Transcript
Nic Schisler (00:00) hello? Hey, how’s your afternoon going good? How was our time in disney? So fun? Good? Was it busy? Was it crowded?
Rae Tompkins (00:13) No, always. But when is it? Not? Yeah, I know. How was your time?
Nic Schisler (00:17) It was good. I mean, stayed local. I mean, it was still very busy here. You know, I think between kids being out of school, other folks here, we went to the aquarium last Wednesday. Yeah. Oh, that was busy, very busy. Yeah.
Nic Schisler (00:38) And I have a sync later today with Melissa. Okay. So I’ll ask about the death master.
Rae Tompkins (00:46) Okay. Yeah. I don’t really know.
Nic Schisler (00:49) I would need to go back. I think they have advanced ongoing monitoring, I believe. So, if that’s the case, then that should be included in that, but I don’t know if they need that true. So, let me find out with her. I have a sync with her at three.
Nic Schisler (01:05) Okay? It was supposed to be me, her and, Bob canceled. I asked if they wanted to reschedule, and then I followed up with her and she said, let’s keep it. So I’ll chat with her and I’ll let you know when I find out.
Laneika Walker (01:18) Cool. Works for me. Okay?
Nic Schisler (01:21) Any fun plans for the weekend?
Rae Tompkins (01:24) No, we have the coughs again, just with the weather and I’m sure disney didn’t help. So, I think we’ll just lay low and recover yet again.
Nic Schisler (01:35) That’s okay?
Rae Tompkins (01:37) I feel like every time we get over one, we get another one.
Nic Schisler (01:40) Just once again, I know a,
Rae Tompkins (01:42) new normal.
Rae Tompkins (01:48) What about you guys? Anything exciting?
Nic Schisler (01:55) Kelsey and I are going out to dinner on Saturday night. Actually, we have a dinner. Yeah, get a little meal and try and taste dinner.
Rae Tompkins (02:06) Yeah, adult time… that’s it. I don’t know where they are.
Nic Schisler (02:57) Do the boys, do they like planes at all? Oh, yeah. Did you see? I don’t know if you know this, but like every year, there’s like an air… show at the charleston air base, but on may the second, they redid it, and so they’re going to do it downtown over the charleston harbor, over the water. And it’s not a long show. It starts at one o’clock and I think it’s just like the blue angels that are going to fly and then another like demonstration. But they’re giving you like instructions like where you can view them from like mount pleasant, Ravenel bridge area and all the things. So something free to do. We’re going to hopefully the weather’s good. We’ll take the girls to go do that, but I didn’t know if they did. So I figured I would mention that to you while we’re sitting here, yeah.
Rae Tompkins (03:50) We drove to disney and they’re like, why aren’t we going to go on a plane? And I’m like, okay, let’s just get there first. All right here’s. Here… she is… hello? Hi. How are you? Good morning?
Laneika Walker (04:07) Or depending on where you are? Good afternoon, yes.
Nic Schisler (04:09) It’s the afternoon here, it.
Melissa Turransky (04:11) Is.
Nic Schisler (04:14) don’t take that away from us. We’ve put, we’ve put in some hours this morning. We’re we’re close to happy hour.
Laneika Walker (04:21) Exactly. You’re living in the future?
Nic Schisler (04:27) Sometimes that’s a good thing. Sometimes it’s not a great thing to be living in the past, but sometimes it also is good to be living in the past. So we’re here, that’s all that matters. I.
Rae Tompkins (04:36) Feel like sometimes though in this time zone, our day doesn’t start till two because all of our other team members are just like kind of catching up to their day. So we get real busy from two to five. So we pick and choose, what time of day we can push through, hi, Melissa.
Laneika Walker (04:52) Hello? Sorry.
Melissa Turransky (04:53) Running behind.
Rae Tompkins (04:54) It’s okay. No worries.
Laneika Walker (04:56) One of those days.
Rae Tompkins (04:57) Yeah.
Melissa Turransky (04:59) So, everybody got their introductions already?
Nic Schisler (05:02) No, we all.
Rae Tompkins (05:04) Oh,
Nic Schisler (05:04) yeah, no, we were waiting, Ray and I were waiting.
Nic Schisler (05:07) Yeah. So we’re all just gathering here at the same time. So, Melissa, if you’d like Ray and I can certainly go through introductions if you all would like to go first and then popcorn it over to us. And then from there, you know, we’re certainly happy to dive in and to whatever you’d like to, you know, discuss this afternoon, next steps takeaways. I know the clock is ticking per SE. So merit, one of, our lead counterparts who’s going to help us with this? She’s actually traveling in India with our offshore team this week. So we probably won’t have her back until Monday to even really get going on this process. I don’t know if that is a red flag to you both, if that’s okay. Like I know there’s a kind of hard deadline if we need to ask for an extension, you know, so we can talk about that as well too if needed.
Melissa Turransky (06:01) Yeah, absolutely. Yeah. So you guys obviously know me. So I guess we’ll just we’ll let Lanika go ahead and speak, and then you guys can introduce yourselves.
Laneika Walker (06:12) Wonderful. Thank you so much, Melissa. So I am Lanika walker. I am on the compliance team at the mosaic level. So corporate compliance, I am assisting the caremore team with vendor audits and a couple of other external audits. So you will be working with me primarily with a dotted line to Melissa. If I have any other questions or concerns. I’ve been with the company for now. Two and a half years. I come from a health plan background with excuse me, a lot of medicaid and medicare insurance background. So I’ve been at this for about 20 years now.
Nic Schisler (06:48) Wow. That’s impressive. Well, it’s great to meet you. Looking forward to partnering with you on this exercise. My name is Nick schuessler, senior account manager here at medallion. I’ve been here for, I think it’d be, I think it’s two years next week. Maybe I really don’t know it’s either last week or this week… but have been supporting the, what was carelon now, caremore relationship really since my time here at medallion. And it’s been nothing but great to partner with Melissa and Bob and team always super responsive and partnership is strong and trying to coordinate and work together. So, happy to kind of support you all during this exercise. And with that, I’ll let Rae go ahead and introduce herself as well.
Rae Tompkins (07:41) Hey, I’m Rae Tompkins. I’ve only been with medallion for about eight months but throughout my time, have been working with Melissa on just kind of day to day operational items, how, you know, if there’s anything in platform that looks like needs to be reworked or any updates on files and progress, lots of experience in the credentialing world. So try to support where I can also supporting the licensing side of the house. So happy.
Melissa Turransky (08:05) To work with you wonderful.
Nic Schisler (08:07) Thank you both. Of course. So with that, I guess Lanika, Melissa, where would… you like to start with the process? Is this something that can pretty much be done asynchronously where we can deliver things to you? Is this a live exercise that you try to do? I think some of that is what Ray and I are trying to understand so we can share that with merit as well. But I don’t know if there was something in particular you kind of wanted to walk through today and we can chat about a bit more. So.
Melissa Turransky (08:45) With, so Lanika and I spoke, we kind of went over what the process you know, is and what would be required. So like we’re going to take on the files. So I will like walk Lanika through the files on the platform to do that part of the audit so that we’ve just kind of removed that from a requirement for you guys to have to do. So it basically is just really like the policies and processes that you have that she would be reviewing. And so that would be you just submitting them to Lanika for review… trying to make it as easy and painless.
Laneika Walker (09:26) As possible? Yeah.
Nic Schisler (09:27) That’s great. So if and when, what would you need from our team? Like how can we, I guess expect to hear from you et cetera. I guess is what maybe I’m not fully understanding… okay.
Laneika Walker (09:47) So, what I was thinking with this process is your team would receive the tools, fill them out, cross, map it to the policy and procedures and things of that matter. What we’ll do at that point is pull down the files and pretty much audit against the audit tool, the files that we’ve selected once we’ve satisfied that we will share the results with you all. And then we’ll walk through it. And if there’s anything that you say, hey, well, we do have that information available. It wasn’t cited correctly or you did not locate it or didn’t go to the right location, we can actually go over that together and correct. So it’ll be more like a working session at that point. And if there is a situation where we cannot find the information that we’re looking for. It’s not evident, then it would be more than likely an opportunity for improvement and then we can discuss next steps from there.
Nic Schisler (10:41) I don’t think I have any questions. Sounds like it’s a pretty straightforward process. Ray, do you?
Rae Tompkins (10:47) No, Melissa, do you have everything you need from us? As far as like policies, anything that we can provide to assist? I think.
Melissa Turransky (10:57) The only ones that I had and I think Lenika that I shared them with you is our delegation agreement with you. And then the… your cii policy. Did I share that with you? I’m not sure if I did, but I do have that one. I don’t have any, anything else.
Rae Tompkins (11:15) Do you need anything else from us? Or do we think that covers? No?
Melissa Turransky (11:19) I think there was hold on. Let me.
Rae Tompkins (11:22) I just want to make sure that we can communicate it back with merit if there’s anything missing that you need from us, we can definitely make sure to get it to you.
Melissa Turransky (11:29) Yeah. Did you?
Laneika Walker (11:30) Receive the engagement notice?
Rae Tompkins (11:33) Ray, let’s see. Yeah, yes, the engagement request. Yes. So.
Laneika Walker (11:40) We have in the engagement, the desk review requirements, and then a list of evidence that would need to be provided… like the following documents are listed there as well.
Melissa Turransky (11:53) Yeah. So, like if you have, if you have a subdelegate, you would give us that information?
Rae Tompkins (11:58) Oh, I will just, I see that now. Okay?
Melissa Turransky (12:00) Yeah, policies procedures you have around your processes? Yep.
Laneika Walker (12:04) Because typically, how it, how I would ideally see it flowing is that I would be able to review your policy and procedure and that’s what governs your process. So the policy allows us to understand that the requirement is understood. And then your process is what governs the policy. And then your evidence in your files would pretty much illustrate that you’re aligning to all three perfect.
Rae Tompkins (12:31) I will make sure that that’s shared with our director of operations and we will work to compile all of those things to provide to you.
Nic Schisler (12:41) And obviously, it looks like your preference would be to send that through a secure environment. Yes.
Laneika Walker (12:50) If that’s easier for your team to do because they’re probably large files. I’m happy to do that and pull them down that way.
Nic Schisler (12:57) Okay. We can figure that out with merit, right? I’m assuming that might be the easiest route rather than just like encrypting one off emails, but we can figure that out, okay?
Melissa Turransky (13:09) Yeah. And we’ve taken the one off encrypted emails too. So if that’s the route, you know, if that’s how it has to be, it’s how it has to be.
Laneika Walker (13:17) Okay. We’re pretty flexible.
Melissa Turransky (13:19) Okay.
Laneika Walker (13:22) And if you have to push out the date and I hope it didn’t cause confusion in the email, I tried my best to provide you a 30 day notice. The timeline would be from April eight through may first for you to get your submissions to us, and then we’ll take that time to review any of the supporting evidence policies and procedures.
Nic Schisler (13:45) Okay. I don’t foresee that being an issue again with the lead to contact an RN who’s going to really kind of help drive this from our end. Again, she’s in India. I think she gets back this week. So we wanted to meet with you all ahead of time just to kind of talk through this scope essentially and then be able to provide that to her. So we’ll drop an update to her. And then I would say if she has any concerns about meeting that deadline, I think there’s no problem for us to be in touch very early next week like by the end of the day on the twentieth on Monday, just to say, hey, like can we get an extension, like is that possible? Or it sounds like we should be able to meet this deadline if we’re gathering documents and we’re running in delays. We’ll give you a heads up and let you know. But, you know, from my side, like I don’t see it being a huge issue, but we’ll certainly talk with her and let you all know… we have some cushion. Thank you.
Laneika Walker (14:37) You’re welcome.
Nic Schisler (14:41) Ray. I don’t think I have any other questions. Melissa, I’ll leave it up to you. If we want to let Lanika drop, do we want to just connect here real quick about the grid you mentioned Jimmy while we had? And then I can save this time for later since we’re live right now, we have 15 minutes. So.
Melissa Turransky (15:00) All right. Okay. Perfect. Thank.
Nic Schisler (15:02) You for the dismissal. Thanks Lanika.
Melissa Turransky (15:04) Nice to meet you. Looking forward.
Nic Schisler (15:05) To working with you and we’ll be in touch. Okay? Likewise.
Laneika Walker (15:08) Thank you. Thank.
Nic Schisler (15:10) You. Bye bye. We actually have something additionally to discuss with you. So this might just work. But why don’t we talk through the grid first and then we can cover our… piece afterwards.
Melissa Turransky (15:27) Yeah, I’m just trying to find Bob’s email real quick. He said he sent it to me. He showed it to me this morning when we were on a call. And then I was like, I don’t remember… seeing that email, but I probably so.
Nic Schisler (15:41) Much happens between nine a. M and like now it’s hard. It’s like, is it still Wednesday or is it Thursday?
Melissa Turransky (15:50) It’s Thursday? I leave tomorrow? Like I’ve been sick all week. I’m like panicking.
Nic Schisler (15:54) Oh, I know you sound under the weather. Are you feeling better the same or?
Melissa Turransky (15:58) Worse, definitely better today and like the pressure is better. So, I’m hoping like one more day before I fly and I’ll be good, but.
Nic Schisler (16:06) is it just allergies?
Melissa Turransky (16:08) Yeah, I think so.
Nic Schisler (16:09) Oh my gosh. Sorry to.
Melissa Turransky (16:10) Hear that. Everybody around me has been like getting like diagnosed with like pneumonia and this and that and I’m just like I’m going to stick with the fact that I have allergies.
Nic Schisler (16:19) Yeah, I like that. Let’s just be optimistic there. It’s just allergies.
Melissa Turransky (16:26) Right. I’m trying to find his, I can explain his grid anyways. I understand what he’s doing. I kind of wish I was like, yeah, he’s like it’s probably in your emails. I’m like, yep. All right. And he’s like if you talk to medallion before us, so basically, he had a chart with, you know, one through 30 days and how many providers fell into each of the buckets, you know. And then he had like the graph, you know, that would show like… you know, like the bar graphs. So it would show like for the peak of a 30 day window of a provider file processing, it would show, you know, maybe you had two that processed in two days and you had like 15 that processed in five days, you know?
Melissa Turransky (17:12) So it would kind of show this like ebb and flow of a month. And his thought behind it is he’s trying, he’s hoping I’m not sure. I’m going to get the same data. Elevance. I got to actually make a request. He wants to show that while elevance… could say they were doing ours within 17 days, a majority of them may have been more on the closer on the 30 day side versus that lower end or whatever. So he kind of wants to show where you got, show your chart against their chart to show not only did we, you know, save time and money, you know? Yeah, that’s right? So.
Nic Schisler (17:53) I think, it sounds like he’s just basically trying to do a bump and compare. It. Sounds like how long?
Melissa Turransky (18:00) Do you think to your own dashboard? Like like I think you have like circle colors, you know, this is just like one of those little like bar graphs, you know, so kind of just that’s the only difference. And I don’t think he’s really… tied to how the graph looks, but it was more like his thought behind it being able to bucket how many providers in each of the time frames in that 30 days?
Nic Schisler (18:31) Ray and I can certainly pull some data to, I guess what would be the date range? Are we looking to do this all time from when we actually started to deliver files? Which if I remember correctly, was like some time in October Ish.
Melissa Turransky (18:47) I think he wants to work with like the first quarter, you know, okay, one.
Nic Schisler (18:51) Of this year that.
Melissa Turransky (18:53) You know, and then he’ll take a quarter of… elevances processing kind of, you know, to show it’s more just to show how… wants to be able to show that you guys, you move faster than they do, which we see, but he wants them to have a visual.
Nic Schisler (19:11) Yeah. Let me… I’m doing something real quick.
Nic Schisler (19:50) So… there is this chart in…
Nic Schisler (20:03) Let’s move some things around here. Sorry, try not to have too many tabs open… in the platform. If… you go to caremore, credentialing, and you go to analytics and click on credentialing. If you come down here, I don’t first of all, I don’t know, but we just recently pushed out a new analytics update. Okay, there is this medium turnaround time and calendar days and so we can actually put a filter on this. Okay? And I can look at… let’s just say last three… months.
Nic Schisler (20:49) It looks like the tat, the total turnaround time from the time that the I’m trying to see if I can get this out of here. Sorry, from the time that it was requested to the time it was with it was to the application was complete, it was with your committee. And then you all voted on it. Yeah, it looks like the total turnaround time. I don’t know if that number is right? Since this is putting us at seven right here. Yeah, I don’t know why, but really, I guess it’s seven days. But really from the time that you requested the time that it’s complete, we’re looking at five calendar.
Melissa Turransky (21:24) Days, right? Yeah, exactly. So.
Nic Schisler (21:26) There’s this bar graph down here that we could download as well too. But, this is all filterable and you can download this, but I can put something together for you that’s maybe a little bit more professional facing and Ray and I can work that on that together if you just want to look at key one, when would you need it by, you… know?
Melissa Turransky (21:47) He, he didn’t even, he didn’t say a date. He was just like if you get in front of medallion before I do, could you share this chart? And then, of course, he didn’t actually send me the chart?
Nic Schisler (21:57) Okay. Maybe.
Melissa Turransky (21:58) Actually, I’ll ask him to email it to me. So you have a visual, yeah.
Nic Schisler (22:02) That would be great if you could maybe get that chart from Bob and then send it to Ray. And, I know we’re due to connect again next Wednesday. Maybe Ray and I can just sync and just try and get something close to maybe what you’re looking for. And then when we meet next Wednesday afternoon, we can cover it then and kind of go from there essentially… Ray, you’re not on that invite by the way, it’s our monthly executive call, but I can add you to it. It’s four PM next Wednesday. If you, if you have something, don’t worry about it. We can always, I can always provide feedback if there is some.
Melissa Turransky (22:40) Okay. Yeah. All right. Does.
Nic Schisler (22:42) That help though, Melissa, do you think just based off of what I showed you in platform, that might be? Yeah, you know?
Melissa Turransky (22:47) Because I could look and see, you know, most of the files are not even going over 10 days, you know? So I could see that like in that little grid because that’s what he was really looking for. He wants to know like how many fall into each of those buckets, you know, like one through 30 days, you know? Yeah. Once I sent his little grid over, yeah.
Nic Schisler (23:06) Yeah. And we’re way under that 30 day mark.
Melissa Turransky (23:10) Yeah. And that’s what I think we know and want to show, you know, that’s why we’re thinking the two graphs, yeah, would really drive it home for them. Like not only do we save money with medallion, look at our turnaround times? Yeah.
Nic Schisler (23:26) I mean, I, I’ll check this in sigma too, but I think the reason why I want to pull this from here is just because this is what you all would see but I would say the night the name number I can’t even talk the main number that we would deliver would be the requested to application complete because basically, that number is five calendar days. And what that’s saying is from the time you all hit request in platform to the time we work the file, QA, etc, the time that it’s actually goes through committee, you all vote on it five calendar days less than a week. I would say that’s like the number that we want to drive home. But once I get there once not.
Melissa Turransky (24:05) Even, I mean, I wouldn’t know, not so much, including because that might be even, it should just be your number like the day completed, not how long it takes us to kick because we’re sending the committee. Sometimes we’re holding files. I mean, not long. We do it like, I think we send out on a Friday and maybe a Tuesday and Friday. So it’s twice a week that we send. But that adds days to the calendar that you guys are not. You have no control over. It’s. Not or, you know… so I think it’s better to, you know, report on the data you guys control like you gave it. Yeah, it was completed. I don’t want to add days to it, no.
Nic Schisler (24:45) Totally totally agree. I think… send the bar graph or.
Melissa Turransky (24:51) Bob’s graph when you can. All right, I got it. I’m going to show you real quick. And then I’ll also send it to you.
Melissa Turransky (25:05) So he was, you know, hoping to be like this is elements, this is medallion and like, you know, show the… you know, where he’s thinking, you know, well, I think you reversed them but he’s you know, thinking like, your like biggest spikes will be in the lower end and there’s no, he didn’t reverse them. So there’s their spikes are all in the 20 day range. You know? Okay. Oh, I see it’s color coded in there. So you’re.
Nic Schisler (25:30) yeah, I see what he’s doing. Okay. That’s how it is okay. Yeah, share this with us and then I’ll see maybe what breakdown we can help with too. Do you know if he pulled the data? Like from, no, I’m assuming you did.
Melissa Turransky (25:43) This is, this is fake data, totally fake data. I have to actually ask that’s why I said like we may not even be able to pull it off with elevance. They, when I ask them to give me a report of all of our turnaround times, they may tell me to pound sand. I don’t know.
Nic Schisler (26:04) It’s always a lovely saying, isn’t it?
Melissa Turransky (26:07) Yeah. Okay.
Nic Schisler (26:10) Yes. Thank you for sending that when you can. We’ll review and then we’ll see how we can help set us up for a successful conversation for you. All great. I mean, at the end of the day, the good news, is like the data is going to be night and day difference for sure. Yes. Yeah. I mean, so that’s positive somebody.
Melissa Turransky (26:31) In the network team was kind of, you know, like they had said to Virginia, like they really needed this person and Virginia had put, you know, ask Ray to like expedite it. We either had it the same day or the very next day, you know, and they were like, what are you? Sure? Yeah.
Nic Schisler (26:45) Yeah. I mean, we’re going to be in very good shape to have these conversations so that’s the positive thing. And a lot of that kudos goes to your team, Ray, you know, you both just kind of touching base on a bi weekly basis, et cetera. So, and we can elaborate that from a partnership standpoint as to, but we’ll help pull something together to make sure you all are lined up for a successful conversation. Okay. Real quick too. Our product team reached out to Ray and I this afternoon and I know that you will have advanced ongoing monitoring as part of our contract. And so most of that includes, you know, Sam, oig, medicaid exclusions, but from their review, it looks like your credentialing files don’t include death master or ofac and a part of the advanced ongoing monitoring package that you have, those service offerings are included, okay with credit files. So, do you recall if there’s a reason why? Like do you not?
Melissa Turransky (27:56) More we weren’t, and it actually probably makes sense to turn it on because, they have been talking about going into medi cal, like we’ve been, we have it checked, but we’ve not had business there. So, but it does sound like that’s the way they’re going. So it would make sense to turn them on. Yeah.
Nic Schisler (28:14) I mean, we can enable that. There’s no additional charge. It’s covered. If you think, hey, we might be going in that direction. We can enable it if 90 days goes by and you’re like we don’t need this. We can disable it so, we can get it enabled for you within minutes. Okay? Yeah.
Melissa Turransky (28:30) Yeah. Let’s do it. Okay?
Nic Schisler (28:31) Ray and I will communicate that back, to our team member. Just figured it would be easier to chat with you, live about this. This was kind of what I was planning to raise with you in a little while anyway, so this works out.
Melissa Turransky (28:42) Okay.
Nic Schisler (28:43) Awesome. All right. Going anywhere fun.
Melissa Turransky (28:46) Going on a cruise? Oh, enjoy. Yeah. Thanks, couple of islands. Hopefully, it’ll be nice and sunny and the ship will not rock too much. Yes. Okay.
Nic Schisler (28:57) Hoping you feel better, hoping you have some great time off. Is there anything else that you need from Ray and I, before you’re out? I,
Melissa Turransky (29:04) don’t think so. No. I keep telling my team like I’m trying to like tie up loose ends and I feel like every meeting I go to, I’m like I feel like it’s like a time bomb. I’m like I’m going to leave and you guys are all going to be like, I don’t know, yeah, that’s just.
Nic Schisler (29:18) Never going to happen. Okay. What I will do is I’ll send a note back to you and Bob just to let him know that we had already connected and we talked through the grid and that we’ll be in touch with data that might be helpful. And if Ray and I have something, if Ray and I have something, I know you’ll be out next week, but we’re planning to speak next Wednesday at four. I’ll bring that to Bob’s attention next Wednesday. On the call, we can kind of just go from there et.
Melissa Turransky (29:47) Cetera. Et cetera. All right. Yep.
Nic Schisler (29:50) Have the best time. Thanks, thanks, Melissa. Talk to you soon. Bye bye.