Transcript
Connor Morley (00:00) hey, Niccole. Hey, Connor. How are.
Niccole Russell (00:03) you?
Connor Morley (00:04) Doing good.
Niccole Russell (00:06) Good. Did you have a good weekend?
Connor Morley (00:08) Yeah, not too bad. Is Adalee joining?
Sheila Simpson (00:14) I’m not sure.
Connor Morley (00:25) Okay. Let me message her real quick.
Niccole Russell (00:36) I did send her a message, not sure if you saw, but I did there, she is, I did send it. So we are good to update the payers for them.
Connor Morley (00:45) Perfect. Okay. Keep working on that import. Okay. Sounds good. All right. I’m going to let them in. I do have an update on that.
Connor Morley (01:00) Sorry, so.
Connor Morley (01:05) Just, hey, everyone. Hello? Hey, good morning. Good afternoon. Okay. So I think just to get started, we’re going to cover the provider… enrollments and group enrollments and the existing enrollments load. So I know that we had just, I think an open question on one payer, and then Adalee, I think you had an update that we were able to import all the provider and group, existing enrollment lines.
Sheila Simpson (01:45) Correct. Yep. Okay.
Connor Morley (01:49) So now within medallion, you should be able to see all of the existing payers and the existing payer enrollments.
Connor Morley (02:09) Any questions there? No. Okay. So really quickly as well for the payer enrollments, just to kind of cover within medallion, you will be able to see them in the enrollment section, and they are kind of grouped in just individual… provider and group enrollments. You can kind of filter a little bit to see group or provider enrollment information here along with the practices, their par status. And then if we had effective date, it would go in there. So for the payers that either have direct enrollment or group enrollment outside of, I think the two payers that we are doing delegated rosters with you are able to go in and do single demographic updates, bulk demographic updates, request revalidation, and do any new payer enrollment. Okay?
Sheila Simpson (03:24) So, I’m assuming that’s where we put, if we find a provider that we at one point thought was enrolled, but for some reason now is not showing enrolled. Is that where we would put in those requests to fix that?
Connor Morley (03:40) Yeah. So I guess in those situations, it kind of depends on what… the issue is. For example, if they’re coming up close to a revalidation date or you’ve received an email from a payer requesting revalidation for one of those providers, then you would be able to go in and request revalidation. For example, if you have a I’m just going to pick one. And if you’ve received a notice of like a notice about the revalidation for a particular provider, you can select the enrollment with that provider. Yeah.
Niccole Russell (04:20) I think where the confusion lies is they haven’t really been trained on the system yet, so that’s still to come as well, correct? Connor?
Connor Morley (04:31) So, we did go through some training a while ago, but it was a really long time ago, but I think we can definitely go through like a full training again starting with payer enrollment and right here, because… now we’ve loaded in all of the existing enrollments.
Niccole Russell (04:53) Gotcha. Is that something you need? Sheila and Brenda? I believe you said something about training. I think that’s why I thought we hadn’t went over it. Sorry. I’m getting my lines mixed here on different clients.
Sheila Simpson (05:07) No, Niccole, you are correct.
Connor Morley (05:09) Okay.
Sheila Simpson (05:11) We truly have not received adequate training on how to utilize the system now. And like if we have this issue come up, how do we resolve that now? Within medallion? If we have a different situation come up? How do we resolve that within medallion? And I know Brenda’s having a lot of issues with, we have new providers that need privileging, what is the step by step process of how do you load these providers in here so that they’re getting the enrollment packets that they’re supposed to and whatnot. So, yes, we really need that full training of how to utilize the system appropriately. Okay?
Connor Morley (05:57) Let’s why don’t we start from the very beginning of kind of what to do to get for like a net new provider. So let’s say for example, you have recently hired a new provider. First step that we need to do is get them into medallion. Okay? And with that, we can go to the providers tab. We can invite them. We would just need their email, first name, last name, their estimated start date profession. And then we can send them an invitation email into medallion. Once their general provider profile has been created. Then either themselves the provider themselves or you all will be able to log into the profile and fill out the information and connect it to caqh. So if you were to then do that, we could go into the profile, go all the way down… do data imports. And here it would say link your caqh profile.
Brenda Runde (07:10) Okay. Can you slow down one second here? So this is the new Guy I just submitted last week, Donald, the Guy that you were just in that’s fine. Stay in him because I like to follow along the caqh information. I wouldn’t have that for him to begin with. But you’re saying we can actually review… and add and relink. So.
Connor Morley (07:43) What do you mean that you weren’t not able? You don’t have a caqh information because it looks like the caqh profile is linked. Huh? I?
Brenda Runde (07:54) Mean, I had the caqh on all like of our previous or our prior providers because Bonnie gave that to us from the co op from rwhc and that was uploaded from a different template. But like this Guy, Donald garrison is a new doctor and I didn’t have the caqh information to begin with. So it must have, maybe it’s something being taken place on your end already then.
Connor Morley (08:26) So it looks like he actually went in and… he added in his social security. So just another piece. If you ever are curious how some information got there, there is an audit trail and we can see like if we’re in the provider profile, basic info, if we click on the updated on, it looks like that Donald garrison was able to go into the system and add in some information like primary phone, social security number. I do not see a caqh id, but it looks like he was able to connect his caqh account.
Niccole Russell (09:09) Okay. Which?
Connor Morley (09:11) Is entirely possible. And providers can do that. They can also go through a resume upload every time we invite them into the platform. They’ll be asked how they want to input. Their information. Could be a resume scan, could be linking their caqh or they could manually do it. Okay? But if we see here, it looks like a caqh profile is linked and then we can pull in additional information from the caqh and we can specify what information to pull to. So we can only pull, we can choose to either select everything… from caqh or we can select certain fields only.
Brenda Runde (10:00) Okay. Yeah. I wouldn’t even know what needs to be selected for the caqh to begin with. So I guess that part I am not aware of.
Connor Morley (10:17) So it’s kind of up to you because it as an organization, how you want to handle this because if the provider caqh profile isn’t up to date, it is… it’s tricky because there’s not much we can do. We ask the providers when they log into medallion to attest that everything is correct. So we onus on the providers to make sure that everything that is on their profile is accurate, whether it’s coming from caqh or it’s or they’ve input it themselves.
Brenda Runde (10:56) Okay. And.
Niccole Russell (11:01) Also, you do have caqh management. So once they confirm that there’s a box that you would select for us to manage that caqh. And yeah, Carter can show you that once you check that box and in their profile, if there’s a username and password that’s the box, you would check. And then in the provider’s profile under external accounts, they should be linking or you should be linking their username and password to their caqh. And then our team would know to go in and manage that for you. So if it’s not a correct caqh, yeah, right there. So if it’s not a correct username or password or if there’s not one at all, but you’ve selected that box, then our team will task out for that information.
Brenda Runde (11:53) Okay. Yeah. I guess that would be where I’m talking about the part where, yeah… I never had his caqh, so I wouldn’t have been able to enter that, but I get it now. I guess.
Niccole Russell (12:06) Yeah. I don’t know who entered the number. I didn’t see it on the audit trail. I didn’t see his… caqh number being updated and then his, I was going to check it to make sure that it was his, but there’s no account associated here for me to go in and make sure that it’s the correct caqh id.
Connor Morley (12:33) Okay. So let’s say for example, we’ll run through this provider through all the steps that’s needed. And we’re going to need him to fill out all his information. Either he can pull it from caqh enter it manually. We’re going to need him to sign his agreements as well. Even as admins. You have the ability to go in and enter in some information in his profile, if you have it, but you will not have the ability to sign any of these agreements here. Okay? So for a brand new provider, it looks like he’s logged in, started to fill out some of this information. You’ll have to make sure that he’s got that he’s logging in. He’s entering the information, you can go into this provider directory, piece, click on caqh management to enable that. So, is that a provider you would want to have caqh management yep?
Brenda Runde (13:41) All of our providers will need that, okay? Like our selfless health employees.
Connor Morley (13:50) Yep. That makes sense.
Brenda Runde (13:53) But do I need to go do that for every one of them then?
Connor Morley (13:56) So what we can do is filter by southwest health or southwest health center teams… and then we can select all with a team of southwest health. So it looks like there are.
Brenda Runde (14:13) There’s people in there that don’t need to be on there though. So that might not work or that filter may not work because there’s a lot of uwp providers right there that I can see.
Connor Morley (14:26) Okay. Is there another filter that we would be able to click in order or use in order to kind of mass click that caqh management?
Brenda Runde (14:42) Sheila, did we ever set up those teams like uw in?
Sheila Simpson (14:48) Well, that was going to be one of my questions for today. Okay? That’s.
Brenda Runde (14:51) what I thought, okay, because once that part is, you know, set up or not, however we get that part figured out, I think that would be easy to separate out the uw and radiology, and all the above. Okay?
Sheila Simpson (15:09) So, I have those teams created, but I don’t see that anybody is… in them. Like there aren’t any providers in other than the southwest health, which there’s… 300 providers, which we don’t have 300 providers, like of.
Brenda Runde (15:29) Our.
Sheila Simpson (15:30) own providers. So, I don’t know how they, I don’t know how this, I created the names, but I don’t know how the providers got assigned.
Sheila Simpson (15:50) I assumed that they were going to be like loaded from that template.
Connor Morley (15:59) So we can’t load them in through the, through that template. We don’t and Adalee, correct me if I’m wrong, but we don’t have a flat file import for team.
Niccole Russell (16:10) Yeah, that’s correct. I.
Brenda Runde (16:12) Thought that was the way you told us to initially do it because remember, we put the line through the page under the providers tab on the template, and then I had to go get individual emails on top of what we already had entered. So, am I misunderstanding or… like on the actual template? The providers tab, all of our providers were on top? And then all of our visiting contracted providers were on the bottom. That’s why we originally set that up that way because that’s how it was supposed to be loaded.
Connor Morley (17:00) So, I think I mis explained it. We can’t load… in the team assignments through that data import template, but it does help us to kind of group them using the data import as a source of truth. So we can use groups or practices in order to pull in providers, which it looks like that’s why southwest health has 300 providers.
Connor Morley (17:36) So, all the providers associated with the southwest health group is being used to pull in to the southwest health team.
Brenda Runde (17:49) But I thought that was why we did the groups because then we will separate them out. Uw providers, uw doctors that’s.
Sheila Simpson (17:59) why you created the agency name?
Connor Morley (18:01) Yeah.
Brenda Runde (18:07) That was why we did that to begin with.
Connor Morley (18:15) So, the only group in… the system is southwest health center with its own tax id. When we’re… thinking about, groups are based off of tax ids… and then the teams themselves.
Connor Morley (18:41) That would be separate. We can associate them with like the practices or the tax id, but we have no way we actually don’t have a way to upload them as a team.
Sheila Simpson (18:59) Okay. So if we go back to the entities that are where the teams are located… if we, when we create these, assign them to a team, does that help you distinguish? What if they need just privileging or if they need both privileging and payer credentialing?
Sheila Simpson (19:37) So from.
Brenda Runde (19:40) from.
Connor Morley (19:42) our standpoint, like maybe… I’m getting a little confused right now. But when you’re making like a payer enrollment for a group, we associate like we filled out the providers practice groups and we have all the information on the providers that are associated with your practice locations and your group and your southwest tax id. So.
Niccole Russell (20:08) I think Connor, is that the teams is just for their view site, right? It’s not for us because ours is separated by tabs. Maybe that’s where the disconnect is. Does that make sense? Sheila and Brenda. So when you request something, whether it be privileging credential, you know, I’d have to look at your credentialing, anything like that, pay your enrollments, it has to be requested under its own specific tab. Meaning these here on the left. Like he’s under payers. If you wanted an enrollment request, you would request it in the top right hand corner. If you wanted credentialing, you would do that. Let’s see. It looks like you have tjc. So we would go to the privileging tab and you would request it there. So the teams lookup is only for your side of the house. It’s nothing that we would utilize. Am I correct to say that Connor? Yes. Okay. The.
Connor Morley (21:07) Teams are in part helpful to if you’re looking at your overall provider directory to kind of separate providers into either different contracting agencies or… internal employees. Okay?
Connor Morley (21:28) So if you’re in the process of creating a new provider into medallion, you would need to click on caqh management. They would enter in their information. We would task out for them to enter in their username and password for caqh. So we could update their policy if they’re an internal provider. But if they’re an external privileging provider, you would not need to hit that. We would not ask for additional information… and we would not need to link their caqh… once their provider profile has been created and they’re starting to enter in their information, the next step would be requesting the privileging or going through the internal tjc credentialing process where you would then go in, request a new initial appointment. And… then that provider was.
Niccole Russell (22:33) Donald garrison, Donald.
Connor Morley (22:34) Garrison… request for southwest health. And then at a later point, our team will assign them with some of those delineation or privileging forms for them to sign off on as well. Once we go in and start to create the packet.
Brenda Runde (22:58) So, by me putting the actual request in for the initial credentialing that this part is not being done, I have to go do another step.
Niccole Russell (23:12) Yes, Brenda. Yeah, any requests that you need, you would have to do manually?
Brenda Runde (23:21) Okay. And then the payor credentialing is another step on.
Niccole Russell (23:26) Top of that. Yes. Yeah. So you would go into the payor enrollment tab and hit the request and go through that process as well.
Connor Morley (23:39) So, once that provider’s been credentialed you would be able to go in.
Connor Morley (23:50) Associate him with a group southwinter, south southwest health, and then associate them with a payer… and you could pick and choose all of the payers that have been enrolled with southwest health by just clicking that button… that select all button. And it would choose all of the payers associated with currently associated with southwest health. And then there’s also some that are currently in the process or currently you’re in current group enrollment for that. And then we would just need to also know the lines of businesses. For each of those payers… we can pull in some automatically just for medicare and medicaid, and some others.
Brenda Runde (24:41) I need to go and fill each one of those lines out. Is that what you’re saying?
Connor Morley (24:47) For the different lines of businesses? Yeah. Yes.
Sheila Simpson (24:56) Is there any way to have it default that if we select all payers, it selects all lines of business that are available.
Brenda Runde (25:04) Because it’s going to be that way for any request we don’t pick and choose like certain payers for any providers, they all get enrolled.
Sheila Simpson (25:14) Except for vision? True?
Connor Morley (25:19) Which one is vision davis vision? Or just the,
Sheila Simpson (25:22) there’s multiple?
Niccole Russell (25:23) Davis? I.
Brenda Runde (25:24) can’t follow them?
Connor Morley (25:26) Yeah. Nicole, I’m not sure of a way to pull in the lines of business automatically for some of our payers. Is that something we can do through the payr… project plans?
Niccole Russell (25:42) I will have to check on that. Generally the team only works what is assigned to that specific line. So that is something that I will have to check on to see if PE if that’s a capability of theirs? Okay?
Connor Morley (26:04) Okay. The only exception to the PE enrollment requests would be your delegated rosters. So for the delegated rosters, those would come to you in a roster… template once a month. Okay. And Adalee, I think we’re working on a sample template for approval, so we can finalize the roster and send that out for the end of this month.
Adalee Arreola (26:40) That’s correct. So I should have that sample out by the end of this week.
Niccole Russell (26:47) Okay. And since we’re talking about payer enrollment here, Sheila, you did ask if we could discuss something on the call. So on the template that you completed confirming those are all of your payers, you agree with our naming convention on that sheet. It asked if there were any rosters that you all use outside of the delegated, it asked if you have any rosters that you use for any payers. None of that was marked. Yes, there were no rosters linked and there were no processes for payer enrollment. So what I meant by my reply was we have just the standard enrollment process. Since you don’t have anything specific to your group that you marked like payers specifically for southwest health, we enroll Aetna this particular way, which would be a non standard way… since you didn’t mark any of that. To me, it looks like everything is enrolled the standard way with each payer. Is that correct to say? I?
Sheila Simpson (27:52) Would have to assume. So we’ve never done those. Yeah.
Niccole Russell (27:55) So, you would know if it was specific kind of like the delegated agreement, it’s something similar to that. So if you had Aetna but you submit this specific form for enrollment, then that would be a non standard enrollment process for you as the group. Okay? So if you’re if you didn’t if you don’t know of any specifics there, then I think we’re good to go ahead and continue with just our standard process for enrollment.
Sheila Simpson (28:22) Yeah, I don’t other.
Niccole Russell (28:24) Than the one I submitted to be done, just wanted to confirm that. Yeah, that’s where the project plans come in. No, this group actually does it this way. And so, okay. So we’re good there.
Sheila Simpson (28:34) Yep. Thank you. Until we learn different from the payr. Yes?
Niccole Russell (28:37) Yes, ma’am, and if you do let us know, we can always add that in as a project plan that, hey, this is how you specifically need to enroll these providers. That’s not a problem to update that. Okay? All right. Conner, you can go ahead. Okay?
Connor Morley (28:57) So once a new payr enrollment request has been made, then you’ll be able to follow along with them in the enrollment requests tab of the payr piece.
Niccole Russell (29:10) And you’ll.
Connor Morley (29:10) be able to see if there’s any additional information that’s needed. For example, if we have here needs client attention on intake, this could be most likely a couple different things. So we just want to confirm what is going on. I think specifically, we have Mary gee, provider revalidation. It looks like we don’t have enough information on the application. So in that case, most likely there will be a provider task or an admin task.
Brenda Runde (29:44) I have that as one of my questions actually because it’s showing as… I need to link provider to practice locations in medallion. I have no idea how to do that… when I go in and I think what I know what I’m doing, the practice locations are showing. So I have no idea what to,
Niccole Russell (30:09) do.
Connor Morley (30:12) okay. So in this case, we can just look at the provider information. We can look. So all of these practices, these are all the practices that the provider’s working… at, right? Right? And this looks correct. Yes. Okay. And if that’s the case, we should be okay, and what we can do is go back to that admin task or it was an admin task or a, it looks like it was an admin task, please link provider to practice locations. All we have to do, all you have to do is mark that task as complete and you can add notes in it that will also say, this is complete. But in order to just alert our team, all you need to do is click on this green circle, mark it as complete. That task will be updated to, in review. Our team will look at it. If they have any additional questions they’ll reach out. But then we should be good in that payor request and continue to be worked on.
Brenda Runde (31:21) Okay. And I,
Niccole Russell (31:22) just want to note there for the task as well. So it’s recently, you know, I’m fairly new to the company. So I’m still learning the medallion way, but I actually just learned something Friday. If you comment on a task now, if you comment on one of these lines, the team will not see it until they conduct their follow up, meaning these lines that are showing on Connor’s screen right now. However, if you have a task and you comment in that task and you’re waiting for a response, the team will not see that until you hit done by provider. So once you complete that task, it then falls into our team’s follow up bucket and then they will comment back. They’ll reopen the task if it’s needed. But I just want to let you know that task. In general. If you just mark a response, a comment, then the team will not receive it until you hit complete. So even if you’re asking a question or need something corrected, they’re not going to see it until you hit complete. So that’s a major step there.
Sheila Simpson (32:32) Can I ask why it shows up that it needs to be completed when it is already there?
Niccole Russell (32:39) He’s in the review. So he’s in the review task right now. Not in the ready. Is that what you mean?
Sheila Simpson (32:45) No, like why are we, why were we asked even to review it? Since she’s already located like already has practice locations assigned?
Niccole Russell (32:55) Click on. It. Was created on the third. Was that information prior to the third? It would have been okay. And I guess Adalee dropped off. So all of that should have been, I can’t tell you why to be honest, if you’re seeing things like that, you can add into the comment section. Information has already been housed, please review, already been housed in the system, please review, and they should be able to see that.
Sheila Simpson (33:31) Okay.
Niccole Russell (33:33) So, I apologize for the additional… task when it doesn’t look like it was needed?
Brenda Runde (33:40) Will her revalidation then be completed now? Or do I need to go do something else again or?
Connor Morley (33:50) So we can look at the request status. It doesn’t look like there’s any more information needed just for that, but if we take a look at their provider profile, we can also see if there are any other tasks. So it doesn’t look like there are any other tasks associated with that?
Connor Morley (34:16) Payer, enrollment request. This is just simply for caqh management, this task right here.
Niccole Russell (34:22) Well, the caqh is needed for provider enrollment. Yeah.
Brenda Runde (34:28) Like I requested the ma, revalidation to be completed for her. I think that’s where this is all stemming from. Yeah, but I definitely didn’t know how to follow up on it because I don’t even know what that meant. Gotcha… our previous cvo did all this for us. We never had to do anything except for send the request for it to be revalidated.
Niccole Russell (34:51) Yeah, yeah. But I get that. That’s kind of my past life as well. So, the medallion way is a little bit different.
Brenda Runde (35:00) That’s okay. We just need to know how to do it, yes.
Niccole Russell (35:03) Yes, absolutely. But.
Brenda Runde (35:05) Her revalidation will be completed then I should be done with her revalidation, her reminder.
Connor Morley (35:17) So, Niccole, we also do have a, but,
Niccole Russell (35:21) is it correct? Because they’ll task out if they can’t get into the system. So, let me pull this, leave that there. For just one second. Let me pull that provider.
Brenda Runde (35:31) And remember back a couple calls ago, I had kind of brought up the situation of two caqh profiles being entered because only the one was on the template. I’m not sure where the other ones came from. We talked about a couple weeks ago.
Sheila Simpson (35:49) Yeah. The other ones we figured out were being entered by the providers themselves. Yeah.
Niccole Russell (35:55) I’ve got the provider name, Connor. So I can pull it up. I just didn’t know the provider name here. So I’ll pull it up and see if I’m able to get into the account here. Let’s see. Oh, yeah. Okay.
Niccole Russell (36:14) So, this was not corrected. That’s why… Connor, we need to remove. I can’t remember the email. I think it was the cbo. I would have to go back and look at their email. Do you recall their email where they said certain ones needed to be removed?
Connor Morley (36:35) Yeah. Let me talk to Adalee on how we can remove those caqhs?
Niccole Russell (36:42) I think this one was just the regular.
Sheila Simpson (36:48) So, I can tell you the one that’s MD isn’t the one that was managed by our previous cbo because like all of those started with the cbo last name, first name?
Niccole Russell (37:02) Okay. So you would not want to use, the.
Sheila Simpson (37:06) MD one? Okay?
Niccole Russell (37:08) Let me try the other one and see if we’re able to get into that. And that could be why if you open the task Connor, it may say we don’t know which one to use. Okay? Yeah, I was able to get into that one. So, let’s see her task. Let’s see what it says. Please provide caqh login on external account section. This will be used for enrolling. If you do not have this information. Yeah, I would say probably because there were multiple there, it doesn’t specify in the task that it was due to multiple being created.
Sheila Simpson (37:47) So, can I remove the duplicate?
Niccole Russell (37:49) I would think so. Cool. And then you can comment back on the task. Once it’s removed, you can comment back on the task and say the information in the profile is up to date and accurate and close it out. And then they’ll proceed as long as that checkbox is marked.
Niccole Russell (38:16) For the caqh management.
Sheila Simpson (38:27) Trying to figure out where that went.
Niccole Russell (38:44) Yeah. And her box is marked there. So we’re… good on that one as far as the caqh management… while.
Brenda Runde (38:54) We’re on the caqh part, can I steer to a different provider that is getting a notification? Yep? Ana, svirchev SVIRCHEV. Sorry. I think I added it. Yep. There you go. I definitely added the wrong letter in her name, but she keeps getting a notification that her practice location information is missing and I think it’s with the caqh, but I… again, don’t.
Connor Morley (39:32) the practice location, office manager details are missing in medallion.
Niccole Russell (39:37) So, you would have to go to the practice location and complete the office manager portion of that, but Niccole.
Connor Morley (39:46) It doesn’t sound like it should be a provider task because the providers don’t have the ability to go to the… practice location and enter in information on the practice location.
Niccole Russell (40:00) No, I agree there.
Connor Morley (40:06) That seems that sounds like that’s a provider.
Niccole Russell (40:11) Task because the admin will be able to see the task on the provider and their own.
Connor Morley (40:21) So, they have all of the practice locations loaded, but on the practice profile?
Connor Morley (40:36) Office manager name and email, is that needed Nicole?
Niccole Russell (40:44) Yeah, it doesn’t say optional, so, yes, it is needed.
Niccole Russell (40:52) So, a lot of the payers, they will require that information. Well, not a lot, but there are select payers that require that information on applications. So, any field that’s in the group practice or provider that says optional, you do not have to include. But if it says, if it does not say optional, then yes, we ask that you include it.
Niccole Russell (41:18) Connor, could you scroll back up to the top? So I can see like really where you are? Sorry?
Connor Morley (41:23) Sorry. Yeah. So it’s groups, group profiles has the overall group profile and then the practice location?
Niccole Russell (41:33) And, yeah, this is set out to a provider, but it should be an admin task.
Connor Morley (41:39) Yeah. Okay.
Niccole Russell (41:42) Looks like there are a few of them that are assigned to providers that should be admin.
Connor Morley (41:47) Niccole, can you take that to the PE ops team to ask… them to reach out to the admins instead of directly the providers? Yeah.
Niccole Russell (42:01) So, let me ask while we’re on the call, what do you want? Who do you want tasks assigned out to? As far as like obviously group stuff would come to you. Do you want any of the providers tasks to come to you? You would still be able to see them as an admin? But do you want them assigned to you? So I have different groups and I’ll give you an example. So I have different groups that, hey, if it belongs to a provider, send it to the provider only obviously, if it’s group, send it to us. And then I have groups that say, send everything to me that’s for the provider, unless you need a provider signature… or I have some that say send all tasks to me as the admin. So, how would you prefer that be distributed?
Brenda Runde (42:55) A good question. And.
Niccole Russell (42:58) again, you can see them all. So don’t think just because it’s assigned to them that you’re not going to be able to see those. So you can still follow up with them and things like that.
Brenda Runde (43:14) I mean, I suppose that they would probably need to come to me but I don’t know.
Niccole Russell (43:23) Wouldn’t.
Connor Morley (43:24) you have the provider stuff go to the provider, Brenda? I mean, if, well.
Niccole Russell (43:28) Yeah.
Brenda Runde (43:31) Any provider related should probably go to them directly.
Niccole Russell (43:35) But, okay. And if it’s something you can complete in their profile, if we’ve tasked out for a Coi to them, but, you know… but you happen to see it and you have it on file, you can always upload that and complete that task out. Okay? Because I can add that into a project plan that says, hey admin tech group only information task out to the admin. However providers task out to the appropriate provider?
Niccole Russell (44:14) So, is that the way you would prefer to do it? Yeah. Okay. Thank you.
Connor Morley (44:32) Okay. So just going back to the enrollment requests so you can see that there are a handful of requests that are in currently being put together once these requests move from like processing or intake. So this request the application is being put together. And then the next step in status would be you’d go to payer processing the application’s submitted. And it is, we’re waiting to hear back from the payer, in this case, medicaid. So you would be able to see some notes for… that task as well. Okay?
Connor Morley (45:33) So, just to summarize the kind of the process would be entering for a net new provider, entering their information into… medallion first just with a basic provider profile, getting them to fill out their provider’s profile, sign the agreements and… link their ceqh, if they have one, if they are a southwest employee, you’ll click on the ceqh management button.
Connor Morley (46:03) If they are not, we can leave that blank. Once that’s been completed. We can move to the privileging credentialing tab. We can request a new initial appointment. Our team put together the application. We do need the provider profile to be at 100 percent and those agreements signed before we can complete that credentialing process and put together the packet. Then once the packet’s been put together and approved, then we can go into the payer enrollment and you can start making requests on that credential provider.
Brenda Runde (46:45) Oh, it all can’t be done right away. I have to go back in and request pieces of it after the original submission.
Brenda Runde (46:59) If you’re saying I can’t request the payer enrollment until the provider profile is 100 percent.
Connor Morley (47:06) It’s up to you because the reason we do not. I mean Niccole, I’m curious to what you’ve seen, but I have seen most organizations… hold off on requesting payer enrollment just because you could still find… sanctions or something through the credentialing process.
Niccole Russell (47:37) I don’t… know that answer to be honest… I guess the,
Steve McCarthy (47:46) concern I have is, I mean, if the provider profile has to be at 100 percent, our biggest issue out here is that, how do we speed the process of getting payer enrollments? And I won’t pretend to know the system, but I mean, how long is it realistic to expect the providers to have that profile at 100 percent, then for Brenda to go back in and request payer credential unless I’m thinking about that wrong? Or is that kind of your question Brenda?
Brenda Runde (48:10) Yeah, no, that’s 100 percent.
Connor Morley (48:13) So, I guess, so if you are worried about potentially the providers taking a long time to complete their profiles, we can turn on profile reminders so that they’ll get continuous notifications to complete their profile from medallion, just to get them logged into the system, filling out their profile and getting that done right now. We only have tasks turned on. So if they have a provider task available, they will get an email notification.
Brenda Runde (48:47) Yeah. I think we actually decided to turn one of them off like two weeks ago because that’s I’m getting a lot of feedback from the.
Niccole Russell (48:56) providers.
Brenda Runde (48:57) so, I don’t know that emailing them every day or I think on Mondays is when they get, their, I don’t know if it’s a status update or what. But a lot of them are like, I got another email. I got another email. I got another email. So, Connor.
Niccole Russell (49:21) For credentialing, does that profile have to be at 100 percent? Yeah. Okay. For provider enrollment, it does not, it has to be at 85 percent and they have to assign their agreements. And if any additional information is required outside of that 85 percent, then we would task out for that.
Niccole Russell (49:46) So it sounds like for credentialing itself, you have to have it at 100 percent. Now, I know once you do the caqh management, that should pull it up but they will have to confirm that information is correct, right? Connor, sounds like it we.
Connor Morley (50:03) Can’t submit anything until they attest and sign their agreement? So even if their profile is at 85 percent complete, but their agreements aren’t signed, they haven’t signed the information release or attestation that their date is accurate, we cannot submit any applications or submit a credentialing packet for review. So that, so it’s so you’re right? If their, if their profile is at 85 percent complete and they have the signed agreements, we can move them forward. But if we, but… if it’s at 85 percent complete and the agreements are not signed, those release authorizations and attestations, we can’t submit anything, correct?
Niccole Russell (50:47) Yeah, yeah. I knew that I knew the authorizations had to be signed but I wasn’t sure as far as the profile for credentialing if it needed to be at 100 percent.
Connor Morley (50:57) That one needs to be at 100 percent. So we can do all of the primary source verifications.
Niccole Russell (51:02) Okay, good. That helps me as well. Thank you. Yeah.
Connor Morley (51:05) So, I.
Brenda Runde (51:06) mean, Brenda.
Connor Morley (51:08) And Sheila, it is up to you, if you… are worried about the process of providers completing their profile in a timely manner and going back and forth waiting for them to complete their profile to go through each step, you can submit requests for both credentialing and payers right after the provider profile has been created… just to have those requests in motion. But we can’t submit any applications until the providers at least logged in and signed their agreements.
Niccole Russell (51:55) That makes sense. So we just need them to sign right away.
Connor Morley (52:03) Yeah, I have been.
Brenda Runde (52:05) Sending welcome emails to like all the new people that I’ve submitted, but… I don’t know.
Steve McCarthy (52:21) Yeah. And I think, was it a couple weeks ago? I think the conversation was, I mean, we didn’t want the providers to have whatever the boy that cried wolf, they’re getting all these emails from Adalee and then ignoring all of them. So I think there was an element and I can’t speak to it effectively probably, but of what was shut off for provider notifications, so I don’t know if they’re still what notifications they’re currently getting, but I guess I’d like to know is if I’d like them to understand if they have something from Adalee and it’s urgent, but… I also don’t know if it can be filtered that way or what emails are going out on it.
Connor Morley (53:00) So, I think what we can do and what… I would recommend is that we notify the providers based on tasks that those provider tasks that have been assigned. Now, one of the things in addition to that is if Brenda or Sheila makes a request for payer enrollment or credentialing… for a new provider, and we don’t and their, that provider’s profile is not at 85 percent or their agreements are not signed, we would create a provider task to get to that provider to complete their information, so we can get moving. So they’re not getting daily profile reminders, that would kind of drown out everything else, but they would get a task reminder. And typically for a provider task, we usually send out three reminders and I can’t remember the exact spacing, I think it’s once every three days, three or four days via email to the provider. And if we have not heard back after the third reminder for that provider task, then we create a duplicate admin task where we would reach out where we would essentially tag Sheila or Brenda and say we cannot get in touch with this provider about this task.
Sheila Simpson (54:32) I think that’s what we would prefer. Okay?
Connor Morley (54:35) So… in, so in that case, just to summarize Sheila and Brenda, when you get a new provider, you can start to make the requests for payer enrollment and credentialing. And then we just need to follow up with those providers on actually filling out their information. I think that works.
Connor Morley (55:09) Okay. So… does that help kind of with the workflow a little bit?
Brenda Runde (55:29) I think a little, yes. I guess I question anybody that I’ve submitted for privileging so far? I mean, I don’t even know if application or sorry, if the privileging piece has been sent out to these, any of them. Because I just got an email this morning from Madison radiology, that they got the application, but they never got the privileging piece. I didn’t realize that was two separate steps.
Connor Morley (56:06) So, yeah, I do not see any privileging… requests in progress.
Connor Morley (56:20) So, in order to get privileges or to go through credentialing, like… if we took Donald… garrison, we would go here and then you could add in their specialty information, and that would start putting together the application process. The packet. It would task them out with the privileging forms to sign. And there are a couple other forms that we have them signed within medallion that… are specific to your, that are specific to your organization. All of those dop… forms that you sent us a while ago. So it’s not just the dop form it’s also hang on while I take a look.
Sheila Simpson (57:19) Connor, what’s dop? I’m sorry?
Connor Morley (57:22) Delineation of privileges? Okay. Thank you. So I have like, the urology, core privileges, radiology, psychology, pa, core privileges, otolaryngology, optometric, core, oncology, nurse practitioner, psychiatric, neurology, mental health, internal med, general surgery, family practice, emergency. And then there is the anesthesia, cardiology… and there is… also a request for reimbursement credentialing form. So depending on what the provider specialty is, they would fill out those forms.
Sheila Simpson (58:20) Brenda, do you have a list of those that you’ve that we need to get the?
Brenda Runde (58:25) Privilege done for? The ones that he just read off? Are ones I sent him already? Okay? There’s… only a select few that get the delineation one though this big 17 pager.
Connor Morley (58:50) I have that form as well. Delineation privileges form. Yep. Yes, I have that one too.
Connor Morley (59:01) So we do send them out depending on… what the provider specialty is. Okay?
Brenda Runde (59:09) But all the people that I’ve submitted so far, I need to go back through and do that piece for you.
Connor Morley (59:14) Would need to go in and create requests for them, correct? Okay?
Connor Morley (59:22) And then they sign all of those forms within medallion via E signature similar to like how they signed the agreements. And at any point, you can go back into view those privileges, privilege… those signed privilege forms. Okay?
Brenda Runde (59:41) And that piece will bring me to another question. Like the uw providers, they’re… credentialing contacts, like to be included on these notifications because they can reach out to the provider or they can complete most of the applications for the provider. Obviously not sign in a test or any of that sort, but they can do a lot of the application for the provider. And I’m I know we’re still kind of stuck on a process for that because I still have a provider that I need to submit yet because I can’t get it to even go. But where are we at with the process of getting… radiology and uw set up with their contacts, so they can help the doctors out a little.
Connor Morley (60:37) So we can add them in as admins… or team… managers.
Niccole Russell (60:51) What would be the difference between the?
Connor Morley (60:52) Two team managers would only be able to see the providers and the requests for the team that they’re assigned to admins, would be able to see all providers and all requests. The other piece about team managers is that they can make requests. So, I don’t think that you want, do you want them to have access to be able to make credentialing or payer enrollment requests?
Brenda Runde (61:28) No, they just need access to their own doctors and not for that request just to view and help complete applications.
Connor Morley (61:45) Yeah, Niccole, maybe we can take this offline. There’s. Not currently just like an assistant role or like a like… an individual provider cannot grant access to like we cannot, we don’t have a role where we could just grant a user individual access to a certain provider’s profile.
Niccole Russell (62:15) Would that not be team manager?
Connor Morley (62:18) They would still be able to see multiple providers and make requests. I don’t… know a way to limit the team manager role to not be able to make requests right now.
Brenda Runde (62:35) I think the other problem that it’s kind of interfering with is the fact that some of these doctors are already at reedsburg, which you guys just took on. And I am getting rejects from like both addresses, both emails that I’m trying to enter, for those specific providers that are already at reedsburg, and are trying to be credentialed here in platteville.
Connor Morley (63:05) So, if you run into that. If you have an example, I’ve.
Brenda Runde (63:12) emailed on them all. Yeah. So if.
Connor Morley (63:15) there is, so for example, if you do run into that, there is actually… I’m really sorry, I have to jump. I actually have to jump to another call.
Connor Morley (63:31) Nicole, can you help me schedule, some additional time tomorrow so that we can go through how… to create the aliases…
Niccole Russell (63:44) Yes, I’ll look at our calendars. I’ll shoot some time over to you, Brenda and Sheila, if you can let us know if any of the times work, Connor, are you Central Time? I’m eastern? Okay. So, am I, Brenda, Sheila, are you eastern as well? We’re central? Okay. Yeah, I’ll look at our calendars and I’ll send over some time.
Connor Morley (64:10) All right. Thank you. I’m sorry, I have to jump. All right. Thank you.