Transcript
Mike Manson (00:00) hey, Leah.
Lia Hood (00:04) Hey, Mike. How are you? I’m good. How are you?
Mike Manson (00:06) Doing?
Lia Hood (00:07) Oh, it has been a day. Let me tell you. Good.
Mike Manson (00:14) Day, busy day somewhere in between.
Lia Hood (00:18) It’s been somewhere in between, but it has been busy.
Mike Manson (00:23) Yeah. Did you have a good weekend? Yeah, Easter break or it?
Lia Hood (00:32) Was rainy on Saturday and cold, but it was nice.
Mike Manson (00:38) Okay. That’s good… William Niccole, welcome.
William Moore (00:46) Thank you. Hi, Mike.
Mike Manson (00:50) Got, Naomi, will be joining shortly and garrison, my manager will be joining as well. I know we had a conversation earlier today regarding caqh. Still, I wanted that… document that Shirley put together, I think would be really helpful in kind of capturing where some of the data discrepancies are, and I just want to let everybody know.
Mike Manson (01:15) Like my goal is to get that escalated to the appropriate parties on our team as soon as possible to figure out what’s happening why it’s happening and how we can fix it as soon as possible. But, I think, you know, Leah just William wanted to just hear from you like… what’s top of mind for you all as we continue the implementation and we’d love to just kind of hear you out on what you’re seeing on your side.
William Moore (01:44) Yeah, top of mind right now is the physician involvement, their engagement and the invite letters that need to go out. Obviously, we’ve done the due diligence on our side. I went and ran it through legal compliance. We got the branding taken care of. We were fully on board with the notion that we were going to stick with y’all’s standard process and get the invites out to the physicians… I’ve mentioned in the past. And I mentioned it last week to Derek and to Cameron that we’ve got certain practices that are very high touch, high sensitivity physicians don’t want to think about credentialing. They don’t want to touch it. They don’t want to know anything about it. They just want it to get it. They want it to get done behind the scenes. I did not realize that SMS was going to become one of the practices. In fact, I have heard they are the worst of the practices regarding physicians who do not want to be involved or bothered with credentialing the idea with us purchasing SMS and having that as an acquisition, I thought was going to give us an opportunity to just kind of come in with a little bit of a different approach and push down what we want to be the workflows for credentialing. Unfortunately, that is not how it shaped up. When I brought it up to the revenue cycle leader Anton rav on a leadership call last week, they very clearly in no uncertain terms said you cannot push anything out to the providers. So with that being the case, we need to figure out a solution that allows the medallion process to kick off utilizing… either an administrative contact, the credentialing team as it currently stands. We got to do something else or figure out something else or we’re going to be dead in the water. So I just wanted to throw that out there at you. I know that’s an important step. I know Leah’s pushed back in the past. I was willing to, you know, do whatever we could to get this as the initial hurdle that we have to get over to go ahead and get the communication out to the providers. But rav… made it very clear and said he’s happy to hop on a phone call and to convey this himself, but would hope that we can work out a solution without having to do that.
Mike Manson (04:22) Okay. Let me ask you this, what is different in the process that we have with medallion versus what you were doing with your normal process and MD-Staff? Well?
William Moore (04:39) I mean, we’ll use a different practice as an example. So we have another practice where we have literally been told we can’t communicate with the physicians at all. They have actually stood up their own communications team internal to that practice that we have to communicate with. Then they take the request back to the provider’s admins. And if the admin has to, they engage the provider. So there are multiple layers that are put in place between us and the providers. For some practices. Again, I didn’t anticipate that SMS was gonna be so sensitive about physician engagement, but evidently they are. So what they’ve done historically Lia, you may have a little bit better insight into the way that they’ve engaged. But my understanding is that they’ve gone through admins or gone through third parties and not to the providers themselves.
Lia Hood (05:33) That is generally correct.
William Moore (05:37) Yeah.
Garrison Goodman (05:37) So this just to confirm this group just wants to own all comms to the providers and doesn’t want an endowment reaching out for your team. So.
William Moore (05:45) We would need to figure out a way to use the credentialing team as it currently stands or practice administrators or regional. You know, honestly, I’m not as familiar with the SMS structure as I should be. So, I’m not sure who else would be the main points of contact, but that ultimately is what we would have to do is have dedicated contacts for each position that we would go through. So.
Lia Hood (06:12) What, and where this really comes into play because we’ve already established that once this kicks off and goes live, all communications would go through our internal team and not to the practice where this is really of issue is with these invites for the existing providers.
William Moore (06:30) And really the reconciliation that goes back to the data we were looking at earlier, if, as part of the physician invite, you’re expecting them to do any reconciliation of the data in the medallion platform. Somebody else is going to have to do that. And.
Lia Hood (06:46) William, I’ve already made it clear that we’ll take care of that in the letter that’s why I asked them to not make any updates. If they have updates. They see that need to be made. They can reach out to our credentialing mailbox and that is on that letter.
William Moore (06:59) Okay. Yeah.
Lia Hood (07:01) I made sure that was there, so.
Mike Manson (07:03) Naomi, correct me if I’m wrong here, but I think the bare minimum that we would need a provider to do in medallion is to come into a test, right? Yeah.
Naomi Denson (07:15) That is the only thing that they have to do admin users. As long as they have an admin user role or a teams manager role, they can make all of the updates, changes, anything needed in the provider. The remainder of the provider’s profile. So,
Lia Hood (07:33) that’s where we’re talking is even that attestation is going to be an issue with going straight to the provider that’s what William’s trying to explain? Is it even that initial invite… for the existing providers cannot be emailed straight to the provider? I was told? And.
William Moore (07:52) I quote, if that letter goes out, I will get eviscerated.
Naomi Denson (07:56) Okay. So the way the invite, the way the invites go out is it goes to the provider’s, email attached to their specific account. There’s no way to route that somewhere else that I’m aware of currently.
Lia Hood (08:13) There is, I’d have to go in and change every single email address.
Naomi Denson (08:16) Yeah. But every email address has to be unique. So each provider cannot have the same email address as another provider if they have the same credentialing contact. So, if there’s one credentialing contact that manages each provider’s like a group of providers’ profiles.
William Moore (08:31) We may have a solution for that too.
Lia Hood (08:35) That’s a longer solution though.
William Moore (08:37) It is, it is a much longer solution.
Mike Manson (08:42) Okay. We.
William Moore (08:45) are just so, you know, where I’m coming from, we are contemplating for the other practice. I was discussing creating a second email for every provider, one that would only be used in the, by the credentialing team for credentialing processes. Yeah. Okay. We don’t go that route if we don’t have to. But just letting you know that, that’s why I said that.
Garrison Goodman (09:10) Yes. So just so I understand we don’t want any comms going out to the provider. We don’t want them to be in the system. And then, you know, just legally, obviously they have to attest in some way or another. How does the org envision? The providers attesting?
Lia Hood (09:36) Can you say that, again? What was that? I didn’t hear the last part. I.
Garrison Goodman (09:39) Apologize, sorry, I might be cutting out on the mobile right now, but so I just want to understand kind of like, hey, we’re exactly where it’s at. I think there’s rephrase exactly what I’m hearing is. We don’t want any comms going out to providers for this group and any attestations would not be done in medallion… from the provider. And then on the other side, you know, kind of on the medallion constraint side, we would obviously the providers need to do their own attestations, where would you all envision this being done there?
Lia Hood (10:20) Are attestations that they have to do that are already done in caqh? So can you pull from caqh, those attestation answers?
Naomi Denson (10:33) The disclosure questions, Those should be coming over already. It’s the attestations of signing the authorization to work. So giving us permission to work on their behalf, the caqh authorization, and then the agreement to update and attest to their data with any changes, and then attesting to the completeness and accuracy of their profile with a signature. So there’s a physical signature that’s electronic signature that’s required on each of the agreements.
Mike Manson (11:15) Yeah, I don’t as far as I understand that’s unavoidable… I mean we can’t there’s a compliance legal requirement for us to be able to do the work on the provider’s behalf, right? Naomi?
Lia Hood (11:31) So, so William, if.
Naomi Denson (11:34) we,
Lia Hood (11:40) if we, I don’t want to say this out loud, but if there’s a way like can we get a PDF? Can we get hard copies and go practice to practice and get these completed and then scan them and upload them. I’m trying to find, I’m trying to find solutions.
Naomi Denson (12:02) Yeah, I have had other customers request that in the past and it’s not been something that we are able to support. It has to be within their platform because we have to know that they’re going in and seeing their full profile to attest to the accuracy of the data or at least that they’ve had the opportunity to, is my understanding. So we aren’t able to take a PDF of the attestations and upload them with a signature. It has to be done in platform?
Naomi Denson (12:37) I mean, it.
William Moore (12:40) Complicates things when we know their profiles are not correct based on available data or at… least complete. I’ll say that. So obviously that challenges us but I.
Naomi Denson (12:55) mean,
William Moore (12:57) I need, at the very least, I mean, if this is absolutely positively a sticking point, there’s no way around it, then we can go back to the operations leaders for SMS, get their perspective on it. And I mean, there’s a way to spin everything. Don’t get me wrong? I get that we can pose this as, hey, this is the one time this gives us. This gives us, you know, third party the ability to operate on your behalf. So you’ll never have to look at this again. But I don’t know when, where and how that message can… be transmitted to the providers and how much prep work is going to have to go into making something like that successful. The hope was that we could find a way around it and not have to go that route. But if that’s the case, I mean, I imagine it’s going to be a week and a half, two weeks before I can get a meeting scheduled. And by the time that, you know, all everything transpires and any internal communications need to take place, decisions have to get made, it’s… just delaying the project at large… so.
Mike Manson (14:20) William, just so I’m clear too. So, this is for existing providers, right? So, like, the new providers that are being onboarded, that seems like the most immediate work that needs to be done is not in this scope, right?
William Moore (14:40) Everybody’s lumped in together right now. Okay? I hear what you’re saying. Yeah, we can get started on the new ones. The new guys don’t have any, you know, clue what the process is, and it would make sense as they’re onboarding to just say, hey, here’s, one more thing to sign… that.
Mike Manson (15:00) Would just allow us to not delay them getting enrolled… right? Like I feel like that.
Lia Hood (15:06) I mean, we’re gonna, I mean, we’re at the point where some of these providers, we have to start the enrollments. We’ve already done. We’ve already started medicare and medicaid to get these at least get those rolling, but we’re at the point where we have to start these enrollments at this point, for some of these providers, we can’t hold them any longer.
Mike Manson (15:21) And Leah, that’s the new providers, right?
William Moore (15:24) Correct.
Mike Manson (15:24) Correct. So, can we do, Naomi, can we do comms just for those providers?
Naomi Denson (15:39) Like the custom invites?
Mike Manson (15:41) I mean, we, I think what I’m hearing is we need to get started yesterday on the new providers that they’ve onboarded, which is 10 new providers. How quickly can we get them into us? Taking on those enrollments? It sounds like they may not be as… picky about how they’re you know, like can we get communication out to just them? Welcome to SMS? Welcome to oneoncology. Medallion is a third party that we’re partnering with to do your enrollments? We need you to come into a test?
William Moore (16:19) Yeah. So, so that.
Naomi Denson (16:21) custom invitation email that you drafted up Lia?
William Moore (16:24) That.
Naomi Denson (16:26) can go to only specific providers. We don’t have to invite all the providers at once. You can pick and choose who we’re inviting. And when,
William Moore (16:34) right. But what.
Lia Hood (16:36) William was saying is that they’re all new onboarding providers and existing providers are lumped into one with this issue.
William Moore (16:44) Yeah. So I’ve been told no communication period. I can go try to tease out, the 10 new ones run that by pressure test, it, see if everyone thinks that would be okay. I mean, logically it seems to be okay, it’s a different subset of providers than the established ones and we very likely may be able to get permission to go ahead and push that out. I just, I’ve got to go run that up the flagpole and see what the team there has to say. I just, I’m not involved in the SMS implementation. I’m not in the day to day. I’ve never met these guys. So I’m having to go based on what I’m told, let me go. Have that conversation with Nirav and with their RCM leader, her name is Jen. I’ll see what their thoughts on it are. If we can get started with the 10, we get started with the 10. And then at least, you know, that’ll buy the team a little bit of time and capacity, and then we can try to figure out what’s going to happen with the rest.
Garrison Goodman (17:44) And William, just to this might be a dumb question. But William, what is, you know, having that, you know, kind of extra either step or login in medallion like some provider experience standpoint, like, you know, why is the operations team like kind of so adverse to that? I?
William Moore (18:04) Mean, in their specific environment, I don’t know there’s just, there’s been a lot of sensitivity with the integration with the changes that are happening with what we’re asking of providers, a lot of new system implementation process changes. I only know from a integration planning standpoint, I know what all they were planning to do. I haven’t been boots on the ground. I don’t know the temperature in the room. So I don’t know what all they’re pushing back on where we’ve been successful, where there have been challenges. My guess is it’s just been a challenging integration to begin with and they don’t want to add one more thing to it is number one, number two, you get a lot of personalities and a lot of just… difficult people to work with. That seems to have been part of this. And then three, I mean, we are a services company and the idea is that we are providing services at a specific level… and I think that that’s also part of it is that these providers just expect that as part of the platform outsourcing their credentialing to oneoncology which I know that this is an acquisition model. It’s a little bit different, but just in general, they expect us just to take care of it for them. Okay?
Garrison Goodman (19:23) Okay. Thank you for helping me understand that.
William Moore (19:29) Yeah, I mean.
Mike Manson (19:33) I get it. I guess… if I were to push back slightly, it’s like, I don’t think we’re asking for… the providers to jump hoops. I mean, they have to log in and attest that the information is correct. I don’t know, I mean, I, when.
William Moore (19:54) when a,
Naomi Denson (19:54) provider is doing a new enrollment or a revalidation currently that requires them to sign something? What is the process? Do you take each separate? Like you’re onboarding a new provider, there’s things that require physical signatures or… electronic signatures. What is the process to get them to sign? Is it you create packets and they sign each thing… separately as you’re submitting them… what is the level of outreach there?
Lia Hood (20:21) I mean, so it’s different for onboarding?
William Moore (20:24) Right? Because.
Lia Hood (20:25) We don’t do existing providers. We don’t manage their hospitals. So it’s really mostly a one stop one time onboarding because we’re doing their enrollments only. And so we get, you know, we get in and we get their enrollments done if there’s not an application that requires a signature, if it does, it routes through that office manager, practice manager. If we need something, if we need an updated document that we don’t have, we can’t get it routes through that office manager, practice site manager to get it from the provider, it all goes through that person. They don’t reach out to the providers directly.
Garrison Goodman (21:06) And then that office manager, how do they get the I,
Lia Hood (21:11) couldn’t tell you. Okay. So it sounds like.
Mike Manson (21:14) in an ideal state, we are routing our request to an office manager that… would then… I don’t even know what’s I’m just trying to think of like what the.
Lia Hood (21:26) best, in other instances where we have situations like this, we route it through that office manager and they corral the physician in between meetings before work on their admin day and sit them down and get something done… that we need them to do that we need them to. Do. We schedule, we have them help us schedule a 10 minute phone call, zoom call with them. So to sit down and walk through, resetting a password to get access and to renew a license. And we do that with them on the call, right? But it all routes through that office manager to help facilitate and get things set up and get things accomplished, not directly with the physician or the provider.
Garrison Goodman (22:10) Yeah, but what it’s worth, we have, you know, many customers who don’t want us reaching out to providers and typically will have an admin managing that relationship. So if it’s you know, another user that’s a, you know, an admin user on their behalf that’s routing everything. And we do have.
Naomi Denson (22:32) The teams functionality too, where you can build specific teams with team manager users that are split out by practice. You can assign specific practice locations to specific teams. So they’re only seeing information for that group of providers. And then they would manage the tasks and the updates and changes for those providers. But.
Lia Hood (22:52) Remember, our team’s going to manage all that. Our issue right now is that direct outreach for these initial forms? Yeah. I mean, that’s the issue at hand is that outreach for those forms that you’re requiring a unique email address for… the rest of the outreach to providers is going to route through us. And then we’ll route to those office managers. If we can’t get you what you need.
William Moore (23:22) We just have to figure out how to get them started yep.
Mike Manson (23:28) I think we’ll probably need to regroup internally on what we can do here because obviously, we want to give a solution that’s going to be, you… know, the best suited for you, but I think we’re probably not going to answer that on this call… Naomi.
Mike Manson (23:47) I think Naomi garrison like let’s get our team together or let’s.
Lia Hood (23:51) Talk. I.
Garrison Goodman (23:52) Think there’s two tracks, right? We’re going to detail this internally and see what other customers have done if the scenarios come up and we’ll share that information with you all. William. Sounds like you’re going to have some conversations on your side to see, hey for net new providers. Can we just do this process? And there’s not an experience they have differently? And I guess… the question is we’ll probably need a day or two on our side, William, on your side, how much time do you think you’ll need?
William Moore (24:23) I’ll have an answer for you about tomorrow on the new providers.
Garrison Goodman (24:28) Okay. This was one item you kind of spent 25 minutes talking about. Is there other items as well?
William Moore (24:39) I mean, the only other thing from my perspective is the information we talked about earlier with caqh, but Leah may have other things that are top of mind or she may want to discuss, but I mean, we’re still very early in the process. I’m.
Lia Hood (24:58) just pulling it up real quick to see what else was on here. So, is the provider invite, payer loading… provider loading? I think we’ve talked about all of those. The only other item was the payer loading was to talk about an update. And I know we’ve mentioned this earlier on evolent and other payers in similar situations like elevent, where it is where there’s… a struggle to load them for us as a payer because… I guess the easiest way to say it is we’re a one off and it’s been an existing payer for us and I just quite frankly don’t have the quote national information on it because it’s been an existing payer and just trying to find out which of these payers you’re going to do and which ones you are not, meaning, how many payers do we have to pull in house? Because medallion’s not going to load them and process them.
Mike Manson (26:01) As far as I understand, the only one that’s in question is evolent. And I am trying to read, I’ve escalated that it is.
Lia Hood (26:10) Not, it is not, there are others Niccole and her team are looking at and evaluating. So that was the first one, but there are others that Niccole’s team is looking at and we’ve not received an answer back on yeah two.
Niccole Russell (26:23) Of them, we did add, I just got confirmation a few moments ago, we’re able to add palm beach pace.
Lia Hood (26:33) Notes have been.
Niccole Russell (26:33) added to the payer sheet if you want to take a look there for hope and Morgan white… does it look like we’re going to be able to do those?
Lia Hood (26:45) Those are those two are nos, the.
Niccole Russell (26:48) Morgan white, instabel? And sanus?
Lia Hood (26:53) Or sanus? And.
Mike Manson (26:57) that’s Niccole because we haven’t been able to connect with someone on their side to give us their sop. So.
Niccole Russell (27:03) Now, we have Leah sent an sop for us, but if it, the payer enrollment team advised that if it is specific to a client and not for every client, we can’t add it to the payer directory because other clients are going to want to choose that payer and they’re not going to be able to. So we’ve reached out like for evolent, we came back with questions as far as groups go. How do you enroll all groups and all tins and all providers? And so we never got an answer on that. You said you were going to take that one, the other ones like for?
Mike Manson (27:41) Hope… reached out for?
Niccole Russell (27:45) A second time, let’s see. So hope I’m sorry, hope we haven’t gotten an answer on. Morgan. White appears to be a broker and not a payer instable. Instablewell is a discount system for self pay patients and there is no enrollment. So that’s across the board maybe they do, but payer enrollment will add it to the directory.
Mike Manson (28:07) Okay.
Mike Manson (28:11) I think we’re coming up at time here. Let me summarize this internally and figure out work streams on all of this. And I think we have, do you have, are you, William and Lia? Are you both available at 11 30 on 11 30 eastern on this Friday? I?
William Moore (28:35) Most likely am not. I’ve got Thursday afternoon fairly wide openly. I don’t have your calendar pulled up, right?
Lia Hood (28:42) Now, I’ve got Thursday afternoon anytime after two 30 central. I can be available. Okay?
Mike Manson (28:49) I’m going to put a song.
William Moore (28:51) Noon and after I can be available, and then Friday is kind of the same situation anytime afternoon, I can be available.
Mike Manson (29:00) Okay. And that’s.
William Moore (29:02) noon central? Yeah. For both of us, I think I’ll I’m going to send an invite.
Mike Manson (29:08) For… three o’clock central on Thursday. Okay. We’ll do what we need to do internally. We’ll come back with what we can do and we’ll figure out a path forward and I appreciate you all bringing this to us.
Mike Manson (29:23) I think in general, you know, we want to get you started on enrolling, your new providers as soon as possible. So we’ll try and unblock that as the most urgent act, you know, action item, but we will work to give you timelines on how we can fix these other issues. Okay?
William Moore (29:41) And I’m already working to try to get time with the folks that I need to talk to. So, if I can get an answer today on the new providers, I’ll go ahead and just email this group and let you know.
Mike Manson (29:52) Okay, great. And then, Leah.
Niccole Russell (29:54) Real quick. If you don’t mind, does santas health manage travel or temporary staff?
Lia Hood (30:02) I don’t know. I’d have to go look. I don’t know the specifics.
Niccole Russell (30:05) Okay. Thank you.
Garrison Goodman (30:09) Just to Healthstream what Mike said, thanks all for bringing, you know, the constraints and challenges to our attention and we look forward to partnering with you all on a solution and finding something that makes sense.
Mike Manson (30:20) I appreciate.
Niccole Russell (30:21) It. Thanks everyone.
Garrison Goodman (30:22) Alrighty. Thanks.
Mike Manson (30:23) Y’all, talk to y’all, soon.