Transcript
Mwinship (00:00) okay, great. Hey, Jason. Good morning. How are you? Good.
Jason Zednick (00:11) Good, good.
Mwinship (00:14) How you doing?
Jason Zednick (00:16) Alright. Let… me, let… him in and we’ll go from there. Okay. Sounds good.
Jason Zednick (00:53) Hey, good morning.
Mwinship (00:57) Good morning. How are you today?
Jason Zednick (01:01) I’m doing okay. How are you?
Mwinship (01:06) Pretty good. All right.
Jason Zednick (01:15) Well, let’s jump into it. What… is top of mind for today?
Mwinship (01:24) I know I sent you an email regarding an audit that I’m doing it’s. My first start to finish audit and they wanted some information for a contact at medallion with the phone number.
Mwinship (01:38) So I didn’t know if I could use you or if there was some other person that should be utilized or… how that worked.
Jason Zednick (01:48) Yeah, it’s a really good question. Hold… on one second. Let me see if I can get that to you right now…
Jason Zednick (02:21) So, I have a name for you. I don’t have a phone number.
Jason Zednick (02:33) Or an email address?
Jason Zednick (02:42) What type of like form is it like? Is it like free text?
Mwinship (02:46) It’s the cii form?
Jason Zednick (02:49) Cause cause we like, we, I can give you an email. I don’t have a phone number,
Mwinship (02:56) Okay. Let me see here. I don’t know if.
Mwinship (03:02) Let’s see here. It says.
Mwinship (03:10) Oh, that’s the wrong form. It’s called a delegated. Nope, that’s not, it. I’ve got three templates they sent me and I can’t remember which one is, which now… okay. It’s not that one… it’s not that one. So, it must be the other one.
Mwinship (03:43) But it did ask for a name and a phone number, but I mean, I’m sure I could put a… email address, and then if they get very persistent, I can always reach back out to you.
Jason Zednick (03:55) Yeah, exactly. Like if they push, you can push me as long as it’s like an open text thing that you can put an email in.
Mwinship (04:02) Yeah. And it is open. It doesn’t have, okay, it looks open because it says, okay.
Jason Zednick (04:11) Yeah. So, let me give you. I’m going to give you.
Mwinship (04:15) That’s not it. Okay.
Jason Zednick (04:18) I’m going to put it in the chat… actually. Let me just email it to you that way you have it.
Mwinship (04:25) All right. That’d be great.
Jason Zednick (04:26) More permanently.
Jason Zednick (04:34) Yeah. Let me do it right now. So, I don’t forget just one second.
Jason Zednick (04:57) All right. So, I just emailed you back. It’s merit Meller, she’s a director of operations here and she oversees our credit program.
Mwinship (05:04) Okay. And then the… other question that they asked is, do you guys utilize AI?
Jason Zednick (05:18) And if.
Mwinship (05:22) so, how is it used?
Jason Zednick (05:26) I don’t know how to answer that question like, yes… but not.
Jason Zednick (05:41) Let me just take a screenshot.
Mwinship (05:44) Of the questions and maybe that might, it might make sense if you’re seeing it from your end because I know the other thing was, let me see here… okay? But.
Jason Zednick (06:05) So, yeah, yeah, please send me the questions. I think the answer to the AI question is like, yeah, we have access to AI tools. We use it on an individual basis, but to my knowledge, we don’t AI… is not used to assess any credentialing work or anything like that.
Jason Zednick (06:28) It’s like… the broadest question imaginable… they could have phrased that a little more merrily, I think… let’s see. All right, I think.
Mwinship (06:43) That’s it. And then I’ve got your certificates. So I don’t need that. So I’ve got those because I want that information as well. Okay. I just sent it to you. Yeah, let’s see.
Jason Zednick (07:05) I might take a second to hit my inbox. Oh, here it is. Okay.
Mwinship (07:43) Oh, there’s more questions as I’m going down. I’m going to send you some additional questions that they, yeah.
Jason Zednick (07:50) So, I think the answer to the second question on this, what’s this screenshot storage of credentialing information? I mean, yeah, you outsourced it to us so you can say yes… and then contact telephone that’s merit, you can put the email.
Mwinship (08:15) Yeah, I don’t think I sent you everything that I should have sent you. So I’ll get that done after the meeting.
Jason Zednick (08:23) Yeah, that sounds great. And I’ll take a look.
Mwinship (08:27) Yeah, because they’re also asking about if you guys, well, between us, and if you guys have been put on any kind of corrective action plans, sanctions fines or other penalties within the last five years.
Jason Zednick (08:44) Not that I’m aware of… but I wouldn’t necessarily be aware. Yeah. So I’ll look at that consolidate… and I’ll run it by my cred team and get like, you know, real language for you to use.
Mwinship (09:01) Okay. Yeah, because like I said, I don’t think I sent you everything that I should have sent you. So I’ll get that to you after the meeting. Yeah, that sounds good. All right. Okay. Other than that, I didn’t really have anything Tina, Alyssa… I actually don’t have anything today. I don’t either. Oh, wow. What?
Jason Zednick (09:21) A good day for me.
Mwinship (09:24) You guys?
Jason Zednick (09:26) Are great. I do owe y’all, a couple emails.
Jason Zednick (09:30) Tina. I think I owe you a one or two things. It’s all on my list. I’ll definitely get to it sooner rather than later. Yeah.
Tina.Ferguson (09:38) The one thing I was wondering about the email that I sent you where I gave you the information to have them transfer those providers back to my medicaid portal on how to do it. I was wondering if they understood that if they’re going to be able to do that for me. So I don’t have to fill that form out for every one of them.
Jason Zednick (09:56) Oh, you know what? I’m meeting with that team like right after this call? Okay? And if we end early, they’re meeting right now, I can follow up on that. I haven’t asked since. Okay. Medicaid portal. Yeah, I’ll follow up with them and let you know, okay?
Tina.Ferguson (10:21) Other than that, I don’t have anything else that’s.
Jason Zednick (10:24) great. KP. Let me pitch to you. How are we doing on the consolidation piece? Did I see that you re signed to adderley or am I mixing things up in my brain?
Kunal Parwani (10:38) No, it’s still me. Okay. Yeah. So I actually have a file ready for us to kind of go over. I’m just having issues with… having my formatting populate on Google sheets. Hold on. Let me share my screen.
Jason Zednick (10:57) Yeah. Let me buy you some time real quick. This reminds me. I believe I sent an email, but I want to talk about that financial info tab that showed up on some of your providers real quick. You can ignore it. You can just totally ignore it. You can tell your providers to ignore it, can.
Mwinship (11:17) That be turned off?
Jason Zednick (11:19) Well, I’m working on that, okay?
Mwinship (11:21) I know that’s what you said in your last email, yeah.
Jason Zednick (11:23) Yeah, it’s because… the revalidation was requested on an enrollment that did not have a group assigned to it, which is just, you know, it’s out of your control. Like you wouldn’t have known to look and you shouldn’t have to know to look for that because we do enrollments for individuals for a few clients that aren’t tied to a group. And we need that information in those instances. Yeah, there’s nothing we.
Tina.Ferguson (11:55) Do with you right now, when you’re saying not assigned to a group, was that the, when we had the two different medicaid lines? Yeah.
Jason Zednick (12:02) Exactly. Okay. All right. So it… shouldn’t even as is it shouldn’t really apply to revalidations or demographic updates. So while I can’t like turn it off, turn it off, they are, I believe removing it from those, which means it wouldn’t trigger for those requests. And then also once KP’s work of consolidating is done, we shouldn’t have that issue anyway. So it’s really just like a series of unfortunate events. But the ultimate message here is I’m working on getting it or disappearing it if not removing it. And your providers definitely don’t have to worry about any of that.
Mwinship (12:53) Okay. But you’re going to continue to try to get that to where that question doesn’t even get asked, those tasks don’t get sent out correct?
Jason Zednick (13:02) Yeah. Okay.
Jason Zednick (13:08) And all right. That’s it for that KP? All.
Kunal Parwani (13:10) Right. Yeah, thank you. Let me show my screen.
Kunal Parwani (13:19) Let me know whenever you guys can see it.
Tina.Ferguson (13:21) I can see it.
Kunal Parwani (13:23) Okay. Sweet. Okay. So as I said before, this is a little bit easier said than done, which is why I’ve kind of created some identification points to identify duplicates, and then kind of need your input on a few items as well. So essentially what I’m doing and what I’ve done is I’ve pulled all existing enrollments for all providers. And what I did was I’m highlighting any that I’m considering, you know, quote unquote like a duplicate. What I’m considering a duplicate is if it has the same provider, payor, state group and practice. So we’ll get to the like the effective date and the line of business piece in just a sec, but essentially at the higher enrollment line level, this is what constitutes as a duplicate. So for example, for this provider, if I look at Aetna Ohio for this group and for this practice, I… should see three lines. So I’m going to actually do it side by side. So it’s a little easier to see. So I have three lines over here for a Bhatia for Aetna Ohio and you’ll see over here, it represents these three lines… technically since they are showing up as different. We want them to show up in one, which is why if you see it’s being highlighted across all three saying this should technically be one enrollment. The next step of that is looking at the lines of business and the effective dates. So if we take a look, so this is the next column over you’ll. See this will take a look at everything up until practice, similar to what we were doing on the enrollment level, but then also include the effective date and the line of business. So if I look here, you’ll see I have two lines with commercial with the same effective date, that represents these two lines over here. Does it show? Yeah. So if you see this is for the same provider, Aetna, payr, same group, same practice, same line of business, commercial with the same effective date as well. So technically, both of these lines should be rolled up into one. However in this case, there’s a third scenario where we have commercial in the original line as well. In this case commercial has a different date. So I’ve created this essentially spreadsheet to help us kind of sift through some of these scenarios and come up with I’d prefer if we can come up with like an overarching logic rather than going case by case because that’ll be easier for you and for us because there are quite a few lines. But yeah. So if I filter for just the duplicates, so, if you’ll see some of them are not duplicates. So some enrollment lines for this provider, for ambetter or amerihealth or buckeyehealth, they don’t have any duplicate lines. They only have one consolidated line. So we can ignore those since we won’t be doing anything with them. And I’ll filter for just the duplicates. So this will give us a full concrete idea of which duplicates are there? How many lines of duplicates are there? And what is a true duplicate, right? Where we saw the same line of business and the same effective date versus what we’re considering a duplicate, but is not really because something is different. So I’m going to need some assistance in kind of identifying either, you know, either per enrollment line or an overarching logic. So what I would recommend is I’m going to send this to you guys. I’m going to try and put this in a live Google sheet. But for some reason every time I try to import, it doesn’t keep my coloring for the duplicates. So I’m going to try and figure that out. But if I can’t I’ll just send you the excel file itself. And essentially what I need assistance with is if we can audit these duplicate lines, especially the ones that have a differing line of business and effective date. If we can come up with logic saying, okay, use the earliest date for that line of business or use the most repeating… date for that line of business, then I can apply that to essentially all scenarios. But what I’m looking for here ideally is for… your audit is to confirm that my identification of these duplicates is correct. And then some guidance on how to roll them up essentially at least for the scenarios where we have different dates or different lines of business. Okay?
Mwinship (18:53) And this was taken off of the sheet on that first?
Kunal Parwani (18:58) No. So what I’m doing is I pulled.
Mwinship (19:00) No, I meant the plans and stuff like that for this to get imported into medallion that spreadsheet that I completed with all the health plans, the effective dates that first spreadsheet that we had. This is where all of that data came from, correct?
Kunal Parwani (19:15) The data that you’re looking here, I’m pulling this directly from what’s into medallion, which is what, yes, which is what we used your sheet to populate with.
Mwinship (19:25) Okay. That’s what it, so that way I can go back and look at that sheet and see, you know, for this provider, what the issue? Okay. That’s what? Yeah. All right.
Kunal Parwani (19:36) Yeah, I’m not too worried about like the like what the issue was, I’m more so focused on essentially trying to identify how to move forward.
Mwinship (19:46) Right. But,
Kunal Parwani (19:47) yeah, if it helps looking back at that sheet to correlate absolutely, feel free to do so. Yeah. And I’ll highlight these three scenarios in an email as well. So you have it in writing just so you know, just so you can refer back to it. But yeah, I’ve been checking myself as well. There’s a lot of lines but I’ve been checking as many as I can pretty much picking one at random and kind of going through looking at them in medallion to see, you know, to see how they’re showing up. But yeah, just another set of eyes and understanding of that, would be great. I’ll include you, Jason as well, obviously. And if you get some time to kind of audit this, that’d be great too.
Kunal Parwani (20:38) Yeah, because some of them are pretty straightforward… but when you look like for example, this Aetna one, the first two lines, those are pretty easy. They’re supposed to be one line. But when you consider the fact that the third enrollment also has that same commercial line of business but with a different date, that’s when it gets a little bit tricky because now we’re trying to do it. Now, we’re trying to, you know, make one line out of three lines with differing data in them, right? So that’s yeah, that’s the only thing.
Mwinship (21:13) Okay. I’ll take a look at that and then compare it to my original responses… on that spreadsheet and see, you know, because I’m pretty sure I broke everything out by plan.
Kunal Parwani (21:28) Yep. You had it by plan and you had it by.
Mwinship (21:31) Payr and by the different plans?
Kunal Parwani (21:34) Yes.
Mwinship (21:35) So that would account for all the duplicates?
Kunal Parwani (21:38) Yes, it should. So, yeah, I’ll try to put this in a live sheet so we can kind of work on it together. Okay? But if it still doesn’t take my formatting, I’ll just send you the excel file itself and then go from there?
Mwinship (21:55) Okay. Sounds good.
Jason Zednick (21:57) Sounds good. Can I ask a question? Yes. And this is well… does the consolidation effort, how does that affect the existing requests?
Kunal Parwani (22:18) You mean the demographic updates? Well?
Jason Zednick (22:21) Yeah. Like any request that’s tied to an enrollment that may change after this is done.
Kunal Parwani (22:28) Isn’t that only going to be demographic updates or revalidations? It’s not going to be a new request that’s going to be attached to an existing enrollment, right?
Jason Zednick (22:36) Yeah, that makes sense. Yeah.
Tina.Ferguson (22:37) I don’t know. I think there are still some new ones that we had put in previously that weren’t all processed yet?
Kunal Parwani (22:48) Like, you mean you requested a line but it’s not complete yet.
Tina.Ferguson (22:53) Well, we had new providers that we requested enrollment, a bulk enrollment for? Yeah?
Jason Zednick (23:01) Oh, right. Like, like.
Tina.Ferguson (23:04) Sone, and we had several.
Kunal Parwani (23:07) Can we take a look at one of them… if you have a name offhand?
Tina.Ferguson (23:14) S o HN?
Tina.Ferguson (23:22) I can’t think of everybody off the top of my head.
Kunal Parwani (23:28) Okay. So there’s a bunch of requests, okay. That if I look at their existing enrollments?
Kunal Parwani (23:40) Yeah. So since you made these requests in platform, I don’t think these are going to have any duplicates. Because if you look over here even usually for all the providers for Aetna, we have had multiple lines, but in this case, we have one line with all the practices with all the lines of business and the same effective date. This piece is a little bit different. This medicare piece because this is coming from this line is coming from caqh versus this is what was requested and completed. So that’s a little bit different. But, yeah, for new providers who you have put a request for in medallion itself, we really don’t have to do any cleanup. There should not be any duplicates for those providers. This should only be for providers that I imported the data for… during implementation.
Tina.Ferguson (24:32) Okay.
Kunal Parwani (24:35) For Jason, for your question, let’s say there is a… I’m gonna use this as an example. Let’s say there is this existing robot. Well, these three that we’re trying to consolidate into one and let’s say one of them has a demographic update request on them. So, while me personally, I can’t do anything about that, but epd and this will be part of the cleanup is… I will ask epd to essentially remap any in process, demographic update requests or revalidation requests. If they find any on any of the duplicate enrollments to remap it to the one that they’re keeping. Yeah.
Jason Zednick (25:30) Okay. Yeah, that makes sense. Yeah, that’s sort of exactly like the kind of thing I would expect. So.
Kunal Parwani (25:36) Yeah, it’s a little bit. Yeah… it’s a little bit tricky, but, yes.
Jason Zednick (25:44) Yeah, I get where you’re going. Yeah, I understand.
Kunal Parwani (25:50) Okay, cool. Yeah, that’s all the fun updates from my side.
Jason Zednick (26:00) All right, great. Well, thank you, KP. Appreciate the breakdown… there.
Kunal Parwani (26:09) Yeah, it took me too long.
Jason Zednick (26:11) No, no, no, that was really complicated.
Kunal Parwani (26:14) I wrapped my head around it. Yeah.
Jason Zednick (26:16) Yeah. It would have taken me a lot longer for sure. Cool. Any questions from the Ohio team?
Mwinship (26:26) I can’t think of anything right at the moment. I will get that email over to you for the delegated audit questions. Yes. And then, I guess, you know, if we continue to see issues or have questions, we can also, you know, continue to email going back and forth as well.
Jason Zednick (26:48) Always. Yes. Okay. All right. All.
Mwinship (26:52) Right. Well, thank you. Well.
Jason Zednick (26:54) Thank you all. Have a wonderful weekend. Bye bye. Take care.