Transcript
Connor Morley (00:00) hey, Rae. Hi… how’s it going?
Rae Tompkins (00:07) It’s Friday?
Connor Morley (00:09) Whoa. Yeah. It’s finally Friday. Oh, I feel like every week’s been a week.
Rae Tompkins (00:16) Every week has been a week.
Jonas Eddy (00:20) Unmute. That would help.
Connor Morley (00:23) Hey, Jonas. Hey.
Jonas Eddy (00:24) Good morning. How are you?
Connor Morley (00:26) Good morning.
Jonas Eddy (00:28) Where’s my camera? All right? I’m a human being, not an eye. All right. Well, hey, so you kind of threw us for a loop there in your email. So I think that’s going to be topic number one. I’m waiting for Mary.
Connor Morley (00:51) Yeah, let’s get Hector and Nico on because I did. I was a little surprised as well that we started sending a lot more than what I thought for the prod test.
Connor Morley (01:08) At least that. Okay. It looks like we have everyone on. Is Hector here? I,
Jonas Eddy (01:15) don’t know. I don’t see him. I don’t know who user is, so that might be me. Who knows? I don’t know, you know, sometimes my little note taker thing joins unexpectedly.
Mary Saiz (01:30) Do we need maybe a real one if Hector can’t join?
Jonas Eddy (01:36) I… mean, I.
Mary Saiz (01:39) don’t know.
Jonas Eddy (01:42) I’m actually very surprised that Hector’s not here. Where is he? Let me check him… hey?
Mary Saiz (01:50) Connor, just while we’re waiting, I do want to bring up something that just came up obviously with those tests. We, already for the few that we sent there’s a few providers that I guess haven’t given permission for the caqh file to be, you know, reviewed, I guess they have to give permission. And, you know, Andros was doing that verification for us. They would follow up with the provider until they gave permission, we are being told, I guess that we have to do that. Once you’ve tried it, you know, once you just can’t get a hold of them or whatever we have to pursue… that from the provider, the permission.
Connor Morley (02:37) Yeah. And we’re specifically talking about if caqh action is required for the not… incomplete profile, but for the roster settings like, for instance, yeah, yeah, right. We’re talking about for the roster settings specifically. Well.
Jonas Eddy (02:57) I don’t know. So I think we need to walk through that because, yeah, it’s a bit of a surprise and I’m you know, I wasn’t on any of the conversations previously. So I don’t know what was said in terms of that process. Yeah. Okay. This is good. Yeah. Okay. So, I.
Connor Morley (03:19) want to kind of split a couple things up like if there is an outdated attestation or the caqh profile is incomplete, we are outreaching directly to the credentialing file or the credentialing in the caqh account. So, for this person?
Rae Tompkins (03:42) So, no actions required from the admins, this is going directly to the contact so they can fix it.
Mary Saiz (03:48) Got it. Good.
Jonas Eddy (03:49) Okay. That’s what we were expecting.
Mary Saiz (03:52) Exactly.
Connor Morley (03:53) Yeah. So, sorry, if I kind of confused things a little bit. So, if we can get access to their caqh, and then we find an issue, we can reach out to the provider to have them correct that issue. Okay?
Jonas Eddy (04:08) And that includes attestation, and that includes giving… you guys?
Mary Saiz (04:15) Permission?
Jonas Eddy (04:17) Permission to download their file or?
Connor Morley (04:19) So that’s where we run into an issue. So, if you see this roster setting error right here, this is where they have… a setting on their caqh profile that stops medallion or any payer from accessing their data in.
Jonas Eddy (04:38) Which case you don’t have a way to contact them?
Connor Morley (04:41) Correct. Got.
Jonas Eddy (04:42) It. Okay. Yeah. Okay. And Mary, this actually makes sense. And I think I’ve already figured out a way to deal with that, but, okay. What else?
Connor Morley (04:57) So, I’m just looking those.
Mary Saiz (04:59) The provider must complete all missing fields in caqh and.
Rae Tompkins (05:02) if you hover over that, Connor, that says one field with a little eye, it’ll give you direct visibility into what we’re outreaching for.
Jonas Eddy (05:12) Okay. So you’re outreaching, that’s the point.
Rae Tompkins (05:14) Yes, to the provider or the cred contact.
Jonas Eddy (05:17) Okay, good. Okay. That’s good. Wait a minute. What’s happening?
Connor Morley (05:24) I’m sorry about that. Sorry about the confusion there. No, no, no, that’s it’s only if we can’t connect to caqh, we have no one to reach out to totally.
Jonas Eddy (05:36) Understood. That’s it, that’s okay. And I see where we should be priming the organization ahead of time in any case for that. So that makes sense. Okay. Any other action that we haven’t talked about?
Mary Saiz (05:59) I guess in general, my question would be how many attempts would you do before you turn it back to us and say we give up?
Connor Morley (06:08) Yeah, Ray, I think the standard is three provider attempts and then we create like an admin task. So.
Rae Tompkins (06:16) For caqh outreach, it’ll continue to outreach until you tell us to stop. So it’s it, there’s not a cap on the caqh. So if we don’t get what we need from Amanda Nino, it’ll keep outreaching until you say this provider, you know, hasn’t given us the information, we can go ahead and stop attempting to outreach, but our system will continuously outreach until we get what we need or.
Niko Byron (06:41) Until the file gets archived because we’ve hit a certain deadline with its like agreed upon before the recredentialing deadline. If it is a recred. Okay?
Jonas Eddy (06:52) Well, yeah. So, you know, we’ve sent, a bunch of files as you saw, and sorry, Connor, if we surprised you, but surprise, it all looks like it’s working and, you know, this was the only thing there were some caqh items there. So, you know, we can easily look at that to see, where the roster setting error ones, right? Yeah. So we’ll look at those. So.
Connor Morley (07:21) There’s only, there was only one with a roster setting error. Okay? It looked like the rest, it was either incomplete. We’re missing the information or an outdated attestation.
Jonas Eddy (07:35) Okay. Excellent. All right. But as far as the rest of the files that we sent, everything seems to be fine, right? Yep.
Connor Morley (07:45) Everything else seems to be fine. I did just want to confirm a couple things on the credentialing packet with you Mary, just to confirm death master, we had our team look into and research that does not look like death master is required for any other payers outside of medicare and medicaid in the state of Florida, okay?
Mary Saiz (08:08) Well, I, our understanding medic, well with medicaid, they have to, AKA, when they apply for their medicaid id, AKA runs the death master. So we’ve only run into this situation with this requirement with a, when we had an exclusive medicare vantage plan which is subsequently sold. You know, we don’t have them any longer. They have a, you know, they were absorbed by another humongous company, but we are, as we mentioned, we’re looking at finalizing negotiations with a medicare advantage. So we’ll bring back that conversation or that additional monitoring package or whatever at the time that we ink that contract because it’s going to be for 20 27, but we have to do some work prior… you know, as far as credentialing some providers, we’re missing a few. So at that point, we’ll talk because right now we don’t our medicaid carriers do not ask us for that specific monitoring database. We usually find out differently. We, when a file is inactive in medicaid, PML, or other avenues, we find out, the provider has passed or, the group lets us know. And, you know, the audits that we’ve done with the medicaid providers, we’ve passed without the deafmaster monitoring. So, so… that’s where we’re at right now, we’re going to kind of keep it the way it is, okay?
Connor Morley (09:53) And that’s fine.
Mary Saiz (09:55) I did send you something this morning. I’m sorry, before I forget something this morning because, we did notify our carriers that we are working with you in addition to, you know, Andros, and… who sent them the agreement as you provided, the executor business agreement, a delegated business agreement. They want additional language and they don’t mind… it being in an addendum format amendment format. I need you to look at that because they’re asking us for that, okay?
Connor Morley (10:33) Yeah. I can let me pass this along and see if we can get it added in as an addendum.
Mary Saiz (10:40) And then obviously, there’s a language there about audits and we’re the ones that do the audits, not you guys, in other words, we’ll audit you once a year, but that section, you know, this is a statement that they have for all their delegated entities, right? So, so you have to take that with a grain of salt, right? So it talks about audit and all that the audits will perform BSN, and we, you know, provide it, we’ll ask you for your pmps and stuff like that, and then we’ll submit it to them. But so if that’s a section that you have an issue with, you know, just it’s okay. What we’ll do is we’ll add our language that we’re the ones responsible for the audits, you know, something for that effect? Okay?
Connor Morley (11:24) That sounds good. And we, if, whenever that audit comes up, just let us know and we’ll provide typically.
Mary Saiz (11:31) They have it in June. So it should be kind of soon, okay? All.
Connor Morley (11:35) Right. Good to know. So, for the credentialing packets, just a couple pieces, I wanted to clarify because we have some steps that we’ve put in already to put together the packets and I just want to clarify a couple things. So, for the cois that you’re looking for the providers, we are collecting that data, I just want to make sure I, we understand your minimums, it’ll look like on the vast majority of them that we’re looking at 1,000,000 for occurrence and 3,000,000 for aggregate. Yeah.
Mary Saiz (12:09) Yeah. Okay. But yeah, and it’s but it’s not necessarily a requirement in Florida, the doctor can opt out. So… you know, you ask for that. If they have it. Beautiful. If they don’t they have to let us know that they bought it out or a statement to that effect that they’re responsible because in Florida, you have to have some kind of an account if you don’t want to. If you don’t buy the insurance, you have to have an account that they backs up the, any kind of lawsuit and do.
Rae Tompkins (12:39) you want that statement on file? If they don’t hold the malpractice, would you like that to be captured?
Mary Saiz (12:47) Yeah. If we could? Yeah, definitely. Okay. So.
Rae Tompkins (12:51) We’ll we’ll outreach as normal. And then if the provider says they don’t have Florida malpractice, what we can do is put in our sop that we would require the practitioner to provide their statement of not holding malpractice that way, it’s on file for you so that you’re aware this provider doesn’t hold it. Okay, perfect. But we would just expect them to give us the form that’s signed. We wouldn’t outreach any additional, you know, to obtain signatures. We would just expect a provider to give us that, and then we can just add it to the file in place of malpractice. Okay?
Mary Saiz (13:24) Well, we’ll let our groups know yep. Okay. Perfect.
Connor Morley (13:30) I didn’t see any come in or in the delegated agreement, but are there any checks for like additional hospital affiliations or collaborative agreements that we should be looking for? We?
Mary Saiz (13:43) Didn’t talk about facilities. Did… we do have a bunch of facilities? I.
Jonas Eddy (13:53) mean, if they are, they do have hospital affiliations, yeah, we’d want to know.
Mary Saiz (13:58) that you’re talking about the provider, hospital affiliations. Yes, we would want it because we would need it, for… a medic for the medicare, the future medicare provider, a carrier that we’re going to. Okay? And either way, it’s good information to have to be honest for all our carriers. Okay? Sounds.
Connor Morley (14:23) Good for license verifications. Just, is it just active licenses or both active and expired licenses? No?
Mary Saiz (14:34) We would want the active them and, I don’t know if you… I don’t know what your policy is, but this is what happened with Andros. They switched on us and we didn’t know this, but we want the highest ranking behavioral health related license to be verified, meaning, you know, them, we have a lot of nurses that were, you know, psych nurses that now have become armps. And what we need to verify is the armp license. It’s a psych, you know, that’s the highest degree. I don’t know if you have that set up in your system? Yes. Jonas, I was.
Jonas Eddy (15:14) Just going to say, well, he’s asking, you know, do we want to know if it’s expired or not, right?
Mary Saiz (15:20) Which, no, no, no, I don’t that’s not what I understood, right? If it’s if, it’s a license, it’s expired for their current degree. Yeah, we want to know that, of course. But what do you mean? So essentially.
Connor Morley (15:35) Do you want us? Like if we get a provider that’s com that’s coming in, they have an active license right now, but in like Georgia… they have an expired license that’s been expired for a year. Do you care about the Georgia license? No, no. Okay. And then that.
Jonas Eddy (15:57) Makes sense. Yeah.
Connor Morley (16:03) For any kind sort of like Dea license, if there’s no Dea, should we collect and verify an alternate prescriber license? We want to confirm that we have it as a yes, but just want to confirm that an.
Mary Saiz (16:19) Alternate prescriber license. The only thing I’m aware of in Florida is the Dea. Yeah, license. So that would be the only one I would ask that to be looked at. And, you know, we have, we run into problems with credentialing when we, when… the other credentialing company flags.
Jonas Eddy (16:51) Mary, you cut out, I?
Rae Tompkins (16:54) Think she may have accidentally dropped from the call.
Connor Morley (16:56) Yeah, I don’t it.
Rae Tompkins (16:58) Was weird. A.
Connor Morley (16:58) Year. Poof.
Jonas Eddy (17:00) Gone. Okay. I think, I know what she was saying though, and hopefully she’ll come back and confirm it, but.
Mary Saiz (17:08) What?
Jonas Eddy (17:10) What we were encountering is all kinds of flags on stuff that was pretty irrelevant, right? Which meant that, you know, credentialing department. Sandra has to go through it and go. Okay. There’s a flag here’s. The reason it’s not really a big deal. It’s not required for Florida or something like that. So, you know, it’s not something we want to waste time on if it is not necessary for Florida. That’s probably what she’s getting at. Yeah, I think that’s what it was, but listen until Sandra go ahead. Yeah.
Sandra (17:48) Then I think that’s what she was getting at the Dea. And then also like the, no board certification?
Jonas Eddy (17:55) Yes, Mary’s saying the computer dropped her off the call. Okay? So let me ask if she’s coming back.
Connor Morley (18:08) And I’m sorry, what were you saying about the board certs? You only care about the active board certs or the ones only relevant for Florida?
Jonas Eddy (18:20) Right. So, in other words, board certification say for an MD is not required in Florida. So if they don’t have one, it doesn’t need to be a flag. You see what I mean? Yep. Yeah. So they have one. Yes, we want to know, but if they don’t we don’t need you to go, hey, alert. There’s a problem, right? Yeah, it’s just, it just wastes our time, your time, our time, right?
Rae Tompkins (18:46) And in regards to that too, I wanted to go back to the malpractice for a sec, just so I make sure I tell the team correctly, yeah, working with Florida providers previously, sometimes they would just like take a picture of their plaque in their office that says, I don’t have malpractice. Would you guys expect like a form signed? Or if we just get an email that states I don’t have malpractice? Is that sufficient enough? Or like what would you expect to be on file? Can.
Jonas Eddy (19:11) we get back to you on that one that’s a compliance thing and she’s not here so.
Rae Tompkins (19:17) Yeah, I just want to make sure we’re capturing what you guys want to capture, but I know it’s tricky because sometimes they’re like, well, I just don’t have it. So we want to make sure that we’re requesting the right document.
Jonas Eddy (19:29) Right. Well, I mean, I guess if they say they don’t have it, then they got to produce something, right?
Jonas Eddy (19:36) Something. I just not exactly sure what? Okay. Do you mind taking a note for that for Elise? Okay. And listen while we wait for Mary, and, you know, she needs to come back and talk about that again. Connor, I noticed when you were sharing that there were some files that had complete next to them. Are there complete files that?
Rae Tompkins (20:05) Just means the caqh import was complete. So now it moves to our credentialing request queue for our team to start the process.
Jonas Eddy (20:12) Got it. Because all everything I have says in progress. So I was like, wait.
Connor Morley (20:18) Yeah.
Jonas Eddy (20:19) We’re not getting a signal. We should be getting. Okay. We’re fine. All right. We’re good. Yeah. Sorry.
Connor Morley (20:24) They’re all in the state of processing right now. Okay? They’ve all been requested. It looks like March 20 fifth. So they have not been completed or moved to that ready status to be sent back to you for board approval. No.
Jonas Eddy (20:40) Problem. Just saw the green light and went… no worries. Yeah, I mean, I sent a message to Mary. I don’t know that she’s coming back because I have a feeling the computer is not being nice. Yeah, she didn’t respond to me. So, Sandra, did you have anything else?
Sandra (21:08) No. So just basically on the caqh, the only outreach that we have to do is when they don’t allow you guys access to their profile?
Connor Morley (21:17) Yes… and out of.
Sandra (21:20) Curiosity, if they, you know, you initially try to sign in and it doesn’t allow them, but then they do allow you before we do a new outreach, does it change in your system or you have to be notified that they’ve given… you access by us? Yeah.
Rae Tompkins (21:36) Once the update’s made our system will auto sync to catch up to the update and it’ll push it over to complete if it picks up on what was completed. Okay?
Jonas Eddy (21:44) So, there’s nothing that we don’t have to resend. No, perfect. Okay. I think we’re good there. Yes. Okay, perfect. And,
Connor Morley (21:54) Nico, that’s true for the setting, the roster setting on the caqh, right? Sorry, what’s the question? Again? So, if their roster setting doesn’t let us pull in the information and then they approve it to be sent to medallion. The auto sync still takes care of that as well. Yeah, it’ll resync every day until it’s successful. So, yeah.
Jonas Eddy (22:16) Successful. Okay… good.
Sandra (22:22) All right. Thanks.
Jonas Eddy (22:23) I can catch you up. Okay that.
Connor Morley (22:25) Sounds good. And then the other question. So I just want to make sure I have this correct for the board certs are not required in Florida. So you don’t want this to be flagged, if a provider does not have a board cert, correct?
Jonas Eddy (22:40) Right. Sandra.
Sandra (22:41) Right. Yes. Okay.
Rae Tompkins (22:43) Verified if they have it, but don’t hold a file if they don’t.
Jonas Eddy (22:46) correct. Right. Yes.
Connor Morley (22:48) Okay. There’s no kind of specific board certs that you do not care about. If they have a board cert period, verify it.
Jonas Eddy (23:06) I would say, yes… you know, yeah, I mean, there is no provider type that requires one. So obviously, we like to know because we transmit that information to the health plans because they put it on their directories, right? This is a board certified provider that’s great. So, if there is one, yeah, we’d want to verify that and transmit it that’s you know, that’s ideal. I don’t okay. See any reason where we would be trying to bend over backwards to make this happen. But obviously, where everyone is found, we would like to be able to save that and transmit it to the plan.
Rae Tompkins (23:51) Yeah. Yep. And that.
Connor Morley (23:53) Makes sense. And we can do that… last question. I just wanted to confirm as well. I know that you guys are working in Florida, but is there any chance that you’d be working in Georgia or any state bordering Florida? So.
Jonas Eddy (24:11) More to come, right? We are definitely planning on expanding into other states. I can’t tell you which ones yet. Okay?
Connor Morley (24:22) Nope, and that’s totally fine. But when you do, when that gets close to expanding into other states, maybe like four to two weeks out. Oh.
Jonas Eddy (24:34) God, it’s way sooner than, that we’d tell you… it’d give you way more time than two to four weeks. We probably know like a year in advance… perfect.
Connor Morley (24:49) Okay. Yeah. Just make sure you let us know so we can update our sops.
Jonas Eddy (24:55) 100 percent, you’ll have more than enough time. We’ll know.
Connor Morley (25:00) Okay. Yeah.
Jonas Eddy (25:01) I mean, onboarding a plan, we usually know, you know, a year in advance… perfect. And that’s just a plan. So going into another state, you know, yeah, we will let you know in advance. Thank you. All right.
Connor Morley (25:19) I did want to check in. You all have access to prod, have you had any issues getting into the production environment?
Jonas Eddy (25:28) I haven’t,, no, no, yeah. Okay. Yeah. All right. Yeah. So far. So good. This is great. You know, very happy about that. Even though you scared the pants off us with that email, Connor… I’m sorry.
Connor Morley (25:46) I’m sorry about that. That’s my bad because, yeah… I was, I thought I looked at it. I was like these are all really quickly. I was like these are all rostering issues and I was like we need to update these. We can’t reach out to them.
Jonas Eddy (26:06) Yeah. I got you. No worries. It’s all good. We’re happy.
Connor Morley (26:10) Okay. Ray, did you have any other credentialing questions?
Rae Tompkins (26:15) No, I’ll just wait to hear from the BSN team on regards to what we should do with the insurance. If an email is sufficient, there should be a form and then we can circle back with the team to make sure that we’re okay, following that step and I’ll let them know about the boards verified if it’s there, but don’t hold a file if it’s not, and if we run into any issues, I’ll definitely reach back out. Fantastic. Okay.
Connor Morley (26:43) I think we’re all set then.
Jonas Eddy (26:44) Yes. Awesome. Well, thank you guys. And I guess we’re still going to have next week meeting. Yep.
Connor Morley (26:53) We’ll still have next week’s meeting once we, you.
Rae Tompkins (26:58) Know, open.
Connor Morley (26:59) Up the floodgates a little bit more then we’re officially live.
Jonas Eddy (27:03) Oh, well, I guess that brings me to the next point then, which is, shall we send more or do you want us to hold off a bit?
Connor Morley (27:15) I think we can hold off a little bit. I’d like to send more potentially next week. I think.
Rae Tompkins (27:22) That just gives our team an opportunity to process the files, see if anything is, you know, strange coming up, give you an opportunity to review completed files. That way we can make sure there’s no issues, and then we can start.
Jonas Eddy (27:34) Okay. So, what’s your timeframe for that approximately? I mean, I think.
Rae Tompkins (27:40) What Connor said a week or so, but I can double check with the team to see when they expect files to be starting to move to complete, and I can kind of give you an update just so you have a chance to review a fully complete file.
Jonas Eddy (27:52) I got you. All right. Well, just for your fyi, and I completely appreciate where you’re coming from, you know, please appreciate that. We’re in like kind of panic mode about getting things moved and get credentialed because there’s a bunch that have been sitting there like a little too long.
Rae Tompkins (28:10) Okay. Yeah, appreciate.
Jonas Eddy (28:12) That. Yeah.
Rae Tompkins (28:13) I’ll definitely get an update from the team and I can circle back. I just want an opportunity for you guys to see a full file. That way if something looks totally off, yes, yep.
Jonas Eddy (28:21) I get it. Absolutely. All right. Well, we’ll keep us posted. Okay? Will do.
Connor Morley (28:28) Thank you all.
Jonas Eddy (28:30) Right guys. Thank you so much. Have a good week. Bye. Have a great weekend.
Connor Morley (28:33) You too. Thank you. Bye now.