Transcript
Leigh Howle (00:00) hi, Melody. Welcome back. Thank you. Yeah. So I guess you went on vacation and then did your kiddos get sick on vacation or when you got back? Yeah, we.
Melody (00:12) all got sick on vacation.
Leigh Howle (00:13) Oh, no. What a bummer. Where did you all go?
Melody (00:19) We went to Tennessee.
Leigh Howle (00:21) Oh, wow. Yeah. We had some crazy weather here. Yeah. Were you here when all that sleet came down? Yeah.
Melody (00:30) Yeah. We got in. It was raining the first day and snowing and then it warmed up until like the seventies? And then the last day we were there, it was like snowing and raining and we were up in the mountains. And so we had like an inch of snow up.
Leigh Howle (00:45) There. Wow. Yeah. Where you wouldn’t expect to have it after you wanted to get away from the snow?
Melody (00:52) Yep. We had a couple days of good weather, so.
Leigh Howle (00:58) Awesome. Yeah. Like this weekend is beautiful. I think it’s supposed to be seventies, eighties. Yeah, that’s good. What’s the temperature where you’re at right now?
Melody (01:09) It’s in the, I think it’s supposed to be in the fifties while we were gone though. We got like two feet of snow. We had like a really bad snowstorm here. So, which was good. And it happened while I was gone, so.
Leigh Howle (01:21) Yeah, kind of digging out from it. Yeah. Well, I hope everybody can get some rest and relaxation this weekend, kind of recoup and get to feeling better. Thank you. Yeah, absolutely. So I think Amy was going to join the meeting just to kind of give you an update on our, the escalation and the cap that we had started. Let me… she said she’s running just a little bit late, okay? But she’ll join when, you know here pretty soon. So we can go ahead and go over. I did have just a few agenda items if you want to go ahead and jump in on those.
Melody (01:58) Sure. Yeah.
Melody (01:59) And I don’t have access. I sent an email yesterday, but for whatever reason, I don’t have access to the sharepoint anymore. So I couldn’t get into the agenda.
Leigh Howle (02:07) Oh, okay. I know gabby manages that. Let me, let me see if I can.
Leigh Howle (02:21) Like give you access. Somehow… maybe if I share my screen, you might help me be able to help me walk through it, I can try and then if not, I can reach out to gabby and just ask her. Yeah. So I’m in the confluent and medallion team site… sharepoint folder… I think.
Leigh Howle (02:49) I need a setting.
Leigh Howle (02:55) Site permission… and,
Leigh Howle (03:20) oh, it doesn’t even have you in the directory?
Leigh Howle (03:27) So… I think you need to be added to the directory and then added in. So I’ll reach out. Yeah, I’ll reach out to gabby.
Leigh Howle (03:42) Okay. Well, I’m happy to talk about any items you wanted to go over. We can just add them as we go. Okay. Yeah. Do you want to go ahead and go first or do you want me to go over what I have?
Melody (03:53) Here?
Leigh Howle (03:54) Okay. So, for therapy network of Georgia, the most recent roster received didn’t confirm the group demographic updates. It only has the providers listed. And so the follow up team was just wondering if your team could reach out to them and confirm group locations or how that could be those lines could be completed?
Melody (04:17) Okay. Sure. Yep. Let me reach out to Sharon and see.
Leigh Howle (04:21) Okay. And the providers are listed at those locations for the group. Okay? So they’re on file. We just need to know like what effective date to use. Okay? Got it. Okay.
Leigh Howle (04:44) And then on bardevon, so, I know we’ve talked about bardevon a few times and I just needed some clarification on line completion. So, I know in our agenda, we had talked about this back in January that said that the effective date would be the fifteenth when the roster was submitted. Yep. And so my question is, do you want it, should the line be completed like submission and completion same day?
Melody (05:14) Yep. That’s what they said. Yep, they can complete it out the same day that they receive the, or send the roster over? Okay?
Leigh Howle (05:25) Okay. And then did you want the revalidation dates to be added with three years?
Melody (05:34) I think, yeah, that’s.
Leigh Howle (05:36) fine. Okay.
Leigh Howle (05:41) Okay. And then for provider ids, do you want that just blank or the mpi number?
Melody (05:46) You can just leave it blank.
Leigh Howle (05:48) Okay. All right. That was all I had on that one. And then great news. I think on the payer mapping exercise. So, 2,818 unique payer names have been verified with the payer directory or there’s a note on the excerpt like the document and there’s 695 left for confluent confirmation and there have been about 100 payer names already imported by our technical solutions team and mapped into the platform? Oh.
Melody (06:25) Nice.
Leigh Howle (06:26) And there’s a confirmation that once everything has been confirmed by, you know, by your team, by you, your team there’s a two day turnaround time on getting those remaining ones.
Melody (06:38) Okay, perfect.
Leigh Howle (06:40) And then I did want to give you an update. I know, you know, before you went on vacay, there were the strive physical therapy, pa, data migration because the group mpis were a little different. Yeah. And so there is a ticket in for that right now. It’s estimated to take about four weeks. So the estimated delivery date is for 826. Okay? And then on the therapy management services, I.
Melody (07:05) was primera?
Leigh Howle (07:06) Recred date import, there was a roster that had been sent over that had their recred date listed, same thing. I wanted to share that ticket number. And then that estimated delivery date is on four eight as well. Okay, perfect. And then, I mean, yeah, just anything you want to talk about.
Melody (07:28) I think the only thing I think I had was just that amerihealth roster. Were you able to? And I’m still digging through emails. But the one that I had sent over, did the team go through what they were able to send over and verify with what is in medallion? And is there anything that needs to be resubmitted or was it already resubmitted… with things that haven’t that weren’t on that roster? Let?
Leigh Howle (08:01) Me pull up that amerihealth New Jersey strive, very important.
Leigh Howle (08:18) Yes, this was done. Okay. Oh, I need to send that back to you. I am so sorry that’s okay. Yeah, this was done… last week, you know, March eleventh. I met with the team and went over these like step by step. So I will go ahead and send a message to them and I’ll send that back out to you by end of day. Okay? Perfect.
Melody (08:51) Oh, and then there was one other, let me see if I have this here. So two things since I have you, so Kyle McDermott, his medicaid, Maryland medicaid, provider revalidation, if we can mark that one as priority just because I don’t believe it’s due until June. I couldn’t find exactly what the revalidate is on it. But the historic like what happened before with Maryland medicaid is that we missed the revalidate on it. And it became like a big mess. So, the brand is just high energy around any of these. And our specialist put it in and asked for it to be expedited, but she just put it in the notes. So I don’t think she understands that we actually have to like put a little star or like put a request into support? So I’ll get with her to do that. But since I have you, if we can just get that marked as priority?
Leigh Howle (09:54) Yes, absolutely. I will go in and mark it a priority. And I’ll also escalate that to our PE team to make sure that this gets immediate attention and submission accurately, correctly. No mistakes on it. So, yeah, I’ll do that one.
Melody (10:11) Yes, thank you. And then there was, I think it’s for text PTS. Let me just look here. Quick. There are, there were several tasks… that were created asking for medicare ids for the group or for a location. And those are actually in the platform already underneath like if you go under the location, there’s like the medicare ptan, it’s listed there already. So I don’t know if there can just be education around that because there’s I believe it’s the medicaid’s that are on hold. There are demographic updates and there’s like probably 10 that have a task on there, needing the medicare id. And it’s already in the platform. And so it’s just a lot of work for us to go in and answer each one of those with that information.
Leigh Howle (11:13) Yeah, I totally agree there should, in my opinion, we have access to paycos, we can pull the medicare id report. It’s got the ptans on it. There should not be a task for a medicare.
Melody (11:23) Id. Yeah, I was going to start just doing just because there is, I mean granted, sometimes there is, but we have like almost 400 tasks and a lot of the time, my team doesn’t know any better and they’ll just answer them. But ultimately, by the end of the year, like I would like to not have to have so many people on our team internally just because we do have medallion as a support. And if… we could start to like slim down like where can we start leaning more heavily on you guys? And if, right now the team has to do like a lot of task answering. So I would like to just start troubleshooting some of these and figuring out is it really something that is needed as a task? And if it is, how can we get you that information better? Or are we just like getting tasks? Like not necessarily, is there more like troubleshooting they could be doing on their end and they’re just like they don’t know where to go… that type of a thing because I think that’s what a lot of it is that we’re just getting the task and we’re just giving you the information that’s already there on.
Leigh Howle (12:27) Our end, right? Right. Yes, I think that’s a great idea. So, one exercise… that another client I’m working on doing is going through all the tasks. So I can do an export of the task and just kind of run… a file and have the subjects identified. So if we could kind of identify why the tasks are created and what is being asked for in the task, it will, then I can take that back to intake ee, wherever, you know, whatever department and just say, hey, this is already here. You don’t need this or you could go back to your team and say, can we go ahead and have this up front? So there isn’t a task. So I think that’s a great idea. Yeah… bye.
Leigh Howle (13:39) Okay. And I’ll take care of those medicare ones. Okay? Thank you, you’re welcome.
Melody (13:46) And that’s all I had. Okay?
Leigh Howle (13:49) Hi, Amy.
Amy Frana (13:53) Hi, can’t get off mute? Sorry for running so late. Good to see you again, Mel, Melody.
Leigh Howle (14:01) So, I haven’t covered the opsync deck, but I know Amy, you’ve got just a few minutes here and then you have to hop.
Amy Frana (14:07) No, I actually don’t need to anymore. I was able to not have to go to that one.
Leigh Howle (14:13) Oh, okay. Awesome. So I have the opsync deck. Should we go ahead and go over that one? Or should we go into the escalation review? Either one?
Amy Frana (14:27) Okay. Whatever your preference is.
Leigh Howle (14:31) Yeah. Let’s go over the escalation review one. We’ll go ahead and cover this… and let me start the slideshow. Oh, wait, this was going to be March eleventh. Let me change the state to today.
Leigh Howle (14:53) Oh, sorry. Okay. Now we’re back and escalation review with outcomes with confluent, and so on this agenda to cover today, it is the root cause analysis and corrective action plan and areas of opportunity in our solution. The payer mapping initiative. We already talked about that earlier. This just has a little more detailed information and then any next steps. So this originated from the top six payers that were, you know, complaining about medallion follow up and excessive outreach. And so this escalation was created and this cap was done to address those issues and have… like corrective action plans and let you know what the current state is.
Leigh Howle (15:50) Amy, do you want me to keep going or do you want to cover anything here?
Amy Frana (15:54) No, you go on here. If you have questions or anything, Melanie that you might have. I will just real quick have a couple of updates at the very end, just kind of more generic but not specific to just this. Okay. Awesome. So training.
Leigh Howle (16:10) Gap. So it was identified with roster mapping errors. There were incorrect entity names also on cois that led to submission inconsistencies. So the bartovan roster was one of those and that has been remapped. So those issues will not be happening going forward. And there has been targeted training on completing applications. Follow up agents have also gotten additional training regarding these submission processes and follow up requirements. So all training has been done for those top six. And then theramatrix was also added in because the one the rep was, you know, simply, I remember her email. She said, I simply cannot work with medallion. So that has also been addressed in the project plan and instructional issues. There were conflicting instructions were identified on the project plan and that did result in some inaccurate submissions. So all of these have been cleaned up. I personally went in to these top seven project plans. I verified follow up. Everything is correct. The team is following, not doing follow up on some and then following the processes that are specific to these other top six. And there is a QC review in place. We talked about that already pre submission so that all of these will be correctly submitted with no errors. The team has been realigned on workflows to ensure that everyone is following this project plan with these updated instructions. And then on follow up analysis discrepancies, we talked about the customized payer name having it when it’s customized, it’s not linked to the directory and the directory is connected to all the automation tools. So once these names, these payer names are fully mapped into the platform, it will enable the automation tools for roster automation, PDF form filling, you know, portals, online portal population. And that will just reduce any human errors and allow for a much more accurate and efficient submission. So, and there are, it is happening for the payers the payer names that match the directory.
Leigh Howle (18:42) So, I mean, it is going on, you know, the automation, but this will just increase the number of automated payers going forward. Great.
Leigh Howle (18:56) Oh, the completion date that will be. I had it 316. So, you know, medallion we did the payer mapping from the directory. And then just… whenever you and your team can have it confirmed, we’ll go ahead and have that done in a couple days. So areas of opportunity and our solution. So this just kind of reiterates what we covered on the previous slide. We talked about submission errors. Vardavan was one of those examples. And then the future state, there is a mandatory pre submission QC for these six payers. And then for poor follow up and communication, there were delayed email responses or duplicated emails, you know, not checking emails to find out what the status was sent over from the payers. So there has been a implementation of true process validation for vardavan st Luke’s, st, Alphonsus, communitycare, bcbx ptpn and theramatrix, so that the team is following the correct instructions on follow up going forward. And then the workflow, disconnect, same thing. Just, you know, having instructional ambiguity in the project plan with the non standardized payer names caused manual intervention. So once we get all these payer names mapped into the platform, it will just really allow processes to go a lot smoother. Great. And so just for some numbers, you know, we talked about the 2,818 that were unique payer names. And as of today, this was last week when I did this, but there were 2,227 completed. These are all done as of today.
Leigh Howle (20:53) So let me go ahead and update this. And… do you want to, do you have an eta Melody on just when the other ones might be? Let me pull this up. I have it right here.
Melody (21:13) Should be by mid next week.
Leigh Howle (21:17) Oh, that’s great. Okay. That sounds good. So I, it is filtered just for the ones that are not done because the ones that were checked have already been mapped and imported as I said earlier. So if there’s any questions or anything on the notes that are listed in column F, just you can add it over into column I and then I will go back in and just, you know, do additional research, reach out to our internal team? If there’s any questions on any of these, okay. Okay. Awesome. I’ll just put this for.
Leigh Howle (21:59) We could say the 20 fifth maybe of next week. Okay. Yeah, perfect. And so just as I said earlier, having those payer names will reduce errors. It will allow all of our automated tools to be utilized. And then it will streamline any processing, reducing bottlenecks, friction. And then it, of course, we’ve talked about this extra bonus before, but it will allow improved reporting capabilities just across the board. It will consolidate the payer names. It will be so much cleaner on reports for enrollment.
Leigh Howle (22:52) All right. And we’ll move on. And so next steps, we’ll import the payer name system updates once everything is signed off. And then, yeah, I think that was all. And then, Amy, did you want to add anything here? Yeah?
Amy Frana (23:08) I just wanted to share because Melody and I apologize if you’ve heard some of this already, but just want to make sure. So I’m sharing with all of our customers. We actually have a coo starting with us on Monday. So, Nate Rosenthal he will be, I don’t know if he’s going, what calls or whatnot he’s going to be jumping in and helping kind of get connected to be able to understand more and learn our business as quickly as possible. But Nate is going to be overseeing all of our operations and have all of my, me and my team and then also all of the operations teams reporting directly to him. Even though he officially starts on Monday. He’s been working. So we’re really hoping that he will hit the ground running pretty quickly. So some of these pieces that Lee is sharing just really want you aware that like he’s getting up to speed, he’s going. He has a lot of the background. All of us have met with him like all of his new directs have met with him to start sharing information. So that’s really the biggest thing just because I want to make sure if you hadn’t heard that you’re aware. And then also don’t know if we ever shared that we actually have a VP of business operations as well, Lawrence bauder, that joined our team. So Lawrence has really we had a business operations individual. We now have him as a leader and we’re going to eventually be growing that team here in the near future but really good partners when we are looking at process improvements and really reporting needs and all of those pieces. So just wanted you to know that we’re expanding the team so that we have more of the right folks in place that will start really deep diving in some of our process issues that are a bit more systemic that I know Lee, Lee’s doing everything she can, with the confluent team to try and get some of that cleaned up. But we may have more updates in the coming months as they get fully ramped.
Leigh Howle (25:17) Okay, great. Perfect. Thank you.
Amy Frana (25:19) Yeah, you’re welcome.
Leigh Howle (25:23) Exciting times. Yeah. All right. So this is one of the last slides in the deck. It’s just, you know, your feedback is important to us. We welcome your feedback and it just has, you know, enhancing our provider data management solutions, we increase our customization capabilities and, you know, for reporting, we’re also expanding on our automation daily. We’re adding more and more payers to our automated list. So just, you know, any feedback, anything you want to share, always open to it. All right, perfect. Thank you.
Leigh Howle (26:14) Right. And then to go over the opsync deck.
Leigh Howle (26:25) On data review, I get really excited about this slide. I think this is one of my favorite slides. It continues to show a decrease in those outstanding enrollments. I think when we first started this project a few months ago, it was way over a 1,000. I want to say it was at 1,400. Yeah. And, it has just, I mean, it’s gone down by almost 600. It’s almost half of what it was when we started this, so.
Amy Frana (26:57) The.
Leigh Howle (26:58) 120 plus went down by 40 and the 90 to 120 has gone down as well. That decreased from last week by 44. The tasks are going down. So your team is working those tasks, I think when we looked at those, it was 747 50 or so. So. Those have gone down by almost 200. There was a just a slight decrease over the last meeting by one, but that’s okay. I’ll take it… and we had talked about paradigm. You know, I sent the email and they were being really picky on, the authorization form. So thank you for sending it to me. I got it over to them. They have what they need for foothills now.
Amy Frana (27:47) Good.
Leigh Howle (27:50) And tricare, I, it’s still at the top of the list. So, I’m having an internal meeting today, if I can, I’m trying to connect with Alex and Bianca. I started to really dig into some of these lines and I’m noticing, some trends. So I do think that there needs to be some, a QA or some type of deep dive especially with tricare west. So I’m working on that one. We talked about amerihealth already and yeah, it’s you know, overall these are going down. We can see a decrease from the last meeting or the one from three four. So I’ll keep pushing the team on this perfect… and completed enrollments. So it, this does show for last week, there was 135 total open requests and of those 39 were submitted and completed within the week. So that’s like for bardavon or, you know, prime one call for those payers that say you’re good to go to complete those enrollments. And then for there was a increase in requests from three eight to three five. So this.
Amy Frana (29:10) one.
Leigh Howle (29:10) Of the things I get when I look at this slide is that from the request to intake complete, there’s a, about 100 that were not moved over to intake complete. So just want to make sure that providers have signed the platform that there’s nothing missing in their profiles. And we talked about the, you know, the report builder and how to look at those providers. So that that’s just something to call out here. Team submitted to 66 and there were two 38 enrollment. So 97 priority lines previous week, there were 111. So those are going down. And then credentialing is going great. You know, 100 percent… RTS SLA, attainment. And actually I went back in history and check this goes all the way back to January 100 percent SLA, perfect. And then on follow up. The, I think the expired follow up is still kind of trending the same, you know, if you, if we look at the last week numbers, there’s really not too many changes in this. So I’m going to be working with them on, I met with them yesterday and went over the follow up. The payers went over exactly what the processes were. So I’ll keep meeting. I meet weekly by two times a week with the PE team. And I’ll keep pushing on this. So there are the good news there’s 2,479 lines that are current and so, that is good. But that 221 is still overdue. I’ll try to get a percentage on that next week. I don’t know if it’s 10 percent, you know, just curious… roster. Follow up is not too bad. There are eight that are past due for follow up and there are 160 current… and total line completions. Trending so far for March, there are 632 that are completed and looks… like February had 1,249… might be a little bit less this month, product updates. I know you get the marketing emails. So this is exciting setting up API keys is something new and it’s integrated into the modules on the left hand side in the platform.
Leigh Howle (31:47) And so, you know, previously had to reach out to amems. But now any customer can go in and request an API nice. And then the gender affirmation treatment and mat, prescription requirement for providers, really appreciate you sending the email over before you went out on vacation and asking for this to be optional. So I pretty, I spearheaded the discussion with our epd team TSM head and am pushing to make this optional for all of confluent providers. So I’m still working on this one, I don’t and Amy, maybe you can help me on this. I’ll share the thread with you and maybe we could, you know, work together on this one. Yeah.
Amy Frana (32:46) Absolutely. Just let me know offline and I can absolutely help.
Leigh Howle (32:50) Awesome. Thank you. You’re welcome… and then expanding payr enrollment request field. So this is really great. It’s an additional option to select the payr directory as having providers listed or not, and also including effective dates. This puts it front and center for the team. So there’s no questions on what this information would be when applications are submitted.
Leigh Howle (33:21) And just better clarity overall. When enrollment requests are partially completed, you’ll see some additional fields that will now show on the left hand side for statuses and they’re color coded. So it will just give you a really quick visibility into what’s completed and what’s in progress. Great. And that was all I had.
Melody (33:43) Awesome. Looks good.
Leigh Howle (33:46) Awesome. All right. So, I will stop sharing my screen… and yeah, I think that was, it. Does anybody have any big plans for the weekend?
Melody (33:59) Not me. We all have to recover?
Leigh Howle (34:04) Yeah. I heard you had sick.
Amy Frana (34:05) Kiddos. I’m sorry.
Melody (34:06) Yeah. Then you get it. I did. Yeah, we all got it.
Amy Frana (34:12) I’m sorry, it’s so going around right now.
Leigh Howle (34:17) Yeah. We’ve got some sick team members out as well and I’ll be watching March madness. I’m a big basketball fan. I think I’ve shared that before. So, yeah, I’ll be probably on the couch watching games. Yeah.
Amy Frana (34:32) Awesome. We’re going to our little cabin up north, hopefully won’t get all muddy but do a little bit of work up there and enjoy some outdoor time.
Melody (34:44) Awesome.
Amy Frana (34:45) Except, Lee, our kid, our oldest is really into March madness and he’s like, wait, are we going to be able to get games up there? I’m like, I don’t know because we don’t know, we’re remote enough that we can’t get the local channels so whatever we can stream that’s what you’ll get to watch.
Leigh Howle (35:02) Yeah. Well, hopefully there’s something playing and that works out and I hope you all get to film better Melody. Yeah, thank you. Yeah. All right. Well, I appreciate your time and I hope everybody has a good weekend.
Melody (35:19) Thanks, you too. Thanks.
Leigh Howle (35:21) Thanks. Bye bye.