Transcript
Naomi Denson (00:00) hey, Adelie. Hi, Naomi. You can’t say hi to yourself. I,
Adalee Arreola (00:08) don’t know what I’m saying at this point. I was reading your comment on the access slack channel.
Naomi Denson (00:17) Yeah.
Adalee Arreola (00:22) I don’t know what Kay is saying.
Naomi Denson (00:26) I don’t know. All right. Let me let Kim in and we’ll figure it out. Okay?
Naomi Denson (00:36) Hi, Kim.
Kimwaters (00:43) Helps if I’m off mute.
Naomi Denson (00:46) It does sometimes… long time, no see. I know, right? All right. So now we have Adelie with us. So, okay, the custom provider invite, I have that with Adelie to get that done. I followed up with Pete. He said that the caqh keys should be a few more days and he’ll send those directly to me when he gets them.
Naomi Denson (01:13) Okay? And then we talked this morning about getting the existing enrollment tabs for the group’s provider facilities to us so that we can load those. And then we’ve got.
Kimwaters (01:28) So, I’ve got a couple of questions. I’ve got a… we’ve got the I’m looking at here. A lot of tabs open. I’ve got the provider. I’ve got the caqh list of like who we manage caqh for. So I’ve got that to send your way. Actually, I think I shared it with you.
Naomi Denson (01:52) The provider caqh seat. Yeah. Okay. Yeah, I was looking at that and I didn’t know what I was looking at. Okay?
Kimwaters (01:57) That’s what it is. So the first tab that says active providers, those are the providers that we manage their caqh. Okay? But you need their… you need it, how, what do you need? Like format wise? We?
Naomi Denson (02:14) Need their Adele, what do we need to bulk enable caqh management for a specific group of providers? Just their email… yep added to this. Yeah. So their email address that’s linked to their profile and medallion. Okay.
Kimwaters (02:37) All right. That’s like one thing that’s harder to pull, but I think I’ve got that.
Naomi Denson (02:43) Yeah, it was actually, I had it, that was the next thing on here was that sheet. So I was like, what am I looking at?
Kimwaters (02:52) So I can add that email address. Okay? And then we can bulk import, got.
Naomi Denson (02:56) It, yes. Well, yeah, it’s a bulk enable, but probably won’t enable it just yet because we haven’t invited them yet. They’ll probably wait until we actually send out the invites to enable that… just so the team doesn’t start setting tasks and stuff to sign agreements that they don’t have access to. And normally, I can be like, hey, they’re not invited yet, don’t pass them. But it’s easier to just enable it once we’re ready. Okay? But if you want to get that ready, we’ll have it emailed. All right. And then I confirmed with our director of operations, she has finalized the final touches to the delegation agreement. So I can get that sent over to you. I did want to touch back on the CMS preclusions. So, we talked earlier and you said you were sure that Andros was pulling the list for you? They?
Kimwaters (03:55) Were, yeah. And Monia hunter came back and said, yeah, it definitely has to be on the initial file… and the recredential links… so we can decide on it. Maybe it has to be done monthly or not. But definitely on the initial and on recredentialing. So first,
Naomi Denson (04:17) thing is, I confirm we actually don’t have access to pull the list for you. However, I was looking at your delegated agreements and your humana agreement indicates that they’re sending you the list. So, I don’t know if humana was sending that to Andros, if you guys had like a sub delegation agreement with Andros?
Jason Zednick (04:39) They would have been sending it. Andros wouldn’t have access as an organization on their own. Oh.
Naomi Denson (04:46) Yeah. I forgot. Jason’s from Andros. Yeah.
Kimwaters (04:52) Good answer. Good?
Naomi Denson (04:53) Answer, Jason. So glad you’re here, hey?
Jason Zednick (04:55) Here to help y’all here to help.
Naomi Denson (04:58) Okay. So humana says it says delegator sending to delegate, yeah, entity. So you would have to get that from humana, or when you assign us as a sub delegate, that they would forward that to us. Okay? Have you started those conversations with humana, devoted centene, about the new sub delegate as with medallion as your cvo to change that?
Kimwaters (05:23) No, not yet. Okay?
Naomi Denson (05:29) So, we might want to do that? Is that?
Kimwaters (05:32) Just a form typically, or?
Naomi Denson (05:36) Typically, we’ll have the like the piece about, I saw it in several of your agreements about sub delegation. If you’re going to change it, you need to notify your contact there so that they can revise and designate medallion as your cvo. Okay?
Naomi Denson (06:00) So, we’ll go ahead and get all three of those other verifications that ofac deathmaster and CMS preclusions configured into the initial credentialing file, figure out the list from humana, of getting that for the CMS preclusions for the monitoring as well. I saw what you sent over to me for the credentialing committee.
Kimwaters (06:21) That’s straight out of the policies and procedures… because if we make changes to that, it sounded like we have to go back and get approval from the payers… right? So.
Naomi Denson (06:34) I just wanted to, okay. So there’s… let me see if I, can I move this go away? Okay? So just looking at this really quickly, it says clean here and then leveling review. And then committee. So there’s three different buckets that you need.
Kimwaters (06:57) Yeah, that’s how it’s written today.
Naomi Denson (07:00) Okay. One thing I wanted that jumped out at me because you have committee here. I don’t want it to get confusing because in the medallion platform, so you would make a request here. Once it’s ready on our end, we put it here and then you guys review it and move it to the designated committee, assign it to the correct committee. And then it goes into this committee tab here. I just want to make sure that if I name the committees, those three titles, you’re going to know… what those mean internally and that this being named committee is not going to cause any confusion.
Kimwaters (07:43) Yeah. I don’t think that’s a problem.
Naomi Denson (07:44) Okay. So, yeah. So they’ll move to ready and then you guys will review the outcomes and the files and then move them to the appropriate committee.
Kimwaters (07:52) Okay. And they bulk like everything that’s in ready that meets certain criteria can like be bulk moved to the right? Okay. Yes. I mean, right now, we’re not doing like mass?
Naomi Denson (08:07) Right. Yeah. Like a lot at once. Yeah. So, and then, so it says currently, money york is the one that approves them. Is that for all three?
Kimwaters (08:18) Yeah. It sounds like they’re having like a meeting. And at the end of that, she’s the one approving like the records with Andros, and going in and like logging.
Naomi Denson (08:30) For all file types though even if they’re not going to committee?
Kimwaters (08:35) Yes. Yeah. Right now, it’s money york and then money hunter as a backup.
Naomi Denson (08:39) Okay. So, I’d create like clean york, clean hunter. So that because if they’re both in the same committee, then they both have to vote. So I’ll just create them each separate buckets with each of these three because.
Kimwaters (08:53) Because like money hunter doesn’t always go to those meetings like she’s just there as the backup. So not in all of them. Okay? All.
Naomi Denson (09:05) Right. So, I’ll set up six separate. Yeah. Okay. I’ll set up six separate buckets, three for money york, three for money hunter. And that’s not confusing at all.
Kimwaters (09:14) No, I know, but, okay. So six separate buckets, meaning like it’s six separate. So you have.
Naomi Denson (09:21) three different committee titles that you want the.
Kimwaters (09:23) Clean depending on who? Okay. So each of them are a committee title is what you’re saying? Yeah, so.
Naomi Denson (09:29) They would be named clean york, and then a clean hunter, and then leveling review york. So.
Kimwaters (09:35) We would have to know if somebody’s going to be out or not. Yeah.
Naomi Denson (09:40) And then if, when you move it to the committee and platform, if they are out, then you can always move them if you can reassign them. Okay. Yeah. So it’s just having that backup there so that in case york was out, you can move it to hunters to capture that, close that file out. Okay? Got it.
Kimwaters (09:59) Okay. All.
Naomi Denson (10:02) Right. And then pay your process scoping, have the next call set up for next Tuesday. And then I did, Jason, I don’t know if you saw my message about the rhc process review separately utilizing our call next Wednesday to do that when mania’s back?
Jason Zednick (10:21) Is that this coming Wednesday? No?
Naomi Denson (10:23) Next week?
Jason Zednick (10:24) Okay. I saw it come through. I have not read it, but.
Kimwaters (10:29) Jason, do you have any like mania’s out? But she is replying to emails like occasionally and I’ve got, you know, I can track down information and get you answers on stuff as well and whatever we need to table for next week we can. But if you guys have questions this week definitely keep sending them over and we’ll get you what we can and table what we need to. Yeah.
Jason Zednick (10:51) For sure, the only thing I was going to ask was if there was the, excel file that I’m locked out of because it’s behind AMC’s, office… I don’t know what to call it. Yeah.
Naomi Denson (11:07) But if you,
Jason Zednick (11:07) could export it and forward it if that’s possible.
Kimwaters (11:11) Which one is it? It’s.
Jason Zednick (11:13) it’s there was an excel spreadsheet. It was like a checklist. I think you said.
Kimwaters (11:19) I’ve sent a lot, so, I’m.
Jason Zednick (11:20) sure. Yeah, yeah.
Kimwaters (11:22) Like, if you go to open the email, does it say like which?
Naomi Denson (11:26) File name?
Kimwaters (11:27) It is, so, I know what,
Jason Zednick (11:29) Yeah. Let me go find it and I’ll jump in. Y’all, can keep going. I’ll look for it. Yeah.
Naomi Denson (11:39) Yeah, cause I’m like, yeah, I’m like you’ve sent a lot.
Kimwaters (11:42) You just got to tell me which one? Yeah.
Naomi Denson (11:44) As they’re sending them though, Jason, I am exporting them to put them into their internal folder here.
Jason Zednick (11:53) Yeah, perfect. Let me get the file name, and then you can, if you’ve already sent it to Naomi, then that’s fine. But I just, I tried to open it and couldn’t yeah, yeah.
Naomi Denson (12:03) All right. And then, raster delegated rasters, we talked about this morning there with Adalee, being built, Adalee, any questions or updates or anything to add from your side?
Adalee Arreola (12:16) No questions at the moment. I’m sure. I’ll have more questions once I’m closer to the end of finishing those, but, yeah, just working through those at the moment.
Naomi Denson (12:27) Okay. And then, the only other thing I had Kim was, I saw your email come through about the group npi, blocking you from updating and adding things to the group profile. I have that escalated internally to try to figure out what the next step is there, Jason, what were you saying about the other customer? They added zeros, and it reverted back. No, they didn’t.
Jason Zednick (12:52) add.
Naomi Denson (12:52) zeros, are they able to work in the group profiles? We?
Jason Zednick (12:55) Sorry. I put the name of the file in the chat so you can check there. Okay. Gotcha. The, no, we had it removed like we did forefront. And it was fine, worked great, but it came back. I don’t know why it came back. And I’ve asked for it to be removed again, but that, that’s where I’m at. So I don’t know, what changed. Okay. So.
Naomi Denson (13:19) But, it was there before, unlike this one where it was never there. And now, when they’re going in and trying to make updates, it’s requiring them to put it in there. Yeah.
Jason Zednick (13:27) It was there before. Yeah, yeah… because that was a change we made to mirror like we did for the other customer because it was working and,
Naomi Denson (13:40) yeah. Okay. Yeah, we have this, hopefully, we’re trying to figure out if our epd team… can help with a configuration here to allow you to save without putting that in there because it’s usually an overall blocker, that has to be there and we’re slowly learning it’s not applicable to everyone.
Kimwaters (13:59) Yeah, no, I didn’t yeah, you would think it would always be there. So, I totally get that. Yeah.
Naomi Denson (14:04) But because of the way you guys are set up, we opted not to. So we are looking into that, but I want you to think that… ignoring.
Kimwaters (14:12) You, I mean, so, I don’t think, can you, actually, I don’t remember off the top of my head if you try to like save in next because I think I had updated or don’t save anything, right? Like just act like you didn’t save anything and like will it, I don’t think it’ll even let you go to the next tab, will it or can I just, okay, I can click around. All right. Yeah.
Naomi Denson (14:37) And you should be able to, what were you trying to add? Do you know,
Kimwaters (14:41) Yeah. Let’s see what was in here. Oh, I added lines of business and I added, which, I guess, I don’t know if lines of business even. Yeah, you can, it’s all of them, right? So, I mean, I,
Naomi Denson (14:54) yeah. So if you want to just work through the other tabs, it should let you still save those pages.
Kimwaters (14:59) And I think I had, I think I had, started to add like the medical, it asked for like medical records, whether that was email or mail. And, I have like an email address for all medical records requests. So.
Naomi Denson (15:12) Yeah, that’s all in this first tab, you should be able to do everything in every other tab until we can figure that out. But this should get you over the line for getting… it most of the way completed. And then, and then adding the group officials for the aos, dos, signatories… gotcha. And.
Kimwaters (15:33) Yeah, that’s the smallest of the groups. So, there’s plenty. I mean, obviously, like there’s plenty to do on the practice side, and others? Yeah, okay.
Naomi Denson (15:42) Perfect. But we’re looking into the npi thing. Okay? Sounds good.
Kimwaters (15:46) All right.
Naomi Denson (15:47) Anything else for us?
Kimwaters (15:50) No, I don’t think so. I think, I’m sure there will be as we’re going through, yeah, and,
Naomi Denson (15:56) I’ll make sure I get Lee added to our call next Wednesday, so we can utilize that call for the rhc process review?
Kimwaters (16:03) And then, we’ll we could add beta providers as early as like maybe not the end of next week, but the following week, maybe like once the caqh data’s imported, yeah, once.
Naomi Denson (16:16) I get those pdqsqs which he said would be a few days to generate and he’ll send those over. And then we can, start the import with the beta providers and doing the comms and inviting them to get the process down. Okay? That would be.
Kimwaters (16:31) Great. And then, I don’t know this was a, it looked like there’d be a way to do this. As we’re going into additional like delegation conversations, I guess number one, do you guys have contacts at like united in the Arkansas area or like blue cross of Arkansas that maybe handle those? If we’re going to like expand delegation, the goal is like get.
Naomi Denson (16:53) That in as.
Kimwaters (16:54) many places as possible. Do you guys have anyone on your end that maybe has some already like great connections that you guys are already working with? That? No?
Naomi Denson (17:04) Because with the delegated side of things, they actually won’t work directly with us. Yeah, no.
Kimwaters (17:10) No, I know they won’t but as far as like, that was another thing we were talking about just because it sounded like you guys work on both the payer and the provider sides. If you’re already in certain places, it sounded like maybe that process goes a little smoother potentially. That was another sales conversation that.
Naomi Denson (17:29) Was my or josh? Yeah. With?
Kimwaters (17:34) Josh just curious like if there’s again more, just like, hey, point us in the right direction, like we’ll go do the work, but, you know, if there’s any way to speed up the expansion of the delegation side that’s one of the goals. And part of that is, some of them have like minimum provider requirements, which was like, I think the question, one of the questions I sent you last week was, hey, is there a way to run a list of like provider? Like how many providers we have in each?
Naomi Denson (18:04) State. Yeah. And Adalee and I were looking into that, we couldn’t find an easy way to pull that report directly from the platform. We have an open ask to our reporting guru Guy to see if he knows of a way to pull that out. I didn’t see that he responded yet. So I’ll tag him on that, Adalee. I.
Kimwaters (18:21) think there was, it looked like there was one report where like it literally said state. So you would think it would be state.
Naomi Denson (18:29) Yeah, but it’s pulling the state of their license. And since we don’t have licensure data anymore, and that doesn’t necessarily mean they’re in that state because they could have licenses in states that aren’t applicable to you. So I was trying to find a way to pull it by the practice location that they’re associated to.
Kimwaters (18:46) Yeah, because they could be in more than one state which is totally fine like that. You want to be able to like count them, right? Yeah. But, okay. Well, not anything down more, just like that’s a side that’s a side. Okay. Yeah, I’m sure. There’s a way, we can find a way to pull it out of athena too, I’m sure. Yeah.
Naomi Denson (19:08) Yeah. We were looking into that. We just didn’t find a real easy way to do it. So we’re trying to find if there’s a way on the back end. Okay? Another report that’s available. Awesome.
Kimwaters (19:20) Well, I appreciate you guys. Thanks so much absolutely.
Naomi Denson (19:22) We will see you Wednesday. Bye. Have a great week bye.