what’s on the actual board portal. So Regina last name, one, zero one, two, four expiration date is the same. I don’t see any… type of records like criminal history or any sanctions, no records. So I think we’re in good status here. This one may have been a one off. I can explore further like why it was slipped to needs attention, but this one looks clean. So all I’m gonna do is I’m gonna save this PDF document directly from the board portal. So… I will save this. You do have to save it as the provider’s first and last name in most cases. So that way the naming convention matches the system. I think from a client perspective, it doesn’t matter but at least from a medallion perspective it does, it will flag it and say like this isn’t the correct provider. And then I am going to again make sure all this is correct, which it is nothing is changing. So I’m just pulling this source… URL, you’ll plug in the source name. So in this case, it’s the osteopathic medical board of California from which I validated from. And then you’ll add that document that will be Regina. And then once you submit and push through, it will automatically clear that needs attention. So you can see it’s out of there and it automatically moves it to manually verified. So if I go and search for her, that should resolve the issue on y, all’s end and you can see she populates there, you can see and view the history from prior. So like if y all are messing with these and you’re like I accidentally did something, I need to go back and look at it. You can view the history of the verifications and then just see who last manually verified it. And then you’ll be able to see that history here as well. So I think this one was marked needs attention by our staff because they saw. I don’t know what, why they marked it might have been the name. Maybe they thought this was the last name, but that’s her middle name. I think the name threw them off. But that is essentially how you would clear those in those status. I will pause there because I know that’s a lot of info. But any questions on the needs attention part or how to validate a license?
Jason R. Hough (16:13) Is it your expectation that we’re going to update your system? So.
Rheta Larson (16:19) The platform is there for you all to use it’s? I mean, I know y all are utilizing the files themselves, but that’s what the intent is here. If we can’t validate something or there’s something that… is a data mismatch. We move this here in platform for you all to like flag. And that way we’re covering like, hey, we tried, we just could not find this. So, I think whatever you’re receiving on the report like this would be good to pair with. In some cases, maybe that way y all can just ensure we’re doing our part the first time, but it’s not the expectation. It’s definitely there for you to utilize though. What?
Jason R. Hough (16:57) Would happen if we don’t update it?
Rheta Larson (17:00) They are going to remain in this status… that needs attention. And essentially the team won’t touch it. So like if it falls back into… it, won’t fall into the queues until it hits like an expiration. Date. So like some of these expired ones, those won’t like be re ran, but anything else? Yeah, that… just may cause us not to touch the file essentially.
Jason R. Hough (17:30) So, if we fix it on our end and we send the outbound file the first week of April, so it is no longer expired on our outbound file, it’s going to remain in your system as a problem.
Rheta Larson (17:44) I believe so if it’s not actioned, I can take that as an action item just to be sure because I don’t know how it would be re ran, Nick, unless you know, at the top of your head like how, yeah, I would need to ask the engineers just to make sure like if that comes back through, will it automatically move it? I will get that answer for you because I’m not entirely certain.
Lisa Frank (18:09) Of course.
Rheta Larson (18:12) But it at least gives you some sort of direction of, hey, why did medallion change this? Like here’s a good one. We updated the expiration date from 2016 to 20 20, but it still expired. So we did flag it to you all to say like, hey, this is a problem. This provider’s license is expired. What do you all want to do with this? From, what action there, does magellan need to do with that clinician, is it remove them from your system? Is it, yeah, that would be with y all’s organization or?
Lisa Frank (18:43) Does that one just have a greater than 30 day expired note instead of a needs attention? Yeah.
Rheta Larson (18:50) Eventually you’ll see this slim down like this will not be a continuous running list. I think once we start isolating these files, this really shouldn’t even be a problem. And we should really reduce this number that require us exploring further. But in the instance that automation or manual validation does fail, that’s what’s going to happen. Like our team is trained to move these to the appropriate status for client review because we don’t know what to do from there if that kind of answers your question.
Lisa Frank (19:27) Yeah. Well… sort of. But I guess the bottom line, I have the same, you know, concern as Jay. I just want to make sure that you are always working off of our current file. And what that means to me is if you point something out here that results in us looking into whatever mismatch occurred or problem there was and we fix it in our system so that… the provider is either now gone off the list completely or has a future term date because we were able to verify on our own that the provider’s license has been renewed. You’ll get that on the next month’s files. So as Jay said that provider would no longer live in your filter, right?
Lisa Frank (20:20) Because… they’d have a future termination date. So the next time that provider’s license expires whether it’s in a year or two years or whatever, we want to make sure that you will see that file. And the only way that in my mind, the only way that wouldn’t be true is if you’re not really working off of the current file, if there’s something that’s preventing you from seeing current file information because it has some previous status in your system… yeah.
Rheta Larson (20:57) I know I understand the ask there and I’m going to double check just to make sure that when that comes through, it does push through to our validation regardless because it should. I just don’t want to give you a definitive yes. And then it happens to be like you have to go in and clear this. But yeah, this should be very minimal like I expect… hopefully zero files to come to this status, but of course, we will make mistakes from time to time. Unfortunately, like that is the part of validation. And if we can’t determine something, we will move it to this status which should be, very minor, but it does put that expectation that y all are at least looking at what did medallion do and what do we need to do to help them to get the correct information? So we will flag it in that capacity, and we can continue to have these conversations on our operational syncs too. If you see a next file. Like out of the 300 files that came over.
Lisa Frank (21:48) Five.
Rheta Larson (21:49) of them had validation issues. We can work those and revalidate them for you. Okay?
Lisa Frank (21:55) All right. We’ll look to see what happens. How many providers are in this status right now?
Rheta Larson (22:06) I think there was 800 when I pulled, let me see. And I don’t know if that’s just like individually… detention… oh, 5,932. That’s what I’m seeing.
Lisa Frank (22:21) If we’re not going in there and doing anything to these files, how will they clear? I mean we’ll be doing something on our end if something is warranted to be done. But if we’re not touching your system in this queue, how would they clear out?
Rheta Larson (22:40) Yeah, I have been seeing from previous or like some of these that have gone through validation like two times, in some cases, it’s because we’re getting that repeat list from you all. So I do believe they are pushing back through for our team to touch like we’ll still get it, but I want to confirm that for you before I make any like confirmed yes or no there, but it should just pull back into the validation queue that our team works off of. And then they’ll grab it and try and revalidate it. Okay. The expired ones. I’m a little bit, those are the ones that I’m concerned with, but I’ll definitely check and answer that for you.
Lisa Frank (23:16) Okay. And my guess is that a lot of those… are those licenses. Either those licenses in particular or the provider attached to those licenses is probably not in most cases on our newest file. I mean, Jay, is that a fair? I know you haven’t worked through all of them, but am I thinking about that right?
Rheta Larson (23:42) Oh, we’re clearing out thousands every week?
Lisa Frank (23:46) Yeah. So, so really you should be experiencing a pretty clean outbound file hopefully are?
Rheta Larson (23:56) You all deleting them from the medallion platform or keeping them? Nothing’s happening within the platform other than just the import. Is that the way I understand it?
Jason R. Hough (24:08) So, what I’m doing on our end is I am either resolving them in our system. Either I am removing the license because it is not necessary, so it should no longer show on our outbound report or I am starting the termination process where we go. We’re going to suspend the provider, send them a letter and then give them a 30 day window in which to rectify the situation. If we get to the end of the 30 days and we have no new information, we are going to remove them from the network, which again, would remove them from our outbound file. Okay? But.
Rheta Larson (24:47) Y all aren’t actually going in the provider’s profile and like deactivating them, correct?
Jason R. Hough (24:53) On your system?
Lisa Frank (24:55) Yes, no. Okay.
Rheta Larson (24:59) Okay. That’s valuable information because, yeah, I mean those, if they’re on the ongoing monitoring and they have an existing license, like they will fall into the queue at some point. So we need to, we need to determine how we can prevent that. If they’re not with y all’s system anymore. Yeah, I think.
Lisa Frank (25:21) That’s the emphasis on working from our current file, right? So, so you’re telling us what action to take that’s you know, that’s what this relationship is. You’re telling us what action to take? We’re taking the appropriate action in our system, and then you’ll see the results of that action in the newest outbound file, which may mean the license is gone or the provider is gone… okay?
Rheta Larson (25:48) Gotcha. Yeah, I’ll get that squared away. I’m just going to open a conversation with our engineering team and most likely product team just to see if that is the case for ilv, just so that way we don’t experience this repeat cycle of providers that y all no longer have on your file. Yeah. All… right. Any other questions for me on the needs attention or the validation piece there for existing licenses? Nothing for me? Perfect. I think in terms of next steps, definitely, when you receive the file on tomorrow, it should be a lot smaller number. And then if you see anything flag it, our team will work through those validations and feel free to utilize this piece just to see if there’s anything that we’ve already identified and caught that may help you with those records. Jay, to my.
Lisa Frank (26:52) knowledge, we haven’t received any training on the portal because there was that issue with something being corrected on medallion’s end. Do you well tell me if I’m wrong? But if that’s true, do you feel like you need or want additional training other than what you just saw today?
Jason R. Hough (27:08) What you said is true, let me get through the backlog to a steady state. And if I need more training or we need training of any kind, I will make that decision then.
Rheta Larson (27:20) Okay. Sounds.
Lisa Frank (27:22) Good… perfect.
Rheta Larson (27:25) Well, I have my action items. I’ll answer those questions for you about the platform like falling off, not running through our license validation queues, and then I will work on getting that final corrective action plan over to you for review, but definitely send us any questions or concerns you have with the file when you are able to review it.
Lisa Frank (27:48) Will do great.
Rheta Larson (27:50) I appreciate y all’s time. If there’s nothing else, I will let everyone go.
Lisa Frank (27:54) Sounds good. Have a good one bye.
Rheta Larson (29:00) You. Thank you.