Transcript
Rae Tompkins (00:00) Sherry, hi, Sheena.
Sheena L. Swihart (00:01) Hello?
Rae Tompkins (00:04) How are you? Good? How are you? I am good. I think it may just be us today.
Sheri Prouty (00:13) Well, it might be a quick call then. I think so. Rae, where are you located at?
Rae Tompkins (00:19) I’m in charleston, South Carolina.
Sheri Prouty (00:21) Oh, okay. I was thinking that y’all were in one spot but y’all work from your homes. It looks like we do. Yes, we’re.
Rae Tompkins (00:28) all over the place… all over. Are you guys pretty spread out too? We?
Sheri Prouty (00:37) Are I’m in Oklahoma? Sheena’s in Michigan? Valerie’s in Georgia. Oh, wow. And our teams are pretty much we have quite a few there in Ohio as well, which we’re based out of, but most of our teams are in different states, Florida, Virginia, Maryland… Georgia. Yeah, Texas.
Sheena L. Swihart (00:57) Virginia.
Sheri Prouty (00:59) Beach, West Virginia.
Rae Tompkins (01:02) I love that. Yeah, we’re pretty spread out too. We have California all the way to east coast, everywhere between like Nicos and Chicago. I’m in South Carolina. So, yeah, we’re pretty spread out.
Sheri Prouty (01:16) That’s cool. Yeah, I never thought to ask you until today for some reason.
Rae Tompkins (01:21) I usually have a blur so it doesn’t look like an office. So, yeah, yeah, that’s what we do. It’s pretty fun to be all spread out. Perfect. Yeah, I know val is out at the conference. I know there’s been lots of ongoing conversations about the state flips, and I know Jordan is meeting with Molly and val on Friday to kind of review some topics that we’ve been discussing. But one of the things I wanted to bring up today was just a reminder on the July recred universe and see if we possibly had an update.
Sheena L. Swihart (01:56) So, because val is at the conference, it is behind currently because, the recred… file is a manual file. Valerie and I have to do that file manually and it’s a lot of work. It is so much work. So we.
Rae Tompkins (02:17) have to pull files.
Sheena L. Swihart (02:19) From different from our credentialing system plus our billing system. And then we have to remove different things. So, it’s a manual pull. So because val’s out, it is behind, but we’re hoping to have it by end of week. We know it’s cutting into your all’s time and we’re fully aware of that, but we’re doing what we can, we have the file pulled. We just haven’t been able to get like working on it, no.
Rae Tompkins (02:51) Worries at all. Just wanted to keep flagging it. Obviously what the understanding is, the later we get it, there may be more returned incomplete files, but we’ll start processing as soon as it’s received and we’ll just continue conversations there.
Sheri Prouty (03:04) So, right to that incomplete question. So, I know that we had talked about and I think it was Jenny that said it bypassing that state piece so that you can finish the rest of the file and do all of the PSV for everything. But like the license, right? Do we know where that’s at? Because then it could be sent back as a risc file and not incomplete because right now incompletes don’t get updated in our system.
Rae Tompkins (03:30) I think based on our last call, val had flagged that we didn’t want to go that route because we weren’t capturing the state that you needed them credentialed for, but I may have misunderstood.
Sheri Prouty (03:46) I thought we could make because you weren’t getting, I don’t know maybe, but I thought it was the other way around that you could bypass it because, and… send it back as, you know, license not verified or whatever as the risc that we could pick up on our side. But if you PSV, everything else, Sheena, keep me honest here.
Sheena L. Swihart (04:09) I don’t remember to be honest that.
Sheri Prouty (04:12) Was a whole week ago?
Sheena L. Swihart (04:13) That?
Sheri Prouty (04:13) Was.
Sheena L. Swihart (04:14) a week ago?
Sheri Prouty (04:15) Yeah, we might want to revisit that okay?
Rae Tompkins (04:18) Yeah, I can definitely let Jordan kind of catch up on what he’ll discuss with Malia and val on Friday. I think where we left off was there was some confusion regarding us not capturing this state.
Rae Tompkins (04:30) Happy to revisit it. I pulled up our notes from our previous call and it looks like… obviously the system isn’t configured that way. So it would need to be configured on our end from a product perspective to see if that’s even possible, but definitely something that we can continue to scope out to see if that’s something we can support and how we can make it obviously a little bit easier for you guys to ensure that, you know, the right data is being collected and that we can continue processing.
Sheri Prouty (04:59) Right, right. Because like I said, they’re incomplete files. We can’t use them. We don’t get notification that they’re incomplete that I can remember. I don’t know if those are the escalations that come back and say they’re incomplete or what. And then, so we’re missing files getting updated into our system. And then we’re scrambling to meet our slas. And I know for recruits they scramble to hit their slas, because if you send back a 1,000 of them as incomplete, that… 1,000, we have to work in house and.
Sheena L. Swihart (05:32) We don’t care about it. We are still, yeah, we’re actually out of compliance with March. Right now. We are still currently working on March files.
Sheri Prouty (05:40) Okay. Because there was over.
Sheena L. Swihart (05:43) 1,600 incomplete files returned. So, and April is not looking any better for us because of the incomplete files.
Rae Tompkins (05:56) Yeah. Let me connect. I think we can probably continue conversations when we have val back next week on kind of just like how we want to level set understanding that the information isn’t going to change whenever cacti sunsets, and we’re switching over to a new platform. So I think we can obviously continue discussions on the best solution moving forward, but I think we can.
Sheena L. Swihart (06:22) We’re still staying in Symplr, right? Cherry. Yeah.
Sheri Prouty (06:26) So the goal right now is to go to a cloud based Symplr which is light years ahead of where we’re at right now as far as capabilities from my understanding. So we are looking into that you’ll know when, and I think valley mentioned that on one of the calls that we were looking to go into a web based version of Symplr don’t have a timeline though we just started talking about it. So stay tuned for that. Also. I wanted to ask, do you guys use fsmb?
Rae Tompkins (07:07) There, I may defer to you on that one to verify boards.
Sheri Prouty (07:12) License not.
Merritt Miller (07:15) Typically for licenses. Well?
Sheri Prouty (07:18) Here’s the reason I asked, we got information from our regulatory that there’s a new requirement for. Hang… on now. I gotta find the email. My email hates me just so you know, it’s… a new ncqa policy change that we just received today as a matter of fact that it was update for ongoing monitoring. So, the new requirement is that we have to monitor sanctions and licensure limitation information for all states in which the practitioner practices, even if those states are not, those states are outside of the organization service area or are not states where the practitioner provides care to the organization and members. So that’s… a new thing, which means that we have to monitor all licenses now is… the way we understand that I see. So val wanted me to ask if you monitor fsmb… we.
Merritt Miller (08:30) So we have an ongoing monitoring solution that’s compliant within cqa. It’s it’s not really using fsmb as the source. We have various kind of scrapers and, some manual, some automated where we’ve been able to, that pulls that data for the team. And then we review it and kind of pass the information back to you all. So.
Sheena L. Swihart (08:52) It’s probably something like what we have for continuous it.
Sheri Prouty (08:56) Could be, it could be similar to what we use for, in Symplr. Yeah.
Merritt Miller (09:00) It might be, we kind of have universes of our customers licenses that we import from caqh or however they send them to us. And then we just monitor those licenses and add like if we uncover additional licenses during cred, we’ll add them to the system and then those will get monitored as well.
Sheri Prouty (09:21) Okay. So we might have to look into what we can do to make sure that we’re meeting this new ncqa requirement. Yeah.
Merritt Miller (09:33) Yeah. It might be a good thing for val to pass to mully or Jordan because it’s a different SKU at medallion. So there would be additional costs associated with that. But we do offer and have an ongoing monitoring solution for licenses.
Rae Tompkins (09:55) Perfect. Sheri and I did just find notes from our previous call that you were going to work to provide us a list of state entities and contiguous states.
Sheri Prouty (10:04) I have that. Okay?
Sheena L. Swihart (10:07) I forgot to send it. So I am going to send it over to you right now, perfect.
Rae Tompkins (10:11) Yeah. I think that was what we needed in order to kind of start preliminary investigation on our side and what that would look like with those state flips. So if you can get that sent over to us, we can kind of take a look at it and see what we’re working with.
Sheena L. Swihart (10:27) I will have that as soon as I find it on my computer.
Rae Tompkins (10:30) Perfect.
Sheena L. Swihart (10:31) Thank.
Rae Tompkins (10:31) you so much. And then I did have one additional sop update request as we’re processing files. There was one additional call out in regards to the boards… the American board of physicians specialties, it’s not an abms board and it’s not on the PSV link and there’s a cost association. Yeah.
Sheri Prouty (10:56) We don’t recognize that board if it’s not an abms board and it’s not on our list of psvs, then we don’t recognize it.
Rae Tompkins (11:03) Perfect. Thank you for that confirmation. Of course. Yeah, that was an abms… aoa, family medicine board for an MD. But since it’s not an abms board and not on the link that we won’t utilize that board. Yeah… thank you for clarifying. I think that was all that we had. Obviously the major thing being the July re creds, if you can get us over that list, Sheena, we’ll take a look and see kind of what that process will look like as far as a product enhancement for those state flips. We are working on, getting those providers switched over to Kentucky from West Virginia. I did go into the caqh import tab and stop out all outreach that’s taking place to that credentialing contact. So there’s no more, you know, admin emails saying, you know, I’ve already answered these. So turned all those off. So that should alleviate that issue. And once they’re re imported correctly, obviously the state should match what’s being populated in caqh. So there shouldn’t be any outreach needed on that aspect?
Sheena L. Swihart (12:06) Yeah. I actually had to involve the market this morning because there was an email that went out this morning to the cred contact. And so I had responded to her to let her know that we were working together to try to get this to get this corrected. And she wanted her representative’s information. So it just so happens, I had a meeting with the West Virginia market this morning. So I had to let her talk to the market to her to the market. And she’s just frustrated because she continues to respond that they do not have a West Virginia license that she can only provide the Kentucky information because she has responded and copied me on it. I am getting copied in these emails that are going back and forth, even the medallion emails that when they are coming back. So, yeah, those emails.
Rae Tompkins (13:14) Totally understand. And I apologize for any inconvenience. I did check that there, she was only receiving outreach for Heather Sloan. It looks like all the other ones were completed. So I went ahead and stopped Heather’s. It looks like there was only two outreach. So we stopped it before the third one was recent. I do know one of the things that I flagged is working with our product team to possibly delay the amount of time in between outreach. So it’s not a continuous day after day email, but moving forward, she should not receive any request in regards to those West Virginia Kentucky providers.
Sheena L. Swihart (13:46) So they’re getting this outreach daily. If they don’t update that’s.
Rae Tompkins (13:53) the way our caqh import tab works is that we’re continuously outreaching to provide the information so that we can get it into a steady state for our team to start processing.
Sheena L. Swihart (14:04) Okay. Now, I, there’s a better understanding of why there’s some abrasion from our providers then.
Sheri Prouty (14:13) So, yeah, because we don’t even send out daily, we don’t send out daily requests. We give them like 10 days to respond, but I know that you guys are on a tighter time schedule to get them back to us, yeah, Nico.
Rae Tompkins (14:27) Merrick, keep me honest. It is daily, correct, just based on the email that I’m seeing that Sherry provided it went out on March thirtieth, and again on April first.
Merritt Miller (14:36) I thought it was usually every other day, but it’s I mean, either way, it’s like it’s a very it’s.
Sheena L. Swihart (14:43) a very aggressive frequency.
Merritt Miller (14:45) Yes, yeah.
Sheri Prouty (14:48) We’re.
Merritt Miller (14:48) investigating that just so you guys know on like the cadences that we send emails. We’re hoping to get to a place where it’s much more strategic on kind of where we see the best response rate and incomplete files.
Sheri Prouty (15:01) Sounds good. Sounds like a good plan. I did want to bring up one thing Ray before we convene. Nico, I sent, I got the list of specialties that you sent over. I bumped them against ours, sent them back. I also created a tab that has our specialties on it and we have like three times as many as what you guys have. So that’s a little. It’s it concerns me because we send over some specialties that it doesn’t look like you guys cred or can maybe you cred them? You just don’t have a cross reference to send them back to us. Not sure. Yeah.
Niko Byron (15:42) We’re investigating those right now and we’ll get back to you with like an explanation and a potential solution going forward. If we’re going to ingest specialty from caresource because obviously, we’re going to need to have that figured out to receive those. So, yeah.
Sheri Prouty (15:57) Okay. Just want to make sure you got it.
Rae Tompkins (16:03) All right. And I just received that email, Sheena, so I’ll get that over to ginny and she can start reviewing that, and I’ll be in touch with any additional questions or any items there in regards to the continuous states and the states that are imported. Okay?
Tracey D. Roberts (16:19) I have one request. Yeah, when will be, when can I expect to see quarter one scorecard data?
Rae Tompkins (16:28) I’ll need to check with Jordan on that, but I can have him follow up directly sure that’d be great absolutely.
Rae Tompkins (16:39) Great. Well, thank you so much. Everyone. Happy to give everyone some time back. I will get this list over to ginny. And then we’ll continue conversations on the state import data and those providers that need to be flipped from West Virginia to Kentucky.
Sheena L. Swihart (16:55) Okay. Thank you. Thanks.
Rae Tompkins (16:57) Everyone. Have a good one.
Sheri Prouty (16:58) Thanks you too. Bye bye.