Transcript
Naomi Denson (00:00) hello? Hello. I am not here yet. How are you guys? Oh, there’s, Melissa?
Naomi Denson (00:24) Hi, Melissa. Hey, there. How are you? I’m good. How are you?
Melissa Butler (00:31) Okay. I had to join on my phone because I don’t know what’s going on. It’s not letting me join on my computer.
Naomi Denson (00:41) No problem. I just restarted.
Melissa Butler (00:44) So, hopefully that’ll help.
Naomi Denson (00:47) Yeah, for sure. There’s Kelly. Hi.
Naomi Denson (00:58) Hi, Kelly. Oh, she’s still joining. She’s spinning.
Naomi Denson (01:15) There she is. Hi, Kelly. Hi, ladies. Sorry, my system was being a little slow trying to let me on. I know I let you in and I was just watching being stubborn today a little bit. All right. Well, let’s jump right in just a couple of things from my end.
Naomi Denson (01:37) I know Melissa, you were going to meet with Jake last week. We had talked about the existing provider enrollments, you guys pulling the data and where it flows out of credstream but with the way things have shifted a little bit, you weren’t sure if that was still something we were going to be working towards, right? Is that still open on the table yep?
Melissa Butler (01:55) We don’t know right now?
Naomi Denson (01:59) Let’s see and then made a significant jump in the provider invites. So, 548 invites had gone out as of this morning and 126 providers had accepted the invitations on the credentialing and ongoing monitoring piece. Previously the npdb auto enrollment for the continuous queries you had requested that we turn off for now? Are you ready to turn that back on? Now that we started making credentialing requests?
Melissa Butler (02:26) Well, we are, but I want to make sure that everybody doesn’t get rerun because it, you know, for especially for npdb because we already did that, right? And they’re supposed to be good for a year?
Naomi Denson (02:42) Rerun like the… ones that were already in there that we ran, or the ones that you already ran?
Melissa Butler (02:49) Yeah. You guys ran them that’s kind of what?
Naomi Denson (02:53) Yeah. So, because we’ve already run them and rostered them through our authorized agent access. They run on a continuous query, but it’s only the one charge per provider per year. So they shouldn’t charge you again for those, it would just be any additional providers that were added after we disabled it.
Melissa Butler (03:11) Okay.
Naomi Denson (03:15) Oh, where did I just do? Perfect? And then just leaving this preclusions note here about the monthly list to share with our team for the monitoring piece. And then do… you see that we have, I think it was 40 requests that have been made for credentialing. The team is working on those. Looks like they’re waiting on some third party responses like for the education verification training, but hopefully you should start seeing some of those moving through to ready, yeah.
Melissa Butler (03:59) I want to go through those just because we haven’t had training on any of that yet, and I want to.
Naomi Denson (04:05) Follow along, yeah, but.
Melissa Butler (04:09) I am still trying to get connected from my PC. I’m still on my phone.
Naomi Denson (04:17) Let me see.
Naomi Denson (04:28) You’re gonna let me?
Naomi Denson (04:37) So, I hijacked as you. So it could be you’ve got it up on my screen here. I don’t know if you can see it because you’re on your phone?
Melissa Butler (04:44) Yeah, that’s my issue is I’m trying to be able to see some, it looks like it’s gonna let me connect.
Naomi Denson (04:55) Let’s hear it.
Naomi Denson (05:11) Are you there, Melissa? You’re muted if you did?
Melissa Butler (05:14) Get connected. Yeah. So I just went in here and was like kind of clicking to try to, you know, follow along. Huh. So.
Melissa Butler (05:28) It credential.
Naomi Denson (05:30) it’s the credentialing tab. So the credential is the full file?
Melissa Butler (05:35) Huh. And,
Naomi Denson (05:37) then, so this is where you can see the full file here. And then the PSB report hovering over this, you can see what’s been completed and verified and what’s still pending?
Melissa Butler (05:50) Okay. So, like if you look at like, I don’t know applications, the top thing that says it’s still pending like what’s still pending? Where are you? I’m gonna pull this up now.
Naomi Denson (06:05) Okay. Yeah. You sure.
Melissa Butler (06:21) is it sharing?
Naomi Denson (06:23) Not yet.
Melissa Butler (06:34) Okay. So, for the report… let’s go, let me go back to the credentialing request.
Melissa Butler (06:53) I think I’m there we go. Okay. So, where were you for where it was showing you the statuses?
Naomi Denson (07:03) Right there hovering over that. So.
Melissa Butler (07:06) You’re saying the ones with the checkmark are complete, yes. So, how do I follow along? So like this says verification is 111 days old, must be no greater than 90. So like,
Naomi Denson (07:17) so the team is going to pull a new verification to put for the credentialing file to meet the ncqa standards.
Melissa Butler (07:23) So, there’s no action, how do we know when action is needed from us?
Naomi Denson (07:27) There will be a task on it, and then if you push like there’ll… be a task created in the overview section, if there’s something needed from you or, you know, through you from the provider.
Melissa Butler (07:43) So, in the,
Naomi Denson (07:48) so, there’s no credentialing tasks as of yet.
Melissa Butler (07:50) Okay. The.
Naomi Denson (07:53) Team’s working through them. There’s none ready yet there?
Naomi Denson (08:02) But I did check in with our credentialing manager this morning and she did say the team is actively working on them now.
Melissa Butler (08:07) Okay. And,
Naomi Denson (08:09) so, as I’m hoping some of them should be moved over to that ready piece. Okay. Yeah, because yeah, just this morning that the CMS preclusions on these with showing is not started. And now they’re showing in progress. So, as soon as those come back and they pull them into the file… and then pending any like third party verifications like education or board certifications that we have to do outreach for.
Melissa Butler (08:40) And where are they in? Where do they pull those from? I guess, I just, I.
Naomi Denson (08:45) wouldn’t yeah. So, the credentialing?
Melissa Butler (08:47) Packet, we just don’t have anything to look at yet, I guess, yeah.
Naomi Denson (08:50) So, if you go back to the credentialing tab and open up the credential link where it says credential, it’s not going to be in the provider’s profile. It’s going to be in here. So you can see on the left hand column there, all of those separate tabs. Huh. This is like where all of the PSV documents and things will be listed. So it’ll show you the status when it was verified. And then it’ll have a screen print out of the verification.
Melissa Butler (09:14) Okay. And are they going to be looking for CVS like resumes in here?
Naomi Denson (09:21) As far as I know, CVS resumes are not part of ncqa guidelines, so.
Melissa Butler (09:29) What are they looking for? Is it caqh that they’re pulling their work history from?
Naomi Denson (09:34) They’re pulling it from the medallion profile. Okay? So when you, if you close out of this, you can see where it says app, completed that column second from last. Yeah. So when you create an initial credentialing request, what it’s doing, the system is scanning the provider’s profile for all of the requirements for the credentialing application. So once that is marked complete, it means everything that was in the provider’s profile is sufficient to complete the credentialing application. Meaning there’s no gaps explanations we have the correct timeframe of work history education and all of that in the provider’s profile. It does also pull in the caqh application to the credentialing packet. But all of the information that we’re looking for to move forward is from the provider’s profile?
Melissa Butler (10:29) Okay. If.
Naomi Denson (10:30) it’s not complete and there is anything missing, that app completed column will say, na, and then you would just hover over that na, and it would tell you exactly what is still missing to complete the profile or the application… working on that. All of them that I’ve seen so far have been complete. So there’s no issues that are holding up the files from like the applications from actually being complete and starting the work.
Melissa Butler (11:02) So, this one is pending CMS preclusions… an npdb yep.
Naomi Denson (11:13) So the team should be running the CMS preclusions through the streamline and the npdb, it ran the credentialing the query originally and then we turned it off. So now it’s saying that npdb is too old. So they would have to manually go and pull it in unless I enable the auto… verifications again and turn them back on like we discussed a few minutes ago.
Melissa Butler (11:36) Okay. How quickly does that happen?
Naomi Denson (11:39) I’m going to turn it on right now and then it should be automatic. Okay?
Melissa Butler (11:45) And then I wanted to look at because it looks like they have pretty much everything else for that file. So we should be able to see what you were talking about… because these are on day six. Okay?
Naomi Denson (12:04) Yeah. So let me turn it back on because I turned off all of the settings, let’s see.
Melissa Butler (12:10) So this is what they pulled in, right? Yes, the verification. All right?
Naomi Denson (12:27) Might take a second or two for it to register, but.
Naomi Denson (12:51) For the work?
Kkeever (12:51) History, I know you said it was from the medallion profile, but is there going to be like notes as to like, did they call? Like, is there a document that’s going to be attached? How they verified the employment?
Naomi Denson (13:04) Like are you guys? So we’re verifying. So the ncqa files verify that they have the information. It’s not outreach to the hospitals like a reference.
Melissa Butler (13:13) Yeah. So this is one of the things from mckellie. We were doing too much. It’s not required to verify employment directly as primary source. It just has to be on their resume or caqh. But because we’re pulling, I guess from caqh, they’re just able to use the medallion record. Okay?
Naomi Denson (13:35) So, essentially, with the credentialing, the medallion, the provider’s profile in medallion is their credentialing application. So that’s why we have them attest to the completeness and accuracy of their profiles before starting credentialing or being able to move forward with credentialing. And with the credentialing requests require that to be updated and maintained like for recredentialing or if the certain changes are made, which isn’t an issue here. But yeah, it’s pulling directly from the provider’s profile.
Melissa Butler (14:08) We’re going to go over this, but is this what the chair is going to look at?
Naomi Denson (14:15) So the summary will, so once it is ready, it’s going to move to that next tab on the ready tab. And then when you open this link up, there is going to be a button in the top left corner of the credentialing file to download it as a PDF.
Melissa Butler (14:29) Okay. So.
Naomi Denson (14:31) It can be done that way, but because the chair does have the committee access in the platform, they can look at it that way too. This is up to you and how you anticipate or expect them to review those, if you want to PDF print them and share them or I.
Melissa Butler (14:46) Do think we want to go ahead and move our training because if we’re going to have some to look at sooner, I’ll give dr beery more time than just the weekend to look at the ones that are ready. So when?
Naomi Denson (15:03) Is the committee meeting again the?
Melissa Butler (15:06) Thirteenth? Okay. And I think we set up, the ninth. So maybe if we can do.
Melissa Butler (15:19) I’m thinking by the second, some of these that were readied for you guys to start credentialing on the twentieth, we should have some of those done. Oh, yeah, yeah, for sure. So if we can, I don’t know if you want to change, I’m.
Naomi Denson (15:33) pretty open on you said the second, yeah.
Melissa Butler (15:37) Because we have a meeting, we can just do the same thing like just repurpose our meeting at 11 o’clock on the second. Oh, yeah, for sure. And then that way it gives me a full week to get with dr beery and show him and then him have more than just a weekend to look at the ones that are ready.
Naomi Denson (15:57) Yes, absolutely.
Naomi Denson (16:06) Okay. I updated that one for the second. So we will move the training up there absolutely. And if you have any questions, you know, if you start seeing them coming in ready before then, which they should be reach out to me, we can set up some async time just to jump on real quick and walk through it outside of the formal training just so, you know, if you see them and you have questions about it, please reach out to me.
Naomi Denson (16:35) We can jump on a quick call and just do a brief overview of, you know, the statuses and things like that as you start seeing them come through.
Melissa Butler (16:43) Sounds good.
Naomi Denson (16:45) And then wanted to just make sure we had time to discuss while Dreama’s here. Any of the PE stuff. I saw that medicaid email from… Kelly. I didn’t know if there was any other updates or questions around the PE. I do have.
Dreama Hembree (17:04) A question for Melissa and team. I want to make sure. I know it was previously mentioned that perhaps the PE stuff was on hold. So I’m not privy to what that status is, but I know there’s at least one provider right now Drew newt that has his lines on hold.
Dreama Hembree (17:23) I know he’s starting six one. Are those going to be medallion owned? Are you guys taking those? I just want to make sure that lines in there that need to be worked, get released. So we’re not, you know, each thinking one another is doing it. I.
Kkeever (17:38) Think that, Melissa, if it’s okay with you, we should just pull newt’s and do it ourselves.
Melissa Butler (17:46) I didn’t know nobody was working newt.
Dreama Hembree (17:50) Well, his start date is six one. So I know that, you know, at least the medicare line. Well, all of the lines there’s 11 lines on hold for him. So, I know with that coming up with the 60 day start with medicare, you know, I wanted to check with you to see what you wanted to do on that one.
Melissa Butler (18:05) I thought, yeah, so I thought for newt, you guys were processing. So the ones that are on hold were just because of the medicare and medicaid enrollments?
Dreama Hembree (18:17) Yeah. All of his lines were placed on hold, it looks like. And then there’s I looked at his particular this morning. So there might be a couple other providers that were stopped that I need to look at their start dates, but I just need to know who you want to handle or if you’re pulling them all back or what the status is of that because I want to make sure they get released to the team, if we’re working those.
Melissa Butler (18:47) Yeah. So, and if.
Dreama Hembree (18:48) you don’t know yet, then that’s okay. I just wanted to bring that up as a, something that we needed to discuss.
Melissa Butler (18:55) His, no, I’m looking at his, and it looks like so like medallion worked Aetna.
Melissa Butler (19:06) I think the other one, the other Aetna that was on hold was, I… don’t know if that needs to be cleared out or what, but we, I’m looking at it now, it says Aetna is medallion owned. One second. I’ll share my screen again.
Dreama Hembree (19:21) Yeah, I’m looking at it.
Kkeever (19:22) I think they processed Melissa all of the commercial payers that were ready to be enrolled for the lines that are being held, are all supplemental applications. So.
Dreama Hembree (19:32) They’re all medallion owned right now, but I just wanted to make sure that they were staying that way and if so, we need to get the ones that can be released, you know, for.
Melissa Butler (19:41) Those carriers. Yeah. But, I thought I didn’t know we needed to like I thought once the, there’s a medicare approval and a medicaid approval, like medallion picks up and works, yeah, if the,
Dreama Hembree (19:53) lines are dependent on another carrier, if there’s a dependency meaning like a managed medicaid, you know, et cetera. Then those will release once, you know, the state application is approved. But in general, like the other ones, I just wanted to make sure that we were still owning those.
Dreama Hembree (20:17) And if you, again, if you guys need to discuss internally that’s fine. I just wanted to make sure that was kind of a topic.
Melissa Butler (20:24) Yeah, I think being processed by medallion, I think that’s what the okay… other than.
Dreama Hembree (20:34) That I didn’t have any questions for you?
Melissa Butler (20:43) I just want to make sure that since you’re bringing it up that once these are ready to go, they’ll go.
Dreama Hembree (20:50) Yes, if they’re on hold for a dependency, you don’t have to do anything. It’ll clear the dependency. Once whatever that is, that’s holding that.
Naomi Denson (20:57) Lineup, yes, it’ll be, yeah, it’ll be linked to like the managed medicaid request would be linked to the medicaid state request. And then as a pending dependency, as soon as that state request, enrollment is marked as completed, it automatically flips the pending dependency status to dependencies met making it workable. So.
Melissa Butler (21:17) Because there’s duplicates in here, it’s a little confusing. So, like we do have… and I don’t want to make, I want to make sure nothing gets missed for him.
Dreama Hembree (21:36) Newt, yeah, I don’t know why there’s Naomi, maybe you can… because there’s lines on hold. There’s lines stopped, right? Yeah.
Naomi Denson (21:47) Because remember, they had been submitted too early. Yes. Melissa, you had asked me to stop all of them. And then they were resubmitted. Okay? So we’ll just look at the on hold there’s 11. So you can see these are on hold pending dependencies. And it’s pending medicare Florida, which looks like it was stopped. Let me see. Oh, my gosh. My email is going crazy. I don’t know if you guys can hear that dinging, but that was a lot of emails at one time. Let’s see why. Okay, it’s showing it’s linked to two requests. One request stopped. Okay. So it’s still linked to the stopped request. So let me, I can’t unlink that with this, but we can get them cleaned up. So they’re not linked to stopped requests anymore, but let’s see.
Naomi Denson (22:56) Okay. So what is the final question on these… six processing?
Naomi Denson (23:10) Yeah.
Melissa Butler (23:14) Are any of these that are on hold?
Melissa Butler (23:22) Like should not be on hold… blocked… you may.
Naomi Denson (23:46) It doesn’t look like it. It looks like they’re all still pending medicare.
Naomi Denson (23:57) Medicaid… or both because of the lines of business. So they look at the lines of business that were requested, and then the payer requirements on if they have medicare and medicaid as a prerequisite for the submission?
Melissa Butler (24:15) Okay. So.
Naomi Denson (24:16) This one government commercial, novanet… what about cigna? Cigna? Yeah.
Melissa Butler (24:28) Is it just a duplicate?
Naomi Denson (24:35) See the signals at the pair?
Melissa Butler (24:39) So, it’s that’s a duplicate. Yeah.
Naomi Denson (24:42) So, this one is request stopped. And then there’s one that’s okay in process. It’s already at the payer?
Melissa Butler (24:56) So out of, so there’s 49 because.
Naomi Denson (25:02) Because 29 of the original ones were stopped. Is there a way to just delete those out? No, they can’t be deleted out. Unfortunately, they just live in this stopped bucket. Okay. But you can filter so you could select all statuses and then just remove the request stopped.
Naomi Denson (25:30) So, now, you’re just seeing what’s left here?
Naomi Denson (25:40) That make sense. Yeah. Okay.
Melissa Butler (25:48) Yep. I just want to make sure that they… get processed as soon as possible.
Naomi Denson (25:56) Yes, ma’am… yeah, we’ve got some that are at the payor… and the others are pending medicare and, or medicaid… okay?
Naomi Denson (26:16) Okay. Anything else? Not from me? Okay. Well, we’ll continue to keep an eye on those credentialing files. If you have any questions that come up before we meet again on the second, reach out, let me know. We can find some time to jump on a call and walk through if you’d want to. And then we’ll do the full training next week sounds.
Melissa Butler (26:39) Good. Thank you.
Naomi Denson (26:40) Thank you. Have a good day, you.
Melissa Butler (26:42) Too, bye.