Transcript
Dreama Hembree (00:00) hi, it’s finally Friday.
Collette Waddell (00:03) It’s finally Friday.
Collette Waddell (00:09) I am, I?
Dreama Hembree (00:12) See you making updates. I do not know what is that? A C 11 compliance, is that, what that she’s saying? Is that C 11 or C? I don’t know what that means.
Collette Waddell (00:24) Where are we?
Lynn Kiter (00:25) Oh, oh.
Collette Waddell (00:27) C, it’s C, I, it stands for credentialing information integrity.
Dreama Hembree (00:33) Ah, okay. Yep. Sorry.
Collette Waddell (00:36) Yes.
Dreama Hembree (00:37) I couldn’t tell if those were ones or I’s or what they were, and I was like, I do not know what that means.
Collette Waddell (00:46) I’ll just elaborate there.
Dreama Hembree (00:51) All right. I think they are here. I see Lynn and Amy, I’ll go ahead and let them in.
Dreama Hembree (01:15) Hi, good afternoon. Hello? Hey?
Lynn Kiter (01:18) There. Hello? Hey, happy Friday.
Dreama Hembree (01:20) Yes, happy Friday.
Lynn Kiter (01:23) Did you have a good vacation, Colette, it?
Collette Waddell (01:26) Was, good. The water was cold in the panhandle of Florida. My children went in, I went into about my knees and I told them not to go far because I wasn’t going to save them.
Lynn Kiter (01:41) Yeah.
Collette Waddell (01:43) I would.
Dreama Hembree (01:44) Have saved them. I’m too cold to save you. I would have saved them.
Collette Waddell (01:46) But I would have, but it was cold. It was, a little too cold for Maya, but it was beautiful, like, it was clear and sunny and, you know, so like just being outside was lovely. So, but yeah, it was nice and, I, which, I, you know, sometimes I’m really bad about, you know, still doing a little work here and there.
Lynn Kiter (02:05) Myself?
Collette Waddell (02:07) I was going to completely unplug so.
Lynn Kiter (02:09) Yeah, good. You got to do that every now and then, right?
Collette Waddell (02:13) Yeah. So, it was good.
Collette Waddell (02:14) Thank you. And thank you for flexibility on pushing this call to today. I know we had to kind of squeeze in, I find another block of time but, greatly.
Dreama Hembree (02:24) Yes, thank you. We appreciate your flexibility on that. You know, that’s not ideal. But we,
Collette Waddell (02:32) do you want to pull up the end of a screen share? Yeah, I.
Dreama Hembree (02:36) was just trying, I’ve hit share like five times and it’s spinning. So, let me try it again.
Collette Waddell (02:41) And if it doesn’t work, I can no.
Dreama Hembree (02:43) I think I got it. It’s saying share anyways. So let me try. I was frantically trying to hit the share button in the background. Well, all right. I think it’s working. Can you all see the agenda? Okay. Yeah. Okay, perfect. So, Lynn, I know I sent a bunch of updates to you via email last night yesterday. Did you have any questions on those? Do you want to go through them individually or?
Lynn Kiter (03:16) I do have, let me pull that one up. I wanted to be clear about, let me find your reply real quick. Do do. Oh, I’ve got too many emails already. Okay. I wanted to clarify, I think one point and that would have been, oh, on the provider that we need to.
Lynn Kiter (03:53) That we didn’t have, we had an Ohio, you know, how we’ve been doing the, whenever we have a new provider profile. We have been in our workflow automatically requesting credentialing because we were doing the service based and there are times where I mean, that has been working out, okay? But there are times where like a team manager will upload information, it’ll complete the requirement and we haven’t really reviewed it and what ended up happening then we had at Catherine’s that Anna Kenrick, that only had the Dea for Ohio. And I don’t know if that came over in caqh, I didn’t really look into it enough, but we didn’t have the Michigan one. The file got credentialed with a flag. And what I’m afraid of is if we move the file forward, it won’t meet the centene, delegation requirement to have a Michigan Dea in the primary source verified within the file, right? And I did read that, you know, we could re, request the file and it would go against consumption. I’m fine with that part, but I wanted to be clear about how to initiate that and will it remain an initial cred file rather than a re, credential? Yeah. So since the file.
Collette Waddell (05:27) is still currently in that ready queue and hasn’t been approved, we essentially would like archive that and just like process a net new one. Now, one thing I did though wanna, I was gonna, and, Dreama, I might just steal your screen for a minute and then I’ll give it back to you. I just have this pulled up… which.
Lynn Kiter (05:53) By the way, we need a little celebration that we passed the pre delegation audit. Yeah. Well, yes, that is.
Dreama Hembree (06:01) Exciting. And.
Lynn Kiter (06:03) Definite lift up to Naomi too because she really helped with a lot of that lift early on. And then definitely the two.
Collette Waddell (06:12) Of you, I’ll relay that to.
Lynn Kiter (06:13) Her. Yes, I know she’ll it’s, a big deal and we’re going to have then due to the fact we moved that forward, we’ll have other agreements that are going to come pretty quickly with other plans. So good.
Dreama Hembree (06:30) Good. That’s exciting. Yes. And we are forever eternal grateful for Naomi on our team because she knows she’s a vast wealth of knowledge she is.
Collette Waddell (06:42) Amazing.
Lynn Kiter (06:44) All right. Let me.
Collette Waddell (06:45) just get to where I can take over. Hold on one second.
Dreama Hembree (06:48) This was for Katherine.
Lynn Kiter (06:51) Correct. Because.
Collette Waddell (06:54) I did want to look at and just kind of like talk through something.
Lynn Kiter (06:58) Okay. Let me replace.
Collette Waddell (07:01) The current share. I might need to zoom in a bit because this is really small… and can you see my screen? Yes?
Lynn Kiter (07:12) I can. Yeah.
Collette Waddell (07:14) So this is like the ready under the credentialing. And then we see Anna’s file here and that we, you know, we had done that and it was processed and moved to this bucket if you will.
Lynn Kiter (07:25) Right. So.
Collette Waddell (07:26) But I did just want to call out something. So, looking at this and this is like a historical, this credentialing kind of packet PDF doesn’t get updated. If data changes in the profile, right? It’s like a snapshot of how it was, what it looked like when it was moved into the queue, correct? Now, so we do see here on the element like the checklist, it says Dea license, Ohio. It was flagged as an issue. And then I’m going to just dive a little bit deeper into that. So here it’s going to say, so the matching criteria. So these… four fields up top, this is the Dea number, what was listed as the state for that, the first name and last name. So then the evidence is the results were, so.
Lynn Kiter (08:17) The PSV?
Collette Waddell (08:18) This piece is that it… is actually reflecting Michigan as the address. So the PSV says that it’s in Michigan. And now the reason why it was flagged as an issue is because our team when they’re just noting a discrepancy between what’s in the profile, what was on the application, so to speak, versus the results, they just flag that and mark that as needs attention or whatever the whole flag is. And so, and the reason I want to say this is because technically your PSV does show that it’s actually a Michigan one.
Lynn Kiter (08:58) Oh, okay. So we can still.
Collette Waddell (09:00) Archive this and I don’t know how, but here’s the thing. I am not like centene, payers. So I don’t know how nitpicky they would be like because the profile data said Ohio, but the results of the search of the query actually show Michigan with like this, you know, Michigan address, zip code. So technically, your packet does actually show the Michigan Dea. Okay? It’s just like it kind of over here. It’s going to say Ohio because that’s how it was entered in the program.
Lynn Kiter (09:38) Yeah. I think the thing is she had two, I think, she must have moved or at one time worked in Ohio or maybe right now, even, right? Yeah. And I don’t believe we had the Ohio like copy in there, but, let me look again here, correct? And I think it got added later. Yep, but that might not be true. Let me look again here too. You’ve got it right there. Yeah.
Collette Waddell (10:07) So, yeah. When you’re in that license and you click, the history, the changes so you can like, so if I start at the bottom, you can see, Ohio Dea and this was through the import. So this is what got imported through that initial caqh pull of data. Yep. And then,
Collette Waddell (10:36) I think, okay. So then, Amy… you added the Michigan Dea?
Lynn Kiter (10:44) Right.
Collette Waddell (10:45) Recently, so, but it’s technically, I think if we go back to, in here?
Lynn Kiter (10:55) It’s technically. Oh, the numbers aren’t any different though?
Collette Waddell (10:58) Are they, the numbers are the same? And this, like is a common, like just the state? Yeah, because they can change the address at any time. So like, yeah, of their existing Dea. So it makes it a little bit, you know, it’s real nice for the providers to be able to just go into Dea request an address update. But like administratively, for everybody who has to track this… it’s not my favorite because it can’t be changed. They just change the address. The number stays the same, the issue.
Lynn Kiter (11:28) Date and expiration.
Collette Waddell (11:30) Stays the same. They can change it.
Lynn Kiter (11:32) Yep. Okay. I’m following now, maybe it would be enough to add a note, you know, how we can add a note to the crag file that PSV… reflects Michigan. That way we can remember what happened if that were to, if the file were to be pulled for an audit. And I mean.
Collette Waddell (11:53) Ultimately, we absolutely can archive this and just have the team process a net new one just for the sake. But I just wanted to kind of show and talk this just so like in the future like you kind of have an idea of like kind of what, you know, where I was going at with this, if it was, you know, especially if it was a more recent you’re like seeing kind of.
Lynn Kiter (12:15) How do I look at that you were able to look at who changed? What do I, we have that ability? Yeah.
Collette Waddell (12:23) So, I am just like impersonating, your view, oh.
Lynn Kiter (12:27) Okay. Updated. Okay. And.
Collette Waddell (12:30) it, and it’s that little hyperlink is in most of these different sections, yep, which is really nice because it shows what was changing.
Lynn Kiter (12:40) Right. And.
Collette Waddell (12:42) then you can see like if something changed like here, the expiration date was updated from this date to this date. So it’s really nice to see the log of the changes yep.
Lynn Kiter (12:55) Is there a way to get an audit log like pulled for, you know, we have to conduct the credentialing integrity audit like you do, but we have to do it against the work that not only our team has done, but we have to audit medallion for quality.
Collette Waddell (13:16) Yeah. So, and I think that was actually one of the items it is.
Lynn Kiter (13:21) We can, we can wait, yeah.
Collette Waddell (13:27) Happy to, actually, I was just kind of adding some verbiage in here because I knew we would chat about it, but I was trying to get ahead of it. And so there is so exactly what you just said. So we’re required as ncqa certified cvo to audit our own universe of files, right?
Lynn Kiter (13:49) So, whenever.
Collette Waddell (13:50) You need that, you can request that from us? Yep.
Lynn Kiter (13:54) That’ll be yearly, they were good with what you provided though. Yes.
Collette Waddell (13:59) So that is that piece. And then exactly what you said, you have to establish your own policy and audits. Yep, we have a like a template that it’s one of those it’s like an audit tool that… other customers have used to be?
Lynn Kiter (14:19) Able to, yeah, I have an audit tool, but what I’m looking for is, would there be a like I can do the like, who updated, right? But I wondered if you have like a global like audit report that could be?
Collette Waddell (14:42) Like or would?
Lynn Kiter (14:43) The recommendation be, when I’m looking for, you know, inappropriate changes if you will, would you recommend that we do exactly, what you were showing like on that Dea, when I look at the updated on hyperlink… would it, would you recommend I do that on my universe of files that I’m going to? Well, I’m going to do five percent or we’re required to do five percent or 50?
Collette Waddell (15:15) Okay. Yes. Yeah, there is no like raw data report like how we?
Lynn Kiter (15:22) Were.
Collette Waddell (15:22) just reviewing. And so, and I know.
Collette Waddell (15:34) I don’t know. I haven’t been asked this. I’ve been asked this once other time because I feel, I think or I thought that, us doing that audit… because I know internally, there’s something that is done to review those like that raw like data change auditing, but it’s not, it’s more of like internal to make sure like we’re meeting those requirements.
Collette Waddell (16:07) But there is nothing.
Lynn Kiter (16:08) We were told we have to audit medallion. And then the other thing, I have a checklist, you know, within the cred files, not only the inappropriate changes, that type of thing related to like even our credentialing minutes, anything like that, but then I have a checklist of, you know, items within the cred file, you know, were they all covered?
Collette Waddell (16:36) Yeah. And that would be, I mean, that would be something I think you would, yeah.
Lynn Kiter (16:43) I went to the file, individual files and really, the, there were a few things that were notated that we didn’t get docked on that. I told them that we’re working on like the dmf?
Collette Waddell (16:57) Oh, being included?
Lynn Kiter (16:59) Huh. Yep. And the preclusion list, yeah.
Collette Waddell (17:07) And, that you did ask about an eta, I was trying to find an open file. I thought… it was completed but I didn’t I needed to like see it for my, okay. So this one was just,
Collette Waddell (17:29) okay. So, this is a net new file that was just put into the, readyq, yes. So, you’ll see here now, it shows the CMS preclusion.
Lynn Kiter (17:40) Oh, okay. They’re there, yay. So.
Collette Waddell (17:43) You’re gonna have like a few of the older ones that aren’t gonna have that, right? And then the newer ones you’ll have it. And I wanted to get like a lot, I was hoping that I’d find it.
Lynn Kiter (17:52) Yay. Okay. Yeah.
Collette Waddell (17:54) So, you’ll see CMS deathmaster, Was that… there was one, wasn’t there one more, oh, medicaid exclusions. I don’t remember if that one was also shown previously. It’s all being done. I don’t think so.
Lynn Kiter (18:12) They were, at one point, they were in the monthly reports.
Collette Waddell (18:17) By the,
Lynn Kiter (18:18) way, we don’t have the April yet. Yeah. So this.
Collette Waddell (18:22) If we go into the provider’s profile… and verifications, you will see it’s down here. There’s like a sanctions. Okay? You’ll see here, it’s oig, Sam, and then deathmaster and medicaid exclusions. But then on the actual… here, I need to find out why isn’t this showing in that list here? Maybe it’s maybe I was moving to, oh, here it is CMS preclusions. It’s just, I don’t know why. I guess technically it’s different. And so deathmaster medicaid exclusions and CMS preclusions. So it’s in the profile, and then you’ll be able in the future, you know, to like view like if there’s like history, you know, like more than.
Lynn Kiter (19:20) One? Okay. Wonderful.
Collette Waddell (19:22) In the future, but then, yes. Now, okay, those are reflected on the checklist in here. So, and that… should cover, these here, right?
Lynn Kiter (19:38) Okay.
Lynn Kiter (19:46) I did have kind of a related question in regard to the cred files and I… couldn’t tell globally, but I wanted to make sure if we have a medical provider, you’re verifying the Dea, if, in the event that they didn’t have an active Dea, it’d probably be flagged, but would… we have to either have the Dea or if none, we have to have documented their plan for coverage?
Collette Waddell (20:29) Let me, so Dea in and of itself is not technically an ncqa requirement, okay?
Lynn Kiter (20:35) It must be a centene, thing,
Collette Waddell (20:39) But I do want to.
Lynn Kiter (20:44) I do want to look real quick. And then the other thing would be admitting privilege or documentation… of their arrangement.
Collette Waddell (21:07) Okay. So I was just double checking what our team kind of like the internal like working notes of how they’re processing the Michigan files. So, for, since Dea is not technically an ncqa requirement, but if you need current Dea, like I can, we can take that back to our credentialing leadership and ask if we can incorporate that as like an element that the specialist is checking and reviewing when they’re preparing your files, they’ll want to know specifically, like do you require a Michigan Dea? And then if… not, if there’s not one on file, do you want us to do like a provider task or an admin task? So they’ll just want to know how to handle that. But again, we’ll I’ll confirm that they can accommodate that like just cross check if it is required and is it required for all provider types? Okay? They’ll want to know that too, right? Yeah. So if you want the team.
Lynn Kiter (22:21) To make sure that okay?
Collette Waddell (22:22) As one of the.
Lynn Kiter (22:23) I can reach out to centene, to get a little more clarity, but they had indicated on the checklist, you know, Dea, if they have one should be verified. But if they don’t have a Dea, which I assume, but I probably shouldn’t that it would only be related to medical providers, right? And I wouldn’t think behavioral health, yeah.
Collette Waddell (22:49) I wouldn’t qualify to.
Lynn Kiter (22:50) Have one, right?
Collette Waddell (22:53) I wanted to see like… if we go in here, I just want to see what it looks like in that profile because I know.
Collette Waddell (23:10) I’m missing it. Hold on.
Collette Waddell (23:17) Like I’ve seen all look around.
Collette Waddell (23:33) Regarding, if there’s… like a question somewhere in one of these sections.
Lynn Kiter (23:39) You know, I thought for, I could be dreaming, but I thought one time we had a provider without one, we put no, and I thought it opened up another field like for a comment, but I couldn’t… maybe I ought to play in the sandbox and that might answer the.
Collette Waddell (24:00) Question. I have, I think that’s what I’m trying to like recall too?
Lynn Kiter (24:04) Yeah.
Collette Waddell (24:10) Might be under this professional information?
Collette Waddell (24:20) Yeah.
Collette Waddell (24:27) Do you have a Dea certificate and then it pulls in the Dea?
Collette Waddell (24:46) I wonder and I don’t want to, I don’t want to alter this provider.
Lynn Kiter (24:49) Yeah. I’m in the play area right now. I was going to see what it would do here.
Lynn Kiter (25:09) And if I… it looks like if we don’t have one, it opens up a please describe how you will handle patients that may require controlled substance. So, I think that’ll be adequate. Okay? And then that you have the ability, to upload a Dea waiver, it opened up when I put that… they’re eligible, but don’t have one… me, see if.
Lynn Kiter (25:57) I think that’ll catch what we need. Okay? And so.
Collette Waddell (26:01) In this application packet under like the earlier pages under this application. And here is where it’ll be reflected. Okay. Do you have a Dea, please describe how you handle instances?
Lynn Kiter (26:17) Oh, yep. You’re catching it there too. It’s in the profile too, under the professional information.
Lynn Kiter (26:31) There’s a controlled substance area. Yeah. So, yes.
Collette Waddell (26:36) So this is being populated onto that, yeah.
Lynn Kiter (26:41) Okay. Checklist. Okay. Perfect.
Collette Waddell (26:46) That’s fantastic. Now, just let dream and I know if like when the team is processing the credentials… files if we need to, and, you know, get.
Lynn Kiter (27:03) one.
Collette Waddell (27:03) If it’s not on file. So we just, you know, if we need to do, and we’ll find out if our team can just accommodate that like additional kind of level of their verifying or tasking to the provider for clarity. But, yeah. Okay. So we can… just let us know, you know, how we can maybe try to support that.
Lynn Kiter (27:28) Okay. All.
Collette Waddell (27:30) right.
Collette Waddell (27:37) And that is… and the admitting privileges or arrangements, I know that’s also in these, I don’t know if it would be shown. Let me just open this up just because it’s a current… because I know this was also in that section.
Collette Waddell (28:02) Not be, because this is not a… position, right?
Collette Waddell (28:17) Right. This.
Collette Waddell (28:27) And professional history… go. Yeah. But I just need to, I guess confirm if.
Collette Waddell (29:05) Captured in like one of these sections for… a position.
Collette Waddell (29:18) Might need to do more… digging and,
Amy Reyes (29:24) it you,
Lynn Kiter (29:24) know the other thing I’ll double check it even if we don’t have it in the cred file. I know I’m pretty sure it’s on the monthly roster. We have to give to them.
Lynn Kiter (29:38) That was a field.
Collette Waddell (29:44) I’m actually going to stop sharing Dreama, I just froze. So, yep.
Lynn Kiter (29:52) Rebecca, sorry, that’s why.
Lynn Kiter (29:59) Thank you.
Collette Waddell (30:06) I’m sorry, Lynn, I had frozen, right? When you were saying you were going to check if just having it in the file is acceptable or? Yeah.
Lynn Kiter (30:15) I’m pretty sure that we have to report that on the monthly roster we have, we’re going to be giving to meridian, but I’ll double check that and find out if that would be adequate or not if we don’t if we don’t have it in the file, gotcha. Gotcha.
Collette Waddell (30:33) Like it’s in the profile but not necessarily in like the credential.
Lynn Kiter (30:36) Right. Yeah.
Amy Reyes (30:38) Okay. Yeah. Just let us.
Collette Waddell (30:41) Know. And then we’ll find out if we need to ask engineering if there’s a way to.
Lynn Kiter (30:45) Pull.
Collette Waddell (30:45) that in?
Dreama Hembree (30:47) Okay.
Lynn Kiter (30:53) I think.
Amy Reyes (30:55) We’re on number.
Dreama Hembree (30:55) Three, the credentialing files that are over 9,020 days?
Lynn Kiter (31:01) Yes, I.
Collette Waddell (31:03) wanted to ask a clarifying question if these were files that are had.
Amy Reyes (31:10) Been advanced?
Collette Waddell (31:11) To like the ready or, and, or committee? Like are they currently sitting in the ready or committee? I?
Lynn Kiter (31:16) Think they’re all in ready?
Collette Waddell (31:20) Okay. So, if you want to, then just give us a list, we can archive those and then.
Lynn Kiter (31:29) kick off.
Amy Reyes (31:31) like current.
Collette Waddell (31:33) Like new files and it’s easier if it hasn’t like they haven’t like gone all the way through and been approved and then already have an initial credential.
Lynn Kiter (31:43) Date.
Collette Waddell (31:43) Logged. And again.
Amy Reyes (31:45) If.
Collette Waddell (31:46) that’s I don’t think that would be the case. But if that’s the case, we can process a new one. And then we’ll just have to kind of go in after that new approval and do like a little override of that initial date, but for any that haven’t that are just kind of still sitting out there still open so to speak.
Amy Reyes (32:04) Right. We.
Collette Waddell (32:05) can just archive, you know, you’ll just send us a list of the ones to archive, and then we’ll generate new ones and have the team process new ones.
Lynn Kiter (32:13) Okay.
Amy Reyes (32:15) We.
Lynn Kiter (32:15) didn’t we’ve had been working on obtaining ad hoc members to represent you know, the type of provider that they are to come to the committee and I think we nearly have that aligned but I worried about the files being kind of older, but, okay, that’ll work. So we think.
Collette Waddell (32:36) And just so I can provide some context when we’re flagging to the team that, you know, that.
Amy Reyes (32:43) Your.
Collette Waddell (32:43) organization, will, you know, will be kind of archiving older ones and then just, you know, having new ones processed.
Lynn Kiter (32:50) Okay.
Collette Waddell (32:50) I know that they’ll just, I want to proactively just let them know that the reasoning just so that, so we don’t expect this to be an ongoing.
Lynn Kiter (33:01) No.
Collette Waddell (33:01) It was more of just, it’s like a retro, you know, yeah, now centers are kind of set up with the appropriate reviewers and,
Amy Reyes (33:11) this is more.
Collette Waddell (33:12) Of just kind of like… starting like hitting the reset button if you, so to speak. Okay. Yeah.
Amy Reyes (33:18) All right. Because I know that.
Collette Waddell (33:20) That would be a follow up question. So, I just want to proactively.
Lynn Kiter (33:23) Oh, sure. And, and to tell you the truth, it’ll probably not happen until our may meeting. We need to have, we provided more guidance in our policy, which that’ll be approved hopefully at the may meeting, and then we’ll be able to bring forward with the ad hoc committee representative… the kind of the files that, you know, have a flagged issue, right?
Collette Waddell (33:53) Okay. But to,
Lynn Kiter (33:54) hear that, you can do that. We’ll definitely provide you a list and kind of the background of what happened why they didn’t get moved forward, if that would be helpful. Yeah.
Collette Waddell (34:04) No, no worries. I mean, we can just dream and I can just relay what you just shared with us just when we, okay inform the team. So.
Amy Reyes (34:13) Just whenever.
Collette Waddell (34:14) you’re ready for us to close the current ones and kick off new ones, just let us know.
Lynn Kiter (34:20) Okay. Perfect.
Dreama Hembree (34:26) I think we’re on number four credentialing provider files for lookalike fqhcs that have.
Lynn Kiter (34:33) Yeah, we had a defined amount that had been kind of relayed of the 1,000,003 1,000,000.
Lynn Kiter (34:39) And now we tried to get further clarification. We have a few, a couple of lookalikes that don’t have federal tour and haven’t been maintaining the 1,000,003 1,000,000. And I did get clarification they have come back and indicated that, and it was a little bit unclear but 100,300 1,000 for what they’re defining a small practice, the 206 100 if they’re large, and then 1,000,003 1,000,000 for hospital. I wanted to like get a defined number of providers that, you know, would meet the definition and they came back and indicated that the practice would determine… what was sufficient for them. And as long as we’re you know, they have the minimum documented here, that would be okay. So I’m thinking would we be able to change moving forward to the 103 100… for our definition of like the minimum amount or?
Amy Reyes (36:00) Would you?
Lynn Kiter (36:01) Recommend we keep it at the 1,000,003 1,000,000, allow the flag to be kind of thought flagged and then take it to committee and give background. So,
Collette Waddell (36:13) I think so.
Amy Reyes (36:15) Here is.
Collette Waddell (36:16) My question to you. So, for example, for let’s just say using mchn catharines, is.
Lynn Kiter (36:25) Every single?
Collette Waddell (36:26) Provider, let’s.
Amy Reyes (36:28) Is this at?
Collette Waddell (36:30) The organization level or is it at like almost the provider level, what these require when the numbers could change? Yeah.
Lynn Kiter (36:39) It would be.
Lynn Kiter (36:45) Yeah, we have two health centers that all of the providers have a low, you know, the lower amount. And then with the others, it, they all have federal tort and, but there are a few providers that might not qualify for federal tort right? So, I’m thinking it would be for mchn, globally, they would minimally need to have the 103 100, but kind of thinking forward, you know, trying to keep it in line with what might come down the pike and the future. I don’t know what the other delegation agreements, what they’re going to require, right? That’s.
Collette Waddell (37:28) exactly. What was going to be a follow up question? Like I’d hate to implement a standard.
Lynn Kiter (37:34) Change it’s almost like.
Amy Reyes (37:38) It almost.
Collette Waddell (37:38) Sounds like it needs to just be like reviewed and determined on.
Lynn Kiter (37:42) Like.
Collette Waddell (37:43) a.
Lynn Kiter (37:43) file?
Collette Waddell (37:43) By file?
Lynn Kiter (37:44) Basis. Yep. Okay.
Amy Reyes (37:46) I’m.
Lynn Kiter (37:46) good with that, you.
Collette Waddell (37:48) Know your team but, and, but on the flip side, I would hate to implement something. And then we.
Amy Reyes (37:57) have all have it.
Lynn Kiter (37:58) Have it, right? Right? Yeah.
Collette Waddell (38:01) So, kind.
Lynn Kiter (38:02) Of in that vein, carefree didn’t get handled uniformly. They, they’re a look alike, federally qualified health center, meaning that they don’t qualify for federal tort claimant coverage and they have a lower, you know, a lower threshold and all of the providers have the same amount.
Lynn Kiter (38:26) But two of them were credentialed clean, we have one credentialed with a flag and then two, I think are two right now that aren’t even being moved forward. Well, they had a, they had a task that they needed a higher amount to even be able to finish credentialing.
Amy Reyes (39:01) we have Tiffany, ash.
Lynn Kiter (39:05) And Brielle, miller were credentialed clean. Michelle Gallagher did come through credentialing with a flag. And then I’ve… replied back to the task. I’m looking for, where were they? There were two that, so.
Amy Reyes (39:27) Two things got dr.
Lynn Kiter (39:31) Farhan badi, and Kara schrader, were.
Amy Reyes (39:37) Indicating.
Lynn Kiter (39:37) that they needed to have the higher amount to move forward. The cred file… still within the requested?
Collette Waddell (39:58) Notes we have… is currently following like the a single kind.
Amy Reyes (40:07) Of like checklist notes?
Collette Waddell (40:09) That they’re referencing Michigan, and the notes currently say for malpractice insurance one.
Amy Reyes (40:21) 1,000,000?
Collette Waddell (40:21) 3,000,000 limits. And then it says ftca accepted with no limits, right?
Amy Reyes (40:28) Is.
Collette Waddell (40:29) acceptable, right?
Lynn Kiter (40:32) For carefree, they have I’m looking at what they have, what is it? Amy? And,
Amy Reyes (40:42) and.
Lynn Kiter (40:42) I get that, but all the providers are being handled differently when they all have the same amount, and it is under the 100 the 1,000,003 1,000,000 threshold and they don’t have federal tort, they don’t qualify yet. Two of the files were brought through clean out of credentialing, one went through credentialing with a flag and two were not moved forward at all yet. Because they question the lower amount. My question is why did two come through clean one?
Amy Reyes (41:19) Come through?
Lynn Kiter (41:19) With a flag. And the other two are, you know, being?
Amy Reyes (41:24) Held up?
Lynn Kiter (41:25) For a higher amount when?
Amy Reyes (41:29) They all have.
Lynn Kiter (41:29) A lower, they all have under the, they all have under the 1,000,003 1,000,000 threshold.
Amy Reyes (41:37) Okay.
Collette Waddell (41:38) I am, hold on. I am, I’m now following… I’m just taking a peek and we can definitely.
Lynn Kiter (41:48) You know, like, what we talked about, handle them individually, but I think they all have 500,001 1,000,000 is what they have for their group coverage.
Collette Waddell (42:01) So, so for Tiffany and Brielle, they both, yeah. So they have that… 101,000,000.
Lynn Kiter (42:14) Correct. And all of them, do, I think?
Collette Waddell (42:18) Yeah. And we didn’t flag it, but really, we should have, right? Our own notes, correct? That say,
Amy Reyes (42:28) Now,
Collette Waddell (42:29) I want to check one thing.
Amy Reyes (42:33) Likely a,
Collette Waddell (42:42) to their files, hold on one second. Where did.
Amy Reyes (42:44) it go?
Lynn Kiter (42:56) I would have thought they would all look like Michelle Gallagher, you know, move forward but with a flag.
Amy Reyes (43:04) Right. And that’s.
Collette Waddell (43:05) what I’m like I’m just diving further deeper into it to make sure that I’m not missing something, but no, you’re right? They should have been flagged. So, this is just, an error or an oversight from the specialist that, right? So I can, and then there.
Lynn Kiter (43:23) Are two that they created a task and I replied to it, the task is in review or completed now, but, for dr bhatti and for Kara schrader, like all of the providers right now are, if, you know, other than the three that are ready or in the requested, but they called out Kara schrader and Farhan bhatti with a task that they, you know, needed to have, the minimum of the 1,000,003 1,000,000 to move forward.
Collette Waddell (44:06) And so, which I get.
Lynn Kiter (44:07) For sure, they would all be flagged by definition, but it didn’t it isn’t uniform.
Amy Reyes (44:14) Right. So.
Collette Waddell (44:15) Yeah. And okay. So, I’m pulling up, the older flat or I guess it wasn’t that it was just.
Amy Reyes (44:22) Not too long ago.
Collette Waddell (44:22) At all, right. Yeah, a few days ago. So, yeah, for dr bhatti for example, the specialist flagged because they’ve identified that lower coverage if you will. And in the notes that they were referencing, yeah, you know, yeah. Okay. But, yeah.
Lynn Kiter (44:39) You know, with the other three, we had the two clean and they didn’t note anything with Gallagher. I mean, they made a flagged file, but it never created a task.
Collette Waddell (44:51) Yeah. So, Dreama and I will notify.
Amy Reyes (44:57) the.
Collette Waddell (44:57) credentialing of just the inconsistencies, yeah.
Amy Reyes (45:02) The files and really?
Lynn Kiter (45:04) Carefree is kind of a one off. I mean, we have two, we’re going to be moving forward with health center, Detroit. We haven’t done any credentialing with them either. But now that we have clarification of the, you know, minimum liability for our meridian agreement, both carefree and health.
Amy Reyes (45:27) Center.
Lynn Kiter (45:27) Detroit, all of the providers are going to have a lower threshold.
Collette Waddell (45:34) Now, and I can.
Amy Reyes (45:36) And I’m fine with.
Lynn Kiter (45:38) Them being flagged, you know, but,
Collette Waddell (45:40) yeah. And we can, you know, if it’s going to be like uniform across. So, let’s say for all of the mchn centers except for this one, you know, for example, like we could ask the credentialing team if they can add almost like a sub note saying.
Amy Reyes (46:02) Okay.
Collette Waddell (46:03) For carefree, the limits for all providers, is these numbers?
Lynn Kiter (46:11) Right. You’re thinking out of like they’re operating for teachers? Yeah. But again, there could be a delegation agreement in the future with lfr. So, so.
Amy Reyes (46:25) Do we want?
Collette Waddell (46:25) To do that? Or do you want to just, right, we’ll just,
Lynn Kiter (46:29) I mean, I think I’m okay. Probably okay with having them flagged. But if we can have uniformity.
Collette Waddell (46:35) Yeah, some consistency in, right? How all the files are being?
Lynn Kiter (46:40) And there could be a day when we get all of the delegated agreements, you know, if they all have a uniformity, but they probably won’t.
Collette Waddell (46:49) Yeah. Okay. So in.
Amy Reyes (46:52) the future if.
Collette Waddell (46:53) it’s you know, almost determined.
Lynn Kiter (46:56) If.
Collette Waddell (46:56) you, so to speak, that okay across the board for everybody for carefree minimum is this number and this number, then Dreama can kind of flag that to the team and ask if, you know, if in our own internal sop, you know, for mchn, you know, we can maybe see if they can just add like a subnote. So for all carefree providers, for example. But until that day comes, maybe we’ll just continue to handle it as it is. But we will let our credentialing management team know that there’s some inconsistencies currently occurring for these files where some are being tasked, some aren’t and then some are being flagged, and some aren’t but they all have the,
Lynn Kiter (47:41) same coverage. Perfect. Okay. All right.
Amy Reyes (47:48) And golly, I think the,
Lynn Kiter (47:49) remaining things you kind of talked to on the reply, you’re going to check into. I know you already deleted out willow… you’re going to check into the brick and mortar type for the local health department. Yes… we got the email about dr stride. We’ll work on that.
Amy Reyes (48:17) The clia, where?
Lynn Kiter (48:19) To file them, you covered?
Lynn Kiter (48:27) Do you have any type of an update from Mitch on the rosters… or the vba including vba and the one for meridian centene?
Collette Waddell (48:42) That is the last thing from this list of items that I had not.
Lynn Kiter (48:45) Had.
Collette Waddell (48:46) time to just dive deep into. Okay? So I can work on that right after our call. I’ll just go poke around to see where we’re at with those. Okay?
Amy Reyes (48:57) I.
Lynn Kiter (48:57) think then we’ve got through everything and it won’t be long before we get the April monthly monitoring.
Collette Waddell (49:06) No, yeah. Sorry, we were going to try and get knocked through all of those, but I think when they were getting them all out, that was like the day I was going out?
Lynn Kiter (49:15) Because our new routine will be like the March that we obtained will be reported to the April credentialing committee, you know, findings or lack thereof, anything new, and then April we’ll report at the may meeting.
Collette Waddell (49:36) OK. So, and then I’m just going to,
Collette Waddell (49:46) the April monitoring reports. So… these… two highlighted things are those like open ended?
Collette Waddell (50:01) So, etm, the rosters, and then the monitoring reports, those we’ll.
Amy Reyes (50:06) continue to work through.
Lynn Kiter (50:11) Well, thank you. I really appreciate it, Amy. Did you have anything that I didn’t add? No, just the dr stride, but I did check and see that he was in there. So he’s all set. So I’ll get him squared away. So. Cool. OK.
Amy Reyes (50:26) Well, thank you ladies.
Lynn Kiter (50:27) Have a great weekend. Have a good weekend. Thank you. Have a good weekend bye.