Transcript
Adalee Arreola (00:00) hi, Connor. Good morning. Hey.
Connor Morley (00:02) Adalee. How’s it going?
Adalee Arreola (00:03) It’s going well. How are you?
Connor Morley (00:07) Oh, doing good. This freaking dop thing like, I don’t even have access to approve it. Do you?
Adalee Arreola (00:15) I’m not sure. Let me go in there and see.
Connor Morley (00:23) It’s like every single step.
Adalee Arreola (00:26) No, seriously. We.
Connor Morley (00:28) Can’t finish?
Adalee Arreola (00:30) Yeah.
Adalee Arreola (00:35) Yeah, that’s how I felt when I was just like mapping them too. I was just like, great. Another thing. Let me look.
Alicia Iannece (01:00) Hi, Retta. Hello? Okay. We’re going.
Adalee Arreola (01:06) To be in the bathroom?
Connor Morley (01:13) I’m going to let them in. Oh, today’s, going to be an interesting meeting. I can already tell.
Adalee Arreola (01:31) Same thing as you Connor.
Connor Morley (01:36) Hey, everyone.
Alicia Iannece (01:40) Good morning.
Connor Morley (01:42) Good morning. Just a couple updates. I know we talked about those dop forms. So, when we were loading them into the system, we noticed that a couple of them were missing like check marks for the providers to be able to complete. So there are a handful of them that haven’t been approved and gone through. We’re working on getting that expedited for today. We went through and added those check boxes, and fields annually, and we’re just waiting on getting those approved right now for, we have a number of them that didn’t pull in correctly.
Alicia Iannece (02:23) It looks like family practice got fixed. That was one that I had noticed.
Connor Morley (02:27) Yeah, it’s we have a, we have a whole list of them that have not been approved. Hang on because I can actually pull it up but it’s like general dentistry. I saw this morning wasn’t approved. There is, a handful but hoping to get those approved today so that you can see them within the system and we should be all set there. The other thing that I wanted to talk about as well around the credentialing is around… kind of like waiving a lot of these pieces. I think, I know we talked about like being able to waive some of the like malpractice. And I think the other one was work history validation. So when… I was talking to the credentialing operations lead about this like they started to bring up some concerns that if we do start to waive this, we’re not going to be compliant with ihc standards or with your bylaws because we only need to do verification for five years for both work history. And I think malpractice insurance and it’s technically claims history that we have to verify, not necessarily malpractice insurance, but we get the claims history when we know what their malpractice insurance is. Yeah.
Alicia Iannece (03:56) So we looked into that a little bit. I dug in, Jenny and I dug into the kind of the ncqa requirement, the joint commission CMS requirements around it. So basically, what we were able to gather is the all three accrediting bodies are saying that the… completion of an npdb query is sufficient for claims history, for collecting claims history, for verifying claims history. The only potential gap would be like pending claims, which providers are expected to disclose that information. And so, my thought process on all of this was that maybe that query to the carrier would be more appropriate if a provider reports pending claims. But beyond that, the npdb query is sufficient and we’ve that’s all that we’ve ever that’s all that our previous cvo ever, did. They never queried malpractice carriers. I’m not saying we’re wrong, but like this is like best practice that you guys are doing. So that’s great. But I think as far as like what’s required, I think just performing the npdb query and expecting the provider to disclose any additional pending information is sufficient for surveys for meeting those accreditation and regulatory requirements. Does that make sense? I.
Connor Morley (05:31) Mean, it makes sense to me, let me, I’m going to ping Jen and see if she can join the call, just.
Alicia Iannece (05:40) So, okay. And I dug into our bylaws too, just to just verify that. And yeah, we all over the place we talk about current malpractice. And then the only other caveat is the expectation that the provider reports any pending information… claims. Is that right? Jenny?
Adalee Arreola (06:01) Yeah.
Alicia Iannece (06:02) Identified. And Connor, I think dr baker would really appreciate being part of this discussion and these Wednesday meetings have just been tough to her to make every week. But I did forward the invite to her for tomorrow’s, touch base so that hopefully we could. So if it makes sense for your contact to join us for that call, that might be good.
Connor Morley (06:24) Yeah, I asked her if she can join tomorrow and she can, but I didn’t know if you guys wanted if we wanted to get her on the call right now.
Alicia Iannece (06:32) I know, try to hash it out but I think if we had dr baker present too, I think that’d be really helpful because she’s really good at trying to help navigate that.
Alicia Iannece (06:39) And she’s like our keeper of the bylaws. So I think it would be helpful for her to be here too for that… okay?
Connor Morley (06:50) I’m just writing down kind of the npdb piece and then, pending.
Alicia Iannece (06:56) And I was actually on a webinar yesterday with a bunch of payer enrollment experts and I asked the question to them about malpractice claims history and they said npdb was sufficient as well. They said that, you know, you’re expected to, what did they say to collect the history like of the past five years? Like, and that can be sufficient with the provider, just disclosing whether they’ve had a claim or a pending claim? Okay? All right, then.
Connor Morley (07:30) We, Jen will join our call for tomorrow and she can kind of talk through with you guys… some of the bylaws. I know she has some concerns on that, and then the,
Adalee Arreola (07:45) other.
Connor Morley (07:46) thing is for, I’m just looking through, it looks like we just have a lot of tasks for the appointments on dops. But then if I look to the privileging piece.
Connor Morley (08:09) One second, we’re going to work on, we’re going to get the dops in as soon as possible, hopefully by the end of today. And then, but… the team’s been working on all… of the appointments, both the initial and reappointments, and I flagged the high priority ones for them. So we’re hoping to have that done by Friday. If we can get these dop forms filled out by then we, should be all set.
Alicia Iannece (08:44) Yeah, it looks like a number of the providers got tasked with completing that.
Connor Morley (08:50) Yep. And they should be getting those. I’m hoping we can get them approved today. Okay? All right. Sorry, just looking through the rest of my notes. Adalee, do you have any other questions on delegated rosters?
Adalee Arreola (09:14) Yes. So, I sent an email, Marcia, can you just confirm that you received it? We were able to generate an example of the delegated rosters for the two delegated agreements that you all have right now that’s basically just a sample. There are like no ads changes or terms just because none of that has been done in our system yet, but the, you know, you can see group data and then like a full tab, you know, and there’s some instructions on the email, but just want to make sure that you received it.
Alicia Iannece (09:51) You’re on mute, Marcia.
Alicia Iannece (09:58) Marcia, you’re on mute.
Mcoffman (10:07) Can you hear me now? Yes. Okay. Yeah, I did get that. And Alicia and I talked through that. There’s some things that we’ll have to go through. I was going to get an email out, but then I got into some other things and I thought, well, we had the call today. There will be some things that we’ll have to because we realized that all of the providers from the system got put on there, which we will have to… figure out how all of, you know, to limit that down to which providers need to go on those rosters because it’s not all of the providers in the system need to go on there.
Alicia Iannece (11:00) Right. Won’t, it pull because our plan was going to be to still, we would put in like an enrollment request, but it would be owned by remc and we would complete it. And so that would show that they’re enrolled with alliance. That would be once everything’s built out. So would then just those enrolled providers pull in to the spreadsheet?
Mcoffman (11:31) That was one of the thoughts. Yeah.
Adalee Arreola (11:35) So, currently, right now, anyone that had like a reappointment date is going to be showing up on like an, that had an appointment date is going to be showing up on the full tab.
Alicia Iannece (11:48) No, that. So, not all of our payers go, not all of our providers go through payer enrollment with us, less than half of our providers go through it. So we, because we don’t do the billing for all of our providers. We only do it for about 120 of them, right?
Adalee Arreola (12:08) So, it sounds like you guys just want to see the tab that adds terms and updates. Those will be like the ones that we’re working on. And then as they go through that process, then they’ll start populating on that tab. Is that like the expectation here?
Connor Morley (12:27) Adalee, I think the expectation is for these delegated rosters that the only providers on both the full and the ads or terms are the providers who have a team of remc associated with them, Alicia.
Alicia Iannece (12:45) Remc. So I was thinking about that. It’s tricky. Yeah, a couple are very obvious, remc and the other team of mep, those two are our main ones and then beam is a third one. And then there are a couple teams where it’s split up where it’s like most of the providers, but maybe not one or two. And then, so it is a little bit wonky. And we’re trying to figure out if do we develop a different team to show just the peer enrollments or those wonky ones for the weird ones? I know, I was hoping there was like a button to say like a roster button, there’s no roster button… but it really be, and like, so the providers practices groups tab, Connor, when we provided that spreadsheet, those are the providers that we should do peer enrollment on. So it would be anyone going through peer enrollment. Still, it wouldn’t be all of our appointments and reappointments because more than half of those providers don’t go through peer enrollment with us.
Connor Morley (13:59) Okay. But if there is a new appointment, let’s say.
Alicia Iannece (14:05) Yeah, then those would get added. Yep, well, not necessarily.
Connor Morley (14:10) Yeah, from my understanding, it would only be if they’re associated with the group and the practice, right?
Alicia Iannece (14:17) So it would be a new appointment who would also go through peer enrollment, right? Any new appointments who also go through peer enrollment?
Connor Morley (14:26) How would we be able to tell that they go through peer enrollment for a new appointment? Is it that they’re associated we?
Alicia Iannece (14:36) Would be submitting a new enrollment request and they would be associated. Yeah, because I was planning on us putting in an alliance enrollment and approving those automatically, like put them as remc owned and approve them even though they’re delegated. That was how I was anticipating the workflow to be Connor.
Adalee Arreola (15:02) I think we probably need to include Karen in this workflow because it sounds a little bit different than how we would usually do for like these fraud customers. I don’t think we usually put in a… an enrollment request if they go through if… there is delegated agreements. But since this might require a unique workflow, I think Karen should be involved here, see if there’s something that we can do for them. Yeah.
Connor Morley (15:33) So, Alicia, if I understand correctly, if there is, it sounds like the providers that should be on the delegated roster would either have an existing enrollment or an enrollment request for alliance?
Alicia Iannece (15:51) Right. Or group house. Yeah, the two that are delegated. Yeah. Okay.
Connor Morley (15:57) Yeah. Adalee, we’ll talk to Karen about this a little further. I think the goal for these delegated rosters is have at least a sample ready for your review within like two weeks and then potentially create the delegated rosters by the end of the month so that you can submit that delegated roster for may, April, end of April may.
Connor Morley (16:33) But,
Adalee Arreola (16:37) for now, Marcia, if you could look at the roster that I generated and just make sure the data points look good, that would be helpful because I mean sometimes maybe I’m not going from the correct field so I can get those updated while we dig into the other piece internally. Okay?
Alicia Iannece (16:54) Yep. And we, yeah, we did look at those. So we have notes, okay, perfect. That Marcia can send over. Yep, there were a few that we have to check… like on our manual roster that we’ve maintained. There were a few on the group health cooperative roster that we had listed as it being a requirement from them. But then it wasn’t included on Marcia’s list that she provided to you. So we want to double check with the payr whether those are still expected to be on.
Adalee Arreola (17:24) Okay. Sounds good. And.
Alicia Iannece (17:26) then one other question regarding them pulling into the directory, that column was blank. So, is there a spot within the provider’s profiles that we’re supposed to be marking that I do notice seeing it on like new enrollment requests, but I haven’t seen it like in a profile?
Adalee Arreola (17:47) Yeah. Let me check out, see if that field is available for you all?
Alicia Iannece (17:55) And then board certification is another one. I don’t know that the payers care about the board certification number. I think they’re more interested in the type of board certification the provider maintains, whether it’s emergency medicine or family practice or diagnostic radiology. I think they’re more interested in that information versus the number? Yep.
Adalee Arreola (18:16) That makes sense. So if you could just put that together in the email, I can make those updates. Okay?
Connor Morley (18:27) I did. If there aren’t, any other questions on?
Alicia Iannece (18:32) I have, I always have questions?
Connor Morley (18:33) No, I.
Alicia Iannece (18:34) delegated.
Connor Morley (18:35) Ross’s.
Alicia Iannece (18:36) On the roster… I think that was it for the main ones that we noticed for rosters, yeah.
Connor Morley (18:44) Okay. All right. Nice. So, I know that Nick is going to get you back the delegated agreement today. So you should get an update on that today. And then for just the payer enrollments not including the delegated rosters, it looks like a lot of them are processing through and have applications submitted. It looks like about 11 have been completed so far for medicaid, quartz, medicare, anthem, blue cross, blue shield and united… on our side. And it looks like the alliance was completed on that’s.
Alicia Iannece (19:22) a delegate. That was one, we submitted those before we realized they were delegated. So I, yeah, I said to close those ones. Okay?
Connor Morley (19:30) Yeah.
Alicia Iannece (19:32) And can we go ahead sorry?
Connor Morley (19:35) And then I was just gonna say for there are a number that are still open that are being processed by the payer, and that we’re following up on and just waiting on that to hear back from the payer. It looks like we have about 52 that are in processing. And for the ones that are in payer processing, we have about.
Connor Morley (20:03) 50? Okay.
Alicia Iannece (20:05) I did get an email from icare about needing to complete additional information. So I threw that on that enrollment request for Stacey warneke, and it went in as like a support ticket and it looks like that just got like updated today that they were looking into it.
Alicia Iannece (20:25) So it hasn’t had any movement yet. And also, we, I got a task for tricare and I’m glad Pete’s on the call. Basically, we learned, okay, so we actually don’t have a formal contract with tricare. And Pete was looking into maybe the contracting opportunities, but we, he decided we are not going to be contracting with them. And so tricare, I think anyone can jump in if I’m saying it wrong, but they basically then just manage us as like non network providers when we have a provider bill for those services. So… I, I’m guessing that we would maybe cancel those enrollment requests as well and potentially not put them through or just put them through as a like just a like a straightforward one again… like ours, like our delegated ones where we don’t need to do additional work.
Peter Frutiger (21:28) Or?
Connor Morley (21:29) Where you would submit them as like ramc owned.
Alicia Iannece (21:35) Yes, I think so. Does that sound right? And Pete, did I say all that the right way? Like they’ll stay at as non network providers for.
Peter Frutiger (21:46) the time being? Yeah, I’m still negotiating with them but they haven’t in six months. They haven’t made a single move off of their initial proposals. And I’ve got four critical issues in their contract language that I’m not going to agree to. And again in 40 plus, you know, 40 years of healthcare. I’ve never had a contract with tricare. So I’m not sure why triwest is pushing for this at this point, but it is interesting. They do pay us in network on the hospital side. It’s just the provider, the pro fees that they tend to deny and we’re just, it’s not that much money. So we’re not that worried about it at this point.
Connor Morley (22:33) Okay. Yeah. Can.
Rheta Larson (22:36) I ask a clarifying question for tricare. Are the providers, are you all only requesting to be enrolled under tricare? Triwest, solely? Like those providers? I see that there’s Tenzin, Emily, true shill.
Alicia Iannece (22:54) Well, I think we had them built out as like tricare being a payer that we contract with, but, I think I had that wrong and they’re just, we see those patients and they just don’t we actually don’t have a legit contract, right? Pete, right? Okay.
Rheta Larson (23:15) Gotcha. And then, so next steps, you just want to cancel these in flight requests and then, and put the requests on the reads for reedsburg side. Yes?
Alicia Iannece (23:25) Okay. Do you know, do?
Rheta Larson (23:29) You all have a blue shield contract, blue shield BCB. S?
Peter Frutiger (23:34) It’s anthem. Yeah. Okay.
Rheta Larson (23:39) Because I know there’s a triwest and blue shield relationship and blue shield handles the demographic updates for any triwest, but, I can take a look at these and then cancel them, pop the notes in on what we discussed as well. And then if anything changes with y’all’s contract that let us know that’s.
Peter Frutiger (23:57) state specific, or is that national? I?
Rheta Larson (24:01) Think it’s specific to California, but I can double check as well. Y’all are primarily in Wisconsin, right? Because.
Peter Frutiger (24:09) I thought WPS handled some of that for us, but… for tricare, but again, with tricare there, there’s no point in contracting because they’re just going to pay you what they’re going to pay you. I mean, so, and some of the contract terms are kind of ridiculous considering what little they pay… but I didn’t see anything in the contract referring to any other provider enrollment help… at least not that I recall. I haven’t read it in a few months, but.
Rheta Larson (24:47) Yeah, I know with triwest and tricare, they’ve had like some weird cascading effects with other payers. I.
Peter Frutiger (24:54) Believe it. Yeah, I mean, tricare has been, you know, one of the goofiest organizations… it’s constantly changing affiliations. It’s been everywhere from Aetna. It was all palmetto originally. So, yeah, they’ve been all over the board… that’s why I don’t bother contracting because it’s going to change in six months anyway.
Rheta Larson (25:19) Gotcha. Okay. I think we’re aligned here in terms of next steps. I’ll if y’all, give me the approval to pop the note into those current in flight, I think there’s three trushall Tenzin, Emily, and then I can mark those as stopped and then wait for the request to pull through for the others?
Alicia Iannece (25:38) Yeah. So, Pete, can I just, can we just put those through as like automatic approval ones like similar to our delegated ones then since we’re still going to see patients there and have tricare listed as a payer?
Peter Frutiger (25:52) Yeah, that makes sense.
Alicia Iannece (25:53) Okay. So, Rheta, actually, if you want to just approve them, like just say they’re completed and they’re accepted acceptable as they are. Does that make sense? It?
Rheta Larson (26:05) Does I’m going to flag these to the team just so that they’re aware of the changes we’re going to make to those. And then I’ll come back to you with any outstanding requests or items that we may need to fulfill that status, but we should be fine to do that.
Alicia Iannece (26:19) Okay. Thank you. Yeah. The last request was for a signature and I can put in the notes too on the task but was for a signature, but it was actually Pete’s signature that was needed for that contract which he’s not going to sign. So that.
Peter Frutiger (26:34) Was sneaky of them. Oh, we can’t get the person who should sign it to sign it. So let’s get somebody else to agree to it.
Alicia Iannece (26:40) So, once we figured out that was what tricare was asking for, that’s what prompted me to touch base with Pete and verify. So, okay.
Rheta Larson (26:50) Gotcha. Yeah, if we find out anything else as well, I’ll definitely let you know. I know they can be a bit tricky. Thank you. Of course.
Alicia Iannece (27:03) I have one other payer question. There’s another task for security health plan for Emily smith, I believe. And… basically, they’re asking medallion’s asking again for logins. And again, I’m not like I’m not like questioning whether medallion deserves logins. It’s more. So just trying to understand the process like what was the previous process and how did we do it? Our contact here who works with all the payers for like our facility credentialing and all that. She is not aware of whether there’s a login that’s required for getting providers enrolled. Marsha, do you know for as far as like the process for adding providers, when you were doing it, was there any need for a login at that? For those providers? Let me look.
Alicia Iannece (28:08) Yeah. They said it typically, it was an application that needed to be completed or an email to send to security health. So if they’re requesting logins, I think medallion could just go ahead and create their own login.
Mcoffman (28:20) Actually, security health for hospital providers. I don’t think we had to do anything.
Alicia Iannece (28:26) Okay. So then it’s for the hospital. So, yeah.
Mcoffman (28:30) So, I think, I don’t know what the process would have been for clinic… okay? For that kind of credentialing?
Alicia Iannece (28:38) So, so we don’t have any, we don’t have any logins, you know, that we maintain for that. So if medallion wants to create one to continue the process, like I would prefer that… unless, because it was requesting us to create a login for medallion, but we don’t have that capability anyways, unless we give you like a username and password to do for you. I don’t know.
Rheta Larson (29:08) Okay. Yeah. I see that we did create one using our medallion email. So, I’m not sure. I’m assuming this is the medicaid Wisconsin group logins that’s.
Alicia Iannece (29:19) the no, that’s we’ve that we figured all that out too, not needing logins for that. This is for security health. For Emily smith. I think it’s Emily. No, maybe it’s let me double check. I,
Rheta Larson (29:31) don’t see an open task for her? That’s why I only see one? Okay. Sorry.
Alicia Iannece (29:36) It’s for Angela. Sorg, Angela, okay. Let’s pull her up. It’s an org admin request. You got to ask.
Rheta Larson (29:50) And then this one’s for security. I think we was, this one flagged to a support ticket as well. This.
Alicia Iannece (29:58) One was not, no, the Emily smith one was with the medicaid stuff, but this one is different and I didn’t put it into a support ticket at all.
Rheta Larson (30:09) Yeah. We did talk about this one though. I do recall this was for a different request… try to fill in the application for security help, but portal requires logins. So please see. Yeah, we, this is the change we made with the team for.
Alicia Iannece (30:28) Our pay your.
Rheta Larson (30:30) Normal email address. So I’ll remind the team here that they shouldn’t be tasking that and I’ll pop a note in somewhere generally just so that they’re aware, but I’ll just mark this as satisfied. And then, we can mark this complete. There shouldn’t be anything if there is something I’ll email you, but I’ll consider this into our last update for the conversation we have for security health plan, credential application, email address update.
Alicia Iannece (30:54) Okay, perfect. Thank.
Rheta Larson (30:55) You just add her to my agenda.
Rheta Larson (31:05) Okay. Gotcha.
Rheta Larson (31:11) Yep. We should be good. There. Any other questions on the open para enrollment requests?
Alicia Iannece (31:24) Not at this time. I think a bunch of them were pending the medicaid approval. So since we’ve got that corrected, it, hopefully they’ll get moving now?
Rheta Larson (31:37) Who’s task? Okay, great. I’ve added that.
Alicia Iannece (31:42) Do you know when the existing enrollments are going to populate in?
Rheta Larson (31:51) The existing enrollments, the ones that Connor covered?
Alicia Iannece (31:57) Sorry, like based on the import template… are you still waiting for something from us for those?
Rheta Larson (32:06) Connor, Adalee, I don’t know if there’s anything pending on that end?
Rheta Larson (32:14) I don’t have anything, Connor, I.
Connor Morley (32:17) see group enrollments, provider enrollments, let me.
Connor Morley (32:29) Sorry, let me double check on that because you’re looking for specifically all the provider enrollments, right? Yes. Yeah. Give me one second.
Connor Morley (32:54) And you wanted us to use the group enrollment and PPG information? Is that right?
Alicia Iannece (33:01) Writers practices groups? Yes. Okay. All right. And like we have a handful of exceptions and I think, do I send you those or do we just get the existing ones in and then we can update the exceptions? Can?
Connor Morley (33:15) You send me those exceptions? Okay?
Alicia Iannece (33:18) Yes. And then I think the only other thing I had was medicaid dates. Like we do have some medicaid revalidation dates for the ones that we need to do.
Connor Morley (33:33) So the… so on the data import template?
Connor Morley (33:45) What?
Connor Morley (33:51) We’re not going to be able to have those revalidation dates if we’re using the group enrollment and the payer provider practice groups information.
Alicia Iannece (34:08) Okay. That’s fine. I… think we can work off that list, the list that we have for the time being for when to request revalidations. And then once it gets into the system eventually, then that, that’ll… correct itself, right? If I’m understanding that correctly?
Connor Morley (34:28) Yep. Okay. It should. Okay.
Alicia Iannece (34:31) Sounds good. So then you just need the exceptions which I think there are only a handful. So I’ll send those over.
Connor Morley (34:41) Okay. Thanks Alicia.
Alicia Iannece (34:49) All right. Oh, another question I had on those was with all the things we’re learning about medicaid, now that we’re seeing more of it par, linked to group versus par, not linked to group… I guess it doesn’t matter either way in the medallion system, like for medicaid, like unless we look each individual provider up, we don’t know… if they’re linked to the group or not for a lot of them. Like we don’t know specifically if they’re linked to us or not, because in Wisconsin, they don’t need to be linked to our group to be able to practice here. So, would it be safer to put in par, not linked or par linked? Like what would be the implications if we have that wrong in medallion? Do you get what I’m asking? Or, right? Like I don’t know what would impact it.
Connor Morley (35:52) So, it’s essentially asking within, I mean, Rheta… the difference between par linked to group and par, not linked to group, would be direct enrollment, right?
Rheta Larson (36:07) Yes. And can you clarify on your question? Sorry, I know you had made this statement for the two and y’all are not able to determine and see who is and is not linked. So, is the question just determining how you input it in the?
Alicia Iannece (36:26) Platform. Yeah, because like they’re par, like they’re approved for medicaid and we are having no issues like they can bill and everything is fine. But I just don’t know whether they’re linked or not linked. So, is it safer to mark, not linked to group but that they’re par and they’re approved? I guess, I don’t know for sure… like I would imagine all of our full time remc providers are linked to the group. But then anyone who’s not employed by us, I can’t you know, we can’t verify whether they are or not unless we go and individually check each one.
Rheta Larson (37:03) Gotcha. Okay. I can dig on the back end too to see if there is some sort of report or something on the admin side that can like bulk… view. But do you have an example of one that you’re working on? That is a good use case for this?
Alicia Iannece (37:25) Of like a couple providers? Yeah. So like mark Meyer, MEIER, he should not be linked to us. Okay? We’re not his primary location, but then… nessem, Benjamin nessem, NESSEIM, he would be linked to us.
Rheta Larson (37:55) Okay, great. I’m going to get these looked at reviewed and then I will circle back and add it to our agenda for tomorrow so we can chat through those and see if there’s a potential workflow there for the admin side. Okay. Thank you. Yep. Definitely.
Rheta Larson (38:16) Anything else I can answer on that side or anything else you want to bring up here in preparation for tomorrow’s sync?
Alicia Iannece (38:23) Regarding, so we talked about malpractice history a bit regarding work verifications, touch on that here, but I also think we should talk about that tomorrow with dr baker there too. So basically, I… think what I’m seeing is… in the provider’s profile, it’s asking for work history and hospital affiliations, right? So any hospital affiliations listed under the hospital affiliations, is going to be a request for privilege verification on the privileging appointment side or reappointments. Either anything listed in the work history is going to be an employment verification, correct? So one, I think the providers don’t understand the difference between the two. So that’s one issue. So they’re just going to put in all of their information that they know. And a good example being any of the team meps, they are emergency physicians that are a contracted group. And so all the hospitals that they go to, they’re not employed by those hospitals. But they listed all of those hospitals in their work history. Some of them did not, all of them, some of them listed them in their work history, some of them listed in their hospital affiliations. They should have probably all listed them in their hospital affiliations, and then their work history should be Madison emergency physicians, the mep, but they don’t truly understand the difference. So not that I’m justifying that at all. I’m just explaining, I think here’s where the headache is happening and the confusion. And basically… I think ncqa, so I looked at ncqa joint commission CMS, Jenny helped me. Thank you, Jenny. We looked at those three accrediting bodies as well and regulatory. And I think like, you know, the… medallion’s potentially taking the verbatim like work history or employment history as what’s needed. But in our historical like experience so far, even with the previous cvo was a hospital affiliation of verifying privileges is almost a priority because it is verifying the clinical competence and whether the provider’s capable of performing the privileges they’re requesting the employment verification can be important and meaningful. But it’s typically like the default or the fallback if we don’t have an ability to request privilege verification. So if they’re employed by a group, but they don’t have a hospital affiliation. So that was our previous cvo’s default. And I did look into all of that and privileges are I think the typical requirement. But I see ncqa talks about work history, so that’s maybe where the confusion is happening. Now, in the three years of me participating in ncqa audits, I understand that ncqa accepts. Privilege verifications as work history verification. Like they’ve not come back and told us that we needed to do employment verifications by any means with our delegated payers, where we’ve done the audits.
Alicia Iannece (41:57) We’ve always passed on that regard. So I don’t know if that’s helpful information, but I think that’s where most of the confusion is happening. Great.
Rheta Larson (42:08) Yeah, I know that’s good feedback and I know we’ll have a larger conversation tomorrow with dr baker and Jen, but I can at least pass this information off and then we can chat through it live tomorrow just to determine how to rectify that in the platform. Are y’all doing like a review of the provider’s profiles post completion or is.
Alicia Iannece (42:28) there?
Rheta Larson (42:29) I think.
Alicia Iannece (42:30) This is prompting us to realize, you know, obviously these are the first files coming through. So we’re learning this new workflow and it’s a big, a bit of a big shift. So, I think what we’re seeing is when new privileging applications need to go through whether it’s a new appointment or a reappointment, we probably need to review that professional history tab and what’s pulling into work history versus hospital affiliations. But we may not always have that information either especially for the contracted providers.
Rheta Larson (43:02) Gotcha. Okay. Yeah, I think that should be a good talking point. Like what are medallions… next steps to ensure the information collected for the employment history and the hospital affiliations is correct? And then maybe there’s a handoff where the admins just do the final review and green light it before we submit. But typically that’s what those tasks are for. Like any application submissions we’ll get the approval for processing. But yeah, we can chat through it tomorrow as well. But I’ll take this feedback and then work with Jen on that prior to our sync.
Alicia Iannece (43:40) Okay. Yeah. I’m initially thinking that anytime a hospital is listed under a work history that it needs to be moved to a hospital affiliation and then just verifying the privileges. We don’t necessarily need to verify the employment. And yes, you could absolutely do both, right? Like that’s probably best practice and the least amount of risk, but I don’t I think it’s redundant for the most part and, you know, kind of it’s like duplicative work that doesn’t need to be happening. So it will just delay the process even more yep.
Rheta Larson (44:16) Yeah. I’m also trying to determine if like the system will flag it as a gap if there’s one where it’s listed in the hospital, not the other, because anything more than I think it’s a 30 day gap, it might flag it. So we’ll work together and make sure that that’s hashed out. And then, yeah, if they can just reference the question, like are there any hospitals where they’re currently admitting have admitting privileges arrangements, or other non admitting affiliations? Like just make sure they’re focusing that attention and adding those hospital affiliations there versus the work history. Yeah.
Alicia Iannece (44:51) I don’t know if there’s and I don’t know if there’s any opportunity to like enhance that section, but if there were, I would almost put that hospital affiliation question first. And then if they had no hospital affiliations, then asking about work history and employment and when they’re employed separately, you know, like kind of putting that hospital affiliation as a priority, but that’s just a recommendation.
Rheta Larson (45:18) Gotcha. Yeah. It’s good feedback. I think everyone has a slightly different workflow. So we definitely want to make sure it fits for all clients, but, I can bring it up with at least the privileging team and determine, you know, if this, then that, and if that works better for that workflow, we can chat through further with product and engineering. Okay? But hopefully, I know that’s like not a straightforward answer. I know it’s a large discussion. So I’ve collected that information as well and I think we have a running agenda of some items we owe you all. So tomorrow, I’ll kind of do similarly what we did on our last previous emails where it’s hashed out all of our outstanding questions. Anything we haven’t answered, just make sure we’re crossing them off the list and then we’ll have a clean slate hopefully by next week, okay?
Alicia Iannece (46:10) I have a couple other items, those verifications that did come through to Jenny to complete were sent via fax. So, if it’s possible to, I don’t and I noticed, so again, here’s what we’re learning and seeing. So, I noticed the providers didn’t list the credential and contact information in the work history there in the work history sections. So, I’m guessing that’s where medallion would be pulling from to send, even though we’re the main contact, you know, like our hospital affiliations that need to be completed by Jenny are not processing through to her because there’s no information on the provider’s profile there. Is that correct? Can?
Rheta Larson (46:58) You give me the example of the ones you sent via fax? So I can take a look at it and just see what was added… that you received, I think.
Alicia Iannece (47:08) Because I think she ended up because Jenny hates faxes. So I think she ended up emailing the person saying, please email this to me.
Rheta Larson (47:15) I did. So if.
Alicia Iannece (47:17) you want to go back and find that, yeah, I’d have to find.
Rheta Larson (47:19) it, yeah. Okay. Yeah. Just give me those examples and I can get that updated internally like we rarely use fax unless we have to. I think the preferred route is always email. So, yeah, it may have just been something that they grabbed and they had easily accessible. So I’ll ensure I sync with the teams, get it updated and they send it first via email. If we don’t hear back, then maybe they’ll try a different route for escalation purposes, like via fax. And.
Alicia Iannece (47:44) Yeah, it went to our generic one for the whole hospital. So they ended up forwarding it to us. So, I think, I’m guessing they went to our website to just grab the information and find it, which I’m sure is probably standard when you don’t have the information in front of you.
Rheta Larson (48:01) Yeah, we can, that’s an easy fix. I think we can get the correct email if you just give me the certain examples and we can get it updated.
Alicia Iannece (48:10) I was just wondering if, you know, that credential or that credential and contact tab? Is that because we don’t have RMC in there? Is that a problem? Yeah, that could be why, but not on the work history part with the actual tab where you have to put, oh, no, I think it’s because it’s on the work history tab… then the, oh,
Rheta Larson (48:32) I’m.
Alicia Iannece (48:34) noticing all of the documents that are created in the packet, go into the documents tab. Is that correct? So, is all of that visible to the provider? Anything?
Rheta Larson (48:47) In the document section from my understanding is visible to the provider, that is correct. So, if it’s in their profile and they’re in their document section, they can see those attachments like I’m in Angela sorg right now. And I see she has 13 documents. And as an admin, you can, I believe hijack as a provider, it should mirror the same view for their profiles. If you just hop in to take a look to see what they’re seeing and I do see those documents listed. Oh, actually.
Alicia Iannece (49:14) How do we hijack?
Jennifer (49:15) Yeah, I want to know how to hijack.
Alicia Iannece (49:16) How do we do that? Because I’m always curious what does it look like for the provider? I don’t know that we know how to do that. Let.
Rheta Larson (49:25) Me check if you all can. It might just be a minute that they can’t Connor.
Alicia Iannece (49:30) Oh, dang. It.
Jennifer (49:34) We can.
Alicia Iannece (49:35) Hide that. You guys can hijack we.
Rheta Larson (49:38) Can hijack. So, I’m actually hijacking as Angela really quickly, but her, the documents aren’t mirroring what I’m seeing there.
Alicia Iannece (49:51) She might not have, well, a better one might be like Colleen, Elliot mccandless. She’s processing both for right now for payer enrollment and privileging my, and my only ask is I have a vague memory of when I took a credentialing one on one class with nams and, they did say the provider has access to like their entire credentialing file except like primary source verifications for like hospital affiliations for privileges and like verification of privileges, so that I have that little fleeting thought in my head like triggering at me like make sure this is okay. So, I don’t know because, I know practice providers have the right to view their credentialing file and all that. And we talked through that a little bit, but, yeah.
Jennifer (50:39) The references and,
Alicia Iannece (50:39) stuff they shouldn’t be. Yeah, but I thought references and hospital verifications potentially are something that is actually confidential even to the provider. So I want to look into that.
Rheta Larson (50:53) Yep. Yeah, I’m in Colleen’s and I’m hijacked as them and I do not, I don’t see the uploaded documents visible. Oh, okay.
Jennifer (51:00) Great. Okay.
Rheta Larson (51:01) We’re actually good there on the admin side, can you all see it? We?
Alicia Iannece (51:05) Can, but I can’t tell what the provider can see and not see. So it was a little concerning to me.
Rheta Larson (51:12) Okay. Yeah. Unless Connor, correct me if I’m wrong, the providers are seeing something different than when we jump into their profile, but it looks like they are not experiencing. They’re not seeing what we see.
Alicia Iannece (51:24) Okay, great. And, is there some level of… security when the document is being uploaded? Is it the type of document that’s being uploaded? I guess I’m just, how does it, how does it know not to pull into the provider’s side? Yeah, to their view in case we have to upload anything. I’m trying to figure that out too.
Alicia Iannece (51:55) Say that one more say.
Connor Morley (51:56) That one more time. So.
Alicia Iannece (51:58) Like, how do we know the provider can’t see those certain documents like.
Jennifer (52:05) What we put like an other document in and we don’t want them to see it. How do we know what they can and can’t see?
Connor Morley (52:13) Gotcha. So, if you are adding a document to the credentialing packet, can the provider see that? Is that, that’s the question, right? Yeah. Like.
Alicia Iannece (52:25) A good example would be when our previous cvo would fail on a work history or like a hospital affiliation verification, we might go and make an attempt ourselves. And if we succeeded, then we would add that to the provider’s file.
Connor Morley (52:42) Let me.
Connor Morley (52:48) let’s talk through Jen with.
Rheta Larson (52:50) Jen.
Connor Morley (52:51) Tomorrow about that because I think she might have an idea.
Rheta Larson (52:57) And just for my understanding, are you referencing the document section of their medallion profile?
Jennifer (53:02) Yeah. Okay.
Rheta Larson (53:05) Yeah, because I’m seeing like I see the providers uploaded by provider, those they can see. And then I see some of the admins, I’m just toggling between two views just to make sure. So I don’t really see a rhyme or reason but yeah, I’ll we’ll add it as an agenda just to make sure we have an understanding of how it flags and masks the documents for the provider’s view. Okay? But at least for the one you called out, I didn’t see they had the ability to view what was uploaded.
Alicia Iannece (53:35) Okay. And like the primary source screenshot from an… HR manager, I thought it was yours from one of their past employers like that would be one that I would say, I wouldn’t expect her to be able to see that, Colleen, to be able to see that in her view.
Rheta Larson (53:54) Okay. Yeah. We’ll have that as an outstanding question just because I’m not sure since it seems there’s a mix for admin and provider view. And I want to make sure we get that answered for you all. Okay?
Alicia Iannece (54:10) I think that’s everything. I did. Have one other quick question about the privileging contact, like the contact for the medallion, like is it acceptable for us to list medallion? I noticed in somebody’s caqh profile. We have this one provider. She’s still getting emails that she needs to reattest her caqh. It’s the same one that we had the ticket in on. I didn’t submit a new ticket because I did it a second time and that one they said was good. And I went in and logged in as her myself yesterday or the day before and was able to see like everything looks normal. Like she doesn’t have to reattest for 108 days or something. So it’s all fine. But I checked the credentialing contacts and removed the one that we needed to remove from the old cbo and I did see that medallion added themselves as a credentialing contact there. So, but they had a separate email. So I’ve noticed three different medallion emails that I wanted to just ask about and if we were to use one like which one should we use? If we’re going to be updating things and I can just put those into the chat. Yeah. And I think the two are on the privileging side. And then the other one was. So the privileging ones there’s two different ones that we saw medallion co, and then privileging medallion at Gmail. Com. And then this reedsburg area medical center at medallionteam. Com. That one was in the caqh profile.
Rheta Larson (55:41) Okay. Gotcha. And you’re seeing it? You’re seeing all three, you’re seeing the differences there or you’re seeing it’s just in different products, I think.
Alicia Iannece (55:49) Different products. Yeah, I apologize the privileging the two for the privileging ones that we saw on like different, I think on different work like either work history or hospital affiliation verifications coming through. We saw those two emails. So I didn’t know why there would be two. And then the one that says remc at medallionteam. Com, that one was in the caqh profile.
Rheta Larson (56:14) Okay. Gotcha. Yeah. I know the generally.
Jennifer (56:17) the rule is I usually don’t respond to anything for Gmail for work purposes. So I was kind of concerned about that one. Okay.
Rheta Larson (56:26) I can dig into these as well and we can add it to the agenda for tomorrow. I just want to see for each product, what we have listed and what is the correct email attached to that product? Because it might be slightly different just so medallion can manage and monitor those. Okay? But you are welcome to use the privilegingatmedallion co for the ones that we previously touched on.
Alicia Iannece (56:48) Okay. Sounds good. Unless it’s pay or enrollment, I know that.
Jennifer (56:52) I didn’t ask for, dr.
Alicia Iannece (56:55) Hopps’s privileging tab under her npdb it says.
Jennifer (57:00) That it has that orange triangle. And I want to know, are we supposed to be doing something for that?
Alicia Iannece (57:05) So, maybe we can do it tomorrow, which provider, dr Hobson, yeah on her privilege. So under the,
Jennifer (57:17) privileging tab for Hobson, there’s an error or an important little exclamation point under her npdb which we know she had a past one, but I was just wondering, do I need to do something to clear that off?
Rheta Larson (57:35) I’m trying to pull that provider Hobson… and then that’s so.
Jennifer (57:43) Close out of that relation. Go here. Is that where you were, see there’s a little triangle there unlike?
Alicia Iannece (57:50) The report, the PSP report, yeah.
Jennifer (57:53) The PSP report likely.
Rheta Larson (57:57) Because something failed… but… I don’t think there’s anything you all need to do. We almost.
Alicia Iannece (58:09) Need like a reviewed like a verified on our end that we’ve seen it and we validated it and we can move on like because otherwise, it just shows as flagged as, yeah, like I don’t really shows as abnormal even though, yeah.
Jennifer (58:21) I don’t know if it’s on me that I need to do something or medallion. OK?
Rheta Larson (58:27) Yeah. I know that there’s nothing currently pending in your admin queue then you should be fine, but I’ll flag this one to the team just so they are aware and they’re we’re sure we’re not missing a task or anything… which I don’t think that’s the case.
Rheta Larson (58:45) But I’ve jotted that one down. I know we’re at a minute. So I want to make sure… we have everything listed. So I have Paula Hobson, and then the mpdb alert flag. Okay? And then I know you said y’all will send the employment verification or sorry, you will send the examples for the employment verification, for the facts, if you can just send me those, and then I can take a look at them. And then I know we have our work for dr baker tomorrow. So we’ll add that agenda so we can go line by line of what we discussed today that we weren’t able to answer. Perfect. All right. I know we’re right at time. Is there anything else before we let y’all go?
Alicia Iannece (59:32) I don’t think so. Thank you, guys. Thank.
Rheta Larson (59:35) You. Thank you. Talk to you tomorrow.
Alicia Iannece (59:37) All right. Thank you. Bye.