Transcript
Dimitri Kielbasiewicz (00:02) hello? Hello?
Vanessa Miller (00:06) Hello?
Matthew Ortiz (00:07) Good afternoon. Good.
Dimitri Kielbasiewicz (00:08) Afternoon… welcome, everyone. And thank you so much for taking some time to help us develop some new features that hopefully you’ll find useful… for your operation. Yeah.
Matthew Ortiz (00:26) We appreciate it. We’re looking forward to the discussion. Sorry, I won’t be on camera, Dimitri or Zach. It’s nice to meet you guys. I’m currently stuffing my face trying to get lunch in from all my back to back meetings. So.
Dimitri Kielbasiewicz (00:38) No worries at all. Do you mind if I record this meeting so that I can refer back to it later? Yeah. Sure. Okay. I’m going to start the recording now.
Dimitri Kielbasiewicz (00:51) And also small housekeeping caveat from my part. An electrical pole is being replaced on my block. I’m on backup right now, but if I disappear suddenly, it’s not because I’m being rude, it’s just because my power went out. So, yeah, with that, I’ll start the recording. All right. Let’s see start.
Dimitri Kielbasiewicz (01:23) Okay. We’ll just do really super quick introductions and then jump right into it. So, as I said before, I’m Dimitri, I’m a product designer here at medallion and I work on the provider and admin experience team. And with me is Zach our head of design listening in and keeping me honest, Zach, if you want to introduce yourself?
Zach Jarvis (01:52) No, you got it. Yeah. I’m Zach, head of design, oversee all medallion’s products and design. I’ve only been here for about a month and a half. So I’ve been popping in here to these to be able to get to know our customers a little bit to kind of see how our sessions are run, and just kind of get a generalized understanding of how you guys use our products and how they’re impacting your life and how you work.
Matthew Ortiz (02:18) Awesome. It’s nice to meet you both. I’ll kick it off from our end. And then I’ll pass it over to Vanessa, Christian and Sam. So I’m our VP of payer strategy and relations. So I handle all of our health plan contracting highly involved in a lot of our delegated credentialing efforts. And, yeah, that’s about it from mine. I’ll pass it over to Vanessa. Hi.
Vanessa Miller (02:38) I’m Vanessa, I’m the vice president of revenue operations. So I intersect from the credentialing Lane. So just all of the individual provider cred, I also have all revcycle and patient access. So, it is very important to me that we get our providers credentialed very quickly because I’m also the one that has to manage all of the downstream impact for scheduling and reimbursement. So… Christian… hello.
Christian Ellis (03:06) I am the credentialing manager at FCC. So my team pretty much handles all of the onboarding process, delegation process, dealing with the payer setups, all that good stuff and getting them ready to go, Sam.
Samantha Ledesma (03:25) Hello, I’m Sam and I’m the credentialing specialist. I work alongside Christian. So whatever she just said, I am right there with her.
Matthew Ortiz (03:39) And that’s it from our end.
Vanessa Miller (03:41) Awesome. Cool.
Dimitri Kielbasiewicz (03:43) Thank you so much for all those introductions. I’ll kick it off with just a little bit of context setting. And then I want to spend maybe 10 minutes, maybe 15 minutes just getting to know your operation a little bit better. We haven’t spoke before in the context of this project. So before I demo anything, I wanted to get a sense of how you run your operation in terms of peer enrollment strategy. Some of these questions might be a little bit obvious, you know, based on conversations that you’ve had with others at medallion. But because I’m a little bit new to your context, you know, please allow me to ask some naive questions. It’ll help me sort of level set and get some context on how you work.
Matthew Ortiz (04:30) Yeah, I can give you a quick voiceover Demetri, if that’s helpful.
Dimitri Kielbasiewicz (04:33) Sure. Yeah. Go for it. Yeah.
Matthew Ortiz (04:35) The team can speak more to like details. I’ll let Christian and Sam chime in when it comes to like our in the weeds activity. But so family care center is an outpatient behavioral health group. So, we have the main type of contract that medallion supports are professional or otherwise called group contracts that’s a contract at the tax id level for the organization. And of course we credential all of our individual practitioners under those group contracts. So we employ a vast number of different provider licensure types. So, psychiatrists, psychologists, master’s level therapists, and then mid level prescribers, so your psychiatric mental health, nurse practitioners, or physician’s assistants. We credential every provider with every payer that’s our model. We’re a big in network type of provider. We make an attempt to contract with every payer in each of our markets. We’re in five different states. Some of our contracts are multi state contracts. We only have one tax id. So that allows us to have a lot more flexibility and ease of kind of strategy when it comes to contracting with our health plans.
Matthew Ortiz (05:45) This means that sometimes we have a true national contract. Like with evernorth, for instance, we have a true national group contract with evernorth… and then we have other payers like optum or unitedhealthcare, where we have a contract that was rooted in Colorado, but we’ve amended and added additional states as we’ve entered these states. So that’s kind of our design. Again, we’re delegated with the vast majority of our payers. I would say 80 to 85 percent of our health plans, we have delegated credencing agreements with the rest we’re doing individual payer enrollments. We provide services to commercial and medicare advantage enrollees as well as tricare or va patients.
Matthew Ortiz (06:27) The only line of business that we don’t support is medicaid. So, you know, we obviously are getting a medicare number for every one of our providers and enrolling them under our group medicare enrollments, unless of course, the providers opted out… trying to think what else? So we’re obviously, we’re always enrolling our providers, tagging them or affiliating them with our group contracts. Sometimes we will submit, you know, multiple requests in the platform, you know, one for the initial enrollment to get the provider enrolled for the commercial product. And then sometimes, you know, if it’s a payer that has medicare advantage, then we’ll submit, you know, the secondary request to add medicare, once the medicare number is finalized… gotcha. I think that’s kind of like the bare. Bones of our operation, Christian and Vanessa, feel free to add anything, but hopefully, that gives you some insight into how we kind of operate.
Dimitri Kielbasiewicz (07:18) Yeah, that’s very helpful. I’ll pause for if anybody else has input before I ask.
Christian Ellis (07:28) I think matt summed it up pretty well from my perspective.
Dimitri Kielbasiewicz (07:31) Okay. Cool. Yeah, I think the first thing that I’d be interested in following up on is the 80 percent delegated for the 20 percent like direct non delegated payer enrollments. I’m assuming you’re doing those through medallion. And second part of the question is like, what is the volume of that look like? 20 percent seems like a small amount. But if your operation is fairly large, you know, what does that volume look like in terms of that 20 percent?
Matthew Ortiz (08:06) Oh, can you restate your first question? Sorry, I was, I,
Dimitri Kielbasiewicz (08:11) Is it, yeah, is it correct to assume that the 20 percent of direct payer enrollments the non delegated ones you’re doing with through medallion? Correct?
Matthew Ortiz (08:19) Correct. Yep. You guys are supporting us, yeah, in both areas, and.
Christian Ellis (08:24) When you said that 20 percent, I mean, we do at, right? As of right now, we have 779 providers. So, and we add, it seems like daily at this point. So, that 20 percent definitely grows and.
Matthew Ortiz (08:41) Obviously, every state is different, you know, like, you know, from a direct enrollment perspective, you know, like it’s pretty much the same payers in most states. We’re not delegated with medicare, obviously can’t delegate with medicare. So that’s one payer, we’re not delegated with Aetna in any state. So, that’s another payer. And then it’s pretty much the blues in a handful of states. So, blue cross blue shield of Arizona of Tennessee and blue cross blue shield of Florida. I think those are pretty much our only non delegated payers right now, Christian?
Christian Ellis (09:11) Well, even though we’re even though we are delegated with tricare for Tennessee and Florida, we still have to submit a request because nine times out of 10, they need certified. So, medallion process. Is that certification for tricare for, Tennessee and Florida got it.
Dimitri Kielbasiewicz (09:28) Okay. Yeah. The, the reason I’m asking about that is because this sort of feature area that I’m working on is very much focused on the direct payer enrollment path. So just wanted to make sure that’s a context that is relevant to you right now. That doesn’t mean that this won’t eventually evolve to being work. We’re realizing, you know, as a team that like payer enrollment is credentialing and credentialing is payer enrollment. Like these are essentially the same things that just take different paths. The direct payer enrollment is the sort of like first problem space that we’re looking to streamline in terms of how requests are generated and managed throughout the life cycle. So, yeah, just wanted to kind of set that context. Sounds like it’s still something that’s very relevant to your operation, just might be a smaller portion.
Matthew Ortiz (10:28) Yeah, absolutely. Yeah. We look at our direct enrollment payers as just as important as our delegate payers. Can I?
Zach Jarvis (10:35) Ask like, you know, the 80 percent of delegated and 20 percent of direct, like if we’re looking at like that’s probably the quantity or the volume, but if we’re looking at like time spent like what are we looking at like in rough percentages of time spent on that 20?
Dimitri Kielbasiewicz (10:49) Percent?
Christian Ellis (10:55) I’m trying to say, I mean, it’s not a lot of time as far as I’m… trying to, I’m, trying to gauge really how much time it is. It’s I don’t… have a quick answer. No.
Zach Jarvis (11:10) Worries. No worries. I was just curious if that’s something you guys?
Christian Ellis (11:12) Like I thought I did, but I’m a liar. I don’t no.
Zach Jarvis (11:15) Worries. No worries. I mean,
Christian Ellis (11:18) it’s just a matter of going in, and just submitting the request, but anything that we can get automated and streamlined is always going to be a plus.
Dimitri Kielbasiewicz (11:29) Awesome. Yeah. So I think you know, some of the other questions that I usually ask for the context setting. I’ll kind of go through those you’ve already answered most of them to be honest, with your preamble but… I think, you know, some of the things that I’m wondering about are like how you determine for the direct payer enrollments, how you determine which providers… get, which enrollment request. So obviously, you’ve already like, you… know, you triage them by payer type, right? So some of them are delegated then for the direct enrollments, it sounds like you do it by group primarily based on what you said earlier, matt.
Matthew Ortiz (12:21) Yes, essentially by state. So yeah, most of our providers operate in a single state. Now, I would say, you know, the vast majority, but we do have some psychiatrists that are licensed in multiple states. Obviously, the only licenses that we’re concerned with are the ones where we operate. So we do not provide services in states outside of the five where we have physical locations.
Matthew Ortiz (12:43) So we do provide telehealth services, but we provide that out of our clinics. So we’re not like a telehealth provider. So, you know, if a provider has a license in Texas, Colorado and Washington, we care about the Texas and Colorado licenses because that’s where we are, we could care less about Washington. Sometimes that’ll be in the medallion platform, of course, but we don’t you know, we’re not tracking that too much. So essentially, we credential each provider with every payer in whatever state where they operate. So, you know, if they’re tied to a clinic in Texas, then we would credential them with every single Texas payer. And then, of course, you know, if they’re tied to multiple states, then we have to credential them with medallion with all payers. So, you know, again, like I said earlier, some of our states have more payers than others. You know, Florida has the, I think Florida or Arizona have least amount of payers, Texas and Colorado have the most, so.
Dimitri Kielbasiewicz (13:36) Okay. And then.
Christian Ellis (13:37) Just to add to that, the only time that will differ is if a provider is medicare opt out. That’s the only time that we would not credential a provider say with medicare other than that all providers get across the board with our contracted payers for that state. But like I said, with medicare, if they’re opted out of medicare, then of course, until that opt out is ended, I will not submit a direct payer enrollment request for that medicare provider.
Dimitri Kielbasiewicz (14:07) Okay. So two follow up questions on that. I guess working backwards, how do you know that a provider is, what determines that they are opt out of that? Medicare? That?
Christian Ellis (14:19) Is part of a verification process that’s required that medallion runs as a requirement for our delegated payers, is if they are, they, if they are, if they are or are not opted out of medicare. And if they are, we get an alert from medallion that they are a medicare opt out and that, that’s when I will go, and determine when that will end. And I work with the provider on getting that termed at the end of the opt out period? Okay?
Dimitri Kielbasiewicz (14:48) And is that something that’s like known prior to the provider being onboarded into medallion? And it’s just some?
Christian Ellis (14:56) No, no. Most of the time the provider has forgotten that they were opted out of medicare because it’s an auto renewal. So, unless 60 days prior to that, it’s a two year, it’s a two year period and it’s 60 days before that two year period ends. If you do not submit in writing a request to terminate the opt out, it automatically renews. So nine times out of 10, the provider is not even aware that they’ve opted out of medicare, got.
Dimitri Kielbasiewicz (15:22) It. Okay. So that it… sort of like leads to a specific consideration around sequencing. And this is part of the sort of part of the problem that we’re trying to solve with these automations is giving you the granular control, to sort of determine that, right? Where you can automate request generation for things that are known and for things that are less known. Like the example that you gave would give you the ability to maybe not generate those, right? Because it’s more of a manual process that requires like another step to happen before. So that’s helpful to know. The other question that I had was just around the statement that every mo, okay. Not every but most providers are enrolled with every payer in the state, that they practice in. Is that determined purely by state? Or are they all associated with like a single group that is in that state? Or is it by practice location? So.
Matthew Ortiz (16:36) The way that we contract, so we have, since we only have the one tax id, we only have one entity. So family care centers, yeah. So all of our contracts are executed under that one single tax id. We, you know, have different agreements by state. So, you know, again like, in Colorado and I’m happy to provide, you know, if you need any resources, I can throw this in the email or something. But in, you know, Colorado, we’re contracted with a specific set of payers in Tennessee, we’re contracted with a different set of payers, you know, they sometimes they are the same across state lines, but we have everything built out into the platform. So like all of our payers are, of course in the platform, the locations where our providers are affiliated are of course built into their profile. So wherever they practice, we essentially are either going to submit them on a delegated roster or submit a payer enrollment for every single payer in that state. So that’s it. So, so the only group is family care center. We do have, you know, different clinics, but we do not like, we don’t look at those clinics as like different entities. They’re just, you know, locations that fall under our group build and under our tax id. So like we don’t like when we credential with or when we contract with the payer, we’re not like we’re looking at it as like, yeah, we’re going to contract these locations. We contract every single location under every single group contract.
Matthew Ortiz (18:00) So it should be uniform that, you know, whether we’re contracted with blue cross, Aetna unitedhealthcare, whoever there is, you know, every location and every provider, is loaded under those pairs. So.
Dimitri Kielbasiewicz (18:14) It sounds like if it’s all one group, then the way you determine the pair… that the provider needs to be enrolled with, is by, you said by state. So it sounds like basically by practice location, essentially, right? Practice location that they’re practicing at, or… then that determines the pair? Yeah.
Matthew Ortiz (18:42) Yeah, I think that would probably be, the number one decision point because, you know, that practice location. I mean, it really is by state. But again, if they practice in more than one state, then we’re going to look at the practice location. So, yeah.
Dimitri Kielbasiewicz (18:52) The reason I’m sort of like getting into that detail is because we don’t really have a like in this tool. We don’t really have a concept of like assigning… a provider to a state directly. It’s sort of derived through their practice location. But sounds like that. You know, that all still sort of fits together. I just wanted to make sure I, I’m understanding the way your.
Matthew Ortiz (19:21) Mental, yeah, it works, and then, what I will say though, sorry, go ahead, Kristen. I’ll say.
Christian Ellis (19:26) The way medallion has it set up now too is when I go into request based upon the way that I set them up, you know, I set up their practice location. Our each state does have their own mpi number. So when I, the mpi number is set up in the drop down for me to choose when I’m setting when I’m doing the direct payer enrollment. So it allows me, to choose by the mpi number, that is attached to that particular state.
Matthew Ortiz (19:54) Good. Call out. Thanks for calling that out. Christian. I totally failed to mention that that’s probably a pretty important component of this. So we have one tax id, but we have separate npis by state. So we have five unique group npis. So that actually probably even more than practice id or practice location. Maybe the npi would be that decision making, you know, indicator because if they have the Texas npi, then they would be credentialed with every Texas payer, or if they have, you know, the Colorado and Tennessee npis, they would be credentialed with every payer in both of those states. So, yeah.
Dimitri Kielbasiewicz (20:31) So that could be analogous to how we think about groups even though in your case, the groups would all have the same tin… they have unique npis. So, okay, that tells me enough about how you sort of have your operation set up and how you determine how you sort of like determine who goes where, yeah.
Matthew Ortiz (21:01) And I will say too, the only thing I would call out is that we’re probably going to be one of the more Symplr providers that you guys talk to as you’re building this out. So, like most, we have grown completely organically so we have not conducted a single M a transaction like we haven’t gobbled up a smaller behavioral health group with a different tax id and legal entity. And all this stuff. So like we have a, very simple approach, it actually makes my job very easy. You know, I’ve been at other companies with multiple tax ids and all these different legal entities because of M a transactions that had occurred at some point in the past. So the way that we’re set up is probably going to be much Symplr than what you’re going to be doing with most other clients that.
Dimitri Kielbasiewicz (21:44) Makes sense. Yeah, an important call out. OK, cool. So let me talk a little bit about what I’m working on and the feature we’re looking to build. The problem we’re trying to solve is kind of twofold. The first part is just reducing the amount of work that your team needs to do every time you request a direct payer enrollment. And in the future, we’re going to figure out a way to make this work for delegated as well. So as you know, today, it’s a completely manual process. You go into the platform, you go to payers, and you click the new payer request button and you have to fill out a form essentially where you determine all of that information, you specify, the provider, their practice locations, the lobs, and I’m assuming you’re referencing some sort of source of truth on your end, whether that’s a spreadsheet or a database that you use to essentially determine everything that you spent the last 20 minutes explaining to me and making sure that the given provider gets the correct payer enrollment request. And you have to do that for every new provider that you bring on. What we’re looking to do is create a system where you can encode all of those rules about who gets what payer enrollment request based on specific attributes. And then those rules or templates as we’re calling them will… run every time you invite a new provider, and they’re going to run against information that you input about that provider information, like their profession, but more importantly which practice locations they’re assigned to, which groups they’re assigned to, which I know is a little bit like fuzzy in your case. And then based on that, the system will generate request suggestions that are based on these rules that you’ve determined. So that the process is somewhat automated. But with you… in the loop with the ability to override those, and I’m going to show you how this works in a second, just giving you the overall kind of concept behind it. The second problem that we’re looking to solve is that by making it easier to get those requests in, we also are looking to have those requests generated sooner in the whole lifecycle of a provider going… through onboarding in the context of medallion. And the reason why is that as soon as we have information about which payer requests the provider needs, or which payer enrollment the provider needs. In the form of requests, we have much more accurate provider profile… data requirements that we can reflect on their profile. It makes it easier for you to input only the information that is actually needed for those requests and information that is accurate to that. So hopefully that reduces back and forth between you, your team and, the medallion intake operations team. I don’t know if that’s something that you’ve experienced in the past where there is a little bit of friction there, where there is back and forth before peer request applications start getting filled out and submitted, you’re getting tasks for adding a license or… adding education information or anything on the provider profile. Is that like friction that you’ve experienced in the past working with medallion?
Christian Ellis (26:07) No, not necessarily because I kind of have a system of, I know what’s needed for the requests. I try to ensure that everything is in place prior to the submission. So to avoid that exact scenario.
Dimitri Kielbasiewicz (26:27) Okay. Gotcha. And then as far as the first problem just in terms of having to manually do those submissions, is that something that feels burdensome? I mean, it sounds like matt mentioned earlier that it is something that you’re looking to streamline and automate… but sort of like re asking the question a different way. Like is that something that you feel takes time out of your day in any significant way? It?
Christian Ellis (27:01) Definitely does take time. I think that once we get, because of our volume of delegated payers, I think once we get both of those, that’s going to be, very nice because like you said, the manual process, it’s tedious. It’s not that it’s when you have the volume that we have, it’s time consuming, but it’s also very tedious. So it’s.
Dimitri Kielbasiewicz (27:25) definitely something.
Christian Ellis (27:25) That we would love. Yeah.
Dimitri Kielbasiewicz (27:27) I think that’s the key thing here, right? That it’s not necessarily a massive volume, but every time you have to do it, there’s a lot of cross referencing that you need to do. Okay. So let me show you some early concepts of what we’re building and you can tell me just in the interest of time and like logistics since you’re not on video, I think I’ll just share what we have. You have access to this. I’ll share a link and you can play around with it on your own as well. But I’ll give you a quick demo and just ask for general feedback in terms of like does this make sense? Does it fit your mental model? Is it clear what this does and how to use it? So let me just jump in here and… share my screen.
Dimitri Kielbasiewicz (28:31) I have many windows open of the same thing. Okay. So this is let’s call this a prototype. So it’s not connected to any real data. So some of the information that you’re seeing here might look a little bit canned, but it’s a pretty accurate representation of what the UI will look like. And what you’re looking at here is an empty… template. And a template is a rule, a set of rules that you set up in order to run these request automations… you would get to this through the payor enrollment tab and we can talk about that another time in more detail in terms of access points, but just kind of looking at it in the context of the template itself. I’ll give you a quick overview of what you’re seeing essentially everything that you’re seeing on the left are the rules or as we call them here conditions. So what this means is if when a provider is invited, if they match any or all of these conditions, and I’ll get into the detail of what those can be in a second, then we want to suggest these requests. So… kind of walking you through it really quick. You know, in your case, I think, you know, one of the most pertinent examples would be practice location because you kind of do it by state and you would say, all right, any providers that we invite, if they are assigned to this practice location in Arizona, then… these are the requests for… the payers that I need and you would go in here and you would fill this out in a similar way to how you fill out your current payer requests. But the difference is that you’re doing this as an automation. So you would go in and you’d say, okay, for Arizona, I’m looking to do, I think you said Aetna wasn’t one that you’re delegated with, right?
Matthew Ortiz (31:07) Aetna blue cross, blue shield of Arizona and medicare would be the three of those.
Dimitri Kielbasiewicz (31:13) Okay. Well, let’s just say maybe for, yeah, Arizona.
Dimitri Kielbasiewicz (31:21) Let’s see.
Dimitri Kielbasiewicz (31:31) Okay. And then I’m just going to put a few basic.
Dimitri Kielbasiewicz (31:39) Examples here, these may not be exactly what you do… but now that this is filled out, this is like a very simplified example of a request template. But basically what this means is when a provider is invited and they’re assigned to any of these practice locations, then these are the payr enrollment requests that we want to generate. And I’ll explain a little bit about how that actually gets applied and practiced in a second. But pausing here for a second would love to get your feedback on like does this generally fit your mental model? Is what you’re seeing making sense to you? And I’ll kind of stop talking now and let you give me a little bit of absolutely.
Christian Ellis (32:37) I like this. It completely makes sense and very streamlined, very efficient.
Matthew Ortiz (32:45) Yeah, I agree. I like this a lot. I mean, this makes a lot of sense. This will help push things along much faster. We’ll take, you know, some of that administrative burden off of our team to do the bigger picture, more value added stuff.
Dimitri Kielbasiewicz (32:58) That we.
Matthew Ortiz (32:59) do. So, I love where you guys are going. Obviously, you know, with a provider like FCC where we’re highly delegated, you know, just because we have more delegation agreements, doesn’t mean that we don’t think that there’s a ton of value in this. And obviously, for your clients that don’t have any delegation, this would be huge like this would have been massive for us when we first started because obviously, it took us some time to get, you know, all the contracts that we had. So, yeah, I love the idea here.
Dimitri Kielbasiewicz (33:26) Yeah, absolutely. Yeah. So then to sort of peel away some more layers and get into more detail. In this example, it’s just core practice locations. But the idea behind this template builder is that you can make it as specific as you need it to be. So, one thing that I’ve noticed speaking to other clients is that and you’ve mentioned this a little bit is that there are always exceptions. So one thing that you can do is you can say, and this may not be a real example for you but just kind of one off the top of my head is like for a specific profession, you can do… yeah, again, this is just like a hypothetical example but you can say that, okay, it’s for these practice locations. But if they’re this profession then don’t… run that payr enrollment request suggestion or you can do it inversely, right? You can say only do it for… these. Like if you’re looking to only enroll like MDS in this context. So this might be a level of granular control that you don’t necessarily need that’s. Okay. Just wanted to call out that, like there are a number of provider attributes that you can actually… specify here beyond just group and practice location to give you a little bit more granular control. And then the second sort of like angle to this is that this might be obvious, maybe not. But… the concept here is that this isn’t a single template that you are able to create as many templates as you need to generate exactly the requests that are needed per state or per group or per whatever. So.
Matthew Ortiz (35:30) We could essentially set up five different templates one for each state and it’s like, okay, if they’re tied to this mpi, do these things?
Dimitri Kielbasiewicz (35:37) Exactly.
Matthew Ortiz (35:38) That’s awesome. One question I’ve got and this may be on your radar, but if it’s not, we have like kind of like for like two step processes. So, for instance, let’s just use one paper as an example Aetna. So we all of our Aetna contracts cover both commercial lines of business and then medicare lines of business. We submit the, you know, we hire a provider, submit the enrollment to get them enrolled with the commercial lines of business. Meanwhile, we’re also having to enroll them under our medicare group enrollment. We can’t add them to the Aetna medicare line of business, until of course, we get the medicare set up. So it’s something where we kind of do a two step, we first get them enrolled with the commercial piece. Then once medicare, is complete, then the team will go in and submit a demographic update to then add medicare to their, you know, enrollment with Aetna. Would this be able to do things like that where it could do kind of that two step process as in like it submits the first enrollment, and then once that enrollment is done, then it submits a demographic update for, you know, medicare or whatever the case may be?
Dimitri Kielbasiewicz (36:44) Yeah, that’s a, it’s a great call out. And, you’re not the only one. As a matter of fact, I think every single customer that I’ve spoken to about this has the same need right, to sequence, the, the government enrollments after the commercial ones. This is something that we, there’s a separate feature that we’re building that solves this problem, that sequences those dependencies appropriately. It is good feedback to hear that it’s something that like fits into this context as far as like your mental model. So, it might be something that we’ll explore potentially like allowing you to encode into this template, that’s not something we’re doing today. We’re solving it differently where that’s a rule set, kind of like in a separate place, but we have a way, to sequence those where, we’re essentially like running the first, like commercial enrollment. And only after that one, is complete, we’ll run, the government one gotcha.
Matthew Ortiz (37:49) Okay. Yeah, obviously, I know you guys are still kind of building this. So I didn’t expect you to have it all figured out, but I did want to at least mention that would, and it sounds like we’re not the only ones that have mentioned that?
Dimitri Kielbasiewicz (37:59) No, not at all. Yeah, that’s it’s good to hear that. To hear that from you just like, make sure that we’re also covering that. A use case sounds like it’s a very common one. I,
Vanessa Miller (38:11) was going to ask a question. I, I’m assuming, right? The intent of this is that it’s going to, in the background automatically assign to medallion to work, right? Do you think that in future iterations, there would be the potential for the ability to have a selection in this, suggest these requests piece that says assigned to client? Because that would allow us to then entirely automate the delegation component as well, right? We’re adding all of those payer lines to each provider, and then we’re monitoring when those payers are actually loading them for delegation. And that’s what helps like trigger their rosters. And so even having like, a, the automation of just to say, anytime we add a provider for a clinic, it automatically aligns all of their both direct and delegated. I know it’s great that’s kind of outside of this scope. But, that logic potentially existing in the future would also be super impactful for.
Dimitri Kielbasiewicz (39:10) Us. Yeah, great to know. Yeah, I think, you said it, right? It’s not something that we’re solving for, in this first sort of like beta version. However, you’re also, as far as this particular question goes, you’re also not the only one, I spoke to another customer that, also mentioned the ability to route client owned versus medallion owned at this level. So it sounds like something that we’re certainly going to look into and make sure that, is a possibility for now, the way you would route it, say, like, hypothetically, if you were using this like feature in beta, just sort of like starting to get your feet wet with it. The way you would do it is, you would only use this for medallion owned, direct payer enrollment requests, and then any client owned ones you would just manually generate. You know, one thing I failed to mention earlier is that this is going to be a completely like complementary feature. It’s not, replacing the flow that you’re using today at all. It’s just an additional way to, to generate requests. So, we’re going to be doing it, in a sort of step by step, way where we’re going to be introducing like, you know, this sort of like narrower, scope and use case for, for how this can be applied, learn from it and then eventually expand it to all of the other use cases as well. So, anyway, thank you for calling that out. It’s it’s really good to know.
Zach Jarvis (40:48) Can I really quick? Like I’m new still. So, I’m still making sure I catch up on everything and making sure I understand. But both matt and Vanessa, like Vanessa, I think you were asked like saying, like we have this really cool feature and like it’s going to like hold our rules of like, you know, like how we, you know, like who we route to the templates, everything like that. What I hear you saying is like, it would be great if we can like really treat that as a source of truth and like leverage that tool even outside of medallion processes. That lets me kind of like keep everything in one place and I can just kind of like, I can figure out who, where it needs to go from depending on, yeah.
Vanessa Miller (41:26) Essentially, right? I think just creating essentially when we onboard a provider being able to just have all the rules fire and trigger for all, you know, payers, whether that’s client assigned or medallion assigned to just kind of automate that process for us. I think, you know, we open on average 10 clinics a year and we have 20 providers per clinic each year. And then you add in, you know, any sort of turnover and it’s a lot of applications… both delegated and direct. And so just even being able to automate these rules, but then say assigned to client instead of assigned to medallion would be, it would allow us to not have to touch this component at all and just really focus on following up with payers.
Zach Jarvis (42:13) Cool. Nice. And then matt, like the, I love the way you’re thinking like the like this is really helping us kind of upfront figure out what the intention is with this provider and lets us just start to build and fill in some of those gaps and build functionality that lets us kind of figure out how do we sequence it? What’s the right? What’s the right way? And like how do we ensure we have the right information upfront when we’re inviting this provider? And just kind of like try to check all our boxes really early on in the process? And then, you know, figure out what to do with it as we go through with automation, right?
Matthew Ortiz (42:44) Yeah. I feel like there’s like so many different ways that you guys could go as you start to build this out. I mean, this is great. We’ve really enjoyed this, you know, as you guys continue to kind of build this out, we would be more than happy to stay engaged in these conversations and brainstorm with you all because I see a ton of value here. And again, think this could go on lots of different you.
Zach Jarvis (43:04) Know.
Matthew Ortiz (43:05) Exciting, exciting different avenues. Yeah.
Dimitri Kielbasiewicz (43:08) Thank you, for joining and giving us the valuable feedback. We didn’t even get to, the other flow. We only have a few minutes left, but I’ll just quickly like give you a 30 second like overview of how the new flow will look like. But essentially, when you’re inviting a provider, you would… then.
Zach Jarvis (43:42) I think, Dimitri, you’re breaking up?
Matthew Ortiz (43:44) Yeah, I wasn’t sure if that was just me or not.
Zach Jarvis (43:46) Yeah, it wasn’t me or not either, Dimitri, I think you’re breaking up, but, but oh, sorry, yeah, maybe we can go back to this. We can show this another time. This is really cool. But I know we’re one minute till, yeah. So, okay.
Dimitri Kielbasiewicz (44:00) I don’t know if you can hear me. Maybe my internet is dead or dying. Yeah, you’re back? Okay. Yeah, let’s.
Matthew Ortiz (44:09) go well.
Zach Jarvis (44:10) No, don’t worry, Dimitri. It’s all over the place, but I’ll sign us out for this but no, really appreciate everybody taking the time to let us dig in like understanding the mental models and like how we’re trying to fit this together and what unlocks is really going to be powerful for us. And so we really appreciate your time. We’ll definitely keep in touch and I’m sure this isn’t the last time you guys are going to see this, but yeah, yeah, I appreciate it. Yeah.
Matthew Ortiz (44:33) We appreciate it too. Thanks for including us, you know, as kind of a part of the brainstorm group. And again, if you want to schedule a follow up discussion, you know, to cover anything that we didn’t get to today in a, you know, talk shop, please reach out. We’re more than happy to.
Dimitri Kielbasiewicz (44:50) Awesome. Thank you. I appreciate it all.
Matthew Ortiz (44:52) Right. Thanks guys. Good to meet you both yep.
Zach Jarvis (44:54) You too. Bye.