Transcript
Amy Frana (00:00) I think you sent me something and I apologize. I did not get a chance to look at it but I trust you.
Leigh Howle (00:09) That’s okay. Thank you. That’s okay. I went, I ran it by Molly earlier. Okay? Thank.
Amy Frana (00:16) You. Yeah, I just was like my gosh. I know our call’s coming up. I need to get on this, but there’s just been so many fires today already.
Leigh Howle (00:32) Yeah, no problem.
Leigh Howle (00:58) I was just addressing a couple of these agenda items that were added. Yeah.
Leigh Howle (01:40) Got it.
Amy Frana (01:46) This one is just Melody, right? Like we haven’t added anybody else back in?
Leigh Howle (01:51) Okay.
Leigh Howle (02:28) There she is.
Amy Frana (02:40) Hey, Melody. Good afternoon.
Leigh Howle (02:46) Hi, Melody. How are you? I’m.
Melody (02:48) good. How are you doing?
Leigh Howle (02:50) Good. You sound a lot better. Yeah, I’m.
Melody (02:56) feeling better.
Leigh Howle (02:57) Awesome. Is everybody over that and ready for spring? Awesome. All right. So, I’ll go ahead and share my screen. We don’t have too many items on the agenda today.
Leigh Howle (03:16) So, let me make this a little bit bigger.
Leigh Howle (03:22) It always seems so small on here, but it could be just me.
Leigh Howle (03:29) Okay. So I put a couple of topics first. I just wanted to give you an update on the strive physical therapy data migration ticket. So that delivery date has been pushed back. I think just a couple of weeks. I didn’t know that it was a four week turnaround time typically for these requests. Now, going forward, I do know this, so it is around four eighteenth, okay?
Melody (03:55) Sounds good. Same.
Leigh Howle (03:56) Thing on the therapy management services for the premier recred date import. So those should be finished around the same time, a couple of weeks… and the payer mapping exercise has been completed. Thank you so much for going in and working hard to have all of those payer names confirmed. I did have a couple of quick questions. I just kind of scanned through it one final time and on the last… ones for wellcare. I just wanted to make sure they shouldn’t be managed health care services. Why is this taking so long? Let me refresh it does say mco. And I know that managed health services isn’t mco in Indiana?
Leigh Howle (04:59) Let me scroll down here to the bottom… okay? Right here. So, the payer name from the existing enrollment is wellcaremco. Wellcarekentucky. Com. Yeah.
Melody (05:26) They do am better.
Leigh Howle (05:31) Yes, I’m trying to get now, which?
Melody (05:35) Ones that fall underneath them?
Leigh Howle (05:38) They have wellcare by allwealth and that’s their medicare plan. They have the three medicades, you know, hoosier care connect, hoosier, healthy, Indiana and hoosier. There’s. A HCC, hoosier care connect. Yeah. And then, and then they have the am better as they exchange plan.
Melody (06:02) Let me look. I think, let me just look at my notes because I know I had to go back and forth with them because there is one that they have to do separately and it might be the wellcare one still.
Leigh Howle (06:17) Yes, there is another wellcare by fidelis. I think it is in the state. So it is a separate enrollment. Yeah.
Melody (06:24) I think that’s one. Yeah. And I had to, I confirmed that with them like four times because they kept confusing me and I was like wait, which ones aren’t good. So, yeah. So I think we have to keep that one as wellcare. Okay?
Leigh Howle (06:36) Okay, perfect. All right. So I will go ahead and check these back… and let me just make a note.
Leigh Howle (06:57) And then I’ll just clear out my highlight. Okay? Awesome.
Leigh Howle (07:09) I did notice it’s not this. So this is just a like pay your name replacement. It’s not an actual line of business update. And I didn’t want to change the name if it had the medicaid or medicare in it without making sure that line of business was listed in the existing enrollment. So I just kind of highlighted some of these options. And I did go in and look at the existing enrollments yesterday. And I noticed that for especially the anthems, there’s a lot of anthems and they all did not have the medicaid line of business.
Melody (07:52) So,
Leigh Howle (07:53) I… don’t think we should change those names because we’ll lose that lob if it gets replaced. So maybe we can have another, you know, project or something. Another exercise where the lines of business get cleaned up and updated a little bit later. Yeah. Okay. So the highlighted orange ones will just stay as is.
Melody (08:24) Okay.
Leigh Howle (08:27) Good deal. Yeah. And this is moving along. So the technical support manager should have this completed by end of week.
Melody (08:34) Okay, great.
Leigh Howle (08:35) Yeah. It’s it’ll change the payer names under existing enrollment and in flight. So your reports will be so much cleaner and consolidated when you go to just, you know, analyze data and metrics. Great. I love this idea on the task naming.
Melody (08:58) Yeah, if that could. Yeah. So I was, I’ve been trying to clean them up a little bit or send like reports to the team to clean up. And I just noticed that there’s a lot that are just different, put in different, but they’re the same things and so I can’t really group them. But if we can get them to standardize them, then I can, and then I can send groups of them to each of my teams.
Leigh Howle (09:19) Absolutely. So what I typically recommend is to have state… and then provider or group and then payer, and then action needed. Yeah, that’d be good. Okay. Okay. Awesome. For ceqh management, do any providers like opt out of that not?
Melody (09:53) Typically… I guess once in a while we’ll get, I mean, very, rarely will providers say that they want to manage their own, but most of the time it’s just turned on for everybody.
Leigh Howle (10:08) Okay.
Leigh Howle (10:19) Okay. Awesome. So where this came from in case you’re wondering, is support had reached out to me about updating ceqh when providers are termed to make sure that they’re have an end date. And then, you know, confluent and medallion credential and contact information is removed from ceqh profiles. And then providers are deactivated. And so when I started to kind of go through there, I was like, well, yes, this is definitely something that can be done. So, I just wanted to confirm that all providers would be using ceqh management. And then we’ll put a workflow in place with support to have these steps actioned?
Melody (11:03) Okay. Yep.
Leigh Howle (11:06) Awesome. And then on this amerihealth one, is it okay? So?
Melody (11:15) This is just, so the roster that you had sent back to me that had the second tab had the missing locations, and then the third tab had just the missing providers. I had sent it over to the brand leader and just asked him to just let us know what locations needed to be added because this is a brand that has like 24 locations. And I didn’t want to just say add all the missing locations. And so I just want to make sure that the original requests were closed out so that we can just make a new demographic update with just the two or three locations that have to be added. And I didn’t want to, I didn’t know if they were still open and they were trying to add all of those 24 locations or like missing locations that were on the original request. I think it’ll be cleaner if we just close the original requests out and then just put the new demographic updates in.
Leigh Howle (11:59) Okay. That makes sense. And yes, they were partially completed if the location was missing on that amerihealth par roster. So I’ll go back to the team and just tell them if there’s a partial completion for those or the provider was listed on there at, do you want to say any location or? Okay, just complete?
Melody (12:23) Okay.
Leigh Howle (12:38) I’ll say for all providers on the part time?
Leigh Howle (12:47) Okay. Got it. I’ll put a ticket in for that one and I’ll ask them to have this done by end of day on Friday. Okay?
Leigh Howle (13:01) Well, we could say, I’ll say tomorrow… we’ll try to get those done and demographic updates. Yes, they can be requested on top of demographic updates. So, but it’ll just be a lot cleaner just to have those completed. I did receive the email, yes, and I will have the team close out those ptpn. Is it covina and escondido? Yeah, yeah.
Melody (13:32) And that’s I mean, we put those requests in.
Melody (13:35) So they’re following up because we put them in. But if we can just get them closed out, and then I have the team, they, we’ve updated our process on our end. So moving forward, we won’t put in provider requests for new locations. It’ll just be the group.
Leigh Howle (13:49) Okay. Awesome. That sounds good. All right. Was there anything else that we should go over on the agenda?
Melody (13:59) Nope. Okay.
Leigh Howle (14:00) Okay. So on the opsync deck… let me go back to the beginning.
Leigh Howle (14:19) All right. So on the data review, I did want to just start out with this slide first to go over PE team training updates just to give you clear visibility, be completely transparent on the training process for any new specialists that come on board. And so this is just a summary of quality controls, audit follow ups. And basically the PE team has a two week extensive training for application oversight. And the team leads go over all things confluent. So project plan processes, follow up requirements for submissions. And then additionally, any new specialists to medallion have a six to 12 week extensive PE training going over, you know, everything involved with medallion and confluent. And then for confluent specific processes. As I said earlier, we have support to the team that is structured to ensure continuity and accuracy before submission. There’s QC processes in place. So for new hires, 100 percent of their work is qc’d and then there are QC support specialists dedicated to confluent that have that extensive PE experience. They are familiar. So they’re providing oversight to any new hires, making sure that all applications are accurate and that they’re following the project plan like to a T, cool. And then we also have full audits that have been implemented to track trends and proactively mitigate any issues. And so that is just another layer on top of the QC, the extensive training just to make sure that everything is moving accurately and efficiently.
Leigh Howle (16:24) All right. Looks good. Thank you. Do you have any questions on this? Nope. This is good. Okay. So on outstanding enrollment requests, these are going down. Still not as much as I would hope to have by now, but it is, we’re still seeing a decrease. Had more actually in the 90 to 120 bucket that went down by 24. I do want to keep an eye on the 30 to 60. This is 864 want to make sure that these are all accurately processing because we don’t want to get into another bottleneck where we have a jump in the 120 or 150… great job on the task. Give a shout out. These just keep going down a decrease of almost 100. And so right now we’re at 377. Great… tricare is still at the top with 96. I did request. I’ve requested reviews. And I have now gone in and showed the team like this is what you need to do. Step one, you need to go back to the application, make sure it was submitted, correctly, review the roster, make sure it was correct. Make sure the follow up was accurate. So I had to do, some like step by step on what I want to see on. These line reviews. So hopefully these will start to go down and I’ll just continue to monitor them weekly. And then for week over week comparison last week, there were 173 open requests. And of those 15 were completed last week, so that’s a fantastic turnaround time on those enrollments prime and onecall fit into that category. Vardavon is another pair that I could add on there for that submission. That would be actually, we can see that here on the 315 increase because that would be where the 51 completed would show up. And then for weekly summaries for just an overall snapshot, there were 405 requests. We had quite a few pass through intake. So there were 508 that went through 234 submissions. And about the same about, you know, 300 enrollments completed… priority lines did go up. They jumped up by about 50. So I, you know, I mark lines of priority if it’s flagged or if it has been processing longer than usual. So we’re seeing a slight increase in those lines. Okay. Then for credentialing, going really well, vix requests for medallion, there were 90 completed and 33 ready. So this is starting to grow which is good. And then for follow up is looking much better this week. So there were 1,463 lines that were current with the payer and 144 overdue which is going down. It is going down, which is what we want overall.
Leigh Howle (19:59) And then for the rosters… this one outlier is just driving me crazy. I’m like why is there one that’s 50 plus overdue? So I’m digging into that one to find out who, which payer this is. And I’ll make sure that this one gets included, you know? Yeah. And then for March, we ended the month with 1,243 completed lines. Nice. And then the, you know, we’ve talked about the tasks analysis and I did send an email over with like just a checklist. So I did also want to share this like task initiative or project that we are collaborating on. So PE, came in at roughly 50 percent of all tasks. And, you know, we know, by reducing these tasks, it increases processing time, reduces delays. So, just wanted to give you kind of an idea of where the task summaries are. So, it looks like about one… 1,029 were due to medicare Pecos E signatures and that was the largest batch like within one subject within the task.
Leigh Howle (21:24) So, one recommendation would be to have providers sign the 855 I certification statement and just upload that into their profile. And then there won’t be a task asking for them to E, sign their applications. Okay? Do you want me to send over that certification form in an email or, yeah, if.
Melody (21:51) you would want to do that? We can look at that.
Leigh Howle (21:54) Okay. Sure. Caqh was another piece to this that was creating some delays. I don’t know why I have a random headline here, but I will delete that before I send it over. And then this just shows an ownership split between the tasks. So we had mostly admin provider at about 57 percent. 28 percent came in with true payer specific processing tasks and I would like to work with the team on identifying what those requirements are so that we can make sure providers have all those documents and everything up front during onboarding. Okay?
Leigh Howle (22:45) And then we talked about, you know, just Pecos making sure that is something that’s set up early on. I did want to ask for Pecos staff, end user access. Does your team request access to providers as… employees?
Melody (23:06) We, to the groups and then we get all of the access to them via the groups.
Leigh Howle (23:11) Yeah. Okay. So I’m wondering if we have, like once a provider’s profile is initiated, if, do you all control the access to the provider’s Pecos account, it.
Melody (23:32) I think it depends. I’ll have to talk with Julie. So, I think Carla and Gina do, those are the two team leads. I’ll have to see how they do. So I know if we are, so for our new providers, if we create their and their npes account, Carla will set up the Pecos like we’ll request it for medallion right away. We request Sarah to see from our end. So we don’t have to have you guys request it on there. But I know Gina does it different, which causes that delay so we can get them doing it the same for our established providers. I think we just give them the directions on how to do it because we don’t have access to that information. But I think… until they’re added to our account, so until after they’re added, we wouldn’t have access to their account. So we don’t get it on the back end. We just wait for you guys to have it. And then once you add it to the account, then we have access to their account. So we just give them the directions on how to do it, but we should walk them through that at a time.
Leigh Howle (24:35) Right. Okay. Yeah. Well, that makes sense. And we’ll continue just to go with the same workflow then it sounds like, you know, there’s a pretty good system in place for it. And… yeah. Okay. Yeah. I did also, one of my actions with the team is to ask them to bundle micro tasks into small like everything in one task. If so there, it reduces duplication and repetition. So I think that would be a takeaway.
Melody (25:08) Yep, that would be nice.
Leigh Howle (25:11) And then this is like our collaborating recommended nighty day plan, just some general ideas throwing out here. Nothing concrete, but, you know, we can work together. I did send over that PE checklist and then just bundling any like PDFS where providers can sign forms ahead of time and having that loaded into their profile. Yeah. And then going ahead and having the medicare, any medicaid portal playbooks that we could build and create that would have like, okay, once the provider is logged in, you know, in the platform, then we’ll go ahead and we can start medicare surrogacy, staff, end user. I can let the intake team know if it’s medicare or medicaid just to approve it and just pass it through. So, I think we have some good ways that we can make some improvements in these processes that would have significant positive impacts long term. So, you know, we can, the goal is for us to track the KPIs based on PE tasks per provider, PE, tasks, per submissions, try to reduce, we can have like a set target that we can, a percentage. We can say, we want to reduce all PE tasks, by the end of Q2, and then maybe go 45 percent by Q3. So we can just kind of work together on a plan to try to get these down over time.
Melody (26:51) Makes sense. Yep.
Leigh Howle (26:53) Okay. Awesome. And, that, was it? Okay? Whoops. Awesome. Well, did you have any… anything else?
Melody (27:07) Nope. I think that’s all okay.
Leigh Howle (27:09) All right. Oh, the cap. So I did send Kelly another email for the sunflower audit. And so, you know, once we can just kind of get together and go over our findings. I’ll coordinate the meeting with everybody. Okay? And then we can just kind of discuss everything in more detail. And, I think that was, yeah, that was all that I had. Okay?
Melody (27:38) That sounds good. Yeah, I meet with Kelly tomorrow. So I’ll just talk with her too on that?
Leigh Howle (27:43) Okay. Awesome. Thank you. Okay. Sounds good. Thank you. Yeah. Thank you, Amy. Did you have anything nope.
Amy Frana (27:51) I just wanted to pop back in and say, have a great rest of the week.
Leigh Howle (27:56) Thank you. Thanks. Thank you too. Bye bye.