Transcript
Kyle Rice (00:00) hey, again, Larissa.
Desirae Hutchinson (00:05) Hi, how’s your afternoon going good? I’m ready to be over tired.
Kyle Rice (00:12) We’re almost there.
Lorraine (00:14) Yeah.
Desirae Hutchinson (00:18) But it’s for the weekend?
Kyle Rice (00:20) Yeah. You got any exciting plans? Yeah.
Desirae Hutchinson (00:24) I wanted to do a, I… wanted to do a like brunch with Easter bunny, but I’m not sure if we have anything coming this year. Like usually Frederick has so many stuff, but this year, they don’t have a lot for, oh, really? Yeah, I remember last year, we did so many eggheads that when Easter actually came, we were like done this year. We just won so far. I.
Kyle Rice (00:53) Know we have an Easter egg hunt actually on Sunday that I am looking forward to. Kids. Love it. They do like a little hayride out to like the Easter egg patch and then they just like throw the eggs everywhere, like.
Desirae Hutchinson (01:04) That’s kind of what they have. Yeah. So.
Kyle Rice (01:07) That’s what we’re getting into through the weekend. I’m hoping for a nice relaxing day tomorrow too.
Desirae Hutchinson (01:14) Get caught up on the laundry. Yeah, definitely on Thursday and.
Kyle Rice (01:19) whatnot and, you know, get the groceries done. That’s true. Maybe a costco run here or there?
Desirae Hutchinson (01:25) Well, costco on the weekends is crazy, right? We sometimes try to go like either Thursday or Friday and, you know, do dinner there where because on the weekend, costco because on the weekend, it’s like mayhem.
Kyle Rice (01:41) Oh, okay. Our costco has because we’re the closest costco to Philadelphia. So we get our costco is like out of control Saturday, Sunday. I despise going there. Madhouse.
Desirae Hutchinson (01:52) Yes, same here. It’s an absolute madhouse. Yes, here too. So we try to go like Thursdays or Friday. Do you use Sam’s club too or you just do costco?
Kyle Rice (02:04) Just costco. We don’t have a Sam’s club near us unfortunately.
Desirae Hutchinson (02:09) Well, I have a friend of Frank’s and I just, I prefer their diapers over, you know, like… the costco ones. So I do diapers there. And sometimes like they have some interesting stuff. But yeah, costco is definitely best.
Kyle Rice (02:26) Costco is costco is king… Lauren you doing anything exciting for the weekend this weekend?
Lorraine (02:37) No, not this weekend. Really. Just… do I have anything this on Sunday? I’m doing something? I don’t know what I’m meeting some friends out. I don’t know what though that’s the only excitement. I’m off on Monday and Tuesday, I have running around to do. My mom keeps me running when I’m off.
Kyle Rice (02:58) Keeping you busy.
Lorraine (02:59) Keeps me too busy.
Kyle Rice (03:00) I fear that, hey, Darlene. Hey, Jen. Happy Friday. Good. How are you guys doing? Doing very well. We almost made it. Yes, happy Friday. Almost almost, it is Friday though it is Friday indeed. Were we waiting on anyone else from the twin side Desirae by chance?
Desirae Hutchinson (03:23) She wasn’t invited. I don’t see her on the invite.
Lorraine (03:27) Oh, she is on the invite. She is on the invite. She.
Desirae Hutchinson (03:30) Was on a call with me. Hold on. Okay. No worries. We can get going. I’ll ask her though, was?
Lorraine (03:38) There?
Kyle Rice (03:40) Anything specific that you guys wanted me to demo for this afternoon?
Kyle Rice (03:43) I have a little bit of a powerpoint to go over and then was going to show the credentialing process and overview in the platform, but I just wanted to check in beforehand if there’s anything specific that we were wanting to see or notate for the team?
Lorraine (03:59) Is anybody going to jump in or should I jump in?
Desirae Hutchinson (04:01) You can go ahead.
Lorraine (04:03) Okay. So, you know, we’re doing the urac stuff. So do your presentation, but some of the stuff that we were asked to detail, right? Was how we can monitor the credentialing process ourselves, how we can check the verification of the primary sources, which I think I already know, but that’s fine. If you can go over that again. And then.
Lorraine (04:35) Hold on. Let me see. There was one other thing I was going to look at… so that we can answer.
Kyle Rice (04:47) Yeah, we can definitely, I can definitely show you how to monitor the verifications, pull the credentialing packet as well. You guys are able to download that as a PDF and then reference all the verifications in there. Perfect. Like the npdb, the education verifications, the license verifications, that’s.
Lorraine (05:03) what we need. Okay, perfect. Okay. And then if there’s a process for resolution of any discrepancies that you have.
Kyle Rice (05:14) Discrepancies, meaning like any?
Lorraine (05:16) Like if there’s any information or any flags that need to be corrected or anything that needs to be addressed, how that is resolved?
Kyle Rice (05:25) Awesome. Yeah. So the file?
Lorraine (05:26) Information kind of stuff, so.
Kyle Rice (05:28) I, the files will come through with a yellow flag on them when they go through committee indicating that they have a process hit on there. So that might be there’s a flag on either the npdb the education verification, or either one of the licenses, and,
Lorraine (05:43) that flag is in the system, we would see that, in the platform. Okay? In the dashboard? Yeah.
Kyle Rice (05:50) Let me jump into platform real quick since most of the questions are related to that. And then we can just kind of dive through and walk through. Lorraine. I actually hijacked your account for today just so that we’re mirroring the.
Lorraine (05:59) View that’s fine.
Kyle Rice (06:01) That you guys will be seeing. So these are all.
Lorraine (06:03) The requests that.
Kyle Rice (06:05) are currently in process. So it looks like we have 12 currently in process for you guys. I believe this is the core group of providers that you guys have kind of across twinhealth. If you want to monitor or take a look at any of the credentials in process, we can see that we just need to get the application completed. So anything with the application completed is currently in process with our credentialing team to obtain the primary source verifications. And then if you click this blue credential here, you’re able to see everything that is being verified currently in process. So you can see for dr siles, this gives like a quick summary of all of her licenses. It shows the status of the current license. So everything looks to be clean on her. And then you can go down and see her application and summary here. So you can essentially monitor everything in process. These are her application verifications. She hasn’t signed her attestation as of yet. And then you can view her malpractice history, her disclosure questions, her work history, validation, any board certificates? And here, this is still in process and still being worked by the team. So we don’t have dates in here as of yet.
Lorraine (07:19) And here’s where it would be, where the verification dates will all be here on the element itself.
Kyle Rice (07:24) Yes. And then once it’s finalized, once the file is finalized, you guys will get a notification. They will be moved ready for committee. And then Lorraine, you can either move it, Lorraine or Larissa who’s ever managing the credentialing workflow, can move these into committee for voting. And from here, it will export the packet and it’s the same credential on here and you can download that via PDF for, so.
Lorraine (07:51) They can either see it here with their access or they can download the file if they want to do it that way.
Kyle Rice (07:56) Yes, exactly. So that’s how you can kind of monitor and see the verifications in process. I did just want to touch on real quick. Just the requirements. So you guys are tracking for anything required for credentialing workflows. So the credentialing intake requirements, we just required the past five years of work history. We ask that the clinician provide an explanation for gaps greater than six months. If the clinician has not been working for five years, we just ask that there’s a full work history from the time of licensure to present. We also just ask that the malpractice insurance is up to date. Each disclosure question must be answered for the credentialing process as well as any question that has an affirmative answer on there. We just ask for some additional explanation and any supplemental information provided for the basic profile information. We just ask that that’s filled out in entirety, so we can locate the accurate data for primary source verification. And then we just ask that the license, all the licenses are added and board certifications are present in our system. That way our team can pull those primary source verifications as part of the credentialing workflow. So for the provider credentialing, this is kind of like a you do we do slide as part of the process. So essentially your team and the providers are responsible for gathering the data, importing all this into the medallion profile from either like an fsmb import or caqh import. We can do that as well as a resume scan as well to help with profile completion. And then we ask that they complete the provider application and include a current attestation within 120 days of the credentialing request. The medallion platform will essentially conduct provider outreach and import all the data. They will confirm the application for completeness. Our team will also complete all psvs. So also do a QA and review for file accuracy. They will auto generate the file for completion. And then you guys will get a notification that it’s ready for committee for review. You can complete the committee review via platform. And then you’ll start to see automatic approval notice and tracking, re, credentials. Once all votes are casted, they will go into the re, credentialing cycle. I believe you guys are in a three year cycle. Correct me if I’m.
Lorraine (10:24) wrong. Yes, three year cycle, so.
Kyle Rice (10:26) Then those will automatically queue up with the new dates within that three years. So if it’s March 27, 20 26, it’ll re, queue that file 30 days before the credentialing date is up for expiration.
Lorraine (10:42) Can you share this powerpoint with us? Jarlene?
Kyle Rice (10:46) Absolutely. So, the process and timeline, typically, the credentials or files are ready in about six days. We have some tech enabled onboarding to assist with provisioning the account. So you can do that through API, batch, file upload, or manual account creation for the profile completion, key steps of the process to ensure application access, typically five days to completion. And then the platform will guide any providers to complete their profile through, excuse me through… any profile alerts. And then in platform caqh data imports may complete the profile to nearly 100 percent, but we may just need the provider to complete the attestation there by.
Lorraine (11:37) The way, how do I get a list of the people that haven’t done their attestation, so I can follow back with them. Can you send that to me on those 12 please?
Kyle Rice (11:45) I can pull those for you Lane. Yeah.
Lorraine (11:48) Sorry to hijack. Go ahead. No, you’re.
Kyle Rice (11:50) all good. Stop me wherever you guys have questions. It’s open floor here. So through the primary source verifications, we’ll typically collect these through six business days or less. Through direct source integrations. We’ll complete all verifications in lieu of and cqa standards. And then additional verifications can be added or requested to the profile as needed for the committee file review. There’s unlimited configurable committees and employee platform chat to help drive speedy committee review. And then for recredentialing and monitoring, medallion will track and flag any irregularities through automated sanctions and expiring monitoring. And recred dates are monitored and the files are moved automatically into the recredentialing queue. So no worries about as soon as these providers get credentialed, they will automatically go into that three year loop and be recredentialed back in the process within that time frame. And then how the delegated setup works. So you guys will take care of selecting the payers you want to be delegated with, and collecting the delegation criteria from the payer, communicating the initial intent of delegation and formatting your committee, which I believe we’ve already have completed… together. We’ll work on the application process for policies, staffing, performance, metrics, and delegation agreements. And then we’ll take care of the policy and procedure templates, along with revision and advisement. We’ll advise on identifying committee members, ongoing committee meetings and best practices for structure and operation. We’ll also take care of adherence of rules and guidelines as specified by the delegation agreement. And then I finally will complete the credentialing for your providers. Well, so I’ll send that over for you guys.
Lorraine (13:34) Anything else? Yeah, that’s very good. That’s a lot of details that we can use to answer the questions that we have from your act, very specifically, right?
Kyle Rice (13:46) Yeah, no worries. I just want to share this additional powerpoint. This is going to give you a little bit better visibility on how it’s going to look when these files start to come through on platform. I think you may have seen this before we.
Lorraine (13:58) Might have, we did a walkthrough at one point.
Kyle Rice (14:01) Yeah, just wanted to double tap here to see if you guys had any questions and give you a little bit more insight into how the process works. So this is what your view will look like. As a member of the credentialing committee. You guys all have… access to the credentialing instance in the medallion platform. So this is how it will look when it, when you vote on a file. So it will you’ll receive a notification from the medallion platform. It’ll say hello, you know, Anupam Goel has been completed and ready to be approved by you. It’ll flag you automatically via email from the platform. This is how you view the file status in the credentialing platform. So if you see the status on here, it gives insight into any verification that has been completed and needs further investigation. So, this is that yellow flag that I was just talking about Lorraine. So you see on the licenses, if it’s green with the shield here, that means that there is no no hits or flags related to that. So they’re.
Lorraine (15:03) ready to go. Those greens mean they’re ready to go?
Kyle Rice (15:05) Greens mean they’re clean and ready to go? Yes. Okay. So you can, I think I just reviewed this too, but deep dive of the medallion file. You can view this. I don’t know why I lost my slideshow here. You can review this by clicking the credential hyperlink here. This will open up a downloadable version of the file with all ncqa primary source verification detailed and divided into status. You can see here that in the committee files that this specific provider has a clean file. And then James Patterson has a hit on the status. So it’ll give you kind of a clear indication of providers with clean files providers with hits, they’ll help facilitate additional review by your committee. And then your additional policies and procedures. Yep, this one’s super important. How does a committee member vote on a file? So once you’re in medallion platform, you’re going to want to be in the credential committee section, scroll to the right of the screen until you get to the vote column. And in here, you can pop open the credentialing file and it’s just going to ask you to vote or vote to approve or vote to reject. I recommend you guys click. I don’t know if you’re going to be doing this asynchronously or if you’re going to be establishing like a committee to review these in depth, but those can be done on the platform here.
Kyle Rice (16:29) So, what happens after I vote, after the credentialing committee members vote, we’ll record a timestamp of each vote. Once all members have voted, the file will be bucketed into our closed file tab as approved, rejected or expired. So you guys can filter those out for future use, and then subsequently, you can download them and export for status as well.
Lorraine (16:57) Once it reaches this status that it’s closed approved, but closed, it’ll start the recycle the recredentialing clock, right? Yep. Exactly.
Kyle Rice (17:07) And where?
Desirae Hutchinson (17:08) Would.
Lorraine (17:08) you see that? Where would you see that? Where would you see the clock? Where would you see where you are with your providers?
Kyle Rice (17:16) So, you’ll see that in the closed tab under credentialing… excuse me, not under closed under scheduled recreds. Okay. So, it’s going to show the recredentialing start date, it’ll show.
Lorraine (17:28) The dates yep.
Kyle Rice (17:28) And recredentialing start deadline. And then those will be automatically queued back into the credentialing requests as soon as that three year cycle hits, how?
Lorraine (17:38) Far in advance of the three day three, how far in advance before that expiration of that credentials file? Do they start working on them?
Kyle Rice (17:47) I believe it’s 30 days 30.
Lorraine (17:49) Days. Okay. Cool. Anything.
Kyle Rice (17:54) Else, I can demo for you guys or any questions that I can answer Lorraine. I will definitely pull the list of attestations that are due for the current.
Lorraine (18:01) Yeah, so that I can follow back up on those. And.
Kyle Rice (18:04) Send that to you. But anything else I can demo for you guys or answer at all?
Lorraine (18:09) Darlene, no.
Desirae Hutchinson (18:11) No, I don’t have any questions at the moment? Looks good.
Lorraine (18:13) Huh. With the information like that. Yeah.
Desirae Hutchinson (18:15) Yeah, looks very good. I.
Lorraine (18:16) think that we can answer all their questions with this.
Desirae Hutchinson (18:22) Agreed. Perfect.
Lorraine (18:25) It’ll be an easy walkthrough when we have to show them. Oh, do they, do you have a login that’s access or view only that can be used by an auditor?
Kyle Rice (18:37) Is that? Yes? So we do have.
Desirae Hutchinson (18:39) You do? Okay, good. We do.
Kyle Rice (18:41) We do have specific team roles and designations. So we can designate a member as an auditor. I believe that will give them specific only view and they’ll have to enable specific access to this credentialing tab, but that will give them view only access to any credentialing files. And then if you need, you can export them or download them to your system and send them as needed to anybody for any audits or anything in that nature.
Lorraine (19:06) I think that when they do their review of us, they’re going to probably want to do it in the platform.
Desirae Hutchinson (19:13) They want to walk through.
Lorraine (19:14) They want to walk through on the platform. Okay. Yeah.
Kyle Rice (19:19) I know that’s is that the, Darlene, correct me if I’m wrong, was that the call we have scheduled for may 20 first?
Desirae Hutchinson (19:24) 20 first. Yeah.
Kyle Rice (19:26) Okay, perfect. Yeah, yeah, I’m happy to demo that for the urac folks. And then I also looped in our director of credentialing so we can pull her in as needed to, for any additional support we need there.
Desirae Hutchinson (19:37) Okay. Very good. All.
Lorraine (19:41) Right. I think, that gives us everything we need. Just share the powerpoints with us and we’re good. Yeah, yeah.
Desirae Hutchinson (19:48) We’ll do a double check just to make sure, but I think we’re I think we’re in great shape then.
Kyle Rice (19:53) Perfect. All right. So I will send the copy of the powerpoints over for you guys for review. Lorraine. I will flag those clinicians needing further attestation.
Lorraine (20:01) Yes. So we can follow up.
Kyle Rice (20:02) Anything else that I can help support today or any other questions?
Lorraine (20:04) One, one thing, Darlene, did you make any headway with these people with the mpdb?
Desirae Hutchinson (20:10) I’m about to call them back because we’ve been playing telephone tag, they call me and then I call them and so back and forth. So I’m hopeful I can get that resolved today and get that on my to do list.
Lorraine (20:22) Okay, great. All right. So, Kyle should hit you back up with that. What’s that number again? DIBD or whatever?
Kyle Rice (20:29) Yeah, D.
Desirae Hutchinson (20:29) B, ID.
Kyle Rice (20:30) DBID number? Yes.
Desirae Hutchinson (20:32) Yeah, DBID.
Lorraine (20:33) Okay.
Kyle Rice (20:33) Great. Yeah. And I know that nbdb is pretty painful with that. So I just recommend staying on top of them as best as possible because they are a little bit painful in terms of getting that authorized. So just let me know when you guys have the number, and I can configure that into our system pretty much instantaneously once we have the number there, okay? All.
Desirae Hutchinson (20:52) Right. Sounds good. Thank.
Lorraine (20:54) you for your time.
Desirae Hutchinson (20:55) Thanks so much.
Kyle Rice (20:56) No worries. Thanks guys. No worries. Got Lorraine and Larissa twice today, and then happy Friday to you guys and I hope you guys all have a great weekend, you?
Desirae Hutchinson (21:05) Too. Bye, bye. Thanks. Bye bye.