Transcript
Leigh Howle (00:00) good morning, Ken. Hey, Lee. How you doing? I’m doing good. How are you?
Ken Haupt (00:07) Doing well. Thanks.
Leigh Howle (00:09) Good.
Leigh Howle (00:15) Are you a golf fan? Did you watch the masters this weekend? Oh, absolutely.
Ken Haupt (00:20) I did. Yes. Yeah, it was awesome. It.
Leigh Howle (00:24) Was it was a roller coaster there at the end?
Ken Haupt (00:29) It’s always a great weekend. So, pretty. And, yeah, just a lot of fun.
Leigh Howle (00:35) Yeah. Did you go? Were you there?
Ken Haupt (00:37) No, it’s on my list. It’s on my bucket list, so.
Leigh Howle (00:40) We’ll see someday. Yeah, I know my husband’s a big golfer too. He played with his grandfather, and he’s always wanted to go. So, I think we’ll put it on the list as well. Yep. Thank you.
Leigh Howle (01:04) Bye Carol.
Leigh Howle (01:13) Good morning. How are you?
Carol (01:15) I’m good. Thank you. How are you?
Leigh Howle (01:18) Yeah, doing good. Good.
Carol (01:20) Good morning, Ken. Hi, Carol.
Carol (01:27) Enjoying the weather, Ken? Absolutely.
Ken Haupt (01:29) I.
Carol (01:30) know me too.
Carol (01:40) How’s your weather Lee?
Leigh Howle (01:42) There, same, it’s beautiful. Beautiful, right?
Leigh Howle (02:03) Should we go ahead? Let me, I’ll just share my screen. At least we can go ahead and get the agenda pulled up. Yeah.
Carol (02:10) I know Michelle is going to join. I don’t know if Laura is back yet. She had appointment this morning. So, and I’m not sure about Linda.
Ken Haupt (02:31) Had some wicked tornadoes go through Minnesota last night. I don’t know exactly where Michelle lives, but, oh,
Carol (02:38) no, that.
Ken Haupt (02:39) Was crazy stuff going through there?
Leigh Howle (02:44) Oh, I didn’t know about that. I hope everybody.
Carol (02:46) Yeah, me too. I didn’t hear about that.
Ken Haupt (02:50) I’m kind of a weather nerd, oh, okay.
Ken Haupt (03:15) She’s logged onto her system. So she may be just trying to get off another call so that’s good.
Carol (05:21) It looks like she’s still in a car.
Leigh Howle (06:24) Should we go over the ones on here, Carol that you added? Or should we wait?
Carol (06:30) We, can… she’s reading my message now? Okay?
Leigh Howle (06:39) On Nicole cumbo, huh. Did you want the surrogacy to go ahead and be approved?
Carol (06:48) Yes, we did okay. So we can, because we can’t submit enrollments until the first of may. So we wanted to have that already taken care of… that’s. Okay. Oh, Michelle said she’ll be here in a sec. She was running over in another meeting. No.
Leigh Howle (07:11) Problem. Okay. Awesome. I will go ahead and let support know if they could just at least move the… medicare line so that the surrogacy could be requested. Okay? And then once that, you know, there’s a task that’s always sent out for the provider to approve that surrogacy. I’ll just add a note in there to wait until the provider has finished residency before submitting the application. You know, they will, medicare will require the provider to have a full active license for enrollment as fee for service, correct? Yes. Okay. So then I’ll just add a note so they, so the team doesn’t submit it. Okay? And did you want to go over Timothy gorski in Indiana?
Carol (08:03) Oh, yes. So, he’s decided to join. Looks like his enrollments were stopped on four six… Jennifer, she was getting ready to term him, and we got an email from the care center saying that he decided to join. So, can we restart his enrollment? Okay?
Leigh Howle (08:26) Oh, yes. Absolutely. Okay.
Carol (08:29) Great. Yeah. Would you, if.
Leigh Howle (08:31) you don’t mind, would you send that to support and CC me on it? Okay. And then that way I can push that through and make sure that those get restarted. So when is he, like, what’s his official start date?
Carol (08:47) If we could let me see, I think it’s.
Carol (09:00) cause it looks like the enrollments were all sent out. So he’s can we use the same? The three one date for this year? Yes, keep that date. Okay. Yeah, cause the enrollments were submitted. Yeah, we can keep, we can just keep that date. That would be great.
Leigh Howle (09:25) Okay. Sounds good. Okay?
Michelle Jared (09:29) Hi, Michelle. Hello. Sorry about that. I just finally had to leave. I mean, I needed to be part of the conversation, but like it’s way over.
Leigh Howle (09:40) Yeah. No worries. We just, Carol just had a couple of things on here for Nicole combo for medicare and I’ll go ahead and ask our intake team to at least push that medicare line through so the surrogacy can go ahead and be in place before he is out of residency in may.
Leigh Howle (10:01) And I’ll add a note onto the line so the team doesn’t submit the application until residency has been completed. Oh, Nicole, for her?
Michelle Jared (10:10) Yeah. And that’s something we had talked to you about a few weeks ago when we were trying to work on things that cause slowdowns and this was one thing because the surrogacy never expires. So we can just get that like right away set up, then that’s one thing we aren’t going to get overview tasks on later, right?
Leigh Howle (10:30) Yeah. I think it’s a great idea and, you know, I think we could also have like forms already in provider profiles like for Indiana, the ihcp form is something that is required on applications. And this is a great example. And you all already get the medicare, the certification statement signed by providers. So they don’t have to E, sign applications. So anywhere that there could be a reduction in tasks and an increase in efficiency on board 100 percent. And then we just talked about Timothy gorski and, you know, he left and Carol was saying now he’s back. So she’s going to send that over to the support team to have them reopen those enrollments and CC me on it.
Michelle Jared (11:26) Great. And then there was one other thing I didn’t get added on here. I sent you the horizon information for the delegated pre delegated audit. Just wanted to make sure that you saw that email and it’s a very fast turnaround time?
Leigh Howle (11:43) Yes, I saw that the 20 seventh.
Michelle Jared (11:45) Yep.
Leigh Howle (11:58) Yes. I, merit is actually, she’s out of the office right now, but she is kind of checking in with internal messaging. So I am going to send that over to her as soon as we get finished with the meeting. I’ll respond to your email and then we’ll figure out what next steps need to happen. I can also schedule a meeting if there’s anything in details that we need to review prior to then just to make sure that everything is in place and ready to go by 427. Okay?
Michelle Jared (12:29) Yeah, because basically everything that’s on that checklist, you guys are going to have to provide for your team too. Because anybody, they said basically the universe in their definition is anything, anybody who touches credentialing or pay enrollment. So, yeah.
Leigh Howle (12:46) I’ve seen these before. I mean, it’s common other, you know, payers do require these. And merit is a lot more familiar on how to complete this and she’s probably already got all the information stored from previous pre delegation audits. So yeah, it shouldn’t be a problem.
Michelle Jared (13:05) Alrighty. Well, thank you. I just wanted to make sure you saw that email. And because it is quick, I’ve been going through our stuff that I got and trying to match it up to the checklist. And ugh. Yes… got it. Thank you. Yeah, thank you.
Leigh Howle (13:26) Should we go back to the cois for pa? We can? Okay. So… if I’m the verbiage was incorrect on the missing the medicare information? Yep. Can you give me a little?
Michelle Jared (13:43) Yeah. So it looks like they don’t have enough coverage and we’re getting overview tasks because they don’t have, they’re the payers are pushing back saying they don’t have enough coverage because they participated in the mcare fund and that verbiage was not on the Coi.
Leigh Howle (13:56) Oh, got it. Okay. And that makes up for that difference in the coverage that’s required. Yep. Okay. So is this all providers and pa that will need that updated? Yep. Okay. That’s good to know. And yeah, caqh team is great. You know, last time the cois came in, they very quickly went through and updated and attested. So we can have a certain like, you know, I would definitely mention in the support request to have this done by a certain date just to give them a target to have this completed. And the wellcare, I think the wellcare meeting went really well. Actually, I responded back to Joyce and CCG on the email, Michelle, it was fantastic. It was the full hour. I’m not sure if Linda or Laura got the chance to fill you in on the meeting. They are in a backlog. And she did send over all of the providers that are currently in process. She sent the full par roster. So I am going to meet with our team internally to go over the workflow, have them review that par roster and complete any enrollments that can be completed. And then the case numbers are already, I already added them onto the excel that’s how she wants the follow up to go. And if there’s any providers that are not on a case as, you know, being in process and not on the roster, the team will resubmit those and we can talk to Joyce. I already asked her to expedite anything that comes through and she said she would. So it was, I feel like it definitely is on the right track now and the meetings are bi weekly, and she is sending a par roster every two weeks, the team, she wants submissions every Friday. I mean, I put all that in the email, so, but yeah, I think, it went well… and.
Michelle Jared (16:04) Those meetings are every other week. I just want to make sure, oh, yeah, the wellclear collaboration.
Leigh Howle (16:09) Yeah.
Michelle Jared (16:09) Okay. I’ve got it on my calendar. Just wanted to make sure I did.
Leigh Howle (16:13) Yeah. So that was good. I’m so glad we finally got to meet. She said she was just going to work all regional. She’s she was familiar with the group. She previously had some connection, not really sure on the details with regional. So, it was really good to just connect with her. And she said, I’ve seen the emails going back and forth with Molly on the payr name enrollment update. So we’ll just continue to follow that and just kind of pause, this piece of it until, that has been finalized.
Michelle Jared (16:57) Yep. I have to share that back with Mike… but I just kind of explained to him, you know, all the problems this is causing with reporting being clean and… he agreed that it needs to be cleaned up and it would be, and we need the lines of business because if we take that out, then the team’s going to have to call on all of them to find out what line of business it was for. So it just causes more work. So honestly, he felt that, you… know, let’s get it cleaned up. Yeah.
Leigh Howle (17:33) And a lot of clients have opted to go that route just because, it is so much more concise on reports and for their, for scheduling it’s just, you know, one pay or the line of business is their effective date. It’s all just, it’s a lot cleaner. Yep. And.
Michelle Jared (17:53) I mean, this still stems back from when we onboarded like with our naming conventions coming out of modio and right? You know. So, this is a long, a… couple of years of stuff that, you know, is inconsistent. So it’ll be good. Yeah.
Leigh Howle (18:11) Yeah, I agree. So. Okay. And then, was there anything else there’s? The agenda is pretty light today?
Ken Haupt (18:22) I had a very important agenda item since Michelle joined Michelle. Are you safe up there? What the heck was going on in Minnesota last night?
Michelle Jared (18:29) Yeah. With the weather, yes. Yeah, that was south of us. So I know it was lots of tornadoes and huge amounts of hail and yeah, it was just north of Rochester. Minnesota is where all that happened. Yeah.
Ken Haupt (18:45) I didn’t know specifically where you lived. I saw everything lighting up in Minnesota. I was like my gosh.
Michelle Jared (18:50) Yeah. Well, we were, it stayed to the south of us because we were expecting to get hit here too, but it was quiet as could be good. Good. I live in the Minneapolis area. So, okay. Bye. Yeah. But thank you for asking. Yeah, glad you’re safe and I think we’re supposed to get snow on Saturday. What? Oh, no, yeah. Oh, wow. It’s like a 50 percent chance. I’m like what? No… that’s crazy bipolar Minnesota weather.
Leigh Howle (19:22) Yep. Yes. Glad you’re safe. Thanks.
Michelle Jared (19:31) Yeah. I’m just trying to think in my head. I know I have a meeting. I was supposed to have a meeting with Amy today, but I was triple booked at the time when our meeting was. So she moved it to Friday. Still kind of working through. I do have one thing, do you know?
Michelle Jared (19:45) And this just baffles me and I just kind of learned this. Do you know? Not one single report has completed date on it as a criteria or an element?
Leigh Howle (20:00) Are you, which type of reporting? So?
Michelle Jared (20:03) Let me, let me steal the screen if that’s okay. Yeah, sure. Oh, which one is it? Oh, there, I think it’s this one. Okay. So, you know, we’ve been busy trying to figure out, you know, like measurements for like request… to completion date and then kind of the front end, which is the request to a submission. And then the last submission to completed. So there’s those metrics, and then we’re trying to parse out just new providers. What does it take from request to completion? For all enrollments? Like for it to become 100 percent credentialed. So I started looking through these reports and they’re… like report builder doesn’t have it either if you do the try to do like a cut, there’s no completed date.
Leigh Howle (20:59) So, in the report builder, you have to, if you use the last note date?
Michelle Jared (21:06) But that’s not always. It doesn’t always equate and that’s what we were doing, but we were finding it’s not completely accurate. So I started, I downloaded, I think it was here. I think I still have it open. I don’t remember which report it was now, but even on this one, there’s requested date, there’s all kinds of stuff on here, but there’s no completion date, app, submission date where I found it is in notes. And again, this makes it really hard to do any sort of analysis. Now, this does equate to the last note date. But if it’s still in progress, like it doesn’t necessarily mean it’s the enrollment’s completed because it could still be even follow up.
Leigh Howle (21:57) Yeah, there’s definitely a way to track it with completed. Let me look at, so.
Michelle Jared (22:06) I used copilot to pull in note details. This enrollment was completed, but I’m like why is there no, not a single report has a completed date column. It’s got everything else. No completed date?
Leigh Howle (22:21) Right. And it’s always been that way. You know, there’s never had a status of completed, but when there’s an effective date given for the provider and the provider has… yeah.
Michelle Jared (22:36) But that’s not necessarily true either because like some of our providers came in and like for revalidation purposes… yeah, I don’t know anyways. I just thought I would mention that because it’s really hard to get to like really clean data and metrics… and we were using the last note date, but it’s… not always.
Leigh Howle (23:05) What about under analytics?
Leigh Howle (23:13) Payer enrollment and down at the bottom, there’s a successful enrollment under analytics, the payer, oh, and I did double check with Molly and the date range did filter correctly. I don’t know what happened last week when I couldn’t get that to filter, but it can be filtered. But under the payer section, there’s a current status and it has successful enrollment, follow up enrollment stopped.
Michelle Jared (23:48) I’m not, where is that at?
Leigh Howle (23:51) It’s towards the bottom. Let’s see under, you know, that payer turnaround time section that we looked at last week.
Michelle Jared (24:00) Well, now, it says median turnaround times.
Leigh Howle (24:04) Right. Yeah. But if you’ll keep going is.
Michelle Jared (24:09) That, the, very, yes, that’s all I got.
Leigh Howle (24:11) Right here. So current status?
Michelle Jared (24:13) Where do you see successful?
Leigh Howle (24:18) Current status, has it in the third column from the left?
Michelle Jared (24:24) I do believe this is the report I used.
Leigh Howle (24:28) Yeah, there’s a successful enrollment on the second row for Sarah packman with clover health.
Michelle Jared (24:40) So, this is new. This has not been here before. I know that they just updated the reports, but this has a request completed date on it.
Leigh Howle (24:52) Yeah. I think… I know this is definitely new and I know the last time we looked at this, you were asking for it to have the last submission date because there were times when there could be resubmissions and you wanted to calculate the date from that second resubmission until completion. And this was where we… went. So it’s intake, complete, first app submitted, request… completed to request, completed request… a first app submitted.
Michelle Jared (25:33) I don’t see anything about resubmission?
Leigh Howle (25:35) Yeah, I don’t either, but.
Michelle Jared (25:38) This definitely would help me get to a, the.
Leigh Howle (25:41) completed part.
Michelle Jared (25:42) Yeah, because that, yeah, I mean, I literally dug through several reports Thursday last week trying to find something. And the best I could find was this report that had the comments. But then, yeah, yesterday, I noticed we have this, all of your existing analytics reports now have a refreshed look. This is, so this is all new like. So I did not know that this was down here. Let me try to, I’m gonna down, oh, my goodness. Can I?
Michelle Jared (26:24) Is there no way to export this? Oh, wait there. Now, it just appeared, yeah, the three dots…
Michelle Jared (26:40) Let me try to play around with this report. Okay. And,
Leigh Howle (26:44) then if you’ll go back up, you know, how last week we had talked about the median turnaround time, calendar days and trying to filter it down by the date range?
Michelle Jared (26:54) Request to complete total 47 days. Is it that can’t be right?
Leigh Howle (27:00) Yeah. So if you go.
Michelle Jared (27:02) Oh, wait there’s like four filters on here.
Michelle Jared (27:08) That cannot be right for the last 12 months, an average of 47 days from request to completion.
Leigh Howle (27:18) So, in what filters do you have set? I?
Michelle Jared (27:22) Don’t have any set? These are automatically on here, but.
Leigh Howle (27:28) Yeah, I don’t have, any filters,
Leigh Howle (27:36) But I did org, and then I selected Axia, still brings up the same data, but there is a way to filter this down. So, right now, mine is showing the last 12 months. So it goes from 420 25 to 320 26. Yeah. And that date range can be changed. So, I know last.
Michelle Jared (27:56) How do you do that last week?
Leigh Howle (27:58) You can select in the last, you can do like between you can do on before.
Michelle Jared (28:05) After, oh, I see. Okay. So if I do like March 20 25.
Leigh Howle (28:22) It didn’t change.
Michelle Jared (28:23) It, nope, it sure didn’t… let’s try.
Michelle Jared (28:50) I still don’t does that seem accurate to you Leigh 55 days to turn around and what?
Leigh Howle (28:56) I, I’m wondering if it’s filtered for demographic updates and it doesn’t include new enrollment? Yeah, no, it doesn’t seem right? New enrollments go anywhere from 60 to 120, and then wellcare’s, been going for a.
Michelle Jared (29:13) 180 days.
Leigh Howle (29:15) Yeah. I don’t.
Michelle Jared (29:21) if I do all… I mean, it’s still the same number of whatever that is. Nope. It didn’t change it. It looks like there’s four filters on here though. Like wait, here, we go. Turnaround time name. I don’t know what SF product name means.
Leigh Howle (29:43) SF product.
Michelle Jared (29:46) Oh, here.
Michelle Jared (29:55) That still didn’t change it.
Michelle Jared (30:00) Yeah, it just, it doesn’t seem accurate to me.
Leigh Howle (30:05) Yeah. Let me, I’ll play around with it a little bit and I’ll get in touch with Molly or someone in our tech support team and just kind of ask if they can give me a little clarity on where that’s pulling from. I’d like to know who are the payers? And I’d like it broken down by provider demographic updates, new enrollments, revalidation, yeah.
Michelle Jared (30:32) Yeah. Are.
Leigh Howle (30:33) the group enrollments included in that? Or is this just by provider? Yeah. So, I think there’s a few more pieces to kind of pull together here.
Michelle Jared (30:46) Yep. I agree. But in the meanwhile, I think I might be able to use this to at least get to the completed. Yeah, because I mean, look at this. Look at these intake to complete request, completed. Look at all these days here. Like, there’s no way it could be 50.
Leigh Howle (31:03) No, yeah. But these seem accurate. So, there should be a way to take those numbers and get an average. Yep. Yeah. Okay. Well, at least there’s the data at the bottom is helpful and that will be able to get you the numbers that you need.
Michelle Jared (31:21) Yeah, I’ll play around with that and see if that’ll and kind of compare it and see like I said, it’s really hard to use comments like in an analysis, so.
Leigh Howle (31:32) Yeah, that makes sense. Yeah.
Michelle Jared (31:35) So, I’ll give that. I’ll give this report a try and play around with it a little bit. Okay. Awesome. And then, yeah, if we can continue working on, this would be great if we could get this accurate because these are the measurements I need like the first app to submit it. So like this is what we are deeming to be the back end. And then the front end requested to first app submission that’s like the front end, the back end. And then what is it overall, right? So request to complete?
Leigh Howle (32:06) Yeah, that sounds good. Yeah, I’ll work on it.
Leigh Howle (32:08) And then, you know, if I can get any insight into where this is pulling from and a little more dig into the data, I’ll definitely send you an email and let you know and I’ll reach out and yeah, I’ll send the report if I can get it or just give you some instructions on how to access it. Okay? That would.
Michelle Jared (32:28) Be good. Okay?
Leigh Howle (32:30) Awesome. Hi, Linda. Hey, sorry, I.
Linda Lipschutz (32:33) Was, I had an appointment but I figured I’d hop on.
Leigh Howle (32:37) Yeah, no problem. No worries at all. I hope your appointment went well.
Linda Lipschutz (32:41) Yep. Just dental, you know, they don’t have evening. So, yeah, gotta get those teeth taken care of.
Leigh Howle (32:50) Yes, very important. Yeah. All right. So, I’ll go ahead and share my screen and we were just going over the app’s like the reporting. And then we’ve already covered the agenda. It was pretty light today, so I moved on to the weekly review.
Leigh Howle (33:14) And to go over the outstanding enrollment request for the 120 plus, there was not a change from last week.
Leigh Howle (33:21) There were 94 last week in the 120 plus. And again, there were 94 this week. The 190 to 120 had a slight increase by eight. And for needs client attention, there was a decrease by nine. Oh, wait, that is an increase by nine. Let me update that.
Leigh Howle (33:53) Okay. There we go.
Leigh Howle (33:59) I’m pretty optimistic that once wellcare gets back on track that the meeting with the rep was productive and that these will start to go down, the majority of these are wellcare coming in at 43. And then the rest are pretty small community health, direct independence has been going great with those meetings.
Michelle Jared (34:26) Yeah, we’ve really made some great strides there and horizon too is going much better now that we’re meeting with them routinely.
Leigh Howle (34:35) Yeah, they’ve fallen off this for sure.
Linda Lipschutz (34:38) Yep. Yeah. If we can get wellcare going… we’d be in really good shape.
Leigh Howle (34:44) Yes, right. That’s the last one. Laura did a great job getting Joyce.
Linda Lipschutz (34:51) Yeah, she did. She did.
Leigh Howle (34:53) Yeah… for follow up. So as of today, there are 394 lines that are current for follow up. There are 31 lines that are overdue for follow up. And there are 104 that will be done this week. And I’m not sure why these have popped up this week. Usually, there’s been none in the seven plus overdue columns. And then just these random ones came up today. So I’ll definitely be going over those with the team when I meet with them and just finding out, you know, identifying these payers and making sure they’re focused on getting those current.
Michelle Jared (35:34) You read my mind. I was going to ask that question, so.
Leigh Howle (35:37) Yeah. Where did these come from? Right? Yes, I was wondering the same, I can drill down into it when and identify the payers. So I think that might be, let me go this way. And then for rosters, there are 516 current roster follow ups there are 22 overdue roster follow ups. And we kind of had the same pattern emerge right here. There’s just a random five that show in the 50 plus overdue category. So I’ll be, I’ll definitely drill down on these columns, the 14 to 28 and 50 plus… and go over those with the team, make sure they get those current. This is a new look. So kind of what we went over earlier on the analytics stashes. So there are, this is request by completed. And there are 242 completed requests for the month of April, and it’s been broken down into a little more details as far as what comprises those completed enrollments, you can see that most of these are from provider or group demographic updates. There’s a piece that are payor enrollments which would be like new enrollments. And then just a tiny little fraction for provider or group revalves.
Leigh Howle (37:03) I like the color coordination on it. I like it being broken down into those details to get an idea of where the bulk of those completed enrollments come from.
Michelle Jared (37:14) Yeah, I like it too. That’s a nice visual.
Leigh Howle (37:19) And then for just overall week over week volumes, there were an increase. We had an uptick in requests for medallion. There were 210 intake, passed, 208 of those over to be submitted. The team got 186 out the door and there were 153 enrollments completed tasks are maintaining pretty steady for 66 coming in this week for outstanding tasks.
Leigh Howle (37:50) And then on credentialing, there were two credentialing files approved for ready, and there was one that was requested as, you know, a new cred file.
Leigh Howle (38:06) And that concludes the opsync deck open for any discussion or any other questions or anything else to go over?
Michelle Jared (38:19) Nothing that I can think of.
Leigh Howle (38:22) I don’t have anything. Oh.
Michelle Jared (38:24) Linda, one thing since you weren’t on, we need to, as Jennifer is working on the Coi uploads, we need to have her put a list together of all the names, and then we have to open a ticket with the list of names for… their team to update caqh.
Leigh Howle (38:48) Okay.
Linda Lipschutz (38:52) I will ask her to compile… a list.
Michelle Jared (38:57) Perfect.
Leigh Howle (39:06) Let me just add on here the report.
Leigh Howle (39:23) Okay. All right. All.
Michelle Jared (39:26) Right. Well, thank you very much. Yeah.
Leigh Howle (39:28) Thank you. I appreciate it. And we get some time back.