Transcript
Naomi Denson (00:00) hello? Hello. How are you? I’m good. How are you?
Brandon Chase (00:07) It’s happy hour bet. I’m not at the happy hour.
Naomi Denson (00:12) But is it? No, where did my screen go? They’re not here yet. Okay. Christy, just got here, but I need to wait that’s.
Brandon Chase (00:24) good. That’s kind of who we need so great. Yeah, but,
Naomi Denson (00:26) Brandon and merit aren’t here yet?
Brandon Chase (00:29) Is merit joining? Yeah. Oh, I didn’t know that. Okay. Yeah.
Naomi Denson (00:33) I had asked her to last week to join and talk through some other stuff with them about changing their committee workflows and stuff like that. She was talking about.
Brandon Chase (00:41) Great.
Naomi Denson (00:42) Hey, Brandon. Okay. Hello? Christy’s here. I was just waiting on you because I think we’ll start with you and then let merit jump in. Yeah. All right. There’s, merit. Hi, we’re going to let Brandon kick us off to kind of level set first and then we’ll jump into the specific questions and stuff. All right?
Naomi Denson (01:17) Hi, Christy.
Christy Garrett (01:20) How are you? Good?
Naomi Denson (01:22) How are you… busy?
Christy Garrett (01:27) Lots of transition over here. Oh, yeah. Yeah. I mean, it’s just, I don’t know that it will ever calm down, but, okay… I’ve.
Naomi Denson (01:37) got Brandon on the call which, you know, and we also have a new face on the call. Merit miller. She’s our director of operations over credentialing and licensing. So she’s joining to kind of talk through some of our open questions about the policies and procedures and different things that we talked about last week. So I will let Brandon kick us off. Okay? Hey, Christy. How are you doing?
Christy Garrett (01:59) Hey, I’m doing. All right. How are you good?
Brandon Chase (02:01) Hey, I just wanted to hop on. I know the team was kind of going back and forth internally on kind of like the three buckets of work. And there were some questions around the ccvs providers and specifically kind of around the ability to vote on those ccvs providers through a committee process in the medallion platform. And I just wanted to come on and say I did a bunch of research. I looked at all of our internal databases and stuff like that and all of the previous calls that we had and we had talked about it was something that our product team was looking into at the time but the ability to actually vote on those ccvs providers in the medallion platform is not something that we are able to do. And I was able to confirm that we did not commit to that during the scoping process. But what we can do is allow you all to upload the approved ccvs providers into the platform using a template. And then from there, you can attach their cred packet to the provider profile. So you will be able to have all those providers in one database. And I do remember, we also talked about the ability to monitor basically your entire network and that is one way that you could do that. So, I just wanted to kind of provide that clarity just so everybody’s on the same page. So.
Christy Garrett (03:38) We still have to have a separate committee meeting just for ccvs providers because we cannot vote on them within the platform.
Brandon Chase (03:47) Correct.
Brandon Chase (03:54) However once they are approved in that ccvs process, that’s where you could take that upload or that file and then upload it into the medallion. So then you’ll have the ability to have those providers in one database. And then also if you do choose to do right now, it’s not something that’s in the contract, but I’m sure it’s something that we could talk about or Nick, you can talk about that with Christy, but we’re able to do continuous monitoring on that entire network. So it’d be the ccvs and non ccvs providers that we could then monitor.
Christy Garrett (04:32) But that’s not in the.
Naomi Denson (04:33) Contract.
Christy Garrett (04:34) What’s that?
Brandon Chase (04:36) Monitoring that’s correct? It’s not.
Christy Garrett (04:53) Okay. Well, I guess it is what it is. I mean, I don’t know what else to say that was, we discussed it very directly the three buckets of work and we were moving to this platform because it would get us into a system where we did not have to have those ongoing credentialing… meetings that everything could be within the system.
Brandon Chase (05:20) Yeah, obviously, I don’t remember these conversations like off the top of my head, I know some of them were dating back over a year ago. So I took those conversations. I literally put them in AI. And I’m like was this ever discussed? Like did we ever agree to this? And like I couldn’t there wasn’t anything there. And again, like, I just didn’t trust my own memory. So, yeah… you know, I did put a decent amount of time into this just to make sure that I was coming to the call with the most accurate information. And again, like, we absolutely did talk about it, but it’s you know, in terms of like the actual ability to vote on those CCPS providers in the platform, it’s not something that we’re able to provide at this point.
Christy Garrett (06:15) And do we have all of the calls recorded? Because this is the second time now that I feel like you are coming back to the table with something different than what we discussed. We discussed that you guys had done facility verification credentialing previously. And then when rubber hits the road, well, you haven’t done it, but we’re going to figure it out. Well, I mean, I have a team figuring it out now. And then this is the second thing now that it just feels very much… like… we discussed the three buckets of work, the three different things that needed to happen.
Christy Garrett (06:58) And now this is the second thing that you said. Well, we didn’t really agree to it. We just discussed it.
Brandon Chase (07:05) Yeah, I think, I mean on the facilities piece, you know, I thought that we kind of agreed that the like, you know, we had actually done the facilities piece, but… there was, you know, I guess we just didn’t agree on what that meant. But yeah, I don’t want to, you know, I’m not trying to kind of rehash old things. I’m just trying to just kind of present the facts. And like I said, I went through, there was 14 different calls in our internal database, put them through AI, and I could not find a single instance where we had agreed to that. So I’m can you?
Christy Garrett (07:51) Send me the 14 calls because I will listen to all of them again and that would be helpful but it’s… we’re still, I guess moving forward despite… you… guys having never done facility verification previously. So, okay. So what are the concerns with the credentialing policy? Let’s move on to that? Yeah.
Naomi Denson (08:19) So, we, merit and her team reviewed your policies and procedures. They had some outstanding questions on things that we need to verify as far as processes. But we also wanted to talk about the committee workflow that we had talked about last week and you had mentioned, you know, possibly having to rewrite your policies for that piece to outline the medallion workflow. So I brought merit in to kind of discuss what the ncqa compliant requirements are as far as the committee meetings and voting in medallion and what the, if there are any differences there.
Christy Garrett (08:58) Well, it sounds like I still have to have the committee meetings since… we… can’t put ccbs… providers through medallion to be voted on.
Christy Garrett (09:17) Is that correct statement?
Merritt Miller (09:18) That, yes?
Christy Garrett (09:20) So that policy does not need to be rewritten.
Naomi Denson (09:23) Right. Yes, you still have to keep your internal committee workflows at like your external committee meetings for review based on how they’re written or if you adjust them, the voting in the in medallion’s platform is essentially approving the files to capture the initial credentialing date, to then trigger it for a re credentialing later on. But it does not replace the need for a true committee, in cqa’s eyes. Yeah.
Merritt Miller (09:59) And, I was just here to support if you had any questions on that or maybe just to understand your thinking of how you were kind of hoping maybe outside of the ccbs files to use our platform in that way.
Christy Garrett (10:11) Well, as I understood it, what we discussed on 13 separate calls was that all… of the providers that needed to go through caqh, would no longer go through caqh. They would go through the medallion platform. They would then be ranked by… the medallion platform. And any issues would be highlighted by the medallion platform. Then people, the committee, the providers on the committee would then go in and be able to vote yes or no and it would then all be housed within the platform. And then I was also told that the ccbs, we would still have to put them through ccbs separately. And then we would upload the file and then it would follow the same process that the providers that they would, you guys wouldn’t do the actual credentialing, the credentialing would be done via ccbs, but they could be voted on within the platform.
Merritt Miller (11:22) Yep. And totally hear you on that and want to make sure at least on like the part for medallion doing the files that we’re all on the same page on which is correct that you can vote on them. It’s definitely still recommended that for any issue files you meet and go through them, but we’re not delegated credentialing decisions or any of that. So just as long as you’re following what is written in your policies, that’s totally fine. But most of our customers still hold committee meetings to some cadence just for their issue files and then use our system to vote on the clean ones kind of in bigger waves.
Christy Garrett (11:59) Okay. So, and it sounds like I still have to have a committee meeting anyway. So I can just, I’m sure export a report from medallion. To.
Christy Garrett (12:14) Have them deemed approved and the committee. So, I guess like I’m I am a little bit confused as to why if they vote on in the medallion system?
Christy Garrett (12:30) Can we still capture notes in the medallion system or is that changed as well?
Merritt Miller (12:37) What, what was the context on the notes? I don’t know. Yeah. And.
Naomi Denson (12:40) the, if they could leave notes on the like on the provider’s profiles in the notes section. Yeah, they could. Yes, you can still leave notes in the provider’s profiles as needed. You still leave notes there. And I think just to merit’s point other customers that we have. So the way their policies are written, they have, you know, a primary like medical director or chair, or someone on their committee that is dedicated to reviewing just the clean files, that would not have to go to committee to vote on and capture the credentialing approvals in medallion. And then only if they are flagged for something that based on your policies and procedures or if they are flagged for anything that is not ncqa approved… they would be flagged as a needs attention file. And then those would go to the external committee meetings for full review and voting and approval. And then someone would come back and log the votes based on the committee decision. Okay? So it’s not taking every single provider’s file. It would depending on how your policies are written. Of course, and if you wanted to rewrite them to accommodate that, it would just be the needs attention files that would need the full committee review. So you wouldn’t be taking all of them.
Naomi Denson (14:12) But with that said, there were some other questions with the policies and procedures and our team building the sops and setup that we need to confirm. The first one is just confirming. Are you, do you solely credential providers in Arkansas or do you allow bordering states or other states?
Christy Garrett (14:31) It’s primarily Arkansas, but we do contiguous counties. Okay?
Naomi Denson (14:37) So, because we’re going to need to turn on it’s called state specific credentialing for your account. So this means that you would request credentialing by state or multiple states. And the verifications that we do would be state like compliant with the requirements of that state. So when you’re making the request, you would request by that either single state or multiple states so that we would verify the correct requirements. Does that make sense?
Christy Garrett (15:06) I believe so, so if they’re in a contiguous county, it would be for Arkansas and Texas, for example.
Naomi Denson (15:12) Right, right. And then… for outreach for anything that might be missing based off of the import from caqh for their application, we need clarification or corrected information from a provider. What would your preference be? Would it be for us to email the credentialing contact that comes in with their caqh file to their profile? Would it be to task you directly so that you could outreach to the credentialing contacts as the payer or a combination of both?
Christy Garrett (15:49) So, you’re saying these providers will still go through caqh?
Naomi Denson (15:53) No. So the way that the profiles are created for the credentialing application, is with the caqh pdqs setup. When you submit your request, it’s automatically going to pull in their caqh profile to medallion. So if there’s anything that’s missing or unclear, there… are certain things that we might have to ask for. If something’s expired in caqh, it wasn’t updated. Maybe they’re malpractice, it has expired, wasn’t updated or expires within the next 30 days. For example, we would have to ask for an updated copy of that to move forward with the credentialing file. So how would you prefer for us to do that outreach? If anything is missing or expired.
Christy Garrett (16:45) Well, I would think, yes, emailing their… credential and contact. Okay.
Naomi Denson (16:55) And then, are there any additional verifications that you need? We didn’t see them outlined in the policies and procedures. But just like the check like ofac, death master, any other streamlined verifications currently with the ncqa packets? It’s Sam, oig, npdb, medicare offed out and medicaid exclusions.
Christy Garrett (17:21) I believe those are not outlined in the policy.
Naomi Denson (17:24) Oh, those are standard ncqa requirements, but sometimes our customers will have additional requirements that… they are primary source verifications that they require. We just always like to double check and make sure none of those streamlined verifications are needed. The others that we offer would be ofac or death master, CMS preclusions?
Christy Garrett (17:57) Ofac, death preclusion. Can you send me a list of those? Because honestly, like right now, we’re checking the, what you listed, the N, I call them, the naughty list, the npdb, the oig, Sam and medicaid exclusions. So, if, because those are the ones that are required, correct?
Naomi Denson (18:19) Yes, those are the ones that are absolutely required. Our customers that are not a payer or a network, they may have agreements with other payers that require them to have those verifications. So, it’s not necessarily an NC requirement, ncqa requirement. It’s a payer requirement for their contract. So, we didn’t know if you as a network or plan require those verifications for a provider to be in network?
Christy Garrett (18:47) Okay. If you can send me the list of verifications, and we can look at that and see if that’s something that we want to add. Currently, we do the ones that are required. Okay? Yeah.
Naomi Denson (19:02) And yeah, we don’t have to add them and merit, I could send her that… like credentialing packet overview that you were putting together for me for another customer just to show her what’s standard in the files. And then the list of the other verifications. Okay? And then deas, are these required verifications for any provider types or are there any provider types excluded that could possibly have a Dea? Or do you only require a Dea for certain specialties or provider types?
Christy Garrett (19:37) We have Dea requirements for specific provider types.
Naomi Denson (19:41) Do you know which ones those are?
Christy Garrett (19:44) I would have to look it up. I do not have that memorized. Okay?
Naomi Denson (19:53) And then the last one was for board certifications. Are there any provider types… that wait? Hold on, I’m reading this very wrong. Are there only certain provider types or specialties that require board certification verification? Or is it any provider type that lists a board certification in their application?
Christy Garrett (20:19) That I’m going to have to be a larise question… okay? Because I believe if they list it, then we have to verify it.
Naomi Denson (20:35) Okay. I will send a list of the questions that we didn’t answer with some supporting, you know, information to you so that you guys can get those answered. This is vital for our team to put together their sops before we start work so that they make sure that they’re verifying everything that’s needed and anything outside of the standard ncqa requirements or anything that applies to only specific providers. Our engineering team has to configure that in the packet so that it’s not one holding up packets and it’s being applied to the correct provider types. So the sooner we can get those answers, the sooner we can go move forward with your provider credentialing.
Christy Garrett (21:21) Okay. Send me the questions and then also the list of verifications. And then you’re also going to send me all of the calls?
Naomi Denson (21:30) Yes, I’ll send you the first half, and then Brandon’s going to send you the calls. Okay? And then the other, only other thing that I had right now is the delegation agreement. I did send that via DocuSign. I’m not sure if you have, if you received that, if you had a chance to look at it yet or had any questions?
Christy Garrett (21:51) I have not looked at it yet. Okay?
Naomi Denson (21:54) That also needs to be signed before we can start any work. So just wanted to put that out there. If you need me to resend it. I’m happy to do so.
Christy Garrett (22:03) No, I saw it come through. I just haven’t… our largest client went through a claims platform transition and we’ve been working on a disruption report and the data that exported is not looking so hot so far and that’s been.
Naomi Denson (22:25) So,
Christy Garrett (22:26) the provider relations team has been blown up with all kinds of fun stuff dealing with claims issues. So that’s like that’s a piece of it that’s why I asked larisse to handle this when she was prior to her vacation. So, but I will try to take a look at that, okay?
Naomi Denson (22:48) All right. Sounds good. So I think we have our next steps. I’ll send a follow up email shortly, with my pieces and then Brandon will follow up with you separately as well.
Christy Garrett (22:59) Okay. Sounds good. All.
Naomi Denson (23:01) Right. Thank you for your time, Christy, and we’ll see you. We’ll see you next week, but email me if you have any questions about anything that we discussed today or that I send over.
Christy Garrett (23:11) Okay. Sounds good. Thank you. Thanks, Christy. Bye all.