Transcript
Naomi Denson (00:00) hi, Adalee.
Adalee Arreola (00:07) Sorry, I couldn’t even find this tab.
Naomi Denson (00:11) I’ve got a couple of people here there’s, Jason… let’s see that’s. Fine.
Naomi Denson (00:27) Cool.
Naomi Denson (00:33) All right. Let me let them in. Oh, no.
Naomi Denson (00:47) Hi. How are you? Good?
Kimwaters (00:49) How’s it going?
Naomi Denson (00:51) Good, good. Halfway through the week.
Kimwaters (00:54) Yeah. I know we’re getting there, right?
Naomi Denson (00:57) Yeah, yeah, thanks, Adalee. Oh, where’d it go? Okay? Let him in. All right, perfect. So I did invite, Adalee areola to our call today. She is going to be your dedicated technical solutions manager throughout the implementation.
Naomi Denson (01:17) I know we have the athena scoping integration call that was scheduled with Peter for Monday. So, Adalee is here if you have any other technical questions that have come up regarding apis or anything similar to that, but.
Kimwaters (01:38) Adalee, do you guys, have you integrated with athena one before? Since you’re not like a marketplace partner, but just was curious if you had done that integration previously. So, if we know, if so, and we know who it’s with, then we can like get a view of their backend so we can hopefully speed that process along.
Adalee Arreola (02:04) Yeah, we are actually working on several with several customers for an athena integration, but there’s a lot of limitations that we found with the athena API. So we don’t have one currently where?
Naomi Denson (02:18) Is.
Adalee Arreola (02:20) fully connected and?
Kimwaters (02:23) On, we can always like take this call offline with a smaller group. But, if it’s if we decide like an API doesn’t make sense with athena just because of the lack of data that it would provide… it feels like there may be some RPA solutions that we could explore with some of that. I don’t know if that’s something that you guys would support us doing or if we would… work on that. But I know the hope was like there’s a lot of manual work right now on, you know, team members logging in and updating like effective dates and things like that. So the idea was the hope was that we could, you know, once that info came in from your end, that could get pushed over and claims could drop faster and those kinds of things. So really just want to explore what’s possible, and then we can make the best decision on like how to move forward. Yep. So.
Adalee Arreola (03:24) We’ve discussed other options like you mentioned for an athena integration. I think this would require like before, we get into any specifics, definitely a dedicated scoping call with our head of solutions and I think we can discuss all of this, so.
Kimwaters (03:40) Yep.
Adalee Arreola (03:41) Naomi, is that something that we’re able to set up or? I think it’s.
Naomi Denson (03:45) not on Monday, yeah.
Adalee Arreola (03:46) Okay, perfect. Yeah.
Naomi Denson (03:48) I think you’re added to that too, Peter scheduled it.
Kimwaters (03:51) So, even if that doesn’t work on the athena side, let’s keep that call, Naomi so that we can at least have the conversation with you guys on like what you’ve experienced so far in that attempt?
Naomi Denson (04:06) Yeah. You’re going to be having that call with Peter on Monday with Sammy, our head of technical solutions to talk through the integration piece?
Kimwaters (04:14) Yeah. Even if athena comes back and says like that doesn’t work for them, I want to make sure that at least our teams get to start… that conversation so we can understand like what’s possible?
Naomi Denson (04:29) Yeah. You’re talking about the, with the technical solutions with athena on the call?
Kimwaters (04:34) Yeah, because athena is on that email thread, trying to coordinate as well. So, even if it doesn’t work for them, I think we still probably it’s still worth having.
Naomi Denson (04:44) Okay. Yeah, for sure. And then, yeah, just as a note, I am going to be out of office on Monday, but Adalee, Sammy and Peter will be on that call.
Naomi Denson (04:59) So, I’m going to cancel our other call while you guys have that one, but I’ll be back Wednesday for us to pick back up. But you guys have already made great progress. We’ve got the npdb set up. I got the payer, the delegated payer list, all of the rosters, the delegated agreements that folder that you shared over with me, that also had your policies and procedures in it. Are those your only policies and procedures for credentialing? Or is that just as it pertains to delegated?
Kimwaters (05:29) So that policy and procedure is, I think broader, I think it was a specific folder around policies and procedures that’s where the delegation folder will have policies… and procedures specific to delegation? Okay. You’ll probably see that in two different places.
Naomi Denson (05:49) Okay. Which one should we go by when building your credentialing files or does it vary by provider type or?
Kimwaters (06:02) Monya, do you have any from a credentialing standpoint, I would imagine the delegation would be stricter.
Staff (06:09) yeah, the delegation is much stricter… and it pretty well covers all of the onboarding type for both. We follow it for both standard credentialing and delegation now. So.
Naomi Denson (06:24) You use the credentialing, the policies and procedures from the delegation folder, not the one that just says policies and procedures.
Staff (06:32) I’m not sure which folders you’re looking at.
Naomi Denson (06:36) I.
Kimwaters (06:36) shared the delegation folder, Monya… and then in the other credentialing folder that we were just looking at whereas the policies and procedures, I shared that as well. But I can, that was not in the delegation folder that was just in the credentialing folder.
Staff (06:55) Okay. I’m looking to see which, let… me see.
Kimwaters (07:00) While you’re looking at that, Matthew wanted to introduce you to the team. So, Naomi medallion, this is Matthew punches. He is our resident athena expert, used to work at athena and has been incredibly helpful with a lot of these conversations when it comes to integration and what kind of impacts that could have down the line. So, Matthew there’s right before you jumped on there’s a call. Adalee is going to be our technical support. On the medallion side. She’s on this call today. We’ve got a call scheduled on Monday that I’ve forwarded to you. If athena can jump on. Great. If not, we can. They’re working through some athena one implementations right now and running into some of the issues you would expect just based off of some of the feedback I know you provided yesterday. Yeah. So there are we just Monday, we’re going to have a deeper dive conversation specifically around integrations and just what is even possible. And I think there’s what’s possible with athena like directly from an API standpoint. And then there’s what’s possible just from like an RPA standpoint, potentially like alleviating some just hands on keyboards time, but just want to make sure you were like on all that cool.
Matthew Punches (08:22) Yeah, that’s awesome. Sounds good. I think the only thing I want to just throw out there just we don’t need to discuss it any further is, you know, unless medallion is on the marketplace or we have the platform package apis are not going to be, you won’t have access, you won’t get the API key. And just to make that straightforward. And currently, from what I’ve looked at, we do not have the platform package.
Kimwaters (08:54) Sure.
Staff (08:56) Yeah, Naomi, the screen that you’re showing there those policy and procedures. Those are the delegation procedures. Those are the only ones that we’ve really gotten approved and going there’s not a general credentialing policy and procedure. Okay?
Naomi Denson (09:17) So, we should be going reviewing these and going by these when we’re building your sops to show what’s needed and your verifications and your psvs, yes. Okay. Perfect.
Kimwaters (09:28) So, ignore the other folder.
Naomi Denson (09:30) Okay. Ignored. Okay, perfect. And then I was going to ask, do you have legacy credentialing files that you could share with us, samples for different provider types, initial credentialing and recredentialing?
Staff (09:46) Okay. We have no recredentialing. We just started down this path last may. Okay. So it’s initial. Okay. And all of our files are sitting basically in Andros, we have, if… you go, I think she shared you credentialing files, where it says delegation there at the top of the channel. Did she also share you one that said credentialing?
Kimwaters (10:19) Not yet. Okay. That one should be coming her way any second, yeah.
Naomi Denson (10:25) Okay. It.
Staff (10:27) Will have individual files.
Naomi Denson (10:30) Okay. And.
Staff (10:33) It shows the PSV and the oig that we pull before they ever get to Andros. Okay?
Kimwaters (10:41) You should have that now. Okay.
Naomi Denson (10:46) Perfect. I’ll go pull that and take a look in just a moment. I did just want to follow up on the custom provider invite if you guys have had a chance to review that and start drafting something up that you want to use or just discussing it when you plan to have that ready?
Kimwaters (11:04) We’re going to have an internal call next week around that. So we’ll, get that to you next week and is that specific to new providers only or providers? Like our current it’s not like the announcement, right? This is like new providers that would be coming on, so.
Naomi Denson (11:23) It’s going to be all providers that we important to medallion that we’re inviting, to log in and complete their profile. What I’ve had other customers do is they draft the custom invite targeting their existing providers. First, make sure we get all of those invited, and then we can do a one time update to target it to new providers going forward.
Kimwaters (11:44) Okay, great. We’ll keep that in mind. We’ll go ahead and write both. So, you’ve got them. Okay?
Naomi Denson (11:50) Perfect. Yeah. And you guys just let us know when you’re ready to hit the switch to flip it to the net new provider only. Okay?
Kimwaters (12:01) And you’ll have users?
Naomi Denson (12:03) You’ll.
Kimwaters (12:03) have all of that you’ll have like first round of that this afternoon?
Naomi Denson (12:07) Okay. Who needs access? Okay, perfect data import template we had set on Monday by end of week. Do we have any outstanding questions or progress updates for the data import template?
Kimwaters (12:20) Yes, we’ve got a couple questions for you on that one. So let’s see… among the many tabs that are open here. All right. I’ve got emails so that’s coming. We’re good. I think we’re good on this tab. If we, go over two groups. Okay? The, on the first line, that tax id is multi state. So, Monya, we were talking earlier, there are right… there’s seven tax ids, but that one’s multi state. So the way that they’ve got it, gatlinburg was the first. So that covers Tennessee. Do you need for certain, I guess certain payers you might need like the npi for that’s tied to like the other states. So, does it make sense to list that same tax id a couple of times to make it state specific for like the blues plans and others for not necessarily seeing it done that way, but that like it’s a, with it?
Naomi Denson (13:26) So you don’t have one group npi designated to this tax id? You have multiple?
Staff (13:34) Multiple, the way ours are set up, every one of our locations has their own npi. They’re enrolled separately linked to that tax id, we don’t we’ll buy group npi for.
Kimwaters (13:50) a whole.
Naomi Denson (13:51) Tax for just this tax id or all of them?
Staff (13:54) They are all set up that way.
Naomi Denson (13:56) Okay. So just for reference medallion’s standard process, historically, what we’ve seen is group npi. So when you make a request, the team’s going to look for that group npi and default to that most of the time. So what we’ve learned from this with, as we get more customers like you that don’t have a group npi, but have individual practice location npis, is we would import the group.
Kimwaters (14:21) With the.
Naomi Denson (14:22) Tax id and we can use a placeholder here like zero zero, so that the team is defaulted to look at the practice profile for the npi on the request. So that they’re not putting the wrong npi and you don’t have to maintain 40 separate group profiles. Okay?
Kimwaters (14:41) The one question and I know this is something that Monya and I are talking about in a little bit. And Amanda you may, if you’ve got time, you may want to jump on this too on from a, so at the practice level, each location has like an rhc rate that it is paid, right? So that’s why it’s done that way. But from a commercial contract standpoint, those are done at the group level. They’re paid?
Naomi Denson (15:08) At the tax?
Kimwaters (15:09) Id level, so, is there not like a?
Naomi Denson (15:15) Maybe?
Kimwaters (15:16) Like primary group or like location that is considered like a group npi, or even in the commercial contracts, is it listed just group tax id? And then multiple locations?
Staff (15:29) Most of our contracts are by tax id, multiple locations?
Naomi Denson (15:34) Jason, are you on the call?
Jason Zednick (15:37) I am on the call.
Naomi Denson (15:39) Do you have any insight into the setup here with what they’re saying with the rhcs and the separate npis on some agreements, and some of them are done by the group?
Jason Zednick (15:52) Not a lot of insight. I think we would need to… understand and map out like if there are contracts where we link to the group npi and the tax id, you know, what, you know, payers and lobs, that is for, versus others… it’s really hard for our teams just based on the way the platform holds the data to like understand that. So we have to like create reference materials so that they know when to use, which. And if most contracts… are at the location npi under the tin, then I would do what Naomi recommended where we eliminate the npi on the group line, so that eliminates a failure point there. And then when there are exceptions to that, we can document it. And then they’ll know to use the group npi. And.
Naomi Denson (17:06) yeah, because.
Staff (17:08) Here’s what we have here’s, what we currently have set up. When we open a clinic, we open it as fee for service. So everything is done, fee for service by the tax id, we add the new clinic npi, we send it in, update our contract. Okay? Once we become rhc certified, the rhc only applies to medicare medicaid, medicare advantage plans and the mcos, the medicaid, you know, they’re like a medicare.
Naomi Denson (17:42) Medicaid?
Kimwaters (17:42) Hmos. Yeah.
Staff (17:44) Yeah. That’s all that applies to a commercial insurance does not recognize an hmo, an rhc, it’s still fee for service. So you’ve got two different contracts associated with that tax id with each location. Does that make sense? So.
Jason Zednick (18:04) They’re two entirely different contracts. Well.
Naomi Denson (18:08) Two.
Kimwaters (18:08) Yeah, two, two contract two contract types. I would say, yeah, so on the, can I, Naomi, can I share my screen real quick so you can see, yeah.
Naomi Denson (18:21) Absolutely. Part of what is.
Kimwaters (18:23) set up, Monya, I’m going to share the right screen this time. So as an example like they’re also, so for those purposes, we’re also going to have like two, two separate indicators, right? We’re going to have a fee for service like medicaid number and an rhc medicaid number. Are.
Naomi Denson (18:48) you sharing your screen yet? Are you still working on it? Oh, yep.
Kimwaters (18:52) For most zoom, does it different? There you go. Say that again, Manda, go ahead all.
Amanda (18:59) Right. For most that we’ve in some states, we have to term our non rhc contract when we become an rhc with medicaid replacement plans like Indiana and I think Oklahoma. So we have to term that out. But in most states, yeah, we have a different number different, a separate rhc and non rhc number, right? Monya?
Kimwaters (19:26) Medicaid because, there are things that’s how like the carve out things get paid, right? Amanda, like you, anything that’s not in like the aar gets paid fee for service. So more just like not to be confusing but like there’s going to be two numbers from both medicare and medicaid except for the exceptions, Amanda mentioned we’ll have all this like work flowed out for you. So you’ll have like a diagram of this, but more just wanted you to know there’s going to be some additional fields… like when you’re asking for a medicaid number or a medicare number? Like there’s going to be two options at the location level.
Matthew Punches (20:13) I have a quick question. Is that?
Kimwaters (20:14) The ability to do like custom fields or not go?
Matthew Punches (20:17) Ahead. Maybe not. Yeah, not a question. Have, are you guys familiar? And do you have past clients that are rhc? Because, you know, the rhc structure, best practice is to do it exactly what they’re doing, right? They have it’s a location specific npi. I was missing that when I was chatting with someone, I’m like wait a second. They’re rhc, and that’s the standard that’s kind of the golden rule for an rhc is to have it at a location npi level. Yeah. So I guess the question is, do you have other rhc clients that you could reference to see how it was built out in their instance?
Naomi Denson (21:00) I’m sure we do. I just was not the one that implemented them personally. I have fqhcs which sound to be kind of similar but definitely… can look into that. Adalee or Jason. Do you have any other guidance or information on the setup given what they just shared… for the import template purposes?
Jason Zednick (21:27) I do not have any rhc clients.
Matthew Punches (21:31) Yeah, it’s a big, yeah.
Kimwaters (21:33) Yeah. We talked extensively about this with like josh levitin, and yeah.
Naomi Denson (21:39) Just because Jason and I don’t doesn’t mean that somebody else on the team doesn’t so we’ll have to reach out, Jason, if you can reach out to the other ems and see if any of them have rhcs.
Matthew Punches (21:50) Set up that.
Naomi Denson (21:51) We could take a look at to provide some additional guidance, but definitely want to have at least group profiles at the tax id level without an, where those individual practice locations are going to come into play. And then… you said sometimes you contract at the tax id level, then when you become an rhc, you have to cancel that original contract to get the new one.
Staff (22:20) That’s only with certain states medicaid.
Amanda (22:24) okay. Not the controller.
Naomi Denson (22:26) Yeah. Okay. So I think what will help us resolve this? I know you said you were going to have all of the workflows drawn out and everything, but this payer process scoping template that I shared with you guys. This is where we can break, really break that down and look at which state does which, and which one has specific rules are set up with the rhcs and which payers state combos those apply to. So I think if we could get this started while Jason and I dig in internally on other customers who have an rhc set up, we can definitely come back with some clarity on the group and practice, not practice, but the group profiles, whether we leave it at just tax id or we have multiple.
Kimwaters (23:16) Okay. No, that makes sense. Well, and we’ve got some recording sessions this afternoon. So we’ll get, we’ll have all that ready for you guys shortly. And then, if you want to, pull up the import document again, Naomi, I’ll there were a couple of other, I think on the practice level you guys are asking for like a for?
Naomi Denson (23:36) Manager?
Kimwaters (23:38) Information, is that, what are you using that for? Just because we use, we have like regional managers, but sometimes they switch like where they’re you know, what they’re over. So just curious.
Naomi Denson (23:53) Yeah, it’s the practice it’s in the platform. It’s it’s titled practice manager. Yeah, if you have individual practice manager contacts or whoever that might be. If it’s one person that oversees several practices, it’s just whoever you want to use.
Kimwaters (24:09) But are you like, what are you using?
Naomi Denson (24:10) That for? Yeah.
Kimwaters (24:12) We’re not what?
Naomi Denson (24:12) Is the purpose?
Staff (24:13) For it, what do you use it for? Do you supply that information out when you’re credentialing or when you’re applying for?
Naomi Denson (24:21) If the payer, if the payer application asks for it, yes.
Staff (24:25) Okay. We don’t supply manager and regional manager or clinic level manager information out. Those people know nothing about credentialing, they answer questions wrong. We don’t give that information.
Naomi Denson (24:40) If there’s somebody internally on this team that should be put there, you can put the same person. So.
Kimwaters (24:47) Yeah, that’s what I was asking. What do you use it for? Because then I can, then I know who, then I know who to give you, right? Yes. So same for like billing info, which, we absolutely have a leader on that side. We can give contact info for different reasons. But that’s helpful. So Monya, we can get together on exactly like which name fills or we put in there. But that’s why we’re asking because we want to make sure, we know what it’s being used for. So we know who to give you. I just.
Naomi Denson (25:18) Realized I’m not showing my screen anymore because I gave it to you. Yeah, I know I’m over here looking at it but.
Kimwaters (25:26) Okay. So there we go. That one that one’s easy enough. And then from a let’s see provider practice groups. I think that was all on that one. And then on the malpractice insurance we are, they’re on a slot policy. So everybody is named obviously like in the policy but like… coverage dates and all of that, it sounded like we’re done at a group level. They obviously, they’re covered. Like once they’re added on. So I don’t know, let.
Naomi Denson (26:03) Me ask is for the malpractice insurance. I’m not even sure why this populates on here is all of the providers malpractice insurance up to date in their caqh profiles. Yes. Then don’t do this tab. Do not waste your time. It’s going to come over with that there.
Staff (26:20) Might be five or six that haven’t went in and attested yet because we just got our mark, we just got our policy up. Yeah.
Naomi Denson (26:28) If there’s a handful that you need to add on here or you can just wait to make confirm their caqh and then before we do the bulk imports. But yeah, don’t duplicate this work because it’s going to create duplicates in their profile. If we, if it comes in from caqh too, and then we import this.
Kimwaters (26:49) If there’s any other tab you want to take away, feel free. No. Okay. And then on the provider enrollment group enrollment, I think this was all Matthew. This is all stuff that’s in athena that we can’t export, but we were going to get with this is with the dataview team to just do a query to pull.
Naomi Denson (27:13) Sure. Yeah. Why can’t we export it?
Kimwaters (27:17) Well, I can get with you afterwards and show you. But if there’s yeah, if we can, then great and I will bypass that. But there were a couple of questions I think on this, but let me get with Matthew on this one. If we can do it without involving them, then I think we should be good to go on that, but we’ll definitely have you the first three tabs done and over probably like later this evening and then we’ll have the rest of it wrapped up shortly. So, yeah, probably by the end.
Naomi Denson (27:47) Yeah. And I’ll reach out and Jason, what was that? Oh, I thought someone else said something. Jason and I will reach out internally to confirm rhc setup with other customers to align on the group profiles and what we should do there.
Kimwaters (28:03) Okay. That’d be great. Other than that if we could take a look at the clickup plan real fast when we were in and more just so that you guys have context of what we discussed during the sales cycle when we were talking through this, you know, goal was to get this done in like 10 weeks if we could eight to 10 weeks if possible. So I think we’re… well, like we’re doing good one week in, but want to take a look at that timeline with you guys and not just from a sales lens and see like where we can really drive down and, you know, buy us some time back or where we feel like there’s opportunity to do that.
Naomi Denson (28:51) Yeah. And the go live date on this plan is not set in stone. So I was working on updating it. We’ll align on the provider. Why is this like this? So the, I don’t.
Kimwaters (29:09) know we couldn’t see some of those other things there.
Naomi Denson (29:12) We go. Okay. Yeah. So the provider communication best practices. So we’ll go over that once you have the custom… invite drafted up. And then I have some other resources that I’ll share out with you on. I shared some out with the provider announcement, email the provider packet. And then we’ll discuss, you know, making sure you communicate with your providers before we release invitations to them. So they know that we’re coming and aren’t surprised or report us as scam, or spam?
Kimwaters (29:46) How early in the process? Do you guys do this? Because usually, like.
Naomi Denson (29:50) sending out the invites? Yeah.
Kimwaters (29:52) I mean, we obviously want to make sure like the communication strategy on our site is in place. I think there’s still enough we don’t know to like send an email out. But like how far before golive, are we sending out provider communication that?
Naomi Denson (30:08) Is 100 percent up to you. It is part of golive and what we account for golive. So, I have some customers that once we get all of the data in depends on how much of their profile you want to own completing and how much you’re holding them responsible for to adjust that timeline on, you know, we need time to push them and have them complete, or we need time for our teams to go in one by one and audit them before we invite them. That’s totally up to you. We can invite in batches. I have some customers that will select a few providers as like Guinea pigs and invite them first, so you can prepare for the type of questions you might be getting back. So, but we don’t invite providers until you say let’s go. So we’ll not do anything without you guys giving us the green light. Do?
Skip Carter (30:57) Those invites all come from the same domain. Is it medallion co? Yes. So, Kim, that’s what I was telling you. We’ve got that as a safe domain. So it should not ever block any emails from them.
Kimwaters (31:09) Awesome. It.
Naomi Denson (31:10) Doesn’t show this here. This is for me to do. I’m going to do that, but you don’t have to do anything there. We’ve already got the npdb set up. We’ve got your credentialing policies and procedures and all of those folders, the delegated roster templates, we are sorting through the roster templates. I’m going to submit those to Adalee for review those. She’ll work on building and she’ll send you samples and you’ll you know, review those and you guys will kind of collaborate back and forth until we confirm that they look good and we can finalize them… but we’ll just get that data import template depending on, you know, Adalee’s initial review on any feedback or corrections that might be needed.
Naomi Denson (31:56) Sometimes that can be some back and forth for a couple of weeks until everything is loaded. Okay? I have to jump. I’ve got another meeting. Yeah, I actually need to, but happy to connect async, if you guys want to set up some additional time before I’m out on Monday, just reach out and let me know.
Kimwaters (32:16) Yeah, Naomi, if you can let me know where we’ve got some room in here to like condense the timeline, I’ll tell.
Naomi Denson (32:23) you guys, I just met with you for the first follow up call on Monday from our kickoff call and you’re already way ahead of customers that I’ve been working with for eight weeks. So you’ve got lots of wiggle room here.
Kimwaters (32:35) I’ll take it. All right?
Naomi Denson (32:36) Yes, yes, no, that’s great. You guys are on top of it. And if you are able to get data to me by the end of the week, that is like sometimes unheard of. Sometimes it’s a month before I get initial data. So you guys are on top of it, we’ll review that and let you know what kind of feedback we have, you’re.
Kimwaters (32:54) talking to a group of overachievers. So I.
Naomi Denson (32:56) love that. I just let go of another implementation with an overachiever and it was the best one. I was ever part of it because she was like, I want it done and I want it done right? The first time. I don’t want you to have to ask me. So I was like, I’m going to miss you. But now I have a new one so well.
Kimwaters (33:12) And in fairness, like the team’s gone through this… twice before and it hasn’t gone great. And so just want to make sure that this is done, right? It’s a really important.
Naomi Denson (33:24) Foundational.
Kimwaters (33:25) Piece for the organization. So, really appreciate all those support and I know there’ll be some like nuances around the rhc components, but thank you guys for leaning into that. We’ll, we’ll work through it all together. So we.
Naomi Denson (33:39) will get you set up. Thank you. Thanks.
Kimwaters (33:42) Guys. Bye bye. Thank you.