Transcript
Adam Pollick (00:00) there he is James.
James Donachie (00:02) Adam, how are you doing?
Adam Pollick (00:04) That’s a good word.
James Donachie (00:05) Oh, we have spring here in Colorado, very nice. Yeah, I think.
Adam Pollick (00:13) Mike and I are envious in New York, New Jersey. It’s still pretty chilly here. We haven’t crested the wave yet.
James Donachie (00:21) That, yeah, you guys are, I think all the, I think all the moisture in the United States somehow ended up in the, in new england slash the Tri state area somehow. Yeah.
Michael Ruiz (00:34) Well, Hawaii too though. Did you guys see that? That’s crazy. Oh, yeah. That’s the fall.
Adam Pollick (00:38) Guys. What’s going on? Yeah, they are like major problems there.
Michael Ruiz (00:42) Major, 40 inches of rain in like four days is nuts that’s crazy.
James Donachie (00:46) That, yeah, that’s I don’t even, you have to have some serious water like mitigation. Yeah. In Hawaii, it’s like one gigantic hill. I don’t know if you guys it is… that’s crazy. We have, they’re already starting our, in Colorado. They’re already starting our water restriction. So I haven’t even gotten my sprinklers… like up and running for the season yet because usually we usually have at least one or two more like frost days. So I like to just to wait until like April, but I found out on because it’s been so warm on Thursday. They’re starting like the water restriction. So I don’t even know if I’ll be able to use them. I might have a dead lawn this year.
Adam Pollick (01:44) You put in some turf there you?
James Donachie (01:45) Go. Yeah, I’m going to be like Arizona with like the zero like the rocks everywhere.
James Donachie (01:56) I know Becky said she’s she’ll be right back but I figure we could get started looking at the data. I have some notes that. So I spent a lot of time with the team going trying to understand the data, how we can fix it the quickest and give you guys like some instructions because what I really wanted to do is like figure out, you know, where things are failing and Michael your email address or your email?
James Donachie (02:34) Was it kind of exactly where I was like seeing things. It was like mostly on address but it’s multiplying. So it’s not nearly as many. It gets like the way that it multiplies out is, you know, it’s one practice location, then it’s 130 providers, but 130 times 14 different payers. So it’s like we just fix one. All of a sudden. We unlock all these different rows. And so what I did and I’m going to share my screen right now is.
Michael Ruiz (03:04) Yeah. A couple things too. Like we’re going to simplify this dramatically as well. There’s only certain plans we’re going to try and test this out initially. Okay, that are really high volume plans for us. So Debbie will give you the list after of what we’re looking at there, but we wanted to maybe just spend some time on. I wanted to understand the npi issue. So what you’re saying is it’s not that they were missing npis individual npis, was it missing? It was non matched? Or was it missing? Because those are very different things?
James Donachie (03:35) Yeah, it was non matched. Okay. That makes sense. And I got the amount of… I got the amount of providers that it was not matched for. It’s 967 of them. And that impacts 13,999 rows on the sheet?
Michael Ruiz (03:55) So here’s what I’m thinking here’s where I think it’s going to benefit medallion to do this work too, right? So plans have a lot of issues with directory accuracy, right? You’re aware of that? Yes. Okay. I would imagine you’re trying to develop a solution to fix that, right? So because they’re not matching what I’m thinking is happening here because again, we would know our data, right? Unless it’s one of these groups that haven’t been imported into medallion as of yet, right? It’s probably people attached to us that are no longer with us at all or may not even be active with the plan. So what would happen here is we would use that when you’re not matching for the mpis, we would actually review them ourselves along with the group names or tax ids and then most likely have to notify the plan to not have them attached to our roster going forward. So it’s a cleanup effort. This is also an effort for the plan to clean up their own directories, but this is a systemic issue as, you know, with health plans. Yeah. So, but I think that’s what’s happening there because in my mind there would be no situation of where there would not be a match unless it’s those group builds that we’re talking about this morning team. So we should, I would just look at that. We should get that list from you of non match. And then we should review what that looks like.
Debbie Argentine (05:16) And I would say I would suspect for healthplus there’s a lot for New York presbyterian because they were on our roster and they’re not in our ipa. So those have since been removed. But you’re working off of an older roster, James. So we actually did a lot of cleanup that should help solve some of those 967.
James Donachie (05:38) OK, perfect. I mean, that sounds like a plan. And I, you know what I was trying to even understand too was, and Debbie and Adam, you guys, I was like, OK, well, you know, we’re saying it’s failing like where, give me some numbers. So, these are my notes from work. So like the 967, it’s like, I think Michael to your point, we’re going to figure it out. One of the examples that was like it was this one provider’s mpi, it didn’t come back as a match. It’s failing almost 500 rows because they’re attached to 14 different locations, times nine different payers, somehow, that math equals 485. So it’s like we’re going to, by fixing one, we’re going to, yeah.
Michael Ruiz (06:21) That fixes everything. Can we do it? And also by narrowing the payers that we’re interested in? Yeah. Can we look this mpi up real quick guys in our system? Yeah, I want to see what this is, give.
Debbie Argentine (06:32) Me, the mpi James?
James Donachie (06:35) Do you want me just to copy it and put it in the chat here?
Debbie Argentine (06:38) Okay. Or you can say it out loud. It doesn’t matter.
James Donachie (06:40) Okay. One, seven, six, zero, five, eight, seven, four, three zero.
Debbie Argentine (06:54) I don’t even have him in our platform that’s.
Michael Ruiz (06:58) exactly my thought guys. That was.
Debbie Argentine (07:03) One seven, six, zero… five, eight, seven, four, three zero.
Michael Ruiz (07:08) Yep. If we look that person up online.
Debbie Argentine (07:14) I’m going to do it right now, yeah.
Michael Ruiz (07:15) Thank you.
James Donachie (07:16) That was going to be my next thing was.
Debbie Argentine (07:18) Eugene palik?
Michael Ruiz (07:20) Okay. Who’s he with?
Debbie Argentine (07:23) Well, I looked at neps.
Michael Ruiz (07:26) How do you spell his last name?
Debbie Argentine (07:28) P a LCHIK palich. Palich.
Michael Ruiz (07:51) Here’s, what I think is happening here. Again, we’re going to take this list. I want the list of everything non matched James, we’re going to take that non matched mpi list here’s. What I think is happening here. We’re going to bump it up against the intellicred list. It’s not going to be there. This Guy, I would guarantee it, he’s just attached to us incorrectly by the plan.
Debbie Argentine (08:13) Yeah. If you can send me the list, that would be awesome. Yeah.
Michael Ruiz (08:16) Yeah. So what’s going to happen, James at the end of the day here, what’s going to happen after this gets fixed on the front end? You’re not going to have many mismatches on mpi that should never be the case in reality. Yeah, but this is all again dirty plan data. We have to then send Debbie. We’re going to have to send this stuff to the plans to take off of our roster, right? Again, this is simple. We went through this exercise. The same exercise we went through with anthem is going to have to be done at a larger scale, but let’s just say that happens, what we’re going to be left remaining with are mismatches due to addresses. And I don’t think we could avoid that unless we end up working with the plans to fix some of the addresses, but I think you’ll see a much higher match rate then after this work’s done.
Debbie Argentine (08:56) He’s with the USA vein group.
Michael Ruiz (08:59) That Guy too.
Debbie Argentine (09:00) Yeah, pallage.
Michael Ruiz (09:02) So he is active with us.
James Donachie (09:04) Yeah.
Debbie Argentine (09:07) Let me try his mpi again. Hold on.
Michael Ruiz (09:09) Yeah. Why did that not show up in the system? I don’t know.
Debbie Argentine (09:16) Let me do it by name. Oh, you know why he’s probably deactivated. He’s probably deactivated and needs to be removed. So he’s probably on a list that Adam just gave me of providers that are no longer with USA vein. I deactivated him. So he’s going to drop to the April roster. So we’ll have to bump that list up against their term list too.
Michael Ruiz (09:39) I’m not following that like wouldn’t that show up in the system if you didn’t deactivate him or you did deactivate?
Debbie Argentine (09:44) Him? I did deactivate him.
Michael Ruiz (09:46) Okay. Yeah. Well, we’ll do that on our side. Let’s just get the list, James. We just need the list from here of everyone who’s not matched. We’ll figure that out every element that, you know, that was provided to like if we can see all the elements on that file just with the non matches that would be great.
James Donachie (10:02) Yeah, I’ll send over, I’ll send over, the full file, that has it like listed out exactly where the non matches are. And then you can just, you can filter, you can filter to see where it is and which is what I did. How I got to, my 967. So do.
Michael Ruiz (10:24) we want to align to, on the plans now because I know we talked about a lot of plans like which maybe we should just align on the plans that matter to me. It’s anthem emblem, Aetna health first. Are there any others that matter?
Debbie Argentine (10:40) You said blue cross, blue shield, health plus emblem, health first? What about Aetna?
Michael Ruiz (10:46) Not.
Debbie Argentine (10:47) unitedhealthcare. No, not.
Michael Ruiz (10:49) Initially, let’s just, I want to work this in a smaller scale first, as a pilot versus having to do all this work. And because what happens is if it doesn’t match on like one of the other plans, it’s just going to kick out anyway.
Debbie Argentine (11:03) All right. So, it was anthem emblem, health first and Aetna.
James Donachie (11:07) Anthem… emblem and.
Michael Ruiz (11:12) All products associated with them that come back but health first.
James Donachie (11:15) Health first.
Debbie Argentine (11:16) And Aetna and I.
Michael Ruiz (11:19) figure like guys, what I’m trying to do is simplify the front end work for us, Debbie, just so that we don’t have to continue, right? It’s just easier. Let’s just if this gets in there, these are all the questions we’re getting is probably 80 percent on these plans. Anyway. Let’s just get this focused. All right. That’ll be our concentration to get things standardized and accurate. But most of the stuff though comes the questions arise about these plans, right? Yeah… Becky, I mean, most of the questions are arising these plans. I would think. Yeah, uhc, is.
James Donachie (11:50) Really?
Michael Ruiz (11:51) Another huge one that we get questions on. Okay. So, uhc commercial. Yeah. Okay. Do we want to add uhc commercial? I’m okay with that. Okay. I have an 11 30 guys. I just want to make sure. Were there anything else we’re tracking for me for this? No, I can send.
James Donachie (12:17) You, these updates too, Michael like on a call like I said, these are just like my notes as I was going through it. Once again, it was like I found I got an example of an address for one of the practices kind of the variations which you guys already know, but it’s more so like once we’re able to fix it. So this 4,016 elmhurst medical PC, you have the 5,670 fourth street, 70 fourth street spelled out 70 fourth street unit one. So like those were just like I just wanted to like as we get those resolved… and cleaned up over time. It’s like that’s.
James Donachie (13:02) Just going to make stuff easier. And some of them are really obvious. And I think that’s where… we’ll be able to do. And then the group level the… tins, there were only about 120 rows that had issues with any of the tins. I know that was like one of the data we were feeling the most confident about. I’m going to guess maybe they’re not active tins anymore, but I’ll just have that kind of called out to the group. I think the payr, this isn’t important because we’re going to tighten up our payr group now. So I think that’s going to help resolve. And then the last thing too was I’ve had the… 25 practices that affected the most like row failure where I was just consolidating a list of them. And then just to kind of give an impact of how that went was, so I had the practice name like the expected kind of location, the rows that were impacted. And then the providers as well. And so that’s kind of how resolving just 25 practice addresses actually fixes a huge portion of this data. There’s thousands of rows that can be resolved pretty quickly. And so I think, that I didn’t want to, I find the sheet very overwhelming to look at and it’s like you actually only really need to make 25 address changes and then that will unlock thousands of rows of data to kind of be imported as well. So, that was just one of, the things that I kind of went through as well.
Michael Ruiz (15:00) Yep. And we’ll work on cleaning that up.
James Donachie (15:02) For sure. Okay? The.
Michael Ruiz (15:05) Only other thing I saw was, I guess Becky had asked for maybe some team manager review. So, you know, if you wanted to just walk through that, James too, that’s fine. But I do feel like, and the reason why we’re asking is, you know, I just don’t want there to be a, an assumption of what something looks like. And then we’re you know, it’s not really that, right? There should just be a level of communication among the teams as it relates to what it looks like.
James Donachie (15:31) Yeah. And I am working… with step right now to kind of get the get something client facing for you guys right now. They’re working in Jira, and it’s just like a it’s like our internal tickets there’s just like a lot of engineering jargon that’s going on it. So, I know that was one of the takeaways. I would imagine that we’ll probably have something like updated for you guys by like the end of the week and then that’s something, we can walk through. But I was happy to hear that it wasn’t going to like really impact the UI. But to your point, I do want to make sure that the usability that they’re creating on the back end, you know, makes sense as well.
Michael Ruiz (16:19) Okay. That’s good with me. All right. I’ll let you leave you guys to it. Thanks thanks, James. Appreciate.
James Donachie (16:25) It. All right. Have a good one.
James Donachie (16:35) And Debbie, I can, I,
Michael Ruiz (16:38) can.
James Donachie (16:39) that doc that, I made those notes on, and then that the full file I can send over to you. But I was trying to get an understanding, you know, like I said earlier this week, I was really trying to understand like, where the easy updates were, on some of these, you know, cause the file like it’s great if you’re maybe if you’re more of an analytic mindset, but it’s like, okay, what? Just tell me exactly… where I can make one update and it unfreezes 500 rows for me because that’s what I’m most interested in.
Debbie Argentine (17:22) Yeah. The address will help a lot. And we did have about, I think about 500 New York presbyterian providers on our health plus roster. So half of that might be resolved now, when you get an updated roster, we’ve cleaned up a lot since that roster was generated back in October, November.
James Donachie (17:40) Got it. No, I think, that, you know, I guess that’s the data’s only good for the, you know, the moment. Yeah. When you hit download and then from there, it starts to age, right? Yep, it’s all.
Debbie Argentine (17:55) Stale after that, no.
James Donachie (17:57) So, I fully expect, you know, and of course, the address like, I don’t know, I’m not an engineering person but, you know, I don’t understand like why, you… know, it’s like the human element being like, okay, I think this address like there’s just like a sweet number at the end of it. I think it’s the same as the other one, like.
Debbie Argentine (18:23) Yeah.
James Donachie (18:25) But that matching logic, I know will be way more complex, but I’ll package all that up, send it over to you with the file. Yeah, with the file. And yeah, it, the other thing about the file too was like when I was actually looking at it like I was like there’s really only like, I think there was like 11, or 12, you know, errors… and they like they weren’t like that uncommon. So it’s like it kind of, it looks like there’s all these problems. But when I like broke it down, I’m like there’s actually only really like… five common problems and five uncommon problems which like these quick fixes will solve like a bunch of them. So that was, I think just kind of making it in a way that it presents a little bit better as well. Well.
Debbie Argentine (19:23) We definitely appreciate that thoroughness. It’s a lot easier. It’s a lot easier pill to swallow when you have, when you approach it from that lens, right? It’s not this big massive problem. It’s just this little problem we have to fix. That impacts all of everything else. So definitely appreciate that.
James Donachie (19:41) Yeah, no, I like, I think that was a miss on our because I mean, that’s what I spent. I literally spent probably four hours like asking questions and being like, okay, break this down. And I’m like, so it’s one address out of practice, but then you’re like then it fails 137 times because there’s 137 providers times 15 because there’s 15 payers and I’m like, okay, all of a sudden, we’re at like 2,500 rows, but I’m like it’s just one.
Adam Pollick (20:12) That intimidating number is suddenly one thing. Yeah.
James Donachie (20:17) It’s just delete the apartment on the street and all of a sudden it works. It’s like it could be like three characters off what?
Adam Pollick (20:27) Are you sending across James again? Just? A, oh, you said you were going to package it all up just to confirm I have everything?
James Donachie (20:33) Yeah, I’ll send the notes that I have like with the examples… perfect. And then, and,
Debbie Argentine (20:40) the file and,
James Donachie (20:41) then the file which I was pulling up right here and I can show you guys. I mean, I didn’t even want to, so.
Debbie Argentine (20:47) Are you guys, still, are you still moving forward with importing what can be imported and then let whatever fail?
James Donachie (20:54) So that’s what they were going to do, but I figured I wanted to, I figured there were some wins that we would be able to get before that.
James Donachie (21:07) Because.
Debbie Argentine (21:07) I know Mike does not want us to go through this file and manually standardize anything because it’s too time consuming, but we can definitely take what shouldn’t be in this file out to increase our import percent.
James Donachie (21:22) Well, if you guys also have a new file, I mean, no.
Debbie Argentine (21:25) I don’t so we don’t I have to create it. So I have to take every payr roster and put it into your template. And I’ve honestly got over 80 hours in that template that you have now with all of the back and forth. So it’s very, it’s a painful process, but we’ll get better going forward.
James Donachie (21:42) Yeah, that, well, I think one, the new payr’s amount. I don’t know why. Okay. There we go. Can you guys see the dropdown here? Yeah. So on column aas… there’s the issues for why it failed. And then these are the only issues. So.
Debbie Argentine (22:05) There’s what do you mean? Payr? So we don’t have the payr on here. Like it’s Oscar or Aetna or?
James Donachie (22:12) Yeah. And I think the one I saw was like CP. Oh.
Debbie Argentine (22:16) Cphl.
James Donachie (22:17) Yeah, which we’re going to get rid of anyway. So that’s going to?
Debbie Argentine (22:20) And partners, you’re going to get rid of partners and cphl?
James Donachie (22:23) Yep. Yeah. So both those should be, but… then when the payr name’s not there. So then there’s like payr name, not there. The group combination not in platform practice.
James Donachie (22:42) So, I.
Debbie Argentine (22:43) think this is perfect compared to how I used to get the file. If you can send this over if you can, we’ll take a look at that. We really need to get this moving forward. So I’ll carve out time in my day to work through this and I want to get this back. I want to get this off of our plate because it’s probably 95 percent of Becky’s headaches.
James Donachie (23:02) Yes, yeah, I will. I’ll send this over to you guys afterwards. So I’ll send this file. And then… I’ll put the notes that I had in the document and then, you know, providers not in platform that’s exactly how I got that number. Like I just kind of like filtered through and was able to see it. So I just wanted to kind of talk through it with you guys a little bit because handing over something like this is quite, yeah… there’s a lot of numbers and stuff. I.
Debbie Argentine (23:36) think you have it in a very user friendly format. So the comments are that’ll be where my focus?
BeckyLewis (23:43) Is at?
James Donachie (23:44) Perfect. Yeah, I can get that over to you right after this call. So, I know we got like 15 minutes left, but then I can kind of get moving on it. I know that if this is kind of our top priority too, I’m happy to… take the last 10 minutes and pull all this together and get it to you in an email. So I’m not wasting any time for you.
Debbie Argentine (24:08) I think we’ve covered. We’ve covered everything. I have some things on my agenda but I can cover those via email. It’s fine. And I think you laid them out already in one of your other emails, so.
James Donachie (24:20) Okay. Yeah. So let me work on just pulling these together right now so I can get them over to you like in the next five to 10 minutes and.
Debbie Argentine (24:29) then, Becky, Adam, do you have anything?
BeckyLewis (24:33) No, no, this was.
Debbie Argentine (24:34) It.
BeckyLewis (24:34) yeah, I don’t have anything.
Debbie Argentine (24:35) Else. Yeah.
BeckyLewis (24:36) The team manager thing was my one big issue. So, I just want to make sure they’re not doing all this work. And then the end result is not what we asked.
James Donachie (24:45) For, yeah, no, I completely agree. I know Steph agrees too. I… they’ve.
BeckyLewis (24:53) been, they were very gung ho in the beginning and then just nothing but silence over the last few months. So we just really need to know what’s going on and what it looks like.
James Donachie (25:03) Yeah, I will, I’ll let Steph know about that too. If I wasn’t so embarrassed and could understand that the Jira ticket, I’d share them with you but like,
BeckyLewis (25:12) I have to use Jira with our it team too. And I’m like what?
James Donachie (25:16) Yeah, I’m like you would just be like what is going on over there? Look to.
BeckyLewis (25:20) me like I’m five. Yeah, I don’t understand any of this.
James Donachie (25:24) Yeah. So, I need an edited, you know, someone to translate what’s being said in there for me… you?
BeckyLewis (25:35) Have to use chatgpt, maybe, yeah, what?
James Donachie (25:39) Is happening? But, okay, well, I will let you guys drop. I’ll send that over to you guys right now and then we’ll just stay in contact over email. Hopefully, I have more updates. This is helpful… and we’re closing out a bunch of these rows.
BeckyLewis (26:08) Yeah, perfect. Thank you.
James Donachie (26:10) All right. Bye everyone. Thank.
Debbie Argentine (26:12) You. Bye bye.