Transcript
Gabrielle Norton (00:00) sorry, I said hello and realized I was on mute.
Melinda Saylor (00:03) Oh, I didn’t even see you trying.
Stephanie Ryan (00:04) to talk. Sorry, I would have called you out. Thanks for sharing Rae.
Gabrielle Norton (00:13) Yeah, happy to.
Stephanie Ryan (01:01) You don’t see them in the waiting room, right? Rae? Yeah, or did they just join? Okay?
Gabrielle Norton (01:06) Yeah, I haven’t pulled up. I don’t see anyone yet. I.
Stephanie Ryan (01:09) Think gabby’s joining this too, but she was just going to listen in.
Stephanie Ryan (01:36) Just waiting on the optum team right now. And I think it is only going to be Kim and Melinda. I didn’t add anybody else from the team. So, unless it got forwarded, it would just be the two of them.
Gabrielle Norton (01:54) That sounds good. And do they know everybody on here’s? Staff? I think they do, right?
Stephanie Ryan (02:02) They have not met Leah. So we’ll do some quick intros just so that they can meet Leah? Perfect. But everybody else they should know.
Gabrielle Norton (02:12) Okay. That sounds good.
Gabrielle Norton (02:30) There’s Kim.
Gabrielle Norton (02:43) Hi, Kim. Hi, Melinda. Hello?
Stephanie Ryan (02:47) Hey, there. How’s it going?
Melinda Saylor (02:50) Good. How are you? I?
Stephanie Ryan (02:52) Am good. You’ve got the medallion crew today. Lucky you. I think you know almost everybody on this call. We do have a new product leader. Well, newer, Leah, you’ve been here for a few months now, right?
Leah Wajnberg (03:06) Four and a half months four?
Stephanie Ryan (03:08) And a half, but who’s counting? So, I thought it would be helpful to introduce you to Leah and then Kim and Melinda, if you wouldn’t mind introducing yourselves as well. I think that would be helpful. And then we can go ahead and get started. Does that sound good?
Melinda Saylor (03:22) Sounds good? Cool.
Leah Wajnberg (03:24) Go ahead, Leah. Great to meet you both. I’m Leah, I’m chief product officer here at medallion, I joined in November prior to starting here. I have spent my whole career in healthcare, started out for many years in healthcare strategy consulting at BCG.
Stephanie Ryan (03:40) And.
Leah Wajnberg (03:41) then spent the last four years prior to medallion at spring health, but very happy to be here and excited to get your feedback today.
Stephanie Ryan (03:51) Thanks, Leah.
Melinda Saylor (03:54) Kim, do you want to go first? Yes.
Kimberly A Harberts (03:58) I’m Kim, harberts, I’m the director of behavioral and physical health credentialing, and I report to Melinda and,
Melinda Saylor (04:07) I’m Melinda Saylor, I am the director of our provider and member operations for behavioral and physical health. So, I lead teams beyond just credentialing, but my history is cred.
Melinda Saylor (04:22) So, Kim and I are excited to hear what you have to share with us today. Nice to meet you, Leah.
Leah Wajnberg (04:29) Nice to meet you too.
Stephanie Ryan (04:31) Alrighty. Rae, if you wouldn’t mind advancing the slide from an agenda perspective, just completed intros. I’ll do a quick product performance review just to tell you like how many cred files we’ve generated, how your SLA is looking, things like that. We are going to spend the bulk of the discussion on the product updates. So, Leah and Yenny are going to be talking about the shared credentialing and kind of where we’ve been and where we’re going and where we’re at today. And then we also pulled together a list of your product feedback or requests that we thought that we could review. We wanted to learn a little bit more about those requests and then ultimately have your team kind of review and kind of rank them from a priority perspective. So we’ll spend some time there. And then a few weeks ago we met because there was some invoice questions. So we have updates on that and we’ve turned it into a corrective action plan to ensure that we have alignment going forward and there’s no confusion. So we will end there and then talk about just next steps and feedback. The intent today is supposed to be conversational. So please stop us along the way with any questions that you have or feedback. We don’t want to be talking at you for an hour. We’d like to be talking with you. So looking forward to a good discussion before we pivot into product performance, any initial questions or items that we are not capturing today that you’d like us to take offline and look back on?
Melinda Saylor (06:09) Okay. Go ahead. Nothing for me. Sorry. I would just, I’m going to let Kim drive from our side as much as possible, but I don’t have any questions.
Kimberly A Harberts (06:19) Yeah, no, I think we just go. And then we’ll see where it leads us.
Stephanie Ryan (06:24) Sounds good. Thanks, Kim. Okay. So from a product performance perspective, this is your total cred files to date. We have delivered 89,903 credentialing files. This data was pulled yesterday.
Stephanie Ryan (06:41) So it says pretty much up to date as it can be in terms of your turnaround time. So that is your median days from when the credit file was requested to the provider application actually being completed. That is two days that metric has stayed the same since I shared this out. I believe in February or maybe it was January but still seeing that consistent two day turnaround time, 100 percent of your providers have been recredentialed on time. And in terms of your SLA, we have hit that at 100 percent and the SLA within the contract is 95 percent of files being returned within five business days. So from our perspective metrics are looking really good, but I’d love to hear from you on any feedback that you may have. From a performance perspective. I know there’s a couple of things that Ray has been working on with the team, but curious to get your thoughts on where you think we should be focusing or where you’d like to see metrics that you don’t see on the slide today, but could be helpful in the future.
Kimberly A Harberts (07:48) From my perspective, can you define the two days again? I’m curious. Does that mean two days from the time we send it to the two days when we receive it back? Is that what your two day turnaround time is?
Stephanie Ryan (08:01) Yeah. So when the cred file is requested from your team and the application actually being completed?
Kimberly A Harberts (08:11) And the percentage of two days is on files right now. I’m just curious too because in there, we, I would like to see like the incomplete… the missing information, no apps, you know, what those put that into that because I know that we get given back but we see, you know, a pretty high percentage of applications both on the re, cred and the cred to come back that have missing information. And so I think we need to look at those metrics too and identify where our opportunity is going forward. So we can tighten that piece up too. Yeah.
Stephanie Ryan (08:55) For sure, Rae, let’s take that one offline. We’ll see what we have in the back end that we can share out. And we can make that a little bit more visible to you from like an ongoing perspective so that we know where we can partner to help improve those metrics.
Kimberly A Harberts (09:13) And then also like the quality metric here because I’m not seeing the quality piece because I know we’ve had lots of conversations about you putting guardrails into specific files, specific elements, getting pick lists… you know, some of the things that we have found. So I would like us to start monitoring those different areas and buckets. So again, so we can make progress and make improvements so that we’re confident as we change our end to end process as we’re you know, pulling the files in, we’re trying to push them straight through that we’re confident of the quality that we’re receiving within, those files. Okay?
Stephanie Ryan (09:55) Really helpful feedback. We will take that back here and see what we can come up with. Rae. I know that you’ve been working through the end of week summary. We can see if we can maybe add some of this into that as well. Yeah.
Kimberly A Harberts (10:10) I think that would be helpful. And I do, I will do a call out as far as from the recredentialing on time. I know that we’ve been receiving the files back. I do believe within… December or January, we, you know, we received a lot of 500 files closed towards the end of the month. That was really hard for us to manage. But I know that those numbers have come down significantly the end of the last two months. So thank you for working through that and ensuring that we, we’re not getting, you know, one big push back to us and that they’re not all just files that we couldn’t close or complete. So you guys have done a good job in the last two months completing those files. So, thank you. Yeah.
Stephanie Ryan (10:59) Of course. Thanks for that feedback. It’s nice to hear that that’s working well. We’ll continue the process that we’re doing today. But if we ever need to revisit that conversation, if you’re seeing an uptick, please let us know. But I think Rae, from an internal perspective, I think we worked that out and we don’t anticipate any hiccups going forward or an influx of requests that they were seeing, right? Correct? Yep should be all good, perfect.
Kimberly A Harberts (11:26) Melinda, anything you would like to see here? No, I think you covered it. Perfect.
Stephanie Ryan (11:33) So I’m hearing quality metrics for sure. We will, we will take that back and see if we can add that into the end of week summary. And then if we can give you more insight into kind of the statuses, right? Like what’s missing? How long is that sitting? Like those turnaround times? So we’ll get creative there and try to fold that into more regular reporting for you as well.
Melinda Saylor (11:59) Thank you. With respect to that. Though, I would say for example, the roughly 90,000 total credit files delivered to date. It would be helpful to know how many of the 89,000 came back to us partially complete. Maybe there was a data element you couldn’t verify the provider wasn’t responding. So, how many of those came back to us? Incomplete? Meaning we had to do additional work before it could go to our Creg committee. How many of the files came back to us with a bow on top because everything was verified and it matched optum’s criteria that we’ve given you. And so it should have been pretty much hands off for us. How many fall into a bucket where the provider reported that they relocated, they’ve retired. You know, you weren’t able to complete it because there was some issue even if that bucket was all bundled together and you didn’t get too granular. I think it would help us to see, you know, what is it, does it match what we’re experiencing day to day? Do your numbers match what we’re feeling? If we’re having to do extra work to get the files completed, then, you know, this slide seems to not be accurate, right? If it feels painful on our side, seeing that you’re reporting two day turnaround time and 100 percent across the board, something’s not matching. So I just, I think right now to Kim’s point, you know, and I shared with Derek recently, I mean we have seen our turnaround time come down for our initial credentialing files since we started working with medallion. And I think that’s I attribute that to the partnership that we have, the ongoing work that both teams have committed to this arrangement. Also some of the technical enhancements on our side that allow us to consume your files in a more automated way than we did with our previous vendor. And so there is a positive story here. And I want you to know even when we give you what I’m going to call constructive feedback, I want you to know that we are still very supportive of medallion and this partnership and to the point that there are other teams within our organization that are going in a different direction and we continue to commit to this partnership, but it’s only going to work for both of us if we can be honest about where we’re falling short. And so I hope that these meetings can help us kind of identify those opportunities. And then we can work together to make it better. Yeah.
Stephanie Ryan (14:38) I completely agree with you Melinda very much. So aligned there. Appreciate the feedback that you’re giving it’s only going to I think strengthen our partnership. And as we can give you more of what you’re looking for from a reporting perspective, I think it will shed light on areas where we can all improve. But it will also, you know, back up the data that we’re showing you today, assuming that it aligns… all good feedback, great recommendations and things that we will consider as we move forward. The intent with these is that we are meeting quarterly to share more from a higher level because we are so in the weeds with your team from a day to day weekly basis. So we’ll make sure that we’re capturing meaningful data for you and have the metrics to back it up too. Thank you. No problem. All right. I am going to pass it over to Yenny. She’s going to be reviewing like I said, the shared credentialing updates, where we’re going where we’ve been, and then we’ll talk about some of your product requests as well. So go ahead and advance one more slide Rae. And then Yenny, I’ll turn it over to you. Thanks.
Yenny Zhang (15:54) Daph, and thank you Kim and Melinda for making time today. So I’m going to provide an update on where credalliance stands specifically on the shared credentialing piece, which we know is a huge part of why you joined credalliance. So we’re going to be direct about where things are, what’s being built and what to expect next. So, over the past year, credentialing has been occurring independently for each credalliance member. This means and most members use the medallion platform in its entirety for credentialing, meaning they store committee votes in platform and have medallion schedule recredentialing such that medallion has a full picture of approvals and rejections. Other members like yourself, give us monthly networks of recred universes. And so as you can imagine, each member has its own quirks and nuances in their credentialing workflows. So we’ve been hard at work trying to support everyone’s individual needs whilst also thinking about how to support credentialing in a shared fashion. Now, credalliance has reached the membership scale in which building out and establishing the parameters of shared credentialing is our primary focus. So, our first target for shared credentialing that we’re working on right now is the recredentialing date alignment engine which is on track to go live in may. And to put it simply, what the engine does is identify overlapping provider npis across credalliance, members to assign a single aligned re, cred date for that npi. One thing worth explaining in more detail is that the alignment engine is designed as a compliance calculation across all members. It uses optum’s dates as a baseline for initial alignment. And subsequently with every alignment action, our engine will ensure that no member is pushed outside of their re, credentialing compliance window. So for optum, we don’t expect any significant disruption to your existing re, credentialing cadences since you’re establishing that first set of aligned dates. And as a part of the release for the alignment engine, you should expect to see reporting that communicates shared re cred volume versus standalone re cred volume along with original re, cred deadlines and shared re cred deadlines. A part of this alignment work means working towards greater consistency across all members. So not just the re cred deadlines, but on the full shared re credentialing window leading up to those deadlines. And that means standardizing both the re, cred start date and the SLA. So every member is working on that same timeline and the benefit to your team is more predictability and file completion and fewer surprises cycle over cycle. This is necessary to respect every member’s regulatory requirements, whether they be from CMS medicaid or state rules. Some of those requirements as you know, are time based. So it’s important that our standard re cred windows give not only your team but other members enough runway to act on completed files before any deadlines hit. And then finally timely visibility into provider terms and rejections is really important to keeping the program running smoothly. This helps us improve predictability and certainty. So we aren’t waiting or guessing to get an updated re, cred deadline from a provider that is needed for alignment. And so, to reiterate the date alignment engine is going to establish that shared re, cred deadline for re cred requests that share the same provider npi, and what’s left to build is true deduplicated provider and third party outreach and shared primary source verifications for that full streamlined and complete shared re credentialing experience. Any questions about this? Kim and Melinda?
Yenny Zhang (19:46) Melinda, I think I’ll let you go first. Okay? Since you kind of started this project with them.
Melinda Saylor (19:53) Yeah. So are… we the outlier in your portfolio? I mean, you mentioned that many of your other customers could have used the full end to end medallion experience. And so I’m just curious if we are the anomaly and what challenges you anticipate with the alliance. If we, if we really are, the one different thing in the box?
Yenny Zhang (20:25) You aren’t the one different thing there are, there is another member that operates similarly to you or we receive like the monthly network files. So I wouldn’t say like optum is like completely different from everyone else, and I would expect that to see additional members probably act in the same way. I think to… the point I made about like receiving explicit rejections and terminations that is really important to ensure predictability. But it’s not like we can’t operate shared recredentialing without those things. Like it definitely helps. But it isn’t going to stop us from doing credit alliance if that makes any sense. Yeah.
Melinda Saylor (21:11) I don’t know if we have the right people on the call, but I’m curious what’s your confidence level with?
Yenny Zhang (21:20) Being.
Melinda Saylor (21:20) able to really launch this, and get momentum behind it? And do you have, even if you don’t tell us who they are? Do you know who your competitors are? And can you give us any sense of how you’re tracking against the progress they’re making? My question stems from the fact that we hear this from other areas and I’m trying to gauge… is the race competitive or, you know, is medallion right there running with the others? And, and, you know, has a shot at really standing this up or do you, I mean, I don’t know, I don’t know that you would tell me if you didn’t think you could do it, but I just, I’m trying to get a sense of what your confidence level is in being able to turn this into something on a national level that really starts to drive meaningful change for the provider. Does it make sense?
Yenny Zhang (22:21) It does make sense? We certainly hope we can do it. I think, you know, as Yenny mentioned, it’s been less.
Leah Wajnberg (22:30) than a year since the official launch. And so it’s really been focusing on getting to this initial level of scale where it makes sense to build out these comprehensive features that Jenny just walked us through. But we’re very optimistic in like the growth path ahead. Acknowledging your point. There are other companies that have, you know, made similar announcements since ours, and we are tracking that and are continuing to invest here so we can stay at the forefront of the market. Okay?
Melinda Saylor (23:02) Great. I don’t think I appreciate the update on the credalliance, it is something that is on our radar and we’ve asked about it before. So it was helpful that you had included it in today’s deck. And it sounds like, you know, good progress. So, for us with the may launch, is there anything we should see operating differently? Or will this be, will this first go live be seamless to us?
Yenny Zhang (23:40) Because you’re setting the initial aligned dates, you shouldn’t see much difference and like, your recred deadlines basically like shouldn’t be moving at.
Leah Wajnberg (23:52) All.
Yenny Zhang (23:52) And.
Melinda Saylor (23:53) our interactions, the files we send you and data that we get back there, won’t need to be any changes to that either?
Yenny Zhang (24:01) We are ensuring that for shared recredentialing, we’ll have the same recred periods. So to be specific, I know right now, excuse me, recredentialing… starts. I think like five months out, for optum. And so we’re for example, we’re looking to shift that to just like four months out to establish some standardization on when credentialing happens for those shared credentialing requests. But other than that, we shouldn’t see any changes to like when files are delivered before the deadline et cetera. So, okay, thank you.
Stephanie Ryan (24:48) Okay. Any other questions on the shared credentialing updates that we’ve provided? As we get closer to that may launch, we’ll obviously be communicating with your team and making sure that we’re staying in lockstep there. But any other questions or comments regarding the shared credentialing piece of the partnership?
Melinda Saylor (25:09) No, I’m good. Thank you. Okay.
Stephanie Ryan (25:13) Then Rae, we can talk through the product priority requests, go ahead.
Rae Tompkins (25:19) Absolutely. Yeah. So one of my roles as the engagement manager for optum is working with optum compiling feedback and then sharing it across teams in medallion. So a lot of the product requests that we discussed recently, I’ve put onto this table so that we can kind of level set the expectations and making sure that we’re capturing all the needs that have been flagged by optum. One of the first things is source name. Optum has flagged that medallion should limit the amount of text that’s populating. As we understand sometimes our agents are typing too much into that text box and it’s causing some issues whenever it’s coming over via Salesforce. We have submitted a product ticket for this item. In the interim. Agents have been notified to limit that text. So that there isn’t any issues. When it’s ever, you know, pushed over to Salesforce, that obviously is a smaller text window.
Leah Wajnberg (26:10) Are you.
Kimberly A Harberts (26:11) guys considering doing a pick list? I mean we’ve had these conversations before to standardize the information that’s coming over. Because when you’re doing freeform text and you don’t have pick lists within the processing of your cred files. Again, it doesn’t standardize it from an auditing and quality perspective. And also from a processor perspective. If we’re reviewing a file, you know, it’s not consistent.
Rae Tompkins (26:39) Absolutely. Yeah. Yenny. Do you want to? Yeah, yeah.
Yenny Zhang (26:43) We are aligned with you on the quality issue and just like the amount of variability that a free text box allows. So, we are planning on adding like a drop down such… that a specialist can only select from a limited set of source names right now, the interim is we’re giving, that list to ops to choose from, and then we’ll build it into the product. So that is planned for next quarter.
Rae Tompkins (27:13) Perfect. Thank you, Yenny. Any additional questions on the source name?
Kimberly A Harberts (27:27) Moving.
Rae Tompkins (27:27) ahead to expiring items. One of the items that optum has flagged is if an item is in the cred packet is nearing expiration, it should not be allowed to be marked clean but held back for additional processing. One example that was provided was that the pli expired between initially receiving the complete app and closing and was not caught by the agent. Again, this is something that I’ve also submitted a product ticket for. In the interim agents have been instructed to review expirations prior to marking the file clean, so that there isn’t any future discrepancies in this area. And.
Kimberly A Harberts (28:00) Then there, again, we’ve had these conversations about the fact that if data is coming over, we shouldn’t be receiving expired information. If there are guardrails in your system similar to what we have. If we send something over and it’s expired, it won’t. Let us move the file forward. Are you planning on putting those mechanisms in place so that we can ensure that we’re not receiving expired information and that the right application is being used when you’re pulling the information? Because I think we’ve seen that happen where a new, you know, pli is being used out of the application and caqh is the source and it’s not the most updated application that’s coming over to us?
Rae Tompkins (28:47) Absolutely. And that’s something that we’re working internally? And I do have some feedback for our next call regarding, the plis that were prevented in the caqh, but the application wasn’t on file, so that we’re going to ensure that whenever we get an updated page that has the updated source information that the newest application is pulling in. So it’s definitely something that we’ve identified with the team and going to ensure that it happens moving forward.
Kimberly A Harberts (29:18) And then do you have a, you said, what’s the timeline on that… this?
Rae Tompkins (29:25) Is we’ve submitted, the product ticket for our team to investigate? But the purpose of this slide is really trying to work with optum to understand, the priority ranking. So, one of the things that Steph will flag at the end of our call is giving optum the opportunity to kind of review this list and rank what is most important to optum as our product team prioritizes the feedback received. Okay.
Stephanie Ryan (29:50) Yeah. I would also just add in addition to that, we thought we captured like the big ones that we’ve been working through. But if there’s anything that we’re missing Kim, your team is welcome to add more to that and prioritize. But this was kind of what we had gathered from like a holistic level. But if there’s more that we need, to be reviewing and prioritize, let us know too.
Kimberly A Harberts (30:19) Sounds good. And.
Rae Tompkins (30:20) Then jumping ahead to the next one, the ability to submit a new request for a provider that’s already in platform. So, there’s been a lot of ongoing discussions about optum’s ability to resubmit a file for a provider who’s already been cancelled or withdrawn, including instances where it’s a non reciprocity state. So we’re looking into the ability to re, ingest these files and working with, you know, our product team to kind of understand the feasibility and what that looks like.
Rae Tompkins (30:52) Any questions there?
Stephanie Ryan (31:00) No, perfect. And then.
Rae Tompkins (31:01) lastly, optum does not want the mpdb ran for files that are not marked complete.
Rae Tompkins (31:06) So mpdb is automatically initiated at the start of a credentialing file. However for files later archived and not fully processed, optum would be charged for the mpdb enrollment. And then there is a solution for this in Q2 of 20 26. So that definitely will be solved moving forward this.
Kimberly A Harberts (31:24) One I’m concerned about because we had this conversation, I believe in August and September and it was still being done. So it was from my understanding that this was fixed and that the mpdb wasn’t being pulled.
Stephanie Ryan (31:42) This did come up during our invoicing discussion, which is the first time that I was hearing about it. I can’t speak to, what happened in the past here. But when talking with the team internally, we have committed to solving for this quarter. And what we’re planning to do is just pull anything that you’ve been charged for to date and we will credit you. And then once this is in place this quarter going forward, we should not see it again. So there is commitment on our side, to get a solution in place in the coming months here. But at this time, there wasn’t a fix. And so it is still charging you at this point for anything that wasn’t completed, but we are pulling a report to determine that impact and then to credit you.
Yenny Zhang (32:32) Back… is the.
Melinda Saylor (32:34) fix focused on the charges or on the timing of running the mpdb?
Yenny Zhang (32:42) So there is two parts to this. So in the interim, while we build the fix in the product, which is to not run mpdb until we have that complete application, I believe we’re doing, the.
Stephanie Ryan (32:56) credits back once.
Yenny Zhang (32:59) We have the solution in place in the product, we won’t have a need to issue credits back because we shouldn’t be running mpdb prematurely. Okay? Great.
Stephanie Ryan (33:09) So, apologies for the confusion there. Happy that we have line of sight into it now and commitments on our end. And we’ll make sure that we are not charging you or you’re not paying for anything that you shouldn’t be. We’ll we’ll be crediting you back and that’s something that within our invoice cap review, I’ve noted and Tim from our finance team is committed to having the numbers by the end of this week here of what that credit is going to look like.
Melinda Saylor (33:40) And you said the solution will be delivered this quarter today’s the last day of Q1. I assume you mean Q2?
Stephanie Ryan (33:49) Yes. Sorry for the confusion there. Nope. I just want to clarify. Thanks. Okay.
Stephanie Ryan (33:57) Before we advance and look at the invoicing questions, Kim, maybe I’ll ask you, is what we captured here. Feel accurate from the conversations you’re hearing from your team, is there any more feedback or requests that we should be looking at as we start to prioritize and determine what we can and cannot do on our end?
Kimberly A Harberts (34:24) I’d like to take it back just make sure there’s nothing at this level that we’re missing. I do know that we submitted the checklist a couple months ago, and at that time, my understanding was that the checklist updates would be done the end of March. Obviously, that won’t happen. So would like to know, you know what that timeline is to update the checklist. We’re still working through the license… grid that you guys sent back because there was inconsistency. So we’ve just been doing a full research of all the licenses again. So we need to have that conversation of if we can update specific licenses as a priority and kind of work through the licenses so that we’re not getting so many coming over as other. So we would need to add that here too… yeah.
Stephanie Ryan (35:21) We can absolutely do that what I’m thinking we’ll do just so that it’s a little bit easier for our teams to work and make this more digestible. We’ll put this into either… an excel spreadsheet or a Google sheet and your team can edit and we can edit. And that way we’ll have the latest kind of working doc together.
Kimberly A Harberts (35:41) Okay. Sounds good. Okay.
Stephanie Ryan (35:44) All right. Then let’s keep moving here. Next is the invoice corrective action plan review. And there’s kind of two prongs to this. So Tim from our finance team was looking into the caqh charges and the npdb charges that were in question. And then merit and her team were looking at lihcc and the national student clearinghouse… questions that you all had. So Tim was not able to join the call today. He is out of the office. But with the caqh charges based on the conversation that we had a few weeks ago, it looked like there was… you guys had identified multiple unique mpis that were billed more than once.
Stephanie Ryan (36:33) So there was some duplicate billing happening. It sounds like from Tim’s review here, there were profession types that were updated and that triggered another caqh charge. And then there were some additional caqh billing errors for some of the providers in January. And so Tim committed to having his final review of the duplicates and any errors completed by the end of this week. And then we would be sending you a credit. And then additionally we’re working to resolve the invoicing issues that we’re seeing with caqh. So nothing that your team is doing incorrectly or that you have to do on your side, we just need to review and credit you for the duplicates and then resolve… why we’re getting another bill with caqh when profession types have changed. So we will have a full review to you and your team by Friday of this week with the total of what we will be crediting you for those charges. And then with go ahead.
Kimberly A Harberts (37:49) And that’s a full review of the whole invoice from August to the end of January. You guys are reviewing everything because we just gave you what we had reviewed. At that point, we’re continuing to review the rest of the line items. So I just want to make sure that we’re speaking the same language that you’re reviewing the total from August to January or you’re just reviewing what we had identified at that point. We.
Stephanie Ryan (38:18) are reviewing everything from August to January?
Stephanie Ryan (38:26) With the npdb charges, looks like there’s a few different things that you all had flagged. There was the duplicates that were being charged twice the caqh applications that were canceled, which we just discussed. And then there were some unknown charges for npdb renewals that you had questions on as well. In Tim’s review, there were duplicate charges that was a one time issue that occurred in August and September of 20 25. And has since been resolved that being said we owe you a credit for those duplicates. So we don’t anticipate seeing any more duplicates going forward, but we do need to credit you for those. So we will again with our review that we are sending you by the end of this week, we will also be sharing what will be credited for those duplicate charges. And then for the caqh applications, we are working on that resolution for Q2 of this quarter, we will plan to pull everything from the last credit that we gave you until that’s fixed and give you a credit for those as well. And then going forward, we should not see that issue anymore because we are correcting it from a product side and it shouldn’t be triggered too early this time going forward. And then for the unknown charges, based on what Tim was telling me, it sounds like there were some providers that like maybe renewed in October. And then npdb like sent them again for a renewal in January. We’re thinking because it’s the start of a new year, but we don’t think that we should like it should have been charged. If you paid for it in October, you shouldn’t have to pay for it. Again. In January, it should be the month that you renew in October. So Tim and his team are working through that piece. And then they’re also planning to provide you with the provider level detail of all the npdb renewals on your invoices going forward.
Melinda Saylor (40:45) That one seems a little confusing to me. So I think we’ll look for some of that detail in what you’re sending us by Friday. If we have additional questions, we’ll circle back with respect to the, I think it was the caqh issue… the one that happened in August or July, August, or did I, sorry, do you remember which one you were saying that about it was August? Or maybe it was the mpdb? I guess I just, I’m curious if you.
Stephanie Ryan (41:20) Did you?
Melinda Saylor (41:21) Know about the problem on your own or did it only come to light when we questioned the invoice? Because honestly, it’s too, the concern would be if you knew about it then why did we have to come to you and say you’re billing us inappropriately, right? If you didn’t know about it? The concern is what controls do you need to implement to have better control over billing? Because obviously, we’re all watching, our pennies, and, you know, need to make sure that everything balances out. So, what… can you tell me more about that? Yeah.
Stephanie Ryan (41:59) Merritt, I’m not sure if you recall if we discovered this in August or September. I can connect with Tim when he’s back. I think he gets back tomorrow and get a little more information. I’m just not sure if you have more background or not.
Merritt Miller (42:13) Or, and just to make sure I’m following the mpdb issue or, the duplicate issue.
Stephanie Ryan (42:19) The duplicates. They, I, it was initially discovered in August September, but it sounds like it was corrected. Go ahead.
Melinda Saylor (42:29) It looks like I believe, it was.
Merritt Miller (42:31) A joint because they, I think it resulted in some duplicate files as well. And so, I think both teams were seeing that happen. So that’s my understanding, but I can take a pass back and make sure that’s been fully resolved. I.
Melinda Saylor (42:45) Guess I’m looking for you to help me have confidence that going forward the invoices will be accurate. And you know, we will still, I think based on what we’ve experienced to date, we will continue to scrutinize those invoices just to make sure that the numbers are right? But realistically, we shouldn’t have to do that.
Melinda Saylor (43:08) So, I’m looking for you to, you know, help me become confident that going forward, it will be okay. And, if there were, if you had a known issue, I’m concerned if you didn’t take that to the next step to say, how did this impact our customers? We need to proactively look to see if we owe them a credit and if you didn’t know about it until we pointed it out again, I’m concerned that you don’t have the right controls in place to make sure you find things before your customer does. I don’t.
Stephanie Ryan (43:41) want to speak for Tim and his team’s process. I will Melinda, I will share this feedback with him. It’s very valid and make sure that after their review and their write up of kind of what we owe you, that we include kind of what checks and balances their team is putting in place so that you feel confident in the invoices that we’re sending you. And then additionally, I think… you know, we’re looking at invoices that are going back to August, if we can agree kind of together that we’re going to review these more frequently and catch any errors… more proactively I think that would be really helpful too from our team’s perspective. So, I’m going to connect with Tim. I’m going to get a little more background from him on the one time issue, how it was resolved?
Merritt Miller (44:34) Why?
Stephanie Ryan (44:35) We wouldn’t have taken it a step further initially to credit you. And then what checks and balances his team is going to put in place to make sure that from an invoicing perspective, you feel confident in what we’re issuing month over month or quarter over quarter. Okay? Thank you. Yep.
Merritt Miller (44:53) Thank you.
Stephanie Ryan (44:54) Now, I know that the lithic charges and the national student clearinghouse charges Merritt your team was kind of looking into and researching what was going on there. Do you want to talk about lithic first? Yep?
Merritt Miller (45:09) So with the lithic charges, we are doing a line by line audit like Steph kind of indicated for some of the other items where that’s at today. And what we’re kind of seeing as trends is there are some expected charges and some not expected charges mostly due to, in some cases, the team is like pushing a button that kind of charges the card twice that should not be happening. You’ll definitely get a credit for those scenarios. We found other use cases where the team was actually trying to be efficient and buy multiple at once and kind of disperse them, which is leading to really confusing invoicing. And we have corrected that behavior. So for the lithic charges, we’ll kind of return to you a line by line with our findings there for you all to take a look at. And then just part of this whole corrective action plan that Steph and I chatted with Tim is we plan to look at the invoice before it goes out to you in the future, so we can kind of take a pass and make sure that the changes we’ve implemented are reflected on the invoice going forward. Before I get into national student clearinghouse. Any questions on the kind of lithic line item? I’m good. I appreciate the update. Kim, is there anything you wanted to ask?
Stephanie Ryan (46:24) No.
Kimberly A Harberts (46:24) I think I’ll just wait and see where we’re at with it. So. Okay.
Merritt Miller (46:30) For national student clearinghouse, what this one was pretty broadly across the board was that we were not using the evidence from the state boards which I know you all kind of called out and put like a lot of details into the invoice for us to review. And so the, we’ve been working since we got that feedback from you all to improve our list of applicable state boards we can use there and the evidence that we maintain. So we’ve kind of assembled a tiger team on my side that is spending all day just trying to collect these and looking at optum’s universe of files to make sure as files come in that we’ve got the applicable state board. If they do primary source verify education so that we can use that instead. So that will kind of all be taken into consideration for the credit. And we just wanted you to know that we were gonna close that gap as quickly as we could on our side. Thank you.
Stephanie Ryan (47:28) Okay. So we will have a full review to you all by the end of the week with more of a summary of what we’re doing to ensure accuracy here… and then feel free to set up more time with us to talk through our findings or we can connect via email as well. Let us know what works best for you, but happy to set up another call to actually review it if we need to.
Merritt Miller (47:57) Sounds good. Okay?
Stephanie Ryan (47:58) Thank you. And then just wrapping up here in terms of next steps, go ahead, Rae… from a product priority perspective, we’d love to get the team’s feedback by April seventeenth. If that’s possible, that gives you a couple weeks to review the product slide that Rae reviewed, determine what your priorities are. And if there are other asks that we need to add to that, we will, I will plan to turn that feedback document into a working document that we can share back to you all. And that way you can add in your priorities, your feedback and any additional items that we may not have flagged. And then once we’re able to get your priorities and your feedback, ideally, we can review that and determine like a go no go with you all by the end of April. Does that timing seem like it works for you all or do you need more time to review?
Kimberly A Harberts (48:58) No, we don’t need more time. We can get that turned around pretty quickly. If you can give us the list, we’ll add our other priorities to it and we’ll rank them for you.
Stephanie Ryan (49:07) Perfect. That sounds great. And then with the invoice cap items, we will get you that final review by the end of this week.
Stephanie Ryan (49:16) And what we will want to know from you once we’ve got your sign off and your understanding of those issues, if you want it to apply to your April invoice, which I think is issued on the ninth. So that might be a little close from a timing perspective, but we also have the option to apply it to any unpaid invoices that we have to date too. So don’t need an answer on that today, but just know we’ve got a couple of options for how we can apply those credits.
Melinda Saylor (49:50) I’m leaning towards saying yes to applying it to the April invoice, with the assumption that if we find that there are some details in dispute and we sort that out and it warrants additional credit, that can be applied to a future invoice. If that feels too messy to you guys or if that wouldn’t work, then I think we’ll likely have to look at may, I want to be sure we have some time to look at this and, you know, kind of get it, right? But I’d… be okay if you apply what you believe is the right amount to April. And then if, as long as you agree that if we discuss further and between the two of us, we determine there’s some additional funds due to optum, that you would apply it to a future invoice. Okay?
Stephanie Ryan (50:41) I think that’s fair. I’ll confirm with Tim and let you know, but that we’ll just say for now that’s the approach that we’ll take.
Stephanie Ryan (50:49) And if anything changes there, I’ll let you know. Perfect. Thank you. Okay. I will also share this deck with you guys after the call, so you’ll have something to look back on. But from a content perspective that’s really what we had prepared for the discussion. I’ll open it up to the two of you. If you have other questions or things that you’d like to talk through. We do have about nine minutes.
Melinda Saylor (51:15) No.
Kimberly A Harberts (51:18) I’m good. I’m just wait, you know, wait for the findings. We’ll get them priority list and I think I’m good today.
Stephanie Ryan (51:25) Perfect. Okay. Well, thank you both so much for your time. Again. The intent is for us to do this quarterly so you will see and hear from us a little bit more, I think than you have in the past. And if any questions come up after the call, don’t hesitate to reach out. We are here to support you. Okay?
Melinda Saylor (51:43) And actually, I apologize before we wrap really quickly, Stephanie. I had owed you a response back regarding our physical health credentialing business. And so, I think, Kim, I believe what I saw come through email just a day or two ago or maybe a week ago, was the roster for physical health? Is that right? Correct?
Kimberly A Harberts (52:02) It’s the universe for physical health. So I.
Melinda Saylor (52:05) think on our side, Stephanie, we’re pretty close to being able to sit down and at least talk about that. And to be completely transparent, we’re kind of 50 50 on whether or not we would move forward with rolling them into this business. We have a relatively small team despite the fact that they do the credit in house. It’s not a huge workforce. And so we were like many companies just facing some pressure to manage to our budget. And so we need to kind of evaluate whether or not shifting the work to medallion represents enough savings to make it worth the effort or if it were better to keep the staff that we have. However, in order for us to make that decision, I still would like to have the conversation with you to understand what it would look like mostly from a cost point of view if we were to roll those credit events into our contract with you. So since we’re close to being organized on our side, we’ll look at calendars and send you some days and times, and maybe we can plan to connect on that in the next week or two. Yeah.
Stephanie Ryan (53:17) That sounds great. I will look for dates and times from you. We’ll get something scheduled and get the correct folks on our side pulled in for that conversation.
Melinda Saylor (53:26) Thank you. I appreciate it. Yeah.
Stephanie Ryan (53:27) Of course. Thanks for the update. Appreciate that, Melinda. Yep. Okay. Well, thank you all so much. We’ll get this deck out to you. I will get that Google sheet out to the team and then we will get you the final invoice reporting by the end of the week.
Melinda Saylor (53:45) Sounds good. Thanks everyone. Thank you for this update.
Kimberly A Harberts (53:48) Yep. Thank you. Bye.