Transcript
Leigh Howle (00:00) hi, Annette. Hi, Addie. Hi, how’s it going good? How are you all?
Addie Oh (00:06) Good. Glad we were able to join this.
Leigh Howle (00:08) Yeah, yeah, it’s an hour long call. We never take the whole time. So, this is perfect. Amazing.
Addie Oh (00:16) By any chance, could Annette and I go for the first half? Because we are double booked on the second half of the call.
Leigh Howle (00:22) Yes, absolutely.
Addie Oh (00:23) Thank you so much.
Annette Hong (00:24) Thank you.
Addie Oh (00:28) I’m very excited to get Melody’s feedback on some of the stuff we’re thinking about. So.
Leigh Howle (00:33) Yeah, and I did pull up the, you know, the locations with active closed archived. So I’ll just kind of go through that with her at the end and send an email out if she has any questions on it. So hopefully this could get wrapped up as well.
Addie Oh (00:47) Perfect. That’d be amazing.
Annette Hong (00:51) Yeah, it kind of sucks that Claude is struggling today because… I had to, I just moved all of our, all of our widgets. I just took screenshots and I had to move them to figjam.
Addie Oh (01:05) Okay. That was okay though. Annette. That worked. Okay. I mean, yeah. Okay. Yeah, it’s like the new version of a snow day is Claude being down? I guess Claude or chatgpt? I.
Annette Hong (01:18) was like, my God, I’m panicking because of the stupid AI cloud is like not working properly.
Leigh Howle (01:29) I felt that way yesterday, Jim and I was down and I was like, what is happening?
Annette Hong (01:34) Oh, no.
Addie Oh (01:36) Yeah, I feel like when slack has issues, I’m like I just, I can’t do a lot of my job.
Leigh Howle (01:42) We.
Annette Hong (01:42) are very slack dependent here.
Addie Oh (01:46) Yeah, yeah.
Annette Hong (03:15) Leah, we’re still waiting for Melody. Yeah.
Leigh Howle (03:18) She just joined. Perfect.
Leigh Howle (03:32) Hi, Melody. How’s it going… good?
Melody (03:40) How are you doing?
Leigh Howle (03:41) Good.
Melody (03:42) Good, good. So we.
Leigh Howle (03:44) have Annette and Addie here to just go over similar questions related to the meeting for last week and then Amy is on the call as well.
Melody (03:51) Sounds good. Amazing. All.
Annette Hong (03:54) Right then let’s get started.
Annette Hong (03:55) All right. So last time we chatted, we were talking about how you keep track of all of your service requests and how you’re monitoring progress across all the lines that you’re responsible for. So kind of continuing on that we prepared a few widgets for you basically just like different types of metrics or like data insights, essentially that we’d like you to react to. I’ve got five for you today. So we’ll just like lightning round through them. And then we’ll do a final wrap up of what we’re planning on showing in terms of activity per line. So also just flashing getting your feedback on viewing history and activity on an existing service request. Alrighty. Let me share my screen real quick.
Annette Hong (05:08) Okay. And, we can all see, the screen. Amazing. All right. First one up. All right. Let me give you. Let me give you like 30 seconds to look over this.
Annette Hong (05:39) Okay. So before I say anything, what do you think, what do you think this widget is showing you?
Melody (05:48) The request that we have in the platform?
Addie Oh (05:52) Okay.
Annette Hong (05:53) Yeah. And how useful would a widget or like numbers or representations like this? How useful would this be for you on a day to day basis? And is this something that would actually be helpful to you? Or is it just like, yeah, I don’t know what I would do with this.
Melody (06:14) It’s good to see as a high level overview for sure.
Annette Hong (06:20) Awesome. Okay. And the way that we are sort of like calling out these different numbers, do these feel like the right things to be calling out for or are there or would you approach this differently?
Melody (06:41) I think that makes sense… for the stalled over 30 days. What does that entail? Does it mean like they haven’t been started or does that also include follow up? I guess… yeah.
Annette Hong (06:59) It would include follow up and stalled, which just means that you haven’t gotten any activity, no updates. Haven’t been hearing back for 30 plus days.
Melody (07:09) Okay. Is it just follow up or are they are new requests included in there? So I guess that would be one to call out. So we have requests in there that haven’t been started or like haven’t, been submitted? And then the other part of it is if it’s a follow up, but we haven’t gotten any action for several days or a period of time. I think those are important to separate because those are two different like escalation paths that we would have to take… amen?
Annette Hong (07:43) All right. Next… let me give you a little bit of time to look over that.
Annette Hong (07:57) All right now, what do you think you’re looking at here?
Melody (08:03) Individual requests… okay?
Annette Hong (08:07) How useful do you think something like this would be for your day to day basis?
Melody (08:12) This is good. I think it would be better too if we had our brand if the group was also included on here for a client like us who has multiple groups just because I don’t no one at the provider level, but if it’s a group level, I know which groups I need to prioritize… awesome.
Annette Hong (08:36) Okay. So you mentioned groups, is there any other additional types of information that’s like similar that’s kind of like in the similar vein that you’d want to see. I’ve noted the I’ve noted down groups. I don’t think so.
Addie Oh (08:56) All right. Also remind me again, Melody for you all is a brand corresponds to a group profile or does that correspond to a practice location on our platform?
Melody (09:05) Brand equals group? Okay?
Annette Hong (09:07) Would.
Addie Oh (09:08) you also want to see a practice location or just group is sufficient?
Annette Hong (09:13) I think if.
Melody (09:14) it, if you could put practice location that’d be fine, but if you can’t group is good enough, and then we can dig into the practice location if needed, practice location isn’t as important unless we’re doing like we’re adding that, and then that’s when we have to really like dig a little bit, narrow it down to that part of it.
Addie Oh (09:35) Got it. That makes sense.
Annette Hong (09:40) All right. We’ll move on to the next one. We’ll give you some time to take a look over that.
Annette Hong (10:01) All right. So, again, what do you think you’re looking at?
Melody (10:07) This is the request by state per payer, highest volume per state. And.
Annette Hong (10:17) Then how useful would this information be to you on a day to day basis?
Melody (10:26) I think it’s good. Yeah… you’re.
Annette Hong (10:32) also free to say if you don’t need anything like just call it out.
Melody (10:36) I don’t I mean, it’s I think it would be helpful. I just don’t know how we would use it right now… probably to look into, see like where we need to tighten up our processes if there’s a process breakdown. So that would be helpful for that, where we should focus. I guess our energy on those.
Annette Hong (10:59) Sounds good. All right. Addie, any questions on this one? Okay. Let’s move on to the next one.
Annette Hong (11:23) All right. Again, what do you think you’re looking at?
Melody (11:27) The cause of the issues? Good?
Annette Hong (11:33) And do you, and do these, does this breakdown make sense to you? Yeah. And how useful would seeing this type of breakdown be to you on a day to day basis that?
Melody (11:47) Would, yeah, that would be helpful because then we can determine if we need to assist or if it’s or where we can help out with the issues.
Annette Hong (11:56) Awesome. Okay. And is there anything additional that you think would be useful for this breakdown?
Melody (12:05) I don’t think so. I think that those are the top ones.
Annette Hong (12:10) Perfect. All right. Last one.
Annette Hong (12:18) Now, for this one, what do you think you’re looking, what do you think you’re looking at?
Melody (12:27) I don’t know how long since the last time it’s been touched?
Annette Hong (12:36) How useful do you think, this metric or this view would be to you?
Melody (12:42) This would be good.
Melody (12:47) If it was more… specific to either a payer, I think or a, or at least a group brand provider. I mean, this doesn’t otherwise, this doesn’t unless I can double click into it. It doesn’t really do much for me.
Annette Hong (13:12) Alrighty. Are.
Addie Oh (13:13) there other ones Melody that you’d call out that being able to like double click or like drill down into the specific request would be helpful. Like would you say that’s true for all of them or like ones in particular?
Melody (13:28) I mean, I think it’s always helpful if you can click into it and then get a more detailed view for everything if possible. But if it was just as is for the other ones, that would be fine too. For that. I don’t think we would have to get any more detail for that. At least we have a direction on where we need to go with those.
Annette Hong (13:50) Cool. Alrighty. I’m now going to ask you to rank the five widgets from I want this to this is fine or like I don’t really need this, okay?
Melody (14:09) Probably the second one would be for number one.
Melody (14:17) And then yep. Then we would leave that at number two. And then I would put, I would flip these next two as three and then four.
Annette Hong (14:28) Like that, yep. Awesome. Okay. Right? Let me, let’s move on to the… timeline or actually, sorry… I missed some questions across these five. We’ve ranked you. So, which one would you, do you imagine yourself checking like the first thing on a Monday morning or like the first thing as you start out your day?
Melody (15:04) Probably the portfolio snapshot. I would look at first. And then I’d go up to the second one and.
Annette Hong (15:14) Then… the flip side of that question, what… out of these or is there anything that you would probably just never look at or you’re like this is great. But also like I just wouldn’t really use this?
Melody (15:30) Probably just that last one because like I said, it doesn’t have much detail that… I would probably ever need to report out on. Awesome.
Annette Hong (15:41) Okay. And then finally, just like thinking about, you know, last time we chatted, we talked a lot about like when you feel stuck and all that like kind of trying to figure out what to do. Is there, is there a, another metric or another sort of like number or data insight that would be helpful for you to like sort of debug and troubleshoot on your own? Aside from the stuff that I just showed you?
Melody (16:11) I don’t think so. I think like I said, if you can break that one down to requests and then follow up, those are like the two things that I manually check for every week got.
Annette Hong (16:22) You? Okay. All right. I’m gonna move on to the second part. So I’m good, Eddie. Okay. All righty. For the second part, basically, we’re now kind of zooming in this. The idea is that you would be able to view all the activity on a per line basis. So instead of,, this would be sort of like an enrichment or an improvement of the notes function which I believe is like the primary way of communicating progress and whatnot. So we’re just trying to automate that and make that formatted to be a little bit more systematic and a lot more a little more structured. So this can, these can get really long, but this is also just a subset of all the different types of things that… we can track record and show you.
Melody (17:17) So,
Annette Hong (17:18) just like quit on a first glance. What is your reaction? Do you like this? Do you not like it, is it too much? Not enough?
Melody (17:29) No, I can already tell. I like it better than what we have for sure.
Annette Hong (17:36) Awesome.
Annette Hong (17:42) In regards to when you are trying to understand like why a request is stalling or why a request is not moving forward? What are the key things that you would be looking for to understand? Like why is this application stuck?
Melody (18:06) So resubmissions for one and then additional information usually are two indications that it’s going to take longer than we’ve anticipated. And then the third one is they’re just not getting a response or an update on however they’re checking the portal or if they’re getting the same thing. So sometimes they can check a portal and it’ll be the same update over and over again for weeks at a time. And so usually, after so many weeks, it’s like a red flag for us to say, okay, is either the payer behind or do something stuck and we need to like dig into it a little bit more.
Annette Hong (18:53) And then if you notice here, we have sort of distinguished the blue, ah… so it’s like human. So that would be on your side, your team. And then also like things that medallion, the platform kind of does automatically or we do on our side, we’re just thinking about distinguishing between like medallion or medallion like human user essentially as.
Melody (19:23) Well.
Annette Hong (19:25) And so, does that distinction work for you?
Melody (19:30) Yeah, that would be helpful.
Annette Hong (19:33) Sounds good. And just like looking at the cards I have shown here, do you imagine or… are there any examples that you don’t see here that you think like should be tracked? Or like I expect to see X, y and Z, things in here as well on top of things that you are seeing here? Yeah.
Addie Oh (20:02) I think the high level ones we’re doing are like status transitions, notes, posted, tasks, completions, emails, getting linked, right? I think those are the main ones right? In it. Am I missing anything?
Annette Hong (20:14) Email thread getting linked like detail updates? Yeah.
Addie Oh (20:19) Like if you change any of the request details, that would also be reflected here. Is there anything else that you can think of Melody that we don’t have that you think would be helpful to also see in this timeline view?
Melody (20:30) I don’t think so. Those are the main ones that we use. And, yeah, and what we highlight when I’m skimming through that’s what I look.
Annette Hong (20:36) For, okay, cool. Awesome. Okay. And then final question before we do a little wrap up, how do you see yourself using one or the other both together? Using one, a little bit more than the other?
Melody (20:56) Between the dashboard and this, yeah. Yeah. So if any of these showed up on that top one or like if the ones that were stalled or then I went into like the more specific ones I would pull up, then I’d go into their specific files that are stalled. And then that’s where I would review the notes in there for just those specific ones to figure out what’s going on?
Annette Hong (21:21) Awesome. Perfect. Okay. And just to wrap up… which of the two or which of these like widgets, which part of this do you think would make the biggest difference to your day?
Annette Hong (21:35) Like right now? Like having this today would be, if you could pick one of these things to have today, what would be like, I want this one. I.
Melody (21:45) would think the notes would probably be the most beneficial.
Annette Hong (21:51) Awesome. Okay. And then anything else that you want to add that we may not have included or something that you think we may have missed?
Melody (22:01) I don’t think so. This is good. This is a good start. Yay. Awesome.
Annette Hong (22:08) Oh, cool. I think those are all the questions that we had for you today. Addie. Anything on your end? No?
Addie Oh (22:17) I think thanks so much. Molly. I know it’s been a couple rounds of iteration, but it’s really helpful for us.
Addie Oh (22:21) So, I think this is stuff that we’re actively working on. And hopefully we’ll have exciting like updates for Leigh and Amy to pass on to you as we get closer to like having something that you all can maybe even like beta test for us. So, yeah, thank you so much.
Annette Hong (22:36) Thanks. Thank you so much.
Addie Oh (22:39) We’ll drop then. Thank y’alls.
Annette Hong (22:41) Thanks, Leigh and Amy.
Melody (22:42) Bye.
Leigh Howle (22:48) That was super helpful… and there’s progress made. So after the last meeting, you know, with going over practice locations, whether they’re archived closed or whether they are going to remain open. There’s a like all clients now are going through and updating their locations so that epd can go in and actually make those changes to the location. So it’s resulting in real action, in the platform. So super helpful really appreciate you taking the time to go over it. And yeah. So yeah, I had a couple of things before we hop into the agenda. I do have the like an escalation deck to kind of go over the results from the cap related to the Montana medicaid group, reval, related to Andy Kyle, with Georgia related to the QC, the bottlenecks, and take complete all that.
Leigh Howle (23:49) So I did, I’ve been monitoring the lines daily since last week and I’ve got a percentage down. It’s roughly at about 65 percent right now. I appreciate you extending the deadline for the team. So they have worked around the clock diligently on the weekend to try and get these lines submitted and out the door. So there’s been significant progress made since then.
Melody (24:19) Great. Thank you.
Leigh Howle (24:21) Thank you. And Amy, do you have anything to add before we go over the deck? Well, not at this time. Okay? Awesome. So Kate was here for a minute but she had to drop to go pick up her son from school and she’s… going to grab him. She said hopefully make it back at the 30 minute mark. So if she, you know, we can go over anything, then when she gets back, maybe we should wait on the deck then and just kind of go over the agenda until she gets back and then we.
Melody (24:57) can cover that.
Leigh Howle (24:58) With her. Okay? I did put quite a few things on here. Melody. Sorry. So first item… I added was healthspring. I know we’ve been talking when cigna went from cigna healthspring to just healthspring. There were some changes in their enrollment and I do have another client that has healthspring with a national contract and it’s just one roster that gets submitted to their NP ops.
Melody (25:25) So I.
Leigh Howle (25:27) just wanted to share that and.
Melody (25:28) I’ll reach out to our contracting and see if maybe they can get something going.
Leigh Howle (25:35) There. Yeah, I don’t know anything about like contract negotiations or rates or anything, but I do know that higher volume has more power when it comes to that.
Leigh Howle (25:46) So I don’t know if that would help. So, we’ll just kind of, and then on the authorized delegated officials, I apologize.
Melody (25:55) I got.
Leigh Howle (25:56) My communication in the email. So it may have been, you know, a little confusing, but Cynthia Mccauley, definitely, she’s ao, all payers. I guess the question the team had was in a task where Bridget was the previous delegated official and the team was told to, you know, replace her with Patrick. So our QC started our QC team was like, okay, hold on is Patrick like replacing Bridget across the board or? Yeah, I think so.
Melody (26:34) I think you can just use Cindy on there. You don’t so even so Cindy just kind of trumps it all. So, what happened is when confluent took over all of these smaller brands, they like, Patrick is one of them that used to be the owner for one of those brands. And so he’s probably listed on there. But really it should be Cindy and we’ve updated all of that and we need to go back into medallion and get it updated on that. And that is something that we need to do. But yeah, I would just always list Cindy, Cynthia… Mccauley on there for anything that’s either delegated or authorized. Just put her in and she should, everything should approve on that end for.
Leigh Howle (27:15) That perfect.
Melody (27:16) They can task it out back to us and we’ll go from there.
Leigh Howle (27:19) Okay, perfect. Okay. Sounds good. Yes, the credentialing approval emails can be turned off. Oh, okay. I just want to make sure that we’re aligned. It’s a global setting. So it.
Melody (27:36) would.
Leigh Howle (27:37) just be for all providers getting cred approval notifications. Is that okay? Let.
Melody (27:44) Me double check. Let me just double check with Kelly on that. I think that should be okay, but I can circle back with you next week before we do it.
Leigh Howle (27:53) Okay. Sounds good. And this kind of random, but I do know that horizon in New Jersey. I have a client going through delegation with them right now and they have this random requirement that providers have to receive a credentialing email. And so that’s.
Melody (28:11) what I was, yeah, I’m thinking that we might have to keep them on because of that. So, and that’s okay. That’s if we have to, we have to and we’ll just make sure that they understand that it’s it does not because I read the email and it does say confluent health like three times in there. So it’s just a matter of them understanding the.
Leigh Howle (28:29) Difference. Okay. All right. Just let me know and I can also find out if there’s a way to list like montefiore, you know, or a way to customize those emails as well. Yep.
Leigh Howle (28:49) And then the, this was random. So I’ve… this is the first time this has come up. So I just wanted to share it. The licensing manager saw a certification for Juan rodriguez and it was American red cross, but it was actually listed in the licensing section. Okay? So just sharing this for feedback.
Melody (29:13) Okay. Yep.
Leigh Howle (29:14) It’s fixed. Okay? Blue cross blue shield, New Mexico enrollment. I know there was a request to add Texas as another state and our payr directory team wanted confirmation that there are practice locations on the border between Texas and New Mexico.
Melody (29:37) They’re… I’ll double check with Carla and get back to you. I don’t know exactly how I’m sure there is, but I don’t know that brand as well. So let me double check with Carla. Okay?
Leigh Howle (29:57) Okay. Sounds good. Therapy network of Georgia. I know this has come up a couple of times but I just wanted to confirm with you. I’ve read some emails yesterday and with the payr address discrepancy on the roster that they have, where it’s five a. And then, you know, we have five B. So do all providers need to be moved from five a to five B?
Melody (30:23) That is my understanding. So if we just up for that particular payr, yeah. So I read that one yesterday too, and I was going back through the email. So if we just update the letter like she said to the new date, then I think it should be fine. Okay.
Leigh Howle (30:41) Good. Those were my instructions to the team. I just wanted to before, I said I would circle back, don’t want any claims to deny and want to make sure that all providers get moved over to five B. Yeah.
Melody (30:56) Okay.
Leigh Howle (30:58) Awesome. Delegated payers. We’ve had our QC team going through enrollments and they brought up these specific brands that have active enrollments in process for these payers. And, they found that the project plan had it listed that they were delegated and just wanted confirmation on that. Yeah.
Melody (31:23) I’ll go through these. I know our optums are ooh, both commonwealth hand therapy. Let me double check… advanced for sure. Optum is, but I’ll double check our payr roster. Most of them probably are. So I will list them out on here for you. Okay, awesome. So.
Leigh Howle (31:44) Just to confirm if they are delegated, would those enrollments need to be stopped or closed?
Melody (31:53) You can. So… we so typically with, I don’t know why they’re putting in requests. So there must be some sort… of miscommunication on our end. And I’ll just if you can send me a, is there a way you can run a report of those that have requests in there? So I can just send it to our team. So I can just let them know if they’re delegated. We just need to put them in the existing payers, because once their credentialing is approved, they can, they’re approved for those plans. So we don’t have to put a request in for you guys to do anything. We just need to put them in our existing. So my question is if they aren’t in the existing, then you would just close them out as like an approved enrollment so that they move over to existing. But if they did both, I don’t that would just duplicate things on your end. So I don’t know exactly how or why they were putting in requests for those, yes.
Leigh Howle (32:44) I will send a report for these delegated payers with these brands or, and then I’ll and then we can just decide if there’s yeah.
Melody (32:58) Yeah.
Leigh Howle (33:13) Okay. For Krista rapp on Florida blue fitness… quest, venice is still under Edwina.
Melody (33:27) So I put the, so I have access to it and I screenshot it and put it down there. I have it marked. And this is the medallion team one that’s under Emily johnson’s so I have you guys marked as administrator for the admin assistant. I updated that last week, so they should have access to it.
Leigh Howle (33:47) Yes, they should. Okay. I’ll double check with them. They, they just sent the message just, I think it was yesterday or the day before. So I’ll have them go in and double check and get Krista rapp moving with Florida blue. This is like urgent. Okay?
Leigh Howle (34:13) Thank you. Payco’s access for sports medicine associates and strive.
Melody (34:23) I gotta look at the sports medicine. Strive. We’re going to cancel that request because we have to do a paper application because there’s a active request pending from February when Edwina was here and the revalidation is going to be due before that one gets approved. So.
Leigh Howle (34:42) We end.
Melody (34:43) up having to do a paper application. So we’re just going to submit that with the paper application, but we’re working on getting access at that level to be able to give you it. But there’s nothing that you guys will need access to right now. So that… can’t be a hold up anymore.
Leigh Howle (35:01) Do you want me to make the line client owned or just cancel it?
Melody (35:06) Yeah, make it client owned and I’ll have Julie update it in there.
Leigh Howle (35:09) Okay.
Leigh Howle (35:15) And then on sports medicine, what… about that one that?
Melody (35:21) One I need to look into because I don’t even know what brand that is… okay? Or what group.
Melody (35:37) But I’ll get with Julie.
Leigh Howle (35:40) Okay. Sounds good.
Melody (35:50) Okay. Yeah. I’ll see if Julie can get if we don’t have it added. I’ll see if we can get it added. And then we’ll add medallion. Okay, perfect. Sounds.
Leigh Howle (36:00) Good. Was there anything to go over anything else on the agenda or anything you wanted me to add?
Melody (36:07) There was just a couple of things that came through. I just wanted you probably didn’t see them yet, but Carla had said there’s a bunch of uptick in tasks for cois for providers to be added to cois. But she said they’re already added to the group Coi, and that the response she got from a medallion agent said that the cois under the group profiles are only accessible to the admin team. So I think they’re confused… yeah.
Leigh Howle (36:36) Anybody can access those cois?
Melody (36:39) Yeah. And so, yeah. So she’s just been like responding to them saying like to check that, but if they could just be shown where to get those, and then we don’t need those tasks to?
Leigh Howle (36:48) Be, yeah, I’ll go through the task and find out, you know, where they’re coming from. So just to clarify on the cois, where it just has the brands listed… are there cois, with the providers’ names? Yeah.
Melody (37:05) So, if they’re under the group profile, they load all of the providers underneath those two. So it’ll have all the brands. And then if you keep scrolling down, all of the providers are listed on those as well. Got it. They should pull them because very rarely do they upload a Coi under the provider’s profile. With that, got it, just get added.
Leigh Howle (37:26) To.
Melody (37:26) the group profile then?
Leigh Howle (37:28) Sounds good.
Melody (37:33) Oh, and then for the… oh, what is it the delegated credentialing addendum that you were talking with Kelly about? If it’s just for signature, you can just have it sent to me and I can sign it if that’s what you were asking about this morning, it.
Leigh Howle (37:50) Was.
Melody (37:50) okay. Yeah. So it can just be sent.
Leigh Howle (37:53) Perfect. Yep.
Leigh Howle (38:05) Okay. That sounds good.
Leigh Howle (38:11) All right. So, welcome back, Kate. I hope everything went good at the school. Yeah.
Kateland Sanders (38:17) They have psats, and I don’t know if y’all do that in your states, but they literally were like, they’ll be done at one o’clock it’s like 11 30 and he’s like, mom, we’re done. I’m waiting at the school and I’m like, are you joking me? Like, can we keep them at school until the time you said? So I had to like run and grab him really quick and I didn’t need to be there for the other, what epd was going over. So, yeah, it went fine.
Leigh Howle (38:40) Okay, good. Yeah, we just went over some agenda items just finished up and are moving into the escalation incident deck.
Melody (38:50) So, okay, we’ll.
Leigh Howle (38:52) go ahead and it’s okay. Did you want to go over anything specific? Or do you want me to run through this?
Kateland Sanders (38:58) You can run through it. I just had that one item. We talked about. It was like the blue cross completions, but we can get, we can do it when we get to that part.
Leigh Howle (39:07) Okay. Sounds good. So, on this, we did a cap and these are the results from the cap and I’ll definitely send this deck out. So, and I know Derek has sent an email over with additional information. And so basically, we’ll just run through the escalation summary, provider, priorities and lines, the root cause analysis and cap that was done stabilization and recovery plan and then next steps.
Melody (39:35) So, in.
Leigh Howle (39:37) The escalation summary, there were delays in workflow, you know, SLA risk, there were QC lines that were creating bottlenecks and intake, complete lines that were sitting and missed or approaching SLA. So QC definitely had an impact on that. And so there has been a resolution in it. Now, we’ve got that team staffed up for priority enrollment risks. Medicaid, Montana was identified with the group revalidation, and then Andy Kiley’s, Georgia medicaid application that required resubmission. So both of these lines are being monitored daily. I’m personally involved in the Montana medicaid group reval. So, and then the next one was just process reliability concerns, you know, feeling confident in enrollments and the processes that we have in place. You know, resubmissions were brought up and sop, mismatches, wanting to make sure that the correct training guides instructions were listed for the team to follow. And so just, you know, you had concerns about reporting ownership and escalation issues, pathways and discipline. And so for… these two priority lines, you’ve been on the email I’ve sent to Angela with Montana medicaid. And I also sent another one today. So you’ve been very, you know, involved. I’ve communicated back and what the issues were, what the resolutions were. So the application was resubmitted on floor 10. I worked very closely with the SME who has called multiple times with Montana medicaid to make sure 100 percent this application is correct. There’s nothing missing. So that one is in process. And then for Andy Kyle, still waiting on the medicare welcome letter. And Bianca checks the emails daily to find out if they have sent that over. They did say seven to 10 day turnaround time. So these are in process… with the payer. And so, for the root cause analysis and cap that was done for operational capacity, the QC bottleneck that was mentioned earlier, there has been a staffing shift that was done with confluent. And there was a newer operating team that was in place. So that kind of created an increase in the QCS, which resulted in the backlog. So to resolve that, there have been tenured confluent, experienced PE specialists added back onto confluent. They are staying, they are not going anywhere is my understanding. And so the backlog has been burned down. As I mentioned earlier, it’s at about 65 percent today. And the target, you know, I think 100 percent was by, was it today or tomorrow?
Kateland Sanders (42:53) Today? It should be cleared by end of day today.
Leigh Howle (42:56) Okay, perfect.
Kateland Sanders (42:58) So the QC piece, I think this morning, we only had 32 lines left on QC that needed to be done, Melody. And then the rest are just the normal apps processing. And that was still the goal to get those completely cleaned outside this off like end of day later today, we do have a night shift that works as well, so they could work late afternoon, but yeah, most everything should be cleaned up by later today, perfect.
Leigh Howle (43:26) And then for payr specific and documentation gaps, certain lines were delayed by, you know, submission requirements, missing documentation, and that has been corrected. So just making sure that, you know, ptpn is definitely an example with making sure all, the resume was correct. And I feel like we’ve done a lot of work to update project plans. There’s a really large initiative underway by one of our expert QC. He’s a he’s incredible. He’s a senior QC specialist and he’s going through the project plan and doing a huge sweep and making sure that everything is correct. He messages me often, and confirms instructions. So, you know, having him going through it, having experienced confluent team members back on confluent’s account. I feel like this is really going to reduce errors and increase efficiency just across the board going forward. And that kind of goes with sop alignment and process controls. I’ll stop there. I know I’ve said a lot in a short time. Do you have any comments or questions? No, this is good. Okay. And then for like stabilization just having the resources back on confluent’s account is going to make, a big difference. The team has worked so hard to get, the burn down on those particular lines. And QC has shifted away from low risk payers to reduce those bottlenecks. So they’ll be focused on the payers that need their attention the most. And then just in progress monitoring, daily monitoring is in place for all of these provider high priority lines. And the queue is the queue work is processed from oldest SLA to newest, unless you flag a priority provider or group enrollment and I always mark it as a priority. And then that goes that surfaces to the top of the queue as well for processing. Yeah. So just expected outcome, you know, having the backlog, recovery, clear accountability across workflow stages, fewer resubmissions through sop correction and targeted retraining, and then just better long term throughput from that payor name mapping exercise that we did that will significantly increase automation now. And so that is just another component that will reduce errors and increase, you know, the speed that providers get enrolled with great. So just for next steps, confirming updated sops. So I am… the review and approve. So we talked about healthspring and tricare west sop update by 420. So the team gets retrained. I know we talked about Oklahoma really appreciate Julie jumping in on that. That was super helpful just to get direct information from bcbf to go through humana for tricare. Yeah.
Melody (46:49) And they just changed that again yesterday, and that’s why I was like, please reach out to Lee because they keep changing it. And so, yeah, we’ll keep you updated but they do that like every six weeks, they’ll be like you need to reach out here. So, we tricare is we don’t hold you guys to the fire for that one just because it’s tricare and they don’t even know what they’re doing over there, so.
Leigh Howle (47:11) Yeah, they don’t I know when I met with a BCBS rep in Texas and happy to jump on calls if Julie or you, anybody could schedule a meeting with BCBS in those core states. And she even said that their department within BCBS for tricare was just, you know, they were trying to build it and get it set up and they were having significant delays. Yeah.
Melody (47:40) That’s what we noticed too. Yeah, we do have that one contact. Now. It seems like that one direct contact as long as she stays there, so.
Leigh Howle (47:51) Yeah. And then just keep the lines moving, you know, making sure that the lines are getting touched and they’re getting submitted, timely stabilization, cadence, run weekly, staffing queues, review everybody’s lines… what they have in the queue to make sure that they’re addressing those and getting those out the door as quickly as possible. And then we talked about expanding automation. So the confluent email triage automation rollout was this week, right? Kate, I think that was this week.
Kateland Sanders (48:30) Yeah, for the emails, yes. Yeah, it started yesterday, training started yesterday and then we’re going to be fully live. I think by end of day tomorrow is the plan. But yeah, we already trialed it on another customer and it worked, really well. So we’re just training the team on how it works into their queues. So basically, the way it works, Melody, is there’s no separate triage team anymore. The email comes in, there’s a higher auto triage, and then anything remaining just gets worked into the queues. So instead of like one team member touching it, triaging, it, attaching it to the line, then it going into the follow up queue, it all happens at the same time. And then we have auto categorization so that if the email just says the app’s still processing, we don’t need to respond to that. So it kind of auto categorizes the urgent emails that actually need a response over just a still processing email. And then the next step of the automation will be to auto post those notes to the line so that it doesn’t take a person just to look at an email and say it’s still processing. So that’s like this is a huge change. And I think this will make like a massive difference.
Leigh Howle (49:38) Awesome. Yeah, it definitely will blue cross blue shield Texas. Like if there’s a way to tell whomever is processing those emails, these are the top payers that require a 24 hour or 48 hour responses or they will just reject applications that might be helpful as well.
Kateland Sanders (50:04) Yeah. And the auto triage already does that. Now, it just hasn’t been, we like trialed it on one account to make sure it was going to work well. So that is how it will happen. So basically like that’ll just go to the top of someone’s queue. If it’s a 24 hour turnaround, it’s like really awesome. I’ve like seen it work on one of the other accounts. So, yeah, this is huge improvement on the email workflow than we’ve ever had before?
Leigh Howle (50:27) Yeah, that’s exciting. I remember like two years ago? I said, can we just put like a red flag on an urgent email? Just anything… awesome?
Kateland Sanders (50:40) Okay. And that?
Leigh Howle (50:41) Was all I had? So, Kate, did, you, should we go into the piece about just accuracy and bcps? I think it was Kansas or Texas? Yeah.
Kateland Sanders (50:54) I think that was like what the confusion was. Melody. I think on the email you sent Derek, it said Kansas, but… I think it may be the same problem for Texas and Kansas. So I wanted to make sure that was just like an example, but there are other blue cross blue shield that work that way there.
Melody (51:11) Are, yeah. So Kansas was just the example because that’s the most recent one that we ended up having to write off a lot of claims. And then we ended up finding five, six more providers that were like that as well. So we audited all of the accounts against our portal and we found them all. Now, we just want to make sure moving forward which we should because we set up the process that they, instead of just closing it at the credentialing letter that they’re getting the actual enrollment letter, which should come after. But when we prematurely close those lines, then they start seeing patients, and for whatever reason, Kansas has to do something and they never get it right? And then they don’t actually load our providers, they end up never being linked. And then they’re seeing patients and we have to write off a ton of claims. And that one brand leader’s about ready to kill me. I’m like.
Kateland Sanders (52:02) Okay. Is it, is it an ever, an issue where it’s like the, I think it’s called like a conditional approval? Is that what you’re seeing is the issue? Like they technically get approved? And then it’s like pending the credentialing? Or is it like the loading of the contracts is what’s not or the lines of business they?
Melody (52:23) Just get the, that the credentialing committee has approved them to be part of blue cross blue shield. And then they, but they say in the letter like now you’ll be sent on to the enrollment, whatever team and wait for notification from them on your once that’s loaded, you’ll get your effective date and all this. But then it’s closed out. So if there’s additional communication, nobody’s even looking for it.
Kateland Sanders (52:50) And then, okay for it.
Melody (52:52) Too, because we just wait because it says it’s approved. We don’t go in and look to see what it is approved. Okay?
Kateland Sanders (52:59) Then, yeah, Lee, the process we set up should work for these. I just wanted to make sure this wasn’t before you were at confluent. We had an issue where Edwina was pushing really hard for them to be closed out if we got a conditional approval. And so I wanted to make sure we weren’t stopping that and then waiting when they technically could be seeing patients because there is, I think it was blue cross Texas. And there was one other one where they sometimes do send because they’re PTS and ots, they’ll send like a conditional approval. And then it’ll say if like the credentialing failed, it’s like before they’re even approved for credentialing, they give you like an approval. And I wanted to make sure it wasn’t that scenario and it was like the one that you’re talking about where it’s like we’re closing it out. And then, yeah.
Melody (53:42) Something’s.
Kateland Sanders (53:43) not getting loaded. So then, Lee, the process we set up should work fine for that then? Good?
Leigh Howle (53:48) Yeah. And Melody, if they’re not, if BCBS Kansas is not loading the contracts that’s on them. And I.
Melody (53:57) thought that, yeah, we fought them and they were like, nope because apparently they’re reaching out for additional information and they weren’t getting responses. So it was like one was because, the office hours they needed clarification on that. And because nobody responded to them, they didn’t load the provider because we were trying to get it backdated to the original credentialing date. And they were like, no, we’ll only do it to like the date of the first letter that was sent for that additional information. And we were like, but I think because it was closed out, no other emails were being looked at, yeah.
Kateland Sanders (54:30) It’s the piece of us completing the enrollment before we got confirmation. So, I think on our side, what happened is they confused that scenario with the provisional approval that I was talking about. And I think that’s why this happened. But I think they’re two separate things. And so the process we set up, we should catch this. And even on the provisional approvals, now, we’re not closing them out in the system. We’re sending a well, if we’re still getting them, I haven’t seen any recently. But if we do get them, the process was to send an email to confluent, to say you technically can be billing, but we’re going to keep the request open because even on the provisional, if we close it out and then they do fail, we would never know that so that even that process has changed where we don’t close them out as completed.
Melody (55:18) Yeah, we, I’ve been pushing hard not to. So for blue cross blue shield, they have a preceptor program here where they can do like they can see patients under another provider’s license. I say that’s the better route even though it’s co signing. But if a, if it’s not written in the credentialing policies for blue cross blue shield, I say it’s not best practice to start seeing patients before you get that actual approval because of cases like that, where they can give you that. And then it ends up being not approved correctly or not gone through the credentialing committee correctly. And then you get a different effective date. And then it’s really not anybody’s fault with the brands because they started seeing patients first. So I said best practice is just wait till you get that actual approval. So I’ve been keeping them away, been trying to deter them from doing even though it’s going to cost them a few weeks of seeing patients. I think it’s better than costing them thousands of dollars in visits. Yeah.
Kateland Sanders (56:11) And it, I almost like would agree with it if it was on a payer that we know would retro. But like we’re talking about the one payer that will not even budge. Yeah, they just like.
Melody (56:20) And like commercial plans are really hard. So I’m like don’t even do it. Yeah, like they’re coming at me like they’re like, well, Edwina did, I was like, well, good for them but we’re not doing it. I think.
Kateland Sanders (56:31) She like still had issues with it though, to be clear, like we were getting escalations about it. Yeah. I’m like, why are.
Melody (56:38) we doing this? Yeah, I’m just like I’m not doing it. So. Okay.
Kateland Sanders (56:42) That sounds good then. Yeah, Lee, the process we set up should work for both of those scenarios, awesome.
Leigh Howle (56:48) Yeah. And I’ll also when I meet with the team, I’ll just reiterate again to definitely make sure that they’re monitoring the emails for BCBS Kansas, Texas, Oklahoma, Montana. Like they, those emails are time sensitive and they must respond if there’s anything missing. And hopefully with the new email triage, that should also capture those. Okay, good deal. And then I just had the opsync deck. This was the last piece. I know we’ve just got a few minutes.
Leigh Howle (57:21) Let me just go down. I’ll start with this slide. This is always the best one I think. So the outstanding enrollment has gone down again. So decreased by 109 for the 150 and 120. So 120 plus. And we started this, it was like 14, I don’t know 1,470 something. So probably already at a 60 percent decrease and the client tasks are still out there. 478. So not too many, just a decrease by five. And we had a shift for the first time in a while with tricare west. It is now in it’s dropped to second place for the top 10 payers and 150 plus amerihealth, caritas, Indiana is coming in at the top with 91. So as I mentioned, the team is starting to shift focus to the top payer here and then just working their way down the list. And for just week over week requests, there was an uptick last week with 553, only 153 of those passed through intake. So might want to just make sure that there’s providers that don’t need to sign agreements, or if you want me to go through and run that report out of report builder for percentages that are complete or providers need to sign. I’m happy to do that and send it over. Just want to make sure we don’t you know, that intake has everything they need to start processing. Okay? And then the team did submit 487. And so those that is good… and request three requests for medallion, there were 48 apps completed. So probably recreds were built into that and follow up. There was an increase in outstanding follow up. So there are 126 lines that are overdue. There’s roughly about 2,700 that are current. So when I meet with the team, I will go over these in the seven day plus. Okay. And it’s just really kind of odd with rosters not usually expired follow up, but there were 43 this week and six are showing up in the 50 plus overdue. So that is a little unusual to me. So I’ll also identify the payers that fall into these buckets and make sure these get addressed. Okay? I’m sure you’ve seen the analytics new look. So completed enrollments for April are coming in at 584. And the last thing I just wanted to, I know we’re at time.
Leigh Howle (60:13) This is the list that I was talking about at the beginning of the meeting. Basically, it is just, these are all the closed practices for confluent. And so under column F where it has migration review status, it just has like, is this practice truly closed? You know, it might reopen at a later date. Do you want it completely archived where it’s completely removed from medallion? Or it’s not really closed? It needs to stay active. Okay. So I’ll send this over in an email and, you know, if you want to, if you could just run down the list and send it back, I’ll get that over to Addie with, or Lynn with epd and they’ll go in and update this great. Any questions on anything? Nope. That’s all looks good. Okay. Awesome. Well, I appreciate your time as always and I hope you have a great rest of your week. Thanks for joining Kate. Bye bye.