Transcript
Mike Manson (00:00) hey, Niccole.
Niccole Russell (00:01) Hi, Mike. How are you?
Mike Manson (00:03) Doing well. How are you doing? I’m.
Niccole Russell (00:04) doing great. Thank you.
Mike Manson (00:10) Did you have an Easter celebration this weekend?
Niccole Russell (00:14) Yes, we did. It was busy. Did you have a good Easter? I?
Mike Manson (00:22) Did, yeah. I’m in Boston… that’s where I’m based out of, but my brother is in Connecticut. I’ve got a niece and a nephew, so we made the trip out to them and had an Easter egg hunt and good food. It was good.
Niccole Russell (00:37) Good, good.
Naomi Denson (00:50) Hello? Hey.
Mike Manson (00:51) Naomi?
Naomi Denson (00:52) Hello? Let’s see. Lia and Shirley are here.
Naomi Denson (01:14) Hello? Good morning. How’s everyone doing?
ShirleyHooker (01:19) Good. Perfect. All right. Well.
Naomi Denson (01:23) Let’s jump in. All right. Wanted to first check in. Have you guys had a chance to review the final version of the provider invite to sign off on that?
Lia Hood (01:37) That’s part of what we’ll talk about in our call this afternoon? Okay? Perfect.
Naomi Denson (01:45) Okay. And then the data imports and blitz, Shirley, we have the group existing enrollments and that is pinning the finalized payer mapping. Are there any updates on that from either you, Niccole or the Lia or Shirley on getting that wrapped up? I.
ShirleyHooker (02:04) Believe, I have two. I believe there was like two of them left. So, after this call, I’ll take a review and send you an email. Okay? I believe there was just like two or three of them and.
Lia Hood (02:17) Those are from what have been sent over for us to look at, right there were.
Naomi Denson (02:21) There were.
Lia Hood (02:22) Last last time we met, there were still several that Niccole and her team were going to review.
Niccole Russell (02:30) Yeah, yes. And as far as evolent goes, I think Mike is working on that.
Mike Manson (02:36) Yeah. I have a meeting with my leadership team tomorrow actually to see like, what is possible there. And I’ll have an update for you. Okay? You know, probably by tomorrow afternoon.
Naomi Denson (02:49) Okay, perfect. The caqh bulk imports for the ones that had failed.
Naomi Denson (02:56) Now we are sitting at only five that were failed. I did see that three of them that the caqh imports did not work, have been being manually worked. So, I don’t know if we want to continue monitoring those to re, syncs. One of two of them are at 82 percent. One of them’s at 42 percent. But like I mentioned, I don’t want to re, I don’t want to try to keep syncing those if, and accidentally undo anything that you guys are working on…
ShirleyHooker (03:27) Yeah, we haven’t been able to get into the provider caqh, we’ve reached out to them. It’s like they might have updated their user, their password on those and those that was notated on that sheet there that, yeah.
Naomi Denson (03:42) Okay. And then the, yeah, and then the two, these two have had no manual changes. So we can still continue to monitor those. I just with the ones that have been your teams have been working. I don’t want to overwrite anything. So these two would be the ones that we continue to watch. And I think they were just social security number mismatches.
ShirleyHooker (04:02) Correct. Yes. And we’ve reached out to the provider to have them call caqh to get that corrected. Okay? Perfect.
Naomi Denson (04:10) And then we’re still working through payor process, scoping payor mapping… outside of the two that Shirley has to review, Niccole. And then the evolent, are there any more payors outstanding that?
Lia Hood (04:25) We are.
Naomi Denson (04:27) anticipating updates or answers from, the upside?
Niccole Russell (04:39) Confirmed. Except for the few that we’re reviewing. Yeah, except for the few that we’re reviewing in the evolent one. Okay. I think there are three I want to say, yeah.
Naomi Denson (04:51) Okay. All right. Perfect. And then, so that’s for the, once we have all of that finalized, we have the group existing enrollments to load. Once we can get those mapped KP. Have you had a chance to look at those any further and have any questions yet?
Kunal Parwani (05:09) For the group enrollments? Yes. Yeah, I did take a look, I think it should be fine. Okay, once.
Naomi Denson (05:15) We have the mapping done.
Kunal Parwani (05:16) Yeah. Once we have the mapping, that should be good. The practices did have the prefix for the abbreviations in the parentheses, but that’s fine. I can remove those and import. Other than that. It looked good.
Naomi Denson (05:29) All right, perfect. And then any update, Shirley on the existing provider enrollments?
ShirleyHooker (05:36) No… no updates on that, but I do have some other questions though. I don’t know if Leah wants to ask about it regarding caqh though, but, yeah, okay.
Lia Hood (05:52) So, Shirley… go ahead and ask, and then I ultimately, I have a question to understand, okay? When we can give you new providers to start working because this, Shirley has like 10 onboarding providers that we’re holding and I can’t hold them much longer to try to get this work done. So, I need to, I’m, trying to understand at what point can we work new, invite new providers? And can we, you know, can we invite the providers and then start the enrollment with the approved payers that we have, or do we have to wait until the entire list is quote approved?
Naomi Denson (06:36) That’s where I’m.
Lia Hood (06:38) at, yeah.
Naomi Denson (06:39) So you can go ahead if you have not already invite the new providers to medallion to start completing their profiles. KP. Can we go ahead and load the existing group enrollments for the payer mappings that are complete? Yeah. So just the confirmed ones, right? Yes. Yeah, I could do that. Let’s hold off on doing that until Shirley reviews those other two. She’s going to send us an email after the call when she’s reviewed those. And just in case they get confirmed and we can have two more. And then we’d just be waiting on evolent. Yeah. So.
Lia Hood (07:14) It’ll be pending evolent and the others that are outstanding that Niccole’s team is working on.
Naomi Denson (07:22) Correct. Yeah. So any, we just typically like to have the existing group enrollments loaded before we start with new provider enrollments, since that can be a prerequisite or a blocker for us to know. And we don’t want to have to go back and forth and say, hey, do you have this existing enrollment? So we can load the ones that have been confirmed and mapped and approved already for those groups. And then you can start with those payers for those new providers. Is it still nine? Yeah, nine new providers?
ShirleyHooker (07:52) Yes, 10. It’s.
Lia Hood (07:53) 10 actually, it’s 10. Okay.
Naomi Denson (07:57) And then you’ll be requesting them for all of the payers that have been mapped or will it vary?
ShirleyHooker (08:01) It’ll vary by their location. And so what I’ll do is I’ll go into the payers and select request on the ones that are applicable for those?
Naomi Denson (08:11) Okay. And we can give the team a heads up on the 10 new providers that will be, that will be coming in, to start net new work after we get the existing enrollments loaded. So we will go officially live with pay enrollment there.
Lia Hood (08:29) And Shirley before please don’t submit or do the invites until you hear a final, from me. Yes.
ShirleyHooker (08:40) Got it. Thank you. The question that I have real quick while we’re on providers is yesterday afternoon, we received see the new cois for our providers where the professional liability policy expires this coming Sunday. And so myself as well as my team are loading those cois in medallion right now under the payor, we’re uploading the documents and uploading updating the malpractice information, updating the expiration date and uploading the face sheet. Okay. And it’s my understanding is that your caqh team was going to be updating caqh with that information. So, you know, I’ve just been getting a lot of requests because the Coi, you know, the caqh needs to be updated,
Naomi Denson (09:44) Have you enabled the provider? So I think we had talked before, so our caqh team is not going to make any updates or changes until the providers are invited have signed their agreements and they’ve been enabled for caqh management in the platform.
Lia Hood (09:59) Okay. Surely that surely we may have to do that work?
Naomi Denson (10:04) Okay. Yes. So they have to be invited.
ShirleyHooker (10:08) Okay.
Lia Hood (10:09) Because that process has not occurred, right? I just realized that when Naomi said it, it’s still going to need to be updated in medallion system, but we’re also going to have to do it in caqh because of timing. And this year reason is that there’s no way that whole process is going to happen within the next three days. When that policy expires or four or five days, I think it’s five days.
ShirleyHooker (10:40) Okay. Thank you. What?
Lia Hood (10:43) I would suggest is let’s pause on medallion and flip over to caqh.
ShirleyHooker (10:51) Okay.
Naomi Denson (10:54) All right. Any other updates or changes? I know we’re last time we didn’t have any updates on need for hospital applications or privileging… anything changed there yet? Or we’re still just focused primarily on enrollment right now?
Lia Hood (11:10) Yeah, we’re still focused on enrollment right now. Okay?
Naomi Denson (11:15) Any other new updates or questions for me?
Lia Hood (11:21) Shirley, did you want to walk through a couple of the examples we found where there were the discrepancies with caqh?
ShirleyHooker (11:29) Yes, I sure can.
Lia Hood (11:31) So, Naomi, when our team has our team’s been working to do some do updates in medallion system and we, they… have, I have asked them to kind of identify where there was information in caqh that was not imported into medallion system. And so that’s Naomi, I’m sorry, Shirley’s team grabbed some screenshots. So I’d like her to walk through those so that we can kind of talk through what may have occurred and why that, why the information didn’t get pulled over?
Naomi Denson (12:06) Okay. Yeah, Shirley, if you want to share your screen, we can walk through those.
ShirleyHooker (12:11) Okay. Yes, just one moment, please. I’m pulling it up here.
ShirleyHooker (12:22) Okay. Where did my share button go there? It is.
ShirleyHooker (12:38) Okay. So can you see my?
Naomi Denson (12:40) Screen? Not seeing your screen yet, Shirley?
ShirleyHooker (12:42) You’re not seeing it yet?
Naomi Denson (12:43) No, with zoom. Got it.
ShirleyHooker (12:47) Got it. Okay. So probably the most important parts of these that I’m noticing that has not been coming through is like the specialties, but like ethnicity, I’m seeing some where the ethnicity is, you know, saying or not to say it’s coming through under the race but not the ethnicity part of it. Okay. Down here, these are the ones that I will going further down are important as well. Is the primary specialty under professional information. The primary specialty is not coming over, whereas primary specialty in caqh is listed here as the internal medicine. Okay? And the provider being board certified with that information as well?
Naomi Denson (13:49) Okay. Let me see… which one was that board certification? Which provider was that?
ShirleyHooker (13:58) Emilio, last name is Emilio. MIN o.
ShirleyHooker (14:06) Let’s see… and like here’s another example of some bigger ones being hospital affiliations. Three hospital affiliation, hospital are in caqh, but only one hospital affiliations for that provider as well. The professional references are not coming over where they’re anywhere from three to six are listed in professional references in caqh and they are blank in medallion.
Naomi Denson (14:53) Okay.
ShirleyHooker (14:56) Ecfmg information not coming over. Okay?
ShirleyHooker (15:05) Certification regarding the board certs certification date is listed in caqh but it’s not populating under board and specialty… and I can, we can get this sent over too.
Naomi Denson (15:20) Yeah. If you’ll share this with me.
ShirleyHooker (15:22) Sure, primary email address, they’re all coming up duplicate with the provider’s email address for sunstate listed for their email address and public email address. But under, in caqh, under primary email address, it is the, this one here was an example of credentialing or credential email listed as the primary and it’s not listed over here.
Naomi Denson (15:54) So, the contact information on the medallion site, on this one, the email that’s their medallion… user email, the, let me see Marshall… that the contact information, their primary email address see. So that is coming over into their credentialing contacts tab. And I see the credentialing SMS at oneoncology com loaded to their credentialing contact.
ShirleyHooker (16:33) And it’s listing the provider’s name. I’ll let me go back. Let me scroll down because that one’s in here. The credentialing contact, it’s coming over as the provider’s name instead of the, I know it’s in here. It’s coming over because we were just talking about that, the credentialing one. So I apologize.
ShirleyHooker (17:02) Here it is. The credential here’s. An example of the credentialing information for Marshall. So under credentialing contacts in medallion, it has the provider’s first name and our credentialing SMS. And the fax number is like not formatted this way. But over in caqh, the credentialing contact is credentialing department and our SMS information here.
ShirleyHooker (17:32) And yes as the primary contact. So instead of credentialing department, it’s coming over as the provider’s first name on all of them. Even if my name was listed here, it’s coming across as the provider’s okay?
William Moore (17:49) Is this normal for your imports? I mean to be completely honest with you, I’m a little surprised that there are this many data discrepancies and challenges with pulling from caqh which was, you know, one of the most, the biggest value drivers. And so I’m a little dismayed to see that there are this many pages of issues.
Naomi Denson (18:10) Yeah. The credentialing… contact coming over as the provider name is one that I’ve heard of before… the certifications without the certification number, when it’s populated in caqh. I’ve not had that one brought to my attention before. There are some nuances with the integration. There. Not everything that’s in caqh is mapped to come over because of it being formatted differently in caqh than it is in medallion. And the integration not aligning is my understanding. I do actually have an open ticket to get a full list of everything that is included in the caqh imports that I need to follow up on to see if that’s been put together yet. KP, I know you and the TSM team have been flagged on that previously before too. Have you seen where we received that list yet? I can check, I don’t think so. But I can check. Okay?
ShirleyHooker (19:22) So, reference, yeah, go ahead. Sorry, we.
William Moore (19:26) Can’t re import at this point, but… whose responsibility is it to go clean this up? If we can’t get kind of a one to one match for what’s in caqh over into the medallion platform? Where does that responsibility fall?
Naomi Denson (19:44) Typically, with the admins or providers to review the profiles and make any changes that need to be updated for accuracy?
William Moore (19:54) Okay. That information just sticking a pin in that is going to be very important into the conversation we have later this afternoon.
Mike Manson (20:04) Yeah. I hear you loud and clear, William. I mean, I will say, you know, Naomi and I worked with spring health which I think I mentioned before with 12,000 providers and we didn’t you know, we didn’t have the same issue. So it could be something that changed on the caqh side, but I can do some digging and try and, you know, take this feedback to Leah walshberg, our chief product officer, make sure that she’s aware of it and see if we can get a fix implemented.
William Moore (20:31) Thanks, Mike. Yeah, I gotcha. We again, we can just kind of pick this up again later on. There’s going to be a lot more to the conversation and to some of the challenges we’re going to face. So there are some headwinds that are starting to blow our way, but I’ll let Shirley pick back up for now and kind of get back through the more technical side of.
ShirleyHooker (20:55) It… got it. The references were a big thing as well too. Some providers have anywhere from, you know, the minimum being three to five professional references. Those are not coming over. That was the credentialing contacts… existing payers. It is, this information here on the existing payers portion, right here is the provider’s main medicare number. It’s not necessarily associated to this practice. This is their main medicare number.
Naomi Denson (21:38) I have a ticket open for this as well that I’ve escalated to stop pulling that in because there’s no way to tell that it is related to you. All… that piece I have addressed internally already and have our technical teams looking into, on if we can stop importing those and having your feedback here that it is irrelevant and not useful to you would be, would help push.
Lia Hood (22:11) That along, but hang on. It is helpful for us to load medicare and medicaid numbers in the system that.
Naomi Denson (22:18) Are applicable?
Lia Hood (22:19) To our practice, that is important information to track in medallion.
ShirleyHooker (22:25) Right. But in caqh,
Naomi Denson (22:27) there’s no way in caqh, the providers are not able to indicate if it is tied to your organization or not. So that’s where it comes in with the existing import template that we’re doing so that we can show the association. So other existing enrollments when they’re imported or when they’re added to medallion, it’s going to show the group information, the practice locations associated. And all of that with the way it comes in from caqh. It just says medicaid Florida here’s their provider id. So there’s no way for our teams or your teams to know that it belongs to you and is associated to you in any way. So.
ShirleyHooker (23:08) Yes. And this one here, it’s pulling the one on the bottom. You would think that it would pull the first one here, the five Z, but it’s pulling that one.
Lia Hood (23:19) Yeah. And so what Shirley’s noting is that there are two medicare ptans loaded in caqh and only one was imported.
Naomi Denson (23:32) Which provider is that?
ShirleyHooker (23:37) It’s same provider. What was it?
ShirleyHooker (23:41) yes, I believe this one is Marshall. Yes. Okay.
Naomi Denson (23:58) I’m just looking… so he has two, but only one is coming over. Okay?
ShirleyHooker (24:15) And there’s a, you know, there’s still other things. I scrolled all the way down to get to the credentialing context because we were on that. So I understand about the linking between the provider’s licenses and the document itself. When the team is, when we are uploading under existing licenses even though there’s already a license in the document file… it’s clearing out the license jurisdiction. We have to re, select Florida and USA every time right here.
ShirleyHooker (25:03) And the same for like the Dea as well too.
Naomi Denson (25:08) That’s when you go in to upload the file.
ShirleyHooker (25:11) Yes, under existing licenses where it shows that it’s missing even though it’s technically not missing because it’s listed in the document section. So you pretty much have to upload the document twice once in the existing license section. And it’s also uploaded down here into the document section. So if it comes across on caqh, you still have to download it and upload it under existing licenses. Yeah, because I understand what you were saying about it not linking over. It just seems like that’s just a double having to double work. It is, it is Shirley?
Mike Manson (25:54) Can you share this document with us so we can take it back to our team? Yeah.
ShirleyHooker (26:00) You bet board certification information being missing. It’s showing initiation date and expiration date and over in caqh, it’s listed and it didn’t populate over here.
Naomi Denson (26:18) Okay. Yeah. This document will definitely be helpful to call out. Yeah.
ShirleyHooker (26:24) And definitely, the, you know, what was a bit concerning to be honest, was the hospital affiliations for this provider to have so many active hospital affiliations listed in caqh here. And only one of them pulling over, you know, some of our providers have so many hospital affiliations. And in order to get this accurate, good data in good data out, we would need to go in and edit and grab all this information and manually enter all of this in under hospital affiliations especially when we needed, we need reports on providers and who and what their hospital affiliations are, which is extremely important on our end.
Mike Manson (27:19) I want to make sure we get this to Leia.
Naomi Denson (27:24) Yes.
Mike Manson (27:26) Leia is our chief product officer… so.
ShirleyHooker (27:33) Yes, I can get all this information over for you as well too. Oh, yeah. Another one that I felt was extremely important as well. Was that, employment details, my understanding that being the provider’s work history, when we have multiple instances of a provider’s employment records, it’s not populating correctly under employment details work.
Naomi Denson (28:02) History would go under their professional history tab… in medallion. So the employment details is employment details as it relates to you. Are they a full time employee? Are they contracted, what’s their employee id? The screen that you’re looking at, I think is under professional info, but there’s another tab there, professional history that shows education, training, work history.
Kunal Parwani (28:31) Yeah. I just checked the work history for this provider. I do see some of the ones that you showed in the screenshot populated there. So Genesis care, 20 first century oncology, holy cross hospital.
ShirleyHooker (28:46) Okay. I.
Kunal Parwani (28:47) see all of them there. Yeah. So it’s a different section.
ShirleyHooker (28:50) Okay. I will note that when I send this out, send this over regarding?
Naomi Denson (28:56) That section. Yeah, this is very helpful. There are some things on here that have been flagged to me before, which is why I have some open tickets already to get a full visual on the imports and what comes over and what does not, and why, and all of that.
Naomi Denson (29:19) But I think this will be really helpful for our teams to look into and be able to provide an answer on us. And like Mike said, we’ll escalate this to our.
ShirleyHooker (29:29) Taliyah. And when we’re trying to get the provider’s profiles up over that threshold of, you know, 85, 86 percent, you know, some of these instances affect that. So they’re having to, you know, just go through and put the simple things that didn’t come over from caqh to get that up over that threshold of the percentage being completed, you know, yes, I totally.
Naomi Denson (30:02) Understand.
ShirleyHooker (30:04) So we’re working to get these profiles up over that threshold that they can be unblocked from payer enrollment even though, you know, yes, these are legacy providers absolutely.
ShirleyHooker (30:19) But… I just feel like we’re you know, my team and myself, we’re having to enter in so much missing information in order to get it over to be an acceptable 85 percent complete on the medallion side that’s just where I’m at with it.
Naomi Denson (30:43) Yes, absolutely. And I appreciate you putting this level of detail together and understand, you know, exactly where you’re coming from. So we will make sure that this is raised and addressed to try to get some, you know, appropriate feedback and solutions for you.
ShirleyHooker (31:03) And can you still see my screen here for medallion here? I can. Okay. So I want to just make sure that this one part here is clear real quick before I let you all go. So when I’m coming down here to malpractice insurance for, we are coming down here to the, in our policy and selecting edit, updating the expiration date and uploading the new face sheet here.
Naomi Denson (31:38) That is what you are doing. So typically, with the malpractice insurance, it’s asking. So you would add a whole new record so that you have the historical information… of the malpractice history for payers that require, you know, like 10 years of liability… insurance… coverage, like the history record. So typically, what we see is it just flags it as expired now. And then we have the new record added for the current.
ShirleyHooker (32:07) Doi. Okay. So.
Naomi Denson (32:09) You do the add malpractice insurance right up at the top there? Okay?
ShirleyHooker (32:13) All right. So I’ll have my team stop because it’s the same policy and everything with the effective date and the retro. Okay? So I’ll have them stop and we’ll have to go back and re, add that line then. Okay. All right. That is all that I have. All right.
Naomi Denson (32:35) Thank you so much, Shirley and I will look out for that document to be shared over. Yeah.
Mike Manson (32:40) We’ll work on getting updates. And when you can expect some of these fixes ASAP, I want to make it a better experience for you.
ShirleyHooker (32:50) Thank you. I appreciate it.