Transcript
Melissa Butler (00:00) hello? All.
Naomi Denson (00:01) Right. Sorry, guys. I ran over.
Naomi Denson (00:13) Hello?
Melissa Butler (00:16) Hey, there.
Naomi Denson (00:18) How’s it going?
Melissa Butler (00:22) All right. How are you?
Naomi Denson (00:25) Good. It’s almost Friday. So there’s that, yeah, we.
Melissa Butler (00:29) Need more time this week. We’re stressing about the end of the week nearing.
Naomi Denson (00:34) Okay. I took off on Monday, so I have a short week anyway. So I’m like definitely need more time, but all right. Did just want to check in on some of the credentialing items that you guys had emailed about the fellowship verification. That configuration is done. We talked about that. You confirmed that you do want those verifications to happen, wanted to check in on the ones that were already completed and marked ready. Are we going to re, request those to be reworked to include that fellowship… if it was not originally, or are we just doing this going forward?
Kkeever (01:15) If it’s a requirement, I don’t think that we can push it through without it, can we, Melissa?
Melissa Butler (01:20) Am I muted? No. Okay. I can’t find my zoom meeting. No, yeah, because it’s required, you know, the, I think you had called out that the ncqa requirement states.
Naomi Denson (01:33) If.
Melissa Butler (01:33) we are, you know, sharing that with the members, then, you know, so if we, if those files get audited and it’s not there, it’ll be an issue. So we have to, we need to get them there, okay?
Naomi Denson (01:47) All right. So we’ll flag those that need to be re, requested to be reworked to include that new verification. And then the caqh application, I talked with our credentialing manager. She’s updated the sop to include the caqh application on all files going forward. She, I did ask her about the other email that you sent about them being, you know, like older like the timeframes on them, there’s no specific timeframe that we have to have on there as long as caqh has not deemed it as expired.
Naomi Denson (02:28) So we shouldn’t we wouldn’t be using any that are over 120 days old, but you had said that some were, so I was wondering if you could give me some examples that you saw.
Melissa Butler (02:39) Yeah, all of them are in November.
Naomi Denson (02:42) Yeah. And.
Melissa Butler (02:43) my concern there too is we turned on caqh management. So, you know, updates have been made to their caqh profiles and they don’t match medallion. So we are, I mean, everything is such a mess right now because all of the profiles they used are like, I don’t I know we turned on caqh management. I was actually going to ask that, have they started doing that? Because I thought once they start to work those and reattest, I mean, to me, that would say we’d be using a more updated application, but all of them are from November, I think Kelly found one from October and that puts us in a pickle because, you know, we have to have time to audit them, get them reviewed and then sent to committee. So if we’re getting one that’s pushing a six month deadline, I mean, it’s we’re having to rush and it shouldn’t be that way. Like we should have time to, you know, to get the file to committee and not worry about these deadlines. I mean, six months that’s an old. I just don’t know why we would. I’m… honestly, I just don’t understand why we’re pulling from, especially since we have caqh management in our contract with medallion. I feel like we, some of these, at least some of them should have been attested by medallion by now. Are we not working on that?
Naomi Denson (04:05) I’m showing that there have been, I think I went to a different screen I’m showing there have been 90 caqh management requests that have been completed. There are a bunch in there that look like they might have tasks because the providers haven’t signed their agreement yet or let’s see.
Kkeever (04:26) Yeah. But all of the files that I pushed through that I’m seeing have signed their agreements because that’s the only reason that I would have you.
Naomi Denson (04:33) Know, do you have a sample file or a person that I could look at off… the top of your head November date? Yeah, that has like a November or October date? Yeah.
Kkeever (04:48) Basically all of them one second. I’ll grab a.
Naomi Denson (04:51) Name. Yeah, I just pulled up one random one and it was December?
Kkeever (04:57) I think I told you when I’m.
Kkeever (05:29) oh, I’m sorry, I think Nicole miller was one that was in November.
Kkeever (05:37) I’m looking at all the ones that are there’s only six in Barry’s bucket. So.
Kkeever (05:47) Stephen, Darcy, Brendan Gonzalez.
Naomi Denson (05:51) Nicole miller.
Kkeever (06:00) There were a couple that were January, but I mean, we’re in April, you know, it’s not like it was. Yeah.
Naomi Denson (06:10) So, Nicole miller… November 26?
Naomi Denson (06:40) 27. Okay. So Nicole miller’s… completed?
Naomi Denson (07:06) Okay. So her app completion date was April six. It was marked ready, April seventh. Her let’s see the… caqh application.
Naomi Denson (07:27) All right. Yeah, because they, it looks like the caqh, they must kind of where is the caqh application for her? It was pulled?
Naomi Denson (07:45) Because I could see you.
Naomi Denson (07:59) Date on the sacred application. So the last attestation was 1,126. We reattested her cqh four six. So this must have been pulled in.
Naomi Denson (08:16) I’m trying to see when this, if there’s any way to see when the caqh… application was actually added to the file. I don’t see where it says that. So I don’t know if they did it on four six. And then like we attested the profile like an hour later and it was just missed, but it was still active at the time we pulled it.
Melissa Butler (08:51) Yeah. I don’t think our concern is that any of them are expired. I think that given that you guys are the cbo and you’re not taking them to committee, and we have to do that work once especially because of the auditing that we’re having to do on our end. I don’t think that they should be cut that close. And then my other concern is, like I said, some of the packets list, you know, going through, it shows that caqh was the means of primary source. But then the caqh packet wasn’t included. So candy’s out and something like that.
Melissa Butler (09:27) I feel like I have to check to make sure that we can even take that because I’m like there’s no primary source. If that file gets audited, the primary source that’s being cited isn’t here. So again, because of that, I have to hold that file for another month. So that concerns me with the last caqh, you know, attestation date. I just don’t think that we should be, we… might need to work it in to where we’re you know, that doesn’t happen that we’re not waiting until, you know, that we have updated packets?
Naomi Denson (10:05) Right. Dreama, any context, anything that you can add there to take back to ops?
Dreama Hembree (10:16) Not right off the top of my head. I do think that we need to circle back with ops and, you know, present their concerns, obviously the valid.
Naomi Denson (10:24) Yeah. I’m looking at this is the one we already looked at Shauna for fiorantio, it says amount of records was verified by data source was caqh, but there’s no caqh app attached and.
Dreama Hembree (10:40) That’s the one with the malpractice that we needed to. Yeah.
Naomi Denson (10:44) Yeah.
Dreama Hembree (10:45) So that’s, on my list?
Melissa Butler (10:49) I have a,
Kkeever (10:50) question is the… medallion team editing any provider information within the provider’s profile?
Melissa Butler (11:04) In medallion, no right? To.
Naomi Denson (11:07) My knowledge, they are not Dreama. Do you know that’s.
Dreama Hembree (11:12) to my knowledge, no, that’s not something that I would do or that I know that the team would do.
Kkeever (11:17) Okay. I didn’t think so. I had a, I had a coordinator mention. She thought that they might have added some employment records and that didn’t sound, I… just didn’t know if that would be something that they would do.
Naomi Denson (11:30) If there was a provider, that was, we can look at the history.
Kkeever (11:32) Yeah. Let me explore.
Kkeever (11:40) Kelsey Arnold.
Naomi Denson (11:44) Kelsey?
Naomi Denson (12:03) You said it was work history? Yeah, I’m not showing that… we made any updates to her profile. These were all at orthosolutions?
Kkeever (12:22) I’m sorry, what was that? Yeah?
Naomi Denson (12:23) These are all done by.
Melissa Butler (12:26) It’s a lady. Yeah.
Kkeever (12:28) Okay. Thank you. I thought so. Yeah.
Naomi Denson (12:31) And then any that say user, this was from… the imports?
Naomi Denson (12:40) Which I don’t know why it’s deleting things. I don’t know. Yeah, the user, yeah, this was the day of the import for caqh. I don’t know why it’s showing deleted though, but.
Dreama Hembree (12:55) Might have been a.
Naomi Denson (12:56) Duplicate maybe, but yeah, we can definitely… and then I’m seeing like, so.
Kkeever (13:05) I’m trying to work through some of the packets before I launch it to our committee to review. I’m seeing aside from, you know, the obvious that we’ve discussed that the packets are outdated. There are like a lot of replicated like work histories that like they just, the packet isn’t matching caqh isn’t matching medallion, so, I don’t know like where the disconnect is coming from, unless our team has like changed the caqh presumably since November. So just like none of the platforms are matching you.
Naomi Denson (13:43) Have an example… yes.
Kkeever (13:47) It was for Neil Kumar, which she might have already corrected it this morning, but the… work history?
Kkeever (14:02) And medallion like had duplicates for… I’m sorry, I went through like so many. My head is spinning a little bit from all of us this morning. It’s… actually Richard pidgeon that I was referring to.
Melissa Butler (14:20) Richard.
Kkeever (14:21) Richard, medallion listed everything once. So, oawf, into foi, which is correct, and to toc, which that date is wrong, but that wouldn’t have been on you guys. So, in medallion, it’s correct in the packet, it pulled Florida orthopaedic twice. And then toc with a completely different date from January of 20 24. And then I need to pull up the caqh. I think I’m still in it. I am, so in caqh, Florida orthopaedic is only entered one time… and toc is there with the January date that matches medallion, but I don’t know where the duplicate records are coming from, and I’ve seen it in multiple pockets where like… foi had like three or four entries at different dates, and I don’t see those dates in caqh or medallion. But again, there’s no way of us knowing like that. Our coordinator, you know, could have gone in or somebody could have gone in to caqh and changed it. I just, is there a way to edit the packet information for a file that’s already put as ready?
Naomi Denson (15:40) No, unfortunately, not how.
Kkeever (15:42) Would we solve that? Would we just have to delete the request out and like start over?
Naomi Denson (15:49) Dreama? Do you know… I?
Dreama Hembree (15:52) Do not know the answer to that right off the top of my head, I can find out. So, for the ask is if there’s duplicate entries or something that doesn’t match caqh, and it’s already been marked ready. What’s the workaround? Yeah.
Kkeever (16:10) If the packet is marked ready and there’s something that we catch that’s like misinformation or needs to be corrected. How do we go about doing that?
Dreama Hembree (16:20) And then the Richard pigeon, is this one of the examples on that one? Yeah. Okay. I will take this back to find out that information for you. I know that I digress but I know I owe you some information on Sarah Henry too. So I’m going to have that to you by the end of the day, but I’ll add this to the list as well.
Naomi Denson (16:42) Okay.
Kkeever (16:43) I’m sorry, guys.
Dreama Hembree (16:45) Oh, no. Hold on, I.
Kkeever (16:46) Apologize. No, I’m just going to… yeah.
Naomi Denson (16:57) Yeah. So, and then Dreama, also on our list is to get the MDS and dos that were not verified with fellowship in the beginning before we had the configuration done to get those reworked.
Kkeever (17:13) And that will be everybody, I think because I don’t think anybody’s fellowship was verified because it wasn’t set as a requirement. So, all of the MD do fellows are going to have to be pulled back.
Dreama Hembree (17:25) So, it’s going to be all of them that were done already.
Kkeever (17:29) Everyone that I’ve looked at has not had the fellowship verified. And I did have a question on the residency… verification. And one in particular, it like lists the American like the abms profile, but then it doesn’t have any information like it shows his board verification, but it doesn’t have anything about his residency, and that was what the data source was for the residency verification.
Naomi Denson (17:58) Which one was that?
Kkeever (18:01) Please hold, I’m going to have to.
Naomi Denson (18:02) Find it again.
Kkeever (18:04) Sorry, yeah.
Naomi Denson (18:05) There’s still the same 14 MD dos that are in ready. So that was the number that I had while we were holding, waiting for candy’s confirmation. The team has been notified to resume MD dos. So any going forward should have the fellowship verifications.
Kkeever (18:25) Huh.
Naomi Denson (18:34) Take a screenshot really quick. So I can.
Kkeever (18:40) I searched Miami and there’s so many that would take you to Miami for residency.
Kkeever (18:59) My name is… sorry. One second. I’m trying to find the it’s.
Dreama Hembree (19:14) okay.
Kkeever (19:34) It’s also a pigeon… so I was auditing it and I just, I don’t see.
Naomi Denson (19:46) Okay. So, what was the call out? Like?
Kkeever (19:49) It says that they use the American board of medical specialties to verify the residency and the SNP that’s in the packet for us to review. Only has the board certification. There is nothing, you know, relative to the residency.
Kkeever (20:16) And then when I go to like, you know, the summary and go to education and training, it says like the university name, but under evidence, the SNP they provided only has like the general board verification from abos.
Naomi Denson (20:33) I wonder if that’s part of like the Edu proxy, like we can verify this because they can’t get their board certification without the residency, but I’ll definitely.
Kkeever (20:47) Ask.
Kkeever (20:54) But I just like, I, okay, I just, I’m struggling with that concept because it’s like we’re not verifying it though. We’re just assuming… like today, we had, we found one of our pas like board certifications lapsed and we weren’t aware. So like if that were to happen and we had already put them through and we hadn’t verified their education because they were board certified. And then their board lapses, like it just, I don’t know, then their education isn’t verified at all. Yeah, I don’t know.
Naomi Denson (21:33) Yeah. Dreama. We… can take this back to the ops team and ask them about that, which provider was it that the board lapsed?
Kkeever (21:43) It was, that was she?
Dreama Hembree (21:46) Was just saying that was an example that if it had lapsed, then the,
Naomi Denson (21:51) education wouldn’t have been there. No, she.
Dreama Hembree (21:54) Was just saying if in the event that had happened, it would have been bad. Gotcha. Yeah, I got pigeon for that one too. Okay.
Naomi Denson (22:07) All right. Yeah. So, Dreama will take the operational process questions back to our ops team. We’ll ask them to rework those 14 MD files and get some clarification on, you know, the files that have psvs that say they’re from caqh but there’s no caqh app… and then to verify the education, residency verification issues.
Naomi Denson (22:37) Anything we’re missing?
Naomi Denson (22:45) Thank you. No. Okay. No, I think just like duplicate records, you know, having to pull. I.
Melissa Butler (22:53) Want to know how we, if… we’re going to, so, for the ones that you guys are looking at for these issues, how are they going to? Because I think you said before Naomi that they couldn’t like pull the packet back and rework it like it had to be a new request.
Naomi Denson (23:15) Yes. I’m I have an open conversation with the team on that to try to figure out how that works.
Melissa Butler (23:20) Okay. Yeah, because we need to know about that and I also want to figure out how we can work with medallion and their credentialing team for the things that we’re calling out that are issues to go back and have them audit the files because, I mean, we’re doing it but it’s also like we shouldn’t have to be doing this like it’s, you know, they should be looking at the work that they’ve done and the issues need to be rectified, you know, we should have, I mean, she’s spending 45 minutes a file just to make sure we want to pass whenever we get audited. You know, we’re trying to get delegated with these payers and with some of these issues, these files won’t pass. So we don’t that’s you know, we want to make sure we’re clean in what we’re producing and putting through committee. And so, you know, we need to make sure that these things that we’re calling out that they’re going back and fixing and you’re not waiting for us to call out every single file with the same issue. Does that make sense?
Naomi Denson (24:28) Yes, absolutely. And yeah, that sorry… Dreama, can help navigate those conversations and make sure that, you know… the team is aligned on those, the issues and making sure they are coordinating an audit if necessary. I do still have the open question out to our credentialing director for the audit standards that we have. I just followed up with her to see if she had those ready to share with me because you had asked for them last week. So I’m waiting for her to share those with me so that you guys can see what our QC and audit process looks like… for the review as we have these things come up and how that’s handled with applications that have already been processed.
Naomi Denson (25:37) Anything else that we’re missing? I don’t know if I’ve missed any emails yet. I know there’s some that dream was handling for some payer enrollment stuff. Yeah.
Dreama Hembree (25:51) I’ll have that to you by end of day from a follow up on that… okay?
Melissa Butler (26:01) Yeah, we’re hoping we can have at least a handful of files for Monday, but again, you know, we’re trying, we need to make sure that everything’s ready by may because again, the caqh packets are so close to, you know, being too old to take to committee. And we don’t you know, we have to make sure that the ones that are being sent are, you know, and that brings up another point like the ones that they’re processing now. Like, you know… we don’t know that they’re going to get to may or June because we’re because of the influx.
Melissa Butler (26:33) So, you know, I think we need to work something in there at least for our group that attestations are, you know, not much farther out than 90 days so that we can especially for this first push of, you know, 600 providers. Yeah.
Naomi Denson (26:54) And she had asked, let me find, thank you.
Dreama Hembree (27:07) So our.
Naomi Denson (27:10) credential manager said caqh will not allow us to use an expired application. Should we task to you admins? If the caqh applications are not available, I can ask her if we can add the timeframe requirement and if it’s past that… yeah. Okay. You said 90 days? Yeah.
Melissa Butler (27:34) That’s preferable.
Naomi Denson (27:50) I’ll ask her to add that note. And then, yes, if it’s not available for some reason, tasking to admins… yeah, because that’s I pay attention to that. I log in every day and look at them.
Melissa Butler (28:03) Oh, another thing I need to ask Naomi, dr beery’s getting every notice we’re getting. Can you quickly show us how to change his notifications? We only want him being notified when he has a file that’s been put in that committee bucket. Yes. Let’s see.
Naomi Denson (28:20) He said, OK, very… make sure the screen.
Dreama Hembree (28:36) Guys, I apologize, I have to drop for another call but I will be in touch by end of day with that outstanding information that I owe. Please let me know if there’s anything else that you need from me.
Melissa Butler (28:47) OK. Thank you, Dreama.
Dreama Hembree (28:49) Thank you. Have a great day you.
Melissa Butler (28:51) Too.
Naomi Denson (28:55) Turned off everything for him except for credentialing.
Melissa Butler (28:58) OK, perfect. Yeah.
Naomi Denson (29:01) So, if you go into the provider’s profile, just select email preferences and you can manage them that way or they can manage them the same way you guys can through their profile here.
Melissa Butler (29:12) Sounds good. OK?
Naomi Denson (29:15) We’ve got some things to take back and update and get some answers for you, but we will be in touch shortly. OK?
Melissa Butler (29:21) Thank you. I appreciate it.
Naomi Denson (29:23) Absolutely. You guys have a good day, you?
Melissa Butler (29:25) Too. Bye.