Transcript
Nave Brar (00:00) hey, Scott.
Scott Everline (00:03) Hey, Nath. How’s it going?
Nave Brar (00:05) Good. How are you?
Scott Everline (00:06) Good. I’m good.
Nave Brar (00:09) Hi, Amy. Welcome. Hi, looks like Zach’s coming in. A few other people just waiting on Manny here. Hey, Zach, welcome. Hello. How’s everybody doing good. How are you? Good?
Zach Miller (00:30) Happy first day of March madness.
Nave Brar (00:32) Oh, yeah. I just, we actually sent out some March madness mailers to some of our clients. It’s like a nice little basketball hoop that you can attach to your wall like a mini basketball like all the kids used to play with back in the days. So that was fun. Got to send that to some of my clients that’s awesome. Amy.
Zach Miller (00:52) Can we sign today so I can get a basketball hoop?
Scott Everline (00:56) Yeah, you have to sign.
Nave Brar (00:58) I’ll send it regardless. I.
Amy Raymond (01:00) Have a client that uses a medallion already. You want me to see if I can rip theirs off?
Zach Miller (01:07) That’s that scrappy, the scrappiness, we keep talking about?
Amy Raymond (01:10) That’s right? That’s startup life right there.
Nave Brar (01:12) We’re not that budget constrained. We’ll get you guys some.
Amy Raymond (01:15) And the man of basketball hoops, Zach needs it.
Zach Miller (01:19) I do. I got the perfect door right here there.
Scott Everline (01:22) You go, it’s funny. My son has one and all we hear is him like he’s 12. It’s the worst. Oh, my God, you would think it was like just him and you think there’s like a full contact it?
Amy Raymond (01:32) Sounds like gunfire going off in the house. Like the, my kids had one that we just took it off. It was like pretty heavy duty like big like the backboard was like this big. It was on one of the doors and it was just constant. I mean, they couldn’t even walk by it without like trying to hang on it. And we’re like that door is not meant to hold your entire house. Yeah, that was the bane of our existence. It somehow disappeared.
Scott Everline (01:55) Oh, yeah. Smart.
Nave Brar (02:00) You gotta, you gotta try the windmill dunk on those. It’s really fun. We used to play like my friends and I, when I was a little bit younger, we used to play all the time on those things in his room. And then we’d do like a two on two. Everybody’s just trying to dunk it over other people. So much fun. Just.
Scott Everline (02:14) Very, full contact if it was anything like brothers and I pushing.
Nave Brar (02:17) People down. Yeah.
Amy Raymond (02:20) Well,
Nave Brar (02:22) it looks like we’re waiting on two people here. Are Manny and Anne going to join? Yeah.
Amy Raymond (02:28) They are planning on it. I just saw a slack exchange. So… stay tuned. They should be joining shortly. Cool.
Nave Brar (02:38) We’ll just wait on that. And then, Amy, how do you know us? Which client refer?
Amy Raymond (02:43) To.
Nave Brar (02:44) us,
Amy Raymond (02:45) brigade.
Nave Brar (02:46) brigade, Scott, are you familiar?
Scott Everline (02:48) La, I was going to look him up real quick, okay?
Nave Brar (02:53) I think Anne also said that, am I pronouncing his name correctly?
Amy Raymond (02:56) On.
Nave Brar (02:57) on? Okay, good to know before he joins, on, he was from weight watchers, I believe, and he was also using medallion?
Amy Raymond (03:06) Oh, nice.
Nave Brar (03:07) Yeah. So, Manny let me know about that a little bit. So, it’s good that you guys have some experience there, yep.
Amy Raymond (03:18) Let me stalk Manny’s calendar real quick.
Scott Everline (03:28) Amy, when you say you have a customer, does that mean like because I didn’t find it’s brigade like a brigade of.
Amy Raymond (03:34) Or seniordoc or geismed, GEIS. S.
Scott Everline (03:39) And so there are customers of sunbound?
Amy Raymond (03:41) No, sorry. I’m new to sunbound. And I’m wrapping up some old contracts. Gotcha. Okay. Yeah… yeah, they use it for their credentialing and tracking all their provider stuff.
Scott Everline (04:10) Oh, sorry. Sorry, if you’re seeing me get up and leave, I made the mistake of not taking this call in my office because this living room is much better. And the dog whenever I’m down here decides she wants to go in and out of the house like 50 times. And so, if I pop up, I’m still listening all.
Amy Raymond (04:26) Good. Oh, there’s Danny, hello?
Nave Brar (04:28) Team. Sorry, I’m late. All good. I’m just going to join in a second welcome. Welcome. Do we want to wait for on, or are we ready to go? Let’s just get rolling here. You have the right people in the room. All right. So, we’ve got a quick chance to meet here. It was, we just talked about basketball hoops pretty much the entire time, but I would like to get like a bit of an introduction into like what everybody does at sunbound? I’m the ae that’s going to be representing medallion from our side, just to make sure that it makes business sense for you guys to choose the solution. We’re going to walk through a bva which is a business value assessment today, so we can put the numbers to the value Scott. Do you want to do a quick intro? And then we’ll go to Amy and Zach.
Scott Everline (05:12) Yeah. Hi. All so I’m nav’s kind of right hand person.
Scott Everline (05:16) I’m the principal solution consultant here at medallion. So just kind of help dive into the weeds. I’ve fortunately unfortunately been in this space for a long time. So about 25 years in health care, both on the payer side and the, and kind of the provider ops technology side. So can get into a lot of different unfortunate rabbit holes. So, happy to kind of go down whichever path makes sense for you all. But just to be here and support the conversation, great.
Amy Raymond (05:42) I’m Amy and I’m our chief operating officer here at sunbound. So rough cycle client onboarding and pay ops all kind of report into me right now.
Zach Miller (05:54) Zach, I am the revenue cycle team lead over here. So we’re on the operations side making sure the nuts and the bolts are tight.
Nave Brar (06:04) Fantastic. An, I just saw that you joined. Do you want to make just a very brief introduction? We’re going to go into a business value assessment that we put together for you after this.
Anh (06:13) Hey, nice to meet you guys. I lead product here at sunbound. And my background is in health tech, worked with spinning up RCM platforms before prior authorizations, and, you know, mostly on the consumer health side.
Nave Brar (06:36) Gotcha. Thanks everyone for the introductions. We did prepare something Manny according to the numbers that you provided us. I know I asked like 500 questions so you couldn’t get all of them, but we made some assumptions along the way. So what we’re going to do is we’re going to walk through that deck and you guys know your business better than I do. So the assumptions that we made, feel free to call them out, say they’re wrong and we’ll make adjustments along the way. Does that sound good? All right. Let’s do it. Let’s get straight into the slideshow mode. Okay? So from what we understood from the first call, the main goals here are to protect billing revenue due to credentialing, recredentialing, and any hiccups that come up along the way, enable new growth.
Nave Brar (07:19) I know you want to go from around 120 mpis today to 1,500 mpis in year five. I know you guys want to get to 150 logos. So we’re trying to make sure that we’re in alignment so we can get you to that scale and then eliminating the manual credentialing work. I think 25 percent of the team lead time is being spent there. And then about 50 percent of the credentialing specialist time, not sure who those people are on this call, but we’re trying to that’s Zach?
Manny Cominsky (07:50) He can better if my estimate was correct?
Nave Brar (07:55) Zach, I’ll.
Zach Miller (07:56) give you like a half thumbs up. No, no. It’s about, right? Yeah, I’d say, my time now is minimal. We brought on someone to help with credentialing. So he’s in there, 50 percent helping with other things. But prior to that coming on, around 25 percent seems about right?
Nave Brar (08:11) Gotcha. Okay. Yeah, we’re going to try to alleviate some of that pain and know you can focus on higher value things and doing credentialing stuff. So we’ll get to that. All right. So we’re going to walk through our understanding key assumptions the challenges and the opportunity. And then we’ll walk through what the future state might look like with medallion. And then from there, we’ll put the numbers to the value, like I said, and then we’ll talk about next steps. Anything else anyone would like to add to this or does this look directionally correct? Good to go cool. So we’ll walk through this top left to bottom, right? The revenue per location Manny provided a range between. I think it was two to four. So I just picked the middle number of 3,000,000 per location… credentialing gaps are causing a one to three month delay. Again, pick the midpoint want to be more conservative two months that can cause either delays or write offs. And then we’re just going to assume that 10 percent of those claims are affected, which effectively results in a 50 K in delayed revenue or written off. Okay. Does that kind of sound in the ballpark or am I completely off?
Manny Cominsky (09:21) Is it revenue protection for us or for the customer?
Nave Brar (09:26) Well, you only get paid if the customer gets paid, right?
Manny Cominsky (09:29) Okay. Yeah. But I mean, sorry, when I see like seven point 5,000,000 revenue at risk, it’s like I would love if that’s our revenue, but yeah, that’s not our delta. So.
Nave Brar (09:38) The way that we were thinking about it is if it’s 3,000,000 dollars per location. And then there’s a subset of the claims associated with that particular facility that are getting written off. We used 10 percent of the claims as a number. So we just took 10 percent of that 3,000,000 dollars in revenue. So.
Amy Raymond (09:57) You’re taking the full revenue at risk for our clients basically. And then we would be taking cut off the top of that. Yeah.
Scott Everline (10:04) So maybe it’d be best to look at whatever the cut is and then redo that math based on or now that you guys have the number and the logic, right? If you don’t want to share the numbers that’s fine too, we can share our algorithm and you guys can work it out. But ultimately, it’s looking at like, you know, you guys again are getting paid when claims are being paid for your customers, like there’s a portion of that you potentially are losing because of delays associated with the credentialing piece.
Nave Brar (10:31) Okay. Yeah. So this can be adjusted up or down. It’s just that kind of had incomplete information. So we tried our best with what we had yep, okay, new revenue. So if we’re assuming Manny, correct me if I’m wrong, Zach, Amy, please, you guys are the experts here in your own business. So credentialing add on. If this was issued as an add on to your existing client base, you would charge three K for credentialing. Is that across all your providers and your facilities? Imagine if one specific facility has 100 providers, would you still charge three K per facility?
Manny Cominsky (11:08) It’s a mix. I think I don’t know Zach, if you know what the all in DSL price would be because it’s a lot of individual items, but it’s anywhere basically between one to three K there, depending on the operator.
Zach Miller (11:26) Yeah, we kind of have like an ad hoc process or ad hoc pricing. So, but yeah, I think Manny’s about, right? If we assume a year out, it’s probably going to be about one to three K that we’ll get for real.
Nave Brar (11:38) Got you facility. So.
Scott Everline (11:40) For each institution regardless of how many providers they might have.
Zach Miller (11:44) It would be per community. So like we do it based on like if they have a medicaid or a credentialing application, we charge X amount of dollars. It like flows a little bit because, you know, it’s every three or four years, whatever it might be, and if they have like all their mcos that come at the same time. So, we have like larger clients that have like, you know, whatever 20 communities underneath them, and then each community needs those credentialing activities, if that helps. I think it doesn’t really answer your question, but that’s the breakdown.
Scott Everline (12:10) Maybe because.
Amy Raymond (12:11) Clarification?
Scott Everline (12:11) Is.
Amy Raymond (12:12) that we’re dealing with the community level credentialing? Not.
Scott Everline (12:15) So, it’s facility based, not provider based, correct? Yeah. And when you say credentialing, this is a rabbit hole that Mandy and I were going back and forth on when you say credentialing, you’re talking about from the sounds of the enrollment process. So their enrollment with the payers, so their enrollment with medicaid, their enrollment with medicare, and then the subsequent like medicare advantage programs or the mco plans, right? So any one community might be enrolled with upwards of 20 payers, right? And that’s the credentialing that you’re looking at, not the primary source verification of the credentials themselves, right? Or both could be both. Yeah.
Zach Miller (12:56) I guess it would be both in terms of like if they had a state medicaid credentialing piece, then we would handle that for them as well. I don’t know if I’m fully understanding your question.
Amy Raymond (13:06) He’s talking about like, so it’s clearer to me on the provider side, like getting a physician credentialed through the state, like submitting their licensure, their driver’s license, their social security numbers, versus making sure once that’s done that they’re enrolled with each of the providers. I think we’re more primarily on the enrollment side that’s.
Scott Everline (13:27) what I’m hearing?
Amy Raymond (13:28) That we have to support or something like that. Is that correct? Zach?
Zach Miller (13:33) Yeah. That’s correct. Okay.
Amy Raymond (13:35) Hence the credentialing versus enrollment rabbit hole which I typed while you were saying that Scott, so, yep.
Scott Everline (13:41) Yeah, yeah. Yeah. Because credentialing like could be primary source verification, right? Literally, just checking that a provider or an institution has the appropriate credentials versus getting them contracted and billable with payers. So that tracks, okay. Does.
Nave Brar (13:55) that change the math at all? Scott or well?
Scott Everline (13:58) I think the math needs to change anyway, a little bit based on the rep protection piece because of like the percent of revenue that they get out of it. I think, yeah, we can go back and sharpen the pencil overall once we kind of present all of this. But I think a lot of that was like the logic that I was tracking as we were building this out.
Nave Brar (14:18) Right. I just want to make sure we have like the metrics to associate the value. Yeah. Okay. Cool. Revenue critical platform. I’m sure you’re aware of this, but you’d have a single source of truth for everything as it relates to credentialing, recredentialing and reducing customer friction when it comes to billing and then higher value focus. We talked about this a little bit earlier instead of dedicating the time of Zach and whoever the new credentialing specialist is, you would reallocate Zach’s time to doing higher value tasks and then scaling to where you want to get to as far as npis this year would probably require one more credentialing specialist as well, which is fully burdened around 85 K. You could say lower. You can say 65 K, but it’s in the it’s in the ballpark, yep.
Amy Raymond (14:58) And then that estimate of fte need was that based off of a certain number of providers per facility or facility, you know, one to one on the facility to mpi.
Nave Brar (15:08) Yeah, it was a one to one but, we got from 120 to 250, I think is where you guys want to grow to this year. Okay? In terms of mpi… good. So left to right, busy slide, we’ll go, very quickly. There’s there’s less slides and just a lot of busy slides. So do left to right here, revenue risk 3,000,000 per location depends on billing readiness for the providers. We walked through that a little bit earlier, credentialing gaps two months away can cause 50 K impact per location, manual tracking right now. You’re using spreadsheets, you guys have a scraper tool, which can sometimes result in denials and rework and then sunbound’s customers get aggravated, scaling costs 170 K, which is related to the ftes, if you scale that out to where you want to get to, which is 150 locations. You’re going to require around nine ftes to do all the credentialing and re credentialing there. So, with that assumption in year five, you’d be experiencing 935 K in overhead as it relates to operations. And then the middle portion is faster revenue start dates, for your providers and the facilities that the providers are working for, which provides billing readiness before claim submissions begin. Scott, do you want to touch on that? I don’t think the provider mix doesn’t matter as much here anymore because we’re talking about facilities. Is that correct? Correct?
Scott Everline (16:36) Yeah, I think it’s more like, the number of payers that we’re looking at per community in that spread. But I think the highlight here was really around confirming whether it was an enrollment process or whether a traditional PSP process. So, I think we’re okay.
Nave Brar (16:51) Yeah. One other thing I wanted to ask, maybe Scott, you can chime in here is like depending on the provider mix, there is a delta between like how long it takes for a specific provider to get credentialed. So, if we’re talking about like MDS versus lvns or cnas, it’s going to be a little bit different, right? Yeah.
Scott Everline (17:14) But you all aren’t doing it at that provider level, right? You’re doing it at that?
Amy Raymond (17:18) Yeah, we don’t care, not that we don’t care. Yeah, we aren’t ourselves dealing with credentialing at the provider level ever. Our provider is the facility is the community. So, yeah, now that said, is there, you know, depending on what this looks like or what the arrangement is like? Does each community get one head that they can log in with and they can manage their own providers through this? Then maybe that’s a value add. But that’s not how we’re it’s not what we’re set up at this first like phase when we’re thinking about how we would use the tool. Yeah.
Scott Everline (17:52) So it’s purely around getting those facilities enrolled. So capturing storing facility data, probably looking at like a group level, and then looking at each community and, or each facility within each community, wrapping those up with like the appropriate tins and mpis, get all the appropriate site visits, certifications, licenses, all that stuff, and then piping that out to the appropriate payers for enrollment and then for revalidation or re enrollment, 36 months, or if it’s medicare, who knows what the whack a mole is that year, right? Yeah, medicare and medicaid, yeah. Okay. I’m tracking got.
Nave Brar (18:26) It. And the middle piece right there, create new revenue. Is what we went over. If you scaled 150 logos three K per facility, assuming 40 percent of those facilities use the services, it’s going to be 180 K in ARR in year five, right? So it’s going to take five years to get there. I want to be clear about that scaling, sorry.
Amy Raymond (18:42) Is that three K at one time?
Nave Brar (18:44) That three K would just be on a, however you decide to charge on an annual basis or whatever it is. It’s just an extra cherry on top as far as what you can generate in ARR scaling, efficiently, centralized credentialing, recredentialing on one platform. And in the complete state you’d control the facility licensing. So you’d primarily be responsible for making sure things credentialed and recredentialed which, you know, reduces the delays and also reduces the amount of write offs that are associated with the credentialing portion of things. And then a single source of truth went over that redundantly consistent claims performance, eliminating denials, disruptions, and creating more predictable outcomes, and then reducing that 935 K that would be required for opex, if you hired nine credentialing specialists… that was a mouthful. Any questions Scott can answer them for you?
Amy Raymond (19:41) Yeah. I think like nine is probably even with that. Yeah, I think like and we already covered this, but just to be clear, the fte count I think is way off given that it’s facility credential or enrollment versus providers. So just, I think as we look at that just to kind of put a flag there. Yeah.
Scott Everline (19:59) I’ll just have like an estimated number internally like, what kind of production an individual person can process, for a?
Amy Raymond (20:08) Facility? Yeah. So for instance, you’re using, what number of mpis at the upper bound?
Nave Brar (20:12) 1,500 many, correct me?
Amy Raymond (20:16) 1,500. OK. And then how many do we have right now? Zach? 120 Ish.
Nave Brar (20:20) Yeah. OK. Yeah.
Amy Raymond (20:23) We’ll see. I just feel like as you were discussing kind of what all went into it, you were talking about numbers of providers per facilities, therefore your number must be inflated?
Nave Brar (20:33) Yeah. I used a conservative number. What we came up with is like 11 point something, but I adjusted down to nine. We’ll revisit that and I’ll adjust this before sending it out.
Amy Raymond (20:42) Sure. OK, great.
Nave Brar (20:46) OK. So I’m going to have Scott cover this. These are the products and SKUs that we think you may need, but I think you might need something completely different because caqh profile maintenance is more to do with providers than anything else. So, Scott.
Scott Everline (21:00) Yeah. I think when we’re focused on from what I’m hearing which is a little bit of a shift from like the initial conversation that we had with Manny or maybe we just misinterpreted it, but I think it’s really around that facility enrollment piece. Yes, we lump the terminology on this slide as provider enrollments and facility enrollments, but essentially what that process is the gathering and storage of that facility data, right? So essentially within the medallion platform, we’re happy to show it to you. And within the medallion platform, there’s a facility instance profile that’s there all the supporting documentation that’s needed for the enrollment process is then stored within medallion. We can work directly with the facilities. So your customers and have them kind of have their own instance to store the facility work. You could have Zach and team kind of manage that process and then liaise between the facility and medallion doesn’t really matter whatever process kind of makes sense as far as the relationship goes and then requesting those enrollments, right? So kind of initiating, you know, facility or community a needs to be enrolled with payers X y and Z. Medallion will then take that process package, all the information specific to the payer requirements. So kind of a backend that tracks all the individual payer requirements by line of business and facility, or group, or provider type. And then we would deliver that back to the payer in whatever method is most efficient. Unfortunately for a lot of payers, it’s like web form filling as you guys probably know, right? It’s a bunch of like sftp document gathering, lumping stuff together. But we do pipe into portals and use templates like roster templates when possible. And then we’ll track that enrollment. So we follow up with the payers all the way through from submission all the way to the point of par adoption or par designation. And then we would notify yourselves as well as the facility admin that, hey, this organization is now par with organization X y and Z. And then we track those revalidations and basically restart prior to the revalidation to make sure that we’re not missing any of those contract renewals. Our big push is around the turnaround time. So getting those from the point of getting the data through the door to getting those enrollments kind of buttoned up and accurately out the door within a 10 day turnaround time. But our typical turnaround time is about five days. So we escalate to that 10 day turnaround time and again just kind of manage that end to end process from submission to once that’s completed the rest of the stuff like we do facility credentialing, again, talking about like primary source verification doesn’t sound like that’s something you all do today. There could potentially within your facilities. Amy, I think like you’re talking about a potential expanded use case further down the road. It could be one of those things where your facilities are looking for a partner to do the primary source verification for providers as well as maybe caqh profile maintenance, right? As well as maybe managing licenses. So, there’s a lot of stuff. We can dig much deeper on the provider end just because there’s more transactions to kind of maintain at the level. So we could double click on that potentially if the time comes that you all want to kind of expand that offering where it’s essentially like a reselling almost of additional services that medallion can provide to your customer base. Does that track? I know I talked for a long time and didn’t follow this slide at all. But does that kind of track with what you all are thinking about?
Amy Raymond (24:30) Yeah. If I shut my eyes, what you said makes sense, correct? Okay to you also.
Zach Miller (24:35) Yeah. So basically, we would like provide you with all the information and documents that you would need to complete a valid re, enrollment, re, credits, whatever we want to call it. You would store that information and the client will come to us requesting, hey, we got this letter from humana. We would put that request in medallion. You would fill it out within 10 to five days, submit to the payer and then do the follow ups on your end. Then you would come back to us saying, hey, this has been complete or hey, we have more questions.
Scott Everline (25:00) Precisely. Yep. And yourselves and the facilities could basically have a full line of sight, that entire process. Yeah. Right. So you’ll see when we do the outreach, you’ll see when the next outreach is, you’ll see any notes we’ll like check for dependencies, right? So like if you’re trying to enroll in humana, but we notice that the facility doesn’t have a medicaid id, we’re not going to pursue with humana until we get that medicaid id either in the system. So we know it’s active or we’ll go and do the medicaid enrollment and then issue the humana, right? Because there’s kind of a cadence of when things need to happen. Otherwise you just gum up the works and do a lot of extra rework. I’m.
Amy Raymond (25:33) sure. This is flexible, but I’m wondering if there’s an ability to have, you know, the facilities upload directly, you know, to you guys. So like is number of users a concern here or because really there’s no need for us to touch something if we have a better process and we can be monitoring with the transparency that the tool would provide. So, something like that is something like that, you know, does that fit within the structure you’re thinking it?
Scott Everline (26:03) Does, so like the way a lot of the RCM customers that we have, the way they do it is they kind of have an enterprise account, and then each one of their customers essentially have their own instance, right? And so what we’re trying to do is not have like one global instance where your customers can then theoretically go see what your other customers are doing, right?
Scott Everline (26:23) So we break it up that way. So each one would have their own organizational access. We don’t charge for platform seats of users. We charge for seats within the system as far as like institutions go. So we would charge for like the transaction of the enrollment. So it’s like a X by X enrollment fee. And then for the number of facilities. So if you have one customer that has 10 facilities, say within a community that are doing enrollments, that would be per facility seat plus whatever transactions we’re managing on the enrollment side. And then they all get kind of billed as their own individual line items. And you guys have visibility into all of that as kind of admins or super users, if you will. Okay?
Zach Miller (27:04) Yep. And then for you’re tracking whenever there are like re, enrollments upcoming, correct? So like if we complete a humana, and then it’s three years out. Do you track that?
Scott Everline (27:12) Yep. Absolutely. Yeah. The only one like Zach you mentioned is like medicare is kind of squirrely. Yeah, right. Like medicare doesn’t do a consistent re enrollment. They kind of cherry pick randomly. It’s almost like a re enrollment lottery where they’ll pull somebody out and say, hey, now’s your chance to do re enrollment. That’s what we see on medicare. I think medicaid is typically more consistent. Yeah, but yeah, the payers will track that validation and we’ll manage that process, right? So when re, validation comes up, we’ll start triggering the process of like making sure we have current documentation. We task out to users saying, hey, it looks like your pli face sheet is out of date. Looks like your clia certificate is expired, right? We’ll do all that to make sure ahead of time and then start kicking off the re, validation process. Got it. Yep.
Nave Brar (28:02) All right. So last slide here is just a synopsis of the numbers that I mentioned. Of course, we’re going to adjust some of these if it’s on nine ftes, if we feel it’s going to be less than that because it’s facilities management. We’ll adjust that down for you. And again, I’m going to send all over to you. Sorry.
Amy Raymond (28:18) Just a double click there because I thought really was gaslighting myself and thought I’d lost my mind. But if we’re saying the number of npis in our current count, is that’s no more than, yeah.
Nave Brar (28:31) Say that again, if we’re.
Amy Raymond (28:33) saying we’re going from 150 to 1,500 npis. So we’re saying basically 10 X, yeah. And we currently use point two five for the 150.
Nave Brar (28:44) I thought we were using point seven five because the team lead in the credentialing specialist. So 25?
Amy Raymond (28:48) Oh, I see. Okay. You’re using a higher? All right. Okay. Yeah.
Nave Brar (28:52) Cool. But I’ll make sure that it’s still seven.
Amy Raymond (28:55) Point five, not nine. Yeah.
Nave Brar (28:58) Reasoning, yeah, I can adjust it down. We will perfect. So this is a synopsis we’ll adjust this, how it needs to be adjusted, and then we’ll send it over to you guys, but that’s the gist of everything. I do want to like save some time here for any questioning. I don’t know if it’s going to be worthwhile for us to get into a demo show, the platform or anything else. This time, just going to be for everyone on the call to ask any questions.
Amy Raymond (29:20) Apologies on my part. Did you have pricing in that?
Nave Brar (29:23) Pricing’s not yet there because this is just for validation purposes.
Amy Raymond (29:26) Perfect. Okay. Just making sure I wasn’t missing a.
Manny Cominsky (29:29) Line demo would be awesome. Yeah.
Amy Raymond (29:31) I hope… so.
Scott Everline (29:37) Let me pull the platform real quick.
Scott Everline (29:50) Sorry, I’m working off of one screen. I’m usually a seven screener kind of Guy.
Scott Everline (29:58) Awesome. Hopefully you all are able to see the medallion platform.
Scott Everline (30:06) We got it. Yep. Okay. Cool. All right. So you’ll see a lot of this stuff. Like as we talked about, right there’s a lot of work that medallion does within the individual provider space as well. So, as a super user, this account is essentially set up for every function that medallion supports when we have customers that are signing up for a specific SKUs or product service lines. Clearly, this on the left hand side will be truncated, right? So you’ll see kind of the facility piece as kind of the primary driver. And then payers is really where we’re tracking that payer enrollment. So I’ll show you what that looks like as well… just to give you an example of like probably not supposed to do this, but I’ll do it anyway, an example of how an RCM customer works, right? So experity is a big RCM vendor. You’ll see essentially, they have an instance for each one of their customer bases. So, Amy kind of addressing what you were talking about, right? Like you have experity at the enterprise level, but then you have 87 unique customers that are within the platform that are kind of managing their own piece. We’re not charging per instance of this customer base, right? So that’s just a little bit of a visual as to how that’s kind of broken down within the platform?
Scott Everline (31:28) As far as the facility records go, I… am able to add a facility. So if I wanted to put another facility in the system. And what this does is it will generate kind of a shell record. And then the admins at the facility will be able to go in and complete the additional components of it, right? So whether it’s you all giving access to the admin at the facility level, and then the facility is coming in and putting this process together or whether it’s you all kind of driving or initiating that you’re welcome to do that as well. But just basic facility information and kind of get the core shell in there.
Manny Cominsky (32:04) Do you guys have a way to get the tin numbers? So you can say, no, it’s more. I just think.
Scott Everline (32:13) From Zach’s point of view, a big.
Manny Cominsky (32:14) Pain point for our customers is like sometimes they don’t even know their tin or mpi numbers to begin with. And we have to, we built our own little fuzzy match engine on the mpi side, but.
Scott Everline (32:27) Tin is, yeah, the irs is really prickly about who they let in. I mean, I would say like as part of, I would assume you guys run into this too, but as part of like the facility information that they need to submit to the payers, it’s going to include a W9.
Amy Raymond (32:47) Which you would think should be easy to get.
Scott Everline (32:51) Yeah. It’s healthcare, it’s healthcare. Nothing is easy to get. No, but that W9 will have the tin number in it and the dba and kind of a lot of that core data.
Amy Raymond (33:00) And even further down the line to be clear, it’s senior living which is also a whole different world from hospital world. So, yeah, yeah.
Scott Everline (33:08) Okay. I can appreciate that. Yeah, unfortunately, that’s not a gap we necessarily fill. I’d imagine your fuzzy logic is like you’re hitting npez and looking for type two mpis based on like a name lookup or something exactly. Yeah. Okay. Yeah. So we’ll be able to capture all that. So whether that’s something that the customer goes out and pursues or maybe something Zach, your team is going out and doing right? Kind of driving some of that handholding to it’s like a value add white glove type service. We’re capturing the facility type taxonomy codes, any kind of special information that might be relevant contact information, medicare medicaid, ids, et cetera. Obviously, if the medicare enrollment hasn’t taken place, that will come back after that enrollment has been submitted… tracking the accreditations, right? So they’re able to upload the accreditation, site visits. I don’t know how often site visits come into play. My understanding is a lot of payers don’t require site visits as long as there’s an accreditation. But if there’s not an accreditation, they want a site visit on record and that’s usually like the CMS site visit… clia certificates, right? Any licenses, malpractice insurance? These are all just screens that are storing things. I’m not hiding anything. It’s just not super exciting to click through because it’s just data, do.
Amy Raymond (34:31) You also have the capability to kind of like require certain things like for instance, if we’re using it to go get the enrollment or whatever for the medicare side, like exactly what’s needed so that the workflow is clear for the end user.
Scott Everline (34:43) Yep. So what happens is once the enrollment has been submitted, so say we’re going to go in and request like a new payer enrollment for this facility. And then.
Scott Everline (35:00) this is like locked down to this specific enrollment. So we’re going to then look at those payer specific rules. So let’s say I’m going to Arizona, and then I’m going to pick Aetna as an easy example. I’ll be able to identify the lines of business, right? So whether it’s medicare or medicaid, Aetna doesn’t have managed medicaid in Arizona. They have to go under a different brand. I think it’s Coventry. But anyway, I’ll then submit that we then map say there’s multiple practice locations. So this is where I would see kind of multiple facilities within the community that potentially be pulled in. And then that would be submitted. I’m not going to hit submit because, oh, I can do next, any special notes I want to put in, if I hit submit, my operations team yells at me, so that will be submitted. And then what we do is we look at the individual requirements for the payers. So I’ll show you a little bit of the secret sauce on the back end. The payer directory that we have is essentially a full kind of repository of payer details. So if I want to look up Aetna, we’ll… map the requirements from Aetna right? So whether it’s a new enrollment, whether it’s a revalidation specifically for the group, what line of business it is, what state it’s in, we’ll take all of that information. And then we’ll map the requirements very specifically to that versus just making this blanket requirement of, hey, you need all this information filled in. It’s very prescriptively mapped to what’s required for that. And what we do is we end up tasking the administrators specific components that are missing. So we’ll say like look, it looks like Aetna in Arizona requires these four documents that aren’t present in your profile, please go back in and populate that. So it’s really driven off of what enrollments we have in flight versus just kind of again, there’s this big, you know, broad net that we throw out there for an exhaustive amount of information.
Scott Everline (37:00) And then… tracking, right? So I can say I’m an individual within the facility. I can track what enrollments I do have. So I’m able to look at my payer list. I can see what enrollment requests are in flight. So how many are actually have been submitted? So I can see what’s been overall. I can see what’s processing. I can see which ones need my attention. And again, I would have a task calling my attention to it. But I’d be able to see specifically what information might be missing based on criteria. This is a demo. So I’m not going to get a ton of information here but it would come back with like, hey, this is the information missing documentation, et cetera.
Scott Everline (37:42) And then we would map this. So this is really like one of my aes hates this analogy, but I like it as like going to a subway sandwich shop and like you order your sandwich and then you watch them make it. You can kind of interact with the person making the sandwich. What do they call them sandwich artists or something? And then at the end, I get my delicious healthy foot long sub for three at the end of the line, this is really where you’re looking through that glass to see kind of the meal being made. So you’ll have access to all that information.
Scott Everline (38:10) Your customers will have access to that information. And then once those enrollments are completed, we then log those here within the enrollments. So we’ll also take existing enrollment. So part of the onboarding process is to understand where your customers have enrollments in place today, as much as that data we can do because one of the pain points we hear is like we do it, but we’ve done a really poor job and we don’t know when revalidation is, or we don’t actually know where we’re enrolled or what facilities are enrolled there, we can do par analysis. So we will do an analysis at the onset to say, you know, go out to the payers that we believe are part of the payor mix and go and validate and then pull those validated enrollments directly into the platform. So you’ll be able to see specifically kind of what enrollments are in place. And then when the revalidations are, and when things are moving forward from there… okay, the payers view is the same thing like I was looking at it as an individual entity, but I can do the exact same thing from a broader like scope of my entire book of business, not just one particular facility, yeah.
Amy Raymond (39:17) Okay.
Scott Everline (39:19) Facilities that’s kind of that’s it in a nutshell right there’s. A lot of stuff going on. But like the facility piece is pretty straightforward, I don’t say easy but straightforward as far as like how the process moves along and kind of what comes back out of the platform… happy to take any questions you?
Zach Miller (39:38) Guys, I’m assuming you guys should know, but do you require any like availability specific payor access to submit those forms or is it all just signature and then PDF submission? Yeah.
Scott Everline (39:49) So we will leverage availity, and we’ll get user credentials to go into availity to submit those, if that’s the best path forward. Yeah, we are actually been working with availity just in an email thread with them the other day about trying to leverage an API because the platform’s funky and it’s like we send so much volume to you guys. And I know you have an API, is there a way we could just automagically feed this to you instead of like robotic form filling on availity?
Amy Raymond (40:20) Based on what I’ve seen about their other apis, good luck, but also not all of our that’s kind of.
Scott Everline (40:25) The color I got back from them, Amy, that’s funny. You say that, huh?
Amy Raymond (40:27) Not all of our communities even necessarily have availity set up. So, I think that’s probably why Zach was asking. So if we don’t have that, that’s not a blocker, you’ll go direct to payr. No.
Scott Everline (40:37) No, yeah, we’ll go directly. We have some like form mapping tools on the back end where we’ll take the data out of the platform and then map to the payr specific forms and then submit those. I think the only thing we don’t support is essentially a fax submission, right? Like that’s. We are inherently opposed to fax, understand. Yeah, even though the industry is not yet?
Zach Miller (41:02) Somehow, not yet. Okay.
Scott Everline (41:08) Any other questions? Anything I went through too quick? Anything you didn’t see that you would have expected to see?
Amy Raymond (41:14) No, I think this makes sense to me. I think when we look at, you know, I know you’re I’m not grading you off of the 3,000 dollars that you kind of just threw out there. But I think as I think about the sensitivity to cost with most of our clients, there’s… some areas that we hadn’t really fully thought about of like I don’t even know to be honest exactly what providers they have to credential themselves with their facility. I know they have ftes that are providers because we do some of the like therapy billing, but I could see a use case where we help them organize their stuff because we know how messy it is. But kind of don’t I don’t want to be the middleman on all of that as we think longer term, but I could see potential value that’s going to be softer Roi than kind of just hard numbers and fte savings because frankly they don’t a lot of them don’t do it well now. So to them, it’s not a savings. They just have the headache every time it comes up. But just thinking out loud, I could see a parallel or additional use case for them that doesn’t necessarily involve us with a product that we’re bringing to them, which is a lot of what we do anyway. So that’s just a side note for me and Manny and Zach to be thinking about. Yeah, I.
Scott Everline (42:27) Mean, I think about like if we go through the bva and put the numbers to the side like the rationale tracks, it’s putting in the right numbers for the rationale and probably using a very similar bva model with your customers, right? Saying look like for every day you’re not enrolled with a payer, how much are you billing payers per day, right? It’s probably multiple thousands of dollars. And if it takes you an extra six weeks to get enrolled, every single one of those days costs money. And that’s ultimately like the approach that medallion takes is not to throw pricing in front of you but more so say like we’re justifying the pricing supporting the pricing model by really coming right out of the gates with an Roi, right? Like it’s going to cost you X, but like based on numbers that we mutually agree on, you’re actually saving four times that five times that 10 times that, and that easily justifies the overall cost of ownership. And so, I think being able to kind of sit down, sharpen the pencil on the numbers now that you guys hopefully kind of understand the approach and the way we think about this problem and the solution.
Nave Brar (43:31) I think.
Scott Everline (43:33) the numbers will kind of help speak for themselves. And then what a lot of RCM customers do is they just do it as a straight pass through, right? It’s like, hey, it’s a value add. We’re bringing this partner to the equation. There’s no cost to us. We’re not gaining anything financially out of it other than just faster turnaround times for claims processing, which gets you all paid faster too, right? But it’s a mutually beneficial arrangement.
Nave Brar (43:59) So, I think that’s pretty much everything on our side. I want to go over one last thing which is just the process and next steps. So we did, I’m going to probably put this as in progress as we adjust the numbers. But I’m going to get the bva from our perspective over to you guys. And then you guys just validate it for us, let us know if it’s all correct. And then from there, we’ll get into the review that you guys can do internally. And then after that, we’ll determine what pricing is going to look like according to where you plan to go grow to the last question I want to ask is like, is this something that you guys want to plan for just this year? Is this going to be a core part of your offering where you want to structure something that’s like more than one year?
Nave Brar (44:45) Obviously pricing is going to be more beneficial if you do. I guess if we turned.
Manny Cominsky (44:50) It on, I’d be surprised if for some reason we turned it off is how I would describe it. If that.
Nave Brar (44:57) Makes sense. That’s good. I’ll present some optionality, then let’s get the Eva portion of it completed. Let’s agree on the numbers, make sure it makes sense first. And then we’ll get into pricing when it’s time to get into pricing. And then I’ll present all the options as far as one, three, five year options.
Amy Raymond (45:11) Do you mind going back to, oh, we’re already at time, will you send this deck? Yes. Yeah. Okay. I just want to gut check some of the assumptions on number of communities. I know you’re mainly going by npi. The other pricing thing we have to keep in mind is like one client could have 100 or 150 communities. And so the, just as we’re thinking about how we’re looking at that. So, yeah, if you send that, then that’s great.
Nave Brar (45:34) Absolutely. I know we’re on time. I’ll send this deck. I’ll send it to the email that you had sent over Mandy with all the assumptions. So everybody has assumptions in front of them. And I’ll just tag everybody in. Sound good. Thank.
Scott Everline (45:45) you. I’ll set.
Nave Brar (45:46) The same time next week too. If we want to reconnect at that point, we can adjust as needed appreciate.
Amy Raymond (45:51) It. Thank you. Thanks y all. Appreciate it, bye.
Scott Everline (45:55) Bye Dave.