Transcript
Diana Rodriguez (00:00) hi, Renay. How are you?
Rae Tompkins (00:02) I’m good. How are.
Zarin Akandh (00:03) you?
Diana Rodriguez (00:04) I’m good. Trying to get over a cold, but all.
Rae Tompkins (00:07) good. I know, I feel like we just got over one at our house and I feel like it’s come back for like round four. We just can’t I think I had a break yeah.
Rae Tompkins (00:24) Good afternoon… hi, Dana.
Zarin Akandh (00:54) We’re just waiting on Carla. I know Angelica is out today.
Zarin Akandh (02:07) You can go ahead and get started and I can fill in.
Rae Tompkins (02:10) Carla, when she’s able to hop on. But one of the things I wanted to review today was just again, some questions regarding self serve versus medallion owned files. So this is just a high level overview of that process. So a carenu responsibility would be to provide accurate rostering information at the time of upload. As medallion is not reviewing terminations. Carenu will determine what provider files will be medallion owned versus carenu owned. At the time the request is submitted, one of the asks that we have is that whenever a carenu file is assigned to medallion, we don’t flip it 24 hours after it’s already been assigned to medallion, and that no additional auditing needs to take place on medallion owned files. As, you know, the process that we’ve outlined is following our ncqa standards and is… you know, kind of the process that we’ve outlined as working with carenu. And then obviously, with the understanding that carenu will process the file internally based on the internal requirements that you’ve set in house… are there any specific questions about, the hybrid model or self… serve versus medallion owned?
Rae Tompkins (03:36) Natalia, I think you’re on mute.
Diana Rodriguez (03:40) Apologize guys. The only thing, the struggle I have is that, you know, when medallion owns it, I know we have 24 hours, but sometimes it’s not completed and the practice is asking for it. So then I have to email you to take it back, not take it back, but I have to email you so you can rush it and all that, you know, when I should be able to have access. We just.
Rae Tompkins (04:06) want to make sure that our team has the ability to work the file if assigned to medallion. So if there is a certain situation where the group reach out to you and you need to process the file faster if you’ll just shoot me an email. I can, you know, work with our operations team just to give them a heads up. We just don’t want a file that’s being actively worked by our team to kind of disappear ownership wise, so that they don’t have direct visibility into the file. But in a situation like that, if you’ll send me a message, I’m happy to work with our operations team on those kind of one off situations. Yeah. Thank.
Zarin Akandh (04:41) You? Okay. I did hear from Carla. She’s having trouble with the link. So I’m going to forward, I want to see if I can forward the email okay for invite. Yeah.
Diana Rodriguez (04:57) Yeah. I just tried doing that as well.
Rae Tompkins (05:03) Yeah. It looks like she may have joined the zoom link, but… it should have updated for all. Let.
Zarin Akandh (05:12) Me see if I can also add her here.
Diana Rodriguez (05:19) Wasn’t gonna, wasn’t Chris gonna be here soon?
Zarin Akandh (05:23) I’m not sure. Okay. Did he, I don’t know if he was invited to this one. He was right. Yeah, he.
Diana Rodriguez (05:33) Was invited and so was Danielle.
Rae Tompkins (05:39) I thought, yeah, I worked with Carla and we, I think Danielle and Chris were removed from this meeting.
Diana Rodriguez (05:46) Okay. Right. Okay.
Karla Glickman (05:48) I’m in it now. I don’t know what happened. It seems that I still have the old one, for zoom and then this one didn’t show up on my calendar. So that was confusing, but thank you Zarin for sending that over. I appreciate it. Perfect.
Rae Tompkins (06:04) Yeah. We, Carla just reviewed this slide that I put together from our conversation that we had last Wednesday, just kind of a high level overview of self for self serve versus medallion owned. So just some kind of carenu responsibilities obviously providing that accurate rostering information at the time of upload, carenu, determining whether it’s going to be a medallion owned file or a carenu file at time of submission. Carenu does not need to review or audit medallion owned files and that we ask that carenu not flip ownership 24 hours after being assigned to medallion. Okay? And… we were just reviewing if there was any specific questions on the self serve hybrid model or if there was anything that I can review with the team to kind of make that process a little easier.
Karla Glickman (07:01) Well, I think, the team probably knows best, right? Specifically when it comes to the item of, the audit just because and I don’t know again if they have shared some specific examples but it was brought to my attention by like several issues where they have to actually audit a couple of let’s say providers that have been credentialed of missing certain information. So this is where our team feels a little bit hesitant of letting go the process of really medallion let’s say owning the actual credentialing from beginning to end because when they have done several spot checks, they have noticed that they’re missing information. And obviously they could kind of fill you in with probably very specific information. But that’s one one of the issues that we have encounter. Yeah, I.
Rae Tompkins (08:00) think the more examples you can provide, I worked with Pauline previously on like a 50 line tracker, obviously with Pauline not being a part of our conversations anymore, that tracker unfortunately never got discussed. But I definitely think there are some opportunities that if there are something that you’re seeing in files that are missing, let us know. We’re I’m happy to update our processing guys so that our team has visibility into the things that carenu would like to see. Understanding that we follow our ncqa accreditation. Everything that’s in the file is something that we’re you know, we’re pulling because, we need to, we, you know, understand that it needs to be in the file. But if it’s something like collaborative agreements that’s not configured for carenu, but it’s an expectation that it be in the file. That’s definitely something that we can work to configure set the expectations and kind of alleviate the need to have to audit every single file, right?
Karla Glickman (08:54) Because, it, as you could probably see just to fit the purpose, right? Just kind of being transparent. If, if I agree in a perfect world, we would love for medallion, to really take ownership from beginning to end of those specific projects or providers and then, our team to really focus on the rest, which just has been pretty much a lot of back and forward where the audit has been taking pretty much longer than really doing, the credentialing beginning to end in house. I.
Rae Tompkins (09:27) Think one thing that would be helpful is if the care new team can provide… high level overview of what you’re seeing in files that are missing. Because I think what’s happening right now is the care new team is auditing medallion owned files, fixing the mistakes that you deem, you know, not necessary or not provided by medallion and not giving us visibility. So we’re never going to know if that’s something that care new needs to have in files if it’s constantly being worked in house. So, I think the more transparent we can be with things that you’re seeing, the easier it is for us to fix it on our end. Yeah.
Diana Rodriguez (10:04) Can, I have we’ve talked about, the collaboratives missing that’s something that I put on that sheet you were talking about that you discussed with Pauline. I put, all the errors I found for days and days. So you should have that, right? But most of this time what’s missing is, you know, the collaborative we’ve talked about that before, yeah.
Rae Tompkins (10:27) And the collaborative agreements was not something that we initially scoped to be part of our processing. And that was something I was hoping to discuss with Pauline. Obviously, the tracker never got discussed. So, I mean, that’s definitely something that we can add to our processing. I can shoot over an email just to, you know, obtain that information. What exactly you’re looking for? Who it applies for NPS? Pas. I think one of the last questions that we had asked Pauline is if the majority of the providers that we’re processing are Florida providers. If the collaborative agreement information is captured at the bottom of the PSV, is that acceptable? Or does care new require a hard copy form to be on file? They?
Diana Rodriguez (11:09) Require a hard form and it has to be within one year.
Rae Tompkins (11:13) Okay, perfect. That’s great context that’s something that we’ve never been told before. So that’s definitely something well, not as we’ve been asking the questions of building our tracker. It was identified that was something that was missing, but that’s like something that hasn’t been on our internal processing guide since we’ve started credentialing carenew files, but that’s definitely something that I can get added a physical form. Do you ask the providers directly for them to provide you the form or is carenew providing the blank form to the providers?
Diana Rodriguez (11:42) I do both, Rae, I’ll attach a blank sample so they’ll get the idea of what we want, and then they either send us the one they have, which they’re entitled to, right? As long as it follows the guidelines. And then I load it into medalli. Okay? Perfect.
Rae Tompkins (12:00) Do you mind sending me the sample template that you utilized so that we can have it on file for our outreach? Of course, and,
Diana Rodriguez (12:08) is that NPS?
Rae Tompkins (12:10) And pas, yes. Okay. And does that fall into the category of aprns… cnps? Aprns, like, you know, how specific?
Diana Rodriguez (12:22) Midwives, aprns… psychiatric, nurse, aprns, whatever you know, follows into that category, mostly aprns, and pas, okay. And nurse midwives, okay? Perfect.
Rae Tompkins (12:39) If you can do me a huge favor, if you can send me that via email, just an outline of who requires it, a copy of that sample template. A one year signature needs to be updated, if not collected… and then I’ll share it back with their operations team. And if they have any specific questions, I can reach back out. But that’s this is the kind of things that, you know, is great feedback so that we’ve identified an issue. I can get it fixed with the medallion operations team and we should alleviate any additional issues there.
Diana Rodriguez (13:11) Yeah. I think a conversation with me, you and Renay, like Carla says would have been great, right? Because we’re the ones that are doing it.
Rae Tompkins (13:19) And it was identified on the tracker that’s something we communicated back to Pauline that it wasn’t something that we were currently in scope to process, doesn’t necessarily mean we weren’t going to, but I think unfortunately, that conversation just not didn’t quite get through with, you know, the shifting of teams but definitely something that we can fix moving forward, yes.
Karla Glickman (13:40) And definitely, I could, Diana, when you send that, I believe you guys do what is called a kind of like a job aid, just kind of give you really specific of what is kind of required. You could just kind of probably copy and paste that to the email to Ray that’s probably going to help them kind of build that. What we want to do, put in into writing, write in an email or kind of like the scope is starting when you guys are going to start requesting the collaborative agreement. Once you guys are credentialing, you know, I do agree. Diana will send that information. You review it with your team and kind of come up with the proposed date of when that’s going to be established, absolutely.
Rae Tompkins (14:26) Once I get the information I’ll share with our operations team, I’ll get our technical team to configure it in platform since it’s not technically a requirement at the moment. That’s definitely something I can keep you updated as it’s built out and something as a go live date.
Diana Rodriguez (14:40) I’ll send you the job aid for the nurse practitioners, the pas. Well, I’ll send it to Renay and she can send it to you. And then I can send you a, we can send you a sample of the collaborative perfect that’d be great. Okay. That’s not that’s great. Yeah.
Rae Tompkins (14:57) Absolutely. Was there anything else top of mind, Diana that you’ve seen as you’re auditing files?
Diana Rodriguez (15:03) Okay. Sometimes I’ve looked in a file and the caqh has been expired, but of course, the file has been sitting there so that’s not. But what I have found is not enough training has been verified. In other words, the provider has internal medicine and nephrology and medallion will go ahead and do the internal medicine part, but they won’t go after the nephrology, meaning they won’t pull an ama or that extra is needed because our let’s say contracting contracted the provider to do internal medicine, nephrology. So, my job is to get both of those educations verified and I have to pull a lot of amas.
Rae Tompkins (15:50) Okay. Yeah. If you do, you have an example top of mind. I know we’ve talked about this previously with Pauline and I think what’s happening is and correct me if I’m wrong. The nephrology isn’t showing on the provider’s caqh application during import. So it’s not populating over to our system. No, it.
Diana Rodriguez (16:06) Is it’s populating it? Is? Okay. Yeah, let me take a look at that. But let me tell you, I think I put some on that excel because now I couldn’t I would have to go back now into all my receipts of the amas that I pulled, see which ones I pulled because there was an error and it’s going to be all mixed up with the ones that I pulled because they’re my files, carenu. So it’s just going to be a lot for me to do. I know.
Rae Tompkins (16:32) I totally understand. Let me pull up.
Diana Rodriguez (16:33) The.
Rae Tompkins (16:34) log, I’ve worked with Pauline on and see if I can identify one of the items that was flagged in that regard. And I already had our quality assurance team review this in preparation to speak to Pauline. So I can definitely provide some context via email on that particular item just on what we found.
Diana Rodriguez (16:51) Thanks, Renay. And just look at that report that we sent you. I tried to add as many little errors as I could just so we could get some feedback from you, but I never heard anything. And now, I know why I was thinking why hasn’t… anybody looked at it? Yeah. I didn’t think that anybody had looked at it to be honest. Oh,
Rae Tompkins (17:11) yeah, no, we had it ready and I think we had prepared to discuss it on one of our calls, which is definitely something that we can continue to do moving forward on our operations calls. We can go line by line on these trackers just so that we have direct visibility and obviously can continue these conversations. Okay? So, yeah, I’ll review this again, make sure everything’s up to date and I can share that via email, thank.
Diana Rodriguez (17:33) You? Yeah.
Rae Tompkins (17:42) All right. Is there anything else for today? No, I… think it will.
Karla Glickman (17:50) be beneficial. So probably, I know this is what you mentioned Ray is to kind of probably go over those specific examples right? On kind of like the next meeting. Okay? Again, it doesn’t have to be line by line. I’ll say let’s just kind of spot check a few, especially those with multiple issues like maybe not the ones, the one offs but those that maybe have multiple issues that we could kind of see and kind of discuss it. We would like to see just the report as a whole as well. But just for discussion next week.
Rae Tompkins (18:30) We did create a tracker and it was created on Google sheets. I can share it with the teams that you have direct visibility. Diana, in that instance, the provider that you just flagged regarding the internal medicine and nephrology, I do have a line update for that under medallion notes. So like you can see directly what our quality assurance team was able to identify. So I’ll make sure that this is shared with everyone on this call just so that you have it. Yes.
Diana Rodriguez (18:55) Share with me how I’m going to be able to look at that… you know, how I can find.
Rae Tompkins (19:03) Oh, yeah. It’s a link so I’ll share it in our follow up post call.
Diana Rodriguez (19:10) So, you know what I was going to talk to you about, you know, on the overview tab where we can see all the tasks like insurance is missing. This is, and then we get the three reach outs, let’s say on a couple. Now, I noticed that they were missing names. So I just rolled back to the credentialing specialist name, please, provider name, please, absolutely.
Rae Tompkins (19:36) I’ll re, flag that to the team to make sure that they’re putting the name in the subject line so that you have visibility into who we’re outreaching for.
Diana Rodriguez (19:44) Oh, good. Okay. Thank you. You’re welcome. Yeah.
Rae Tompkins (19:47) I see one request for update missing cui?
Diana Rodriguez (19:50) That’s me.
Rae Tompkins (19:52) If you don’t know who we’re reaching out for. So, yeah, I’ll flag that back to the team.
Diana Rodriguez (19:59) Just remember Ray, we didn’t know that we had to reach out. I mean, we didn’t know about that… really honestly. So I, yeah, no wonder. They sat there and sat there and sat there because I didn’t know that I had to look for them.
Rae Tompkins (20:18) Renay, did you have a question? I hope you’re on mute?
Diana Rodriguez (20:26) Regarding facilities going back like to September when I started loading them into medallion? Are you guys doing like ongoing monitoring even though they’re not moved forward for like the psvs?
Rae Tompkins (20:45) If we’ve processed the file, we’re pulling the oig, Sam, those?
Diana Rodriguez (20:51) Items are being pulled on an ongoing basis. Just.
Rae Tompkins (20:56) The one time when the file is uploaded, just.
Diana Rodriguez (20:59) The one time? Okay? And do you know if.
Rae Tompkins (21:02) just the.
Diana Rodriguez (21:04) one time is good enough for like ncqa CMS audits or anything like that or?
Rae Tompkins (21:12) Is it, I need to double? Let me double check internally. I know the verifications are valid for a certain amount of time. I think there’s a little bit of gray area in regards to ncqa and facility files, how long those verifications are valid for once pulled and put in the packet. I think we had previously spoke that if carenu, identifies that the verification on file is older, we can put a process in place where we archive the existing facility request and re, request it for our team to rework, I think I had researched that. Let me see if I can find it in my email and I can definitely send it in a follow up. I’ve reached out to the team for clarification on how long those verifications are valid for, but I can definitely follow up. Okay?
Diana Rodriguez (21:53) Because I noticed, like with the hanger, I forget the whole name of this hanger, their applications have expired, and I noticed that recently they started putting in the data bank and the preclusion into it. So, but it has to be done all over again since like the insurance and application have both expired. Okay. Yeah. So it’s something that’s I’m sorry, go ahead as you’re reviewing.
Rae Tompkins (22:23) Those, and you notice that the verifications are expired. If you’ll shoot me over an email. That way, obviously, we don’t want our team to pull the CMS preclusions and mpdbs if the work needs to be reprocessed. But if you’ll let me know as you’re reviewing files that need to be reworked, I can go ahead and archive them that way, you know, both teams have an opportunity to kind of catch up.
Diana Rodriguez (22:44) Okay. That’s perfect. Thank you. Just.
Karla Glickman (22:45) To piggyback Renay, I know you probably have more questions, but just to piggyback on, I know you mentioned that you guys for facility and for both, right? Ncqa guidelines for both facilities and providers, have you provided what those kind of like specifics that you guys look for both for providers and facilities? Have you provided that before Ray?
Rae Tompkins (23:13) The verifications we pull for both. Yes. Okay. And that was in our follow up we had on our conversation Wednesday, we kind of went on a high level overview. Yes, that was, yeah, on provider guidelines. Got it. Okay. I got the email. Yeah. Okay. Perfect. Yeah.
Diana Rodriguez (23:29) So, my next question is so… on the verifications for the Samp gov. I’m still not seeing the date stamp and that was supposed to be implemented on 129 for the document that Karla shared with me the other day. Do you have?
Rae Tompkins (23:52) A specific example of the ones that you’ve seen that did not have that just so I can use it as a.
Diana Rodriguez (23:56) Talking point to our team. Okay. Hang on. Let’s see.
Diana Rodriguez (24:07) I have hanger. The mpi is one four, eight, seven, seven, four, three five, three zero. Oh, perfect.
Rae Tompkins (24:17) That was the one I just pulled up. Let me, let me share that back to the team so that they, and obviously, I’ve expressed the urgency that we need to make sure that those are being included, but to provide a specific example back to the team, I’ll make sure that they’re aware of that same thing with.
Diana Rodriguez (24:32) The clias, they don’t have date stamps or anything. Okay?
Diana Rodriguez (24:45) Then I noticed that we have providers sitting in credentialing, but… they’ve already been credentialed. I mean, sorry, in committed, but they’ve already been credentialed and so when I look at the provider’s name, I go into like the history and I can see that they’ve already been credentialed. So I don’t know how to get those out or move forward, but I can send you the spreadsheet that I’ve been working on and maybe you can look at it and see what’s going on. So they’re in.
Rae Tompkins (25:24) committee, but have already been approved. Yes. Exactly. Okay. So we would need a vote to be made within platform. And then once that date is made, I can update the approval date on my end. But in order for us to do anything, they need to be voted on out of committee.
Diana Rodriguez (25:44) Okay. Even though there’s a date already in medallion, do you have an example of a.
Rae Tompkins (25:49) provider.
Diana Rodriguez (25:50) let me get my spreadsheet.
Diana Rodriguez (26:12) Thank you. Several spirituals in one second, no.
Rae Tompkins (26:18) Worries.
Diana Rodriguez (26:27) thank you.
Diana Rodriguez (26:44) Thanks. I thought I had it open. I might have to send it to you. Yeah, that’s.
Rae Tompkins (26:52) fine. If you’ll provide me an example, so I can investigate what may have happened, but everyone that’s in committee will need to be voted on. And then I can adjust the dates post approval, say they were already approved back in end of March, but the date was just voted on today. I can update the system to reflect that March date. But if someone is showing under committee that was already approved in platform, I’ll just need an example to kind of investigate with our tech team.
Diana Rodriguez (27:21) I think I found it. Okay. I found it. If you look at, let me spell the name for you. It’s a y ESH a last name is KIETZM a N and… P, I is one, three three six seven, zero, three four six one, which is a P a. There’s a date in their credentials of 10 18 of 24.
Rae Tompkins (28:01) Let me take this one offline and see what I can figure out. I can’t find them right now in platform, but I may have just typed the MPI or name misspelled. So I’ll if you can send me that via email, that way I can investigate and I’m happy to provide an update. Okay?
Diana Rodriguez (28:15) Thank you. And then I also noticed that there are like some doubles of facilities. So if I just send you the names and the MPI’s you can take those duplicates out. Yes.
Rae Tompkins (28:28) I’ll clean those.
Diana Rodriguez (28:28) Up.
Diana Rodriguez (28:38) That’s it. Well, I know one more thing I’m sorry, no. So in medallion, there are providers sitting in, let me get my medallion back. There are providers sitting in requests for medallion since I believe March third. So I was just wondering, are you holding off on credentialing… or is there just… communication gap or something?
Rae Tompkins (29:17) I want to double check. There are currently only four files sitting in the request queue that are app complete. Some of the names being Patrice, Torrence, Kimberly ristu, and Julia mahanin, let me follow up with the team for an update on those. I can see everything.
Diana Rodriguez (29:37) Looks.
Rae Tompkins (29:37) Good on my end, but I want to see why they’re not moving. So I’ll definitely provide an update. But if there were any other names?
Diana Rodriguez (29:43) Okay. I have it working on the rest of them because they did not import correctly. Okay. So I have them working on that.
Diana Rodriguez (30:01) I think that was it. Were.
Rae Tompkins (30:05) There anything else? I know we’re right at time. Thank you. Yeah, absolutely. I’ll send a follow up email. I’ll get this tracker sent over. So everyone has visibility and then we will continue conversations, Diana. If you’ll send me that information for the collaborative agreements, I’ll get that worked perfect.
Diana Rodriguez (30:26) I’ll be happy to do it. Thank you so.
Rae Tompkins (30:27) Much. Everyone. Thank you.
Diana Rodriguez (30:29) Bye bye. Thank you. Bye bye.