Transcript
Connor Morley (00:00) hey, Nicole… did we start the payer scoping for this group?
Niccole Russell (00:14) Got so many things going on right now.
Norma Mendo (00:21) I don’t think we,
Connor Morley (00:28) I feel like I can’t keep track of… all of them. All right? We’ll get it done. There’s no good way to search on them.
Niccole Russell (00:41) I got so many going on. I’m even helping Amy with some of her tier iii ones. So, I’ve got a boo coos of scoping… I don’t feel like we have them.
Norma Mendo (00:57) Yeah.
Connor Morley (00:59) All right. I don’t see them in.
Connor Morley (01:13) I have their payer scoping doc.
Niccole Russell (01:17) Have you received the payer scoping from them?
Connor Morley (01:27) No, I don’t think so. Like.
Niccole Russell (01:28) At least with payer names listed. Okay?
Connor Morley (01:31) I think I have some payer names on here. Actually, I just have to confirm the states… okay? And run it through the automapper, hey, Norma.
Connor Morley (01:57) Can you hear us?
Niccole Russell (02:00) You’re on mute? Okay?
Norma Mendo (02:01) There? How’s that?
Connor Morley (02:03) There we go. We got you.
Norma Mendo (02:05) Oh, thank God. He didn’t hear what I was talking about? Hunter, boy. How come? I can’t hear him?
Connor Morley (02:13) Oh, no.
Norma Mendo (02:15) So, Rachel is out today?
Connor Morley (02:19) Okay. No worries. But… I.
Norma Mendo (02:25) think she added a couple of things for you on the group section. Okay? There’s still a lot to do.
Connor Morley (02:37) But, the group enrollments, you guys just had two, if I remember correctly?
Norma Mendo (02:42) Correct. I think, yeah. But what I noticed on the group section, there’s 19 percent. What are we missing?
Connor Morley (02:50) Oh, sorry. I’m talking about two different things right now. Sorry, sorry, you’re talking about the group profiles. I thought we were talking about group enrollments?
Norma Mendo (02:58) No, just the profile.
Connor Morley (03:00) Hang on one second. So I can show you, I.
Norma Mendo (03:07) Thought she had sent that over, but,
Connor Morley (03:09) yeah, no, she did. For the group profiles, this is what you’re talking about right here? I can’t.
Norma Mendo (03:18) see it?
Niccole Russell (03:21) Populating there?
Norma Mendo (03:22) You go, yes.
Connor Morley (03:26) Yeah, we’re at like 19 percent. So, the information on the group profile is like date of incorporation, some mailing information, billing information. And then a lot of financial information like tax classification, W9 form irs, letter, bank name. I.
Norma Mendo (03:49) Can,, I can tag? I can target this one this week.
Connor Morley (03:53) Okay. That sounds good. And then in addition to that, we also want to make sure it looks like your practice locations. Do look pretty good.
Norma Mendo (04:00) Yeah, we went over that yesterday and… I think the only thing I needed to submit to her was a couple of documentations like you wanted, the medicare… initial enrollment, you know, just to prove and then the business license. And of course, I realized that the one in Illinois goes by group. So I have to come up with that. But I think everything else as far as punching in the information entering is all in. It’s just a matter of uploading some of the documents that you need to coordinate with what we added.
Connor Morley (04:41) Yeah, I think that’s really it like for some of them, it is, I think there’s some accreditation.
Norma Mendo (04:47) What I did not see is nothing on the dme, there’s only one,, there’s two dmes on the medicare section. I didn’t see if I just added to the medicare or is there another section for that?
Connor Morley (05:01) What do you mean by dme?
Norma Mendo (05:03) Oh, wait, no, no, no, we don’t credential, dme. Never mind.
Connor Morley (05:09) Dme. As in durable?
Norma Mendo (05:10) Medical equipment. Yeah. Other than that, I did also wanted to discuss with you. I’ve been noticing a lot of the providers are not adding their references. Is that under the, they can’t close it, you know, like under.
Connor Morley (05:33) So references really depends if we have to do peer references as a part of your credentialing, which I think we do. Yes, right? Yes. So part of like references in particular, because we don’t make it required on the profile. But when we get to the point of like re, credentialing or initial appointments, that is something that we task out and we have them fill out our like peer reference form to tell us who do they want us to reach out to?
Norma Mendo (06:08) Okay. For example, there’s a couple of new ones in here. And like dr batchelor.
Norma Mendo (06:21) He filled out everything. I just thought it would be best to just have them fill out what you need even though we always would require their references at the initial time they start. Yep. So.
Connor Morley (06:37) With dr batchelor, and one thing is like with him in particular, once we request, he’s a new, right? So we would go in, pick dr batchelor pick midwestern university, and then select privileges, and then we would assign him to fill out the peer references. I mean, it is something that they can fill out for.
Norma Mendo (07:07) Sure. And.
Connor Morley (07:08) They can do that by going into their profile. It’s just not required because we don’t require it for like pay or enrollment kind of information. So if they wanted to fill out peer references, it actually does look like we have it.
Norma Mendo (07:26) Well, I made him do it. Oh, because what happens is when they initially come on board, they do a 15 minute, 20 minute walk with Norma and just hello and who I am and what you do and what we do. And it’s of course, I’ve been finding it very simple now to send the invite so they can fill it out. Sometimes you don’t see them later. So it’s kind of nice to kind of get them to do everything at one time. Yeah, instead of reaching back to them. And they get all these emails, they get annoyed by the fact that they’re working upstairs all day. Usually, you don’t they’re on the floors. It’s not like the hospitals or the clinics where you can find them very easy. These doctors are all over the different sections of the whole building. Yeah. So I just thought it’s something that we have always required. It isn’t it is within our, did Rachel send the policies yet?
Connor Morley (08:27) Hang on while I just double check. I thought you did. I just want to make sure that I have them midwestern docs.
Connor Morley (08:40) One second.
Norma Mendo (08:44) And I’m still trying to, when some of these providers come in as employees full time, they do go through human resources. So I was going to reach out to them to make sure that if they’re most places, they’re asking for references there. But it’s a whole different type of references. When they’re employees, they’re asking for personal references… here in the clinic. We’re asking for professional references based on their CVS based on their documentations that they provide. So, I think it’s on our policy noted part… of the PSV, we request three, but we really only by policy only need two, but we always request three.
Connor Morley (09:38) So… I can turn on and make peer references required?
Norma Mendo (09:45) I think it’s going to help you and help me?
Connor Morley (09:48) Will your, but I can, but I have to turn on for everyone. So will that be frustrating for some of the providers who already… are credentialed? But since.
Norma Mendo (10:05) they had the references on their caqh, would it populate? No?
Connor Morley (10:10) We pull in pretty much everything that’s on caqh. I can double check with the provider, if you know of one.
Connor Morley (10:26) If there’s a good provider who?
Connor Morley (10:34) Has caqh and let’s,
Norma Mendo (10:38) try dr, hold on.
Connor Morley (10:41) See a John anderson that has everything. I don’t know if that’s a new one or not?
Norma Mendo (10:46) New, but that’s okay.
Connor Morley (10:49) John anderson, professional history?
Norma Mendo (10:54) Yep.
Connor Morley (10:56) We have peer references for him.
Norma Mendo (10:58) I made him too. I kind of added him, and of course, every time I said the word, I need your references, they’re like it’s not mandatory. And I said, well, Norma said, so… Simon says write your references. Like right now somebody decided to skip me on the initial welcoming and they just added them to our system. And I’m like, okay, let me get this straight. So everything’s being denied. You register the Da, which is his name is different. The mpi is different. I medicare’d up that him different. So, all his names are different. So, did anybody check with Norma to make sure that before you enter him, all his names, legal names are not all scattered everywhere. So, yeah, all.
Connor Morley (11:44) Right. I am looking at a Jenny Lau who looks like she… has been with you for a little bit. It looks like she did not.
Norma Mendo (12:02) Do references.
Connor Morley (12:04) No, we do have references for her, however, it looks like that pulled in from ceqh. Oh, okay. Okay.
Norma Mendo (12:16) Because I did see that we were 94 providers already approved or the amount from yesterday?
Connor Morley (12:26) So, you have just looking, yeah… you got about 110 providers with 100 percent profile completion. Yeah.
Norma Mendo (12:38) I had 27 appointments yesterday with the meetings. Oh boy.
Connor Morley (12:42) They.
Norma Mendo (12:43) Had no idea what I’m telling you. They got, they’re so spoiled at midwestern I.
Connor Morley (12:51) But to answer your earlier question, I do not have those credit policies from Rachel… unless, no, that’s Nicole. You’re talking about government plans? Yeah, I don’t have those credit policies for.
Norma Mendo (13:07) Okay. That’s going to be the number one thing we need to work on for you next week, Monday, Tuesday, because without that, you wouldn’t have any idea on what it states.
Connor Morley (13:17) You have no idea. And, and just to put things into perspective, I need about two weeks… finalize the sop with our team to make sure that they’ve been trained on it. They know what information to pull and how to pull it into the packet. So, I was looking at starting going through some of these initial and reappointments putting together packets for them first week of may I’m starting to get a little worried. If I don’t get the credit policies, we might not hit that.
Norma Mendo (13:53) Put that on my note. Yes. And I think.
Norma Mendo (14:02) I will send Rachel and put a meeting on her calendar to set up.
Norma Mendo (14:14) Yeah. And just to give you an idea.
Norma Mendo (14:21) Let me look up dr delisio or dr Lau. I can look up dr Lau since you’re looking at that one.
Connor Morley (14:28) So it does look like the, if they have peer references, we pull that in… from what I can tell right now.
Connor Morley (14:46) I can double check that. I might look at a couple other folks. We’ll get Florencia. Yeh.
Norma Mendo (14:58) I mean, most of the,
Norma Mendo (15:08) I just wanted to see if I can. So the,
Norma Mendo (15:21) the PSV which is the verification that we do for all the providers… like I said, the references are two that we grab. And then we, once you’re done with it, I… don’t know how they’re going to do this, but I would generate the PSV into the file for the education part. As I mentioned that’s an education part. So when we get accredited, they don’t come to me as a credentialing person. If they don’t see anything on the education part for the PSV that each provider was verified for their documentations. And of course, the verification of two references is one that they, it has to bypass before they close that. Again, I’ll go through the policies with Rachel and make sure that you get that because that’s important for you to kind of have.
Connor Morley (16:13) Yeah. So we do have a PSV for education… on our side. Okay? And, so you would not have to do that. Part of what we do is we do something that aligns with tgc and ncqa standards called Edu proxy… Nicole, would you be able to explain Edu proxy a little bit better? Because from my understanding, it essentially says, if they’re licensed, then the primary source verification for the education has already been done, but we can also do other education verification as well on our side and put that into the packet for your review. Okay?
Norma Mendo (17:01) Yeah. There has to be something and I don’t know if anybody like I upload the PSV, there is a section in the education part. When they come through accreditation, it’s primary source verification, state license, all of that on an initial visit, they get uploaded over there. So they don’t come through credentialing, but you’d be surprised when they come in here and they graphed all charts. And one of them is a doctor that somehow… the PSV wasn’t uploaded and they come in here just to check. And then of course, they’re checking other things as well. So.
Connor Morley (17:31) The good news is on our side, we essentially all the information that you put into the profile, we PSV, we primary source, verify all of that. So if I show you this demo account with fake data, we essentially let me know if you can see my screen… once you place a request, and the provider profile is at 100 percent, we package that all up into a credentialing packet and it has a bunch of information. So we go through and we verify education. So we can use degree verify or we can do Edu proxy. We’ll tell you when it was verified, who verified it on our team, whether it was automatic or not. So you can see all of this at a high level just by looking at the credentialing file for all the different verifications that we do. And then there’s also work history validation and peer references that we do as well. And then we have a PSV report. So this one would show you if there’s any time where, you know, we found something that needs your attention instead of a green checkmark that says clear, it would be like a yellow yield sign. And then if there is something more serious or adverse, that would be a red stop sign. And it would be emailed directly to you as a notification, put in an org admin task, essentially asking you, what do you want to do with this? Do you still want us to go to committee? So you can deny it? Do you want us to archive this? Essentially like how do you want to handle this very serious verification? So when you look at it, and if I show you once it goes into committee, you’ll see like, hey, this license popped up as an issue and it didn’t pass our checks. Okay? And then we can go in and we can look at the credentialing packet, we can specifically go to the licenses section and see the document. For example, this pa license has been revoked and you can see some notes on there that your staff would be able to do as well as whoever’s approving it, got it. Okay. So you can see evidence in there. So the nice part is you just have to make the request. We’ll put the packet together for you. And then essentially… just tell us. And then once it’s in committee for review, then you would be able to either approve or deny it. So I can also actually log… in as the wrong person. But essentially it’ll say approve or deny. And then you’ll be able to keep track of all of the ones that you’ve approved or denied or archived if never went through. So you can see rejected. Approved, there is going to be an option for deferred in the future. Okay? But that’s probably going to come out either later this quarter or the quarter after.
Norma Mendo (20:34) Got it. Okay. That’s a similarity of how we have. It’s. Going to make a lot of difference. I’m going to, I mean, I can’t I don’t know if I can share mine, but everything you have in your system, I used to have to put it in another system and it was exactly the double work for me.
Connor Morley (20:59) Yeah, let’s not do that anymore.
Norma Mendo (21:02) So that’s going to be very nice and when they have their meetings, they can just pull up medallion, they can see everything without me entering all this information on the other end. Okay? That’s fine. Yeah, I think the verification again, you’re… the one running it on the other side. So, I was just trying to make sure that you would get everything you need before you start reaching out to everybody. It’s going to be very hard to reach some of these doctors. I’m telling you after you, when you have them, it’s when you get everything from them. Yeah. So.
Connor Morley (21:37) In that space, typically, what we do, we reach out to the providers three times, if we don’t hear back from them, then we would assign an org admin task to you and Rachel, letting you know like, hey, we can’t get a hold of this provider. We’re waiting on information from them in order to move them through either payer, enrollment or credentialing. Can you help us? Yeah.
Norma Mendo (21:59) So that’s the same way that we used to get our PSV Symplr person. We got to the point where we… were, it was getting too long. So they would actually just reach out to me and then I would reach out to them CC, whoever you know, CC you or whoever was handling it. And then they would get the information right away.
Connor Morley (22:20) Yeah. Okay.
Norma Mendo (22:22) That’s fine. All right. I’m going to work on the policies for you that’s going to be the high priority for you for Monday. And then I will try to fill in the section over here, words of the group and finish off on the other that Rachel just needs from me that requested some of the documentations to start looking for them. Okay? And then as… far as the references, if we, if it’s 95 of them already entered for us to get back to them and say, hey, but if we can gather them from the caqh… it would be very helpful. How are you able to identify the new ones that come on board? Like I, you know, how we gave invites recently to a lot of new ones?
Connor Morley (23:15) Yep. So let me pull that up there’s. A pretty typically… what I’ll do if you want to see the new ones you can go into, medallion, I have this filtered on, but I can reset that and what I would do. Just look at date invited instead of sort by ascending sort by descending so you can see all of the ones that have most recently joined. Okay?
Norma Mendo (23:50) Yeah. Those are the ones that are going to need PSV. Yep.
Connor Morley (23:54) And so when they, once we’re ready to start doing the credentialing on these, you’ll go into credentialing, you’ll make the request for initial credentialing, and then sorry, you’ll go through privileging because you guys align you’re not full tjc credentialing… but in order for us to do peer references and work history validation, we need you to go through privileging and I’ll remove this credentialing piece so it doesn’t so it’s not confusing.
Norma Mendo (24:27) Okay. All right. Okay. Well, we’re moving along, we’re trying to get everything we’re hoping and our goal is to get the other 95 doctors or, you know, get in there. And Rachel’s been reaching out to them, giving them most of the ones that aren’t so hopefully may first is the goal we’re hoping we can hit that goal. Yeah. Perfect. All right. Anything else on your end?
Connor Morley (24:57) That’s it.
Norma Mendo (25:00) Okay. All right. Well, thank you, Nicole. Thank you, Connor. And we’ll talk next Thursday, but I think that Rachel will send everything to you. You’re being in communication with her by email. So we’ll try to get that to you by Monday and I will send her a little reminder right now. She’ll probably read it tonight. All right. Okay.
Connor Morley (25:17) Perfect. Thank.
Norma Mendo (25:18) You all right, thank you. Bye bye.