Transcript
Rae Tompkins (00:00) hey, Rae, hello. How are you?
Valerie Lewis (00:02) I’m good. How are you?
Rae Tompkins (00:04) Doing good.
Rae Tompkins (00:18) I have about 26 more to update for those cred contacts, but I’ll let you know as soon as it’s done, there was, I think like 120 associated with that group. So, yeah.
Valerie Lewis (00:31) There.
Yenny Zhang (00:31) Was a lot coming.
Valerie Lewis (00:33) Through. I appreciate it. Yeah.
Rae Tompkins (00:39) And in the instance where there was a Michelle email on file, but there was already a provider enrollment, I’m just removing Michelle completely. That way. She doesn’t get those.
Valerie Lewis (00:50) Yeah, perfect.
Rae Tompkins (01:01) We can go ahead and get started.
Rae Tompkins (01:08) Shared here. I wanted to start off the meeting, just flagging the July recred, universe we can get that as soon as possible just to make sure that we can alleviate some of the files that are coming over incomplete, to make sure our team has enough time for processing. Do we have an estimate from the caresource team when we can expect to receive that?
Valerie Lewis (01:37) Yeah, we’re.
Valerie Lewis (01:43) working on it. So hopefully by the end of this week, right? Okay. But you have April may and June, is that correct? That you’re processing?
Rae Tompkins (01:54) Yes, we’re just coming up to the processing time for July. So we just want to make sure that we get it as soon as possible. Okay? And then we had a request from support from spine. I think that was supposed to say Payne’s. I put Payne’s, they wanted an email address or a phone number that they could reach out to caresource in regards to a group of providers that are being credentialed, would it be best to just give them that credit escalations email?
Valerie Lewis (02:24) Please don’t do that. We’ll give you a number. What market is it? Do you know?
Rae Tompkins (02:30) I’m not sure. I haven’t I don’t have direct visibility into when the groups reach out. I can go find the intercom ticket and possibly there’s an address associated, but it was just a ticket we would.
Valerie Lewis (02:40) Direct them to their provider services rep, but I would need to know what market, what state they’re in to send that over to them so you can forward it to us, and then we’ll forward it on to our… provider services team, but it’s market specific. So I at least need to know what state they’re in.
Rae Tompkins (02:59) Okay. Yeah, I can just get support to forward it over to forward the ticket to credit escalations. But don’t give the contact to the rep.
Valerie Lewis (03:07) Please? Okay, perfect.
Rae Tompkins (03:10) Just flagged to Sherry. I’m reviewing the credentialing contact report. There’s about 23 more from when I updated this. So hopefully I can get that updated and there’s no more reach outs to Michelle as requested. So I’ll circle back as soon as that’s complete… our team has been obviously with the new information regarding board clarification. I wanted to flag here. We just said NPS and advanced nurses, but wanted to clarify if nurse midwife, and nurse anesthetist. I always have a hard time saying that are considered advanced practice nurses in regards to caresource and require boards to be on file.
Valerie Lewis (03:54) Crnas, we don’t cred, and… nurse midwives would have a board.
Rae Tompkins (04:01) So nurse midwives would need a board on file. Crnas would not.
Valerie Lewis (04:06) Sharon, she’s going to keep me honest, but yeah, we don’t yeah, blah, blah. Crnas, no, we don’t cred them. So they’re not required to have a board, nurse midwife, yes.
Rae Tompkins (04:17) Cool. I appreciate that. I wanted to talk about specialties and the state flips as I know these kind of ongoing conversations, wanted to talk about the best way to get the specialty information directly from caresource. There are a couple different options. We can override what’s populating from caqh via a taxonomy code, or we can add a primary specialty to the start work file. Wanted to see like what the caresource team was thinking in regards to providing that to us? Where would you expect to live in platform? Is that something easily accessible to provide to us? So we can start possibly ingesting that information… just to overall consensus of it? Yeah.
Valerie Lewis (05:09) We wouldn’t we don’t know the taxonomy. We would just have the specialty that we can add… to the start work file.
Rae Tompkins (05:22) Okay. So you would just add Miko, ginny, are there, do we foresee any issues with importing it directly to the specialty field? Yeah.
Yenny Zhang (05:33) Yeah, I just want to make sure that like the specialties that you provide, like the values are able to be mapped to our values. So, val, do you have a sense or like have a list of possible specialty values that you would be providing to us? Yeah.
Valerie Lewis (05:52) So, I mean, we can crosswalk them to the, to your specialties that you’ve provided to us, right? And so when it does come over, it is with whatever specialty we have crosswalk, you know, whatever medallion specialty on the start work file. I mean, if that’s what we needed to do and it’ll be all specialties you need, the majority of these would be MDS, right? Who only list internal medicine as their primary, but they’re practicing gastro or hemoc or something else that wasn’t on their caqh, but was on something that they sent to us, right? So, I think the majority of the providers that we’ve discovered were medical doctors, right? But one thing we did do go ahead, hold on Nico. So Ray sent us a list of all of the specialties that have been processed by your team. There was a column when we looked at it for primary and secondary, do you do verification for both? So the primary was internal medicine. The secondary was gastro, right? So do you do the verification for both primary and secondary specialties?
Merritt Miller (07:09) Yes. Right now, we’re verifying what’s just provided to us. So without knowing which one caresource is specifically looking for, they’re doing both.
Valerie Lewis (07:20) Okay. Because we compared the specialties that Ray sent back and we noticed that a lot of them were secondary, right? And so if you have, this is something that was new started Meredith merit, sorry, merit, or has this been the way since medallion has been processing caresource’s requests this?
Merritt Miller (07:46) Is how we process them. They don’t currently tie up the specialties given and make sure there’s always something that matched since we don’t pass back the specific specialty. They’re just looking for that active board cert based on the provider type. So that’s why you might see some discrepancies there. Like they’re not holding a file or saying it’s incomplete. If we can’t get both board certs, they’re just passing you the one that we are finding.
Valerie Lewis (08:11) Got it. Which is the problem. Okay?
Merritt Miller (08:13) Yeah. Okay. Yeah. And we want to partner with you to get your specialty list and credential to those we want to do that with you. I cannot understand the frustration.
Valerie Lewis (08:22) Yeah. So again, how we send, if we add a field to the start work file for specialty, we can make sure that the specialty that we’re sending over is medallion’s specialty, right? Like we have internal medicine, we have gastro and you have internal medicine, dash gastro or something like that. We can match it up to the crosswalk that Nico provided to us of your list of specialties. And.
Niko Byron (08:48) I can give you, yeah, I can give you a more updated crosswalk of just everything that our API can take in if that’s helpful as well.
Valerie Lewis (08:55) Okay. Yep. That’ll help and.
Merritt Miller (08:59) val, before, we can, we should start with that. And then I just have a few questions on like actually operationalizing this to make sure when we have the specialty, we’re working the files based on how you all are looking for is the best way to kind of send in writing what we are proposing to do or do you guys have a document that outlines how you want us to handle them? Thinking through scenarios? Like if you pass us a specialty, they don’t have a board cert for that specialty. Do you want an incomplete file? Do you just want, do you want us to not verify any board certs, what I’m assuming, but I just want to make sure we kind of outline the different scenarios the team will run into and build our sop.
Valerie Lewis (09:33) Yeah, we can probably create something for you guys of what our expectation would be, right? That if we send over a specialty, they’re not certified in it, education, right? Would be the next thing that we would need you to check ama aoa. And then, I mean, even if they’re not boarded, verification of education. If you get that it’s complete file, send it back. If you don’t get an education and verification because they’re not board certified, then that’s when it’s incomplete, send that back as a risk. But yeah, we can probably type something up as to what the, you know, what we would like medallion to do for us when it comes to these specialties.
Merritt Miller (10:12) Okay. Yeah. Whatever’s easier if it’s easier for us to type something up and you review it and provide edits or if you want to just type something up and share it with us, we, I know you have a lot on your plate, so we’re happy to figure that out. So.
Valerie Lewis (10:24) Let me ask my team leads, who I’ll probably assign this to Sherry and Sheena. Do you want to type something up or do you want medallion to type something up and then we can review it?
Sheri Prouty (10:37) I’m going to go with if they can type it up and we can review it to match what we would expect. That would be great.
Merritt Miller (10:46) I agree that.
Sheri Prouty (10:47) Would be a huge help for us.
Rae Tompkins (10:49) Yeah. We’ll type out all the possible scenarios that our team would run into. And if we put like an expected behavior that doesn’t match what caresource expects, we can just like kind of keep a working doc to make sure that we’re all aligned on the expectations.
Merritt Miller (11:05) Perfect. Well, Ray and I will coordinate kind of timing on getting that back to you guys, but we will work on that… okay?
Rae Tompkins (11:14) Perfect. Any additional questions on specialty?
Yenny Zhang (11:19) Yeah, just for my knowledge. So you did mention it’s primarily for MDS, but would we expect to see specialty associated with like the specialty specification associated with other professions like NPS etc?
Valerie Lewis (11:35) Sherry, what do you see? You did? The kind of review of the specialties compared to what we have in our system? Can you kind of give an update of what you saw?
Sheri Prouty (11:44) Yeah. So like val mentioned, a lot of it was MDS or dos where they would have internal med, gastro, or gastro, internal med. Some of them had emergency med, and then internal med or something like that. So, I think the crosswalk is going to help with that a lot because we don’t do emergency meds but we would internal med if that makes sense. Some of them were nurse practitioners where you had a certified nurse specialist, but we have a CP. Those are not the same specialty. They’re two different qualifications. Some of… them had nurses… you know, can have family, they can have mental health. They could have family prac, they could have, you know, geriatrics or whatever. The extra special D is after a CMP. Some of yours didn’t have that, but we do, which is what we would want them to be cred in and potentially board in, but at least have education, right? And those, and then there were some that just didn’t match at all. Some of those specialties you have, like I can’t remember what it was like feeding and swallowing… something or other. It was something I have never ever seen before. And what we had was totally different. So I think where that crosswalk will come in handy for those types of things. And then some of them just weren’t right? You had like… a certified nurse practitioner. They were a therapist or something along that line?
Yenny Zhang (13:26) When you, for the last example, like how did that surface in our system? Was it that we labeled the provider as like a therapist, but they were actually a nurse practitioner. I think it was the other?
Sheri Prouty (13:41) Way around?
Yenny Zhang (13:42) Oh, so.
Sheri Prouty (13:43) Like it was, what I did was I took the primary and secondary specialties that Ray sent back to me and I bumped it against what we cred them for or what we entered them for, I should say in our system. And then that’s where I determined the differences from what you guys were processing versus what we had or needed them to be processed as.
Yenny Zhang (14:06) Got it. I see. Okay. Sounds like, yeah, we’ll need to do some like crosswalk work just to ensure things are aligned? Yeah.
Sheri Prouty (14:17) Yep. Thank you. You’re welcome.
Rae Tompkins (14:21) Okay. The next topic being moline had flagged to fletcher that there was a state audit failed. Wanted to see if we can get some more information. Yeah.
Valerie Lewis (14:36) We missed our slas. So there were the ones that you’re archiving by the time you get it back to us, right? It’s either close to expiring in our SLA or it’s past that, right? And so a couple of them, we missed it. I mean, if you do an average overall, we’re okay.
Valerie Lewis (14:59) But there were quite a few and Indiana is one of our toughest states that I can do everything. Perfect for one month. The next month, I miss one. They find that one I missed, right? So we’re just kind of we just have to come up with a solution quickly. And then we’re at risk right now of all of the re creds not meeting March because you returned so many as… archived. Now, we are struggling from an internal processing standpoint of we’re not going to meet some of them. Some of them are going to go over, we’re just not going to be able to do it just due to the volume. And I have a small re cred team.
Rae Tompkins (15:45) And did you say Indiana was the state that you’re working through the cap right now or?
Yenny Zhang (15:51) Is it a few?
Valerie Lewis (15:52) Indiana is the state we’re working through the cap right now, but there are a few others in other states but again, they… don’t find it, right? Good, right?
Valerie Lewis (16:03) Indiana finds everything that we don’t we miss for some way. Somehow, I don’t know, but it’s Indiana so far that have identified some out of SLA items.
Yenny Zhang (16:16) And val, do you mind going over how SLA is based? Is it based off of the complete app completed on date?
Valerie Lewis (16:24) It is based off, yeah, it’s based off the completed app, right? So, for Indiana, we have 15 days to tell them that they’re missing something, right? So that’s the SLA, not the, you know what I mean? We have 15 days. It’s a rule in Indiana to tell them if they’re missing something, which means we need to pull the caqh app. We need to review it. And we need to make sure that we have notified this provider that we’re missing something in 15 days, right? Some of the ones that have been returned didn’t do the outreach at all because you’ve gotten to the point where the state didn’t match the license and so nothing else was done, right? So then you send it back. And now I’ve missed that 15 day to tell that provider that your caqh isn’t updated and you’re missing something, right? And it’s reporting that I have to do to the state to show them how many I missed.
Yenny Zhang (17:13) Yeah. I understand. That is painful. There’s state laws that depend on this. I guess we could walk through like a specific example like for Indiana for instance, and like how our system is kind of like maybe working based off of the requested state. So please interrupt me if I’m getting something wrong here. So it seems like we would run into a situation in which we’re like missing this SLA, if a recred comes in and the requested state is like Illinois or something. But then we’re outreaching for an Illinois license and the provider actually has an Indiana. So what medallion’s doing right now is we’re archiving that request, sending it back to you. You understand that it’s Indiana. And then maybe it’s just like too late. We’ve already passed like that 15 days to tell the provider that they’re missing something and that’s why like that’s like an example of why we’re running into issues the.
Valerie Lewis (18:18) Issue that we’re having with the state right now is what I report out on is initial, right? So even with the initial side, we have 15 days to tell the provider that, hey, we received your request, but this is what’s pending, right? And so, because it, we were hoping to get the file back before those 15 days, right? And that if they’re complete, we’re not outreaching, we’re not looking, we’re not identifying, right? So when I get the file back as archived from medallion, I’m at 14 days, it’s I can’t the volume that I receive back. I can’t look at that really quickly and get that to that provider and say, hey, so now I’m over the 15 days from a recred perspective of what you’re archiving is when you send them back to me, you sent back 1,500 of them in archive. And so I can’t flip them back to you and then have you do them, I have to now assign them to my team because they’re due to expire in this month, right? So that is also causing where we know that we’re going to go out of recred. And I had to do mandatory overtime to try to get as close to the number completed as possible, right?
Valerie Lewis (19:30) For this month because you’re closing them, you’re stopping and then sending them back. And then wanting me to send it back to you. And that’s just not that’s not a feat that’s not a quick turnaround for us. It’s not automated. We have to pull it. Now. We’re looking at the licenses making sure that, you know, this one is that one, right? And so I can just tell you previously license was not something we gave to the cvo at all. They just pull it. It was agreed that you, if the provider is licensed in caresource states, or any contiguous states around the caresource states run those verifications. It was just a process that they did, right? Based on that criteria. And then they just sent it back to us, whatever license they found.
Yenny Zhang (20:17) I see. Yeah, that is painful to have to like go through all those return files. And just to clarify like this is only a problem if say we’re still working like with Indiana, there’s only a problem if the request is coming in and the requested state isn’t Indiana.
Valerie Lewis (20:39) Well, so let me explain how we do it, right? So we load a provider based on the line of business that they’re coming in for, right? Because each state has a specific requirement on what credentialing needs to be done. Indiana, I’m going to use it always because Indiana is my toughest market. And so there are specific items that we have to do. So when we load them into our system, we’re loading them under an Indiana entity, right? And then we load their licenses. Well, the issue that we’re noticing now is we also have a caqh import that updates our Symplr system with all licenses at the time we load them. But caqh is not coming back and saying, okay, their Indiana license is now expired. You need to remove that one, right? So we do have expired things. We do have an ongoing monitoring but that’s a whole nother process however. So when the last pull that we did, Yenny, we pulled the provider’s entity and all of the licenses that we have in our system, right? I didn’t look at expiration dates because we know that some of them are expired. And then Sheena and I went through and removed all of the ones that were not a state care sources in or any contiguous states of the state that caresource is in. And that is what we sent over that’s what we sent over the first time and that’s what we sent over for this last load. And that is probably what we’ll send over again, right? Because there is no way I can go through and say, hey, although I have this as Ohio, the primary license is pa because he also has an Ohio or had an Ohio license. So, I’m pulling everything that was already in our system, whether it’s current or not. And again, it’s based on the state caresource is in and any contiguous state around that state is what I’m putting if the provider had a license has a license or the license is in our capta system. That is what I’m pulling on the recred file that I’m sending over to you. Well, we found that doesn’t work either that’s not working either because you guys are still closing them because the provider said that he’s not working in Ohio. He’s working in pa, I know, but he has an Ohio license or if he doesn’t have an Ohio license, verify the pa, I sent that too and send it back, send it back as incomplete. Hey, Valerie you sent over these two licenses, he’s not licensed in this one. He’s only licensed in pa. So I completed it and sent it back with that license only.
Yenny Zhang (23:05) I see. Thank you for explaining all of that. I guess it’s the expected outcome from that, like with the, that the provider’s credentialed in whatever state that they’re able to practice in then. So like given, okay.
Valerie Lewis (23:25) Well, look, we’ll see that in the system that, okay, he’s a pa, right? Cause we’re not sending you our addresses, either, right? Like, so you can’t you’re just taking what license I’m saying that they have in our system. I’m only pulling out the information that we have in. I’m not saying it’s 100 percent, right? I’m just saying that when the caqh feeds into our Symplr system, it loads all the licenses on their caqh, that’s why at the time they were loaded. So, for like the re creds, they were loaded three years ago, they might not have those licenses anymore. However, that’s the license that we have in the system. And I have no way of pulling all of the addresses this provider has been with over the last three years and saying, okay, this is only pa, he had an Ohio license. We would assume that he still has one. And if he doesn’t verify it, say it’s expired, look at pa because I’m sending that too and then send me back the one that’s current and active as an issue file though.
Yenny Zhang (24:31) Okay. So.
Rae Tompkins (24:32) I.
Yenny Zhang (24:33) guess, is there a use case when you’re like I am trying to credential the provider in this state only. And I want you to go based off of that. Is that, is that a flow that, or like, or an outcome that you would want? Like I’m trying to credential the provider in this state only?
Valerie Lewis (24:53) And so when I like when we sent over the last three credit file, there were some that was just in the one state… Indiana.
Valerie Lewis (25:00) I’m going to say Indiana, I go to Indiana is my go to uni. So Indiana, right? So that’s the only state that they were in. I only listed that once. Now, Ohio, if they had a pa license, I listed Ohio and pa as the licenses, right? I think some of them came back where the provider didn’t have an Ohio, his Ohio license had expired.
Rae Tompkins (25:28) OK.
Valerie Lewis (25:30) But he also had a pa, and the pa was valid and current. OK, send it back, OK?
Yenny Zhang (25:39) So you’re just trying to capture like as much given… like a provider’s licenses, you’re trying to capture like as many states in those licenses as possible as.
Valerie Lewis (25:50) possible caresource states or contiguous states to caresource states. Yes. I see. So we have California. We have Texas. I didn’t send those because we’re not well, Texas, I sent because we have Arkansas. So you see what I’m saying? I didn’t send any California on the list because we’re nowhere out that way. So I don’t need their license.
Yenny Zhang (26:11) Interesting. OK. Thank you for going over that with me. Did any others on the call have questions about this before we go into some ways we can like solution and make this less burdensome.
Rae Tompkins (26:24) A question regarding like you said that Symplr may be sunsetting, is there a possible solution or an expectation of like when that may happen?
Valerie Lewis (26:35) We’re updating Symplr, right? So we’re possibly moving to more of a web based platform rather than what we have currently with the dinosaur of a system we have right now, we’re looking to, they will eventually sunset. However… we’re looking to move that up a little bit. We were kind of waiting on them at the end of this year, but our system has been giving us trouble and they’re no longer servicing our system. I think we’re on a SaaS or something if that sounds like it’s right to somebody. And we’re moving more to the web based version. Hopefully, hopefully we’re having meetings beginning April first to kind of talk through what that looks like for us. Okay?
Rae Tompkins (27:24) And I just have one more question before we get into like the solution part of it, is there anything we can do to help with the state cap for Indiana… to support? If you’ll just let us know if there’s anything we can do try.
Valerie Lewis (27:36) To fix these issues. So we won’t have this going forward. Yeah, that would probably be it.
Rae Tompkins (27:40) I will say that we did stop the archiving of requests. There are no longer requests being archived until we can kind of investigate internally what that looks like. But I do want to flag that since we stopped archiving, there will be a lot more aging requests sitting in the request queue only because those files aren’t being worked as we kind of investigate a solution. But moving forward, you won’t receive as many archive files for the issue regarding the states. But we’re still collecting the information that I can share back to you. Once we get the confirmation that the provider isn’t licensed, we’re just not archiving them right away… so.
Valerie Lewis (28:19) Let me ask you a question. So if I send you a file today, when do you look at it tomorrow? What would be the expectation of you to look at this file and tell me that you’re archiving it?
Rae Tompkins (28:33) So the outreach will happen through the caqh import. We’ll outreach to say, hey, you’re not licensed in this state that caresource provides. When our support team receives a message that’s when they’re archiving it, receiving the message from the provider, saying, I’m not licensed in Indiana… all right?
Valerie Lewis (28:51) But my question is that if that’s the first thing that you get to that you’re stopping that file, then we’re not notifying the provider. Again. Now, I’m back to the notification of the provider for Indiana, then we’re not notifying him that something else could be wrong with his file, right? We’re not looking at it.
Rae Tompkins (29:11) No. So it stops whenever it can’t match the license because the import won’t be successful. So, in order to be a successful import and workable by our team, the issue that we’re running into right now is it’s not matching caqh versus what caresource is providing?
Valerie Lewis (29:34) Okay.
Yenny Zhang (29:35) Yeah. And I think I’d like to talk about like a, an interim solution right now while kind… of like prevent allow us to move further on a file if that happens. But yeah, going back to Ray’s point before we go there is sunsetting off of Symplr like how is that going to change? I guess information we get from caresource on the start work file with regards to the states, like are we going to get states in which we know the provider, like should be licensed in or is nothing going to change about that process, the data?
Valerie Lewis (30:21) Is going to be the same, right? Even with the new on a web based on a web based platform, the data is still going to be the same, right? So it’s not, I mean, there could probably be some more API, but again, it’s the same thing that we’re sending over to you now.
Yenny Zhang (30:41) I see. So it’ll still just be based off of like the licenses that you have for the provider, the known licenses you have for a provider and whether they’re caresource or the contiguous states. Yep. Interesting. Okay.
Yenny Zhang (31:03) All right. I think should we go into talking about… actually if I could take a step back? So I think why like the issue with our system right now and how it’s like mismatched with how you’re sending over data is that the requested state is very important because obviously, you know, there’s like state laws that depend on that state. There are certain verifications that can depend on the state that’s supplied in the request. And obviously, we need to ensure that the provider is like licensed in that state. So, I think that’s why like our system is, you know, pretty rigid on credentialing based off of that. So, I think long term, we’re trying to understand if like this is something that… like a workflow that we can partner on with those parameters in mind.
Yenny Zhang (32:10) Okay.
Valerie Lewis (32:24) Yeah, I don’t… I mean, again,
Valerie Lewis (32:34) we never had to provide the states before Yenny. So I got to think about, right? Like, you know, with the previous cvo, it was just to verify these states, right?
Valerie Lewis (32:47) Again, like I said, the data is going to be the same, right? So, I mean, I would be able to hopefully talk to symplr who manages to see the Symplr platform to see how we can possibly add a flag, right? Like to say primary, I don’t know what their new system looks like. Maybe they have that option, and then we would do the exercise when we move our data over to say, hey, this is the primary license, right? The only problem with that is for us again, what if they are working at other in other states as well, right? Like how would we be able to identify… all of that? Like again, the data is still going to be the same. I don’t the data is still going to be the same. Again. I haven’t looked at the new system to see where we’re moving to and how that will be beneficial. I will know more after the first of April.
Yenny Zhang (33:43) Got it. Okay. Maybe we can talk more about like long term after April. I think we still do want to like make some changes to ensure that what’s happening right now is not so burdensome for your team. So, are we okay to move on? Thanks, Ray and teamers? Are there any questions? Okay? Oh merit.
Merritt Miller (34:12) No, I was just going to say we appreciate it. Val, I think we’re just trying to understand because this is kind of the standard across all of our other customers and something we just haven’t run into of it being an issue to date. And so we’re just trying to figure out like how the data is getting to medallion. So, as we’re thinking through like how to partner with you all on this, what we can do in the future, but yeah, I was just going to say, I appreciate you walking us through it. It’s helpful.
Yenny Zhang (34:40) Okay. So, yeah, right now, I think the limitations of our system are that we’re kind of like blocked, like if we’re given like a state, we kind of just like are like where’s the license for that state? And then, you know, provider credit contact might be like, I don’t have a license for that state. And then we like archive the file and that’s it. What we’re looking to explore is once we get information that like an email from the provider that says, I’m not licensed in this state. We’re looking to build in a step for us to just change the requested state on that license request based off of the state that a provider’s licensed, in caqh essentially to like get past that like state license requirement and then continue credentialing. Is that something that would work?
Valerie Lewis (35:35) That may help… that may, let me look at it because we can also pull caqh. I don’t know if it gives us the licensing on our reports that we pull, but maybe we can kind of maybe do a bump against it, right? And with what we have in our system and only send over the licenses, I know that won’t work because then how would, you know?
Valerie Lewis (35:57) And I’m sorry to cut this short, but Sherry and Sheena can pick it up but, I gotta jump. I had a hard stop at three 30. Oh, no worries. Yeah. So Sherry and Sheena should be able, to continue speaking to what… we can do with the system that we currently have.
Sheri Prouty (36:14) Right.
Valerie Lewis (36:16) They, they should be able, to speak to it. I may be able to jump back on real quick. I just need to go over here real quick, but Sherry and Sheena should be able to speak to it, but I appreciate everybody trying to work through this, trying to figure this out. Thank you so much. Thanks, alrighty.
Yenny Zhang (36:39) All right. I guess, Sherry.
Sheri Prouty (36:44) Yeah, it’s a lot. I know it’s a lot.
Yenny Zhang (36:48) Yeah, we, I understand that this is like very messy and like really hard for your team. It’s also a little hard for us. So, just trying to think through some creative ways to.
Sheri Prouty (36:56) move.
Yenny Zhang (36:57) Credentialing along. Is that something that could work? Where like, we get the feedback from the provider. They’re not licensed in the state that came in to.
Sheri Prouty (37:06) start workfile medallion would.
Yenny Zhang (37:09) Change the requested state on the request. So basically ensuring that we’re like we would require a license from the new state that is based off of what is in caqh. So.
Sheri Prouty (37:24) Would you change the state based on what they tell you? So, for example, we have a lot of issues with Wisconsin right now with one particular group where most of their providers are in Minnesota. Yeah. And you guys keep asking for Wisconsin, they are not practicing in Wisconsin, but it’s a Wisconsin group, if that makes sense, and it’s in our Wisconsin entity, it’s kind of similar to the Ohio with a pa provider, right? It’s a bordering state. So… if they send it back to you and say, I don’t have a license in Wisconsin. I actually am licensed in Minnesota. You’re talking about changing it in your system to Minnesota and then outreaching for that Minnesota license, and then continuing on with the credentialing, correct? Yes. Is that what I’m understanding? Yeah, like val said, that might work… or may work as she put it. I think that, that’s something that we would have to see how well that works because I think sometimes I don’t know if all of the feedback that you guys get from them, tell you what state they’re in. They just say, hey, I’m not licensed in West Virginia. I don’t know because we don’t see, that… that’s all working out. I’m looking for the response and the files that you guys get back. As long as they provide you with the state it might work.
Yenny Zhang (38:57) I see. So another option would be just to go up based off of what states they’re licensed in based off of what’s in their caqh application. The thing is that there could be like multiple states represented.
Sheri Prouty (39:11) And it might be not be the one that we need either, yeah, because our caqh is not our source of truth. So, and I think that’s where we’re running into the problem. Now you guys are trying to, you guys use caqh, right? As a source of truth. So whatever license on there is what you guys go after, not necessarily what we’re sending you. And so it’s… I think we’re still going to run into the same problem if you continue to use caqh for licenses.
Yenny Zhang (39:42) I think, yeah, maybe this is where I’m getting a little confused is like if you’re sending over Wisconsin. So the intent is that you do want to try to credential the provider in Wisconsin, right? For Wisconsin.
Sheri Prouty (39:56) So,
Sheri Prouty (40:01) it shouldn’t pull Wisconsin license. It should pull Minnesota, but it might pull Wisconsin as well because it’s in a Wisconsin entity. Keep in mind, we don’t have an entity for every single state that somebody’s licensed in. It’s only based on the state that we are in… for that insurance… if that makes sense. So we’re like in Wisconsin, Ohio, you know, Indiana, West Virginia, Florida, Georgia, right? Georgia can be a Georgia provider could also be practicing for a Florida group, be… located in Georgia, but they would not have a Florida license because it’s across the border. So we would send you Florida, but you guys might see Georgia and say, hey, you don’t have a… they can practice in states.
Valerie Lewis (40:54) That they’re not licensed in no?
Sheri Prouty (40:56) They would live in Georgia, work across the border in Florida. They should be licensed in Florida. But if you see that you’re going to be possibly reaching out for Georgia and they’re not licensed in Georgia, that’s kind of like the Ohio, Pennsylvania, right? It’s bordered. We sent you Ohio and pa, you’re like they’re not licensed in Ohio, they’re licensed in pa, and then you guys stop, it. Does that make sense?
Yenny Zhang (41:22) So, is there like a, so it sounds like there’s like obviously the contiguous states like those are the known groupings. So is the, I guess workflow like try to do Wisconsin, then check the other valid contiguous states and go based off of that.
Sheri Prouty (41:48) So if we send you Wisconsin… it might work that way. I’m going to give you another made work that way just depends without seeing it and see how it’s going to function and work. It’s really hard to say that, yeah, that’s going to work and bounce back. I.
Yenny Zhang (42:05) Think what would help maybe is if, I have like an assumed mental model, of a process that could work based off of like this contiguous state groupings. So maybe if like we write out our assumption of what could work based off of that and, you know, share it with you to read and review, then maybe we can like get some more clarity and alignment, on a possible solution. Would that help if we like take this back? Kind of like do?
Sheri Prouty (42:40) Something, write it out? Yeah, write it out and then send it over. Yeah, I think that would be a great place for us to start. Yeah, for sure. Okay?
Rae Tompkins (42:46) Cool. I.
Yenny Zhang (42:47) Think, yeah, I think what I would need from your team is just, yeah, the set of like the contiguous states like the states that caresource operates in and how they’re all related to each other with the examples that you gave like the Georgia, Florida and the, you know, I hope Pennsylvania, Wisconsin, Minnesota, kind of like all those groupings.
Rae Tompkins (43:07) Then we.
Yenny Zhang (43:08) can write something out based off of that. Okay.
Sheri Prouty (43:12) She didn’t all work on that. I’m out of the office from the second through the seventh of April. So we’ll try to get it before then I.
Yenny Zhang (43:25) Appreciate it a lot. Thank you.
Sheri Prouty (43:27) Right after that.
Yenny Zhang (43:28) Yeah, I.
Rae Tompkins (43:29) think too that the more context we can get from your conversation with the migration. I think valid flag that’s happening in the beginning of April will also kind of support as we kind of investigate the best solution. So the sooner the better, but we can kind of use both sets of information, the states information and then like the Symplr migration to kind of better understand what the big picture will look like moving forward but obviously underlying being that we want to do everything we can to make this successful and kind of alleviate some of, the… craziness that’s occurring. So we appreciate everyone’s patience as we kind of continue conversations internally. Yeah, we appreciate that. Was there anything else? Yeah?
Sheri Prouty (44:15) I still have a question for Nico? Yeah.
Rae Tompkins (44:18) That was on my PBS.
Sheri Prouty (44:19) Yeah.
Rae Tompkins (44:19) Yeah.
Niko Byron (44:22) So we actually, I have a hopeful fix that I pushed today that might alleviate.
Sheena L. Swihart (44:29) The.
Niko Byron (44:30) problem. It’s hard to test on my end, but the file we delete the files we delivered today for clean risk, if you were able to split those, if you could please let me know because I basically am rewriting the PDFS after we download them each time, which hopefully should simulate the sort of compressing and uncompressing you’re doing on your end. And hopefully we can just alleviate that step you guys are having to take manually that’s taken up so much time that.
Sheri Prouty (44:56) Would be amazing. I was going to say the only thing that we found that works is if we do save as and save it as a compressed… file for PDF and then it allows us to do it. So maybe that’s what you’re doing?
Yenny Zhang (45:11) Until.
Niko Byron (45:11) Yeah, it’s a little bit different, but it should maybe do the same thing at the end of the day is what I’m hoping. So, yeah, just let me know if you can, if you can split today’s file and if not, we’ll go back to the drawing board, but hopefully we’ll put this into rest and.
Sheri Prouty (45:25) You said it, the ones you said at three nine, right?
Niko Byron (45:28) Yes, you guys are east coast time, right? So, yeah, it would be two nine. Yeah.
Sheri Prouty (45:33) Well, I’m Central Time, but yeah, the rest of my team is east standard time, yeah.
Niko Byron (45:39) Yeah. The ones, it should be the 325 file. Okay?
Sheri Prouty (45:43) Perfect. I’ll open them up and see if I can get them to split awesome.
Rae Tompkins (45:49) Perfect. If you’ll just let us know and we’ll… go from there. Were there any other questions or anything that we can help with today? Understanding, obviously, these conversations will continue as we work through the items flagged. Yeah.
Sheena L. Swihart (46:06) Ray, I actually on that on those emails that you sent over on Monday, we had a provider that… you sent over that was no longer with a group. Yeah. And it got archived. And the thing is that the provider should have had two additional groups that should have had outreach too. I don’t see it since it got archived. I don’t see where… any additional outreach went. Yeah.
Rae Tompkins (46:44) Do you mind? Do you have that name of the… if not, I sent a lot. So, hi, Paul and I’m going through those right now and working with our support team to make sure we’re providing more visibility in mpi, but obviously, if outreach only went to one, let.
Sheena L. Swihart (47:03) Me, I just dropped the mpi into the chat because this provider has a difficult name and we’re not exactly sure if we have it right in our system either.
Rae Tompkins (47:18) Don’t worry. Yeah, I can definitely look into this and I can reach out to our support team to see if outreach was going somewhere else and the… shuffling of understanding if we get a termination notice from one group, yeah.
Sheena L. Swihart (47:32) Because this is a June recred. So, if… there was an other outreach to that, how can I get this one back in process?
Rae Tompkins (47:45) Absolutely. I can restore it to put back into the request queue and just remove the contact that stated they’re no longer associated with. Okay. But I’ll also get with our support team to kind of level set like if one group says no, but there are two others, how that works. Okay?
Sheena L. Swihart (48:04) Yeah, that would be great.
Valerie Lewis (48:06) Hold on a second. Hold on a minute. I think that’s still going to put us back where we are with the license because how do you know, those two groups are the two groups Sheena that we have? They’re pulling off a caqh, how do you know that the groups that they have on caqh are the same groups we have in our system that the provider is still with?
Rae Tompkins (48:27) There were three?
Sheena L. Swihart (48:30) Groups in Symplr, we should have sent all three groups over.
Rae Tompkins (48:35) But we.
Valerie Lewis (48:35) should have sent all three credit contacts because that’s what pretty much always send, right? Correct?
Sheena L. Swihart (48:41) So the other two contacts should have gone over.
Rae Tompkins (48:45) Okay. So it looks like I just pulled up this provider. They have, you know, like you said, some additional contacts, we may have received the one that said they weren’t but… okay. Do you mind sending me the contacts that you’re seeing on your end? So I can compare what’s coming over sure on the start work file. I just want to see if they match, yeah, absolutely to see if these were because I see a lot of them source is caqh. So I think a lot of them were imported directly from caqh. I’m only showing one the provider’s email address is source customer, and then the join groups. So there’s only two on file in the provider’s profile that say customer. So the rest were like val said, caqh imported contacts, okay?
Sheena L. Swihart (49:44) And then I will also look at the, try… to look at the RCM or the rcred report and make sure that all groups went over. All correct contacts went over also.
Rae Tompkins (49:57) Okay. Yeah. So I’ll I.
Sheena L. Swihart (49:59) can send you this one too.
Rae Tompkins (50:03) If it’s a case where you can easily identify, I understand why you didn’t dr. Elias, I’m hoping that’s correct, if you see that he should have other groups that weren’t imported over, but the provider was archived, I can put them back into process with an updated cred content. Okay. Yeah. But yeah, it looks like maybe one is coming over provider and one caqh or one non caqh contact, so.
Sheena L. Swihart (50:33) Okay. Yeah. Let me take a look at that and then I will email you. Okay?
Rae Tompkins (50:38) Perfect. Yeah. And I’m going through the list that was sent over, that was utilizing the incorrect cred escalations email. I’m working with our support team for more visibility on populating the mpi, the group that they were associated with the note in the email. So I’ll continuously and the,
Sheri Prouty (50:54) person they talked with.
Rae Tompkins (50:55) Yes, yes, that’s on the table as well. So like we got an email from Janice, Janice’s, email. Is this, Janice said they’re no longer with this group as of this day. So I kind of broke it into four tables for the support team to start filling out. But I’m definitely going backwards and providing more information on the ones that were already sent.
Sheri Prouty (51:17) Okay. Thank you. And Nico, that did not work. Okay? Sounds.
Niko Byron (51:21) Good. We’ll take another look, so.
Sheri Prouty (51:24) I can show you what they showed me to do as a workaround on our side… if that might help. And maybe it’s something you can do before you save them. I don’t know sure, but… open one. Let me share.
Sheri Prouty (51:48) I know when you can see my screen.
Niko Byron (51:50) Yep. We can see it. Okay?
Sheri Prouty (51:52) So like this is one that came over today, I.
Rae Tompkins (51:55) Believe. And then.
Sheri Prouty (51:56) So what we have to do is do a menu save as other.
Sheena L. Swihart (52:01) Reduce.
Sheri Prouty (52:02) sized PDF… and retain existing and click. OK. And once it saves, then we can split it.
Niko Byron (52:16) Yeah, I’ll take another pass at it and see if I can rewrite it another way that is able to facilitate this. But thanks for taking.
Rae Tompkins (52:24) A look, yeah, of.
Sheri Prouty (52:26) Course. And I think that remember, we talked about where it’s housed at because you said it’s a third party. I’m just wondering if they changed something so that when, of course, you download it and then you compressed, it changes your file too. Yeah, the.
Niko Byron (52:38) research… I’ve done is basically that like in order to save space, a lot of these PDFS are like have references. So they’re like if there’s like an image or certain text things, they’ll all reference these things in order to like reduce the size of them. And so it’s not really like it looks like, you know, 100 pages, but it’s really like… a bunch of references to these shared objects across the pages, which makes it sort of unsplittable. But if you’re able to rewrite it a certain way, then it sort of undoes all that and puts it in a state where it should be splittable. So that’s what I’m trying to do. And I think that’s why what you’re with the process you’re doing makes seems to work. But yeah, I’ll take another look and see if we.
Sheri Prouty (53:20) can figure.
Niko Byron (53:21) out how to do that. Thank you. No problem.
Rae Tompkins (53:27) Alrighty. Well, thank you so much everyone. Obviously, we’ll continue conversations on all the items flagged today. I’ll continue updating the credit escalations, emails that were sent in correctly, and we’ll be in touch with any additional findings. Thank you. Have a good one. Everyone. Thank.
Sheena L. Swihart (53:45) You. Bye bye.