Transcript
Leigh Howle (00:00) hey, Brittani. Hey, how are you? Doing good? How are you? Good? Awesome. I know. Yeah. So I don’t want to take a lot of your time. I really appreciate you helping on the call today. So I’ll just, you know, do an intro and then let you take it away. And just, I’ve addressed everything on the agenda that they want to go over. So it’s a 30 minute call. I don’t think it’ll take too long and what was the integration that they were interested in again?
Brittani Luyen (00:37) Webhooks. So essentially, it’s like lifecycle tracking, but I’m curious of like what exactly they were interested in using it for, which is why I wanted to hop on the call. I also don’t think it’ll take too long. I think it’ll be like 10 to 15 minutes if that. So I just wanted to, I mean, it depends on how much they chat, but yeah, I am curious like why they were interested in this?
Leigh Howle (00:57) Okay, awesome. All right. Here we go. I’ll let them in.
Leigh Howle (01:09) Hi, Kelsey.
Kelsey (01:11) Hey, Leigh. How’s it going?
Leigh Howle (01:13) Good. How are you?
Kelsey (01:14) Doing well. Thanks for letting me join this meeting. I had a few questions kind of from the candid side and as the medallion data relates to some things we’re seeing in candid?
Leigh Howle (01:27) Awesome. Perfect. Should.
Brenda Kelly (01:30) We do that part first so we can get… to our other stuff afterwards.
SB (01:37) Yeah, let’s.
Kelsey (01:40) yeah. So one thing we’re seeing in candid. Is obviously, we pull in the provider data from medallion into candid. And we’re seeing that the billing provider address in candid is actually the pay to address. So it’s their lockbox address. So I just wanted to see kind of where in medallion, we can update the billing provider address to reflect the correct address, which Brenda, I know we’ve talked about, but I don’t have off the top of my head right now there’s.
Brenda Kelly (02:13) 16 one Lewis.
SB (02:15) So, hold on Kelsey, because I think like correct for you, incorrect for the only place I have to list. This information is not the same. Oh.
Kelsey (02:26) Okay. So.
SB (02:28) In the group’s address, it lists that address as the… let me see where it is. My apologies for that phone right there… at the billing address. And I don’t have any other location to list the billing address other than that box and,
Kelsey (02:54) in your case, the billing address would be like, the.
SB (02:58) po box. Yeah, where they would like bill, where the claim would come from, right? Like this billing address?
Kelsey (03:05) Yeah. Okay. And,
SB (03:09) I don’t have anywhere else to list this address unless Leigh, you have an alternative.
Leigh Howle (03:13) No, that’s the best place to put the billing address. The remit, it would be in that location. Yeah. And,
Kelsey (03:20) how does medallion use that? I’m curious like, is that critical?
Leigh Howle (03:26) Yes.
Kelsey (03:26) It is critical. Okay. Yeah.
SB (03:28) It goes on all of our applications.
Kelsey (03:31) Got it. Okay. Then. I think… that’s just something we’ll just flag internally that we’ll need to use.
SB (03:40) Yeah, because the other, yeah, the other, like because I tried to look there’s nothing in like these group addresses like, yeah, that’s the only other place. This is the only place that this billing address is listed. And when you have it in the group view like this is.
Kelsey (04:00) So,
SB (04:00) we use these numbers in conjunction with the practice addresses. When we fill out a group application, a payrollment application.
Kelsey (04:08) Okay. Got it. Brenda, this is something we’ll just need to maybe create a rule for, to change the address in candid. Okay. So we don’t lead to like claims getting rejected with the po box address.
Brenda Kelly (04:20) Because because that is hitting box 33, correct?
Leigh Howle (04:25) I mean, 32.
Kelsey (04:26) 32. Yes. Yep. Okay. And we’ll have that basically sent as the pay to address in candid. Yeah. Okay. Okay. And then I,
Brenda Kelly (04:37) think, we meet this week, don’t we, yes, Wednesday. Yeah.
Kelsey (04:42) And then one other quick thing, do we add the provider medicaid? Ids? Is that sort of medallion as well?
Leigh Howle (04:50) Yes, it is. Okay. It gets added into the enrollment when it is completed, and it does have a separate field that is just called provider id.
Kelsey (04:59) Okay, perfect. Okay. That’s all I had Brenda if it’s okay for me to drop, I’ll leave you all to it. Yep. Thank you for letting me take some time.
Leigh Howle (05:10) Oh, wait, before you hop, Kelsey, I wanted to introduce you to Brittany. Oh, yeah. She is one of our product that’s okay. She’s one of our product managers and she wanted to hop on today to talk about webhub and just some data exchange.
Kelsey (05:24) Yeah. Oh, yeah. I’ll hang on too. Nice to meet you, Brittany. Nice.
Brittani Luyen (05:29) To meet you, Kelsey. I’m actually joining because I think someone on y’all’s team emailed our support team because you had seen like in the platform, we are sharing a little bit more about our alpha that we’re going to launch with webhugs. I don’t know if that’s someone on this call, if there’s someone else that I should chat with.
Brittani Luyen (05:47) But yeah, I just wanted to better understand as we start to build out these capabilities, what you all are looking for, so we can make sure like it fits your needs perfectly.
Kelsey (05:55) Yeah, absolutely. It’s actually funny enough right now. I’m working with frontier kind of as their implementation manager, but I’m going to start working in partnerships at candid kind of being like a product partnerships owner for lots of our partners like medallion. So Brittani, maybe the two of us could set up a separate call where we kind of scope out some of these needs. And I could definitely be your main point there at least to start.
Brittani Luyen (06:19) Cool. Yeah, if you don’t yeah, we can chat now, but if you’d rather have a separate call, like we could definitely do that as well. But, yeah, like.
Kelsey (06:27) Yeah, or now works. I just wasn’t sure if you all had other topics to go over, but happy to discuss now. Cool.
Brittani Luyen (06:34) Okay. Yeah. I would be curious to understand like what if there’s anything specific that you are looking for from a webhook capability? If there are certain things that you’re looking to track certain events, certain workflows that you all are leveraging today, that you’d be curious about being available via the webhook?
Kelsey (06:51) Yeah. So, I know right now what we pull in is any just provider data and any changes there? Yeah. So I guess right now it’s a nightly sync. So I guess the changes with a webhook is it would be real time, I’m guessing rather than nightly.
Brittani Luyen (07:09) Yeah. And I think so the webhook would be much more focused on like changes to things right? To your point, like if provider data changes. And so maybe tell me a little bit more about like what provider data changes that you are monitoring today, and like what kind of actions you take in your platform or things that you do in your platform that, you know, would change with like the provider data changes?
Kelsey (07:30) Yeah. So most of our customers would basically maintain provider data like all that configuration in candid kind of as like one of our fixed configuration items. The advantage of working with medallion is customers who work with medallion, we have this out of the box integration. So they’re not needing to maintain the same data in two places. So we have before claims are sent out the door through candid. We basically have rules that validate like is this provider credentialed with the payer? And we match that with the date of service on the claim. So we’re not actually monitoring for any changes per SE, just more, so like is this data populated and that data matches against some of our validations? So, I guess I’m trying to think exactly how webhooks would change our existing workflows because right now we, it syncs nightly which is totally fine, but we’re not actually like pulling any apis or anything for changes right now. Oh, I think you’re on mute. Sorry. Got it. There you go. That’s.
Brittani Luyen (08:36) super helpful. Yeah. So the way that we generally would recommend using webhooks is if there are specific workflows that you would like to trigger. So I think you guys have license and payer enrollment for frontier specifically. So if, for example, like there are certain actions that you would want to take when a provider gets an enrollment, like if there’s you know, if someone’s monitoring that or pulling that data today and then completing certain actions instead of monitoring that, you could get notified via our API that this new provider is enrolled or you want to be notified, you know, that like there’s a blocker on an enrollment request that requires like an admin task, a provider task, and you want that to trigger some type of notification workflow on your end, those are some ways you might use like an integration. So with webhooks. And so webhooks would sort of just give you like real time updates on how things are changing and therefore, you can integrate them into your own workflows and sort of understand, okay, like this thing happened in medallion, I get notified about it in real time and that allows me to take some other action in the frontier platform or trigger some type of workflow?
Kelsey (09:45) Got it. That could be interesting to kind of explore because right now we have like a dashboard report if there’s any errors, basically like if there’s missing provider information in medallion, that isn’t allowing us to pull that data into candid. So that could be interesting. Something I can kind of discuss with our product team if it would make more sense to, instead of just having like a static dashboard, more of like a task based system, where that would be, I think kind of a bigger build on our side because it’s like very different from what we’re doing now, but that could definitely be interesting to explore and I can pass this along to our product team.
Brittani Luyen (10:22) Okay. Yeah, great. We will update our API docs. Once this is available. We’re currently building out this functionality. It will probably be out in the next like month or two. Okay. Yeah, we’re starting with payer enrollment status tracking. So these lifecycle changes that happen when like a payer enrollment is requested, and then it’s you know, take is completed. And then it’s submitted and then, you know, are there any blockers during submitted? And then once the enrollment is active, that’s where we’re starting. But we can think about other types of things that you may want to track as well. Like on the licensing side, we’d have to build that new. So just keep us posted on like what your requirements are. And then once we’ve built out what we’re building for the payer enrollment webhook, capabilities, I’ll share those with you via API doc and you can evaluate to see whether there’s anything that you want to specifically implement from that?
Kelsey (11:09) Awesome. Thank you so much. That sounds great and exciting work that you guys are doing. Thank you so much. Yeah.
SB (11:15) Leigh, I think that’s all I had. And so, yeah, this was very helpful. Thanks Kelsey.
Leigh Howle (11:19) Yeah. Okay. Thank you, Brittany. Thanks, Kelsey. Shay. Did you or Brenda have any questions for Brittany?
SB (11:25) No, this really wasn’t my project. So I’m just here as a spectator.
Leigh Howle (11:32) Okay. Sounds good. Thank you, everyone. Thanks. Bye. All right. So it looks like the agenda I’ve kind of commented back and forth on a few things so we can go ahead and go over that unless you all wanted to talk about anything else.
SB (11:50) Nope. I’m all good on that. Let me just pull up the agenda. Oh, you got it. Okay. Hold on.
Leigh Howle (12:01) Yeah, I’m sharing my screen. It’s taking a minute.
SB (12:03) There we go. No, that’s okay, mine was taking a second too. Okay. So, yes. Okay. So Coi, so there’s no way to batch those in when like, or to upload it in the group section, you have to individually load it into. I’m thinking on like a long term, right? Like when we’re up to 150 providers, are we really going in? Because while we’re managing caqh, we’re uploading those to two profiles to medallion and to caqh. Okay?
Leigh Howle (12:35) Yeah. So I checked, I just spot checked a couple of providers. I went into Ethan Hansen and it did show the current liability practice and for like liability.
SB (12:45) If I was touching them, I touched them and then it looks like somebody from the support team also got those. I was just making sure that there was no function to update those in a batch in… medallion.
Leigh Howle (13:00) Okay. So I do know that support can batch all providers with the Coi. And it looks like me, yeah, the lloyds of London’s here.
SB (13:16) So, there’s no function. So, because it did take us, you know, 15 days, right? And then all these tasks came out to say, hey update, there’s, no way that medallion has a function that batches this from the beginning, right? Because the other thing, is, I’m, not only sending this support, I also have to upload them into caqh. So why would I not just upload them into medallion while I’m already in their profiles getting their caqh information? Because obviously, I wouldn’t use the caqh import because you said something about it erases what’s in the system. So I didn’t want to erase anything either. So it seemed like there was only, right. Like, and if we’re at 100 providers, then we’re uploading malpractice phase sheets for 102 100, if you count their caqh. Hopefully it will be delegated.
Leigh Howle (14:05) Yeah, definitely. Want to don’t want any duplications if at all possible. Yeah. So I think I can, it’s a great product feedback request and I can send that over to our epd team. So.
SB (14:19) I thought when we uploaded it when we started in medallion, there was some sort of a group function like in the group profile, but I couldn’t find it. So I must’ve been crazy. Okay. So then humana, I see what it is. Okay. Thank you for that indication. So, Chris Beasley’s, effective date for humana is one five. So when we got the approval notice, they had entered… it backwards, is that what we’re saying on the next item? Yes?
Leigh Howle (14:53) Okay.
SB (14:54) Perfect. I will fix that on my end too. So, I was like, ooh, I’m holding on that Guy, but I could see humana backdating or future dating their credentialing files. I could just see them do something ridiculous. Well, what.
Leigh Howle (15:06) happened is the actual roster that gets submitted to humana has on column R for the effective date, day, month, year. So it’s backwards. So that’s what the team submitted following that format, five, 126. So when the approval came in, humana used the five 126 and I have requested to our payr mapping team that they just manually change that format. So it is not so confusing. And did you want me to reopen the line and request the backdate?
SB (15:39) No, if it is the backdate, if that is what it’s supposed to be, and we just need to change our, right? That’s what you’re saying is it should be one five of 20 26 or did they actually give it a futuristic date? Oh, okay. Don’t worry about backdating it because humana will never backdate it. That’s just a nightmare to go through. I think, Brenda, what’s your call? Beasley, we gotta go fix him really quick.
Leigh Howle (16:13) Yeah, but, it’s their error.
SB (16:16) Yeah. I mean, if you think that they will do it, then go for it.
Brenda Kelly (16:19) I’m sorry, I was, I had an issue when you were talking, I had a serious issue with champ, va, we’re on the phone with them. So it’s hard not to have to deal with them when we’re on the phone. What was your question? I’m so sorry.
SB (16:33) No, you’re all right. So what happened is it’s the, so we submitted an error format date or we submitted an error date due to a format. So what the date is, see how they put this in here.
SB (16:46) Humana’s effective date on the roster is flipped. So instead of month day year, it’s day, month year. So that’s why it’s wrong. So, the effective date for Chris Beasley in humana is may fifth, may first… and.
Leigh Howle (17:10) it’s a, it’s an error on humana because that is how they have their roster. So do you want me to reopen the line and request that they backdate it to one five or as far back as they could go? Because this is on them?
Brenda Kelly (17:23) Right. I mean, it really doesn’t matter to me. We don’t have him open available for any humana patients. But the least they can do is try to make it effective, you know, April first… but I don’t know how long that would take to request that. And that’s why?
SB (17:43) I was like, yeah.
Brenda Kelly (17:45) No, I mean, it’s literally five weeks away from may first. We’ll just stay with may first so, that we don’t get confused with on our patient side. Yeah.
SB (17:55) That’s what I was kind of thinking too or delayed, right? Like I also want this line to be closed and him to have an effective date versus like leaving the line open. And then his, right? Okay. I’ll just put a note in my calendar and I will just flip his humana on our side when may first comes.
Brenda Kelly (18:15) May first rolls around. Thank you. But.
SB (18:18) This is, that is see, I told you humana would do croaky things. They are terrible. I hate humana. Yeah. Okay. Let me see. Okay. So the perique thing, I think we got it figured out. Yes. I think there was just some notes that I was missing. Okay. So the durling thing, she did sign her profile, she.
Leigh Howle (18:38) Did. And it was a picture instead of an actual like signature and E sign. So she did go in on three 710 and E sign it?
SB (18:47) Okay. So when she, but she E, signed this back in July or back in November. So it just now got caught. Is that what we’re saying? Yes. Okay. Cool. I just wanted to make sure that there wasn’t a new, I was like, wait, how from November of 20 24 to March of 20 26. Are we just now? Like I was kind of confused there. That’s what I wasn’t sure of. Yeah.
Leigh Howle (19:09) And I looked at the caqh profile authorization, and when I click on this little like signature, it still pulls up the PDF like the signature page of it. But the most important one, the info release is good to go. Okay?
SB (19:25) Cool. That’s that was helpful. Thank you for explaining it. I was like, wait, where did this go wrong? Yes. So I need it to be, yes, bell is do, and our zuby is, ao… Reza has just stepped aside a little bit. And so we just need signatures just need to go directed towards them.
Leigh Howle (19:43) Okay. All right. I will let the team know.
SB (19:45) But we just don’t.
Brenda Kelly (19:48) want to bug him. Yeah, we can leave him as a signer, but just not send to him.
SB (19:52) Yeah, I absolutely have to. Yeah, Brenda, I’m not changing anything in paycos, but if we want to change him in medallion, you can.
Leigh Howle (20:02) Okay. That sounds good. Yeah, I’ll let the team know. Cool.
SB (20:05) Yes. And then Arizona group application is what is still open. So I didn’t know if the amet, so I think I actually submitted the amet, thinking that was the application that was still open. So I sent in his release, right? I have to take the termination notice, go ahead, Brenda… but it looks like his group application is still open for correction… and I think it’s open on somebody else’s side.
Leigh Howle (20:35) Okay. Do you?
SB (20:37) Want me to send the information really quick?
Leigh Howle (20:40) Yeah. So this was for amet?
SB (20:42) No, it’s for Arizona… but he was the one who was supposed to be reassigned to Arizona, and then he left our group, but the group application is still open. So we have another provider living in Arizona, so I didn’t know if so here’s, let me just throw you this. And then I’ll so I didn’t know what the application was open for, if it was open for a termed provider or is it open for one of our new providers? And she’s joining here in just a couple of weeks?
Leigh Howle (21:13) Okay. I’ll check into it. I’ll go into the medicare group application and find out what’s going on and if it needs to be returned for corrections? So the new provider can be added or?
SB (21:21) That’s where I was like, yeah, I didn’t know. I was like, yeah, I didn’t know who it was stuck on. So I sent it in your chat that’s the, that’s what I can see on my end.
Leigh Howle (21:30) Yeah, I got it. It’s opening.
Brenda Kelly (21:51) Guys. I’m sorry, I have to jump off this meeting, you’re.
SB (21:53) okay.
Leigh Howle (21:54) Okay. Bye. Thanks, Brenda. Bye. All right. I got that one. Cool. Okay?
SB (22:03) And then the st Luke’s I uploaded admin plans for all four of our states into the group profile. Is that work? Does that work?
Leigh Howle (22:13) It does. Yeah, I would recommend adding like a end date on the old address and then a start date for the new address. And.
SB (22:21) Then, yes. Okay. Can you show me actually in medallion how to request that? So I can make sure that I am doing it correctly? Sure.
Leigh Howle (22:33) So, if we go into the practices, yep, you know, how you’re parentheses, and then adding the telehealth, and then the provider’s name. So in the old address, you could just put like parentheses by the practice location name ending on this date or closing or inactive or something just to let everybody know that location is inactive. And then on the new location, under any providers that are going to be affiliated with that location, I’ll just go to the frontier psychiatry id.
SB (23:07) Lee, can I one second? Hold on?
Leigh Howle (23:09) Yeah, sure.
SB (23:30) We have a new little puppy and she was outside the office, but she’s like small enough to get out the gate and I could hear her barking at something out there. Oh, my.
Leigh Howle (23:42) goodness. She was.
SB (23:43) Snoozing during this meeting. And then I’m like God, she’s going to run away. I’m going to leave her out there. Okay? So when we go in, when we change, so we don’t necessarily want to rewrite the old, you just want to put an end date on the old and then add the new.
Leigh Howle (24:00) Yes. So this.
SB (24:01) Is the one we’re getting rid of, right? This is going away. So.
Leigh Howle (24:07) There’s not, currently. Let me turn my video off. I’m getting feedback. Okay. There’s not an end date here as an option. But when you go under the provider profile to… let’s just go to Claire, I guess as an example under practices, there is an option to do a start date. Okay? And an end date? Okay? And this will automatically go into any enrollment that is requested. If you don’t want to go through and add all that, you could just put it in the note provider will be, you know, working at this new location on this date, so.
SB (24:51) What I’m saying though is that this practice location is now becoming the other practice location. So this is closing. So I need my group enrollment to be changed.
Leigh Howle (25:03) Yeah. There’s.
SB (25:05) at the actual level,
Leigh Howle (25:06) yeah, there’s not. Would that?
SB (25:07) Be a demographic update or do you guys do not take care of those? Yeah.
Leigh Howle (25:12) It’s a demographic update. We can do that if you wanted to request it in.
SB (25:17) A bulk. Yeah. So I do it by bulk. So I go into, I would go into groups. I would add the new practice location information, and then I would come in here to request and go to bulk demographic update. I would select all of our Idaho payers.
Leigh Howle (25:35) Right. So I.
SB (25:37) would add and remove, right? So I would be removing this. That other address. Is that correct? Yes. Okay. And then, and then they would give maybe an effective date down there. Yes. Okay. Cool. Okay. I just wanted to make sure that that’s how that went… awesome. And is there anything else about address changes? I don’t think we’ve ever done with you guys before. No.
Leigh Howle (25:59) Just, you know, some of the payers will require that address to be changed at the group level. And then it, you know, it’ll just kind of, and then the providers, yeah, it’ll trickle down and it just the start and end dates will be important to give that information to the payers. Because as we know, they will just randomly pick a date if we don’t give it to them.
SB (26:20) Yes, no, we’ve got dates set and everything is moving forward. So we’re ready to move on.
Leigh Howle (26:26) Okay.
SB (26:28) So on to us, right? Actually, this is going to meet some domicile requirements. So the blues, we’ll be getting the blue cross Idaho’s regents, some of those contracts that require some physical presence. So.
Leigh Howle (26:42) Okay. That sounds good. Yeah, yes.
SB (26:46) So anyways, yes. And then st Luke’s looks like it was all well, I think really honestly when I went into the application, if you don’t click to the next, like in the same screen, you have to click license and then upload and then Dea, and then upload and then boards and then upload it’s. Kind of silly how they have it versus like, you know what I mean? You need to, it will let you skip the step. Yeah. You know what I mean? So I’m like, well, that’s kind of your own fault for, I mean, we all know what is required for an application. Yes, but don’t let your application also submit information that’s not complete. I don’t know. Yeah. Did.
Leigh Howle (27:26) They, one of the requirements was an admin plan. Yes. Have you, is there a PDF on that? Or is that built into the application there?
SB (27:34) Isn’t there was just like a request on the backend. Okay? So, their application, like I said, it’s a silly because like… you can see where there’s like a laundry list of things that are required like a license and the Dea and an admin plan. But their application portal will let you submit the application without those requirements… and you actually have to like kind of toggle down the list. I do want to see one. I,
Leigh Howle (28:05) mean, yeah, if you’re in it, I think that would be helpful and I definitely shared the feedback to the team. So everybody is on the same page as far as submitting.
SB (28:13) I think it’s just a new one, right? And so everybody’s like it just is one of those things where we have to get used to it. Yeah. But here it’s this one.
SB (28:27) And it’s super space sensitive. So the team was always setting it back. The logins don’t work and I’m like you can’t use the space. Okay? So I don’t even know if it will let me do it because I’m not a provider. Oh, yeah. Okay. So, it won’t really, let me probably do anything.
SB (28:51) But basically, the application looks like this and you, this has deas, right? And then you have to come back over here and then click it again and you have to add the license and then you have to add the admin plan. Then it doesn’t the application is just kind of not, it’s… not very clean like they just could do a better job at it. Okay? I see how the team kind of missed it, right? Like because see how you have to create a new every time and they weren’t coming in here. So they were coming in here and they were put one, her medical license in here, right? And instead of coming back over to create new and create all of these other lines, the application was getting submitted with just the medical license.
Leigh Howle (29:35) Gotcha. And they.
SB (29:36) Were coming back and they were like, hey, you need to add the Dea and the controlled substance. Well, you need to make this a required field to add all three of these things.
Leigh Howle (29:43) Right. Yes, before allowing submission, yeah.
SB (29:48) Right. Yes, exactly. Right? And then I think down here in supporting documents is where it said admit plan. Okay.
Leigh Howle (29:59) Well, that’s good to know. So if it is there, they’ll just pull it out of that. Yeah.
SB (30:04) So they’re here, it’s just silly that they let you complete the application without having to actually provide the information.
Leigh Howle (30:13) Yeah. So like,
SB (30:15) I said, I just wanted to let your team know like, hey, we have to go back and double check these because there’s an opportunity for error if you just don’t know what’s provided in the application and you don’t continue to hit new and keep adding to what is required here… if that makes sense? It.
Leigh Howle (30:35) Does. Yeah. Okay. Awesome. Okay. One.
SB (30:42) Of those things, I’m like, well, I’ll help, you know, I don’t ever mind. Like I don’t ever want anybody to be like, you know, filling out an application and like getting the wrong answer because it’s somebody doesn’t clearly message their app. You know what I mean? Like that’s? No fault to anybody else. It’s just a, hey, heads up. We had to provide a lot of extra information because their application is actually.
Leigh Howle (31:03) Quite healthy. Yeah. Hospital, I used to do some privileging and they’re all different, you know, each portal is different. They have different ways. Yeah.
SB (31:12) Yes. And as you get to know them, you know, that like it’s truly just a security setting, right? It’s the way you set your application up and I don’t know, I always say this when I’m in an application system. So, we just did Nevada medicaid and their application system is new and it’s absolutely dreadful. I’m like somebody should sit on the provider side and fill out their own applications.
Leigh Howle (31:36) Oh, totally. Yeah. Like I.
SB (31:38) Didn’t reinvent the wheel here. Your application is faulty because nobody looked at it from the side that your providers are filling it out on, you know? Yeah, yeah, we got a return for our licensing number, but Montana license numbers are like 19 characters long, but their application only allows for 12.
Leigh Howle (31:59) Oh, boy. And.
SB (32:00) I’m like, I’m not gonna get rejected because you guys don’t have enough characters like, right? Yeah.
Leigh Howle (32:07) They definitely, yeah.
SB (32:10) You should, that shouldn’t happen to you?
Leigh Howle (32:13) Yeah, that’s frustrating. Yeah. Yes.
SB (32:16) So, anyways, I truly appreciate all your help as always. Oh.
Leigh Howle (32:19) Before we hop ahead, I did have one quick question. So, I’m finding on st Luke’s that they are sending emails once the committee meeting has approved the providers, and they’re using the committee meeting date as the effective date, and then they’re just doing a reval, three years in the future. The lines of the business. The lines of business are the same. So, my question was, do you guys require the provider id?
SB (32:45) We do not. No. Okay. So.
Leigh Howle (32:48) What do you think about as soon as the team gets that committee meeting approval, email, having them go ahead and just we can just complete the line?
SB (32:56) 100 percent?
Leigh Howle (32:58) Okay. So, I’ll just let them know to use these like this will be the same information over and over, except those dates will be whatever’s sent from st Luke’s okay. Yeah.
SB (33:11) Totally, if we are waiting for some sort of like and st Luke’s is weird, I would imagine st Luke’s is probably doing theirs that way because they’re kind of a pho style, right? Right? And so that’s probably why they’re sending out those credit committee dates, right? For those other organizations that they’re credentialing for. So we can totally use it too. We just need to know that that’s how they’re being used.
Leigh Howle (33:36) Okay. That’ll definitely decrease any delays on completion because we were going back and forth trying to get all this required information. So this will speed it up for sure. Okay?
SB (33:47) Perfect. Honestly, I truly appreciate it because I don’t know, like just like the other application part, right? Like a well informed team, like it’s not their fault that things delay, but we can, you know, knowledge is power, right? We can just shift things and look at it a little differently or, you know, hey, by the way, this application system isn’t so great. So don’t forget to use your brain that day. You’re filling out that application and forgetting those des, you know, like I’m like, gosh, I just, I think it’s so silly that they always try to like trick, you know, like.
Leigh Howle (34:18) Yeah, right. Like humana, like the humana roster. I’m like why do they have the dates formatted? Wrong? I mean, it’s just pretty straightforward. We I,
SB (34:27) just had it.
Leigh Howle (34:27) Out, we’re not in Europe, yeah.
SB (34:30) I just had a lady out for a lady at humana recently because they sent me back on one of our lcsws, you guys had sent over a… an application and I think I followed up on it and she forwarded back to me the denial while it was an lcsw, and she denied for a Dea, a hospital privileging her malpractice was due to expire within 45 days, something else and I reamed them with the ncqa requirements because I was like, this is crap. This is humana scrubbing a caqh application and finding any reason not even applicable to be denying our applications. Like an lcsw doesn’t have an admit plan. You cannot deny her application because she doesn’t have an admit plan. She doesn’t prescribe like lost my mind on this lady. I was like, this is totally ridiculous, yeah, because they shouldn’t be able to do those things, no.
Leigh Howle (35:28) They shouldn’t and a lot of it too could be just AI going in and, you know, checking boxes. Yes. I mean, I.
SB (35:35) truly think that that’s what humana is up to is they do like a pre screening of their caqh applications because you can almost see it the way that they send the format over to you, right? A screenshot. Yes, right. And you’re like that’s not even applicable to that provider type. So, either a human never looked at it.
Leigh Howle (35:53) Right, right. Or?
SB (35:55) You’re just setting a basis guidelines to every single application. But I don’t know how many times I’ve looked at notes and not just your notes. They’re my notes, they’re notes from, you know, humana, when I work with other teams in, humana, never acknowledges that application for at least 60 days. And I wonder if it’s these AI screening things that just boot all these applications out because they say, hey, every provider has to have a Dea. Well, that’s not true.
Leigh Howle (36:22) Right, right. And I recently saw it like about six months ago, they sent out an email alert saying that all providers would be finished in 30 days. They have some new 30 day cap on processing using caqh. Yeah.
SB (36:37) Right. I would love to see it because I’m pretty sure when you send them an email, they don’t even get back to you for 90 days.
Leigh Howle (36:43) Right.
SB (36:44) But when you submit their application, there used to be a banner that said, please don’t contact us for at least 60 days. Yeah. But in those 60 days, they say they never received your application.
Leigh Howle (36:54) Right? Calling it’s they’re one of the payers that I’ve always thought calling is just the best way to go with them.
SB (37:00) Yeah, I’m like, I think that you should, we should be able to report these payers who do these types of things like 45 days for a malpractice. I’m sorry, no malpractice company gives us a new certification for 45 days. You get it like the week before.
Leigh Howle (37:17) Oh, if you’re lucky, sometimes it’s even after, yeah, after the date has passed, you have to.
SB (37:23) Ask, give them your first trial to get it, you know, a month before. But first, you know what I mean? I’m like there’s nothing in the caqh or in tqa that says that we have to have a, an act. I said, we have to have an active insurance policy at the time of approval. It says nothing about a future expiration date, nothing.
Leigh Howle (37:42) That’s a good point. Yeah.
SB (37:44) Yeah. I threw back every single one of them. I’m like if you guys are going to list on your website that you guys credential our providers by ncqa, you’re going to follow their rules?
Leigh Howle (37:52) Right. Yeah, good.
SB (37:54) That’s good. So mad. So, anyways, if you guys ever run across any knowledge, is power anything like that where your payers are just giving you a hard time, send them over. We would, we are happy to say, hey, that we are not going to waste each other’s time anymore.
Leigh Howle (38:09) That’s awesome to know. Yeah, I will, if I’ll talk to the team, you know, and find out if they’re getting any pushback on any of the payers? And then I’ll just, I’ll loop you in. If there’s any issues, any questions or any additional information, you could share some?
SB (38:22) Yeah, or like I said, you know, we were, I’m happy to go. Say, no, you’re wrong fix.
Leigh Howle (38:28) My problem.
SB (38:30) I think that it’s somewhere somebody has to hold these payers accountable. That is just a waste of time and then talk about like cost, right? Like, yeah, talk about costs.
Leigh Howle (38:40) Well, that’s what the insurance commissioner, like the state insurance commissioner boards are for. They’re supposed to have, you know, public input and complaints can be submitted. They’re supposed to investigate the complaints and find out exactly what these payers, somebody has to hold them accountable. I,
SB (38:54) would like to see how many insurance payer complaints they investigate versus provider incidences, they investigate, right? True.
Leigh Howle (39:05) Oh,
SB (39:06) yeah, I mean, I’m sort of billing medicare billing, you know what I mean? And some poor companies just like accidentally didn’t know what they were doing, and then they’ve written a whole newsletter on them versus an insurance company denying authorizations, and all, you know what I mean? Like it?
Leigh Howle (39:20) Just, yeah, it does. Yeah, it does anyways.
SB (39:24) You have a wonderful week, you?
Leigh Howle (39:26) Too. Shay, you too. I hope you have a great week.
SB (39:29) I’m always here I.
Leigh Howle (39:31) Will I appreciate you appreciate?
SB (39:33) You too.
Leigh Howle (39:34) All right. Take care. Bye, bye bye.