Transcript
Jason Zednick (00:00) hi, Eileen. How are y’all,
Jason Zednick (00:08) hello. How are you? I’m good. Can you hear me? Okay? I have some construction. I can, I am, good. It’s very loud for me. So I can barely hear myself. But as long as y’all can hear me.
Janelle Carpenter (00:26) Okay.
Jason Zednick (00:29) All right.
Jason Zednick (00:39) Hello. So I have a couple of priority providers… I want to put on your radar because… let… me just pull it up.
Jason Zednick (01:13) So, we have.
Jason Zednick (01:21) Some of these privileging requests here. And, oh, sorry, I’m on the wrong account… ignore all that… and I’ll go to y’all.
Jason Zednick (01:48) Some of these privileging providers, my team can’t move on them because the profiles are incomplete or there’s like a task that just hasn’t been actioned by the provider. I went in and I wrote down the names, I can share that with you. But can we work over the next week or two to… you know, get them up to speed so that my appointments team can work on them. So tell.
Janelle Carpenter (02:22) me a little bit more what, because a, I’ve never got into this privileging tab. So here’s what, when I looked it up, what I know… privileging and credentialing at swope health, when they are first onboarding is basically the same. You’re basically checking the exact same things that you would do for credentialing that’s what’s required by hrsa, fqhc, Missouri department of health requires for privileging this additional training. And so, our privileging and credentialing dates for ftca, hrsa, fqhc is the same date, same content that we do for our upfront credentialing. Then for Missouri department of health, we do an additional training with our BH, behavioral health department, that meets the Missouri department of health requirement. So help me understand what you guys are doing with privileging?
Jason Zednick (03:36) That is what we’re doing like that accurately describes the process. It is very similar to the credentialing. There are different standards applied to the verifications that are done. But yes, they are similar processes. And you can see like the credentialing report is like very similar. The workflow is similar. They’re just different standards that are being applied. And I shared with you a couple a month or two ago. Our sop for the privileging side of things and, I can find that and put it back in your inbox, but that outlines sort of what we are doing on these privilege and violence.
Janelle Carpenter (04:31) So our privileging and our credentialing date because it’s the same. Should.
Jason Zednick (04:35) be the same. They are separate. They’re separate, they’re separate files. They’re separate processes. They’re separate standards.
Janelle Carpenter (04:51) Hey, Jason, can you let Thelma in real quick?
Jason Zednick (04:53) Oh, yeah, of course. I can. Thanks you’re good, thank you.
Janelle Carpenter (05:01) So I’m trying to be very careful how I say this from the documentation I got from hrsa, fqhc, all of that, what… we at swope health have done up front from a credentialing perspective also gets our folks privileged and credentialed and that’s the same date. Our Missouri department of health though does have different standards and it includes a training that is done over two days. So their privileging date which meets the Missouri department of health standards is different. But the up front credentialing privileging which is required the same content. Those dates are the same. So I think I’m not understanding if these people, yeah, I think I’m not understanding Jason because we went and actually looked at the content, validated it with different people to make sure because we’ve been updating our content and our ftca site based on the information they gave us. That’s why I’m confused because we still have so much to do from a credentialing perspective. I don’t know why this privileging is showing up unless you’re doing it from a Missouri department of health. And if so, that’s a different group that’s managing the true Missouri department of health privileging requirements.
Jason Zednick (06:47) I think I’m hard… pressed to speak to the state requirements right now. I’m looking at the work that’s been submitted from a medallion perspective, and we can’t proceed with this work that has been submitted because the profiles are not complete. That’s where I’m coming from today. I would have to go back and talk to sort… of go back and look at materials from the implementation to understand what the intention was with these files to really wrap my head around that. What I can say is these requests were made and we’re unable to action them at the moment. Okay? So, let’s.
Janelle Carpenter (07:42) just take a specific example, Michelle redsman, her profile is 100 percent. However, the task that is still in her overview is for professional references. This is from a credentialing perspective. What are you telling me that is missing from a privileging perspective? Because we are making the dates exactly the same for the upfront and the every two year privileging and credentialing for the ftca requirements. Now, again, when you get to the Missouri department of health, privileging requirements, that date is different. So, can you give me the example on Michelle redsman? What’s missing?
Jason Zednick (08:28) It is the, it is the references… yes, yeah, that is. So looking at Michelle redsman, she has the references professional references task on the appointments. Now called privileging. There’s some terminology there, but there’s… because.
Janelle Carpenter (08:53) I’m getting it just off of her normal overview, her profile the.
Jason Zednick (08:57) Overview there. So, but.
Janelle Carpenter (09:00) I’m not sure why you guys are doing different work. Again. We pulled the information truly from FTC application to understand the difference between credentialing and privileging. So we had to go in and update the ehb site. Okay? And it there because they both are called privileging. Is why in the past, there was a lot of confusion. But when we actually looked at the requirements that upfront piece, and even on this example that we’re looking at that upfront piece, if they are credentialed and approved, they are also privileged and approved upfront from an ftca requirement perspective. Now, Missouri department of health, that is not accurate. But their privileging is that two day training. So I don’t know, but it’s the same task that’s why I’m like, okay, so it’s the same task, but I don’t want your dates to be different because we are updating that currently in the ehb site, ftca site, the government site, I guess I should say I, an argument… heh… so for.
Jason Zednick (10:21) Michelle, let’s… just look at Michelle. We have a ncqa… credential PSV all set scheduled to recredential, ncqa 20 28. So she’s set there. We also have a request to do a privileging… file that’s medallion’s term here and run verifications under… the appointment’s privileging product. And that’s the work that was submitted. Again. I can’t exactly speak to like the intention of what that is. I wasn’t a part of those conversations, but we have these requests.
Janelle Carpenter (11:17) So, who does the request come from?
Jason Zednick (11:21) It came from… swope, submitted this work to us.
Janelle Carpenter (11:29) Back in September… or August or July. Is that what you’re thinking? Some?
Jason Zednick (11:36) Of these were February. Some of them were November between November and February. So, I’m.
Janelle Carpenter (11:45) pretty sure and… Thelma keep me honest, I wouldn’t have submitted a request for you to privilege anyone because we went and actually looked at the documentation to understand what privileging meant. So, I don’t know who would have given you a request to privilege different than their credentialing date. Now, the BH team manages the privileging for Missouri department of health. They do all of their, I don’t I think that’s outside of here. I’m pretty sure because there isn’t a BH representative on here. So I don’t think they even have access to medallions. I’m just trying to kind of get to the bottom and understand that. Is this something that was requested prior to doing the research to understand that there’s two different types of privileging that’s what I’m trying to figure out? I.
Jason Zednick (12:43) mean, yeah, that very well may be the case because.
Janelle Carpenter (12:48) it’s the same task that’s why I wanted to look at a specific example. And since it’s the same task now, bottom line is the task still needs to be done, but I don’t want in medallion, there to be two different credentialing and privileging dates because then from swope’s perspective, we also are managing the BH privileging which is the two day training for Missouri department of health.
Jason Zednick (13:16) Am I making sense? Well, they are stored separately in terms of like that. So we wouldn’t confuse the two days. So all valid concerns aside, they would be separate and there’s no risk of like confusing those at least on that part. I’m showing that.
Janelle Carpenter (13:41) So if I’m re, credentialing somebody on let’s… go April first and then there, so I make them go in and do all the stuff to re, credential them on April first and you guys have a privileging date of may first, when in reality, I just did all of the work for their credentialing date. Then I come up that they now have a privileging date. Then all that work is you guys are doing double work as well, when in reality, that credentialing stuff is the same?
Jason Zednick (14:22) Yes, we can reuse and do reuse anything that we can. The only thing that we would have to redo in that regard or you would have to redo is whatever the gulf between those two requirements are, if we have a verification that was done in April, that’s going to be valid for the privileging verification, if it’s the same thing, but they are different requirement sets. They’re different verifications. There is overlap but there’s also.
Janelle Carpenter (14:58) So in the research we did, we didn’t find anything that was different, which is why our dates are lined up and so, and we are reporting that through the government on their site based on what we have done prior to medallion, even so if you need to be recredentialed on April first and it’s the same requirements. We are keeping those dates the same. You’re giving your ftca privileging date is also may first if.
Jason Zednick (15:38) That is the case. Then it sounds like it sounds like you don’t need these privileging files at all.
Janelle Carpenter (15:47) I mean, and I will send you what we got off of the hrsa ftca site. I can send you that documentation. And again, the Missouri department of health, their privileging is different, but I can send you and I mean, I am, if you come back and you’re like Janelle, these three requirements are different and that’s why we do it different. Then I’ll let it go and our dates can be different. But then we have to go back in before ftca comes in. If it’s a matter of a different level of I don’t know check but it didn’t outline that in what we looked at… because then I’ll have to go back in and update those 500 records because it’s everybody. It’s not just providers. I think we’re at 580 some. I.
Jason Zednick (16:42) Mean, I believe you. If you say they match and, you know, please send, I can, I’ll.
Janelle Carpenter (16:45) send them. Yeah, I mean, Michelle ritzman, is credentialed. I’ve dug into it too.
Jason Zednick (16:50) Michelle is credentialed, she is like in the credentialing cycle, from that perspective, she’s fine. Now, if this other, I want to call it joint commission, it’s not quite joint commission, but closer to that is unnecessary, then… that’s a different conversation, okay?
Janelle Carpenter (17:18) I’m taking the action item down, Jason, because again… I might be oversimplifying, but when we looked at it and we talked to Brandy was in there, Valeska. So people from our compliance group and I took those documents with me to just try to verify that. Okay? Because this is what I’m getting ready to do is I updated.
Jason Zednick (17:40) A lot of things that.
Janelle Carpenter (17:41) hadn’t been deleted. So, but I will send those to you because I’m I could very well be wrong when.
Jason Zednick (17:48) Was that conversation that you, when y’all talked about that?
Janelle Carpenter (17:54) When was it? Oh gosh. I probably, it’s been, I would say this year because I finally got into the ehc, the government side. I was able to get in and when I got in, I don’t know who was the last person that updated it, but there were a lot of people on the government site, the ehb site that were no longer with the company. So once we got those out, then Eileen and I started working on the dates and that’s when I went in and did the research because the dates were different, but everything I had heard was about the Missouri department of health privileging, but there’s two, they call it. They both call it privileging. So that’s when I did the research. So maybe mid January Ish,
Jason Zednick (18:46) it sounds like what you said earlier might be true that these were submitted because most of them, most of these were submitted before that were done under… a different understanding. And maybe now that you have a better understanding, it’s like actually maybe we don’t need it. That may be true. I don’t know, please send me the standards. I would love to, you… know, skim them, see what happens.
Janelle Carpenter (19:16) I’m with you. I’m like because.
Jason Zednick (19:17) I do also have like, I have the document that says, hey, this is what we are doing for these files and we can do that assessment of, like, is this all covered by this other? Like, yeah, I can confirm, you know, if they’re easily digestible, you know, sometimes that conversation.
Janelle Carpenter (19:37) But we will figure it out one way or another. Either way. It looks like the tasks are the same. And I’m going to have to figure out on Michelle. I have gone back to her a couple of times. I had to figure out how to get her to give me some additional references because, you know, Jason, can I ask a question? Nobody’s responding.
Janelle Carpenter (19:56) Yeah. Can I ask a question? Why wouldn’t you have like this? Ritzman says peer references, they’re on our caqh, why would you ask us that?
Janelle Carpenter (20:10) They reach out to them?
Jason Zednick (20:12) Your references?
Janelle Carpenter (20:13) Are.
Janelle Carpenter (20:13) on your caqh, we’ve.
Jason Zednick (20:15) reached out to references and not heard back. That’s why we’re asking for new references.
Janelle Carpenter (20:19) Yeah, that’s what it says in our file. Is they reached out. So you’re.
Janelle Carpenter (20:23) actually going out and calling these references?
Janelle Carpenter (20:25) Yeah… yep.
Jason Zednick (20:28) But that’s not something that we do on a credentialing file. We only do that on these privileging files really? Yeah. Oh, the difference, yeah. What?
Janelle Carpenter (20:39) Purpose would it be for dr Latimer?
Janelle Carpenter (20:44) Same… I would think. Okay. All right. So, so, so… Jason, what I heard you say at the beginning of the call is.
Janelle Carpenter (21:09) pay, right now. Pay more attention to the tasks that are in the privileging or just the overall like Thelma pulled a report for us today, and, you know, highlighted which ones were hers, which ones were ours, and to work on those. So there’s so many to work on. I’m trying to figure out, I.
Jason Zednick (21:29) Think given our uncertainty on the necessity here, I would say follow… Thelma’s priorities because those are active applications to payers that we want to get through. And it sounds like this, is less of a priority than that will.
Janelle Carpenter (21:54) Do. And I’ll put Eileen on that. I’m in the middle of it at the audit, but I have two more questions after you have yours.
Jason Zednick (22:02) Oh, yeah. Just last thought there for most of these questions… of whether it’s necessary or not aside. It’s really just they need to complete the profile which will unblock both Thelma and this and that’s really it. So a bit of a twofer there, but we can look into that further for sure. Yeah, please send me that those materials so I can, okay, I will do that. Yeah. Thank you. Okay. Yeah. Go ahead. Your other questions?
Janelle Carpenter (22:32) And then the, them… signing their agreements. What I found is I send them the really detailed. I try to get them on teams. If it’s not working, then Eileen’s stopping by the different clinics to try to get them through.
Janelle Carpenter (22:50) I’m running downstairs to try to get them to sign it. It’s just not a, it’s not a quick thing. I have Eber today that she said, I finished it and I’m like there’s nothing signed. So, I’m like let me know when you have a minute and I’ll and where you’re at and I’ll come to you and do it because it takes five minutes when I can get them to let me come do it with them. But, you know, would,
Jason Zednick (23:16) it be helpful if I recorded like a one minute loom and I can give you the link and I’m like, hey, this is how you do it and you click here and you put the date and that’s it, would that help?
Janelle Carpenter (23:25) We’ll try, I mean, and I would give them step by step. We’ll throw it in there because I send them the link specifically to theirs, right? And say here’s the four categories, sign it, click the attestation box, type in your name, and I don’t remember which one one of them you actually put your initials in. And then I repeat it the four times and poor dr parsons was like, I’m doing it. I’ve done it. Well. What he hadn’t done was put in his initials, but I ran downstairs and took chocolate with me and he was happy when I left and it took us two minutes, I.
Jason Zednick (24:04) Mean, you brought chocolate that’s always good? Yeah, whatever.
Janelle Carpenter (24:07) I can do, I’m trying to get him to get it done. So we will work on that.
Jason Zednick (24:13) Yeah, I’ll get you that. Yeah, that’ll.
Janelle Carpenter (24:16) help?
Jason Zednick (24:17) I’ll put it to the top of my list just so you have another tool, something to help. Yeah, I get it. We’ll.
Janelle Carpenter (24:23) try it because I had put in some screenshots but I didn’t do the video. Yeah. Okay. Did you have another question for me? And then I have two for you?
Jason Zednick (24:33) No, no, please, go ahead. Okay?
Janelle Carpenter (24:35) So, dr Cruz was in training with me yesterday, and I want to make sure that we’re not doing the process wrong, which could be causing his problem. So, dr Cruz said, hey, I have everything done, but I’m still getting messages from medallion that I don’t have it done. So while he was there, I had him pull up his account. And so if you look at his account, it was all green. Yesterday. Now, there’s a task outstanding. So I’m like what is this task outstanding? So it’s the caqh profile authorization attestation. So, is that actually in his caqh profile or is that actually, are they saying the attestation that’s in the agreements that he’s supposed to sign that way? Because it’s there. So I actually, that’s what I had him open. I was like, okay, let’s go to your agreements. And so I’m opening it right now on my screen and I didn’t see that there was a problem. Okay? So it’s that box?
Jason Zednick (25:46) Do you want to share? I have it pulled up for you? So it’s.
Janelle Carpenter (25:51) the little box he didn’t click. I see it now. I didn’t see it when he was with me yesterday. It was all green. It.
Jason Zednick (25:59) Is very easy to miss. Okay. I totally understand how it, but it is, it’s the box. Yeah. Okay. I.
Janelle Carpenter (26:12) Will get back to him. I was afraid because he said, well, it’s going to my personal email because as soon as we know they are coming on, this is the part I wanted to verify because again yesterday, it was completely green and it was, there wasn’t a little arrow yesterday or a little triangle today. There is. So I see it today. Yesterday, I was like, no, it looks like you’ve done it all. So I just wanted to make sure that Eileen sending it to them. The initial request goes to their personal email before their swope email is active, because the swope email usually isn’t active until like the Friday before they start. So I wanted to make sure that wasn’t messing something up.
Jason Zednick (26:58) No, that change wouldn’t affect all.
Janelle Carpenter (27:03) Right. I will get back with him and let him know what the problem is. Aye. All right. And.
Jason Zednick (27:08) This is that, you know, that box that signing process. Everybody messaged that. It’s very easy. I totally, I’m very sympathetic and I get it.
Janelle Carpenter (27:19) Please put that in your video. It will be okay. And then.
Jason Zednick (27:25) I,
Janelle Carpenter (27:25) just… please now, I forgot. So somebody else go because I forgot what my third thing was. I have to think about it. Somebody else can go to.
Janelle Carpenter (27:39) Update him on. Oh,
Janelle Carpenter (27:42) thank you, Thelma, I was like, I know there was something else I was going to do. So, now that we are de delegated with unitedhealthcare… thank you, Thelma I need to make sure that you guys are aware that going forward, you guys will be… overseeing the uhc commercial and the uhc medicare plans?
Jason Zednick (28:12) So, you said commercial and?
Janelle Carpenter (28:14) Medicare.
Jason Zednick (28:16) medicare? Yeah, sorry?
Janelle Carpenter (28:19) I have construction and I can’t, do you see anything more official than me just saying those words… let?
Jason Zednick (28:26) Me, think about it,
Jason Zednick (28:35) No. Is there any thing… outside of the normal uhc enrollment process that you do differently that we don’t already know about? Like, I know the mpi stuff that’s going to apply to everything. I have nothing to say there. If there’s nothing outside of the normal process that everyone else follows, then no, then that’s all I need to know and we’ll you can submit a request and we’ll take it and we’ll be fine. I’ve.
Janelle Carpenter (29:08) been submitting requests since we’ve been on the phone. So you should have some.
Jason Zednick (29:12) Okay, perfect. Yeah, thank.
Janelle Carpenter (29:14) You, Thelma, you’re welcome. And is that something you would normally do? Or is that something I should be doing? I,
Janelle Carpenter (29:20) would normally do it. You would just put the provider’s locations and everything that you already do. And I do the insurance part.
Janelle Carpenter (29:27) Okay. Cool. Thank you. You’re welcome. Yes. And thanks for the reminder. I’m like, I know there was something I had written down. I needed to do. Thank you. Cool. Well, that was an easy one. Jason.
Jason Zednick (29:44) Yeah, I mean, great. Yeah.
Janelle Carpenter (29:48) Okay.
Jason Zednick (29:53) Anything else?
Janelle Carpenter (29:58) No. Do you have any updates for me?
Jason Zednick (30:02) I don’t I was just going to ask if in the last week you’ve heard anything, I’ll use the word negative from any of the payers regarding enrollments?
Janelle Carpenter (30:14) No, I wouldn’t say negative. Yeah.
Jason Zednick (30:17) I would say a learning curve, but it’s all I could think of, you know, mishaps, missteps. You know? Yes.
Janelle Carpenter (30:24) No, I actually have a meeting with blue cross and blue shield on… the tenth. Okay. So, next week, it’s… an hour. So I will take notes and then I don’t know who all will be in the meeting when I get ready to train you and your staff on what to do, but you could let me know. Yeah.
Jason Zednick (30:54) I think it will probably just be me, but I will talk to my team and, you know, if there’s someone else, I’ll let you know and make sure that, they show up. But… I am available. So, I just, you know, whenever you’re ready, let me know and we’ll find time and I’m very happy to.
Janelle Carpenter (31:15) Do you want to join the call with me? And I can still take notes and go over any questions after we get off the phone or do you just prefer I just listen? What do you want? Essence? Do you want me to just listen and just update Jason or do you want him to join the call as well?
Jason Zednick (31:38) What time on the test?
Janelle Carpenter (31:40) I think she said nine 30 to 10 30… Central Time? Sorry?
Jason Zednick (31:52) Oh, so 10 30 till 11 30?
Janelle Carpenter (31:57) No. So, they’re Central Time as well. I believe, oh, sorry, I’m.
Jason Zednick (32:02) eastern. Oh.
Janelle Carpenter (32:04) Yes. Yeah.
Jason Zednick (32:05) Yeah. I have another client at 11 o’clock.
Janelle Carpenter (32:12) Eileen, can you move to phone please?
Janelle Carpenter (32:18) Okay. I didn’t hear you. I’m sorry.
Jason Zednick (32:20) I have another client at 11 o’clock oh, okay. Okay. So that would be in the way. But I can definitely like, if you want to meet later that day with me and we can go over it. I have a pretty free afternoon after that, okay?
Janelle Carpenter (32:40) Well, it’ll probably be the next day because I was going to make like helpful hints and like documentation like I did the last time.
Jason Zednick (32:47) No, I love that. Yeah. Okay. Let me give you time to do that for sure. Okay?
Janelle Carpenter (32:55) And then I have been putting in requests for unitedhealthcare. I don’t know if you have like a separate tab for unitedhealthcare dental, for the commercial piece, or is it just unitedhealthcare commercial?
Jason Zednick (33:11) I think it’s just unitedhealthcare commercial. Okay?
Janelle Carpenter (33:15) And then for unitedhealthcare, for the behavioral health piece, we use optum. So, do you need something different for that? Or you’ll just your staff will just know to enroll them in optum as well for commercial and medicare because I know they do that with blue cross blue shield. I’m just not sure how they handle unitedhealthcare? Okay?
Jason Zednick (33:40) Yeah, I’m pretty sure we have it just documented. Let me just chat.
Janelle Carpenter (34:02) And I noticed they fixed the group name on the payer enrollment piece. So we’re just still waiting on them to say… how it’s going to work on the back end or what are we waiting on your upper management?
Jason Zednick (34:18) We’re not waiting on anything like my team knows how to process it. Okay? We wanted to pull off that npi, to like eliminate a failure point, you know, But, they have been instructed on what to do. And so, they should be following that.
Janelle Carpenter (34:39) Okay.
Jason Zednick (34:40) That, that is, yeah, for.
Janelle Carpenter (34:42) The ones that enrollment was completed before this was implemented, how are they doing that? And will we be charged for those services?
Jason Zednick (34:52) They are… reviewing previous submissions. Okay? I believe anything that needs to be reworked, you will not be charged for. Okay. Yes, I need to do some cleanup… on… our sort of internal document of instructions, But that’s sort of like an aside thing. But, yeah. Okay. They’re gonna, they’re gonna look and make sure that.
Janelle Carpenter (35:30) Because I know all of medicare needs to be reworked… because we, a lot of our providers float. So, we want them enrolled in all the clinics because we don’t we never know which clinic they’re going to on a day to day basis.
Jason Zednick (35:48) Were they submitted with those locations?
Janelle Carpenter (35:52) Yes. Okay. Let me look at it and I sent you an example of one of them in the email via email.
Jason Zednick (36:15) Yeah. Let me talk to that. Okay. Yeah. And then,
Jason Zednick (36:29) let me ask… one second. I am not, it is not immediately clear to me. I’m trying to think of the best way to phrase this, for… the behavioral providers are united.
Janelle Carpenter (37:37) Because we only have one contract with united. So they, I would think that once you do the initial enrollment, they should automatically flow over to optum. But if you get any kickback, I guess, just let me know. And then we could try… a different workflow. I guess, yeah.
Jason Zednick (37:57) Let me ask my team something real quick. Okay? And then if I need you to do anything different, I will let you know. Let me ask, but I’m going to find out one thing and then, okay, thank you.
Janelle Carpenter (38:10) Yeah.
Jason Zednick (38:10) No, thank you.
Jason Zednick (38:31) All right. Anything else?
Janelle Carpenter (38:38) I don’t have anything.
Janelle Carpenter (38:45) Me, either, I just couldn’t find my unmute button all.
Jason Zednick (38:50) Right. Great. Well, thank you all. Please send me that documentation. I’m going to ask about this united optum thing, and then I will go back and look at that, I know at email you’re talking about Thelma with the medicare piece. So, I’ll go look at that and talk to my team and see where we are on. Looking at those past submissions. Thank you. All right. Thank you. All right. Thank you all bye.
Janelle Carpenter (39:20) Bye. Thank you.