Transcript
Naomi Denson (00:00) bye, Karen. Bye… Brittany is here.
Naomi Denson (00:09) Okay. Bye Brittany.
Brittany’s IPhone (00:17) Hey, good afternoon. How are you? Doing good. How are you? Good? I’ve got a two year old home with the flu though, so I didn’t want to cancel. So our schedules have been kind of tough, but I apologize for any background.
Naomi Denson (00:32) No, I totally can relate so.
Brittany’s IPhone (00:34) No.
Naomi Denson (00:36) Issues here. But, yeah, Karen is with us from our privileging product and engineering team. So she wanted to just talk through your dops with you. She had some questions. Yeah.
Karen Mok (00:49) Awesome. I’m just going to share my screen. It shouldn’t take long. So I had a look at the optum ones and they generally look like this. Is that correct? Brittany?
Brittany’s IPhone (01:03) Yes, we’ve got several different iterations of this but more or less we have the name, it’s just organized differently unfortunately by specialty. But, yeah.
Karen Mok (01:15) Okay. So generally, with magine, we group the privileges into categories like core, special, non core procedural admitting, etc. And when we looked at this, these dops, there isn’t that kind of grouping. So I just wanted to confirm if optum does have any categorizations of the privileges. So.
Brittany’s IPhone (01:35) By some specialties, we do, we are primarily orthopedic pain and neuro. Those are our primary specialties. So you’ll see those are a little bit more organized by core, non core and that’s and even with it being core, I think you all are familiar that accrediting bodies still want, you know, the listing of procedures and specifics underneath where you go. You know, yes, no. On each, this one is a little dated. It’s more, it’s grouped by categories. I mean, I’m fine to break those out into core and non core. I guess whatever would be helpful for you guys?
Karen Mok (02:09) Yeah. Would category one be core? And then category two is non core. Yep. Okay. Great. Just want to make sure I’m making the right assumptions here. And this is one has the core listed. Yeah. So I guess for this one where there’s no categorization, we do have to like list. It, somehow, is it okay to just call all of these core?
Brittany’s IPhone (02:32) Yes, if we don’t have a call out section on it for non core or cat? Ii? Yes, it’s just standard core privileges.
Karen Mok (02:39) Okay, great. Let me just check. Okay, yeah, those would be core and you have the signature on there. That looks great. Okay?
Karen Mok (02:59) And then I just have a question on the like committee voting process for privileges. Is that something that’s done with the appointment?
Brittany’s IPhone (03:09) How do you mean or?
Karen Mok (03:11) How does it work? Like when a provider requests this? And this DLP form is sent with a packet to the committee? Is that something you have visibility into like whether the committee is voting on this, whether to approve each individual privilege selected by the provider?
Brittany’s IPhone (03:28) Like here, yeah, it’s more. I mean, I’ll tell you we’ve never had a situation where they’ve requested one and they’ve checked no. So it tends to mirror exactly what they’ve requested because they’re declaring to us by their, you know, virtue of their training and comfortability, what they’re going to be doing in our facility. So that goes to one meeting and it’s usually a blanket, yes or no from those committees. So, but again, to match what they’ve requested. So if you have to build it where, you know, we need to go through each one and select yes or no. I mean that’s kind of what we do now is manually go through and grant it as yes or no to match requested?
Karen Mok (04:04) Yeah, that’s kind of what I was thinking because I see here that there’s like a line item granted yes or no for each one. So I wasn’t sure if that was something standard for you all or that’s what we’re trying to figure out is like should it be one there’s like the appointment like accept or approve or deny, right? And then there’s like privileges. Is it like a separate category from the appointment? And then it’s a proven or no or like you want to see like a drop down of all the.
Brittany’s IPhone (04:36) Yeah. So with, and you’ll see it on like surgery partners like they really do want you going by line item. When you’re surveyed, they won’t let us just say, you know, say approved as requested as a blanket for a category. And the providers themselves, you know, might say, well, I’m going to practice this way, but I’m not going to, you know, dabble in whatever hematology or something on this one, for example. So we do need to keep it that way. And then at the bottom, you’re going to see a lot of these where for committee sign off, we have rec recommended as approved or as modified and that’s really just summarizing above if there were changes or not. And again, 99 point nine percent of the time it’s as requested. So, got.
Karen Mok (05:13) It got it. And the approval is like happening on the form, or is it like done through like the vendor platform in the past?
Brittany’s IPhone (05:22) It’s done on the form. So once we get it from the requesting provider, you know, they have the requested section filled in and then we go through and then the granted, you know, it’s usually approved to match. And then it’s the bottom sign offs you’re seeing here on the screen. Okay?
Naomi Denson (05:37) All right.
Karen Mok (05:39) That’s very helpful. Thank you so much, Brittany. I think that covers all of the questions that I have now.
Brittany’s IPhone (05:43) I’m curious. This one, did I send this one to you? I mean, I must have, but it looks like an older… that looks a little bit older. Yeah. Is there any other internal medicine on here?
Karen Mok (05:56) No. Okay.
Brittany’s IPhone (05:58) That’s really odd that one because that looks like an older form. So I’ll just go back and double check here. Yeah, I mean, make a note for follow up on that one. Okay?
Karen Mok (06:07) Yeah. There’s a couple there’s, family practice, general surgery and internal medicine that are all from.
Karen Mok (06:18) That one. All right. That sounds good. That’s all the questions I have.
Naomi Denson (06:21) Thank you. All right… Brittany, I did just want to quickly talk through the npdb, the two dbids that you gave me. Yes, I know one was for optum for the providers that are going under payor enrollment, correct? And the other one was for the arc of Georgia dba, premier… entity for the providers to be separated.
Brittany’s IPhone (06:49) Yes. So the arc of Georgia is just for premier surgery center, and that’s just for appointments. There’s no payor enrollment associated with that, you know, id, but the optum umbrella consists of three facilities that’s optum, screven, optum, patental and optum surgery center. And we are doing appointments and payor enrollment amongst those three facilities. Okay?
Naomi Denson (07:12) So, the hangup that I have is in medallion, we can have one dbid per organization or we can break it out by group profiles. So I took the optum one and attached it to the three, the provider enrollment group profiles that we created, right? But I don’t have a group profile for the premier one and there’s no way to associate it to just that entity. So, my proposal is that we create just like a dummy group profile and associate those providers to that group so that I can connect that dbid to that one.
Brittany’s IPhone (07:52) Sure. It’s just a redundant naming convention at that point, right? Yeah, it’s not going to change function really.
Naomi Denson (07:58) You don’t have to complete it or anything. It just gives me the platform to be able to add that second dbid in and then associating, I’ll take the tab that you had added the providers to for cvo work. Only those providers we would associate just to that group that works. Okay? And there’s no crossover, correct?
Brittany’s IPhone (08:20) Oh, between the providers themselves, in those groups, yeah.
Naomi Denson (08:23) The providers, like from the providers, one tab, there’s none like from the providers two tab. There’s none that are also in the other groups that are going to be participating with pay enrollment.
Brittany’s IPhone (08:34) Yeah, there are, yeah, less than 10 providers, but still, because what happens is, you know, you’ve got dr smith that’s primarily working at tatnall and uses pay enrollment for those clinics. But then he has privileges at optum surgery center. Okay? Is.
Naomi Denson (08:53) there any reason? Because I’ve had other customers that have come in and the situation is a little bit different where they have multiple dbids, but for the purpose of like monitoring and querying, they opt to just use their primary in PDB registration for all providers. Is there like, is there any reason that they’re separated or should remain separated? Otherwise just those 10 providers would be queried… and rostered to both?
Brittany’s IPhone (09:26) I mean, I guess the only concern comes from, you know, the CMS guideline that each facility has to have its own credentialing process, right? So, but if we’re saying this is a cbo and centralized, then I guess the name that appears on the entity at the top really shouldn’t matter at that point. I guess if that’s the case, I don’t know.
Naomi Denson (09:50) Yeah. Let me, I mean.
Brittany’s IPhone (09:52) I can make an argument that way. But here’s my only concern is the surveyor comes in has to say, okay, when you query dr smith, and they happen to know, well, wait, this isn’t from your surgery center, querying him. This is optum health center. You know, I’ve never seen them get that detailed, but technically then, is it, I don’t know. And then if you have to report something, right? Like the facility itself has to make a disclosure.
Naomi Denson (10:16) Right. Yeah. I guess what you’re I’m trying to do, yeah.
Brittany’s IPhone (10:20) It’s only less than 10. So, I guess I’m okay with the duplicity of it, if you are, but I guess.
Naomi Denson (10:27) Yeah… I don’t see any. I don’t see any issue with it as long as you don’t and it’s such a low number.
Brittany’s IPhone (10:33) It is. Yeah. So,
Naomi Denson (10:36) it’s not going to do a whole lot for like, you know, pass through fees or anything like that per.
Brittany’s IPhone (10:40) year, right? It’s like what? Two dollars to query it? Yeah.
Naomi Denson (10:44) Two dollars per year and.
Brittany’s IPhone (10:46) if it’s a low number, yeah, let’s just proceed the way we have.
Naomi Denson (10:50) Okay, perfect. And then I had one other question on, the pay enrollment side, the three groups that we set up with the multiple practice locations. I had one email from you… and I’m just trying to determine and make sure that we’re set up correctly just because of some other things that have surfaced internally with some of our customers setups.
Naomi Denson (11:18) And I just want to make sure that, do you bill at the group level for payer enrollment? Like when you submit your enrollment request, are you using the group npi that you provided or are you using the individual practice location npis?
Brittany’s IPhone (11:32) It’s payer specific. So we are using that group npi for all except anthem and ambutter. Okay?
Naomi Denson (11:45) Could you, and I don’t know if you started this yet? The payer process scoping template that I’ve been throwing out there on our calls?
Brittany’s IPhone (11:53) Yes, that you’re asking no one’s probably completed but you need, yes.
Naomi Denson (11:56) And, yeah, and nobody’s saying anything. And I’m like my gosh, I feel like this is going to go sideways because every time I asked Victor about it, he’s just, yeah, standard processes are fine. And I’m like, but, I just, I need to know.
Brittany’s IPhone (12:10) So I will say we’re unique in that space though most are going to follow whatever, they put down on paper, whether that’s the group or location.
Naomi Denson (12:19) Okay. Yeah, cause most of them like most of the ones that I’ve seen are just like one group and like a practice or a handful of practices that are doing this. But the way you set up and the way it originally came over, and then we excluded the rural health centers because we’re not really enrolling them… right? So there there will be groups. I just want to make sure that we’re set up correctly. So if you could do that, fill that out for all of your payers, so that we can just do, our scoping internally just to make sure that everyone’s aligned and I can resend you that the newest latest template.
Brittany’s IPhone (12:54) Yeah, yes. I mean, that’s where that’s been honestly, the slow part is me locating the link, but, and also for us pay enrollments just moving slower because of the amount of volume, the volume of detail needed. We’ve really pivoted to the cvo work and gathering all those caqh ids which we, I am told we are like almost done with that, but that’s just been painful getting that from a lot of our groups. So, yeah.
Naomi Denson (13:15) I just wanted to come to a point where there’s an urgent need for enrollment and then we don’t have this done and then you have to submit requests and then it’s done wrong. So, no.
Brittany’s IPhone (13:26) Absolutely. And, and we’re pretty, I mean, we have a very stable enrollment process right now. I haven’t even notified them yet because I, again, I just don’t want too long a runway there for a transition, but yeah, I will fill that out just so you know, the scope of what you’re dealing with. And then as we have like net new, right? I would like to make sure those are going through the new process eventually. And again, from optim’s point of view, our thought is we’ll start with the cbo work first and then move over to the payr enrollment. Yes.
Naomi Denson (13:54) Exactly. Yeah. I just wanted while I had you here just to make sure that I, no.
Brittany’s IPhone (13:58) I’ve heard you every time you brought it up and I know we’re one of the big ones reasons why I bet you the others are a little more straightforward. We’re just, you know, this is how we’ve operated from a legacy perspective and it’s what it is. Yeah… perfect.
Naomi Denson (14:12) Okay. That was all I had today. I really appreciate the time. I hope your little one feels better.
Brittany’s IPhone (14:16) Thanks.
Naomi Denson (14:17) I just have one.
Karen Mok (14:18) More question if that’s okay on the privilege voting. So, is there any requirement to like document the voting of the privileges and some sort of like auditable trail for you or is it okay to just have that recorded in the dop?
Brittany’s IPhone (14:33) We just do it on the dop basis because our minutes from our mec and governing board will kind of be that record otherwise of voting. But the dop is just, you know, what the, you know, document on file to say that it was approved in the date. So, yeah.
Karen Mok (14:50) Okay. All right. Thank you.
Brittany’s IPhone (14:53) All right. Thanks so much ladies have a good one. Bye. All right. Bye bye.