Transcript
Jack Schell (00:00) Jack, good… morning, Shelby. How are you doing?
Shelby Winschel (00:08) I’m doing good. How are you? I’m.
Jack Schell (00:10) doing all right. I’m just getting back from some time off. So catching up, I went to, I was traveling a bit for a couple days off, which hasn’t happened in a while. So that was nice. But what about you? How was your weekend?
Shelby Winschel (00:26) Yeah, good for you taking time off. It was good. It was just rain the whole time. So not much you could do.
Jack Schell (00:33) Yeah. Remind me where you are.
Shelby Winschel (00:36) I am in between Houston and Austin.
Jack Schell (00:38) Okay. I thought, I knew it was Texas. I wasn’t sure where in Texas, a lot of rain.
Shelby Winschel (00:45) Yes, tons of rain. I mean, I think it rained for the most of last week and then, you know, off and on and then this weekend, it was just all day Saturday, majority of the day, Sunday. I mean, it’s still wet outside and it hasn’t rained since Sunday. So it tells you how much rain.
Jack Schell (01:04) Gotcha. Well, I hope that you stayed dry and were able to still relax with the weekend. New week can’t believe it’s mid April already, which is kind of crazy. I know. Yeah… I just want to definitely address. I got some updates from Lindsay from while I was out that it sounds like you’ve been running up against some delays with pay enrollment requests that you’ve submitted and I was catching up on some of her notes.
Jack Schell (01:43) It looks like she was doing some, just investigating of where some things stood on the PE side. And I know that she sent, I think she sent a note yesterday just recapping our team’s review of that. Yes. From what I can see, it sounds like it looks like tasks might have been holding up some of the process here, but definitely want to just hear from you what it is that you’re coming up against that, you know, as I touch base with Lindsay and leadership that I can represent and just make sure that everything’s clear for you all.
Shelby Winschel (02:27) Yeah, absolutely. So we initially submitted one provider through the process just to kind of see how it goes and how quickly it could go through.
Jack Schell (02:39) Versus.
Shelby Winschel (02:41) you know, my team going in manually doing it, excuse me, and we had sent a few commercial payers out December eighteenth and there wasn’t much movement.
Shelby Winschel (02:53) And then January eighth, we took them back over and moved them to client owned because they were just sitting. And then we tried a month later in February to do a medicaid enrollment for that same provider. And it was, there was a ton of back and forth. You know, first it was that the groups weren’t completed 100 percent. But then it was because that brick and mortar dropped down. And so we were able to, you know, find a loophole around that and still be able to get enrollments done. And then they came back and needed, you know, several more items. One thing being access to the portal, which I wasn’t I didn’t know that I had to give them access to the portals for the payers. And so if we had known that initially I could have done that prior during implementation. And so that was another issue. And then they came back and said that there’s a medicare waiver require or a medicaid medicare ptan requirement for tmhp which is not true because we only see zero to 20 years of age. So, we can have the medicare waiver, we’re eligible for the medicare waiver. And I had submitted a screenshot of exactly how to submit it for that questionnaire in the tmhp enrollment, and it said zero to 20 and they got it submitted. And that next day I got an email that there were deficiencies, so I went in and I looked at it and they had submitted it for zero to 21.
Shelby Winschel (04:30) But my screenshot has said zero to 20. So I went in, fixed it and resubmitted it. And then it was approved. So just, I feel like a whole bunch of babysitting… and it just, you know, the communication was severely delayed and… you know, Lindsay had looked into it for us two weeks ago, and she had come back and said that the credentialing team told her that we needed to click complete for each task. But that was never told to us. And so just, I feel like constant back and forth and really just not like, a resolution, to many of the things that we’ve encountered. And so I’m really hesitant on submitting more enrollments for our providers through medallion because of this.
Jack Schell (05:26) Yeah, appreciate you sharing the context. And I definitely understand that there sounds like there’s more back and forth than would be ideal to get these requests completed. You know, I’m sure some of that is just us getting up to speed together with requests and you know, there are sometimes some just like processes to further document along the way as we continue to learn where your career requests are going to lay with priority. But also, of course, it does look like Lindsay’s been able to acknowledge a couple areas where moving forward in your operational syncs, there can be greater visibility. I do want to speak to that like your operational syncs with Lindsay. You know, you should be reviewing these priority requests so that things don’t get lost in flight. And so it does sound like you were doing that and you all were working together on the specific requests, but I hear you on the back and forth with our specialist team where, you know, you’ve said, hey, we are eligible for skipping this waiver because of the zero to 20 age, etc those examples, you know, we definitely will provide the feedback to our team to ensure that they’re following the processes that are clearly documented for goodside. One of those things that helps support that as well is of course, the various project plan and just learning your payer priorities and processes, which is something that you worked with the implementation team on. So I’ll make sure with Lindsay that we’re also revisiting in your operational sinks on a regular basis what those standards are. And if there are any changes that need to be made to that for visibility for our specialist team that should hopefully cut down on some of the back and forth. I’m thinking specifically for this medicare waiver example where, you know, you’ve expressed goodside’s eligible for skipping that. I want to make sure that’s captured in the project or process plan that we have for you so that the specialist team can reference that we could even like add the steps specifically that you said you screenshotted so that that’s there in the future. Yeah, you know, we are of course set up to start handling your requests and our team’s ready to start working your requests which we want to do. Obviously, we want it to be perfect, there will be things that we’ll go back and forth with you on. And then once we go back and forth on them once we can get ahead of it and set clear expectations for moving forward the next time if those things aren’t already outlined. So I just want to, you know, definitely hear you and I’m going to make sure that I meet with Lindsay since I was out when this happened. Conversation looks like it started internally… but I hope that we can get you to a place of confidence to submit additional requests because, you know, Lindsay will make sure in those touch points that you have with her that things are moving forward and if there are any blockers that they’re addressed. And so, you know, your highest priority requests are going to be treated with priority too.
Shelby Winschel (08:58) So, yeah, yeah, yeah. I appreciate that. I know there’s growing pains, you know, on both sides, you know, this is a new company for the specialist team to work on. And if I need to meet with them or somebody over that department to kind of go through like the process for each payer, I can do that too. I just, I want the system to work how it should.
Jack Schell (09:30) Yeah, of course.
Shelby Winschel (09:31) And, you know, push things through and, you know, allow my team and I to trust that the system is doing what it should and we not have to babysit.
Jack Schell (09:43) Babysitting. Yeah, of course. And you know, it will take additional requests for our team to prove to you that we can handle it though. I definitely hear you on the apprehension given the one that you’ve put through, you know, I don’t often see with the clients that I work with that are doing the specific payer enrollment requests with us. You know, we… with every 102 100 requests like, you know, we get, there might be one or two that have a couple pain points that we need to work through. But in general, you know, I don’t see that we experience these delays or, you know, the friction, but I think one of the points here that stands out to me is just the tasks. And I think that now that Lindsay and you have worked through this one example, I think it’s obviously important that in your touch bases with Lindsay that we’re reviewing tasks and just making sure that if there’s any high priority tasks that need to be completed or addressed, that we’re doing that? And that they’re actually actively talked about when you all are together. And then she can go directly to our team if there’s any need to. But I want you to trust us and feel confident submitting more requests because the turnaround times that I do see for clients is generally a lot better than what can be done internally since we do have our team constantly following up on these applications. I think that I hear you sometimes there’s a little more back and forth on the tasks than we’d like, but you go through it once and we can document it and make sure that it doesn’t happen again. So I’ll get with Lindsay as I said, and make sure that we’re… all aligned on what needs to be addressed here or like improved. And then she can, you know, change the cadence with you in terms of what the agenda looks like for how you review your work together, that’ll hopefully help keep things moving forward too. I am also trying to find in here.
Shelby Winschel (12:01) Yeah.
Jack Schell (12:03) Go ahead, sorry.
Shelby Winschel (12:04) I want to give you an update. Nicole kindred is no longer with our company.
Jack Schell (12:09) Okay. I was going to ask.
Shelby Winschel (12:11) Yeah. So she’s no longer here. So it’ll just be you and I on these calls. For now, we are looking for a new RCM director. And so until then it’ll just be us. Okay?
Jack Schell (12:27) All right. That sounds good. I appreciate the update. Where is I’m just looking for at implementation? Did you complete like a payor priority or payor process template for us?
Shelby Winschel (12:44) Yes. Okay.
Jack Schell (12:46) That’s great. That’s what I would have assumed. I’m just looking, I wonder if my access changed on the document, you know, since I’m not on the specialist team, I might not have access to it, but I wanted to see if I could get in there and just take a peek real quick to see if we’ve updated with any of the details that you’ve been going back and forth on so that we don’t go back and forth on them again. Okay. Yeah. But I’ll take that as an action item just to make sure that Lindsay’s considering that as well. Okay. Yeah. Sounds like we might need to be just a little more specific for like medicare as an example… in terms of processes to make sure that things go through smoothly.
Jack Schell (13:35) Awesome. Anything additional that you had that you wanted to discuss with me… in terms of the partnership or on the good side end of things?
Shelby Winschel (13:49) So, I think things are holding pretty steady right now. Still, no talk about growth like we thought… really just, you know, we’ve got new hires coming down the pipeline and right now, my team is kind of taking that in manually just because of the issues with medallion. So I’m hoping, you know, we can kind of fix these issues pretty quickly and, you know, maybe the next provider, I think they’re doing onboarding right now, but once they’re ready for credentialing, we can try again with the system and see how it flows that way. Yeah.
Jack Schell (14:38) Do you, do you do any licensing for your new hires first? Or?
Shelby Winschel (14:45) No, no.
Jack Schell (14:46) Okay. Everybody.
Shelby Winschel (14:47) You.
Jack Schell (14:47) verify.
Shelby Winschel (14:48) okay.
Jack Schell (14:49) Everybody you have, everybody you hire comes in with the licenses required already. Yes. Okay. So, do you submit, you know, the payor enrollments or the credentialing enrollments prior to… their start? I assume?
Shelby Winschel (15:08) Yes. So we try and get every like while they’re still onboarding as long as they’ve completed their credentialing packets, we go ahead and start submitting for payor enrollments, tmhp or medicaid is first because the mcos won’t accept the enrollment until then and then we do the commercial and then mcos last. Okay? And then they can start? Okay.
Jack Schell (15:35) Well, I think that if you do have somebody coming on board then like, you know, it could be good to go through this process again. And now with Lindsay on your side to represent your needs, want to see how we do and make sure that you feel confident with our payor enrollment process. I’m confident in it, but I know that those are just words. So we need to prove to you yes, given the example, but I just want to ask you to like, let us prove to you that we can handle these requests and we will get them done, you know?
Shelby Winschel (16:18) Okay. Yeah, we can try again with one of these providers and go in there and see. And I think our next call with Lindsay is next week, so it may be good to start it this week so we can review next week. Okay. Yeah.
Jack Schell (16:36) Let’s if… you are going to submit one, why don’t you send, if you decide you’re going to do that this week ahead of the meeting with Lindsay, just send me and Lindsay a note that you’re going to send a new provider through.
Jack Schell (16:52) And then we will make sure that it’s treated with priority. You know, we don’t if you submit like 100 requests at a time, we can’t mark like 100 requests with priority, our team, you know, obviously is going to have thresholds around that. But with this next one, let’s mark it as priority and let’s make sure that it has high visibility from our team. We’ll show you how that works. But if you just shoot me and Lindsay and know like, hey, let’s try this again. Here’s. The provider… and we’ll watch it and we’ll make sure, you know, we’ll pay close attention to what tasks come through, you know, is that a task that’s been completed? Is it something that we need to do on, you know, our end, your end? And then, you know, we can go from there. Okay?
Shelby Winschel (17:40) Yeah, that sounds good. I’ll see where this provider’s at with onboarding, and credentialing, okay? And then we can go ahead and submit?
Jack Schell (17:47) Okay. Does your team, I forget? Does your team complete provider profiles on behalf of your providers in medallion? Or do you invite your providers to medallion and they complete them? So we.
Shelby Winschel (18:01) for the most part have invited. Well, actually I’ll take that back. We have invited all the providers to the medallion profiles that we’ve set up for them. The issue is getting the providers to go on there and actually complete it. So I do have one person on my team who’s actively in there adding information for the provider as much as they can. I know there’s a section where the provider has to sign which we can’t complete. So I’d say half and half. Okay?
Jack Schell (18:30) All right. So, it’s like your providers are invited but your team will do a lot of the foundational work until the provider absolutely needs to do something, right? Okay. Just good to know. All right. And then caqh, we’re… leveraging that, right?
Shelby Winschel (18:52) Yeah. So my team is taking that on and updating them for the new hires and then also maintaining them.
Jack Schell (19:03) Okay. All right. Because I know that you have caqh management with us. Yeah, for the bi directional syncs, make sure that whatever’s updated is reflected in both, right? Just double checking here. Okay. All right. Well, I had also prepared just like the typical execution readout and consumption review that we would cover in these calls since there hasn’t been much work completed.
Jack Schell (19:38) It’s a little bit bare. But again, as we continue to do more work, we’ll continue to look at these… metrics to measure our success. If the volume does increase, that’d be great. We’ll start to get more meaningful metrics here on turnaround times. Things have been pretty steady since the beginning of the year. So definitely want to see hopefully you taking advantage of more of the requests that can be completed. And then I was always wanting to touch base just on consumption since this is an annual, you know, spend with the current consumption, current contract, about 20 percent consumed. And of course, as, you know, anything unused in this first year will roll over into the next year.
Jack Schell (20:28) So, you know, I think that it does seem we’re pacing that you’ll have quite a bit of a rollover to year two. So, hopefully, you know, with these next couple of requests, we build some confidence and reestablish trust here. And we can make sure that we’re creating as much visibility as possible to the processes so that we can take on more work. And then if, you know, goodside does move into a place of growth, you know, you’ll be well set up with services to take that on.
Shelby Winschel (20:59) Yeah, absolutely. Okay.
Jack Schell (21:03) All right. Any last items for you before we hop here?
Shelby Winschel (21:09) I don’t think so. I’ll shoot you and Lindsay an email once I’ve pushed a new provider through medallion, and then her and I will meet next Thursday, I believe. And so we’ll kind of track that and hopefully we can just start submitting all new hires through medallion but nothing currently.
Jack Schell (21:27) Okay. All right. As mentioned, I’m going to try to find time. I just got back from some time off. So I’m going to try and find time with Lindsay as soon as possible to make sure that her and I are aligned and that I have complete understanding of any items or areas where we can improve… but appreciate you sharing this up with us.
Shelby Winschel (21:48) Yeah, thank you so much.
Jack Schell (21:50) All right. Thank you, Shelby. Talk soon, all.
Shelby Winschel (21:53) Right. Thanks. Bye bye.