Transcript
Philip Stefani (00:00) you know, and,
Noah Laack-Veeder (00:01) you said Kirby’s in st Louis?
Philip Stefani (00:03) That’s right? Not in st Louis, but he’s in the waiting room.
Noah Laack-Veeder (00:10) All right, sweet.
Philip Stefani (00:11) I’m gonna let him in.
Noah Laack-Veeder (00:24) Hi, Kirby. How’s it going?
Philip Stefani (00:31) You’re on mute by the way, if you are talking, yeah.
Kirby Cole (00:33) I know. Sorry.
Philip Stefani (00:34) There we go. How you doing?
Kirby Cole (00:36) Good brother. Sorry, I know that I owed you some stuff. It’s been crazy. I was trying to get a lot of moves going on behind the scenes with some of the stuff we talked about. So I haven’t forgot about you. I just haven’t had the time yet. Yep. No.
Philip Stefani (00:51) Worries. Yeah, we can kind of cover that stuff at the end. Totally understand you’re super busy with everything we discussed, so we can look at getting that and then just build out from there. But yeah, I know real quick. We got 45 minutes on the calendar for today. Does that still work for you? Yep? Perfect. So, yeah, we’ll just do some quick intros because we got one new face from the medallion side, and then, yeah, just want to recap the conversation, make sure we’re tracking what’s most important to you primarily spend a lot of the time in the platform, just a high level overview of the workflow, get your feedback on that. And then, yeah, kind of as it relates to those inputs, I sent along, just what would a business case look like? And how do we go about building that out? So that is my agenda. Is there anything in particular you were looking to cover that I didn’t mention?
Kirby Cole (01:45) That’s it.
Philip Stefani (01:46) Sounds good. Cool. So just for quick intros for this meeting, I was able to get Noah from our solutions consulting team. So Noah has a great deal of expertise in, you know, really large scale deployments across all of our product suites. So, those organizations that are dealing with licensing, credentialing, payer, enrollment, privileging, kind of all in one deployment.
Philip Stefani (02:08) So I’ve given Noah a little background on the conversation so far, he’s probably going to have some questions of his own, but yeah, I’ll pass it over to Noah for a quick intro. Cool. Yeah.
Noah Laack-Veeder (02:16) Hey, Kirby heard you’re in st Louis. I’m also a midwest Guy, I’m in Madison, Wisconsin. So I’m not sure if you’re a sports fan, if you might like the packers, maybe I don’t know.
Kirby Cole (02:28) I have a chiefs Guy over here, you know? Yeah.
Noah Laack-Veeder (02:31) See that makes sense. That makes sense. It kind of probably depends. Would you say? It’s like 50 50 chiefs, packers or majority people like the chiefs?
Kirby Cole (02:39) Oh, it’s mostly chiefs and then we’ve got like a bunch of cowboys fans. There’s a lot of cowboys fans in st Louis, which is odd.
Noah Laack-Veeder (02:48) Yeah. Well, I’m not a cowboys fan, which is probably good news. But yeah, about me, I’m lead consultant, lead solution consultant here. I’m really excited to do the demo today. If you don’t mind, I have a few questions and a little bit about visual workshop. I like to do together before we do that. Just so the demo makes complete sense. But yeah, just great to meet you. Yeah.
Kirby Cole (03:08) I’ll get, yeah. So I grew up in columbia. So, when I was a kid there was no football team in st Louis. So I was a chiefs fan. Rams got here. I kind of bought in a little bit, didn’t care when they left and back to the chiefs. So, yeah.
Noah Laack-Veeder (03:19) Because it’s funny because like the, I remember when the st Louis rams were a thing, but I’m like do people like the rams now? I mean, now that they’re in California?
Kirby Cole (03:28) And the Guy who owned them is a columbia Guy, he’s actually from columbia, Missouri. He’s an asshole. So, so.
Noah Laack-Veeder (03:33) We don’t like him. Okay, cool. Good to know. But yeah, great to meet you. I was super excited for the conversation today. Yeah.
Kirby Cole (03:39) Happy to answer whatever questions. I just got to say guys, I do have a hard stop at the 45 minutes. And I mean, if we want more time, I don’t want to waste. I don’t want to ask you guys for more time, but at the same time, I do have a hard stop. So, yeah.
Philip Stefani (03:50) No worries. We are pretty dialed. So we’re ready to cover everything and if we need to schedule more time, we can absolutely do that, but we will finish up by the 45 mark.
Philip Stefani (03:59) All right. So just to orient us, recapping the conversation from last time, you know, I won’t read through all of this but essentially biggest points credentialing is moving under you. Kirby, you guys are PE backed so obviously like the EBITDA measurement is top of mind potentially as you come up for a sale or fundraising round in the near future as it relates to credentialing specifically. And I know Noah will have a couple questions on this, but there’s two teams currently broken out across optometry and ophthalmology, you’ve got credentialing timelines that are 150 day plus for some payers. We’re talking about licensing, payer, enrollment, privileging in some instances. And just the biggest things that you flagged, Kirby, it sounded like no proactive follow up. And the biggest blocker is maybe the team is waiting for all of the information from a provider before they start submitting any applications rather than getting applications out the door once they have kind of those minimum requirements. And yeah, we can talk about kind of the financial implications of this. But, you know, every day that this delays is essentially money that eyecare partners is risking or not getting. So we’ll kind of look at that as well. Anything we’re missing here? Anything that you would want to make sure we prioritize?
Kirby Cole (05:15) I think that’s the main stuff.
Philip Stefani (05:18) Okay.
Kirby Cole (05:19) And I think, I just think, you know, the one thing, why did that? My screen just got smaller? You know, just for your, as you walk this demo or questions you might have like we’re pretty open to, you know, sort of a menu of solutions, if that makes sense, right? I know you guys have different pieces of what we do, which is probably why you’re on the call. But, you know, if we get down the path and we think that I’m going to use the word outsourcing because I don’t know what else to call it. But if we think that there’s a value in shrinking our team and moving resources your way, I think we’re open to that. That doesn’t make sense. We don’t have to one thing. Phil, I didn’t I’ve seen that after we hung up, we do use a licensing vendor so that’s definitely on the table. I would absolutely want that to be with one person. If you guys do licensure, we… help a few a year, you know, on that spend.
Kirby Cole (06:15) So I would want to consolidate that if we move over as well. And then if there’s anything else. So, no, I don’t know very much about credentialing, right? So if there are other things like privileging that has costs associated with it, like, and maybe we’re using like just let’s line those out so I can go look around too to see if there’s other dollars that we can pull into the overall pool that we have available from a budget as it aligns to the things that we decide we should move forward with.
Noah Laack-Veeder (06:45) Yeah, no, that is super helpful. Maybe Phil, I can start screen sharing and we can kind of start working through this unless you wanted to cover anything.
Philip Stefani (06:52) No. Let’s start working through the process pieces we’ll do that we’ll jump into the platform for the workflow, and then we’ll round it out with, hey, this is what the outcomes you’ll get from the platform are, this is what we think the financial implications of that could be. And then really just want to get your feedback on that and kind of work with you on how we put that together. Yep. Cool. All right. Noah. All you?
Noah Laack-Veeder (07:14) All right. So I’m glad you told me. And again, no judgment here about like not knowing a bunch about credentialing like I can also just hopefully you lead this conversation a little bit more about that process too. It’s obviously all Phil and I do every day. So happy to talk about it. My wife doesn’t like hearing about it but potential customers do. Can you see my screen here with some boxes? Okay. Cool. So ultimately like what I heard from Phil and I kind of just copied and pasted the notes that you just talked about is we have all of these activities more or less happening today and they’re happening in sequence Kirby, is that correct?
Kirby Cole (07:57) Yes. And.
Noah Laack-Veeder (07:59) Then, so when we talk about credentialing, like it means a lot of things to a lot of different people. Do, you know, are you guys doing like any primary source verifications, things like are you checking like npdb for sanctions and stuff like that? Yes. Is that what you call credentialing? So.
Kirby Cole (08:18) We actually check sanctions in the recruiting process. So we want to know ahead of time because we don’t want to hire people with sanctions, good credentialing. So.
Kirby Cole (08:31) Credentialing for us is probably a combination of what you have here under credentialing and payer enrollment. It is actually taking the, and I might be wrong, but it is taking the file that we put into qgenda, submitting those to all of the payers and then working that file to get them parred. So I don’t know how that lines here.
Noah Laack-Veeder (08:47) Got it. Yep. That makes sense. I guess with the, and that we’ll come back to that. So that’s really helpful actually because I think that explains to me what the qgenda piece is for. Yeah, I.
Kirby Cole (08:58) think I heard, go ahead. I.
Noah Laack-Veeder (09:01) Think I heard mention of like privileging. So, is that being done also in the pre app or pre hiring process or is that happening like after they’re hired?
Kirby Cole (09:10) Privileging happens after they’re hired and there are and I would say for your workflow, this one we might have to adjust, but I believe that… privileging is done in two ways for us. And like once we get, so, we’re announcing next week just so you guys know, I’m giving you crazy confidence Thursday the changes. So I’ll be able to talk more with my new teams, a lot more openly at the end of next week. But to me, I think the privileging piece, we’re really going to want to have them weigh in on especially for the ophthalmologists yep because I think there’s two ways we’re doing it. I think there’s privileging at our locations, but there’s also external asc privileging and I want to say that the asc privileging is handled today by the asc leaders and the operations leaders, not by the credentialing team itself. But the credentialing team is holding up passing the file until we get everything necessary for the asc privileging that they don’t even do. So it’s a process break. It’s stupid. And then, so I need to understand who is doing the two pieces, but that’s a question I don’t fully understand today. So.
Noah Laack-Veeder (10:22) You’re saying that like the privileging for like the external locations is done by a different team. What did you call them? Yes?
Kirby Cole (10:28) So for the ascs directly where we’re getting privileges that is being done by the local operations team.
Noah Laack-Veeder (10:37) And local operations team, they’re still eyecare partners, employees. They’re.
Kirby Cole (10:41) eyecare partners. But so eyecare partners owns 60 practices. The person doing that would be somebody who works at the practice itself. So it’s likely the practice leader, somebody they delegated it to or the asc team that’s part of the workflow, I have to figure out too. I think it’s the operations leader. And if it’s we just, there’s a lot of questions around that step. I’ll just leave it at that.
Noah Laack-Veeder (11:02) That makes sense. And then are they, is the we’ll go into this? Let’s just make an assumption, but this is happening. And then once this is done, like all of this has to be done for a provider, and then we will start doing payer enrollments that’s correct? We.
Kirby Cole (11:18) Have to have the entire file completed TB test. Now. They’re making us freaking hold a file. If a TB test is set to like expire in the next three months, they’re making us hold the file and make the doctor go get the TB test before it’s even necessary. Like it’s all these crazy rules to create less work for them. Is how it feels to everybody not in credentialing?
Noah Laack-Veeder (11:39) Yeah. And I think that’s the question is like, is this a payer requirement or is like, because ultimately, the only reason that I think we should delay this process is if we think that a claim’s going to get done because.
Kirby Cole (11:51) this is, that’s it. And that is not the way we do things today. We have built a process that I’m going to use like that coddles our internal team to where they don’t have to do bits and pieces of the work or track the work they’re doing until they have it all. So it’s one. So it’s just, it’s not efficient. We have doctors who start who could have medicare medicaid and two payers ready to go. And we don’t and we’re not there because we haven’t started the file. It’s a really inefficient process. And the biggest problem for me and I will lean on you guys a ton for this. I don’t know what they’re saying is true or not. Yeah. And I can tell you like I talked to two of our operators yesterday and kind of discussed the fact that there were probably some changes coming in cred, and they were so excited and they’re like, well, when I had it five years ago, we did this and when I had it five years ago, that wasn’t a rule. And so they could be right, they could be wrong. There could have been changes in the last five to seven years since we bought the practice and moved it over centrally. But like, I don’t know what I don’t know the truth between both sides of that conversation. But what I do know and how I feel like we should be the bar I think will align with what you said is we go payer by payer, minimum requirements to submit. And as soon as you have those minimum requirements, you submit it.
Noah Laack-Veeder (13:03) Yes, I agree. And I think that if you can leave this conversation with like one question I think is a really good one is just like how I think about it. It’s just like I’m my surfboard is a claim and is like, is this not going to, am I going to get denied, right?
Kirby Cole (13:16) So that’s.
Noah Laack-Veeder (13:19) ultimately, like what we need to figure out, maybe that is the case. I think there are still instances where we can make this more optimized. But I think that’s the ultimate question. And then, so I just want to understand systems a bit and I know if you’re like, I just want to bring my team in and talk about this more, but I heard that we’re using excel spreadsheets, what are we using excel for versus qgenda in this process?
Kirby Cole (13:41) That’s a great question. They do not know how to use qgenda. Reporting. Okay. And so we do a bi weekly meeting with both credentialing teams. We have two divisions in those meetings. We don’t pull open qgenda. We pull up a spreadsheet that they’re updating. So they’re going to qgenda, going to a spreadsheet and updating it, and then walking us through that update. Oh, interesting. And we have seen multiple errors on that excel file where they were like, yeah, this one’s good. We got notification, uhc’s, good to go. Somebody on the, actually, it was on the payr team was like, no, we just got a denial letter. What are you talking about? But they had it checked as green in their excel file. So there’s a human error perspective that has caught us multiple times that we would like to eliminate for.
Noah Laack-Veeder (14:31) Reporting. So then, is that only being used for like status updates for like who’s bar, who’s not bar? Yeah, that’s.
Kirby Cole (14:39) exactly, right. And we had no visibility into that until I asked for that.
Noah Laack-Veeder (14:44) Well, that’s really interesting, Phil, and I kind of putting you maybe in a time machine about like a year and a half ago, we had a conversation with a organization similar process. And what ended up happening is that they were like, yeah, we don’t know if someone’s par for two weeks and we’re like, well, so then you can’t build you’re not like scheduling people for two weeks because you’re just waiting on this data, right? So that’s something that, so, I’m just pulling this up because again, I really appreciate you doing this like the demo is going to be valuable absolutely. But I think what’s going to be more valuable is just like showing you the new process of medallion is showing you like this is how this is all going to work. I’m fine.
Kirby Cole (15:23) With having that conversation today and doing the demo later for if just because I do have that hard stop like whatever, again, I don’t want to monopolize your all’s time. But like I don’t want to rush through this thing because we’ve been through two vendors, in my years here and neither have delivered. And so it’s really important that if we make this decision, it’s got to it’s. Got to be right?
Noah Laack-Veeder (15:43) Yeah. And those vendors, were they there for payer enrollment or what?
Kirby Cole (15:47) Yeah. So, yeah. So it was symplr first, we had symplr. Okay. So we do have another tool besides qgenda and I don’t remember the name of it. I think there might be a second tool. I’ll have to, this is where my lack of knowledge comes into play but we had symplr… we set it all up first. It was just, we outsourced the entire thing when I was first here and it was broken. So then we moved to symplr, thinking that would have savings, but then we ended up still outsourcing with symplr, but then building a team in between us and symplr. So the team got bigger. The symplr team didn’t get any smaller but we gained zero efficiency.
Noah Laack-Veeder (16:22) Yeah, yeah, yeah.
Kirby Cole (16:23) Symplr wasn’t the right partner went to qgenda. One of the primary driving factors. So, my boss was part of the qgenda… RFP and selection, he said one of the primary reasons they picked qgenda was reporting. And so I don’t know if it’s just a technical understanding from our teams to be able to build out those reports or work back with qgenda. But I asked for a simple percentage par report for the new hires. And the current leader was like, yeah, we have that and I’m like, okay, send it to me. She sends me a file that probably had, I don’t know.
Kirby Cole (17:01) So it was just a data. There was no, there was nothing valuable.
Noah Laack-Veeder (17:04) There was no analysis done. I couldn’t see.
Kirby Cole (17:06) New hire versus recred, it was all in one ugly ass file. And that’s what she thought would solve the need that I was asking for. And she’s just like here you go and walked away and she automated that. So I get that stupid ass report every single week and there is nothing in there that I can use.
Noah Laack-Veeder (17:21) Yeah. So like it’s not solving your problem of who’s par, who’s not, it’s like you have to go in there and figure it out. There’s no like easy answer to that question. Okay. And yeah, just so you know, that you’re not the first person to say that. So this is really helpful. One thing I’m not seeing too. And again, if you don’t know, it’s totally fine. Do you know if you all are leveraging caqh at all for this process? We?
Kirby Cole (17:48) Are, and we actually even volunteer to go in and get our doctor’s logins to caqh. Does that sound right?
Noah Laack-Veeder (17:56) Yeah. So yeah. Tell me more about this. So, yeah.
Kirby Cole (17:58) So we’ll actually say, so I mean, we really try to white glove it as much as possible. So I don’t know what we’re getting out of caqh but we’re saying, hey doctor, if you give us your login, the team that I have today actually will go in and pull or update or whatever they need to do in caqh or the doctor can do it themselves?
Noah Laack-Veeder (18:13) And then that’s all happening manually. Like there’s no automations happening there’s. No like integration between qgenda and caqh that, you know, of.
Kirby Cole (18:21) That sounds accurate to me. I could be wrong and maybe we put a question mark to double check that. But to me, I don’t think that we are manually getting anything out of caqh. I’ll ask real quick. Yeah… you know, if we have so in a perfect world, caqh would be integrated.
Noah Laack-Veeder (18:44) Yeah.
Kirby Cole (18:44) Integrated in with… I mean.
Noah Laack-Veeder (18:49) If you’re using qgenda to populate the forms and sending it to pay enrollment, like there should be a connection between caqh and qgenda typically.
Kirby Cole (18:57) I’ll find out Heather might know if not, it would be one of those questions. We might have to put a, I hate to say put a pin in. Gosh. I hate buzzwords, but wait on an.
Noah Laack-Veeder (19:03) Answer for us. Yeah, you know, I think I would double click on that one. Kirby, I’ll make sure not to use any more buzzwords. Okay? I might make dad jokes. I have a seven month old and it just really sped up that process of dad jokes. I have.
Kirby Cole (19:18) A whole dad joke generator. One of my former employees wanted to be a python coder. Yeah. And so he actually made me a dad joke generator.
Noah Laack-Veeder (19:27) That’s hilarious.
Kirby Cole (19:28) I’ll flip through and update people. Yeah, it’s called Kirby’s corny. Dad joke. It’s right here. Yeah.
Noah Laack-Veeder (19:37) Okay. So next, we’ve got to copyright that Kirby, every meeting we have from now on, if we have the opportunity to meet with you again, I hope we do, I need us to start with a generated.
Kirby Cole (19:46) Dad joke. I start a lot of meetings with dad jokes. We had Mckenzie here for two years and every Mckenzie meeting I had, I start with a dad joke.
Noah Laack-Veeder (19:53) Hey, well, come on me and Phil like them too. So this is great. I’m trying to think anything. So your provider data as you understand, is only housed in qgenda. Do you have like an HR system that you’re using? Or? Oh yeah.
Kirby Cole (20:10) We use dayforce. Okay? Dayforce and qgenda are definitely not integrated. Okay? And so when we are putting a new provider into our HRIS system, like when I first started here, we weren’t even capturing mpi number. Oh, interesting. And so we do not do that, but that’s a manual input. So when we move a provider into the hired status, we add the mpi number as part of our internal manual data input to their record.
Noah Laack-Veeder (20:41) Okay. Yeah, that makes sense. Okay?
Kirby Cole (20:44) Dayforce is not a real good integration partner. If you guys are integrated, they might be freaking shocked.
Noah Laack-Veeder (20:53) Yeah, I’ll have to check. I mean, it’s all about like if they get an API absolutely, if they don’t then it’s like have we built like a sftp integration where they just send files back and forth, they’re.
Kirby Cole (21:05) a little behind the times there’s.
Noah Laack-Veeder (21:07) a lot of them, a lot of tools like that licensing, what was the vendor that you all are using today? If?
Kirby Cole (21:13) You’re willing to share onesource?
Noah Laack-Veeder (21:16) One source. And then you said that. So, with your licensing use case, obviously, it just does it happen after they’re hired or you do this before they’re hired?
Kirby Cole (21:27) Say that again? Like.
Noah Laack-Veeder (21:28) When do you license people? Is it after they’re hired or before?
Kirby Cole (21:32) Oh, no, no cause, then they can’t see patients. We, I mean, no, we license them as soon as soon as they sign the contract or they don’t have a license. We connect them with one source immediately to kick that process off. Even if that means we have to wait, you know, if it’s a, if it’s a resident and they’re still in training, we still make that introduction really quickly so they can start populating whatever they need for their license.
Kirby Cole (21:54) Yeah. So, the way the word, so just the way that the workflow works for us and it’s going to change a bit. So we hire them right now, the folks on my team, the credentialing, the clinical onboarding team reaches out and we say, hey, we’re going to help you with all this stuff. And then they kick off these, yeah, they kick these things off. It’s going to move to a different team, but it’s still going to be the same thing. One sort of connect one touch point on the end to get it all put together. But yeah, we do licensing right away.
Noah Laack-Veeder (22:22) Yeah, that makes sense. I’m just putting in like a box here. I perform at parties if you ever need a party trick of someone putting together a process maps. I’m your Guy just so you know?
Kirby Cole (22:42) I’m terrible at it. Yeah.
Noah Laack-Veeder (22:44) No one’s ever asked me to perform at a birthday party, but if you want to be the first one, you know, I’ll give you a, I might do it for free. Okay? So, this makes sense. So cool. Yeah.
Kirby Cole (22:55) You’ll learn when you start to meet with my teams, I’m really good at creative ideas and solutions and identifying root cause issues, building a workflow or a process. I want to freaking end it. I hate it.
Noah Laack-Veeder (23:07) Well, that’s what I’m here for, so.
Kirby Cole (23:09) When we build this out, you’ll be leaning onto some other folks that are better that are more type a in that regard. Yeah.
Noah Laack-Veeder (23:14) If we build it, they will come, you know, they said, yeah, they will solutions will come. Okay. So this makes sense. So ultimately, I’m just going to do like a extremely quick demo just to show you like this. Ultimately, the pitch here is that I feel like we can do all of this in a single system that’s my pitch.
Kirby Cole (23:33) That makes we love single system or I do. So.
Noah Laack-Veeder (23:39) Besides the day force that’s the only thing that we need to work with, but otherwise everything else, so.
Kirby Cole (23:45) It doesn’t integrate. I’m not worried about it. I’m not like that’s. Not that’s not going to be a you issue. Like we don’t expect anybody to integrate in with day force that’s a day force. We shouldn’t have ever picked day force out of the gate. So, yeah, and.
Noah Laack-Veeder (23:59) That, and that, that’s all it’s usually, I mean, typically organizations will just have a like an HR system and a medallion. Like there’s really not a use case where we don’t we just replace yep. All right. So, let me just open this up. I just gotta, I have this one tab that I want to show you here. So just basic introduction to medallion. So we’ve got all of your provider data in one spot. So you’re not going to have to navigate spreadsheets and qgenda to get this information. Is my bandwidth? Okay? By the way? Okay? I was just my computer was like slowing down. So for example, if I want to get information on Michelle, I can click open her profile and then I’ll be able to view all the information about her for any of these use cases that we’re talking about. So whether it’s credentialing, whether it’s payer, enrollment, whether it’s privileging, whether it’s licensing. I’ve got all that information in a single system and I can even use this as like a document, a secure document place. So if you’re saying that you have qgenda in spreadsheets, I’m assuming qgenda has documents as well, but just know that everything is going to be in one place.
Kirby Cole (25:17) From.
Noah Laack-Veeder (25:17) a reporting standpoint I just want to jump to that I’ll show you the workflow in a second is we already have that report you’re looking for who’s par and with who all in one spot.
Kirby Cole (25:27) Is that like just new hires? It could?
Noah Laack-Veeder (25:29) Be, yeah, we can add attributes here and kind of.
Kirby Cole (25:32) Like that’s an attribute that’s really critical that I want to be able to delineate between who are we trying to get started and who are we just re credentialing?
Noah Laack-Veeder (25:39) Yep. Like one thing we could probably add in here is like new hire date and if it’s and one thing I’ll say is like if it’s not out of the box in this view, we’ve got a report like we can during implementation, make a report that has all that already. So it’s customized to your liking. But ultimately like, yeah, just click on it. And there it is emailed, whatever it might be. Usually it’s like in like analytics tab or something. But not only that like if you’re having your status meeting, we’ve got robust status in the platform. So you’re not gonna have to have someone generate a status report like this is the status of all of my enrollments across the organization.
Kirby Cole (26:23) Question. Sorry. Yeah, go for it. And this is thinking through like I’m trying to think through… you know, I know that we can add in like pay dates. So can we add in the kind of, I don’t want to say any field but I mean do we have the opportunity to add custom… fields to this?
Noah Laack-Veeder (26:42) That’s usually, yeah, that’s usually done through like a there’s like the view that you have here. And then there’s kind of like these day to day operation reports that might be custom fields or whatever it might be. We can, it’ll either be a field in this or it could be like another tab you click that has that view that you’re looking for. But the answer is, yes, like we can add those custom fields.
Kirby Cole (27:04) The reason why I ask is it looks like this organization is actually no, that’s payr, you know, one field if possible, that would be awesome to add. Would be the brand itself. The actual practice name. Yeah, that way we can review. I mean, state would hit it. If it’s just state that’s fine. But practice view is what our, you know, they’re actually going to care about.
Noah Laack-Veeder (27:25) Yeah. Let me actually show you that. We do have like the practice view for both enrollments and for like the status we call those like locations. So that’s something that we have. But just high level here. All I’m trying to show you is that like you’re not going to have to go elsewhere to find this. Like this is going to be either out of the box on the screen or you’re going to click in an analytics tab and have that report. But ultimately, one of the coolest parts of medallion is that we get this data really easily. So we actually have an integration with caqh. So earlier, I think you’re going to ask your team or whatever if they have it that’s great. You can ask them if they don’t have it. That’s also okay because like you’re going to have it with a medallion. So what your providers like this is how it works. Like we can invite all your providers at once they click, get started. And from, we actually can pre populate their entire profile. So like when Michelle or whoever like it can either be Michelle or someone on your team providing that white glove service. This is already pre populated with all the information from caqh. There’s no need to populate this in the medallion like it’s just there. I think it’s just there. And the best part is if you need to update it, like you mentioned providers don’t want to log into caqh, they’re happy to give you their login, which is great. We’ll store it in the platform. Yeah.
Kirby Cole (28:55) They do. Yeah, they do all the time, yeah.
Noah Laack-Veeder (28:57) And we’re like, yeah, and we’re like, okay, give us your login if anything updates in medallion. We will update caqh automatically too. So both ways. Yeah. The other thing in doing this kind of you’re evaluating like, hey, and we haven’t even talked about like the performance, I’ll kind of give Phil some time to talk about this a little more, but to submit a new enrollment, it’s just really easy. You just click a couple buttons. You just say, hey, who do I need? Let’s do, Michelle for which group contract, whatever it might be for which payer, you don’t need to know anything about the payer? What medallion does, is as a company, we have process guides for every major payer in the us and smaller payers. Like I think our guides up to like almost 900 payers at this point. So we have automatic rules that will check applications and information and highlight where issues might arise. Ultimately. This prevents your claims from being denied due to enrollment issues. So we just have the auto checks to make sure that that’s not going to happen. Nice. And then flashing the screen, we do licensing same idea. This is a very speed run demo. You need a new license. Tell me for who? So we’ll do let’s do Michelle, she needs a new license in a state. I don’t know if she needs deas or csrs, well, if I click on this, it’ll tell you what you need by the way. So if you’re like I don’t remember CSR and deas, like at Iowa, we’ll automatically give you all the licenses that you need for this type of provider. Awesome. The value here again is just like you just tell us what you need and they’re like, okay, I already added it in submit request. Same idea with the enrollment.
Kirby Cole (30:45) Does specialty matter for that? Like that was MD doctor? Like this is just an item. I just don’t know like does ophthalmology do credentialing different than cardiology or is it always the same that’s.
Noah Laack-Veeder (30:57) a good question. It might be part of like the application packet that they highlight there. But yeah, high level thing. You’d think that like licensing means that you could be credentialed. It’s like every step is a little bit more intense. So sometimes like it’s just like you’re an MD. Great. Now, I need to know if you’re like sanctions and then I need to know if you have privileges, each of those have different checks. It’d be great if they just did them all on a license, but that just doesn’t happen. So ultimately, that’s like a very big speed run of medallion. But just going back to your process like if all of this is kind of happening piecemeal in different systems like this was one… what’s it called one source. Yeah, you can have one system that is doing all of this and you wouldn’t need to use qgenda, the excel report. And once data gets in here once we don’t need to do it again and from a provider perspective, since we have the integration with caqh and we have some robust tasking, I’ll show you if anything is outstanding for your white glove team, we’ll summarize all the open actions and then they can even do these on your provider’s behalf and they can. So we’ve organized it where if we can’t automate it, it’ll be organized so your team can quickly act on it and get it done with the provider. Thanks in.
Kirby Cole (32:26) The beginning, would we try to just type data over from qgenda or would we start completely from scratch and have all of our doctors submit?
Noah Laack-Veeder (32:33) We would want to that’s a good question sometimes like it depends on like a couple things. It could be, it could be the qgenda piece. It could also be that we just leverage caqh. It could be a combo of both. But if we get that far in the conversation, I’ll introduce you to our head of implementation so they can kind of walk you through that. So I want to pass it back to you, Phil, but from Kirby, from your perspective, and I mean, obviously there are gaps to fill in here. But does the kind of the pitch of we can do all of this? Is that landing? Yeah?
Kirby Cole (33:10) I mean, one place to kick off one place to report, one place to close down, and one place to re credential. And then all the little pieces that I don’t know enough about along the way, yeah, that’s ideal. Okay, perfect.
Philip Stefani (33:23) Yeah, really appreciate that. Wanted to pivot to kind of like what we see the impact of these process changes being and get your feedback on this. So let me share. Okay. So, you know, summarizing in very broad strokes, what we looked at in the demo. Like today, the team is grabbing information manually from providers like we would automate that process with the caqh data pool. Then your team is waiting until they have all the information for all of the payr applications to get those out the door. We would be able to submit those applications as we have the critical needs for each of those applications. So we’re doing parallel application submission and processing once we reach those payr requirements with logic that’s built into the medallion platform. So getting those applications out the door faster. This is a really important piece because what I want to highlight is we actually have a contractual guarantee in the form of an SLA for how long it’ll take to get those applications out the door. So if you request all of those applications, our contract will guarantee all of those out the door in 10 days across the 200,000 applications that we submit per year. The attainment is currently a little less than four days. So giving you just like really strong predictability as well as timeline improvements on how those applications get out the door. And then finally how.
Kirby Cole (34:44) do you deal with those metrics for doctors who aren’t ready yet? Right? Like haven’t, passed boards still in school. Do you just not start to clock until they do? That’s? What our team here is. And I don’t blame them but like they like it’s just an it’s just a, we have this back and forth on the timing. And to me that the timing like we shouldn’t hold your team accountable for somebody if they can’t give you a license or their boards especially. But there’s or they haven’t graduated. There’s a few things that I think could… skew that number higher.
Philip Stefani (35:12) Yeah, yeah. Absolutely. It’s a good call out. And for edge cases like that where you’re still waiting on the board certifications or whatever it might be, we will pause the clock because, you know, to your point that’s not something that we can control, but in terms of gathering the information that is out there and available with something like the caqh integration, I mean, we’re seeing this timeline cut down to less than two hours for complete caqh profiles. So for providers who have all that information like they’re going to be ready to go extremely quickly. So in terms of how we kind of map this out, I kind of made some assumptions based on the original conversation, but these are essentially some of the inputs I was asking for in my email so we can align this to what you’re seeing today.
Philip Stefani (35:57) But I think some of this is already aligned based on the previous conversation. So if it’s taking 14 days, call it to get all of the provider data that you need for all your applications medallion’s, cutting that down to two days for any provider. And for 95 percent of providers, it’s going to take less than two hours. It sounds like you have some edge cases where you’re waiting on those board certs. So that might change that number. We’ll want to align with you on that. But this is kind of in broad strokes, the effect for primary source verification. Yeah, go ahead.
Kirby Cole (36:27) And so I have my team, the team that I own today does this piece. And so we’re probably three to four days to get that file completed. When we’re not waiting on one of those outstanding documents.
Noah Laack-Veeder (36:38) Just.
Kirby Cole (36:39) so you, I just want to make sure that when we pitch this like that was one of the things we identified three years ago. Like, hey guys, why are we not asking this doctor every day for his shit? So that team we built out.
Philip Stefani (36:50) Okay. So.
Kirby Cole (36:51) That piece is the most efficient piece of the process.
Philip Stefani (36:55) And that’s this one up here, collecting provider data. Okay? I.
Kirby Cole (36:58) call that four days on average for us.
Philip Stefani (37:00) Okay. Three to four days?
Noah Laack-Veeder (37:02) Oh,
Philip Stefani (37:02) God, sorry, bill. I was just going to say, yeah, so you’re way ahead of a lot of organizations that we see that’s good to hear. And so it sounds like maybe then the opportunity would be on these other pieces of the process like the payer enrollment processing timeline, that sort of thing.
Kirby Cole (37:15) Yeah. And that number could take a hit because we are going to not backfill one of the three people who are doing it, which is part of the reason why I’m moving on to this role, but yeah, I mean, that is we cleaned that up and thought that would fix everything and it didn’t.
Philip Stefani (37:27) yeah. And I know on the first call, you mentioned like we’re seeing 150 plus days for full payer enrollment. Like is that average? Is that normal? Or is that like an outlier?
Kirby Cole (37:37) Their SLA is 180 days?
Philip Stefani (37:41) Okay. And that’s from when they submit an application to when the provider will be par or is that the entire process that?
Kirby Cole (37:47) Is from, when the, that is from when they have every single document required and submit into qgenda, it takes them, they’re on average 180 days that’s their SLA? Okay?
Philip Stefani (38:01) So that’s included whose.
Noah Laack-Veeder (38:02) SLA, is that qgenda’s or your team’s SLA? That?
Kirby Cole (38:05) Is the team that I don’t manage today? No, that I, in the next week, I’m going to have. So they just,
Noah Laack-Veeder (38:11) got it. Got it. Sit.
Kirby Cole (38:13) On files is probably not quite the right expression, but they’re not aggressive in the follow up and the things to get these pieces closed out.
Noah Laack-Veeder (38:20) Yeah. And that’s one thing I didn’t even cover in the demo, but we’ll we can talk more. Is that pay your follow up? We, that’s a use case. We’re heavily using the latest AI, whether it’s email, scraping, agentic, phone calls, things like that. So we are seeing the payer follow up is an area where people are doing it like one by one because of the latest technology, we’re like able to contact hundreds of payers at once. So it’s we’re really automating that process and it’s leading to really fast turnaround times. Yeah.
Philip Stefani (38:52) Perfect. Yeah, that’s a great transition. So, in terms of like.
Kirby Cole (38:54) One other thing for this metric, one of the other things to keep in mind also with the 150 days that’s also slight of hand because they’re saying it’s from when they have the entire file completed and we’re not going to be comparing apples to apples. So while what we might not be able to do is say that we’re going to close the gap because par still could take 150 days. But what we could say is we know that again medica and medicaid take 60 start billing. And these other like those things don’t happen today. That will also, so it might not be the full par number that we can close out as much, but we can get them billing somewhere or multiple places faster. So I don’t want, I don’t want you guys to lose sight of that sort of efficiency gain as well because again, they don’t start the clock until the provider data. That first step is 100 percent to the hardest thing which is what makes that timeline go longer.
Philip Stefani (39:49) Got it. Okay. So they’re essentially waiting until they have all of that information and then start.
Kirby Cole (39:54) sending the file until there’s a TB test on file. And whatever the shit is for the ascs, that is ridiculous that they don’t even touch, they will not submit the file until they have it all. That is when it drags on our time that.
Philip Stefani (40:05) Piece where they’re waiting to have everything. Is that the piece that takes two to four days or how long does that take like to get everything for a?
Kirby Cole (40:13) Provider? So that’s where the way that they report it out, they carve those days out. So like, they kind of, they’re kind of like cheating the metric a little bit. Yeah, because what they’re not saying is we could do medicare and medicaid with what we got in two days. They’re saying we can’t start medicare and medicaid until we have the TB test retaken. And so we’ve lost all those days, on the medicare and medicaid side of the house. So we say we sent you the file on time in two to three days minus the if it’s a board certification or whatever. So that’s our metric, that gap. They like to dance around it when we talk metrics. I.
Philip Stefani (40:49) See. Okay, that makes sense. And so it sounds like the delay there is just waiting for those, you know, additional pieces of the file that are maybe not even relevant for something like a medicare or medicaid?
Kirby Cole (40:59) 1,000,000 percent. Okay.
Philip Stefani (41:02) That is super helpful. So, I know we’ve just got four minutes left. I want to be mindful of time Kirby in terms of like how we would turn something like this like timeline improvements in a very specific process credentialing into like business impact for eyecare partners.
Philip Stefani (41:16) Like this is typically what this ladder is up to. And so medallion is going to deliver 99 point five percent, you know, quality reduction in error rate. And so this is going to have a couple of different impacts. We’re going to reduce the time that deferred claims from credentialing errors are spending in. Ar. We would want to quantify with you how much of your claims that is. Any claims denials from credentialing those are going to be eliminated as well because we’re error proofing these applications before they get out the door. Additionally, there’s the revenue acceleration piece, which we’ve kind of talked about, but that’s like through proactive payer follow ups, parallel application submission, error proofing those apps. We’re going to be delivering 30 to 60 percent timeline improvements there.
Kirby Cole (41:59) That’s going to be a hard one at baseline for us. So we’ll have to get creative if we’re trying to put dollars and cents behind to help the sales pitch internally. That’s going to be a little bit more of a challenge, but we’ll figure it out.
Philip Stefani (42:08) Okay. And that’s a challenge just because of like this sleight of hand that you just described, yeah.
Kirby Cole (42:12) Like like how they, so, I mean, so what we should be in my opinion, we should say is we enrolled 25 MDS this year. Every one of them, it took 150 days to get medicare and medicaid done? What percentage of their work was medicare and medicaid? That could have been done in 60 days. So they could have been seeing patients like there’s I don’t know there’s just, I don’t want to lose sight of that metric. Like there’s dollars there that are really important yeah.
Philip Stefani (42:34) 100 percent so definitely want to align with you on that. And I know you’re waiting for that team to kind of fully come under you so you can actually look at the data. So we’ll kind of stand by for that. But then the last piece of this is potentially reduction of credentialing cost. And so there’s the opportunity to free up headcount for more strategic process or even, you know, reduce that payroll spend. And I believe you said there’s 21 people doing this today. Is that right? OK. Yeah. So, yeah, that’s for.
Kirby Cole (43:00) a 1,000 providers?
Philip Stefani (43:02) For a 1,000 providers? Yeah. OK. Yeah. So that’s definitely. So.
Kirby Cole (43:07) That’s way easier. Like, so 300 is the mddo side. That is the more complicated side. They have a team of eight that does those 300 plus, call it 250 optometrists on that side of the house?
Philip Stefani (43:21) The other?
Kirby Cole (43:22) Side is 500 is just optometrists alone and that is, it’s an easier credentialing process. But there’s still a lot of shit wrong with that team.
Philip Stefani (43:32) And did you say it’s the same amount of people on both of those teams?
Kirby Cole (43:35) No. So the optimal, yeah… it’s about the same. They are divided up about equally. It’s eight and eight, eight and up. Yeah, it’s about half and half. Okay?
Philip Stefani (43:47) That is super helpful. So, yeah, in terms of what we would do once we kind of get those inputs that I sent is essentially like put numbers to this. And so I kind of made some assumptions about, you know, total claims, denials and claims write offs as well as the revenue acceleration. I can kind of walk through like how we calculate these.
Kirby Cole (44:06) I got to run my wife’s banging on the door, yeah.
Philip Stefani (44:09) No, totally understand. But this is essentially like what we would build out in terms of next steps, I’ll follow up with what those inputs are that we need. Thank you. I’ll.
Kirby Cole (44:18) save it up to the top of my files, my inbox and not read it. So I make sure to get to it.
Philip Stefani (44:24) Do you think like by next Thursday would be fair for going over those pieces?
Kirby Cole (44:30) Let me see the request. Again. I’m not having these conversations until Thursday morning with the impacted teams.
Philip Stefani (44:37) Oh, that’s right. And.
Kirby Cole (44:39) So, they’re going to think it’s really fishy if I’m poking around for some of this data. Yeah, I don’t want to. So maybe a little bit longer than that, maybe like mid next week. So what I would really, yeah, I think that would be safer so that I can ask the hard questions.
Philip Stefani (44:59) Yeah, that makes sense. I can put a touch base maybe for like this same time on Tuesday the 30 first, it’s like a week and a half from today, and then if we need to move it around, we can, does that work?
Kirby Cole (45:12) What time is this? Was it 11?
Philip Stefani (45:15) Yeah, this was at 11.
Kirby Cole (45:17) Can we do 11 30? Yeah, absolutely 11.
Philip Stefani (45:22) 30 that’s Tuesday, the 30 first. Okay. Cool. Any other questions before we go? I know we’re out of time. Yeah.
Kirby Cole (45:31) They’re literally going in and they’re logging in to caqh… walk through each section listed in caqh with the provider to ensure all the information is accurate and updated as much as possible. So, yeah, it’s very manual. Okay. That’s what we figured. But, yeah, thank you so much for getting that information.
Philip Stefani (45:52) Perfect. Well, yeah, I know we’re out of time. Really appreciate it.
Kirby Cole (45:55) Yeah. Sorry. Thanks so much Kirby all good. Nice to meet you. I don’t want to get in trouble. All right. Talk to you guys later. Bye guys.