Transcript
Chris Jones (00:00) hi, keeling, how are you?
Chris Jones (00:06) You’re muted? Can you hear me? I can hear you now. How are you?
Kacheung (00:14) Good. How are you doing? I’m so excited, you know, to look at the demo.
Chris Jones (00:19) Oh, good. Yeah, perfect. That’s great. I’m glad it came together. We had a little bit of scheduling hurdles to overcome here at the last minute, but I think I’ve got us covered. So, if we can just sit tight for a moment, that’ll be great.
Kacheung (00:35) Yeah, that’s good. You know, since I’m doing the insurance enrollment. Yeah, I hope I’m looking for the like automatic kind of processing and save a lot of money, okay?
Chris Jones (00:49) Okay. Good deal. Okay. And then who all will be joining on your side today?
Kacheung (00:57) I’m not sure how many people, but I think, you know, Taylor’s saying that some of our group may not be able to join, but I don’t have to follow this, you know, because this is more like about the insurance, right? Yeah.
Chris Jones (01:12) Yeah. Okay. And that’s fine. Hi, Taylor. How are you? Alexi? Good afternoon.
Tayler Wyss (01:20) Doing all right. How are you?
Chris Jones (01:22) I’m doing pretty well, although I feel like it should be a Friday already, which is not a good sign.
Tayler Wyss (01:28) No, I wish that it was Friday at four o’clock that’s amazing. I will take that. It’s a good feeling.
Chris Jones (01:36) That would be fantastic.
Tayler Wyss (01:39) We should have, on our side. One more person joining us. Anik is going.
Chris Jones (01:44) To come on. Okay. Looks like Anik is joining right now. Look at that right? On cue. Hey, Anik, how are you? Everybody’s muted by default, so.
Anik Conley-Das (01:58) Hi. How are you guys?
Chris Jones (02:00) Doing well. Thank you. All right. So, I was just telling kevling that, we had a last minute scheduling shake up. So, I’ve I thought we’re going to have to push the call but I don’t think we’re going to, I’ve got somebody joining us, maybe a minute or two, yeah, getting here today… but while we’re waiting on him, we do have new faces here. I’m new to the conversation. So I’ll, introduce myself really quick. I know you guys had a call previously. I think it was Dave wallach and, Tyler was on as well. So, Tyler’s no longer with the company. Dave still is, Dave leads the team that I’m part of. He had a personal conflict, so he’s not able to join today, but we do have Hassan Zahir who should be joining momentarily and, and then, we can get started. So, let me ping him really quick. Thanks.
Anik Conley-Das (03:01) Chris and, I, for what it’s worth, I don’t know if kayling and Alexei maybe have jumped in or already kind of said this out loud, but today’s, focus is really going to be like a technical demo of the platform. And, I actually want to direct towards kayling here. I think kayling is going to be like the person to maybe drive some of the conversation around the functionality and stuff like that. So, take me as a backseat person.
Chris Jones (03:24) Okay. Got it. Okay. Cool. And I see, Hassan’s joined as well. Hi, Hassan. How are you? Doing well? How are you today? Chris doing well. So, I think we’ve got the crew on, from Boston healthcare and, you know, I was just explaining. We’ve got, you know, we’re new faces for everybody here. Just the last call was with Dave and, Tyler, Tyler’s obviously no longer with the company and Dave got pulled in another direction this afternoon.
Chris Jones (03:47) So, just to level set. So, we had initial discussion, we got a little bit of a basic understanding for what you guys are looking to accomplish. You’ve met kind of behind the scenes, talked through some things and it sounds like you’re interested in going a little bit deeper in and getting an understanding for, the product. I think you want to focus on, some workflows and, and then probably have some questions as well. But it sounds like this will be more of a technical conversation today. So, is that accurate? And if so, maybe you can start off with just, you know, kind of, a high level overview of what you were, you know, wanting to understand more about, and then we can take it from there that sound okay… perfect. Okay. Does anybody want to lead from the Boston side?
Tayler Wyss (04:42) This will be kayling, this will be, the opportunity, to share some of the workflow questions that you had, or about automating, the processes that you’re currently doing manually… that’s correct?
Tayler Wyss (05:05) And let us know if you’re talking because we’re not hearing you.
Kacheung (05:10) Oh, sorry. Do you hear me?
Tayler Wyss (05:13) Oh, yes, yes, we do. Perfect. So, kayling, do you want to talk about some of, the questions you had around workflow, following the last conversation we had with medallion… I think should.
Kacheung (05:28) We look at the demo first. I did list out, you know, some questions, for example, you know, it depends on, you know, how your database constructed. I mean, definitely, I want to look at, you know, data management. And then I saw your online information. You do have the crep alliance. I mean, something like, you know, the system is like going to have to, you know, doing the credentialing and the credentialing. I saw a couple of words about automatic in your processing, that’s what I’m excited to look at. And I mean, I believe when I look at your database and then I will see, I will want to ask a question when it comes across that area rather than I throw out all the questions that I don’t know about your system, right?
Tayler Wyss (06:17) Yes. And so yes, Kayleen. Everyone, everyone’s excited about automation these days. So a lot of the work that she’s doing is around report running and how customizable that is for the different insurance companies that we panel with and the data management, like what fields are being completed by providers or how is, what’s being stored and where? And yeah… I think that’s like the biggest that’s maybe the biggest area of wonderings that we have but, are happy to see any of the, that workflow.
Kacheung (07:00) And I also want to add one more point. You know, I saw you have, a delegated payer enrollment. I mean, I have a question about like, you know, how it work, you know, in the park system. I mean that’s mean that it will automatically send out all our enrollment that is in our how to work plan. Okay?
Hassan Zahir (07:22) I think that all of that, is good and more than happy to get into the platform before we do that. You’re just going to have to forgive my ignorance coming into the call a little bit blind because, you know, Chris, is taking over where previously we had Tyler and then Dave who Tyler and Chris both report into, isn’t able to join the call.
Hassan Zahir (07:46) So I would love to just kind of be able to level set just a little bit kind of do just some quick intros, let every find out who everyone is, what’s important, what was previously discussed. And then more than happy to kind of walk through the platform. We’ll be able to touch, on a high level. I can go into like a generic demo environment wouldn’t have anything customized to you today, but hopefully we will be able to find out enough so that in the coming days we can do a deep dive and then we can speak to the technical capabilities. We can speak to how we’re able to support delegated agreements, delegated support setup, whether that’s policies and procedures or whatever the case may. Be. So, so happy to do all of that and really just be adaptable. But, I would love to kind of first understand who is, who’s on the call? What’s important to who is on the call and make sure that the perspective of which I’m showing the platform is aligning with, what the needs are. So I think that, we have a little bit of that right now, but hopefully we can just kind of pause and take a step back if that’s okay with everyone.
Tayler Wyss (09:04) Yes, thank you for the reminder that you’re both new to this conversation with us. That is, that was a helpful reminder. We did a demo, and, you know, had had laid all our desires out on the table, with folks previously. And so I will let anyone… else share, how.
Kacheung (09:27) Broadly.
Tayler Wyss (09:29) they’d like to see a demo, but I think really if we could get into more technical specific parts for kayling and Alexei’s workflows, but we can definitely start with introductions. So my name is Taylor and I am in the it department. I like that one of the questions you asked was what is important or what each of us needs from this. And so really what I need is to improve kayling and Alexei’s lives from what they’re currently using for their credentialing program, which is not… it’s not an ideal state. It just doesn’t work very well. And so I’m… here to advocate for them and support the conversation. And then I will let, I will let others introduce themselves. Maybe Anik, do you want to go next? Yeah.
Anik Conley-Das (10:19) I’m probably in Taylor’s camp in the same vein. So, my name is Anik, kandidas, I’m the head of HR here, and I think HR is a common use group that you probably work with on the front end of the credentialing process. So that’s not uncommon. I guess the unique part here is that Derek and I actually go way back. So like he and I have chatted for I.
Kacheung (10:42) Don’t know decade.
Anik Conley-Das (10:43) Plus at this point, so just something to throw in there for you guys. But it’s also part of why I’m sort of internally championing this potential tool. Okay?
Hassan Zahir (10:53) Not that that’s going to change anything, but it is nice to know hopefully we’re going to give you the best demo regardless, but knowing that, you know, Derek that is super cool because that means that you have an understanding of medallion, how we’ve grown some of the awards that we’ve won, and how we try to be advocates, for our customers. And so hopefully we can highlight some of that. So, so a pleasure to meet you and thank you for sharing Anik.
Kacheung (11:26) Thank you. And Alexi and kayling, I thought Alessia would go first but anyway, I can go ahead because after Alessia entered the data into the database, and then we did the initial for our provider internally. And once we get all the data, they will notify me and I will start processing the insurance enrollment for each provider for different payer, including all this paperwork. Actually, you know, I need to submit like different kind of like enrollment can be a form, can be a roster. I mean, provider roster can be completed in online portal or… like submit, you know, the special form that the payer listed on the website that’s why this is a lot of like, you know, manual work. And I hope, you know, the system can help me to optimize all this, you know, reporting mapping all the data field or even do something automatically that is perfect by the way I’m working with, you know, my title is like potentialing and finance project.
Tayler Wyss (12:48) Specialist. Thank you.
Hassan Zahir (12:53) Kaylin. That really helps a couple of questions there. When you say kind of rosters, do you have delegated agreements in place or is this non delegated roster submission?
Kacheung (13:03) Yeah, we are the non delegated.
Hassan Zahir (13:06) Non delegated roster submission.
Kacheung (13:08) Yeah, because we all do it by ourselves. Yep. Okay.
Hassan Zahir (13:12) Thank you. That helps out a whole lot. And so for you, it’s about the data getting into the system. Is there a way to assist with getting the data mapped automatically to these rosters to these individualized applications that are specific per payer, and just lessening the manual work associated with that?
Kacheung (13:33) Right. Yeah. I think, you know, customized, you know, report or user defined field. You know, sometimes you may have a lot of different fields, but we may need to add a little bit more, try to be like, you know, narrow down like running the report and… yeah, mapping the form and all like this kind of works are currently we are doing in our like database. Okay?
Hassan Zahir (13:56) That helps out a whole lot. And again, I, thank you all for kind of taking a step back to kind of help me out with an understanding of where we are, would love to hear from Alexi as well.
Alexei Alvarado (14:11) Yeah. I, so currently I am responsible for.
Alexei Alvarado (14:25) Reviewing credentialing applications, which means our own internal forms that we require for various reasons and like actual credential documents. So, for a physician, for example… the state license that allows them to practice the Dea, mcsr board certification or mcsr being the state level prescribing in Massachusetts and etc, and also.
Alexei Alvarado (15:05) Entering all the data into our database so that we can then, so that I can then send reminders to people when credentials are expiring on an ongoing basis and.
Alexei Alvarado (15:25) do primary source verifications on an ongoing basis. And I guess my… understanding of what you guys offer is basically eliminates my position maybe. So I’m not sure how I fit into this but I’m not 100 percent clear on that. Yeah.
Hassan Zahir (15:46) And so what we try to do is what we tell people is that ultimately we want to automate as much of the process as possible. What it normally does is it facilitates the ability for existing teams to be able to take on more work to be more efficient to grow with the organization or allows the organization to grow without having to add additional headcount. There always has to be medallion administrators. And those are the individuals who are going to log into the system. They will make all of the requests. They will design the reports. They will do all of those sorts of things. So, from the perspective of a team of two that’s working today, my perception would not be that this is something that would eliminate your position, but the hope would be that it makes life easier on you. And if you do have other job duties and functions that you need to perform, we would hopefully give you more time to be able to do those, maybe to be more hands on with difficult things that you’re facing in the credentialing department. But I think that when we do show the platform here momentarily, it will give a little bit more clarity into kind of what this looks like end to end. I’m going to ask some questions as I’m showing. So again, I’m going to ask that you forgive my ignorance here because I just kind of was introduced to what was going on. And hopefully we can proceed from there if that’s fair with everyone.
Chris Jones (17:22) And just one more question there too. So you guys are using healthstream today. Is that correct?
Kacheung (17:30) Healthstream? Yep. Okay.
Alexei Alvarado (17:31) Their Healthstream, one app, local version, yes.
Chris Jones (17:35) Okay. Gotcha. And then I guess psvs have been a bit of a challenge for you as well. Can you elaborate a little bit on what you’re seeing there? Yeah.
Chris Jones (17:55) The issue?
Alexei Alvarado (18:00) It’s a little bit hard to get a good read on it because Massachusetts is also a bad state for this stuff because they’ve changed. They’ve… changed websites entirely and also changed things within different. They’ve made a lot of changes over the years. And so it’s hard for me to know whether to blame healthstream for that and how much of that is if they have to like recode everything because… of the state has changed things on their end, but it’s just taken a long time when those things happen to get updates, but.
Alexei Alvarado (18:55) Yeah. Okay.
Chris Jones (18:58) Okay. Good. That’s helpful. Okay, perfect. So, I think Hassan, I’m good. I know there’s going to be a ton of questions as we dive into this. So, you know, maybe we just start there. Then now we’re 20 minutes in at this point?
Alexei Alvarado (19:15) Yeah, no.
Hassan Zahir (19:15) I agree. So what I’m going to do is I’m going to go ahead and pull up the demo environment and we can kind of get started from here. Everyone is probably used to this, but I’m going to say, hey, everyone, can you let me know if you can see my screen? Yes. Okay. Perfect. And so what we’re looking at is the medallion application or the medallion platform, if you will. Medallion is designed to be a provider data management platform with the ability to perform all of these workflows. I’m going to make some assumptions on how things happen today and where I make those assumptions, please feel free to correct me. I’m just speaking based upon what I know from existing prospects and customers of ours. And so generally, what happens is a new provider gets a welcome offer that’s probably coming from human resources. Maybe they’re going through, you know, your a HRIS system, maybe they have, you know, have a candidate applicant tracking system or something along those lines, they get the welcome offer and then they go through probably like a background check, and then they need to go through the credentialing process. Are you doing an internal credentialing process for them first where you’re verifying everything that’s exactly what I imagine. So that’s where all of the psvs and the verification is going to come. You capture everything required in order to go through the internal credentialing process. And then it’s time to get them in role with the health plans. And then that’s where the process is kind of like picking up, but that’s what kayling is doing, correct?
Kacheung (20:51) Sorry, you mean I’m responsible for the insurance enrollment only, right?
Hassan Zahir (20:57) I’m sorry, I call that payor enrollment, but enrollment with those insurance plans?
Kacheung (21:02) Correct? Okay. Perfect.
Hassan Zahir (21:04) And so, and how you would reimagine that with medallion, is that let’s say a new provider, let’s say a new provider has started. I’m sorry, I saw something in the chat… great state paying for credential. And so, and so how that would work is like a new provider starts in medallion. We are what they call participating a participating organization with caqh. And so we try to expedite the process as much as possible when it comes to getting a new provider into the system in medallion onboard. It. Now, we can feed this information from an HRIS system. This could come from a workday or from an applicant tracking system. If you already have that provider data. One of the biggest places of provider abrasion is that they feel like they’re getting asked for the same information multiple times. And so we do try to ensure that we can, via an API, we can connect and we can pull that data over. But also, we provide the providers with a portal to capture this information. So, on the front end, Alexi, as opposed to you having to manually capture all of this information, your role in this process. And that’s why I was sure to say, hey, this isn’t about eliminating roles. This is about making your life easier. Your role would be to invite a provider to the medallion platform. What that’s going to look like is you would say, hey, this is a new provider, first name, last name, email address. This is when we’re expecting them to start. And then you’re going to choose the provider type and put in their profession. It’s going to send them a welcome email. What that is going to allow to happen as opposed to you having to continuously interact with them and try to capture the data or get the information into the system. It’s going to send them an email that looks not too dissimilar from what you see on the screen. So it’s going to say Boston healthcare is partnering with medallion to simplify and expedite your enrollment and credentialing process. And it’s going to allow them to kind of read who we are, what’s going on, what the partnership looks like. And then they’ll come and click and get started. And then, so let’s say I’ve got my generic provider. Dr, Naomi Ely is going to say, hey, Boston healthcare has partnered with us to help with licensing, credentialing, payer, enrollment, ongoing monitoring, let’s get started. It’s going to tell them how to kickstart their profile. The biggest thing here is that we can get data into the system in multiple ways and it’s reducing how much data the provider has to give us and so they can of course, manually fill out a profile. But that’s the old school way there is the ability for us to extract data from a resume. And that’s really cool if it’s for a new provider out of fellowship, out of residency or newly licensed or the likes we can extract data from their resume. But the most typical process is that we pull data from caqh, the providers who have caqh profiles that are up to date and attested to which is kind of like our verification gate, we can pull in their data typically in, we say up to four hours, but generally between 30 minutes to an hour. We’re able to pull in all of their data from caqh. Why that’s important is because for your initial credentialing, that’s happening with the psvs, Alexi, 100 percent of that data should be available via caqh. So out of the gate, we’ll have 100 percent of the data needed for caqh. And then we’ll identify the remaining data elements that need to be captured to get enrolled with the health plans. And so, kayling, what will happen is we would partner with you, we would say which health plans do you have existing group contracts with? And so we know when a provider starts, what the data requirements are for those health plans. And we’ll ensure that during onboarding, we’re requesting all of that data and requesting that data. One time. We don’t want you to have to go back to the provider. We don’t want this to be an experience for the provider where they’re dissatisfied or it creates abrasion. And so we would verify the information for the provider profile and caqh perfect. Now, we can link their caqh profile and it’s going to pull that data into medallion. The provider is going to get a view that doesn’t look too dissimilar from this. Again, we’ll pull in all the data automatically from caqh. So you’ll see we’ll pull in their basic information, like the demographic information. We’ll pull in their professional information from caqh. If they have information in there about their csrs, Dea, subscriber, licenses, we’ll pull in their professional history. We’ll pull in like any references if needed. We’ll pull in any existing licenses that exist in caqh, even access to like external accounts, we can log in medallion as well. And so if we need to perform some sort of functionality on their behalf. All of that pulls into the provider’s profile. Another thing that we do is we pull in the documents from caqh, but you can also upload documents into medallion. Medallion is going to extract the data from those documents and use that to complete these sections and complete that provider’s profile. And so the net of that is that a process that takes some of our customers or was taking some of our customers, you know, up to 10 business days. On average. We’re seeing that completed in a couple of hours. And the reason being is the vast majority of this data. Again, 100 percent of the data required for like your internal credentialing process can be pulled in from caqh. The remaining data we will give to the providers via what’s known as a task. They go through the task… going to look similar to this. So there’ll be tasks that exist and there’ll be provider tasks out there. It’s going to say, hey, dr, Naomi Ely, we completed your onboarding, but if we’re doing licensing for her, then we need to complete this background check, fingerprinting, if we are doing payer enrollment, then maybe for a specific payer, we need a copy of your driver’s license. We’ll task this out to the providers and the providers need to complete these things in order to complete their profile. Once they complete those things, they’ll come in, they’ll sign this agreement or this attestation form. They can sign it just in the app. I want to highlight that we also have the ability to do this from a mobile experience. So providers are busy, they’re always on the go if they want to be able to complete this from a mobile phone, they can go in again. The last thing that they have to complete is adding the signature, they can just use their finger and they’ll be able to kind of touch on the screen, complete that agreement. Once that is completed. We have this complete and existing profile on a provider where all of the downstream workflows that now need to be completed, whether that’s the credentialing for the psvs or the enrollment with health plans, Alexi, you can kick off the credentialing process. And kayling, you can kick off the enrollment process as soon as the credentialing process has been completed. We’re going to automate the vast majority of the credentialing process. And I’ll kind of get to those downstream workflows. Excuse me, I’ll get to those downstream workflows here momentarily, but that’s been a whole lot of me talking kind of showing the platform kayling, I would love to pause and see like if this, how this is all integrated into the system, if that makes sense. And then Alexi, I would love to understand if you see that there’s value in us pulling this data down from caqh as opposed to you having to get that information and then get it into the system because we’re going to automatically pull that in. And then the missing data can be entered in by the providers themselves. So again, I’ll pause here and try to get that feedback.
Hassan Zahir (29:49) I have a question. Can you pull.
Kacheung (29:52) the data from the caqh? If the caqh, I mean, if the caqh has expired, the attestation… when the.
Hassan Zahir (30:02) attestation has expired, we will not pull it in that’s our verification gate. We want to make sure that the caqh profile has been recently attested to before we pull that data down. So we don’t want to pull in the data just to have the provider go in and change all of the data. And since caqh they will already have like their accounts and information there, we would not pull it in. We have the ability to, but we want to make sure that we’re pulling in recent data only. So we would recommend that you contact that provider, ask them to update and attest to the data in caqh. And then we can pull that data back down from that point.
Kacheung (30:48) Okay. I mean the reason I ask it because some provider will work with different. I mean, the primary location is not belong to the Boston healthcare for the homeless program. It end up, you know, the other party, the administrator, they really, you know, not follow through the rule to attest on behalf of the provider. That is somehow we need to work with, you know, the other parties or.
Hassan Zahir (31:13) Work with the.
Kacheung (31:15) provider, you know, to do the expectation before we can start the processing.
Hassan Zahir (31:23) Right? Because we want parity in what’s in caqh and what’s on the application. And so that’s why we, that’s another reason why we would not pull the data in and start the process until the provider’s profile has been updated and attested to. We also do have the ability to where we can update caqh. So, as a participating org, not only do we have the ability to download data from caqh, but we can push data up to caqh that way, if a provider updates just their medallion profile… we can push data into caqh and then we can update it and we could attest to it on their behalf. So there is like that component although the preference is that we first pull the data down from caqh that they’ve attested to, and then all they have to do is modify the data in the medallion platform, as opposed to entering all of the data in the medallion platform. I hope that answered the question if I heard it correctly.
Kacheung (32:25) Okay. I understand that because, you know, for our provider, I mean, normally, you know, for a new provider, we will.
Hassan Zahir (32:33) get their.
Kacheung (32:34) Login. And then once I’m ready to do the insurance enrollment, I will like, you know, update their caqh by importing our practice location, any like, you know, outdated license. I will upload it takes me, you know, it depends on how complicated an hour or so to complete it. That is the reason why I’m saying that probably we need to change our workflow a little bit in order to download the correct information into the medtrainer. No, you’re.
Hassan Zahir (33:04) right. The other, that’s why I was saying the other piece too is like even if it’s up, if they don’t have like your practice locations and that information in there, as long as they’ve recently attested to it, you can still pull their information down once they change it in medallion, then we can push it back up to caqh. And at that point in time, then there will be parity. So, yes, that workflow changes would likely change a little. But as long as they’ve recently attested to the data, then you can save that information in medallion. We also under that third party section for providers, I’m sorry, the external account section for providers, we have places where a provider could enter securely their caqh username and password, and then that can be, again that can be used for the updating. So it would require a little bit of change management. But if we download the data from caqh and they update their medallion profile, then there’s no need to go back and update caqh. We would automatically update caqh so that there was parity between what was in the medallion system, our back end database and what was in caqh. So we can tackle that in a couple of different ways because we do know that that’s a challenge from time to time. So thank you absolutely.
Anik Conley-Das (34:32) Can I ask a quick question outside of just providers who have caqh profiles for a second? Yeah, for sure. I think previously we had talked about non licensed non certified staff not really being a target audience to be able to go through this process.
Hassan Zahir (34:52) Through medallion.
Kacheung (34:54) We have.
Anik Conley-Das (34:54) Folks who have certifications at a much lower level that we do credentialing for, but they don’t have the need to be then put into, you know, the insurance backend per SE. So that I just want to confirm that is not a population that we can roster in medallion that we could push back and forth between an HRIS and medallion. Is that correct? It?
Hassan Zahir (35:15) Depends. It depends on which types of individuals those are. So like if I’m thinking like I think of like cert, individual certifications, like I’m just trying to think of like a provider type like a rbt or a doula or someone like that who maintains certifications, those types of individuals. Yes, we can pull into medallion, they don’t necessarily have to be licensed providers, but generally, we’re looking for them to be a type of provider, if that makes sense.
Kacheung (35:47) Yeah. So you,
Anik Conley-Das (35:48) can’t just handle just handling certifications, right? That’s not the use case for medallion. In this case, you could.
Alexei Alvarado (35:54) Have, right? If it’s.
Hassan Zahir (35:56) somebody who is just like you’re tracking like just BLS, but they don’t see any form of patients or provide any form of service, then, no, we would not track them in medallion. It would be just like non licensed providers or certified providers. So like I was saying, like a doula, or like an rbt, someone where maybe you want like ongoing monitoring like Sam or oig, you want to verify the dates of their certifications, you want to add in verifications, like basic life savings, or, you know, or something like that, those sorts of individuals go into the platform, but it wouldn’t be like someone who works at the front desk, but they’re required to have BLS certification.
Anik Conley-Das (36:46) So you unmuted, I am assuming this triggered something for.
Alexei Alvarado (36:50) You? Yeah, no, I just want to clarify.
Alexei Alvarado (37:01) I just want to clarify for us, we… are… one of the main things we’re concerned about when it comes to credentialing is, or the main thing that we’re concerned about is following… requirements. So, federal government.
Hassan Zahir (37:24) Fqac. Yeah. And so.
Alexei Alvarado (37:28) And their definition of who requires credentialing and privileging is basically anyone who is… ever be considered clinical in any possible way ever, which I… think is different from how some people think about it or some industries or whatever. And so there’s a difference for us. You could have for example, like you said a front desk person and their supervisor wants them to have BLS… certification. The way that it’s currently works at our organization is that has nothing to do with credentialing does nothing to do with me. That can happen. It also doesn’t matter because there’s a 1,000 other people with the BLS certification who are available at all times. So I don’t know why that happens, but the other thing is, but so there’s a difference between that and someone like a medical assistant who Massachusetts has no opinion on what a medical assistant is or what they do or what their training is, or what they can call themselves. And so they’re very much clinical and even by not even the most like they’re very obviously clinical and they’re seeing patients and touching patients. But there’s no state certification. And so… in essence, the only thing the only credential that we’re tracking is BLS… or CPR or whatever equivalent. So, there’s a big difference between those two groups. If, if they see patients.
Hassan Zahir (39:24) And touch patients, we can support them, for example, like the Louisiana primary care association and Michigan primary care association, which are these medical or these, you know, associations that are made up primarily of federally qualified health centers are.
Alexei Alvarado (39:41) Customers.
Hassan Zahir (39:42) Of ours. So we will make sure that we get you compliant to the point of meeting hrsa standards. We would need to have a conversation about who you consider to be someone who’s I’ll just say for a lack of better term in the continuum of care, like they see a patient touch a patient. We would consider those to be non licensed providers, but we still treat those in the platform as providers. We wouldn’t make a credentialing request for them to have, you know, license background, Sam, oig, ofac, like all of those mpdb, we wouldn’t make a request for them to have those things. But those types of providers can maintain a profile in medallion. They would just not have a credentialing request against them, and they would not have a enrollment request against them, but they would be eligible for just a profile in medallion.
Alexei Alvarado (40:42) Just to clarify on that.
Alexei Alvarado (40:47) The.
Alexei Alvarado (40:52) we enroll everybody who’s credentialed in PDB continuous query. And so a medical assistant like I said, would be someone that we would want to be enrolled or someone that we currently do and would continue to want to. And that’s because hrsa is also… they contradict themselves all the time. And so we have to act… in order to minimize risk, there… could be an argument, yeah, in order to minimize risk, we try to be maybe a little bit overzealous. But basically, the way we look at it is like hrsa has this list of requirements that everyone has to do who falls under the umbrella of basically… anyone clinical. And obviously a medical assistant doesn’t have a Dea registration. So that’s not applicable. But it’s not really correct to say that it’s the mpdb isn’t applicable to them based on our interpretation of that because basically they actually lie and contradict themselves. But unless it’s, very explicit that it’s not applicable, we err on the side of it is applicable. And so, yeah, I’m sorry, I was going to.
Hassan Zahir (42:23) Say that’s fair. The point that I was making was just like if there was like someone who was not eligible for one of those sanctions checks, we wouldn’t run those sanctions checks on them, we’re not just going to blanketly run those sanctions checks on those provider types, those requests have to be made. And then we identify who’s eligible for what we consider to be ongoing monitoring and which level of ongoing monitoring, meaning who’s going through Sam, oig, ofac, mpdb SSN deafmaster will require medicare medicaid, like the opt outs all of those things are customizable in the platform. So, I wasn’t saying it to say that for an ma, that was the case. I was just saying it to say based upon the requirements or how we would dictate who was eligible for ongoing monitoring. And then in that provider’s profile, you would see the results of those requirements of those credentialing events.
Alexei Alvarado (43:24) And.
Hassan Zahir (43:26) so, you can dictate, you could say, okay, we’re going to have 300 licenses for what we’re referring to as providers, but we’re going to make 200 credentialing requests.
Alexei Alvarado (43:39) And then we’re going to,
Hassan Zahir (43:41) run ongoing monitoring on the full, you know, population or a portion of that population. And so from like a provider’s perspective, depending upon what is applicable and what’s not applicable. And I’ll show you what that looks like under the verifications tab here, Alexi.
Alexei Alvarado (44:03) Verifications.
Hassan Zahir (44:03) Tab, you can will identify what’s going to be applicable and what’s going to be excluded. Again, looking at a demo environment because I just had to go into a generic demo environment, but we can choose what’s going to be included and what’s going to be excluded based upon, that provider. And so like these automations fail because this isn’t a real provider. I can’t check a fake provider’s, npi number because it doesn’t exist. But some of these checks, like we can just simulate them. Do they answer state disclosure questions? The work history answers, but we can identify it. Doesn’t have to be an all or nothing. If they’re eligible for national practitioner data bank, then we’ll run mpdb on them. If they’re not eligible for it, then we won’t, run it. If they’re eligible for state licenses, prescriber licenses, MSR in Massachusetts for the CSR Dea, then we’ll run it, oig, Sam ofac, like I said, exclusions, op, outs, we’ll run those. So there doesn’t have to be an all or nothing approach here. It’s more. So what requirements do you need to have met? And then we can tie that to the provider type. And that’s why when we make that enrollment request, we choose the first name, last name, the provider’s email address, their estimated start date, and then the provider type, and then we populate the rest of the data from there. So hopefully, that gave a little bit of clarity to support the answer that I was attempting to give, but maybe only gave you 60 percent of the answer. And, this fills in the blanks.
Alexei Alvarado (45:43) Yeah, no, that’s helpful. Hopeful I do.
Alexei Alvarado (46:02) I think about is.
Alexei Alvarado (46:08) Not a scenario in which someone is coming to us as a medical assistant, but maybe they worked as a doctor in another state and they killed a 1,000 patients, worst case scenario, right? I theoretically, I want to know that even though they’re not coming to us as a doctor and they can slip through the cracks I guess in our current process. But… like I will.
Alexei Alvarado (46:40) Check to see if someone has a license in this state, at least if they’re like an unlicensed person and… double check. And another… thing that happens is, well, also, someone could be coming to us as a physician in Massachusetts and they may have worked somewhere else. And even though I ask them to provide, and even though like caqh would theoretically be asking them to provide licenses for everywhere, it’s not gonna flag. Oh, you didn’t as long as there’s one license in there that’s considered… right? And if you wanted to hide the fact that you were licensed somewhere else and there’s… something bad… like it was revoked or something, then it would be easy to hide it in that way theoretically, hopefully that would be caught in the mpdb.
Hassan Zahir (47:48) That’s what happens. Yeah.
Alexei Alvarado (47:50) But I just, I wonder about, so like what happens for me is, what… happens for me is that, I… will note like I was like, oh, well, I see that this person on, I see on their resume. Oh, this person worked in New York for 10 years. Why didn’t they tell me about their New York license and why doesn’t that appear anywhere? Else? But then that triggers me to check the New York… certification website. And then I can see it there. And I’m just, I’m wondering if.
Alexei Alvarado (48:37) that’s if… there’s a way to not lose that part of our process. Yeah, I mean.
Hassan Zahir (48:45) That definitely sounds like a niche or a nuanced scenario because as you were discussing like mpdb if they were previously licensed somewhere else, mpdb should catch it. If they previously had a license and it was in caqh, then medallion would be pulling that license down for them from caqh. If someone is like deleting it from caqh, it hasn’t flagged mpdb. And then they’re coming to you, it just.
Alexei Alvarado (49:25) Seems like such.
Hassan Zahir (49:25) An odd scenario where it.
Alexei Alvarado (49:29) If they were trying to hide.
Hassan Zahir (49:30) It, I imagine they would probably hide where they worked in New York as well. It’s not to say that they would hide both of those and then leave it on the resume. But I do think that we try to do everything that’s required to meet federal standards in that instance. But there always just exists a scenario that, you know, I mean could theoretically exist.
Anik Conley-Das (49:57) Can I just jump in here? I think Alexei, great question, very edge case scenario, very edge case. Like, I think this is like, I don’t know, I hope we never see a percentage of this ever appearing of our credentialing applications. Can I jump to privileging because I think this is another question that I had like, how does privileging work? Because Alexei does all of that through DocuSign right now and I don’t feel that that’s necessarily our best solution either.
Hassan Zahir (50:25) So, can you explain to me just kind of like what the privileging process looks like today? Like I made assumptions and it seemed like we were aligned on hiring credentialing that goes to the health plan enrollment. Can you walk me through what privileging looks like and who’s managing that today?
Anik Conley-Das (50:41) That’s Alexei as well. So I think Alexei can probably speak to that.
Alexei Alvarado (50:46) Yeah. So we think about credentialing and privileging as being… not the same but fully… intertwined.
Hassan Zahir (51:01) Right. You look at the privileging as being a part of the overarching credentialing process?
Alexei Alvarado (51:07) As part of the credentialing and the privileging process before I started in this position nine years ago, I think the most recent hrsa site visit.
Alexei Alvarado (51:21) I got yelled at for not saying and privileging every time they said credentialing. And so, because they’re like don’t forget about privileging and so, I was taught to always think about them as connected.
Alexei Alvarado (51:37) At the hip, I guess. But so, like for example, so our credentialing application that we have people fill out is a credentialing and privileging application. And… so that means we’re asking for their credentials… but we’re also asking them.
Alexei Alvarado (52:04) Here is the delineation of privileges form that we have them fill out. And that’s… all part that’s all in one document. And it’s not very complex. Like, I know like just when working with hospitals like a physician might have like a 25 page delineation of privileges form. And they’re doing surgery and all kinds of things that we’re not doing. And so our forms are pretty simple but, and our process is pretty simple, but.
Hassan Zahir (52:38) It’s yeah.
Alexei Alvarado (52:41) So, yeah, I guess really the main thing is just,
Alexei Alvarado (52:54) the form, and then I ask a manager to sign it. And like, generally, for… the most part, everyone within a specific provider type is going to request the same things. And sometimes that means people don’t request stuff that they should. And I say I need you to request this because this is like standard… but it’s pretty.
Alexei Alvarado (53:26) Yeah. And.
Hassan Zahir (53:27) I’m going to be, I guess I’m going to go for like to be pretty succinct, try to go for brevity here because we’re coming up on just a few minutes left. Ultimately, Alexi, what happens in medallion is that we do think of like privileging as being a part of the entire credentialing process in the medallion platform. When you’re starting, to treat someone through this process, we call it their initial appointment. That way we can perform all of the privileging you can dictate to us whether or not like peer reviews are required and the likes or if you need it just to hrsa standards. But we treat that as a new initial appointment that’s where, you know, the provider is first coming and joining you would make that request in the system. We would choose who that provider is or who those providers are. I.
Anik Conley-Das (54:23) Should say we would.
Hassan Zahir (54:24) Choose the entity. It would be your local or it would be your local organization. We also do support like completing of like third party hospital applications where they get privileges at third party sites. But you would choose yourself not a partner app or directly completing an application. And then you would come through and you would choose the delineation of privileges forms. Again. I didn’t have time to prepare this demo. So when I choose like these partner sites, it’s not going to give me like true dop forms because we would be getting that from them. We would kind of feel like, you know, the providers form. We would get the one time link. Then we would get out, we would complete the D or complete the dops at that point in time. But what we could do is we could set it up so that based upon the provider type, if you want them to get standard privileges based upon that provider type, we can assign the dop form that’s available right there because of the fact that when the provider goes through onboarding, and they sign that attestation, in that attestation, they are saying that it gives you the, or it gives them the ability to then use their electronic signature throughout the rest of the application. The standard dop form would be selected. We would hit submit, the provider would come in, verify that privileging request. They would electronically sign it. We would go through and then still perform all of those psvs. It would come back and come back in the form of a full credentialing packet. You would be able to take this to the manager or to the medical director, whatever the case or what needs to happen. But all of the information will come back. You would have the full packet. It would show you like all of the provider checks that have been done, the verification of licenses, if there were peer, references, the board certifications, all of those things. You can manage this in platform and give access to a manager to complete this in platform. So they would have the ability you could route it to what we call the committees based upon if it needs review or if it was clean. So I could come in and I could choose one of these looks like maybe I, yeah, I have these ready. I can choose where I want to send this packet to which committee or a committee could just be an individual. It could be a medical director. It could be something came back on, you know, their insurance. It could be anything that comes back where you want to route it for needs review. If it’s clean, then you can route that to a manager or someone on the committee to then come in. They will review the packet like I just did. They’ll select who that provider is. In this case, we’ll choose dr Maldonado, and we would cast the vote. And so you could go through, you could approve it. You can add notes to it. You can change the committee. You can do whatever it is that you would want to be able to do. So, we do support that privileging workflow. We can set up standardized delineation of privileges or DLP forms, and then you would be able to work through that process as well. It’s probably worth having a little bit more time to discuss. We’re coming up on the top of the hour. And I do have a hard stop. So I wanted to make sure that I at least showed you that does exist in the platform. We treat that as the privileging workflow. So in this case, the credentials the entire process would run through privileging for those providers who require privileges?
Anik Conley-Das (58:06) Anik, is that what you were looking to see there? I was, yeah, this was specifically something that Alexei I think does very in a mixture of ways. So I am aware of that being a pain point and I know that’s usually a friction pain point with the providers of having to provide duplication of information ids and such as part of that process. So I think that’s very much in line with what it was for. I am sorry that kayling didn’t get to see her side of it, which is, I think the main thing that we really wanted to start off with, but I think we did some initial intros which I really appreciated. I would love kayling if you’re still game for this. I think it makes sense to maybe see the other side of the platform, the insurance or pay enrollment side as the next step.
Hassan Zahir (58:52) Because, I actually see.
Anik Conley-Das (58:53) Quite a bit of value in continuing the conversation with medallion based on just the demo today.
Hassan Zahir (58:59) There is a lot of value and a lot of automation that exists on that side that I think would be really beneficial for kayling as well.
Anik Conley-Das (59:07) Yeah, I’m excited to look at. Should we let’s get to?
Hassan Zahir (59:10) Another meeting please?
Tayler Wyss (59:12) Yes, we definitely can schedule another one. I don’t know Hasan if we’ll have you back or if we’re going to have someone else explaining and I’m just wondering if you.
Hassan Zahir (59:26) know without having.
Tayler Wyss (59:27) to restart a third time, if there’s a,
Hassan Zahir (59:29) continuity. And just for clarity, like I actually lead the solutions consultant team here at medallion and Chris and I are both located in the same city. We’re both here in Columbus, Ohio, that tie between us, I think has us working well. I was a part of his onboarding. And so absolutely, Chris can make sure that on the next call for continuity that I’m on there for the demo, if we need to do like further scoping, I may pull someone in for my team just from a time constraints perspective. But no way are we going to put you through this again. Really appreciate you sharing everything with us, getting us up to speed and Chris can make sure that we get the next one on the books.
Anik Conley-Das (60:12) That sounds good. Chris.
Tayler Wyss (60:14) What’s the best way to get scheduled with you? Is it, if I offer some dates or do you have a link?
Anik Conley-Das (60:19) Yeah, if you want to.
Hassan Zahir (60:20) See what works for your team and just throw out some times, then I’ll get it coordinated on my.
Anik Conley-Das (60:23) end. Can I say one last thing I think Hasan what I really appreciated about you specifically is that you carry such technical knowledge about all of the different sort of checks that we have to go through. And I speak for Alexei when I say, I don’t think he’s had any other interaction with any other platform where we were able to talk about npdb in that level of detail. So for what that’s worth, so really appreciate that. I think we do need to continue in this way, absolutely this.
Hassan Zahir (60:51) Is like I said, it’s not only because, you know, Derek but this is what Derek wants us to do. He wants us to be able to build relationships and this is more than just a platform. This is medallion looking to be your partner and hopefully we can have these conversations. And even if we decided the part is friends, at least, you know, that we’re going to do everything we can to show you how we can support you.
Anik Conley-Das (61:18) Thank.
Hassan Zahir (61:19) you absolutely. Thank you all for your time. I’m sorry, I do have to run, but I’m excited for the next call.
Anik Conley-Das (61:25) All right. Thank you.
Tayler Wyss (61:26) Thanks everyone.
Anik Conley-Das (61:27) See you.