Transcript
Peter Bosworth (00:00) hi, merit. Sorry. How are you?
Merritt Miller (00:02) Oh, I’m good. I’m really happy. It’s Friday.
Peter Bosworth (00:05) Me too. This has been a very dense week.
Merritt Miller (00:09) Oh, no. Every channel I click into, I’m just like,
Peter Bosworth (00:12) what is that? There are like several times a week where I wonder how you do what you do?
Merritt Miller (00:20) No, no, I, I’m just ready to have the weekend. You must be like, I was just eating something and I realized what time it was to myself.
Peter Bosworth (00:32) Yeah, I… know. Sorry, I.
Collette Waddell (00:35) Realized I just had to, I was talking to Mike and I have to call him back after this, but I realized you probably didn’t have access to the waiting room.
Peter Bosworth (00:46) Oh, no sweat. And.
Collette Waddell (00:48) then I was trying to edit it, but then, because it already started like, it wouldn’t because I was going to add you guys as co hosts, but I didn’t anyways, Alex is here.
Alexander Olmetti (01:12) Hi, Alex. Hey, afternoon.
Collette Waddell (01:16) How are you doing? Happy Friday?
Alexander Olmetti (01:19) Happy Friday. We, made it how y’all, doing… very good doing.
Peter Bosworth (01:24) Well,
Collette Waddell (01:25) I’m ready for the weekend?
Alexander Olmetti (01:27) Any big plans… March madness?
Merritt Miller (01:34) Just.
Alexander Olmetti (01:35) in the power stash, where, what’s the new, what’s the new location?
Peter Bosworth (01:40) The new location, of me, yeah.
Alexander Olmetti (01:43) Where are you going to, where are you going to showcase the power stash now? What’s the new spot?
Peter Bosworth (01:46) It’s a great question. One we’re still deliberating on. I don’t know somewhere behind in front of a TV watching March madness though. Oh, nice. Very cool. What about you?
Alexander Olmetti (02:01) Probably just going to lay low. I was in Costa Rica for vacation last week, which was nice. So probably, and still just catching up, with emails. So, it’s been a crazy week, but well, worth, the relaxing time. Nice. Sounds fun. Yeah. Is… Jim, I, are we still waiting on him? No, I can ping him. Let’s see. We’ll make sure. Okay… let’s see. I know he’s been having connectivity issues.
Collette Waddell (02:40) Let’s see.
Alexander Olmetti (02:50) Just pinged him, so he’s aware he might be running late for another call.
Alexander Olmetti (02:59) Maybe just give it another minute if that’s okay?
Alexander Olmetti (03:40) We can maybe get started. I haven’t heard from him. He might be just meeting with one of our credentialing specialists right now. And then we can kind of catch him up as he comes in, if that’s okay with y’all,
Collette Waddell (03:52) yeah, absolutely. Alex, have you? Let me just, do, hang on. I think he’s here.
Collette Waddell (04:13) Jim.
Merritt Miller (04:19) Hi, everyone.
Collette Waddell (04:23) How are you? Hi, good. How are you doing?
Merritt Miller (04:26) I’m doing well. Thanks good.
Peter Bosworth (04:29) Sorry, I’m a little,
Merritt Miller (04:30) late I.
Collette Waddell (04:32) know you were just fine. We were just, I wasn’t certain if you all have met merit before our director of operations. Merit, this is Alex and Jim, and then with us is Callie as well, who’s also from the credentialing management team. And they’re really, your subject matter experts here for this conversation. But, and I have just a disclaimer, I have also been dropped from a few of my calls today because my internet keeps or something keeps happening. So I may go off camera just because it just to have a little bit more stability there.
Collette Waddell (05:16) Hang on merit. I don’t have, and I know we were looking at those questions. Apologies, I… don’t have it ready for this call so I can pull that up unless somebody else might have that open.
Merritt Miller (05:33) Let me see. I’ve got, I think the agenda you linked on this meeting. Do you just want me to share this Collette? Would that be helpful?
Collette Waddell (05:41) If you don’t mind?
Merritt Miller (05:45) It’s not well, really nice to meet you guys. Yeah, I oversee credentialing licensing and privileging here, and I work with kind of Collette and Peter more on the background and I wanted to bring Callie on our side who oversees credentialing quality and processes, just to kind of see how some of these customer facing calls go. But we’re just here to help answer some of the questions you guys asked. Let me see. Can you see the screen? Okay?
Alexander Olmetti (06:11) Yep. Perfect. Nice to meet y’all, yeah.
Merritt Miller (06:15) Yeah, really nice to meet you guys. I, I’ll just dig right into these two questions. And if anything, if you guys have anything else that you want to chat through, happy to go through it.
Merritt Miller (06:23) So, the first question I think was around locum, tenants providers around how you guys are working with them and wanted to understand if you should be credentialing them or not. And so, I believe I pulled from the standard, just trying to understand how you were working with them and just wanted to see if you had any other questions for us around locum tenants… just.
Alexander Olmetti (06:43) For us, I mean, we have to, you know, whenever we get a notification from HR, one of our locations that needs a locum, you know, we will inform our malpractice carrier, but from there, because they’re substituting for an established provider who’s out on vacation or what have you, and they will just be, you know, when the claims go out the door, they’re billing under that provider’s name. They use the appropriate modifier, we’re not doing any credentialing for those providers at all whatsoever. But then when, you know, Jim did a really like when he was doing his review on it, he brought up a really good point. Like now, it looks like the ncqa standards have changed around this. Do we just want to maybe work ahead of it or play it safe by saying, if we ever get a locums that comes in, it’s onboarded for a limited period of time even if it’s less than 60 days? Do we just go ahead and submit that credentialing request to medallion? And just get that reviewed? Yeah.
Merritt Miller (07:40) That would be my recommendation is to go ahead and have us credential them. And if there’s anything we can help work out with the workflow, just let us know. But I would definitely recommend that they did change that last year.
Jim Robson (07:51) Yeah. Does it matter how long there’s times when we have locums like cover for just a few days. Does that matter?
Merritt Miller (08:02) Ncqa is pretty silent on that. You might want to check with your compliance team. I don’t I guess I’ll say this like I don’t know how ncqa would know that or not. They’re just probably going to look for your roster. And the guideline is if they’re doing locums for you to do it, but it doesn’t get into like that kind of specific details.
Jim Robson (08:19) Thank you.
Collette Waddell (08:20) Now, and I will say, it would be up to your organization. I have had previous experience with organizations, credentialing locum providers.
Jim Robson (08:33) Some credential.
Collette Waddell (08:35) Them, and they are, you know, only credentialed for the dates of coverage, you know, for that assignment. Whereas I’ve seen others where it was in their own organizational policies, where they essentially would keep them like active in the credentialing platform. Should they come back, you know, and need to provide coverage. Again. So that way they didn’t have to re credential them. It was almost like they were just categorized in a certain way, but I think, that would be, you know, you all would determine, you know, if you wanted to push them through and then immediately deactivate them in the platform, you know, or leave them and.
Jim Robson (09:17) I understand this is provisionally credentialed. So the elements are less for a locum, is that correct?
Merritt Miller (09:26) Yes, we don’t have any customers who really call upon the provisional portion of it. So that’s something which I assume you’ll want to do. We’ll just kind of need to work through how that would flow through our system, but we’re happy to support that because that is what it says.
Jim Robson (09:42) One of the things is the amount of time that we get is usually not great. So I just want to make sure that whatever our policies state we can meet that given the really quick turnaround times that locums sometimes have with us.
Merritt Miller (10:04) Yep. Absolutely. What do you get? Because I think the biggest hurdle I see like the process side Callie and I can figure out for provisional credentialing. It would just be like excluding the verifications that aren’t needed would, do you get enough of, their information so that we have what we need to run credentialing? Like did they submit an application to you that you can put into medallion?
Jim Robson (10:25) I mean we’re going to have to like shift to that. And that’s what we need to determine exactly what elements we need. Does it make more sense? Is it not that much different between the two to just get the whole thing? Do we try to get their caqh information? So all of that is what we’re going to have to develop before we reach out to blue cross blue shield again to make sure that what we do is feasible in terms of the turnaround time with medallion?
Merritt Miller (11:03) Okay. Well, Callie and I will start kind of scoping out how we would do this on our side. If you’ll just keep us updated on, you know, anything you all need from us or how we can partner on this if we want to like test one. Once you have one, we are happy to go through those iterations.
Jim Robson (11:18) That sounds great. Thank you. Great.
Merritt Miller (11:24) Okay. Anything else on locums or good to go on that question. We’ll just follow up with you guys on that.
Alexander Olmetti (11:32) No, it was very helpful. Thank you. Of course.
Merritt Miller (11:35) Next was on the credentialing information, integrity audit analysis tool. And just if you guys need to do it if we do it, and I’ll just kind of voice over my response there. So we do this and distribute it to all of our customers doing credentialing with us. I’ve seen a mixed bag where some payers will just kind of take our audit and be like check good to go. And then we’ve had a few sticklers that need our customers to also do a cii audit on the items we’re not delegated for such as credentialing decisions and committee meeting dates. We can help you put the template together. It’s because the data is stored in medallion. The approach to the audit is the same but I’ve just seen a little bit of both ways for what they’ll ask for, but we have our audit that we can give you guys.
Jim Robson (12:22) Awesome. I did get the audit tool. It was different than what I’m used to because the choices were like zero or na, and I just didn’t quite understand when I was doing audits before. In my former life, it was very much based on attestation dates. And are we hitting all of these elements and during dates to make sure that they match up? So that’s the kind of audit I’m used to conducting. And I didn’t know if best practice we did a little bit of auditing on what we’re getting from medallion. And that’s just something obviously internally we’ll have to develop. But the CI tool was very new to me. So I was just wondering like, yeah, yeah.
Merritt Miller (13:17) They really rocked the industry last year and they rolled that out from the systems control audit. So we have like a policy on it. We’ve got the audit we can give you. And then we have sometimes they ask for like medallion’s training on that. So we can share any of that with you when you need it. And then you’ll of course want to audit us as your sub delegate, but we can see what happens with the CI audit. And if they end up needing more from you, we can go from there. Great. Perfect. Well, anything, I think those were the main questions. I think maybe one more was asking for the updated certifications.
Alexander Olmetti (13:52) Correct the.
Jim Robson (13:54) Ones, yeah, the ones we have as are expired… in 20 24. I know you have updated ones. So, yeah, if we, just in case we’re asked for those?
Peter Bosworth (14:09) Yeah. Did we not? I thought we sent the new ones and it says like issued on 20 24 and then it says expired on 20 26, I just wanted to make sure there wasn’t confusion on those two, but maybe you do have the old ones and in which case, we can send you the new ones. Sorry, I’m not sure where that ended up in terms of the emails. Yeah.
Jim Robson (14:34) The certificates that I show have an expiration date of 20 24. OK?
Peter Bosworth (14:41) That’s really that’s easy for us.
Jim Robson (14:43) To send… and it just may be overkill because, you know, when we get audited or when blue cross reaches out, you’re just going to provide those. So, I don’t know that I really need them because, you know, this will be our first audit.
Merritt Miller (15:01) So, yeah.
Jim Robson (15:02) If you’re like, you know, they’re going to just ask us for it, but if you want them, you can have them. Yeah, I.
Peter Bosworth (15:09) just have them right here. So I’ll just send them.
Merritt Miller (15:12) Yeah, yeah.
Collette Waddell (15:14) It looks like we may have sent them on November 12.
Jim Robson (15:19) And I’m sure that, yeah, thank you for sending those. Thank you. Sorry that I missed them.
Collette Waddell (15:27) Oh, no, that’s OK.
Alexander Olmetti (15:29) Well,
Collette Waddell (15:30) I went back and I was just making sure I attached the right ones.
Jim Robson (15:34) Oh, I’m sure you did.
Collette Waddell (15:37) I’ll.
Jim Robson (15:37) just make sure they get updated in our little folder.
Alexander Olmetti (15:41) And merit, I apologize. We were talking about the audit tool that Jim mentioned, how it had changed in terms of like the fields and descriptions you said you had like a resource that we could use that tells you what the fields mean and how they’re filled out. Is that what you mentioned that you would send us?
Merritt Miller (15:56) No, it’s a training where like you are required to have a policy on it, conduct the audit and then train your staff on information integrity. So, sometimes payers will ask for like your subdelegates evidence of that training. So we have that if you need it.
Alexander Olmetti (16:10) OK. Yeah. And yeah, I mean, this will be our first. We appreciate it. As Jim said, like we appreciate all the help. This is just, we’re just trying to make sure we’re dotting the I’s and crossing the T’s before we go into our first initial run with blue cross. They’re our biggest payer across our practices and service areas. I think maybe Colette, I could be wrong, but you’d mentioned that you all do have a client that is either ongoing or going through the process with blue cross of North Carolina or maybe just concluded.
Collette Waddell (16:40) I think they’re like on the same trajectory timeline as you are. They’re not there yet, but I just, I remember seeing… blue cross, blue shield of North Carolina and they’re working for, towards a couple and I just know that that’s one of them but, they’re… not there yet. Yeah, they’re still working on other things for them and.
Alexander Olmetti (17:06) you think roughly, they’re taking the same, I would say due diligence steps as we’re doing. I.
Collette Waddell (17:11) Think so. That’s kind of what I’m starting to, you know, when I’m getting inquiries similarly. Yeah, I think they’re still working through that.
Alexander Olmetti (17:19) Cool. Okay, perfect. Yep. It’s just, yeah, Jim and I, we’re kind of a lean and mean shop here at avance. So we’re just, you know, we’re trying to make sure we’re dividing out the time accordingly, but, you know, obviously, you know, ensuring that we have the right, you know, time and amount folks that are on it and making sure that we’re pushing this through as expeditiously as we can. So, but we want to do it, right? So, yeah, yeah, if you, as we move forward, we’ll one of the big things too is just in with locum. It’s a great point. We do need to develop a wider policy or refinement of our current policy with avance. Because sometimes Jim and I will get a request for locums and it’s a very informal ask and we have to essentially back it out, have it formally put through a support ticket process, ensure that we’re getting all the information we need and then keeping our malpractice carrier informed as well. So this is something that we will, once we iron that out from a credentialing perspective, we will put those elements in a refined document that then our ops teams, medical and legal can then just sign off on. So there’s a lot of good that comes out of this too, you know, from a holistic lens is that this will benefit our organization from a wider perspective as well. So this is a positive. So I love it. Great.
Merritt Miller (18:41) Well, yeah, we’re looking forward to building that out too. We knew about this a year ago, just haven’t, had anyone with locums to kind of let us test out some provisional credentialing, but we’ve got the bones to do it. So we will kind of Callie and I will take figuring out a process on our side. And when you guys have your policies or draft, if there’s anything we can look over, just let us know.
Alexander Olmetti (19:00) Yeah. And Jim, thanks for catching that man because that was a huge wrinkle that makes you kind of pause and think what changed? Yeah. And how can we cater to it with the new process? So it was very instrumental and thank you, merit. Yeah.
Collette Waddell (19:16) Appreciate everybody. Is there anything else that we can help with for these last few minutes?
Alexander Olmetti (19:24) No, you know, this is great from like, you know, just keeping us honest on how we’re interpreting these things. Yeah, you know, we want to go into it appropriately and blue cross has been very amenable to working with us. I know they have like very strict standards on the number of providers that they want credentialed. They want to look at recredentialing files. We don’t have those, but, you know, we’ve kind of explained that to them that this is our first foray into it so to speak, and they were right. They’re ready to work with us. So, you know, we just that’s awesome. Yeah, we want to make sure we’re ready to go.
Collette Waddell (19:56) Button up all the things yep.
Alexander Olmetti (19:59) Exactly. Awesome. Yeah.
Jim Robson (20:01) All right. So, our next step will be Alex sending them the initial, all the information that they’re asking for. And so we’re just wanting to make sure that all our, like Alex said, I’s are dotted and T’s are crossed.
Collette Waddell (20:16) Absolutely. We’ll continue to bring, you know, to myself, Peter, and we’ll pull merit and Callie in, you know, as we move forward. And as you kind of formalize all of those things.
Alexander Olmetti (20:30) And Boz will keep rocking the power stash until we are able to get a delegated agreement in place that’s our good luck charm. So.
Jim Robson (20:40) Yeah, no raisers coming this.
Alexander Olmetti (20:43) Way. All right. Very cool. Are you guys in the duke part of North Carolina or in the not?
Jim Robson (20:51) Duke part or the chapel hill? We’re located right in Durham. So, yeah, right in the heart of duke. Yep. Oh, wow. Okay. I.
Merritt Miller (21:02) Didn’t realize that I just moved from Charlotte down to charleston. So, I’m fairly same region as you all.
Alexander Olmetti (21:09) Very cool. Awesome. Nice. I love charleston. It’s beautiful. Yeah.
Merritt Miller (21:15) It’s hot, but it’s great. Good place. Well, so, nice meeting you guys.
Jim Robson (21:22) Likewise. Thank.
Collette Waddell (21:23) you everybody for your time. Have a great weekend have.
Alexander Olmetti (21:28) A great weekend. Bye.
Collette Waddell (21:29) Thank you.