Transcript
Leigh Howle (00:00) hi, Annette. Can you hear me? Yes. Can you hear me? Yeah. Hi, Melody. Hey.
Annette Hong (00:14) Hello again, Melody. Have we.
Leigh Howle (00:18) met yet Annette?
Annette Hong (00:21) No, I just joined a few months ago, so I’m still slowly making my way known. It’s lovely to meet you.
Leigh Howle (00:30) You too. Yeah. Hi, Lynn.
Linh Nguyen (00:33) Hello? Hey, Melody.
Annette Hong (00:35) Lynn.
Leigh Howle (00:40) All right. So, Lynn, do you want to go ahead and take it away?
Linh Nguyen (00:45) Yes. Do we have 30 minutes of this? How do you typically split this time? Yeah.
Leigh Howle (00:52) It’s an hour long meeting. We typically go over just PE, information, go over any, I have an opsync deck that I cover, but you guys can definitely go first.
Linh Nguyen (01:04) Okay, great. Yeah. Hopefully we won’t need the full 30, but we’ll go ahead and get started, Annette, do you mind sharing?
Annette Hong (01:19) Okay. So Melody.
Linh Nguyen (01:23) We are working right now on practice location status is kind of how we’ve called it internally, but essentially, we’re going to capture active inactive and archive statuses for practice locations. So, a little bit of the context here is that we’ve noticed that there’s no way or not noticed, but we know that there’s no way to close a practice location in medallion. So, a lot of our customers have added like a prefix to the practice location name like termed this date, close this date, don’t use this location. And so we really want to address properly storing this data and representing it within medallion one more slide, please. Yeah. So what we’re going to introduce is kind of these three statuses we’ll have active, which is what, you know, practice locations as today they’re open. They’re operational inactive, meaning that they’re closed winding down potentially closed. Yeah, should no longer be available for requests and then archive, which is kind of a replacement to the deletion feature today, but preserving that data a little bit better. So it’s closed or maybe it’s a location that you accidentally created, and then it would be hidden from medallion. So we’ll kind of go over these differences, but those are the three statuses that we are thinking about right now. Any questions before switching over to Annette? Nope? Okay, cool.
Annette Hong (02:55) Amazing. Okay. So I’ll walk you through three different scenarios. The first one would be marking a practice as inactive and inactive as in it’s already closed. The closed date is in the past. So it’s already happened in that scenario, how this would work is you would navigate to either the table where you find all your practice locations or your other option is to like go directly into the practice locations profile. And then in the little menu over here, you’ll see that archive replaces the deletion. But for now, we’re just going to focus on marking as inactive. So if I want to mark this one as inactive, would go click on that. And then we will push this modal that says like, hey, once this place is inactive, this location will no longer be available to add to any new enrollment or any new service requests, but any in progress service requests would be unaffected. Those will be seen through to the end unless you go in and like manually decide not to, but those will continue as expected. And you should be able to still see this practice location and places because it is going to be part of it may be part of service requests and whatnot. And we will also give you a way to quickly see what service requests are tied to this practice location, if any. So if you click on the view requests, the idea is that we would open up a new tab and that new tab would be like the filter down view of all the service requests related to this practice location. And we’re also going to ask you to input a close date. So let’s say that this place closed in February. You mark it as inactive, then you’ll see that, the practice location will receive an inactive badge and this inactive badge will show up wherever you see that practice location. So it’ll that information will always just carry along with it. Again within the practice location will show like here’s, the close date, it’s inactive. And then any other place that you may see it. So, so if there’s any like existing enrollments in progress or you want to do like a demo, a demographic update or yeah, demographic update, you should still be able to see the practice location. But again, you’ll just see the inactive tag?
Annette Hong (05:30) Yeah. And then the second scenario I wanted to walk you through is marking a practice as inactive, but it is closing. So the close date is in the future. So same thing you go to the practice location, you click on mark inactive. But in this case, you can enter like a future date. And if you enter a future date, we’ll just push a little message that says like this location will automatically become inactive on this date. And until then this place is active, you can edit clear or whatnot. If you mark it as inactive, it’s similar to the closed or the inactive tag. We’re just showing a closing tag. It’s going to function as like a normal active practice location. It’s just that additional visual indication that, hey, a close date has been set for this location. Therefore just letting you know, keep in mind this place is closing. Awesome. And then, yeah. So the same thing. All the same places that you would see that inactive tag, it would just be a different variant of that. So it would just be like the closing we’re again going to show like the closing date and whatnot. And so that’s marking inactive in the future. And then finally, what if you want to just archive a practice with archiving, you should be able to access it the same way that you would marking as inactive. So let’s say you want to archive this health site center. In that case, we’re actually going to check if there are any in progress service requests first. And if there are, if we find any, then we’re actually just going to block you from being able to archive. We’re going to ask you to either like close them out, finish them, wait for them to be done. Basically, you need to hit zero in progress service requests in order for a practice location to be archived. And in the case that we are able to recognize that you have no in progress service requests, we just let you know, hey, like if you archive, this place is going to be hidden, it’s going to be removed from all the workflows and associations. And also, this is not, this isn’t reversible. So this cannot be undone. So purely, it’s like disappearing from the platform. But we’re retaining all the data and whatnot, it’s just hiding it from the front end. And in that scenario, we will just remove it as you can see it’s not there anymore. And by the off chance that you click into like the practice location profile URL, you can still access the page. We’re not going to be like page not found. We’re just going to very clearly mark. That, hey, this place is archived. It was archived on this date. You can look at all the information. But like none of it’s editable. It’s just like a snapshot of what it was prior to being archived. So those are the three flows. Any questions?
Melody (08:36) No, this is perfect. We’ve been wanting something like this. So this is great. This will be great. Okay.
Linh Nguyen (08:45) Amazing. Yeah. I think we wanted to just confirm or like I guess validate with you how to like what, how the inactive location should either appear or not appear for the following requests. So the way that we were thinking about for new enrollments, so as a net walkthrough any in progress enrollments would still like continue to process. But any new enrollments that are like requests that are created, you wouldn’t see the closed or inactive location in that practice location. Like in the selectable options, does that track with you?
Melody (09:28) Yeah, that’s perfect. Yeah. Okay.
Linh Nguyen (09:30) And then for demographic updates, we would let you select it in like the location removals, but you wouldn’t be able to select the closed location in the additions. Like if you want a location. Yeah. And then for revalidations, I was curious what you were thinking there are, how you would, yeah, think or expect that to work. Would you expect to see the closed locations on your revalidation requests or should those be hidden?
Melody (09:59) Those should be hidden as well. Yep. So they, yeah, otherwise I would hide them or they’ll be selected inadvertently and then they’ll be trying to revalidate a closed location. Okay? That.
Linh Nguyen (10:13) Makes sense. And then, yeah, I was curious about the distinction between archived… and inactive. What are some examples of like when you would like when your organization would archive a location versus marking it as inactive?
Melody (10:31) I think once it’s been actually closed and all services have been stopped there for over 90 days, then we would probably archive it because we know that we’re not going to need that information anymore or have to reference that or maybe even after a year’s time, sometimes we still have to go back when we’re doing our demographic updates just to reference that old location to make sure this is the old location versus the new location. If we’re relocating. So sometimes it’s nice to have that. But once it’s been past a year and everything’s been complete, then we don’t need to see that anymore. So then we would archive it just so it’s out of there and not clogging anything.
Linh Nguyen (11:11) Got it. Okay. Yeah, that’s really helpful. And then I’m also curious, I think we dropped, but no worries. I’m also curious about, I guess like reactivating, or reopening, does that ever happen with confluent where you like close a location and then later you reopen it or something like that because we hadn’t considered that as part of this?
Melody (11:36) I think it actually has happened. Okay. Actually, occasionally, I think it has not since I’ve been here but I know in the past, they have done that before where they’ve closed a location and then several years later they’ll think about reopening it depending on demand… so it could happen but it’s not something that happens regularly.
Linh Nguyen (11:58) Okay. And then I guess like what happens with the enrollments when a location is reopened, we would.
Melody (12:05) Still have to reactivate all of them because by then they’ve expired, so we would have to go through the whole re enrollment.
Linh Nguyen (12:11) Okay. So it does sound like it’s pretty rare, right? It is.
Melody (12:16) Yep. Okay. And.
Linh Nguyen (12:17) So, the way I guess like just to, you know, like something’s rare and then it pops up after we release it. So the way that we were thinking about handling that is you would just have to like create a new practice location. Essentially, there’s no way to reopen one at least like within the current scope that we were thinking. And then let me see. I’m just looking at our list of questions here to make sure we cover everything.
Linh Nguyen (12:52) Oh, I guess I wanted to confirm like when a location is inactive, the way that we were thinking about it is like all the fields that are in the profile would still be editable? So like you could change the location, like any of the information essentially in this basic info, does that resonate with you or is there any issue that you might see with allowing that… I?
Melody (13:16) Don’t think so. Once it’s inactive, I don’t think we’d probably touch it anyways. But yeah. Okay. Yeah, that makes sense in case we would have to change like an authorized official or something that would be? I don’t actually, I don’t think we even have authorized officials on that screen. So, yeah, it would be fine.
Linh Nguyen (13:36) Okay, great. Any other questions Annette do you want to talk?
Melody (13:43) About backfill?
Linh Nguyen (13:45) Yeah, I was going to wait until after if you don’t have any other ones I can talk about.
Melody (13:49) That I think we’ve I think we covered all.
Linh Nguyen (13:51) The questions, okay. Amazing. So, yeah, the last kind of question for us is around like, yeah, backfill migration of this. So we noticed that a lot of, I think there’s like 80 65 locations right now that we pulled that confluent has like closed and then like insert date before the location name we were thinking about just like as we roll this out, all these locations would continue to be active unless we like did something with that unless like you manually moved it or we could also just like automatically do it for you. So we’ll share that list with Leigh and then she can like kind of review it with you. But what we would do would essentially be removing that like closed insert date from the practice location, name, moving that date to the closed date and then marking the location as inactive for you. So it would be like 65 locations essentially that would happen to or you can like pick and choose from the list. Yeah. But yeah, we were thinking about doing that. How does that sound? Yeah.
Melody (14:49) That would be great. Yeah, if you could share the list because we were actually we and what I’ve been doing because I didn’t know, I’ve just been deleting them because they, what has been happening is that our team is putting them in for the requests. And then your team are like the PE team is doing exactly what they’re supposed to be doing, but they’re adding them right? The enrollment requests and we’re like this isn’t a location and it’s just causing a lot of whatever, but it’s because our team is putting them on the request or like if there’s like a automation, they’re getting added. So I’ve been going through and deleting them. And so if we can get the list, I can let you know which ones can just be archived versus which ones that we want to see. Yeah.
Linh Nguyen (15:24) Exactly. Yeah, that would be perfect. I’ll share that out. And then our timing for this is like end of the month. So, okay, you have, yeah, time to review the list, but we’ll we’re hoping to go live. Yeah, end of April?
Melody (15:36) Okay. Sounds great. All.
Linh Nguyen (15:38) Right. Well, thanks so much for the feedback. Melody this was, we’ll stay on until Lee comes back. Maybe she’s having computer issues. Are you here Lee?
Linh Nguyen (15:57) Are you back? Okay. Yes, I’m back. Okay, good. I think Annette and I are done. So we’ll drop from the call. Thank you so much for letting us join and get feedback. Yeah, sure. Anytime. Thank you ladies.
Melody (16:11) Appreciate it. Bye. So.
Linh Nguyen (16:11) Much.
Leigh Howle (16:14) I know my zoom was going in and out and it kept dropping and I was like, my goodness, I missed the last part of that call. But anyways, how’s your day going? Good, good. Awesome. I know there’s been a couple of escalations. So there’s definitely some fires going on over here, but we are working through it and we, I can go ahead and give you an update. I just sent an email out on the Montana medicaid group revalidation. So, oh,
Melody (16:47) yeah. Yep. I didn’t quickly review that. I have to, I’ll have to reach out to get that business license, which I will do after this call.
Leigh Howle (16:54) Okay, perfect. So I have instructions to the SME who has been making these phone calls to email Angela once the business license has been updated into the application. So everything is good to go and ask her to expedite and process in the next 24 hours, if she can’t for whatever reason we are asking for the revalidation due date to be extended, like offer a grace period due to their system issues. And so we’re just kind of, yeah. So as soon as that comes through that business license, we’ll make sure that gets expedited with the email… on really quick for Kylie for Georgia medicaid, Andy… Kyle?
Melody (17:47) Oh, yeah. I’m.
Leigh Howle (17:50) being told that Georgia medicare is requiring a CMS approval letter. Yeah. So the team is trying it’s not in her completed enrollment. I’ve already looked for that and I’m being told that Georgia medicaid does not accept the CMS medicare id report or the approved application for the provider. So we’re trying to get the actual medicare approval letter, okay?
Melody (18:26) Okay. Yeah, because I would, you guys did it. So you guys should, Bianca should probably be able to pull it?
Leigh Howle (18:39) Yep. She’s one of the first people I pinged. She’s looking to see if we can get the medicare approval letter and I’ll this was back.
Melody (18:47) Edwin’s emails and see if anything’s in there too. Cause sometimes she’ll get the letters too, cause she’s like on the application, but yeah, I’ll check it too if Bianca can’t find.
Leigh Howle (18:59) It, yeah. Okay. This was four minutes ago. So she’s oh, okay.
Melody (19:12) Back in June.
Melody (19:21) Okay.
Leigh Howle (19:23) And… for, I guess we could go ahead and go into like the recovery plan on getting the impacted lines updated. So, I met with the team yesterday… and.
Leigh Howle (20:41) I’m sorry… I’m just going to turn my camera off. Okay?
Melody (20:46) I’ll turn it off too that way you’re not just staring at me.
Leigh Howle (20:50) So, yeah. So for I met with the team yesterday and there as I mentioned in the email capacity planning to make sure that all hands are on deck to ensure that there’s enough specialists to do the QC and to make sure that the applications are correct. I think I’ll just be transparent with what I was told. There’s some back and forth as you probably guessed with the QC just making sure the application’s correct. And that’s where we’re getting the bottleneck on the applications. So I have asked for, I think if I can identify the top maybe 10 or 20 payers where this is happening, then I’m going to work with Alex and Bianca to create templates and training guides like, you know, step by step on the apps. So that would really speed that process up.
Melody (21:52) Absolutely. Yep.
Leigh Howle (21:54) So that’s yeah. So that’s one one of the resolutions I’m working on and then the other one is just, you know, I think having the applications qc’d are it’s very important and that just ensures we don’t get into that same cycle of having them go into the 150 plus timeline. So it’s just making, you know, it’s just like initially right now, ensuring that they are accurate and that it’s an efficient process.
Melody (22:28) Right. Yep. Absolutely. Yeah, I think that’s our, so those are the two things that I see that are happening now which is causing escalations on our end. Is that there’s and the two that I put on here. So I, we have an escalation track or two and two of the escalations that came through today. When I look at them, it’s there’s two things happening. One is either the app gets stuck in the QC and where it’s been requested, it gets into intake, it goes to QC. And then it gets stuck in this QC like back and forth. And then it ends up being there for almost two or three weeks and not getting submitted. And so then the brand escalates and is like, has this been submitted because they get a report as well? We have a API that runs a report that gives the updated statuses of everything. So they can see that the application hasn’t even been put into a submitted status yet. Yep. The other part is just moving the requests from a requested state just into like an intake complete, or I mean from intake complete to an assigned state. It’s like that is taking a longer period of time.
Melody (23:42) So we have a lot of lines that are running over that seven day SLA, moving into almost 14 days is what I’m seeing to even get started. And so that’s like it’s starting to get concerning because then if they do have to go into QC on top of them already being 14 days behind, we’re going to start running into some issues with our brands, at least especially with our top payers which are medicaid’s and blue cross and those types of payers.
Leigh Howle (24:13) Right. Definitely. I definitely understand just the time sensitivity and making sure the application is submitted. And so I’ll kind of keep all the blues. And I’m going to, when I did account last week and this week there were about three 30 in the QC back and forth stages. And there were 30 that were QC completed today that are supposed to get out the door. And when I looked at intake complete, I want to say there was, I don’t know maybe 30 percent of those 40 percent were intake complete. So I definitely will share this feedback with Amy and Molly, Kate, Nicole, just to make sure that there is a commitment to have the right staff in place that are experienced and trained in PE to be able to correctly populate the applications, you know, maybe going back once if that twice max, right? With QC to just to reduce this, the back and forth.
Melody (25:43) Okay.
Leigh Howle (25:46) Yeah. Okay. So work, I’m still working on that. There’s a cap I’m working on that is associated with this. So I’ll send that, you know, do the same thing that we did last time. I’ll have a slide to go over the resolution from the cap. And then I’ll update you weekly and so on Elizabeth. Aug. I did escalate both enrollments to the PE team like during the meeting when you were, when we were listening to Lynn and Annette. And then I was working on getting Warren O’Connell, sent… over as well as a priority. Okay? I have asked the PE team to have all, I think it was like three 33 40 something lines in QC and intake complete to be submitted by Friday. Okay? All.
Melody (26:49) Of it. They.
Leigh Howle (26:50) Said I did get a commitment that it would be done. So I will continue to monitor that and, you know, just make sure that they’re expediting… those applications, focusing on the blue cross, blue shields, the medicaid, and just, you know, making sure those are submitted as quickly as possible. Oh, a couple things. I added the task folder and the shared drive. I did just drop some documents in there under tasks. Okay? So I’m not sure how you wanted to set it up, but I think it would be, you know, I can share my screen. I think it would help just.
Melody (27:41) Julie.
Leigh Howle (27:41) Or whomever is working in that state to have those documents up front… and let me pull up the folder. Here we go.
Leigh Howle (28:02) I made it purple. So tasks.
Melody (28:06) I don’t see your screen if you’re sharing? Oh yeah.
Leigh Howle (28:10) Thank you.
Leigh Howle (28:16) Okay. So, under, can you see this now? Yeah. Okay. So I just called it tasks. It’s like a purple folder and it’s just kind of mixed in with like all the documents down… here at the bottom. Oh.
Melody (28:33) Okay. And,
Leigh Howle (28:34) then I called it payers just in case there’s any, you know, different types of documents that are associated with tasks. This would be like the Georgia poa, Indiana medicaid ihcp agreement. I put in the two medicare’s this is the cert statement and the CMS for 60. I also added, and I probably should pull these out, but this is just, I just made these over the years for other clients that have asked for instructions. So they’re… pretty good. And I did a step by step with screenshots on signing the platform. Okay? And then this is just Courtney in intake. She approved this authorization attestation guide just to let providers know why they have to sign and attest in the platform. And when those are required, so probably should just kind of… pull these. I mean, they’re not really payer related, but they’re really good to share with you.
Melody (29:42) Know, providers.
Leigh Howle (29:43) When they’re onboarding, okay? Failed, verify the existence,
Leigh Howle (29:55) What, Instructions for signing medallions? Well, I’ll put that one back, verify. Oh, it’s there. Thank you. Okay. Yeah, there’s I wonder where that went. Usually, it goes back to the original folder, but it didn’t do that. Yeah.
Melody (30:30) I.
Leigh Howle (30:31) don’t know. All right. And then therapy… network of Georgia April roster. Yeah, I don’t the team was asking for it and I checked my emails. I didn’t see it yet. I don’t think they’ve sent this over. Oh.
Melody (30:51) Okay. Let me reach out to her and see.
Leigh Howle (30:54) Okay. Yeah.
Melody (30:57) Let me, I’ll just email Sharon and see if they’ve sent it.
Leigh Howle (31:01) Okay. Thank.
Melody (31:02) You, yeah.
Leigh Howle (31:03) And the team checked the inbox, Alex did, and he didn’t see it. Okay. Bianca is on the call with medicare right now.
Melody (31:13) Oh, good. So.
Leigh Howle (31:14) She should be able to get that.
Leigh Howle (31:22) Usually, they can email it. I don’t know how long it takes if there is a delay. I will just send you an email and let you know.
Melody (31:32) Okay.
Leigh Howle (31:33) And then, was there anything else that you wanted to go over on the agenda? No, that’s all okay. On the opsync deck. Oh, sign me up.
Leigh Howle (32:02) So the outstanding enrollments continue to go down. There was a decrease in 124 from last week. So it is at 710, which is almost 50 percent of where we started out with, this push to get these done. So need to change gears to go to the submission piece of it. Now, the intake complete QC. Now that I feel like the team’s definitely processing these enrollments and getting these completed… there were, there was an increase in the client attention the tasks. So it went up by 100 on that. Not sure what if there were, if there were an increase in requests over the last week, that could be where these got triggered from.
Melody (33:01) Okay. Yeah, we can take a look. Yeah.
Leigh Howle (33:05) We’ll have a slide coming up that’ll give us the numbers on how many requests came in tricare west. These were reviewed. And I do have the results of that review. I want to say there were like 77 that had to be resubmitted and maybe… 20 were correctly in process. So I don’t know if it is connected to that humana email. I don’t even know where that came from. So that got reaped. So this is good. These are correctly processing moving in the right direction. Now, the team will just go down the list. Amerihealth, caritas, Indiana will be next up, okay? And completed versus open enrollment. There were 165 open. As of 329 and 33 of those were completed. Here are the requests. So yeah, it looks like there was a decrease in the request, but 330 did pass and take complete and the team has a submission of two 38 with enrollments completed of 321. Okay?
Leigh Howle (34:39) Priority lines there’s 200. So there has been a jump in the priority lines last week. It was 146. I did confirm with Alex when there are priority lines, they do get bumped up to the top of the queue. So when the specialists go to work, their queues, these lines are like flagged as needing submission. Okay, got it. And credentialing, there were two requests, 119 completed and 28 ready.
Leigh Howle (35:22) On the follow up, there are 1,337 lines that are current with payers. There are 172 lines that are overdue for follow up and 493 requests that are due this week.
Melody (35:41) Oh, that’s what I had a question. Just think when it said credentialing when it is in the, when it’s in the ready bucket, do we, when there’s actions, do we have to select the send to clean files or how does that get sent over to the committee for review?
Leigh Howle (36:04) I mean, yeah, you guys do send it, we.
Melody (36:08) Send it. Okay. Julie’s on vacation. So we just have a lot in here and I was like, wait, usually, I just go into the committee and vote. So I’m like, I think I have to do something.
Leigh Howle (36:17) Yeah.
Melody (36:21) Okay.
Leigh Howle (36:22) Thank you. Sure. Yeah, I saw her out of office. So for… the roster follow up, there are 929 current and there are 20 that are overdue. Okay? And I do go over these weekly with the team. I meet with them Tuesday Thursday and I do surface this… April had 375 completion. So far. March ended the month with 1,243.
Leigh Howle (37:06) And that was the end of the deck. Okay?
Leigh Howle (37:16) All right. So, that was all that I had. I didn’t payer names. So really… good news. The payer names were imported.
Leigh Howle (37:30) Everything has been done from TSM as far as like initial pass. All of the lines were the payer names. You’ve probably already noticed that they’ve gotten updated. Yeah, there were, I think he said there was like a 1,000 that were just kind of outliers that we, I’m working with the TSM on identifying, you know, some, just the state was missing in the directory and I had flagged all of those as I came across them. So I just need to circle back with the directory team and just say, hey, can you just, can you add the state and, you know, just let me know when it’s done. And then we’ll he’ll go back and rerun those so that they do get added. But we’re just kind of working finishing out those last part pieces on it. Hope to have that finished by this Friday. Okay?
Melody (38:22) Awesome. And on.
Leigh Howle (38:28) The medallion review. So, I still check in on it, but there hasn’t been any added in a while. Let me see where the last date is. Where’s the data… issue start date that can’t be right? I’d probably say three four.
Melody (38:54) Yeah, I think Juwan probably is the only we’ve told him to try to do the support tickets as much as possible. So hopefully there’s not too many coming over on that.
Leigh Howle (39:07) Okay. That’s good. Yeah. And if you guys still get the error, just feel free to loop me in on whatever action is needed and I’ll get it going in the right direction. Okay. All right. Awesome. Well, I hope you have a great rest of your day. I appreciate your time.
Melody (39:30) Thank you too all.
Leigh Howle (39:32) Right. Thanks, Melody. All right. Bye bye.