Spillin' Tea Across America: Missouri

[00:00:00] Welcome back to Credentialing Chronicles, where we spill the tea on the doctors you see. And we're spilling it baby all across America. Well Nyleen and Shannon sitting there talking about you while you pull up a chair.

[00:00:20] Girl, Missouri really said, Nyleen, show me. Show me the diploma, honey. Show me the license. Show me the authorizations. Show me who even paid the claim. I mean at this point, right? Oh my goodness, Missouri. I've never been to Missouri. So I want to go to Missouri. I think we should go to Missouri, right?

[00:00:44] I was in Missouri after we left the Iowa went right down to Missouri. We have a client over in Kansas City area. So how cool. Had to see the little show me state. So anyway, you know, while we're at it though, show me why half the real hospitals, honey, are struggling. Oh no, don't tell me.

[00:01:06] Yeah. Well, and then why don't you show me why the MSP is somehow expected to know all of that before 9am while somebody is emailing urgent in all caps? I know with no application attached. That's been asked for several times. And no privilege form. No references. Oh, no, but he starts on Monday. No, ma'am. The doctor would like to start on Monday.

[00:01:34] Those are two very different sentences that they should be saying. Yeah, right. Well, here we are. Welcome back to Credentialing Chronicles, everybody. Where we spill the tea across America and explain credentialing, privileging, enrollment, compliance, governance, mess, hiding behind the headlines. Anyway, I'm Shannon. And I'm Nyleen. And today we are in Missouri. How many state board tabs do you have open right now, Nyleen?

[00:02:02] Oh, Shannon, way too many. And that's exactly why our sponsor, Bataan Health, exists. Search, verify, monitor, and keep the receipts, honey, for the auditors. BatonHealth.com. So before anyone sends us a demand letter, let us do our official disclaimer, honey. Oh, no, not a demand letter.

[00:02:25] Well, we do not credential, employ, privilege, enroll, supervise, represent, or personally know any of these individuals or organizations discussed in this episode unless we expressly tell you otherwise. Exactly. Exactly. We are two credentialing professionals researching publicly available reporting information, you guys, government releases, legislative court information. I mean, we're looking everywhere, y'all.

[00:02:53] And then talking about what the stories can teach our industry, right? Well, charges and allegations, Shannon, as we know, are not convictions. We love using our allegories, right? Right? So, and a lawsuit truly is not a final finding, right? Class certification does not prove liability. Everyone is presumed innocent unless and until proven guilty.

[00:03:21] And organizations aren't really entitled to present their side, whether we're talking about criminal cases or whether we're talking about the medical staff process situations, you know? And we're definitely not giving legal, medical, or insurance advice on this podcast, you guys. We are giving education. We're giving some damn good commentary. And a little bit of what the credentialing is going on out there in the world, y'all, so we can bring it to you. Right.

[00:03:46] So, check your contracts, you know, check your current law, your state law, your bylaws, and your own qualified counsel before ever doing anything. Okay, Nyleen, I feel like we have credentialed the disclaimer now. Let's get into the team. Okay, so tell me the story. You're going to tell me the first story? Yes, I'm going to tell you. I'm ready. Okay, so I got all my little pockets already.

[00:04:14] Okay, so in June 2026, this year, love, federal prosecutors in the Western District of Missouri announced that a case that had stopped me in the tracks. A Missouri woman, you all, was charged, okay, literally, by complaint with forgery and using fraudulent nursing credentials. How many times do we talk about that? I know. No. My goodness.

[00:04:42] Well, I was reading on the story, and then according to the government's allegations, she had presented college records and even a diploma saying that she had graduated from a licensed practical nurse program so she could obtain hospital employment as a graduated practical nurse. I know we've been talking so much about the practical nurses, Nylee, right? And that part got me.

[00:05:12] Prosecutors say that the nurses overseeing her work, Nylee literally recognized what they described only as incompetence, baby. They literally reported their reports triggered an investigation and ultimately led to her termination. What? First, we need to say it again. Those are allegations, though, allegedly. But the operational question, yeah, the operational question is real.

[00:05:41] How far did a document travel before somebody verified the source behind it? Yeah, and, you know, the nursing graduating diploma is always hard, you know. They go through national clearinghouse, you know, that's what a lot of us use out there to verify education. But not all organizations are in the national clearinghouse. You really have to kind of look at that list to see who's approved to be on there.

[00:06:10] And so because of a diploma, you know, literally you all is a piece of paper. Primary source verification is the conversation with the institution, board, registry or approved source that says, yes, this person completed this program. Yes, this license is real. Yes, this license is active. And there are or not restrictions.

[00:06:33] Yeah, and even when a role doesn't go through the same exact medical staff credentialing, we really want to make this information for HR. I mean, yes, that's true. A lot of times we're not the ones credentialing all of this, but the premise never changes. Right. The basis of the information does not change because the physicians, right, we have they have their own credentialing pathway.

[00:06:57] The organization still needs to have a dispensable hiring, licensing, competency and supervision process for any health care practitioner, provider, person touching a patient. Correct. Nyleen, exactly. And credentialing people hear a story like this all the time. Right. I mean, we've talked about the Nightingale place that's come out with all of it. Operation Nightingale. And there are nurses that are still being found out.

[00:07:25] But really, they need to immediately ask, was the school contacted directly? Like, was the program approved? Was eligibility confirmed for the program with the Board of Nursing? Was the applicant trained as a graduate awaiting examination for her end class? What scope was permitted? Who was supervising? And what did the policy literally require for graduation?

[00:07:53] Well, and did the verifier type the web address independently or just clicked whatever arrived in the mail or just that a certificate is enough? And let's just pause here one second because let's talk about certificates for a minute. I can I just ask why we are still asking for every single certificate? Because we're seeing this stuff that a certificate can be forged. So just what school did you go to? Let me go to that primary source. Give me a copy of your transcripts.

[00:08:20] Like, if you want to be particular about something, be particular about the transcript and not the certificate, not the piece of paper or the diploma saying that. Yeah. Nyleen, I mean, I really think you need to say that again because people aren't really understanding that. Fraud is prettier now. Right? Right? Yes. Of course. You can make up anything. I mean, Canva is magic. Canva is magic. A fake document may even have a seal. A fake website may have a phone number, you guys.

[00:08:50] Or a person, on the other hand, may answer the literal phone and say, register's office. I mean, if your verification chain begins and ends with information supplied by that applicant, you may only be verifying the applicant's story with the applicant's other story. Right? True, true. And that's why source independence matters. It's also why staff education matters.

[00:09:16] Nurses, whatever kind of nurses level of nursing that you have, it doesn't matter. Reportedly, yes. Because what happened was the nurses around this person, right? Or the nurses supervising this person because an LPN can't work independently had noticed the clinical problem. They became the second safety net when the paper process may not have caught it. But listen, side note, I'm preparing for a very cool presentation that's coming up.

[00:09:46] And one of the things that I say is exactly that, right? The paperwork will eventually show up to a real person or to the floor or to the patient. So we want to make sure we're verifying that paperwork because it can really translate to safety. Yeah, which brings us to something like credentialing teams. Sometimes they just don't want to hear this, right? You know, sometimes the HR doesn't want to hear this.

[00:10:11] You know, a clean file does not guarantee a competent practitioner all the time. Mm-hmm. And one concern from a colleague does not automatically prove incompetence either because the person can say, oh, she's picking on me. You know, the organization does need to have a fair process to receive, document, escalate, investigate, and act on any concerns, whether that's on the floor, right? Or in the MSO department or within physicians, right?

[00:10:41] So each one has a different process. You are 100% correct. We are not replacing due process with hallway gossip people. We are saying that the system needs multiple controls, which we are finding everywhere. Verification before entry, supervision during onboarding, competency assessment, clear escalation pathways, you guys. And of course, a leadership willing to learn and listen. Right. Right.

[00:11:08] Because what happens when a nurse says something isn't right and the response is, well, HR cleared her. Oh, yes. That fairies all the time. That phrase, somebody else cleared it. It's how risk it's passed around until it lands on a patient. You all. Mm-hmm. Mm-hmm. So let's make this practical. If I'm listening from a hospital, right? What do I audit tomorrow?

[00:11:36] Well, I would say number one is map every clinical role to the exact verification pathway. Employee, contractor, agency clinician, locum, graduate status clinicians, telehealth practitioners who verifies what from which source and at what point before the person ever touches a patient. Well, and I think number two really is test the sample, right?

[00:12:05] Don't ask whether a policy exists. Pull actual files and then reconstruct the trail, right? You get a complaint. You know what? Let me just double check that license again, you know? Yeah, yeah, yeah. Yeah, even medical staff directors pulling one or two files a quarter and just running an independent verification on it to see is your team actually out there doing correct work. I mean, that's just a little nugget of gold.

[00:12:33] But number three, really confirming the system captures the source, the date, the verifier, the result, the expiration, the sanction, the restriction, and truly any disciplinary resolution that happened. A screenshot with no URL and no date, it's not a beautiful art of trail. And it's really making your organization look weak and at risk. Well, another one is make sure competency concerns don't disappear in an email inbox.

[00:13:03] Okay. And it's really scary because really staff needs to know where to report, right? Who owns the investigation and when immediate protective action is appropriate? Like, so side note, something that really did happen to me, which this is a good insert, is don't wait until your circulator nurse Googles who's in the room.

[00:13:31] Because that HR had never Googled all of these people. This person decided to Google and turns out this guy was in the hospital, in the operating room with completely fake credentials. Yeah, we just onboarded a new client and they have been doing credentialing for a really long time. It's an organization required to do credentialing. And today we finally got their first file out because they're just brand new, just signed.

[00:13:59] And we went through their first file that they got. And honey, they were like, oh my God, you have the Google report, everything. Oh my God, it's so organized. It's this and that. And they were just so happy about this file because when you look at the files before, you can see the disorganization, how it's not. And, you know, and it's like, oh, I think I can really trust that we're onboarding good providers. And I was like, yes, yes, you can. That's a good thing.

[00:14:28] So going back to what we're talking about, sorry for my off track. No retaliation, right? I mean, if they're saying, you know, hey, Susie is looking like she's not very competent and she's speaking up. I mean, she is speaking up in good faith. And if the people closest to care are afraid to raise concerns about colleagues, then your policy is decorative and it's really not working. Well, and that's the first Missouri lesson, right?

[00:14:55] Documents open the door, but verification and ongoing competency keep patients safe. Yeah, you're completely right, Nailene. I mean, let's talk about the thing that makes patients, doctors, billing teams, and office managers want to throw a laptop though, right? I mean, I know you've been talking about it a lot too, but those prior authorizations, because Missouri is having a lot of problems with them. Yeah, a lot. Well, we need more information or the office says we sent it.

[00:15:22] The insurer says, well, not the information that I want. And then the patient says, well, why am I getting the treatment? And everybody turns towards the doctor and somehow it's the doctor's fault. Yeah. And meanwhile, the physician turns towards the staff and the staff turns towards the portal, right? Ability and every other one. And the portal has been temporary unavailable since what? Maybe Tuesday? Oh, Lord.

[00:15:45] Well, Missouri lawmakers have been openly describing prior authorization truly as an administrative barrier that can delay care and burden providers. But I mean, kudos to Missouri because Lord knows this is a national problem. Well, just this year, the governor signed a House bill, a broad health care package with several insurance and transparency provisions.

[00:16:11] The bill was actually approved in July 13th of 2026 with an overall effective date, literally, Nylene, of August 28, 2026. Although particular provisions and technology deadlines have their own dates, you know, so listeners do take one effective date and apply it to all of your sections. I mean, do not take one effective date because they have broken out like technology and other provisions.

[00:16:40] But a lot of the insurance stuff is taking effect August.

[00:17:12] Right. It's called electronic prior authorization, total infrastructure to, I guess, ultimately help patients be able to actually obtain the care that they need. It also addresses certain third party liability situations involving Missouri's Health Net. The headline version is that a responsible third party should not be able to deny a claim solely because its own prior authorization was not obtained when the statutory condition applies.

[00:17:41] oh but everybody listening needs to read the actual requirement and then of course your own contract because this is not permission to just stop obtaining authorizations because you know those payers are going to leverage their contract against you thank you for saying that nyleen because you ain't never lied sister gang never lied because somebody will hear what we will

[00:18:07] are saying that they cannot deny solely for prior authorization and decide that authorizations are canceled in missouri no put the scissors down they are not canceled um it is a clinical denial or an enrollment failure wearing a denial costume i mean that's what we're really asking about so here's where credentialing and enrollment enter the chat because the patient hears my insurance

[00:18:32] denied it but technically that phrase can hide 10 different failures right yes you are never lying one was you know one medical necessity uh medical necessity deny was authorization missing was the service performed outside the approved date range was the rendering provider not loaded was the group contract effective but the practitioner's effective date still pending i mean was the

[00:19:02] location never added was the taxonomy wrong nyleen we can go on and on about all the things well and was the physician privileged for the procedure at the facility but not enrolled with the payer at that site it you know that is the one privileging says that the facility authorizes you to perform the service and payer enrollment says that the payer recognizes that the provider group location and billing

[00:19:28] all have a relationship one does not automatically create the other right so similarly just getting that authorization number does not guarantee payment which is the absolute worst thing because it's like saying oh i'm gonna have my plumber over and he might do the work but man just because i said you can come over to my house doesn't mean i'm gonna pay you like that is insane because you gave me the

[00:19:55] authorization to do the work i have to pay you for what you did for me so it may establish that the payer found the service medically necessary but claims can still fail because well they just found another loophole like okay plumber maybe you didn't smell right so because you didn't smell right i'm not gonna pay you like that is what insurance companies are doing and that's why it boils my head and i'm like actually i'm gonna start getting a headache if i keep talking about this but anyway

[00:20:25] claims can fail for all kinds of things right so they use eligibility they use coding they use network benefit exclusions coordination of benefits provide for providers i mean you name it they can find like their entire job is to find a reason not to pay a claim yeah i'm talking about missouri real client situation right now um you know we had us we had one two people with the same first name and different

[00:20:53] last names and one is a medical provider one is a bh provider could contract to them all at the same time and everybody's in the right place right mpi i mean you could go on to uhc's portal you could see that the ones are connected medical but then when you they sent the billing and the billing said no this person is only on the bh plans and we're like what no that's not true let me pull up like here's the uhc

[00:21:21] portal here's the printout here showing that she's on all the medical plans nope she's only on the bh plans i mean so i've had so i told the biller at this point i said look i didn't gave you the thing i didn't told you the mpi the text id anything else you guys call me on a three-way because i can't if i don't know what she's saying but i can tell you this person's on a medical plan you know like i mean she's not a bh provider so i mean like you said even if they are finding things that they want to

[00:21:50] they'll make stuff up to deny i know and so that's why doctors need it because our poor doctors are working so hard and yet can never raise their rates or can have 20 years experience and get paid the same thing as a doctor who just got out of medical school and the pattern of denials may be telling you that the payer directory the enrollment roster the effective date of the file is wrong and

[00:22:15] that not every authorization specialist suddenly forgot to do their job so it's not the doctor's fault and the poor girls and guys at our offices we're killing ourselves trying to do this so that the patient gets the help and yet i'm sorry i just need two minutes on a soapbox but the patient is the one paying thousands and thousands and thousands of dollars for this okay let's just not forget that and for the for the claim to be denied i mean like you said the doctor's done the work

[00:22:44] you know and then sent it out and these are just in office regular routine things and you know it's and it's just so sad and msps need to understand that the downstream impact you guys of clean provided data we may not submit every claim and as msps we really don't unless you're on the billing side you know but really our data babe it feeds credentialing privileging enrollment directories schedules access

[00:23:10] i mean a bad effective date becomes a denied claim about location you guys becomes an out-of-network bill and a missing privilege can literally become a canceled case okay so if we were consulting for a missouri organization which i know you do i don't but i would want a monthly denial huddle with credentialing enrollment rev cycle utilization management contracting and clinical leadership

[00:23:37] correct you got to and not a meeting where everybody brings stories right you're bringing categories and numbers denial reasons payer service location rendering provider you are looking for patterns network status effective date authorization status overturn rate dollars aging and you guys root cause document it all then separate preventable administrative denials from clinical utilization

[00:24:05] denials right yes nyleen you know this is what we're trying to do this is the real help because you cannot fix a taxonomy problem with a net with another medical necessity note and you cannot fix a medical necessity note denial by updating a caqh you guys so diagnose the right disease oh that was smooth shannon i think i've been waiting all week to say it every state has a different story

[00:24:32] but one thing doesn't change healthcare organizations across the country are facing increasing pressure to navigate a more complex reimbursement landscape whether it's evolving payer policies managed care challenges staffing shortages or just the need to improve your overall financial performance today's surgical providers are being asked to do more than ever before in order for you to get some

[00:24:58] practical assistance please visit nimble rcm.com and let them know credentialing chronicles thank you well now we move from administrative frustrations to the part that affects whether a community has a hospital at all you guys i mean really because it's getting to that point nyleen does this community even get a hospital well reporting on missouri's rural health landscape says nearly 55 percent of the state's rural hospitals

[00:25:22] unfortunately are operating at a loss and federal medicaid and the affordable care act changes are expected to increase coverage losses and uncompensated care over the coming years i mean there is that big huge rural you know care act and that everybody has applying to um you know our hospital here in georgia is actively applying for grants just to try and help us out and see you know can we get a little extra

[00:25:50] to help us grow a particular division i mean estimates cited by missouri's health policy reporting suggests nearly 130 000 to 170 000 missourians could lose coverage over this next decade and the state you guys can lose approximately 23 billion dollars in federal health care funding during this period i mean you know all of the cuts it's really really affecting rural hospitals and it's it's very bad to

[00:26:19] see wow those are projections not a claim that all the loss happens tomorrow again but missouri is also receiving a rural transformation funding like i had mentioned about 216 million dollars was announced actually in 2026 but analysts and hospital leaders caution that transformation um money is not really like a dollar for dollar replacement for medicaid losses and really

[00:26:47] patients this is where we're going to slow down for you because i know we have a lot of patients that listen to our episodes because they're like what what is going on so a rural hospital is not just a building with an emergency room sign okay it may be the closest up up straight ups ups that trick care behavioral health access imaging laboratory you guys infusion services a swing bed a stabilization

[00:27:12] point we're talking for miles i mean miles right so if one service line closes the hospital may technically remain open while access you know quietly disappears exactly nyleen exactly a community can lose maternity care without losing the hospital right it can lose surgeons anesthesia coverage in patient

[00:27:37] behavioral health or even specialty clinics one piece at a time before you i'll ever realize it's gone wow so then the next hospital what are they going to do just absorb more volume ambulance transports get longer families miss work patients delay and care emergency departments become the default there's no doctors there's no one close to me i'm gonna drive the hour my hand's falling off but i'll just use the

[00:28:05] towel like you you're limiting the ability to get the care that you actually need and you ain't lying and delayed care usually does not come it does not mean it's cheaper care it's more expensive well and let's talk about budgets because shannon the budget pressure looks just as bad in the credentialing office right what does that mean for us yeah vacancies consolidated

[00:28:30] roles one msp you know this nyleen supporting two facilities 500 physicians leadership asking whether temporary villages can solve a permanent workforce problem and they're constantly using locums more telehealth more cross coverage more requests to just make an exception this time more risk for benefits and the day that is 100 true and more hands tied behind your back as an msp the dangerous

[00:29:00] part is that the urgency sounds reasonable because that's solved the problem but guess what cardiologists can't start for 90 days because well the committee calendar is low the hospital genuinely needs coverage patients genuinely need care i mean if you're a rural hospital you may have only one or two doctors in leadership so what are you going to do and that's the question that they're all asking themselves this

[00:29:23] is why the answer cannot simply be no strong msps help design a compliant faster pathway complete application requirements they delegate verifications where permitted clean data integration slow meetings when authorized i mean oh i'm sorry special meetings when authorized temporary privilege is only when the criteria is met and documented leadership accountability is very important but emergency

[00:29:47] staffing cannot become emergency standards forever like you said there's a huge financial implication to get low phones there's a huge financial implication to get travel nursing like it's not cheap and if the organization that repeatedly needs temporary privileges nyleen because what recruiting committee cadence on boarding or even payer enrollment is broken that is a system problem that they are

[00:30:11] experiencing call us we got you we can help you not an exceptional circumstance if it's always happening right and so when facilities emerge or share services leadership needs to ask whether credentials files medical staffs privilege forms quality data and payer enrollment applications actually align a shared logo does not create shared privileges guys so keep that in mind if we're merging with another health system

[00:30:41] yeah i mean people think you know a shared electronical health record you know creates some type of shared reappointment and it doesn't right a physician working at hospital a cannot assume the exact authority over hospital b especially because a lot of times these hospitals may offer different services some may offer ob care and some may not yeah and telehealth health is not a magic portal through license and privileging rules it is a care

[00:31:10] delivery method not a compliance exception and i really wish leadership would understand that so if you're a patient in rural missouri right what should you ask before a planned service oh why do you always ask me the hard questions i guess whether the facility the the physician the anesthesia group i mean the imaging provider you can literally go down the list right are they all in

[00:31:37] network that's what you need to know are they in network with your insurance ask whether authorization is required and who is obtaining the authorization because that's where we're seeing a lot of denials and get your reference numbers okay ask what happens if the practitioner charges um changes on the day of so you know you need to document all of this well we're gonna have some informed patients and people going crazy in the hospital asking for this information but if access is disappearing ask the

[00:32:06] hospital what's actually changing right we remain committed to the community you know that saying we remain committed to our community it's not the same as a labor and delivery remains open 24 7 right or the operating room actually is only open from eight into two monday wednesday friday so good luck if you need surgery on tuesday right but it doesn't look like that nylene what does it look like it looks like a patient coming into the the emergency room ready to have

[00:32:35] a baby and you know being turned away and being told to come back when their contractions are one minute apart or something like that and then what the baby is born in the car or you know somebody's having heart problems and then and then what they go home and have a heart attack at night i mean so patients deserve plain language facts which service which states where do you go which transportation support exists and who can answer your coverage questions and is the provider available

[00:33:03] that you need okay so let's talk a little bit about patient portals everybody loves all these patient portals and of course everybody you see right has their own patient portal because of course the government made this a regulation so it's not our fault guys it's the government's fault but um we want to just let you know this is just an ongoing civil litigation so fyi and allegedly okay because this is

[00:33:33] allegedly but missouri's next story is a different kind of credentialing adjacent nightmare that we're finding out and again they're they're everywhere at you all the patient portal and the invisible technology riding along with it um is what we'd like to talk about so in litigation involving this health

[00:33:52] system and a medical system a missouri judge certified class potentially involving more than 90 000 patients the plaintiffs allege that protected patient portal activity girl was shared with facebook and google the tracking technology it's just unbelievable the defendants can contest those allegations and class

[00:34:22] certifications does not establish liability but the governance question is already here who knows what is installed on your health care website and portal who knows that because leadership may hear oh analytics and think oh it's page views but a tracking tool can actually collect your urls your clicks your

[00:34:45] appointment actions physician searches or information that reveals something about the care a person is seeking like just think hey i have knee pain right how many doctors come up that's really interesting yeah i mean imagine a patient is searching for an oncologist a behavioral health provider of a fertility care or an infection disease specialist even without the entire chart the context can be deeply

[00:35:13] sensitive to patients everywhere that's true and this cannot live only with marketing or it i mean privacy security compliance legal vendor management and operational owners i guess need a common inventory uh honey who msps may think this is not my portal they don't want another place to have to manage but our provider directories find a dot pages referral tool scheduling links professional profiles you all and

[00:35:41] medical staff systems are part of this digital ecosystem oh my goodness so if a directory says the doctor the doctor accepts a plan when the doctor actually doesn't then the patient may make a financial decision based on a financial decision based on technically inaccurate data so if a tracking tool captures the search that creates

[00:36:06] like another layer of risk a hundred percent so this story is not only did somebody violate privacy law allegedly the broader lesson is can the organization identify every third party script what it collects where it sends data the contractual author authority and whether patient consent or another lawful basis exist and i like to say this about credentialing software too some of these questions you all when you're doing your demos

[00:36:36] ask these questions where are they collecting your information and putting it and it can it turn the tool off without breaking the portal yes because if your privacy plan is please do not click anything we need another plan i mean we need another plan we need a plan b well then give them the five question test

[00:37:00] okay one what pixels cookies session recording tools chat tools and analytics scripts run on every patient facing page is that what our patients should be asking i guess okay maybe two what exact field or events do they collect that one's a lot easier to relate to because you can start asking like oh are you watching my click kind of thing yeah you're right you're right where does the data go right or maybe what vendor agreement and

[00:37:30] privacy analysis support the use i think that is a good one look at you being an it guru over here honey i've had to learn from my msps for the patients i mean we are out here and researching i mean what about who retest after every website or portal update because we get the updates all the time nyleen but who's out there auditing the the updates does it work better you gave me the

[00:37:57] update but is it working better i don't know okay well check this one out because you know me i love me some compliance does the public privacy notice match what the technology actually does and when was the last time that those were ever updated on your website i'm gonna say allegedly no okay allegedly so yes a policy cannot promise one thing while the code literally does another and i mean you

[00:38:26] know we see this time and time again that is crazy so before we close missouri also enacted several healthcare access changes in 2026 that we really wanted to bring you and we feel every msp deserves to put on their sticky note nyleen take it away babe okay so house bill and y'all can look this up house

[00:38:48] bill 2372 i love it house bill 2372 includes telehealth community paramedicine prior authorization transparency patient protections involving anesthesia and contrast enhanced mammography and other coverage changes other enacted measures address health care licensure and reciprocity how you say that word

[00:39:14] reciprocity the operational reminder is that reciprocity or compact eligibility does not mean skip credentialing y'all right verify the privilege to practice through the applicable compact or the state process right confirm that scope confirm the discipline history confirm whether the practitioner meets the facility's appointment and privileging criteria like y'all are are all accustomed to do

[00:39:42] and then just make sure that payer enrollment is also being done true the state also expanded areas such as doula coverage yes under missouri's health yeah under missouri's health net and community paramedicine whenever a benefit or a practitioner pathway changes you all organizations need to map four separate questions okay who may provide it under whose authority what credentials or registry status

[00:40:10] are required and how does the claim get paid that's what you all need to think about so coverage without a provider network is just a promise on paper and a provider without enrollment you all can deliver care and still create a financial mess for the organization and missouri is the perfect example of why access credentialing privileging privilege and reimbursement and governance cannot operate in just little

[00:40:35] kingdoms we all need to love each other very very much oh you're very right you're very right no you're very right okay so we want to definitely lead out with our psa's okay guys msp you are not the paperwork department you are part you are part you are essential you are the life the love of the patient safety system verify from the source right preserve your audit trail escalate your discrepancies understand

[00:41:05] where your data travels and when somebody asks you to move fast show them the safe way to move fast same thing for provider enrollment specialists my provider enrollment msp love you um same thing make sure you're gathering that data and your msp at your facility in your ms oh your medical staff office y'all are sharing the right things confirming the same things having the right things i mean i can't just

[00:41:31] tell you i just took over per moment and girl the socials the birthdays i mean the importance of that data the secrecy of that data is so important so all of you are important and we love you very much patients when you hear the word denied ask what was denied why was it denied was it medically necessity prior authorization network status eligibility coding guys write this stuff down

[00:41:59] was it provider enrollment or were they missing information ask for the denial in writing the appeal instructions and the deadline and the reference number if the first explanation makes no sense you keep asking you use your voice and doctors my lovely doctors my lovely practitioners listen we feel your

[00:42:21] pain we want you to get paid we understand that we are all working off of your hands um do not assume that just having an active license means you can bill right away and are gonna get paid right away or because i signed the contract it means it's effective or i signed my privilege form now i have privileges right it does not happen like that the directory listing you have to wait you have to be listed

[00:42:48] in the directory we have to get a letter it has to be anytime you enroll or anytime you get privileges keep that letter track each one confirm every location every effective date review your profiles and love your caqh which is this thing that like houses all your information that has to be updated every time you move every time you get a good job so you are ultimately responsible for that information live it

[00:43:13] love it learn it and we have a special one today for leaders because i know we have many many ceos coos chief nursing officers cmos that listen to us protect the people who raise good faith concerns you guys budget pressure is real workforce shortage is real but the patient should never become the place where the organization tests whether it can its actual controls are working so missouri told us to show me

[00:43:42] so here is what we want every health care organization to be able to show the source the decision the authorization the privilege the enrollment the data trail and the out accountability so missouri kudos to you and maybe show us some barbecue next time oh please oh yes well guys this has been credentialing

[00:44:06] chronicles spilling the tea i'm nailene i'm shannon stay credentialed not canceled oh shannon that was a lot of tea honey but have they subscribed yet to hear it next week on all of these platforms please subscribe like and follow us and follow us on our channel and we'll see you next week on the next week