Transcript
Peter Bosworth (00:00) hi, Amanda. Good.
Amanda Traynham (00:01) Morning.
Peter Bosworth (00:02) Good morning. How are you? I’m.
Amanda Traynham (00:05) fine. How are you today?
Peter Bosworth (00:07) I’m well, thanks. Yeah. How’s everything in your neck of the woods?
Amanda Traynham (00:15) Down here in Birmingham, Alabama. Yep. I don’t remember where you are, but.
Peter Bosworth (00:23) I’m in Colorado.
Amanda Traynham (00:26) Colorado. Okay. It’s beautiful here and Birmingham, it’s I mean, it’s perfect weather, I.
Peter Bosworth (00:34) Imagine it’s probably not too hot yet, no.
Amanda Traynham (00:38) It’s 74 degrees and sunny and slightly windy and it’s beautiful. Excellent.
Peter Bosworth (00:52) Okay. So… there’s admittedly the last two weeks, I was pulled into a bunch of different deals and the end of Q1 was a mad dash, but I know we have some open items with in terms of like npdb, this plan about moving providers over to medallion to monitor npdb enrollment.
Peter Bosworth (01:21) And then there’s like discussions about a master file and ways to basically make sweeping changes to the provider network with like one file import. But before I kind of get into all of that, what’s top of mind for you right now with medallion, that’s.
Amanda Traynham (01:41) really, the main thing, we actually, you know, the other hurdle on our side is ingesting this Json file to get that imported into our credentialing system, our host data provider data system, and we have got some movement on that. So that will be wonderful. But that’s not going to be, I don’t think that’s going to require any support on the medallion side unless there’s like a question about what a specific… header might be or I don’t know what you call it in the Json file, but the header for the data? If there, if there’s a data dictionary that might be requested, I’m not sure.
Peter Bosworth (02:27) Okay. So… quick question on that. I think it came up like two Fridays ago where.
Amanda Traynham (02:39) There.
Peter Bosworth (02:40) was like an additional ask around the Json file and it was basically could because right now we send you the Json file of like the Pat of the credentialing files that are in ready. But then if I was reading this correctly, it’s like the ask, is, hey, is it possible to split partial packets and separate the ones that are in ready and then the ones that are like in?
Amanda Traynham (03:10) I guess in?
Peter Bosworth (03:13) Progress or was it archived? I can’t remember which requested?
Amanda Traynham (03:20) No, if that was the request for the Json because we, okay, maybe I do remember this. So maybe… we’re mixing a couple conversations together, but I can confirm with Alyssa. What I see the request was is, if, instead… of mark, I don’t remember what all the indicators are in. Medallion. I need to log in the dashboard to see this. But instead of marking something as closed… I think is what the terminology is instead of marking something as closed they wanted to… did I hang up on you?
Peter Bosworth (04:07) No, no, no, I’m here.
Amanda Traynham (04:10) Can you hear me? Yeah, I can hear you. I just don’t see my little zoom window anymore when I opened up my browser… here. So, but I’m glad you can hear me. So, I think the question or the ask was instead of marking something as closed to mark it as partial… or something so that we could go in and finish working a file that medallion was having a hard time getting the information back on because there’s slas around how long something needs to sit before it was marked as such. Okay, I think maybe… that’s where this is coming from. Like if we’re if they’re going to send a partial packet, is that going to be in a separate Json or is it going to be in the regular Json feed? Maybe that’s what we’re trying to answer here.
Peter Bosworth (05:08) Yeah.
Peter Bosworth (05:17) Yeah, it’s interesting. I think so, like Alyssa probably brought this up because she wants to move the process faster. And I think the partial packets that we’re doing right now have been helpful. And then she’s asking to separate the Json for clean files and then the Json for closed slash archived files specifically in relation to these partial packets.
Amanda Traynham (05:44) Yeah, that must have been one that I missed. So it sounds like the ask is to separate them somehow so that we know which providers… are not actually complete because we’re wanting to automate the credentialing based on that data coming back from medallion, instead of us viewing anything. We’re just going to accept it as clean. We’re going to audit… to make sure that everything is working as expected. But the hope is when it comes back from medallion, we’re going to say, okay, they’re good to go. We’re just going to accept this file as completed. And so if they’re all coming back in the same Json, we’ll need to figure out a way to identify the ones that really aren’t and they need to be worked. But that may be something that we can work through with our resource at symplr that’s working with the Json splitter to grab that status. However it’s coming back in the Json, to pick up those files and put some status and our system on those files.
Peter Bosworth (07:08) Okay. Yeah. I just set up time for me to connect again with Nico and Ray and just like to determine whether or not that is going to require a lift from us or not. Yeah, it probably.
Amanda Traynham (07:24) Can be handled with our Json splitter and dynamic import of that data into symplr and I have a call with that technical resource tomorrow. I believe it’s tomorrow. See there tomorrow Monday. And so I’ll ask her about that. Okay?
Peter Bosworth (07:44) Awesome. That would be great.
Peter Bosworth (07:54) I think it’s time.
Amanda Traynham (08:06) I’ll touch base with you after I meet with her, okay?
Peter Bosworth (08:10) Yeah, just let us know and then just… kind of going through a list of things here. So we updated the configurations on… like board configurations. We’ve updated basically the fact that like we are not going to verify this has been updated for a while. I just want to confirm, you know, how we’re not, you don’t want us to run board certifications for certain provider types, yes, because.
Amanda Traynham (08:47) The board is essentially required for licensing. And so it’s not a necessary check, right?
Peter Bosworth (09:00) So that is mapped out in detail.
Peter Bosworth (09:08) And then the biggest thing I think is just like the operational… challenge of this basically… this like single sheet, this import sheet and how that would work? And yeah, I just think that’s like want to just double confirm on this call that it’s like something that we definitely want to pursue and put resources into completing. And then.
Amanda Traynham (09:41) we’ll like,
Peter Bosworth (09:43) Nico’s Nico and I are working on that. So it’s uploading a master file to medallion to update the provider records. If a provider exists, update the record, if a provider is new, create a new provider profile. If the provider is missing from the file, deactivate them, et cetera. Well.
Amanda Traynham (10:04) Yes. Ideally, that’s what we would like to do. But after we met last time, I had just a one to one chat with Alyssa about why this seems like it’s going like, why does this seem like it’s different than what we have expected from the outset? And we kind of had a realization that even… though the only option that medallion has for enrolling providers into the mpdb is that continuous querying option that’s the only option that we were told by Naomi when we set up the account is that we had to set you up as a continuous query account. And so, I think that’s where maybe some of the confusion started is we were thinking, okay if they have to be set up as continuous monitoring, if that’s the only way they can be set up, then that means they’re performing continuous monitoring, but that is not actually in fact what I think medallion was… trying… going to be doing. It’s just a technical component that, that’s the only way you could be set up. You truly are wanting… to just do one time querying on behalf of viva, not continuous monitoring. It’s one time query at the time of initial credentialing, and one time query at the time of repread for viva even though you’re enrolling the provider into continuous monitoring. So.
Peter Bosworth (11:59) We definitely like Naomi is correct in saying that, you know, like our workflow is always going to be enrolling in the continuous query. But then why do you say, why do you say that like that? Ours isn’t a true continuous monitoring because.
Amanda Traynham (12:16) That’s not the package quote unquote that we’ve signed up for with medallion. We signed up for just your regular program. When you and I talked about doing an ongoing monitoring program, it was inclusive of continuous monitoring with the mpdb and you had those different levels of different things.
Peter Bosworth (12:38) Yes.
Amanda Traynham (12:39) And so, I don’t think medallion’s intent is to perform ongoing monitoring of the mpdb even though you are enrolling our providers into continuous monitoring. And so the reason why I had this kind of realization was when I asked about the notifications because if medallion is enrolling our providers into continuous monitoring and something happens in between Fred cycles, medallion or Veva should be notified because they’re enrolled in continuous monitoring. If you don’t enroll them into continuous monitoring, you don’t get those alerts. You’re setting them up as a one time query. You’re just grabbing what is this provider’s situation today? So by enrolling them into continuous monitoring that allows you as the business to get a notification anytime something new pops up. And so when I was asking about, okay, who’s getting these notifications? There… was a little bit of hesitation on like a definite answer. And I don’t know if we’ve tested this or not. But if… viva, we were originally thinking okay, if medallion is enrolling them into continuous monitoring and viva is also maintaining a record of that same provider in a continuous monitoring arrangement… then we’re monitoring the same provider in… the same fashion. It’s not necessary. But it is necessary if medallion is not going to be… able to share if… we’re not going to get the alerts as they come up for the provider in continuous monitoring. So, I think that was where the big question mark for me was as we try to manage our internal process, the question is, well, should we be removing our record if medallion has our provider enrolled in continuous monitoring also? And the only way to answer that question is if medallion’s enrolled provider, if we’re going to get the alerts, if something pops up in between cred cycles… right? So here’s.
Peter Bosworth (15:24) what should happen is that you should receive an email alert… you email notifications for medicare, opt out alerts, npdb alerts, Sam… alerts, oig, alerts, you would not receive an email for… the other, I guess verifications that wouldn’t be included unless we did a kind of contract amendment. But because right now, like we.
Amanda Traynham (16:01) And.
Peter Bosworth (16:02) this is honestly… something that’s kind of confusing about the viva contract with medallion to be honest because basically everybody every medallion customer has ongoing monitoring because we need to have it turned on to run the verifications to pull them into the files. So like there is basically a basic ongoing monitoring package going on in the background of viva’s medallion instance, even though it’s not technically like paid for or contracted for.
Amanda Traynham (16:34) So I.
Peter Bosworth (16:35) mean, I’m just looking at this for example… this is just the ongoing monitoring tab in viva health’s instance, and.
Amanda Traynham (16:53) Is that right? Or do we, you?
Peter Bosworth (16:58) Can see this?
Amanda Traynham (17:01) Yeah.
Amanda Traynham (17:07) All right. I’ve got analytics pulled up and you are under ongoing monitoring. Okay. I see the mpdb verification, the medicare opt out verification, Sam, and oig, yes. Okay.
Peter Bosworth (17:26) Yeah. So this is on… and like this is happening for… lack of a better word. Yes, I would be surprised if you’ve received no emails from medallion notifying you of an mpdb alert. Are you saying that’s the case?
Amanda Traynham (17:49) Not from, I have personally me, I have not received a medallion notification of an mpdb disclosure. Now, if I’m not the person on the account to receive the notification, maybe it’s just Alyssa. I’m not sure on the back end who is set up to receive those alerts?
Amanda Traynham (18:14) But let me… so currently, here, I’m going to share my screen real quick. So, this is an example of this… is really old, but this is what will pop up. If one of our providers shows up in a disclosure, we get an email directly from the mpdb that says your organization’s received a report disclosure on one of your databank, continuous query, subject enrollments. Please go to the databank and look at your reports. And so we would log in directly to the mpdb and go take a look at the alerts in there. And so what I’m concerned about is if medallion is the one receiving the alerts… are we still going to be able to log into the mpdb to see that alert on our provider that’s been enrolled in continuous monitoring? Because we need to be able to see that.
Peter Bosworth (19:21) Yeah. So basically, we aggregate the alert. So first of all, you should be receiving an alert and then if there was something, if there was like an outcome, an issue with an outcome, and then what would happen is… okay. So let me maybe go back a little bit. So… this is that analytics page we were in, right? Can you see this? And then, so, you know, I just picked a random provider. Gabriel chamblin says that there was an outcome that needs attention. And probably this was just when we imported him to medallion. And like at that time, there was a flag. Okay? And so I click on his provider link and this verifications tab is going to aggregate all the different verifications we’ve run on him. And in the npdb section… like when we enrolled him in the continuous query… you can just click on this whole line. And so this is where you’ll get the report of the adverse action.
Amanda Traynham (20:48) And then I see the source it takes you to the npdb.
Peter Bosworth (20:52) Yeah. So the source, the one thing is that it takes you to this generalized link rather than the specific npdb link.
Amanda Traynham (21:02) Yeah, but we should still be able to see the alert… license suspended for practicing without board approval… yeah.
Amanda Traynham (21:21) So… like,
Peter Bosworth (21:26) I guess it’s it kind of comes down to how we want to define alerts. Like do you want to receive like is receiving an email or is like this column being in red? And then at the time of credentialing, it’s going to show a flag, the continuous nature. I get what you mean? It’s like I should receive an email. I should receive some kind of notification in real time that there’s been a new thing.
Amanda Traynham (21:48) Right. I mean, it’s potentially a very adverse situation. And so we need to have that real time notification of a provider that has an adverse action on their npdb. And so, and like I said, this is just like growing pains because this is different than what we would typically get like, I think maybe not. I’m not sure yet. We would typically get a notification in real time from the npdb that, hey, there’s an alert on one of your providers that you’ve enrolled in continuous monitoring. And then we just go directly to npdb and look at that alert. So with what I’m hearing you say is that we should also be getting an alert from medallion at the point that alert from npdb comes in. But what you’re saying is the alert from npdb is going to medallion, not to viva.
Peter Bosworth (22:46) It should go to viva via medallion… like.
Amanda Traynham (22:57) In real time, like at the time that medallion gets the notification… yes, I’m going to log in to this and see.
Peter Bosworth (23:16) So… the subject line on one, like one of my customers, a different customer forwarded me the email that they received. And the subject line is alert, colon medallion found an issue with the sanction check for provider name.
Amanda Traynham (23:36) And so then they go to the npdb website.
Peter Bosworth (23:39) Well, so then the email.
Peter Bosworth (23:46) The email just takes you to a link of the medallion verification. Okay. Yeah, wait… it says like, hi, medallion has noticed a potential issue with one of your provider’s check results. The npdb blah, blah, please visit the provider’s verification here for more details and screenshots. Thanks.
Amanda Traynham (24:26) All right. I need to here’s… what I’d like to do. I’m going to take this person. I mean, there’s a whole bunch of things showing up in this dashboard.
Amanda Traynham (24:40) As long as we can get to the primary source document that’s what’s so important because having a medallion screen print is one thing. But having the actual npdb document is what we put in the provider’s file. When we present that as an adverse provider that might need action, it needs to be on the npdb letterhead document that we, you know, as the primary source. And so perhaps… that’s… provided, somehow see who was this?
Peter Bosworth (25:23) Gabriel shamblin, yeah.
Amanda Traynham (25:29) Because it looks like it has in the verification, it has like all the information I would expect to see in that npdb report… but it’s not on npdb letterhead, like it is a table of the information.
Peter Bosworth (25:45) Yeah, and so this is something that I’ve answered like fielded before it’s like we aggregate the information because ncqa doesn’t ncqa is basically how we’re doing. It is approved by ncqa like the automated intake of information.
Amanda Traynham (26:09) But, which is good, but I can’t I don’t know how to export this. There may be a way to export this from the medallion website and I think having the URL is helpful because that’s your source, but I need to be able to go in to the npdb and get to this. Yeah… yeah, it may be fine that we have the medallion piece, but I need to confirm that information is accessible in the npdb.
Peter Bosworth (26:46) Okay. Let me ask some people about that.
Peter Bosworth (26:56) Because I’m not seeing an obvious way to get to that exact provider’s case in npdb. I.
Amanda Traynham (27:02) might be able to query it, but that’s going to be a query on our side. I guess that’s where I’m kind of struggling with this. It’s like if… they’re enrolled in continuous monitoring, we should be able to access whatever has been flagged in npdb… right? That’s my outstanding question here. And I think it goes back to what you were saying earlier. It’s like, yes… the only way that medallion can do this is by doing continuous monitoring. But viva, you haven’t paid for ongoing monitoring. So you’re not really technically performing continuous monitoring for viva. You’re doing one time queries but setting them up for continuous monitoring. And so I guess the next question would be like and I need to go back to your documentation when you provided a quote on this stuff. But is there a way to just do the npdb or does it have to be a full package? And I think there were several levels that you quoted out. But if medallion… is not truly performing ongoing monitoring on our behalf, you’re truly just doing the one time query. But obviously, I can access that dashboard and see the ongoing monitoring. I… just struggling through how to develop our process around getting to alerts that occur between thread cycles. And so we can print out what’s in the ongoing monitoring. But that’s not the way we’ve historically presented data for our adverse review. We’ve always presented the npdb disclosure document. And so, I think if we’re not able to access that true alert in the npdb account, then we’re going to have to do a one time query to get to that which it’s already been queried and it’s in our medallion system. So it’s just kind of a weird circle that we’re in.
Peter Bosworth (29:23) So, ideally, though, if we were running ongoing monitoring and we did flag that, there was an npdb alert and you’re saying like, okay, it’s all well and good that you guys aggregate the information in your medallion system. But if you also just provided a link to the exact provider’s case that would work.
Amanda Traynham (29:43) Yeah, we would need that PSV documentation. I think having the table and I hear what you’re saying with the ncqa accredited process, but I need to be able to get to the source data. I need to be able to replicate what you have in the system. And it sounds like the only way to replicate that is to perform a one time query on a provider that medallion has flagged so that I could get that document, right?
Amanda Traynham (30:18) We can come back around on this a little bit. I need to talk with Alyssa some… but I really think it boils down to the fact that we’re not going to get alerts because we’re not truly set up for ongoing monitoring with medallion. We can see it. If we go into the dashboard… we can go look at it, but we’re not going to get prompted to go look at it. Is what it sounds like?
Peter Bosworth (30:49) Yeah, that is it because we’re not fully set up that way but even still, let me just confirm that if you were, you would receive the email, which, yeah, I know you would receive the email, but the idea about the link to the provider’s exact npdb case, that… might be a roadblock here perhaps.
Amanda Traynham (31:15) And so in the meantime, what we’ll be doing then is maintaining two records for our providers medallion’s going to enroll in continuous monitoring. Viva is also going to enroll the provider into continuous monitoring. We’re not going to delete medallion’s record because I know that throws off the cycle stuff. But for the interim, until we figure out a better plan, we’re going to be having two records for the same provider enrolled into continuous monitoring so that we can continue getting our alerts. Because we don’t want to miss those. We can certainly start incorporating reviewing the ongoing monitoring dashboard for issues that pop up. But that’s not quite as efficient as at the point of when you have an issue identified on a credentialed provider because these issues may be for providers that are still in process, right? Have to look further into the record to determine. Okay. Is this a re, cred? Is this a new provider? So there’s a few things we need to work out. So we’re just going to run the two processes side by side. Okay. We’re not going to have any records. We’re going to manage our own continuous monitoring. We understand that you have to enroll the provider into continuous monitoring.
Amanda Traynham (32:33) There’s no way for you to just enroll them as a one time query at point of cred. And then we can explore how to make that a better like smoother process. Yes. Yeah. Okay. I have another call. I’m actually late for so. Thanks.
Peter Bosworth (32:58) Sounds good. Thank you, Amanda. Great.
Amanda Traynham (33:01) Work today and we’ll get there over the next couple of weeks. I think we’ll be able to figure out a better process here.
Peter Bosworth (33:08) I agree. Have a great day you.
Amanda Traynham (33:11) too. Thank you. Bye bye bye.