Transcript
Naomi Denson (00:00) hi, Greg.
Gregory Campbell (00:01) Hey, good morning, Naomi. How’s it going?
Naomi Denson (00:04) Good. How are you? Good. Okay. Just Barrett and Nicole here. How are we looking on the data?
Gregory Campbell (00:17) Looks like there’s still corrections to be made, but I think it’s getting closer is what it looks like.
Naomi Denson (00:24) Well, that’s good. Let me, let Barrett cool.
Naomi Denson (00:34) About Don and Jonathan. So… in this.
Naomi Denson (00:53) Hey, everyone. Hey, how are you? How’s it going?
BarretPickering (01:00) It’s wonderful. How are you?
Naomi Denson (01:02) Wonderful, Barrett. You’re always so chipper.
BarretPickering (01:07) And I,
Naomi Denson (01:08) don’t know now if you’re being sarcastic or not.
BarretPickering (01:11) Every day is a great day. Naomi, until we have to talk about credentialing and enrollment.
Naomi Denson (01:18) I, at my last job, just a side story. We had a, this like, I don’t even know what to call him. He was like a motivational speaker type Guy that like came into the workplace and like he was very excited all the time and every meeting we had with him, he would open it up, be like… today’s going to be a great day. And do you know why? And then we were all supposed to chant because every day is a great day. It was that when you just said that Barrett, it just made me think of him. I.
BarretPickering (01:53) can tell you. I’m not paid to be emotional motivational speaker, unfortunately.
Naomi Denson (02:02) Give me one second. Guys. Let me let my dogs outside really quick and then we’ll get started.
Naomi Denson (02:23) Okay. Sorry about that. Okay. Let’s jump right in. Greg. Do you want to walk through the data as it stands?
Gregory Campbell (02:35) Yeah, sure thing. Hey, everyone, I’m realizing my sheet for some reason is taking a bit to load all of the cells, but happy to sort of talk through if you guys had any questions, it looks like there’s been quite a bit of progress made to the template so far? Oh, here it comes.
BarretPickering (02:51) Yeah. So here’s what I’m thinking. So we’ve done a lot and it’s about as good as it’s going to get potentially a lot of these error codes are postal codes because they start with zero. So I don’t know if they’re actually issues. And then I was thinking we could just generate kind of a fallout report of the information we don’t have that we’re going to have to go gather. So that way we could just get going on this thing. I don’t know what your thoughts are on that. And then we have time carved out tomorrow to talk through a lot of the payr stuff. Okay?
Gregory Campbell (03:32) So, for the ones that do have the address, postal code missing a zero, we will need that entered before we load it into medallion.
BarretPickering (03:40) It’s not, I don’t believe they’re actually missing a zero. We’re.
ClintAnderson (03:46) just.
MatthewSpurling (03:46) going to add the leading zero?
ClintAnderson (03:47) That’s just a simple formatting thing. Yeah.
BarretPickering (03:50) Okay. Same.
MatthewSpurling (03:51) Thing as we did last time we were on the call, we’re just going to add an additional zero to the beginning of the format for that call.
BarretPickering (03:56) Well, we can fix that. That’s not. Yeah, that’s an easy fix. Okay? Sweet.
MatthewSpurling (04:03) Greg, you did that for us last time? You did the exact same thing. I forget. I think it was for the social security number?
Gregory Campbell (04:10) Yeah, that’s possible. I mean, for those, yeah, that’s something I can take a look at. I might be able. I could have a quick fix out for that for you guys. But all the other ones, like I did notice errors like this base profile already exists in medallion. It’s like this provider, for example, we already have in your instance.
BarretPickering (04:30) Yeah, that’s fine. She can just drop off of this sheet if she’s already in there.
Gregory Campbell (04:35) Yeah, perfect. Okay. So, if you guys are okay with me removing rows like that, I can go ahead and help out. So like this one, for example, this provider’s already in here.
BarretPickering (04:48) The ones that are essentially left, I didn’t do the exact math but whatever’s left in there that’s I… don’t know where all these went.
BarretPickering (05:02) I don’t know how our provider list dropped through. Oh, mine’s just not loading the ones that have email and… of all the ones that aren’t getting uploaded, it’s just gonna take time and we can manually enter those, but we’re gonna have to just reach out to these affiliates and I don’t really feel like we should hold up everything else to just try to get this exact. If those are the two issues on a provider, let’s just make it like a fallout list. Is that possible?
Gregory Campbell (05:40) So, we try to make sure we get all of these loaded just in one go if possible.
BarretPickering (05:48) It’s just not gonna be possible because there’s a few 1,000 of these and we just can’t get a hold of them to get this information fast enough to where it’s gonna matter. And I don’t know if anybody else has any thoughts on that.
ClintAnderson (06:06) No, I’m in agreement with you Barrett. I mean, we need to move forward with it with where it’s at. Especially I think part of the challenge too is like we can’t filter this report. You know, some of the challenges with the leading zeros, it makes it look like something is, you know, wrong when it’s not. So we don’t we end up working the same thing, twice, right? So we need to get to a point where we can like actually truly see what is, you… know, not… acceptable and what is… I don’t know who’s fixing the lines as we speak, but you can see, you know, there’s more dropping off because somebody’s probably fixing a leading zero or something. So I think we just need to get to a point where we can put this in, see where we’re at and then we can work the remaining exceptions. I.
BarretPickering (07:09) Guess my question is like, you can.
Gregory Campbell (07:13) help out here, Clint. So with the filtering, we are able to filter this report for everyone if possible. We do have this feature right here. I usually start with row seven just because that’s the last of the header rows. So, for example, if you wanted to only filter for the rows that have issues with the postal code, once you’ve added this filter, we can clear and then only filter for rows that have only the postal code error. So that’s something that I use when cleaning up the data, I just want to make sure you’re on the same page with that. But I can, Naomi and I can take this internally just to determine how we can best proceed given that the data will likely remain incomplete. We are seeing a lot of trues here. So, I think the best path forward for us is to just try to alleviate as many of the errors as we can. And then if needed determine a new plan of action.
ClintAnderson (08:09) Well, and I think, you know, previously, it was someone said that it needs to be 85 percent complete or something like that.
ClintAnderson (08:16) I’m guessing we’re there especially when you consider all the different data fields that are out there. I would imagine we are at an 85 percent or greater completion across this, the payer mapping all of the different, you know, tabs. So I.
Gregory Campbell (08:36) think we’re.
ClintAnderson (08:38) at a point, I agree 100 percent with Barrett, we’ve got to just get it in there so that we can see where we’re at and then we can work… exceptions. I.
Naomi Denson (08:48) Just want to clarify that 85 percent complete is applicable to like enrollment work individually for like a provider’s individual profile needs to be at least 85 percent complete for our team to pick it up. Group profiles need to be the same thing for any group enrollment request, practice profiles individually, not collectively as a whole that we have 85 percent of your data.
Gregory Campbell (09:13) Yeah. Even on.
Naomi Denson (09:14) The even on the group, like just looking at the group profiles tab, I still see a lot of missing optional fields there that would account towards the percentage for each individual group. So.
MatthewSpurling (09:27) Why would they, why would they count towards the percentage if it’s optional?
Naomi Denson (09:31) Because it’s as I, we’ve mentioned before, so there’s required fields in the data import template. And then there’s optional fields. The required fields are required only from a technical aspect for the import to work. All optional fields will eventually be required in the group profiles to complete the profile. So we give them to you here so that we can import them and take that manual work off of you. But eventually for us to do any work at the group level, those will be required to complete the full profile.
Gregory Campbell (10:04) Right. So just to piggyback off what Naomi said, this required scope is really just outlining the minimum data required to just set up an initial group profile. And just to continue on in terms of what we’re looking for from the base profiles, the providers, the practices, and the groups. What we’re trying to avoid here is when we do get to these later tabs for provider enrollments, provider enrollment requests, and then your group enrollments and group enrollment requests, each of these will require the base profiles to be set up to enter in a provider enrollment, for example. So basically, we can move forward with only loading the ones that are showing as true here. The thing that I want to call out if we do so is that the revere team might be responsible for loading all of the enrollments for those providers and practices and groups manually in the platform since those initial base profiles wouldn’t have been set up at this stage.
BarretPickering (11:05) And that’s fine. I think it’s we just want to get this thing functional. And then we can do some fixing as we go. I think the problem is we’ll be sitting here until December fourteenth if we wait on every affiliated practice to have cells a through az filled out… in my mind. And I don’t know, and that could be a terrible philosophy, but.
ClintAnderson (11:31) No, you’re right?
Gregory Campbell (11:34) Okay. Yeah. If you guys are okay with that, I mean we can work off of just what is showing as true. And then as you guys are filling out these additional tabs for the enrollments, you’ll just have to be mindful that any of the ones that are listing an enrollment for a group that doesn’t exist in platform or a provider that doesn’t exist in platform. For example, it’ll throw an error. And if we could just limit to adding to these sheets for objects that are already in medallion, all of those imports will be successful.
MatthewSpurling (12:07) Yeah. So we move with everything that says true today. We know that anything that has the false still is providers that we need to work individually. Maybe we just split that tab into two separate tabs so that we know everything is on the same page. Anything that is on the tab that has everything true is being loaded. Everything that’s false. Are things that’s responsible for revere to close out slash, potentially upload to medallion ourselves.
Gregory Campbell (12:36) Okay. Yeah. I’m in alignment with that. That sounds great. I can go ahead and I know some of these look like there’ll be quick fixes in terms of just like adding a leading zero for example. So I’ll take a look at that… errors like this though with the social, I won’t. Yeah, yeah.
BarretPickering (12:54) And those are the ones it’s going to take us time to get a hold of some of these people to be like we need your social and that’s what I don’t want to be sitting here waiting on for multiple months.
Naomi Denson (13:08) Okay. Sounds.
Gregory Campbell (13:09) Good. Yeah, I feel like, I have a really strong sense of what you guys are looking for here. I’ll get as much of this data loaded as possible and then move the ones, that have errors into a separate tab.
BarretPickering (13:20) Thank you, Greg. I know this will make more work for Don Nicole, whoever in the future, but I appreciate you guys up front and we’ll make it happen.
Gregory Campbell (13:32) Cool. Sounds good. So.
MatthewSpurling (13:34) We got to work the false plus we got to go back to that group list and work on making sure we populate not just the required but the optional tab columns. Yeah.
Gregory Campbell (13:43) And if so, with the optional columns, you guys are actually okay to not add those. Now, what essentially would happen is if we loaded them blank, folks would be tasked for populating those once they’re already in medallion. And at that point, you’re just entering data into our platform directly instead of the, yeah, I’m with you. Okay?
BarretPickering (14:03) And we can do that.
Gregory Campbell (14:07) Awesome. Well, happy to turn it back over to you, Naomi, that’s all of what I wanted to discuss.
Naomi Denson (14:13) All right. And then next on my list, I have the village provider topic.
Nicole Hills (14:21) So, I.
Naomi Denson (14:22) know we went live with some payer enrollment for some new village providers. I’m seeing 163 requests made so far. There are 79 of those requests that are being held up by tasks. So, Nicole wanted to see if you had any… questions on the tasks. And then Dalton, if you last week, we had talked about you going through and reviewing just the group profile and the practice location profiles to verify that all of the information was accurate and correct as it pertains to revere versus what we just moved over from village.
Dalton (14:58) Yeah. I did make all those updates. I made sure to get with the local legal practice managers to find out… you know, a few more of those locations closed. So I put the closed on there. So I don’t know if we need to, I need to delete them or, you know, whatever… we need to do. I just need to move the providers from those first. It’s been kind of like a step by step process and stuff keeps popping up. So, I did get the updated W9 for the group and that should… be in there. So hopefully some stuff started moving, but we’ll see.
Naomi Denson (15:41) Okay. Yeah. Just using the closed for now is good. They are about to release a product update where you can, you know, it’s going to be an actual option to list it as closed with the date it closed and everything like that for tracking purposes. But we won’t delete them just for, you know, historical reference… in case ever, you need to update an existing enrollment that was brought over that was tied to that location or something like that. We want to keep those in there. Okay? Nicole, what questions do you have around the tasks?
Nicole Hills (16:19) So, some of the tasks like where it was saying, please, where was the… like William Larosa, please complete group tasks to complete the provider profile, updated W9.
Naomi Denson (16:36) And.
Dalton (16:36) that’s what I just uploaded that.
Nicole Hills (16:38) Okay. Next.
Dalton (16:39) Time they touch it.
Naomi Denson (16:41) Okay. Perfect.
Nicole Hills (16:46) All right. So that’s good. So.
Dalton (16:48) Then we should just mark it complete.
Nicole Hills (16:50) So, yeah, do I mark it complete? Or? Okay. Yeah. All right. I will mark that complete. So I also had a question on when we have a provider who is changing tins… moving from a current revere practice and is going to be moving over to like a villagemd… how, I guess what’s the best way to, I guess handle something when it’s just switching, is it like a whole new enrollment or?
Naomi Denson (17:30) I guess it is a whole new enrollment if they’re being assigned to a new group and new tax id because they’re being it’s a new enrollment to be tied to a completely separate contract?
Nicole Hills (17:40) Okay. And… what about when there are like demographic changes or location changes for providers, if we need to, if they’re already enrolled, and then we just need to add a secondary location or move their practice locations and also just demographic information. How do those get handled? Yeah. So.
Naomi Denson (18:03) In order to submit a demographic update request, first, there has to be an existing enrollment for that provider, that payor that group combination in the platform. We did move all of them over from village. And then with revere’s side that’s what the data import template is gonna load.
Nicole Hills (18:20) Okay. So.
Naomi Denson (18:21) If it’s if… it’s in the existing enrollments tab here, if you just need one payor, you would just find the existing enrollment either through here. You can search for a payor filter by provider, whatever, or from the provider’s profile. They have the same enrollments tab for just their existing enrollments. So you can do a one off request, demographic update for a single, for a single payor. If the provider changed their name, you need to update their practice locations with all of their existing enrollments. You can do a bulk demographic update request. So you’re wanting to update for one provider, you would select the provider. You would say we need to add a practice location, choose the practice location that you want to add. And… then you can add any additional details, provider starting at this location on this date, whatever the case may be. If you need to remove other practice locations, maybe that have closed, you can do that as well. And then on the next screen, it’s going to show you all of their existing enrollments and the group associated. So you can just say I need all of these updated. And then it would create 28 separate requests for all of their individual existing enrollments with each payer and then submit it that way.
Nicole Hills (19:42) OK, great. OK. And what about terms? Like when we have providers that are leaving… how do we submit?
Naomi Denson (19:54) Those requests, we do not terminate direct enrollments if the provider terms and we’re working delegated rosters for them, we will send an updated roster with terms on it for those providers. But as far as like direct enrollment like terming it with medicare, we actually don’t handle terminations that way. OK? But just when a provider does leave for them to fall onto that delegation roster as a term, yeah, or you deactivate their profile, OK? You need to go into the provider’s profile and then go into their professional info section and add in their termination date here.
Nicole Hills (20:40) Oh, OK. Okay. Great. And if we have kind of a provider who needs to be rushed… their start date is like we just need a provider to start. Is there a certain process or like a specific request on how we could, I guess, make sure that provider’s enrollment gets submitted and followed up on like a high priority. So.
Naomi Denson (21:14) There is, you would submit the request just like you normally would. OK, then reach out to, after implementation, reach out to your engagement manager and they can mark it as a priority on our end. OK. Now, keep in mind, we can mark it as priority, but it gets less of a priority if we are marking everything as a priority.
Nicole Hills (21:37) Right, right.
Naomi Denson (21:38) So, I have some customers who will go in and say mark everything as priority. Well, then nothing’s a priority because it doesn’t work that way, right? Right? But they do still hold that they try to get it submitted. They will filter by priorities. OK? But they, it’s still going to be within that 10 day SLA, and, you know, pending any outreach needed from the provider updates, you know, tasks or anything that are blocking us from submission. So, OK, we can add the tag to it. OK, just as we can certainly see you submit it as normal, reach out to your engagement manager, say I need this provider with these payers that I just submitted as a priority. OK? And we’ll do our best to make them as such.
Nicole Hills (22:22) OK. And is that Dina Deanna, Dreama, that’s our engagement manager, right?
Naomi Denson (22:30) Yes, Dreama. OK.
Nicole Hills (22:31) Dreama. OK. And what was my other question? Is there like an extra fee? Like when it’s a high priority?
Naomi Denson (22:44) No, there’s not a fee. OK. And like I mentioned, you know, we try to make them a priority, OK? But it’s still going to at least be submitted within that 10 day? OK?
Nicole Hills (22:55) All right. Just good to know. Yeah.
Nicole Hills (23:02) I think that’s all that I had on my end. OK. Yeah, I think that’s all I had on my end. Great.
Naomi Denson (23:12) And the village providers, for the village providers, for the ncqa cred, for the delegated rosters, I know Greg, we were working on transferring those village rosters over the original turnaround time was four weeks. Do we have an update on those?
Gregory Campbell (23:36) Hey, Naomi, nothing yet at this time, I did check with the TSM responsible for the village rosters and those should be good to go. But when I have an update, I’ll be sure to let you all know, okay?
Naomi Denson (23:47) Perfect. And then I had asked this question before, but I don’t know if we got a clear answer for the village providers credentialing files and are we following revere’s policies and procedures or are we sticking to the sfps for village?
BarretPickering (24:05) Further to find that. So, are you talking about like credentialing?
Naomi Denson (24:12) So, the committee credentialing policies and procedures that you guys sent us for ncqa for the delegated agreements? Are we following revere’s processes?
BarretPickering (24:24) We’re going to have to, yes, yes.
Naomi Denson (24:26) Okay. Do we have? Because I’m still working with our team internally to make sure that your sfps are in place for ncqa. Cred. So just, we haven’t submitted or have a need for any village providers for credentialing yet? Correct? No. Okay. One other question, gab sent me this credentialing committee like chart of the committee members. What I need to know is who’s going to be responsible for voting in medallion?
ClintAnderson (24:59) That’s going to change, that committee is going to change. Yeah.
Naomi Denson (25:03) So, not all committee members need to be in medallion for voting because you’re still going to have your revere committee meetings and meeting minutes documented. Typically, what I see is like the medical director plus one physician backup in case the medical director is out voting and reviewing on clean files, depending on what’s in your policy and procedures, of course. And then sometimes an admin like gab can come in after the committee meeting after the votes are documented and recorded with the final decision, can come back and log the votes in medallion to… approve or reject?
ClintAnderson (25:40) Yeah, I don’t want.
Naomi Denson (25:41) Any of those.
ClintAnderson (25:42) Folks on the committee… it needs to be… it needs to be Dawn on this call. And then it will… be… dr Hatfield and dr.
BarretPickering (26:13) Weatherall.
MatthewSpurling (26:14) We can have a follow up with this one. And I think we’re all in agreement that the list that’s there is outdated from when we transitioned from steward to revere, and needs to be changed.
Naomi Denson (26:26) Okay. Yeah.
MatthewSpurling (26:28) By.
Naomi Denson (26:28) the time you guys are set… up so Dawn and then just which structure, how would you like the committees named? The most common that I see is a clean committee, and then a need detention committee for anything that has flags on it. Perfect. When we go through the credentialing training, I’ll show you how you are. Anyone that’s a credentialing administrator access will assign the files as they come through from our team to the appropriate committee for voting. Yeah. But yeah, just something that I want you guys to think about and so I can get a clear answer on who needs a committee. If there are more than one person in any given committee in medallion, all of them have to vote in order to close the file. So typically, I say limit it to one person per committee and then have a backup just in case because you guys are going to be documenting and recording your committee votes internally as well. Yeah.
MatthewSpurling (27:23) Because like the list we have here has a Massachusetts medical director, it has an Arizona medical director. It has a Massachusetts affiliate director. So we should probably take it back and say, do we want it to be mass Tennessee, Arizona? How does that all shake out? I?
ClintAnderson (27:38) Talked to Tommy? Cool. And I think it’s just Hatfield and weatherall. And that’s it.
MatthewSpurling (27:44) Awesome. And because that’s for all of revere, not just village.
ClintAnderson (27:48) Yeah, all of revere, yeah.
Naomi Denson (27:53) We’ll just confirm… that as we get closer and it takes me two seconds to build them. So just wanted to make sure it’s on your radar. And then we have our payer process scoping call scheduled for tomorrow. I did notice only Matthew and Barrett are on that. Do gab and Don need to be on that as well?
BarretPickering (28:10) I think Don’s on there, but let.
Naomi Denson (28:13) me.
BarretPickering (28:13) just reach.
Naomi Denson (28:13) I can only see the two of you on my end. So I just wanted to make sure everybody’s included that needs to be able to appropriately review all of the processes together with Drema.
BarretPickering (28:24) Don, I have you on there?
Naomi Denson (28:27) Yeah, I’m on there. Okay, perfect. Okay. All right. That is all I have. We’ve got one minute left. Are there any other questions for… me?
Nicole Hills (28:41) I do have a quick question. Maybe it’s not quick, but is there a way where a provider can go through both the credentialing and the payer enrollment?
Naomi Denson (28:53) Yeah, one doesn’t block the other one.
Nicole Hills (28:55) Doesn’t block the other. Okay. Like if the credentialing piece gets to a point where enough has been processed, that can still continue and go through the committee while the payer enrollment is still, yeah.
Naomi Denson (29:10) Because the payer enrollment is direct enrollment. So the payers are doing the credentialing. The purpose of the actual credentialing is for your delegated rosters, right? We are responsible as the cvo for the credentialing.
Nicole Hills (29:22) Okay. Great. Wonderful. Thank you. Yeah, that’s it. And.
Naomi Denson (29:26) then in terms of delegated agreements, revere already has delegated agreements in place. Have you guys already started notifying your payers of… sub delegating to medallion? I think we had talked about it once before and you guys had that on your radar, but hadn’t actually sent notifications yet. Is that correct?
Dalton (29:47) I mean, we’ve been with medallion, village. Arizona has been with medallion for a while, so, I think, yeah.
Naomi Denson (29:54) I’m more referring to the separate agreements that revere has that aren’t for village. Oh, okay. Sorry.
Nicole Hills (30:02) I don’t know the answer to that. Would anyone on the call know? I don’t think so, but I don’t know.
Naomi Denson (30:12) Okay. I’ll follow up on my email and include that piece just to make sure it’s on your radar because before we really start credentialing and sending rosters, it’s usually a good idea to let the payers know who they’re coming from. Yeah. Well, we actually don’t send the rosters directly to the payers. We send them back to you and you submit them, but you do have to most like payor agreements will have a note in there that if you’re going to sub delegate to a cvo, you have to let them know and do an amendment. So I just wanted to.
Nicole Hills (30:37) Make sure amendment and all right. Yeah, all that fun stuff.
Naomi Denson (30:40) Okay. Sounds good. Rules. All right, guys. Rules. Thanks, Naomi. No problem. You guys have a good day, you.
Nicole Hills (30:48) Too. Bye.
Naomi Denson (30:49) Bye.