Transcript
Sheena L. Swihart (00:00) blue? Hello?
Rae Tompkins (00:09) Please? Everyone.
Sheena L. Swihart (00:15) Doing okay. Still battling snow up here? Yay.
Merritt Miller (00:19) We.
Rae Tompkins (00:20) had a good spell of 80, and we dropped back to 65 and I think it’s cold, so I feel bad for saying that when.
Valerie Lewis (00:27) You have snow.
Rae Tompkins (00:30) Not quite the same.
Rae Tompkins (00:38) Sheena, where are you? Again? I?
Sheena L. Swihart (00:39) Am in northern Michigan? Oh, yeah, I am. Yeah, I’m 30 Miles south of the upper peninsula. So… yeah, it’s kind.
Rae Tompkins (00:50) Of yeah.
Sheena L. Swihart (00:53) This has been the worst winter since we moved here.
Rae Tompkins (00:58) You never know what the weather’s gonna do.
Sheena L. Swihart (01:00) No, absolutely not.
Rae Tompkins (01:03) Do you enjoy the snow at least?
Sheena L. Swihart (01:05) No, absolutely not.
Valerie Lewis (01:07) No,
Sheena L. Swihart (01:09) I’m not a winter person at all. See.
Rae Tompkins (01:12) I think I would do very well in a colder climate. I am not a fan of heat and I think I live in the wrong place.
Rae Tompkins (01:25) Alrighty. I think we are, is Sherry able to join today?
Sheena L. Swihart (01:33) She is out today? Okay? Perfect.
Rae Tompkins (01:36) We can go ahead and get started. Wanted to just remind the caresource team of the July recred universe. If we can get that sent over to us as soon as possible, just so that we can minimize the amount of incomplete files.
Valerie Lewis (01:51) Yeah. So, to minimize because we’re behind on sending it to you, we’re going to extend the date that you have to return it to us. And so, I’m going to give you until… seven five, right? On seven five. If you can return everything back to us that hasn’t been done on that, that’s after the holiday on that day, that’ll be great. I know we’re delayed in getting it to you just to kind of make sure that you get the, enough time right? To outreach and do all of those things to those providers. Okay?
Rae Tompkins (02:26) Perfect. Do you know when we should expect to receive it? Just so our team can kind of prepare once we receive it, we’ll kind of jump right in.
Valerie Lewis (02:35) Yeah. So Sheena and I have been working on it every day even over the weekend for the last five days and just when we’re about to send it, Sheena finds something that’s wrong. So then we have to kind of go back, right? So I think we’ve pretty much fixed everything that was on there to make sure that all of the cred contacts are listed. There’s an address, nothing to kick it out. And then we are combing through those licenses, right? So those aren’t the delay either in getting it back. So, Sheena, do, you know, I want to burn the whole thing and start again, but do you want to, do you have, do you have an etc?
Sheena L. Swihart (03:22) By the end of the week?
Rae Tompkins (03:28) Perfect. Yeah. Well, as soon as we get it, we’ll start processing. We’ll plan to return by seven five, and I’ll follow up to any questions we may have internally. I appreciate the update. Perfect. Wanted to get some clarification val on the fsmb that was referenced on our last call. We just want to make sure we understand the ask in regards to utilizing the fsmb for licenses on the caresource side. I.
Valerie Lewis (04:00) Was just wondering if you use the fsmb to capture all of the licenses up front. So when you do initial and re credit because you’re sending all of those licenses back to us, we’re importing those into our credentialing system. And then we’re able to monitor them for that point. But because we’re not credentialing these providers or identifying all of the licenses that they’re with. We were just wondering how we would be able to get that into our system so we can monitor from month to month without having to run the fsmb. That’s the only way I was just asking, how are you capturing up front? All of the providers licenses that they are with? Is it only what’s listed on their caqh, or, but my question or do you run an fsmb at initial and re cred to identify all the licenses so we can monitor them so you can monitor them all. But if you do capture that at initial and re cred, then you’re sending those back to us on the CDT, and we’re importing them as well into our credentialing system for us to monitor, right? So that’s where the fsmb question came from. Okay?
Merritt Miller (05:11) Yeah. I’m happy to take that one. Val, that’s helpful clarification. We take in the license information from caqh, then we verify that directly with each state licensing source. So we don’t pull fsmb for that data. Okay?
Valerie Lewis (05:31) Okay. But you do pull sfmb data, right? And if so, when, during what cycle we?
Merritt Miller (05:41) Don’t use fsmb as a source for licenses?
Valerie Lewis (05:47) Okay. Alrighty. Thank you. Thank.
Rae Tompkins (05:52) You for clarifying that. We just wanted to make sure we understood the ask, so.
Valerie Lewis (05:57) Another, quick question. Yeah, quick question. So, because we’re only sending you the… licenses that, so we’d have to talk about licenses, right? And what we’re going to get back because this is going to be an ncqa requirement that we’re going to have to monitor them, right? And so if we’re only sending you the licenses that the provider practice… or the contiguous state, what are you sending back to us? Just those two license verifications? Or are you sending back all licenses on the caqh?
Merritt Miller (06:37) Niko, keep me honest, but we will send back everything that comes over on the credit application. So, caqh, we will verify that and return it to you.
Valerie Lewis (06:47) Okay. All right. But then something is going in your system that if they’re missing or it’s an expired, you’re not outreaching for a license that the provider’s not by or working in per SE, correct? The?
Merritt Miller (07:00) Only time that happens is kind of the known issue right now of us looking for the state tied to the request?
Valerie Lewis (07:08) Okay. Yep. As long as we get all the, okay. Okay. So we get all licenses back. All right? That’s that’s… Nico, can you confirm you’re sending back share? You know, do you know if we’re getting back all licenses? I know we’re getting back a big packet.
Niko Byron (07:21) You should be getting back all licenses.
Valerie Lewis (07:23) Okay. In the CDT, not just on the PDFS, right? Okay. All righty. That works.
Niko Byron (07:30) Except for expired licenses, I think in some of the files where you don’t want those, but, yeah.
Valerie Lewis (07:40) Yeah. Okay. Let me, we’ll circle back to the expired licenses because it could be that they just expired yesterday, right? And then I would need them back or this month and then they renew, then, yeah, we’ll talk about that later though.
Niko Byron (07:53) Yeah, I’d have to look at the logic on what we did. I think we agreed on what’s going on and it’s a little complex, but yeah. Okay. Thank you. Alrighty.
Rae Tompkins (08:06) The next thing is specialties, our team is reviewing the caresource imported specialty document that was provided to us versus what’s in the medallion platform. Currently, there are quite a few that obviously are already in our platform, but there are some that we’re kind of investigating internally to either add or work with caresource to kind of come to a more stable specialty to map to.
Valerie Lewis (08:31) Nico.
Rae Tompkins (08:32) Did you have anything you wanted to add there?
Niko Byron (08:33) Yeah. I was wondering if we wanted to go over, this is a working document. So don’t necessarily judge everything that’s on here just yet, but I wanted to go over a few things that are I’m about to share my screen if that’s okay that we’re working through and that we’re noticing as like a potential issue or something we just, I think need to talk through. But so this is the thing I think was it Sherry or Sheena, you and I were working on this together. Like I sent the list of all of our specialties. And then you crosswalked it to this column C and then you had your full list of specialties here. Nope. That would have been Sherry. Okay. Sherry, I made another sheet here that’s like the unmapped ones. So basically all the ones that weren’t you know, listed here in column C that weren’t crosswalked from this larger list of the caresource specialties. And I’m just going through them all and trying to kind of take a closer look and how we can get that. Like what specialties I guess we need to make in our platform at the end of the day is what it comes down to. And for some of these, I have a few examples we can talk about. We have a concept in medallion called like profession. And then we also have specialty. And so for some of these, it looks like the caresource specialty is kind of a combination of the profession and the specialty. So an example here would be this nurse practitioner, certified nurse practitioner, mental health. We have the nurse practitioner profession. And then we also have a mental health specialty. And so I’m just trying to think of the easiest way like it’s gonna be hard to just maybe this is the way to just keep like a constant running map to know what everything maps to from the caresource specialty side on our side. And then split it out and the proper things to get mapped. But maybe that is the best option. But yeah, I guess. And then I was also noticing there were some, there were a few that were a little bit like duplicated. I’ll see if I can find a couple examples in here. Yeah, like we have this like internal medicine dash and the unmapped ones. But then we have internal medicine without the dash over here… and we.
Valerie Lewis (10:48) have, so, you could delete one of those because it’s what you’re sending, what we’re sending you and what you’re sending back to us so you can remove the dupes, right? So we will send you… like would we receive?
Niko Byron (11:00) The.
Valerie Lewis (11:00) dupes, you would receive those with the dash because the team is just picking.
Niko Byron (11:05) Yeah. So we would have to still map them. Yeah. But I.
Valerie Lewis (11:08) got a question maybe for you, Meredith on the nurse pracs, you… don’t put the nurse pracs in specific to what… they’re doing, like the specification of the nurse prac, especially by the board certifications. You just put them in your system as nurse prac. I.
Merritt Miller (11:33) believe we have a like we have this certification that they hold and then kind of like a taxonomy section, but we don’t currently support this kind of specialty field and then credentialing to it. And, and that’s where Nico and I are trying to figure out like we are very game to support this for you. All. I think we’re just trying to figure out how to get the correct data to the operations team to credential to.
Valerie Lewis (11:57) And.
Niko Byron (11:58) so, I think what it comes down to is that these are, yeah, like I said, some of them are a combination of what we would call profession and what we would call specialty. Some of them are just the specialty and some of them are just the profession in some cases. And so I.
Valerie Lewis (12:15) guess what?
Niko Byron (12:16) I’m currently thinking and let me know if this makes sense. Is that like we, hopefully… this wouldn’t need to be maintained, but we, in our integration side of things where I am doing the automation like maintain a map of this stuff of like caresource to what provider, what specialty and profession it would come out to be. And then when I am ingesting a given file, I go to that map. I see, let’s say, I see, you know, this one certified nurse practitioner, mental health comes over as the caresource specialty. I know then to create the provider profile with nurse practitioner as a profession, mental health as a specialty? Okay? So.
Valerie Lewis (12:55) Should we clean this up to remove the ones we don’t cred, so you don’t be spinning your wheels to try to figure out what specialty when we know we’re not going to send that over? Yeah.
Niko Byron (13:02) That’d be great. I can make sure because I was cleaning this up right before this meeting too. So let me take another hour or two. I can get it to you by the end of the day and yeah, you can at least take a look because some of these also like, I’m being a little liberal with like I have this suggested specialty mapping that might not be right? And maybe we can add another column that’s like unacceptable for that or something along those lines too. So then we can know like, okay, there’s truly nothing in our platform that represents this and we need to figure that out. Basically it could.
Valerie Lewis (13:31) be something you should create. So, yeah, so you do your part, send it back and then we’ll just take one final look and remove the specialties. Like we’ll never credential anyone for aeromed. We won’t it’s in our system, but we won’t. Yeah. Right. So don’t try to figure out how you’re going to get that or map that too. There’s no reason. So, yeah, if you just update, send it back over, then we’ll delete the ones that we don’t do, I do need to talk about behavioral analysts, but it could be added to the next agenda Ray because now they want us to identify a master versus a doctorate, right? So their certification now is a new certification that they have that identifies them as a doctorate in behavioral analysts that we have to try. But because we talk about that next meeting, not right now I?
Rae Tompkins (14:20) Will put it on our agenda for next time. Thank you. Of course. Are there any additional questions on the specialties before we jump ahead?
Valerie Lewis (14:32) So, where are we with? Okay? So with creating a new start work file to include specialties. We, once we finalize this list, yeah, will that be ready to go then once we?
Niko Byron (14:45) Finalize this list. I think we’ll be very close. I don’t think it’s a ton of work. Like I think this is where the majority of the work is going to come in. I guess I actually, I should say from my side, I should talk to merit before I say it’s not going to be a ton of work because I think we’re probably going to have to do a lot in terms of sop for cred side of things. But in terms of just like the automation, it shouldn’t be too much beyond this. I just need to do another step to apply the specialty and profession after importing the provider. But yeah, merit, I’m curious if I’m digging us into a hole by saying it’s not going to be that much work, no.
Merritt Miller (15:19) No, I think the biggest gap for my team is just pointing them to where to get the correct one and then making sure I’ve got clear steps on, you know, if there’s a mismatch, how care source wants us to handle, and I think we walked through a few of those cases already about so I can whenever like we’ve got the data tied up Nico and I can kind of propose like this is where it’s going to go. This is how ops is going to handle. This is how we’ll be returned to you and kind of get a yes or no from you and your team. And, I think there of course, could be scenarios that pop up in the future that maybe we want to chat through. But for the most part, I, it shouldn’t take too much on op side to do this.
Rae Tompkins (15:58) Perfect. We’ll definitely keep you updated. Ego mentioned, he’ll send this to you to review, and then we’ll kind of start the process of investigating internally and keep care source updated on the new start work file.
Rae Tompkins (16:15) So, and then jumping ahead to the requested states based on the contiguous state logic that was provided to us. You put this together from a product perspective. And I just wanted to review it with cure source. I’ll send this to you post call as well so that you have an opportunity to review internally but wanted to discuss high level on our call today. So obviously, we understand that when a requested state can’t match a provider’s license, what our current process is that we’re unable to continue processing if it doesn’t match what’s listed in provider caqh. So the information that we were provided from care source is the care source states, and then the valid contiguous states around the care source state. So… the proposal that we put together is obviously when a credentialing request is received from care source, the caqh import reveals there’s no active licenses in the original requested state. And then the provider confirms whether they’re licensed in that state or not. So the process steps that we’ve outlined is step one, identify the mismatch. So during the caqh import, the system can’t match an active request to the requested state in the start work file. So we’re not going to archive the file. We’ll check this contiguous states table that Yenny put together based on the information provided from care source to identify if one of those states is around the state that care source provided us. And then we’ll review the provider’s caqh profile for any active licenses in those contiguous states.
Rae Tompkins (17:49) Step… three would be determine the updated requested state. So if an active license exists in one of the contiguous states on the map medallion would update the requested state to that state. And then proceed with credentialing. For example, if the provider came over in as Georgia but was licensed in South Carolina, we would update the credentialing course to be a South Carolina credentialing file, so that we can proceed with credentialing. If… active license request exists in multiple, we would update the requested state, aligning with the provider’s, primary work history address or flag it for care source review. And if there was no active request in the requested state or any contiguous states, we would escalate per step five, step four would update the requested state to the credentialing requested, the confirmed license in state by the provider. We would proceed with all remaining verifications, PSV boards, etc, based on the updated state. And the change in the file would be the reason for the state update. If no valid license is found, we would flag. The file for care source review rather than archiving, we would run as many verifications as possible in PDB, Sam, oig, medicaid, opt out npi, Dea document, the states document, the states that we’ve checked in the outcome, coordinate with the care source team, Sherry Sheena for next steps but not allowing a large file number to go unaged in the queue. Are there any questions? Top of mind there? Just kind of on this process that we’ve outlined. Yes, couple going back up to.
Valerie Lewis (19:38) the continuous state section, please. So what we’re sending you is only where we have in our system where the provider is licensed. So, for instance, if I send you Georgia and South Carolina, but Georgia is not listed on the provider’s caqh, what steps even though I’m sending it to you that he has Georgia, he’s working in Georgia, what are the steps for that? We would.
Rae Tompkins (20:06) Check the states around Georgia. So if you submitted a request for Georgia, we would see if the license, what, or the provider was licensed in Tennessee, North Carolina, South Carolina, Florida, or Alabama, once we receive that confirmation, we would update the cred request to reflect the state the provider is licensed in order for us to proceed with the credentialing. I.
Valerie Lewis (20:28) Sent you Georgia. Are you not checking Georgia well, because go.
Rae Tompkins (20:33) Ahead.
Valerie Lewis (20:33) I’m sorry… if we receive.
Rae Tompkins (20:37) Confirmation via caqh in outreach that the provider isn’t licensed in Georgia, that’s when we would check the contiguous states? So it’s a way for us to be able to proceed with credentialing.
Rae Tompkins (20:48) So if you requested a provider to be processed in Georgia, but we received direct confirmation via caqh in outreach that the provider isn’t licensed in that state that’s when we would check contiguous states in order to update the correct request.
Valerie Lewis (21:02) So, is there a way to kind of track providers that you’re outreaching to confirm if they have a license in the state, when you can confirm it by just looking up the Georgia licensing board, I would like to know how many are being returned based on as in complete based on no response to that particular question. When you?
Rae Tompkins (21:24) Can check?
Valerie Lewis (21:25) The website to see if they’re licensed and not necessarily… waiting for the group to respond to you on something, you can look up yourself. So I’m okay with this process, but I would be curious to know and I don’t know how it would get that from you on how many files are pending a response from the group on confirmation on if that provider is licensed in a state that you can look up with the licensing board?
Rae Tompkins (21:56) The first step of kicking off a provider request is to utilize the caqh import. So it kind of goes out to caqh and matches what’s requested versus what’s in their profile. So our team isn’t necessarily working a file until that process is complete. When it goes out.
Valerie Lewis (22:14) To caqh identifies that George is not on the license, then your system automatically kicks out a letter to the group or would somebody have to look at it to generate a letter to the group that George is not on your caqh? And are you still licensed in that state?
Rae Tompkins (22:29) That’s part of the automation that kicks off that says you’re not licensed in that state. And that’s when we’re getting confirmation from the credit contacts and providers. I’m not licensed in this state. Yenny, correct me if I’m wrong, that’s the process, correct?
Valerie Lewis (22:43) Yeah.
Valerie Lewis (22:48) Okay. I’d be curious to know Ray. I’ll come back to you. It’s like tell me on a monthly, right? What’s the percentage that the group didn’t reply? And so that file is just pending when you can look it up to see that. Okay, I looked up the Georgia board. They’re not on there. They’re not licensed. Let me keep it pushing… so we can circle back. This is fine. But we can circle back to that because then I’ll be curious to know groups don’t always reply right on request on if you’re licensed or not, they may not reply and I don’t want it to just sit when it’s something that we can check.
Rae Tompkins (23:24) We would verify it.
Rae Tompkins (23:29) Yeah. Let me circle back with the team internally to figure out the best solution to get you kind of the numbers. I know previously, we were sending those emails whenever the files were archived. Hey, we reached out to this group. This provider’s not licensed in this state. I know we’re kind of over communicating to the credits galatians channel right now. So let me search the best option to get you a report that kind of has that information and I can definitely, you know, obviously continue conversation. I’ll send you this document for your review internally. And then we can obviously just continue conversations there. Yeah.
Valerie Lewis (24:02) Sounds good. And.
Rae Tompkins (24:07) then I wanted to flag multiple contacts for groups. So as of three three, until current four two. We, our process has been if we receive confirmation from our group that a provider is no longer being credentialed or no longer associated with that group. What our team has been doing is archiving the request, notifying the credits, galatians channel on this day, this email stated that the provider is no longer associated with this group. And we’ve been archiving the request. I did do internal investigation to find that there were 38 providers that were archived but had a secondary contact. So we are investigating a solution internally to continue outreach to those groups that should still have outreach. You know, that because we didn’t receive confirmation from that group, the provider has turned only one of the ones that was provided directly from caresource. Annabelle lackey was an example.
Valerie Lewis (25:01) We received.
Rae Tompkins (25:02) an email. I can’t remember Sherry, Sheena, if it was directly who it was, but we received that we should no longer be outreaching to this particular group when I went back to look at the file. It had already been archived because we received confirmation from one of the groups she had that she was no longer associated. So we archived the file when we should have been continuing with outreach to, in order to get the file to completed status. So I’ll keep the caresource team up to date as we kind of investigate solutions moving forward. Like I said, there was only 38 providers that were affected by this. I’m happy to share this list directly to you post call so that you have visibility into that. But I will keep the team updated as we kind of comb through the best solution moving forward. Our team. Once we receive confirmation that they’re not associated with one group. We’ll delete that group out of the provider’s. Profile and outreach will continue to other groups as provided.
Rae Tompkins (26:12) Great. Does the caresource team have any questions? Top of mind, we can help with today?
Sheena L. Swihart (26:18) So, I do have a question. I sent you and Nico an email. I… don’t know it was Monday or Tuesday about app clean dates. Yes, I am.
Rae Tompkins (26:32) Looking into, yeah, I’m looking into that one internally. I’m sorry, I haven’t had a chance to respond, but I’m working with the ops team to see if I can figure out why that date was different from the app complete date. So I can definitely provide an update via email as soon as I get confirmation. We’re.
Sheena L. Swihart (26:47) noticing like because Sherry’s been out for several days and I’ve been working on her side of stuff, which has been very odd for me. I’ve noticed though that we’re getting that application complete date. It’s different because it gives one date. But then like I look at the verification dates and they’re newer verification dates. So I’m not sure where this application date is coming. This completed application date’s, coming from, if there’s newer verification dates, wouldn’t it be that newer verification date for us. If you’re still out verifying information… it would be a complete packet, right? Valerie… I think the app?
Niko Byron (27:37) Clean date is referencing when the application had everything we deemed it to be workable for credentialing as opposed to like when… the packet like is clean or like done. I guess, yeah, the app clean?
Valerie Lewis (27:51) Date is when you receive a completed credentialing application. The fresh until date is something different, but the, are we talking app clean or fresh until Sheena?
Sheena L. Swihart (27:59) App clean?
Rae Tompkins (28:02) It’s the.
Valerie Lewis (28:02) Date we were that you receive a completed app. The issue we’re seeing is you completed it that you received a completed app a month ago, but we didn’t get the file until 30 days, 20 days, 15 days later. And we’re wondering what was the delay, right? Because if you have to outreach to the provider, then that app is not clean.
Rae Tompkins (28:22) Yeah, right. Yeah. So the example provided was Leah Barron, her complete app received date was March third, 20 26, but the file wasn’t marked complete until fourth or 20 26 for 320 26. So just to clarify what took the file that long for processing from when it was marked app received to when it was marked complete to care source. I will definitely make sure to get an answer to you as soon as possible, okay? And.
Sheena L. Swihart (28:53) Then I have one other thing. Pikeville hospital… I got included on their emails that have been going back and forth with medallion. So the other day there was one day last week, there was an email that came through that was, it was an email to show that a provider file was resolved. And I think this was after that after we had talked and you were flipping all the files over to Kentucky, and.
Rae Tompkins (29:34) it.
Sheena L. Swihart (29:36) showed that the provider was resolved. However, they received four emails at.
Rae Tompkins (29:43) the same.
Sheena L. Swihart (29:45) Time if not within a minute of each other to say that this one provider was resolved, that’s I came into that on a on that morning and that’s excessive.
Valerie Lewis (29:59) Do you happen to?
Rae Tompkins (30:01) Know the name of the provider?
Sheena L. Swihart (30:03) Let me go look at my email real quick because I was like, why, where did all these come from? So let me, and we were able to.
Rae Tompkins (30:16) Get all those providers flipped by Neco confirmed we got that updated. So we’ll continue.
Sheena L. Swihart (30:22) Yeah. There was one that came through. I want to say this morning… that they’re asking that Sandra brown responded to. That. Said the provider does not work in West Virginia. It’s a Kentucky provider and, but I want to say it’s a new one.
Rae Tompkins (30:45) I happen to know the name of that provider. So I can make sure it was on the initial list we utilized to flip. I don’t.
Sheena L. Swihart (30:50) think it was on the initial list. Okay? I… think this is one that has been sent over since that initial list. Okay? Will I’m… gonna have to look for that email… if you?
Rae Tompkins (31:11) Don’t mind giving me the name? I can definitely look into it internally to figure out one, why that outreach happened so many times and kind of understand the expected behavior. And if there’s something we can do to kind of eliminate the amount of outreach that’s in at one time? Yeah.
Sheena L. Swihart (31:28) I can definitely do that. And then, and then I can find the other one. Okay. That came through. It’s either today or yesterday that it’s a new provider for pikeville because all of pikeville is going to come over as West Virginia.
Rae Tompkins (31:50) Okay. Yeah. We, I’ll put that on our list to follow up on internally to see how we can support additional requests that need to be flipped and the best solution? Okay? I think.
Sheena L. Swihart (32:02) That’s all I have perfect.
Rae Tompkins (32:08) Well, we’ll make sure to get all these items to you as soon as possible. And we’ll continue conversations internally to best support the state flips and, the state request, and I will keep the caresource team updated. Alrighty. Thank you. Thanks so much, everyone. Bye bye.