Transcript
Naomi Denson (00:00) morning. Hi, Melissa.
Naomi Denson (00:10) Hi, good morning. How are you? Good. How are you? Doing good? It’s almost Friday. All right. So pretty much same agenda as last week. Just want to check in if we have any updates from baptist on their data.
Melissa Mendez (00:26) No, I sent them an email a couple of days ago… just as Teresa had sent me like the list of providers that worked at each location. So, I put it on her template for her and asked her like please review and, you know, fill out the rest of the information. So, yeah.
Naomi Denson (00:48) All right. Anything. Any new updates from southwest or priority healthcare on moving forward? I know they’ve gotten kind of quiet.
Melissa Mendez (00:56) Yeah. I actually got an email yesterday from southwest and they said that they are ready to send out the communication to their providers and just to give them like that heads up that invitation from medallion is coming. So, I haven’t checked medallion this morning to see if they had sent out the invitations yet. But sounds like they’re getting ready to do that soon. So that’s good.
Naomi Denson (01:21) Perfect. And the two, three new centers that you were working on a sub license agreement for to start bringing in any update on who those are, if we are going to be getting templates… from them. Yeah.
Melissa Mendez (01:37) I haven’t heard any updates from Andy on that, okay?
Naomi Denson (01:40) Just a reminder. I’m not even sharing my screen, just a reminder. We have that tracking sheet that I linked in here for you. When you do find out who they are, you’ll just add them to that sheet so that I know who they are and I can start building their platform. Okay? And then any movement on building the lpca committees?
Melissa Mendez (02:05) Andy keeps saying that the executive director now understands the importance of it, but I don’t think there’s been real movement. Yeah. Okay. Perfect.
Naomi Denson (02:19) So, the only other thing I wanted to follow up on was for baptist, I sent an email on Monday about their policies and procedures. Did you see that? Yes, and not a majority of what they have listed, we wouldn’t do as part of ncqa? Yeah.
Melissa Mendez (02:38) And I did forward that information to them. They haven’t responded. So, I’m not sure. I was curious if you’ve seen like with other clients or the other health center network. Like I don’t know. I’m trying to think of like maybe some resource that I can build so that they can understand like what the ncqa requirements will be done by medallion. And then like hrsa requirements or joint commission requirements or, you know, like anything else will need to continue? Yeah, like I don’t know if you’ve seen any.
Naomi Denson (03:17) Yeah, I think we have something.
Melissa Mendez (03:22) Let.
Naomi Denson (03:23) me check with our credentialing director, because like we could send like a… sample packet of an ncqa packet so they could see what all a standard ncqa file includes or see if she has some sort of outline. I think it’s.
Naomi Denson (03:54) yeah, I don’t know. Yeah, let me, I’ll reach out to her. Okay?
Naomi Denson (04:14) Yeah, I’ll get the outline or send you a sample packet just like a dummy packet, so they can see everything, all the PSPS and things that are included in there, and then determine what they would still need to be responsible for.
Melissa Mendez (04:28) Okay, perfect. Yeah, that’d be helpful.
Naomi Denson (04:31) Okay. Perfect. Any other questions for me? Any? I know you haven’t gotten anything else from them?
Melissa Mendez (04:39) Yeah, I haven’t gotten anything else, but I guess, I… was wondering if you could help me think through like the, how the baptist committees would be set up because so, I know that they have like their CMO does an initial review and then either the CMO or the CEO will issue a recommendation and then that recommendation gets sent to the board or a board designee. So, does that mean we would have the CMO and the CEO and the board designee as voters in medallion. And yeah.
Naomi Denson (05:19) Yeah. So previously… like in the beginning of this implementation, there was like a standard process. I explained the committee structures to you recently. They’ve made some enhancements to our committee, so we can do multi step workflow committees, so we could set it up with the CMO. You said, how does it go CMO to CEO or medical director to CMO?
Melissa Mendez (05:42) So, it looks like the CMO does the full like a review of the full file and then either the CMO or the CEO will issue a recommendation, but I mean, the CMO always has to do that review. So.
Naomi Denson (05:57) Yeah. So what, we can do like a three step flow. All of the members that need to vote would be, need access to medallion as admins to vote in the platform obviously. And then we could set up the workflow. So it’s a three step flow CMO, and then CEO or CMO as approval. And then you as a credentialing administrator could go in or whoever if they designate other credentialing administrators could go in and say CMO voted on this, they push it through. Both the CMO and the CEO are in the second step of the committee. But if one of them votes, you do have the ability to skip a vote or the CMO would just log his vote again to capture that flow. And then it would push to the group of the board members all in one committee and they would all vote. And then if you have like five people in that board and you only need a majority and three of them have voted and two have not, you could skip votes to push it to a closed file. Is my understanding, I’m still kind of learning that it’s very new but I have learned how to set it up and that is my understanding of it. So we can set up a multi step flow for files that need it.
Melissa Mendez (07:09) Okay. Let’s say that committee or sorry, the board is five people. That doesn’t mean the five board members would need a login, correct? It means that a board.
Naomi Denson (07:21) Doesn’t need for them to be in the committee in the platform, they would need a login. So if they are providers under baptist too, they would just have a practice provider and admin role, meaning we would give them the credentialing committee member access. They would still have their provider profile and then they don’t get the full view of everything. They just have that committee member access so that they can see the files as they come through and are assigned to their committee to vote on. Okay?
Melissa Mendez (07:52) I guess I, and maybe it’s because things have changed but I thought we had talked about like an admin would go in and log the votes.
Naomi Denson (08:03) And say, like, yeah, and they can. So with ncqa, they can. So typically, it’s like a medical director or CMO that would go in and review any clean files that aren’t going to the full committee. And then an admin can log the votes as a credentialing committee member, who would build their own committee for them for like need detention files that are going to a full committee review. There are minutes being taken, there’s votes being taken and, you know, documented. And then you can come back and log the result one time to close out the ncqa file. But because of the baptist credentialing policies and procedures looking like they’re tjc to… remain. Since… we’re not doing the entire file, it probably doesn’t matter because they’re just going to pull the file out like… pull the file out, add their additional stuff to it and then take it to a full committee meeting that they’re maintaining internally and not necessarily from medallion. So, I guess we don’t really have to have the full internal flow as long as an admin is closing out the files internally when they voted. Okay. And then since they’re doing that for their purposes now and not for lpca’s purposes, those providers would have to go back through credentialing later on if we were going to include them in like delegated agreements and track their ncqa credentialing under lpca. Does that make sense?
Melissa Mendez (09:28) Right. Yeah. Since.
Naomi Denson (09:31) We’re not following your policies and procedures for this one off, we’re following theirs when you start moving into getting your delegated agreements and such, you want them to be compliant and credentialed under lpca and not, right?
Melissa Mendez (09:44) Them. Okay. That makes sense for audit purposes. Of course, I think we had previously talked about there being like a clean files committee and a needs attention committee, but is that still the case or is it just following our multi step process now? And,
Naomi Denson (10:04) like you can have as many committees set up as you want. There’s no limit to they can be structured and built. However you guys deem necessary as it’s outlined in your policies and procedures. So as long as it states in your policies and procedures that a credentialing manager or administrator can vote on certain types of files that meet those requirements, then you can vote on them. If it says that they have to, every file has to go through a full committee vote. And then the medical director or whoever has the final decision, then they have to log the vote for audit purposes. Okay? So I would just make sure that there’s some point in your policies and procedures that state that a credentialing manager or supervisor, somebody that is not a medical professional or a medical chair or director CMO can vote on the files… to approve them after the… meetings. Then this should be fine. Okay. And remind me, are you working with a consultant, an ncqa consultant or like anyone outside? Okay? Just wanted to make sure. Yeah.
Naomi Denson (11:30) So we can set up as many committees structures formats. You can name them whatever you want. Just you guys tell me and I build it how you want it to be set up. Those needs attention and clear committees are just examples of what I most commonly see for the ncqa files to keep them separate. So all of the clean files would go straight to the medical director, they review them and approve them. If they are not going to go to the full committee meetings… and then needs attention, files can be reviewed by a credentialing administrator, determined if they meet your requirements. So say they’re flagged as needs attention on the credentialing file for something coming up on their npdb. But it was 20 years ago. But your policies state that you only care about anything in the last 10 years. So then you could look at that and say this was 20 years ago. They’re fine. We’re going to push them through as a clean file to the clean committee. They don’t need to go to this full meeting. Does that make sense? Yeah.
Melissa Mendez (12:26) Okay. So.
Naomi Denson (12:28) We’re going to flag them. We can’t set the limitations specific to your policies internally. We’re going to flag anything and everything that we find and then you look at that and determine, hey, no, we’re fine with this. We can push this through. Got it. Okay. It’s still, it’s not going to change the status of the file in medallion, but you guys can determine… what you want to do with it. Okay?
Melissa Mendez (12:57) Okay. I think that’s making sense. Okay?
Naomi Denson (13:03) Yeah, if you want to soak it all in, reach out if you have any other questions or if you want me to re, explain it and write it, I can, I,
Melissa Mendez (13:11) appreciate that. Yeah. Okay.
Naomi Denson (13:13) I’ll send the recording and everything out as well so that you can re, listen to it and make sure that I didn’t confuse you. Okay?
Melissa Mendez (13:24) Sounds good. Anything else? No, I don’t think so. Okay?
Naomi Denson (13:31) If you hear anything from Teresa, please let me know and… we’ll work on getting that imported once she’s confirmed and approved everything, I think she’s trying to do as little as possible. Yeah, she’s like here it is, do with it what you want. I know you’re like, no, I.
Melissa Mendez (13:50) need a little more.
Naomi Denson (13:52) Yeah, yeah. I remember that from the very beginning and she would just send it in random format and we were like, what is this?
Melissa Mendez (13:59) Yeah, yeah. I don’t know why… it.
Naomi Denson (14:03) Happens. I don’t know it happens, but yeah, just let me know if anything comes out of that. And then if you hear anything about that PJC, like their requirements, and I’ll try to check with our credentialing team to find out if we can get like an outline.
Melissa Mendez (14:17) Okay, awesome. Thank you.
Naomi Denson (14:19) No problem. You guys have a good day. Have a good weekend.
Melissa Mendez (14:22) Thanks, you too. Bye.