Transcript
Samantha Bouchard (00:00) hey, Sam. Hey, Jake. Good morning. Good?
Jake Shubert (00:04) Morning. How are you?
Samantha Bouchard (00:05) Good. How are you doing?
Jake Shubert (00:07) I’m doing good, got.
Samantha Bouchard (00:09) To meet Molly from the account manager team. She lives like 10 minutes from me. So, we met for a coffee this morning, which was nice. That’s cool. Yeah, so fun to be like, I’m meeting a co worker.
Jake Shubert (00:22) Yeah, that is sweet. Though… also, she did not accept the invite but I emailed her and she confirmed over email if you saw that. So we should be good. Yeah, me and Nicole live like 20 minutes apart. We’ve only met up in person one time. So we have to change that.
Samantha Bouchard (00:43) Yeah, it’s nice. I mean, you guys are tough because I feel like your day is like out of the gate, just get started because you’re west coast. Yeah. Then we have like noon is when, 10 10 or 11 is usually when our day like takes off, but.
Jake Shubert (00:58) Yeah, I used to have that in the past where it’s like, yeah, and that’s it’s nice. I.
Samantha Bouchard (01:05) prefer, I don’t think I could ever do west coast like, I know you guys get like the slower afternoon sometimes, but I’m like I get my most like the most of my work done in the morning. I’m like just such a morning person.
Jake Shubert (01:18) Yeah, it’s tough. You log on at like eight or something or eight 30 and they’re just like, yeah, you’re just jumping into it there’s stuff you’re missing there’s, slacks there’s, emails and you’re like, oh, all right. I guess I’m awake like.
Samantha Bouchard (01:28) Yeah, people have been working for like three hours.
Jake Shubert (01:31) Yeah, exactly.
Samantha Bouchard (01:35) Any fun plans this weekend?
Jake Shubert (01:38) Not really honestly… next weekend. Me and my girlfriend are going to California just to see our family. Our family lives out there. So that’ll be cool. But this weekend mostly just laying low. How about you?
Samantha Bouchard (01:52) Yeah, I think the same, just packing. Yeah, we leave for disney a week from Friday. So just making sure we’re like good to go.
Jake Shubert (02:00) Yeah, early packing makes sense. Especially like going with kids and stuff. I feel like.
Samantha Bouchard (02:05) Yeah, I want to be all packed by like this weekend. It’s you know, I never thought I would be like that corny disney mom that like wants to have the matching outfits.
Jake Shubert (02:14) But it’s.
Samantha Bouchard (02:16) nice because it’s like just streamlined packing.
Jake Shubert (02:19) Have you picked the matching outfits? We?
Samantha Bouchard (02:22) Got a couple. Yeah. Hi, Rachel.
Jake Shubert (02:24) Hey, Rachel. How are you? Oh, you’re on mute by the way? Take your time?
Rachel Bregman (02:34) It’s so funny. It’s like mute by default. I guess I.
Jake Shubert (02:37) know, I think it must be a setting that I have enabled somewhere. I got to figure that out because it’s just, I don’t I,
Rachel Bregman (02:43) don’t see the benefit. It’s not like that for me for everything, but I think it is, somehow, so I’ll.
Jake Shubert (02:48) have to figure that out. Okay. Yeah. Well, maybe it’s a both of us problem. Who knows, but me and Sam were just talking that she’s going on her first family disney trip next week. Oh, wow.
Rachel Bregman (03:00) And.
Jake Shubert (03:01) Sam just brought up matching outfits. I have to ask, what are the matching outfits. Is it like any, is it anything disney related or it’s just like?
Rachel Bregman (03:08) Is it princess themed? Yeah. So.
Samantha Bouchard (03:09) I have a four and a half year old, Rachel and a two and a half year old, and I’m like not like the like disney person, but I just, my daughter really will think that they’re real princesses. And I just like feel like it’s just such this small window that I don’t want to miss it.
Rachel Bregman (03:25) You’re right? But.
Samantha Bouchard (03:26) Yeah. I was like, I never thought in a 1,000,000 years, I’d be like ordering these like matching outfits, but I was telling Jake from like a packing perspective. It just makes it so easy because we’re like, okay, we’re going to wear this day, this day, well?
Rachel Bregman (03:39) I’ll.
Samantha Bouchard (03:39) tell.
Rachel Bregman (03:39) you, we’re not all so big like disney type parents but one of the highlights of raising our children and we have five was taking our fourth daughter to have this like private breakfast meeting. I don’t know what it’s called exactly with one of the princesses.
Jake Shubert (03:55) That’s cool. So.
Rachel Bregman (03:56) If it’s if it’s at all a possibility for you, I would recommend it’s like you have breakfast and they come over to the table and then you take a picture with them and it’s like a, you know.
Samantha Bouchard (04:07) I know I actually, I have like these alert like I’m getting like it’s, the, like the hardcore disney people. Like, it is like an intense society. I’m like trying to figure it all out, but I have these mouse alerts on like Cinderella’s royal table, which is like inside the castle. So I’m like trying to get, a breakfast reservation.
Rachel Bregman (04:30) Okay. So that’s what it was. It was definitely, I would definitely recommend that.
Jake Shubert (04:33) That’s awesome. Also, the phrase mouse alerts is really something.
Samantha Bouchard (04:39) You have to pay for them, Jake. They’re six dollars.
Jake Shubert (04:42) You have to pay for the alerts?
Samantha Bouchard (04:44) Yes, because like it will alert you like the second that one of the reservation opens up and there’s another one that’s 12 dollars where it actually logs in and books it for you. There’s a whole technology side to this disney life. I.
Jake Shubert (04:58) I mean, the way they figured out how to monetize everything, is.
Samantha Bouchard (05:01) Crazy. Well, other people are doing these. Yeah, no, I agree. Yeah.
Jake Shubert (05:07) Rachel, I feel like we could talk about disney experiences forever, but thank you for joining the call and we could jump into things. I don’t think we’ve got a chance to meet Sam yet, so we can maybe start off with.
Rachel Bregman (05:17) No, it’s great to meet you.
Jake Shubert (05:18) Yeah, we can start off with an intro for Sam. Yeah, Sam, I’ll pass it over to you.
Samantha Bouchard (05:22) Yeah, nice to meet you, Rachel. I am Jake’s product and technical counterpart. So I’ll be showing you the demo today and here to support for any, you know, kind of like deep dive, product operations, questions, things like that. So, it’s super nice to meet you. And I am in awe that you have five children. I am expecting my third in August and I, I’m just fingers crossed. I’ll be able to.
Rachel Bregman (05:46) Figure it out. Oh, yeah. Well, two to three is the hardest. After that. It’s all gravy.
Samantha Bouchard (05:51) That’s what I hear. That’s what I hear.
Rachel Bregman (05:54) So, you’ll be good?
Jake Shubert (05:56) That’s awesome. Sweet. Well, Rachel, we’ve set up 45 minutes for today’s. Call. I just want to double check. I don’t know if we’re going to need the.
Rachel Bregman (06:02) Full time. Yeah, I have another meeting at 1,245. So, okay.
Jake Shubert (06:05) That’s perfect. Yeah. Like I said, I don’t know if we’re going to need the full time here, but just in case, okay, cool. Well, we can jump into things then here’s our sort of plan for today’s. Call and just love your feedback to make sure we’re on the same page. So I want to start off just doing a brief review of sort of what we talked about last time, Rachel to make sure we’re on the same page, we don’t have anything wrong as well as talking about sort of like our core value drivers that we see with other customers just to sort of help sort of framework for our demo. Then we’ll obviously jump right into the demo, spend most of our time there on today’s. Call. Then I wanted to end just making sure that we chat through scoping that way when we get to pricing, we have the right accurate inputs for a proposal for you and then just sort of discussing like your evaluation criteria next steps if you’re interested and sort of just going from there, that sound like a fine plan to you?
Rachel Bregman (06:55) Yeah. Okay. I would say keep two short and keep more space for four. Okay, we can because I know what the value I feel like. I know what the value drivers are. You don’t have to convince me, you know, that it’s a great service efficient, et cetera. Et cetera. I was going.
Jake Shubert (07:13) To say especially like since you have firsthand experience with medallion like this is sort of the framework that I do on a lot of calls when there’s a little bit more educating involved and that’s not really the case here. So I appreciate the feedback. I’ll probably just flash them on the screen and then we’ll just jump into the demo. Cool. So again just wanted to sort of recap our last chat to make sure we had everything accurate. And since Sam wasn’t on that call just to make sure something that we’re missing would be helpful to review with Sam. So I know you guys have about 30 providers today, likely hiring around 10 or so over the next 12 months, a portion of your enrollments of three payers total go through those two ipas, one of which vitalize is a medallion customer for the enrollments that you guys handle internally. That’s for about 15 payers and the folks who are doing those enrollments, it’s a three person cred team, one of which is the HR supervisor, and then two of which are the actual credentialing specialists doing that work things we’re trying to solve for visibility and reporting. Rachel. You called out that like sometimes things hit 90 plus days and they’re not really flagged for you. It’s not clear why they’re taking so long. It’s hard to sort of see the statuses and revalidations and just make sure everything’s in one platform and not spread across spreadsheets because things are done manually today. Obviously, they’re more prone to human error than if they were automated. So making sure that sort of human intervention is included but not relied on like human data input and then improving turnaround times. Those right now can stretch to 90 to 120 plus days depending on the payer they’re trying to bring that down. So that way providers get in network faster, that was it. I don’t want to spend too much time on this slide. But is this inaccurate sort of lay of the land? Rachel? Yeah. Okay, cool. And then my only question here was since we didn’t talk about it last time like big picture, what are sort of the growth goals for you personally? And for westside overall?
Rachel Bregman (09:01) Just sort of like beyond the like… growing and adding providers? Yeah, just.
Jake Shubert (09:08) Sort of curious like if there are, you know, high level initiatives that you’re sort of planning out of the, you know, short to medium term?
Rachel Bregman (09:14) No, I mean we’re really just looking to expand and grow, okay?
Jake Shubert (09:18) And that would be adding providers, right? And,
Rachel Bregman (09:20) that’s typically adding providers, adding locations. But yeah, cool. Great. I’d say right now we’re focused, you know, primarily as, you know, like in New York and New Jersey, but I would say probably also along with growth, we might look to expand a little bit geographically.
Jake Shubert (09:37) Yeah, that makes sense that.
Rachel Bregman (09:38) May affect, you know, like what payers we take or having to add certain payers depending on, yeah.
Jake Shubert (09:43) Absolutely. And obviously, that’s like a pretty common use case for us since we have all the payers mapped across all 50 states. It’s like you guys wouldn’t need to do the research on payer requirements and things like that. Cool. So then this will really be the last slide that I actually talk through and I’ll just flash the value drivers in the next slide. But with 30 providers today and two folks managing credentialing, seems like the sort of the current coverage ratio for you guys is about 15 providers to one employee managing credentialing. This is not counting the HR supervisor who is spending some time on credit today, but just the specialists themselves just wanted to call this out because with medallion, as you might already know, the ratio that we see with our clients is for every one employee you have managing credentialing with medallion, they can support 500 providers. So the goal here is obviously to think about scaling locations, providers, new geographies. The idea would be to scale technologies and having to add headcount. Yeah. So just one double check. Is this like is this sort of coverage ratio? Like is this accurate? The 15 providers to one employee?
Rachel Bregman (10:46) You know what I will say is I don’t know exactly on the credentialing team side, who else they may or may not have working on it? I know that there’s one person, I mean, really one person that I interface with, he has another person. So they’re really like we said, are two of them, I don’t know underneath that, who else they may or may not have working on other parts of it. Yeah.
Jake Shubert (11:09) So it’s at least those two folks, maybe some more tangentially involved?
Rachel Bregman (11:13) Right. It’s possible that they have other people doing other things, but I don’t know. Cool. And.
Jake Shubert (11:19) In terms of working with medallion, would it be the HR supervisor who’s acting as like the medallion admin? Would it be that person?
Rachel Bregman (11:26) Yes, that would be the goal, okay. Awesome or someone equivalent. But basically that type of person?
Jake Shubert (11:32) Cool. That makes sense. And then here, like you said, I’m not going to talk through these because you already understand medallion. So I’ll just sort of skip through this. My only question I guess is for those two employees right now who are managing credentialing, those would be the two people who would be getting replaced or reallocated if medallion were to join the team. Is that accurate?
Rachel Bregman (11:52) Correct.
Jake Shubert (11:52) Okay. And I guess out of curiosity how much of those people folks make per year today?
Rachel Bregman (11:58) How much do we pay them? Yeah, I’d have to look it up to give you a, I believe we pay a flat fee of 2000 dollars a month.
Jake Shubert (12:09) To each of them or total.
Rachel Bregman (12:11) No total.
Jake Shubert (12:12) Total. Okay, cool. Awesome. I.
Rachel Bregman (12:15) Have to double check to make sure that’s like exact, but that’s like ballpark.
Jake Shubert (12:18) Yeah, that’s helpful. Awesome. Sam. Any other questions here before we jump into the demo itself?
Samantha Bouchard (12:27) Just a question. This is being managed today, Rachel, primarily on spreadsheets. Is that accurate? Or is there a tool you are using?
Rachel Bregman (12:36) Or is there what sorry?
Samantha Bouchard (12:38) A tool you’re utilizing?
Rachel Bregman (12:41) So, it’s managed on spreadsheets in terms of like our communication to each other. Okay? Like Jake alluded to, you know, one of the people who are doing like the IP E is using vitalize and using medallion already. So like there’s certain things that they may be managing on different platforms, but in terms of like my communication with them or how I see who’s par with what that’s all on spreadsheets?
Samantha Bouchard (13:09) Got it. Okay. That’s helpful? Thank you. Cool. And.
Jake Shubert (13:13) Then Rachel, from your perspective? Is there anything specific you want to see in the demo today? Just to make sure that me and Sam spend time on it?
Samantha Bouchard (13:19) I think a,
Rachel Bregman (13:20) general overview would be great. And then I guess what I’m particularly curious about would be like what kind… of alerts or what kind of visibility is there into like snags in the system, you know, so like when things aren’t going as they should, kind of what that looks like from my perspective.
Rachel Bregman (13:40) Yep, and, or potentially from the HR person’s perspective who’s from our end?
Samantha Bouchard (13:48) Great. Awesome. Yeah. Well, let’s dive in Rachel. I want this to be conversational. So any questions along the way, please feel free to stop me. I’m happy to dig into anything a little bit deeper but we’ll start here. So, you know, as you know, medallion is an end to end provider data management platform. What you’re seeing here is kind of like the crux of medallion. We collect a lot of data on your provider, so we can perform various downstream functions very smoothly. You know, by having that data up front. And then what we do is we make gathering that data much Symplr, so much less administrative burden. And a lot of, you know, less like back and forth kind of filling in those data gaps. And this is where we store all that. So we’ll start here, we’ll look at payer enrollment and then we’ll look at the analytics and the report builder that we give you access to for that additional visibility lens. So, you know, you mentioned you have some practices in New Jersey and New York, potentially some room for expansion. We are going to not only store all of your individual provider and data into an individual profile, but we’re going to store that group and practice information as well. This would contain all the information on your group contracts, the practices that are then associated to those groups. And we go a layer deeper and can also surface all of the providers that are then associated to that particular to that particular practice. So pretty much table stakes here. But I like to show it because just within a couple of clicks or through our reporting feature, you really have that innate instant visibility into kind of your overall data and we make it really easy and simple for, how we store it.
Rachel Bregman (15:46) Do we appear on this already as a practice since vitalize is using medallion? You?
Samantha Bouchard (15:54) Would likely, yes, appear as a practice. So up here in this top right corner, this is like our demo instance, but vitalize has its own instance as well, right? Oh.
Rachel Bregman (16:06) So it would appear as vitalize, and then within vitalize, it would appear as like a practice perhaps or as an individual provider depending on how they do it.
Samantha Bouchard (16:13) Yep, exactly. Yeah. And Jake mentioned you had some questions around how we could like utilize the data that’s already in vitalize as well. So we do have a process to make that happen for you all. So we’ll definitely talk through how we can kind of like utilize the data that’s already there. So as you have a net new provider, pretty simple, add five fields of data, and then they are going to receive a welcome email. We can co brand this with all of your information. From there. We have a proprietary bidirectional integration with caqh which is highly utilized. We need caqh id, social security number and last name. And with that information, we’re able to instantly pull in the data from the profile from their caqh profile that’s needed. So we’ll populate up to 70 percent of that profile, you know, making it extremely easy on the provider and your, you know, your administrator, you know, just like reduces that overall data collection, right?
Rachel Bregman (17:24) So two questions, if they don’t have a caqh profile, their new grad, whatever they haven’t created that yet, how, what does that look like on your end?
Samantha Bouchard (17:33) Yeah, great question. So with our caqh with… our caqh profile connection, it’s bi directional so we can pull information and we can also push information. So, do you know today, is your team, is the administrators on your team? Are they doing the quarterly attestations on behalf of your providers?
Rachel Bregman (17:58) Yes, they should be okay. And.
Samantha Bouchard (18:01) Then in the case of a new grad, are they sometimes creating that caqh profile?
Rachel Bregman (18:07) For them, I believe they’re sometimes creating it for them. Yeah as well. Yeah.
Samantha Bouchard (18:13) That’s what we hear that’s what we hear quite a bit. So with caqh, there’s a maintenance piece. There’s a quarterly attestation piece. The importance of that is if you fill out a provider enrollment application and it does not match what’s on caqh. It’s an instant failure denial. We want to avoid that at all costs. So we can have medallion be your source of truth and any changes made in medallion get pushed into caqh so we can take that on your behalf in addition to the quarterly attestations. So that’s a frequent offering that many of our customers utilize today because it’s just an absolute pain for.
Rachel Bregman (19:00) These, right there would have to be, right? Like if it’s bi directional, if they update caqh and it’s not matching what you have. Yes, like it has to be in a sense really one way. Yeah.
Jake Shubert (19:10) There has to be a link there or else things wouldn’t match 100 percent.
Rachel Bregman (19:14) So, in other words, if we have a new provider, they don’t yet have caqh part of what you would do would be create the caqh profile or we create it, but we just put like a username and password and that’s it don’t fill it with anything.
Samantha Bouchard (19:26) Yeah, you’re spot on. So we can’t actually, the only thing we can’t do is the creation. So we would still look to your team to create that profile. But then what we would do is everything can get filled out in medallion. We have a resume scanner that they can populate where we have OCR technology. If you’ve ever used turbotax, where you like take a picture of the document, take it. And then it kind of populates your W ii on the system that’s what we’ll do with the resume. So we’ll take all that key pieces of information and put it into the profile. And then once everything is in medallion, we’ll push that to caqh. So ultimately reducing the process as it would be today, which would be filling it out in caqh and then potentially filling it out in another tool or spreadsheet, or paperwork, right?
Rachel Bregman (20:16) And then I have like a little bit of a nitty gritty question. Does that include pushing over things like non mandatory forms? So, for example, like caqh as, you know, has certain things that are documents, I should say, certain things that are mandatory, right? Like you have to upload your Dea or maybe not your Dea, you have to upload your license. You have to upload your malpractice face sheet. And then there’s like a whole bunch of things that are like optional including maybe like hospital privileges coverage and things like that, which that’s something in my experience that often leads to a delay? Like it won’t be in there. And then an insurance company will ask for that kind of months down. So does everything even like optional stuff that has the possibility of going in there? Get uploaded? Yes?
Samantha Bouchard (21:01) So, we have a full document storage page here with that OCR technology that I mentioned. So if they need their diploma, for example, you can take a picture of this, take a picture of your diploma that’s on your wall and it’s going to automatically get pulled into the system. And it’s going to use that OCR technology to pull that data in if it’s needed somewhere in the profile. But we do recommend that you would store any and all things here related to the provider. That’s going to make this very simple for administrators of your practice. It’s going to make it very simple for you as a provider to just have everything in one place and then anything in here can be pushed into caqh as well.
Rachel Bregman (21:44) Got it. And so when we create a new provider, the requirements are going to be, the basic requirements are going to be their caqh id number, obviously, their name, and what else?
Samantha Bouchard (21:57) Caqh to do the import? We need caqh id, social security number, and last name, got.
Jake Shubert (22:03) It, and something that’s really helpful about that, Rachel is we do not require the caqh username and password. Often as you might have seen providers won’t know that they have to request a new password. They have to dig it out. It takes a long period of time. So we take that part out of the equation. So to pull information from caqh, we do not need the username and password.
Rachel Bregman (22:21) Which is got it. Just the username. And in your experience with most providers practices like the size of ours, is this being done by individual providers when they start the job, or is this being done by a centralized like a general HR kind of person?
Samantha Bouchard (22:34) So I think it can be a combination of both. We definitely make it. I’ve talked to direct providers who have used because I used to be on the implementation side of the house. And so I’ve talked to providers just to get some feedback on what their experience is like. And they’re like of the millions of these that I have filled out, this has definitely been the most streamlined and straightforward. So, I think where we’re pulling in, we’re pulling in the data that’s already in caqh, depending on any additional data that your team has internally, they can certainly have access as an administrator to fill in any gaps. But we’re going to give the provider very clear indication on they’re going to have their own portal as well. So it looks very similar to this just without some of this additional information. And so anything that’s outstanding for them is going to be clearly outlined in a task so that they’re able to fill in those gaps. But I think what’s important for you from a visibility perspective that you don’t have today is you don’t really know, you know, does dr smith still need to provide his deas that’s what’s holding that up is, you know, do we need this so you can log in here? You can see provider tasks, and you’re going to have complete visibility into anything that could potentially be outstanding for that provider?
Rachel Bregman (23:56) Got it. And then just to make sure I’m clear, can this information be populated by both my administrator and the provider? Yes, like they’ll both have access. So if my admin has all the information, they can just boom, put it in, correct. And then at the same time, let’s say the provider puts it in first, then my admin just wouldn’t have to put it in a.
Jake Shubert (24:16) 100 percent. Okay?
Rachel Bregman (24:17) You got.
Samantha Bouchard (24:17) It, yeah. So all of these tasks that are for a provider, your individual administrator can come right in and mark it complete. So yeah, they can do whatever. And then while we’re in here, I’ll just highlight this just from a tracking perspective. Obviously license tracking is something that, you know, if a license expires, you guys are going to your provider is going to get kicked out back for claims and things like that. So we are going to monitor every single document that’s in the platform, let you know if it’s coming up on expiration. These notifications are also going to go to the providers as well. And then we do have ongoing monitoring that can monitor for, you know, license checks and things like that and alert you if anything does expire or is up for expiration as well.
Rachel Bregman (25:07) Okay. And that gets, they get alerted by email. Yes. Does it, also, is there also like some sort of like a flag that appears on this site? Like if there’s expirables and something is expirable, does it like show a little like, I don’t know like red flag or something?
Jake Shubert (25:23) They’ll have a notification there in the top right? As well as a notification in the tasks page. And I think like Sam mentioned this, those tasks also be delegated to the admins or if they have a clinical supervisor, like you can determine that sort of escalation path to make sure it gets seen and resolved the best way possible.
Rachel Bregman (25:41) Got it. Okay. Cool.
Samantha Bouchard (25:42) Yeah. We try to do like a nice combination of both active and passive notifications. So everything that’s going to be at the tip of your fingers in the platform as an administrator. But then you’re also going to have those active notifications and our emails really summarize like it will be you’ll get like a weekly summary that you can edit in your administrators, and it will be, you know, all grouped really nicely in like different categories to draw your attention to anything that’s needed.
Jake Shubert (26:11) Yeah, I guess Rachel for the, what you’ve just seen so far for gathering provider data onboarding them, flagging the tasks. How does that sort of compare to like the current state today?
Rachel Bregman (26:22) I mean, I can’t really tell you to be honest because I’m not the one doing.
Jake Shubert (26:28) It.
Rachel Bregman (26:29) I imagine that again, like the people who are doing this have to go through medallion? So I imagine that for them, this is all, this would be like all very familiar and similar, if not exactly the same because they are all having to go to do a medallion profile?
Jake Shubert (26:46) Yep. Got it. Yeah, it’s one to check in, right?
Rachel Bregman (26:48) So that’s like for everyone except for the people who do like again, those two insurances through the other ipa that doesn’t involve medallion. I imagine for them, this would be, this would be similar although I think that, yeah, like one of the things that they, we’re having difficulty with, I think was getting responses from the providers. So like providers would sort of like ignore the medallion emails or like we’d get a lot of like medallion, the invitation expired, you have to go in and do it again, which means like either they saw it and ignored it or they, you… know, which is either their fault or maybe my team’s fault for not like being more on top of them and saying, you know, make sure to do this. So I see a lot of that from… like.
Samantha Bouchard (27:38) Yeah. And I think one of the challenges that your providers might be facing where this is like a couple payers are in medallion, and then the rest of their payers are done via a portal or paper form through your administrators is that they’re not in like, so like with medallion, we have relationships and all payer requirements across all 50 states, all payers documented into our system, Rachel, and each one of those requirements is kind of like layered into our technology. So the second that your team makes requests for enrollments, which I’ll show you in a second, we’re going to instantly surface anything that’s outstanding. And likely what’s happening today is like they’re kind of getting those outstanding items potentially for the payers. But then your other team is working those manually. And so they’re probably like, okay, I’m getting an email from here, but I’m getting this task. And so there could be just like some confusion among like how that’s coming? And then like the timing of when they’re getting that information in. So I think by utilizing medallion across all of your payers, you’re drastically going to reduce that and you’re going to reduce that overall time… because we have some other of your providers in our platform. The way that we would bring those profiles into medallion is we would, we’d be able to copy those over directly from our other instance. We do need approval from the provider to do that. It’s just like a simple quick signature just that we can take their information over. But we would work with you for that during implementation which would drastically decrease your implementation.
Rachel Bregman (29:24) Right. Okay, great.
Jake Shubert (29:26) And then just to be respectful of your time, Rachel, Sam, let’s maybe jump into the enrollment request portion. I think that’d be the next best place to go.
Samantha Bouchard (29:34) Yeah, absolutely. So today, what your administrators are likely doing is they probably have a word doc with requirements. They’re kind of going in. They’re manually filling it out. That can be very error prone. They’re doing a double check with caqh, hopefully to make sure it’s not going to bounce back. All of this with medallion is going to be done with our technology. So essentially your providers come in, your administrator owns the strategy who needs to be enrolled. Where do they need to be enrolled? We’re going to surface that to you and medallion is going to own the execution. So you would select the new provider that’s coming on. You would select the group that they’re associated with. And then you would select the state that you’re looking for. And what we’re going to do is we’re going to tell you all of the enrollments that are already processing for them. We’re going to tell you all of the group contracts that you currently have under that tin. So with a simple check of this, you can say enroll in all 15 plans. You would associate some practice locations, hit complete, and that’s where your work ends and medallion takes over. So we’re going to show you the status it’s in. If it’s payr processing, we’re going to attach the application. We’re going to give you complete visibility into each individual line item until we get that approval. We’ll follow up with the payr… programatically via email. We have an AI phone calling service. We have portal checkers and scrapers that will do those checks on our behalf. The second that payr status is achieved, you’re going to be notified in an email. It’s going to be available in the account so that there isn’t ever a delay in you releasing those claims for billing or holding back a provider from giving services. Okay?
Rachel Bregman (31:37) Can I ask a question about where let’s say like a scenario that we recently encountered a provider was credentialed? But then was told that the… panels were closed for specific plans within that insurance company. How would something like that be? Which is problematic for us? Because we have group contracts. And so all of our providers are supposed to be loaded to all the plans that we have. So like one of the frustrations I had for example is like that team just was like, oh, okay. They’re closed and like that was the end of it and, you know, I’m finding out like a month later that happened.
Samantha Bouchard (32:18) Yeah. So.
Rachel Bregman (32:18) How would something like that appear on this end or what? Yeah.
Samantha Bouchard (32:22) That’s a great question. So we’re going to essentially surface the status back from the payer, we’ll create an administrative task. There can be appeals done on that case. So we’re going to surface everything in the individual line to do the appeal. If we know that there’s a closed panel, we will surface that to you ahead of time to block the request. However sometimes those panels are changing pretty rapidly. And so we’re not always, you know, we can’t always surface that because they’re just always opening and closing the panels, Rachel. But I do hear that if you’re frequently getting closed panels, you can add a letter. And so part of working with medallion, you get an engagement manager who’s your operational expert. And some what we hear they’ll include a letter in the application that really explains like why, you know, your provider should be included in the network. And that has seemed to have helped some of those denial rates. So we have a lot of great insight. And so if you’re experiencing issues like that, your engagement manager will really strategize with you on the best method to kind of to get through that.
Rachel Bregman (33:40) So if they were let’s say for one of these like denied because the panel is closed, it would just show as like denied or what would it show as here instead of requested?
Samantha Bouchard (33:51) Yeah. I would say like non par. So it would let you know. And then in the notes and the sections, you’re going to have a bunch of notes that indicate any information we have. We’re going to have like a copy of the application. We’re going to have a copy of their response letter. So you have then everything you need to file that appeal directly and we can support you with that.
Rachel Bregman (34:15) And how would I file that appeal directly? That’s going to be the outside medallion or that’s within?
Samantha Bouchard (34:21) You can work directly with like through the notes here to like work with one of our reps to file that appeal. Yeah. So it would all be tracked in that individual line which… I think we find really helpful. And then a lot of times like just having the data in the line itself is something that is like really supports because a lot of times this data can like get lost in translation. And then, you know, there might be an additional enrollment that comes up or, you know, something a lot in those lines.
Samantha Bouchard (34:58) But ultimately, with our technology, so like our ability to log in and programmatically fill out these portals, our ability to portal scrape status. What we’re seeing is an average enrollment timeframe of 54 days. So I think I saw in the notes sometimes you’re seeing like 60 or 90 plus or potentially longer. So, you know, we would drastically reduce those overall turnaround times for, you know, accelerating that revenue.
Rachel Bregman (35:31) Again, like, yeah, I mean, I think that just to be clear also with those, like most of the ones that go through, OK, go through OK, quickly. It’s really the ones where there are issues like this, like saying there’s a closed panel or saying that they’re you.
Samantha Bouchard (35:44) know, missing.
Rachel Bregman (35:45) Documentation that’s already been submitted like those, you know, are the ones… that can bump that time out significantly. So, I guess that’s why I’m particularly like curious about how that process works, you know, like how it works when things don’t go as they should.
Jake Shubert (36:05) Yeah. What was the sort of detail we provided helpful there? Are there additional.
Rachel Bregman (36:09) Questions, I mean, a little bit a little bit. I’m not, I’m still not totally sure like what gets… us beyond the… like. And maybe if we don’t have time today, maybe we just need another time to like talk a little bit more about that. But sort of like what gets us beyond the a beyond the like blocker of like this is blocked. And now, how do we get it fixed like that to me is like would be the big kind of benefit of medallion if there is, if there is, a big benefit, you know, like the 95 percent of stuff that goes well, like even though it’s annoying that they’re using spreadsheets and even though it’s not efficient and it’s whatever, you know, it’s cheap and it’s let’s say working most of the time, but the times when it’s not working that’s when it’s super important to us.
Samantha Bouchard (36:56) Yeah, one.
Rachel Bregman (36:57) Other question I just had and then sorry, then we can talk is that also… you know, one of the things that I find challenging with the people we’re working with also is vis a vis communication and sort of the understanding of like what the difference is between a group contract and when we need to sign individual contracts. And there’s a lot of like back and forth around that. And like we have a group contract, we all are supposed to be the same rates and yet somebody will get credentialed with united for example, and they’ll be sent like an individual contract that they have to sign. And then we’re told, well, if you don’t sign it, then the whole credentialing thing is going to be not happening but you do have to sign it. And once you sign it, don’t worry. They’ll like accept your other contract. And there’s like a lot of confusion I find around that.
Rachel Bregman (37:42) Is that something you’re familiar with or is there like would we end up with an individual who we could speak to about those things, who would understand those types of problems? Like, I don’t even know if that’s a real problem or if it’s just our lack of communication between our teams that make it difficult to sort of really understand what’s going on.
Samantha Bouchard (38:03) So, with the enrollment, you’re saying that they’re not attaching them to the group. They’re then giving them an individual contract.
Rachel Bregman (38:12) Sometimes like a lot of times we’ll get emails like provider must sign this unitedhealthcare contract, you know, and, or provider must, you know, here’s the contract for such and such, they have to sign it. If they don’t sign it, then, you know, they’re going to void their credentialing request. They can’t process the credentialing request until they’ve signed the contract kind of thing… which seems like a little counterintuitive because again, we have like one group contract. So it doesn’t seem like any of our individual doctors should be having to sign individual contracts or any kind of contracts. It seems like they should just be applying for credentialing loading into the system attached to our group. And like that’s yeah.
Samantha Bouchard (38:49) So to me that sounds like potentially like an error on the application itself. And so I know you’re kind of bucketing like the closed panels which like that’s something that’s kind of like out of everybody’s control, right? Like that’s at like the helm of the payer. But then there’s an additional bucket of information where you’re getting like rejections due to like application errors. And I think that’s really where medallion is going to streamline that process for you, Rachel, because we’re going to be checking that caqh matches. So we’re going to avoid that. There’s any denials for that. We’re going to check. We’re going to automatically check npez and confirm like that the mpi and everything’s accurate. We’re going to validate their… taxonomy code, right? We’re doing all of these additional checks behind the scenes to ensure that when that application goes through, it’s going to go through like without any additional errors. So, I think in this scenario that you mentioned with united like that would come back through medallion, we would be notified by the payer and we would sort that out directly with you all. Whether that be an administrative task that gets flagged if we need an additional information or we’d be able to communicate with the payer directly, right?
Jake Shubert (40:04) Yeah. Well, Rachel, we got about five minutes left. Yeah, let’s.
Rachel Bregman (40:07) talk about it. Yeah.
Jake Shubert (40:08) I know you said you had a hard stop. Is there anything else in the platform you want to say or should we save that?
Rachel Bregman (40:11) For the next time? No. I mean, I think I get a good idea. It looks like a nice platform though.
Jake Shubert (40:15) Well, we appreciate that real quick, Rachel, what I want to do before we just chat through like when we should meet again is actually just, I want to just validate the scoping inputs we have. So, that way when we do build out pricing, I’m showing you like an actual accurate proposal. Let me share my screen here. If my zoom will actually let me. Okay, perfect. Can you see my screen? Okay. Yeah. So I just wanted to validate this super quickly. So, 30 payers today, hiring about 10 over the next 12 months. So we’re looking at, you know, 40 pay, 40 providers whose data we’d be managing, doing caqh monitoring, doing caqh management for, or doing ongoing monitoring checks for, for payer enrollments.
Jake Shubert (40:57) Obviously, the 30 providers you already have are already credentials. We don’t need to do enrollments for those folks, but it’d be the 10 new providers who are getting enrolled with those 15 or so payers, that are handled outside of the ipas. And then for revalidations, that’s where we look at the 30 providers you guys do have across their 15 payers. Since typical revalidation terms are over a three year time span, we typically do a division of three there, getting us to 150 revalidations around, ballpark that would be processed per year. Do these look like directionally accurate to you? Is there any feedback you have on these inputs?
Rachel Bregman (41:30) Yeah. I mean, I guess how important is it that these numbers are specific? Like if we actually have 28 providers versus 30, is that gonna like change our pricing or if we hire 15 people instead of 10 people? Like how specific should I be looking to get with you obviously?
Jake Shubert (41:44) The more specific, the better that being said, like, right? So the way our contracts are built out is we have what’s called skew flexibility in them, which means that across skews and across years, you’re able to move around the spend that you have in the contract because we know credentialing is an inexact science. So, if you do 28 providers instead of 30 in year one like that delta in spend, you can push forward to year two or year three or vice versa. You hire more folks than you expect and you bring on 15 providers, you can pull forward that spend from year two and year three. If you’re not paying it out of pocket, so we try to make it as sort of fungible as possible. So it doesn’t need to be exact. But obviously, if there are, if there’s feedback you have here on these numbers, like we want to make sure we’re as close to the pin as we can be. Okay?
Rachel Bregman (42:25) So, would you do me a favor? Can you just send me in an email this slide? So I can then like go through and actually, you know, count and make sure we’re looking.
Jake Shubert (42:32) That’d be great. Yeah, I can absolutely do that.
Rachel Bregman (42:34) So you’re saying that total providers are 40 30. We have already 10 new ongoing monitoring, caqh management payor enrollment.
Jake Shubert (42:45) Yep. So I can send this over email then. Yeah, any feedback you have? I can make some updates there. As far as next steps go. We want to make sure we’re chatting through sort of the error resolution questions that you had that we didn’t have enough time to dive into today if there’s anything else you want to see in the platform, we can do that as well. And then maybe sort of chat through like evaluation criteria, timeline, that kind of stuff on the next call. Sure. Do you have maybe 30 minutes for later this week or early next week? I.
Rachel Bregman (43:14) Think early next week is going to be best because I’m actually theoretically on vacation with my daughter right now, but.
Jake Shubert (43:21) Yeah, I’ll see you next week then?
Rachel Bregman (43:23) So, it’s perfect. How?
Samantha Bouchard (43:25) About would?
Jake Shubert (43:26) Tuesday work for you? Give?
Rachel Bregman (43:28) Me one sec, should it should work?
Rachel Bregman (43:36) Yeah, that’s fine.
Jake Shubert (43:40) How about, can you do one PM eastern? So 10 am pacific?
Jake Shubert (43:50) Sure. Okay, perfect. I’ll send over that invite and I’ll send over the email and say, Rachel with these inputs. And then whenever you get a chance, just shoot me an email back and I’ll make some adjustments on our side.
Rachel Bregman (44:00) Okay, terrific. Cool. Well.
Jake Shubert (44:02) Thanks so much, Rachel. All right. Really appreciate the time to chat today. Enjoy your vacation. Thank you. And we will chat next week sounds.
Rachel Bregman (44:10) Good. And you too, Samantha or Sam have a good time in disney. Thank.
Samantha Bouchard (44:13) You. Nice to meet you.
Rachel Bregman (44:14) Nice to meet you. Bye bye.