Transcript
Shannon Costine (00:00) are already in the waiting room? Hey, Nate, do you want me to let everyone in or just wait? Yeah, okay.
Kateland Sanders (01:10) Hey, Shannon.
Shannon Costine (01:11) Hey, Derek. How are you? Good. Thanks. I’ve got Denise Skyler and Corie right now in the waiting room. Okay? I can pause until we get Kate in.
Derek Lo (01:23) Yeah, maybe just give it two seconds.
Shannon Costine (01:28) Oh, Taylor’s here now. Okay. You want me to let everybody in?
Derek Lo (01:32) Yeah, thank you. You can kick it off.
Shannon Costine (01:43) Hey, guys. How are you, hello?
Shannon Costine (01:52) All right, Taylor, do we have everybody from your side?
Taylor Williams (01:55) We do.
Shannon Costine (01:57) There’s four of us. Okay, perfect. Kate, I will let you kick it off.
Kateland Sanders (02:06) Hey, everyone. I’m going to share my screen. We just provided kind of a summary of where we’re at to date, some of our latest updates.
Kateland Sanders (02:17) I know I sent some of this over via email last week, but pre app submission, we are at 60 enrollments. So those have all been corrected based on the spreadsheet we sent over last week with anything your team had called out, we’ve corrected all of those. We actually did double QC, and then we had leadership look over it again. So all of those are just kind of sitting holding right now, but everything has been updated in our post submission. These are the 40 enrollments that had already been sent to the payr for processing. So we’re just following up with them. Those were outside of the ones from last week that we had been working on. We still have the 37 enrollments and pending dependency. These are mostly pending the group to be enrolled or those practice locations to be added. We did go ahead and remove the group npi from those, and went ahead and selected a primary practice if it wasn’t already selected. And then we have nine completed enrollments approved by the payr. I will pause there. Any questions on the current count?
Taylor Williams (03:21) So, for me, who’s not involved in the detail, each enrollment is a provider with payr, right?
Kateland Sanders (03:28) Or a group with payr, you know, group and provider enrollments is.
Taylor Williams (03:34) The denominator 146.
Kateland Sanders (03:38) I believe it’s actually one… it’s either 146 or 147. I think one of them may have had to be stopped because it was done in error… but that would be the total request. There are three in requested that their profiles are not completed to move through. So those are not included in this summary.
Taylor Williams (04:15) Warrior, Skyler, is there anything, any questions related to this?
Corie Will (04:20) Are those corrected? The pre app submissions? Are those corrections visible to us currently?
Kateland Sanders (04:29) Only the three that we agreed on at the group level. Those are the ones that are uploaded in that overview client task. All of the rest of these are in the background. We could upload them so you could see them, but we only uploaded one per payr last week for you to review.
Corie Will (04:48) But, like, for example, I don’t see it anymore.
Derek Lo (04:56) Can you go to the next slide?
Kateland Sanders (04:58) Yeah, maybe that will.
Derek Lo (04:59) That summarizes some of the updates we made, which I think Corie was maybe calling out last week too.
Corie Will (05:05) Yeah. Like is the medicaid Arizona application available for review? I’m not, I don’t think I’m seeing it yeah.
Kateland Sanders (05:12) So you can’t see that one yet. We actually just got the portal resolved today. So what was in there was up to date. There were the three things that you had called out the mpi issue of the additional mpis not being added to that lower additional information section. So that part did get resolved, the enrollment disclosure documentation, there was a issue where we were putting all of the approved medicaid in that it’s like a free text box and it was not able to save the amount of characters that it was. We even like tried taking out dashes and abbreviating and it was just too large. So we ended up taking all of it out and adding in a section that just said see attached. And then I uploaded an actual PDF of all of your approvals and that’s in the document section. I did confirm with Arizona medicaid that is accepted. And they said that was okay as long as we put in the free box, the free text box to see the attachment. The one part that we did get stuck on is the controlling interest section which I know you called out. So dr Warnell was added under the wrong owner type. I do have a drop down of what is available. It would only let me remove her. It wouldn’t let me update what her ownership type was, which we know she’s not the coo and so we had to just remove her, which is why I didn’t upload a new copy because you wouldn’t have been able to see. We couldn’t make any changes. I had to submit a bug ticket to get them to unlock the portal. And actually like advise how they wanted us to put that in. I actually talked to them this morning. They were able to resolve that actually was just in the application. There’s still not a great selection of how to put her into the application. So I actually was going to email you. I think we should put it as managing employee, but there’s not direct owner there’s not president. Yeah.
Corie Will (06:59) I’d have to look because we’ve submitted applications before. So I just have to see what we’ve done in.
Kateland Sanders (07:03) The past, yeah, I can send you the drop down of the options Corie, just so you can see what it is. But that’s why that’s the last piece that’s remaining. And then I did get it unlocked to add in the additional other offices that she owns because at that part, there was only the one and we need to list all of those and that got unlocked this morning as well.
Kateland Sanders (07:26) Any questions on Arizona medicaid?
Corie Will (07:35) I don’t believe so. I don’t know if this will be referenced later in the slides. But like some of the other pending applications we had like Missouri medicaid, like I don’t see that draft available anywhere yeah.
Kateland Sanders (07:52) So for Missouri medicaid, I can actually upload that one as well for you today. If you would like to review it. What we ended up finding out is there is two additional documents besides the PDF that you had reviewed before. I know it’s still in the portal, but when it prints out, it’s a PDF form. There’s actually two additional forms that needed to be added per npi. So our team completed that late last week. It went through double QC. And then I reviewed it last night and this morning again, just to make sure we captured everything, we did confirm that those are requirements for each npi just because that is a nuance. It’s not at the tax id level. It’s at the npi level. So I can send all of those over. They’ll just be now three documents per npi instead of just the one.
Kateland Sanders (08:41) Awesome. And then the pnoa and the Loi question. And I don’t know if this like made sense in my email, Corie, the ones and I know, I think you were looking at the overview just now and said you can’t see them anymore. Some of those were the old original ones that were in there. I went ahead and just removed all of those and only uploaded the ones that we did make the corrections. They’re corrected now on the back end, we just kind of held until you reviewed the ones that were already updated first last week when the rest of them were going through the double QC and the corrections. Okay? And then I just broke this down. I know we sent this last time but this is just a breakdown of kind of each category and where things are. Like I said, there are the three requested that are not counted in the overview section, just because we haven’t started work on those. Those are just the profiles need additional information on them. And then we have the processing with payr broken down by… payr. And then processing with medallion in this column. Corie, I did include the ones that are in the overview section for you to review. Like we know the one for, I believe it’s the helpsmart one that’s the one we’re waiting on the effective date, which I think it’s good to submit. We just need to make sure that you and Skyler were okay with the effective date.
Corie Will (09:58) Okay. Yeah. Well, like if you upload the other ones we’ll go through and get all those.
Kateland Sanders (10:04) Okay, perfect. And then this is just the pending dependency and then we do have the nine completed for the medicaid Nebraska.
Kateland Sanders (10:15) Any other questions on this? And then we can go into next steps in our action plan moving forward.
Taylor Williams (10:24) So, I know you said this, I just want to confirm some of the errors on the previous apps that we were reviewing were old that you technically didn’t refresh. But now you’re going to refresh so that the team can see it.
Kateland Sanders (10:40) Yeah. And to be clear, there were the ones that we called out in the email, the pnoa from Missouri, Arizona. There was the errors that’s what we just walked through, the claim doc was corrected. And then the healthsmart is uploaded. And so those were ready for review. There were just the old ones still in there that you could see that didn’t have the updated application because it was going through corrections and the double QC review end of last week. Okay?
Kateland Sanders (11:13) Awesome. And this is similar to what we’ve shared before. We did adjust the dates just a little bit. So, right now, from March thirtieth to April third, we want to get approvals, Corie, to the ones that are in there for all the remaining group ones. Once those are approved, we can go ahead and submit the provider ones as well. Some of those are one in the same, you know, the roster has some providers on it as well. So those could be submitted as well. We will continue our internal quality control based on the updated QC checklist that is specific to forefront now. And then we want to bring down forefront review to 50 percent of the new submissions or whatever we agree on Corie, whatever you’re comfortable with from April third to April twentieth, request any new set of enrollments for the specific cohort that you have. And then we’re hoping by April twentieth, we reach kind of a steady state and we don’t see any new issues.
Corie Will (12:10) Yeah, I don’t see the bringing the review down? I don’t see that happening anytime soon.
Kateland Sanders (12:20) Do you want that to be 100 percent? Do you have a number 100 percent?
Taylor Williams (12:35) Let me, so, let me ask because this is one of my main kind of points and transparency. We didn’t meet before this meeting just to kind of go through things. One of the things that main reasons why we reached out to medallion was to have technology help us with work, not just switch manual for manual… how much of what we’re going through now as it relates to the quality control, the review is it will always be a manual step or once… you’ve I guess linked the technology with our information to the payor. Once it’s there and cleaned up, you technically won’t have to touch it again unless the payor changes.
Derek Lo (13:39) Yeah, it’s a super fair question. And the short of it is… right now we have basically an internal library. It’s about 100 payers or so that we have fully automated. So obviously that’s not, it’s not 100 percent coverage. I will say that roadmap is defined by our customers essentially like what goes on it. And yeah, I mean every week that goes by, we’re constantly adding essentially enrollment, you know, forms to that library that are then fully automated. And so, yeah, we can get you the exact, like specifics on what the coverage looks like specific to your payers set. But I’d also say like we especially given, you know, what, what’s unfolded in the last, you know, six weeks. I think like we Nate and I can definitely sit down with our CTO and essentially prioritize the payers that you all, you know, that their highest priority to forefront faster so that no matter what the coverage is today, which is not 100 percent, you know, gets up closer to, you know, 50 100 percent quicker. I think right now generally across everything we’re around about a quarter Ish automated. And again, it varies depending on the specific payer mix. So for some clients, it’s higher for others, it’s a little, it’s a little bit lower. So, I totally hear the point, and it’s very fair.
Derek Lo (15:09) I will also say on the roster side, that is where we are essentially 100 percent automated and we essentially, you know, it’s a much Symplr process, right? To generate an automatic roster than to map, you know, a bunch of arbitrary enrollment forms. So yeah, we can get back with a more clear timeline and like specifics on all that. Yeah.
Taylor Williams (15:34) I think one. Sorry.
Corie Will (15:37) I was going to say, I think one point that Taylor is referring to is not necessarily the mapped payer applications but that there are fields on the applications that don’t exist in medallions. So if your team is having to manually fill in those and what are we doing to prevent that got?
Derek Lo (15:55) It, okay. That’s helpful as well. Yeah.
Taylor Williams (15:57) And to really, yeah, Corie spot on. I think the big thing is, you know, quite honestly that forefront review which listed here at the 50 percent, quite honestly, I’m like at two percent, if it truly is an automated link, once we review one or two or three or four and say, hey, that’s good. Like we’re good. Let’s move on. Yeah. And but anytime there’s humans in the middle of this, then it’s constant, yeah, yeah.
Derek Lo (16:30) We, we hear you loud and clear on, that makes sense. I think, on the point that, yeah, that Corie just made, I think we would like to maybe like, yeah, we’ll double take that as an action from today and, you know, Nate and I will sync up with Kate to understand what the just like to basically see that list cause, it’s not one that I’ve actually looked at yet for you all specifically. So, yeah, I like to know, what that gap is, and then we can also come back with the timeline on one, the feasibility and then two like, you know, which specific fields we can get put into the platform.
Taylor Williams (17:07) Yeah. Cause again… I mean, obviously y’all, if it’s better than anybody since you’re a technology company, it’s got to work, you know, better than we do. Otherwise, you might as well just keep the humans involved.
Derek Lo (17:21) Yep. Understood. So.
Taylor Williams (17:24) And, yeah. So here’s what I would like to kind of see. Well, and Corie said it until that, there’s a high degree of reliability where there’s less human hands involved in the process. It’s got to be a high rate of review… yeah.
Derek Lo (17:46) I mean, our hope, in everything that we’ve been doing the past, you know, especially week two weeks is, you know, where things are not yet automated to raise the bar on opera, you know, on the operational output, being high quality, so that, you know, no matter, the, you know, level of automation on the form mappings, you know, we are producing, you know, what we should be, and I think that, the spreadsheet and like QC checklist that, you know, again we should have had. I recognize many, you know, several weeks ago, is, I think now in place, and the team has been retrained on that and we’re going to make sure that, you know, that is closely followed. So, I think, you know, hope is that, you know, pretty quickly we’re going to see quite a dramatic improvement. I know that has not been fully realized yet. But, you know, we definitely can be uploading more of these now that we have the director from you all, to review these. I think we just didn’t want to, you know, to the maybe comment a couple of meetings ago on just like overwhelming you all, and being cognizant, of your time. But I understand that needs to happen, you know, now so that we can regain, some trust.
Taylor Williams (19:00) Yeah. And let me just kind of just… well does slide seven say, thank you. Yeah. Okay. Cool.
Kateland Sanders (19:11) Yes, it does.
Taylor Williams (19:12) All right. Just making sure before I kind of get to where we’re at. And so again, it’s the lack of in the question that I asked and I’ll just be super transparent because it’s just a lot easier than to have to worry about where we stand. The question I asked internal to our team is, do we think the problem is technology or people or human error? What just got us to here? And the answer was a combination of both. But I think the technology improvements can help with obviously reducing human error. I do think there’s been some recognized gaps in the manual intervention that has been… resolved or starting to be resolved? Where, you know, if I’m thinking fairly, it’s not fair to y’all to have to go through 100 percent review. On the other hand, you gotta go through 100 percent review because of where we’re at. And, you know, the constant like drain on your organizational resources bothers… me because one, it just means we’re not in a good spot.
Taylor Williams (20:32) But also, it bothers me because it means y’all are in a good spot organizationally and that’s more thinking about y’all, and I know you can probably say, well, Pam, that’s our company, we do what we gotta do, but it still bothers me. And so, you know, where we’re kind of stuck with this is like we need it to work. We don’t trust it. The drain on our team has been immense and quite honestly, we don’t know what to do.
Taylor Williams (21:13) Without a complete drain on your team to say, hey, y’all, gotta go back and get this right before you send it over to us. And so… before we get to the April third on, I… guess, let me just ask Corie and Skyler if Kate releases those submissions to y’all… is it, I mean, how big of a time consumption… is it to review all that?
Corie Will (21:57) I guess it depends on what it looks like.
Taylor Williams (22:05) I think for, well, I.
Taylor Williams (22:12) Sorry, is it like a day a week or is it we don’t know still?
Corie Will (22:19) Like if she sent them at four, we could have them reviewed by five or something like that. Like it’s pretty straightforward… okay?
Taylor Williams (22:28) I kind of go ahead I.
Kateland Sanders (22:31) Also was going to say Corie, if it’s more, if it’s easier for me to put them like in a folder like here’s, all of pnoa here’s. All if it’s like having to click through each task is a lot too. I can, we can also change that if that’s helpful.
Corie Will (22:44) No task is fine. Okay.
Taylor Williams (22:51) So, let me kind of just go back to this. You know, again, I think the, Derek… going back, I think kind of a review of the… manual intervention is where the QA process or the QC process, will, you know, be higher the more, unless we just start connecting technology with just hardwiring it to where we don’t have to worry about having to go back through all of this,
Taylor Williams (23:25) Corie, I guess once you and Skyler, start going through that, those list of enrollments obviously go back through the, some of the nuances that we had talked about, you know, whether it be mpi dbas, ownership disclosures and so forth. And then from that perspective, I think once we review it and make sure all the nuances are there, I think Derek come back and say, hey, here are the improvements we can do in technology that increases… the chance of obviously accuracy versus manual intervention. And then we can talk about, you know, what next steps there are like the April third going forward? Yeah.
Derek Lo (24:12) Yeah, that makes sense to us… in terms of next steps. So, yeah, we’ll plan to send those over. We can convene again as soon as tomorrow or whenever it makes sense to you all. And then, yeah, we can go from there. Okay?
Taylor Williams (24:27) Yeah. Let us, we will reach back out, but let us give us a chance to review. And then we’ll kind of, and then in the meantime, y’all, do, the review of technology automation versus manual intervention. Yeah, that sounds.
Derek Lo (24:43) Good.
Taylor Williams (24:44) And then just for, from my… just thought process.
Taylor Williams (24:55) What, how many? So there’s how many payers are we, do we have across three states that we’re playing with six or three? Or it’s six, six across three states. Yeah.
Kateland Sanders (25:12) Correct. It’s. I just switched the slide. It’s Arizona, Missouri, and Nebraska. Okay?
Taylor Williams (25:20) And there’s just a question, not saying that we do it or just say how many payers do we have in those three states?
Corie Will (25:50) I think I had done the math and it would be, I’m trying to think how many unique payers?
Derek Lo (25:59) I believe Corie, you would say, I don’t even know if they’re meaning like 40, but, yeah.
Corie Will (26:03) Yeah, 32, 32.
Taylor Williams (26:05) Across all three or per state?
Corie Will (26:09) 32 across all those states that are unique. Okay. So, some like obviously share.
Taylor Williams (26:24) And just a thought, I’m sorry, just a question again for me who?
Taylor Williams (26:33) How different or unique is like a medicare?
Corie Will (26:39) In each of those states, medicare is all the same… do what medicaid is vastly different?
Taylor Williams (26:47) Sorry, what did you say about medicare?
Corie Will (26:50) Medicare is all the same. Okay. So if.
Taylor Williams (26:55) and I’m just thinking through, if you turned on medicare, that would be, should be relatively easy, right?
Corie Will (27:01) We already have those done for this, these specific particular providers because we had to do that day one. And,
Taylor Williams (27:08) like a blue is different per state. Yes. How, how medallion do y’all, normally say? Okay, if you’ve got 32 payers across three states, how do you normally take clients through deciding where, when to go next? Who goes next and what to do? How do you, how do you review those nuances? So that instead of going through the trial and error that we’ve been through to say, hey, blue cross, blue shield, Nebraska, here are all the different nuances that we need to. And, my hope is to hear all the connections and hear the data fields that we need that you don’t have in your system and all that stuff. How do you connect the dots of all that, and then say, okay, now review this one so that it all of the work is done as Denise says, measure twice cut once. Well, I think she says that sometimes, but be, you know, be very methodical in the process before you hit the go button, yeah.
Derek Lo (28:15) So, so we have we, in the last, I think it was maybe two to three months. So I mean, it was like, right? I think unfortunately, right after getting you all on board with us, we essentially revamped this entire process and so like, our current process for this looks a lot like what we’ve kind of done in the last couple weeks and again, what we should have done at the outset. But essentially, it’s now, we have a whole set of standard payr processes. We call it, our payr directory. So, we would basically go in there, and show you this is like our process for, you know, the, these next set of payr’s you know, does this differ with, you know, how you all do things? And so, and if it does, then we go and then mark that down. And we essentially would add that to the sheet that we’ve created now, and then make sure that, you know, those custom sops are getting into the workflow. So that’s that is actually our process. Now, it’s something that, you know, has been a work in progress for a while for cases like this because I mean not all customers that we work with have custom workflows. In fact, it’s actually somewhat rare. And so it just kind of was a, you know, in this particular case, a confluence of like a bunch of things going wrong while this process had, you know, basically in implementation had not been redefined. And so, but, that is what we would do now going forward and what we’d suggest for like, you know, this next set once we’re hopefully able to, you know, to get there after this week.
Taylor Williams (29:44) Yeah. I, you know, I, not knowing the detail too much, I think that would be the preferred method versus, yeah kind of what we’ve gone through today. Yeah.
Derek Lo (29:55) Definitely.
Taylor Williams (29:56) Alrighty. So y’all, have the list of well, and instead of, I guess the technology stuff, I wonder if you’ve got your payr set up, maybe that’s more of what we look to for what’s automatic versus manual because I assume anytime we say we’re a nuance there that’s a manual versus a technology but maybe not, yeah.
Derek Lo (30:28) That’s a good point. We’ll follow up on that as well. Yeah. And then, and then, yeah, I mean, again, I don’t want to get ahead of ourselves. But if, whenever you all feel ready to send us the next set of payr, assuming I don’t maybe we already have this. If we don’t that would be helpful. And then we could also look at of the next cohort, what do we already have automated? So we can go and look at that too. And if we’ve already received that data, then we’ll follow up, with our team to get it.
Taylor Williams (30:57) Okay. So, so let’s do this for today’s call, and then I will put a maybe next steps would be. So as of today, we’ll review the enrollments that you’ll release soon. And then Derek, if y’all can go ahead and start getting together the 32 payers that we have across these three states look to start looking at your, I call it profile or whatever it is that you refer to.
Taylor Williams (31:30) And then once we review it, kind of understand where we’re at with it, then maybe the next call be how… nuanced are the, some of the payers? And then, you know, I guess going from there, how much of technology is going to drive it, maybe we start with those versus the manual. We put those toward the end… that’s boring Corey and Skyler’s thumb stamp of approval on what’s being said today.
Taylor Williams (32:06) Okay, awesome.
Derek Lo (32:09) Thanks a lot. Thanks. Okay.
Corie Will (32:12) Talk to you soon.