Transcript
Jake Shubert (00:00) hello?
Samantha Bouchard (00:01) Hey,
Brent Koskosky (00:03) we.
Samantha Bouchard (00:03) meet again?
Jake Shubert (00:05) Thought we do. I’m sure demoing and stuff while you’re sick is your favorite.
Samantha Bouchard (00:13) Oh, my gosh. I just hope I don’t sound like a, at least we’re not like in an office together, like remember, like the office days and like your co workers come in so sick and you would just be like, yeah, my God.
Jake Shubert (00:29) That was like maybe my biggest pet peeve ever. It’s like people who come into work in the office while sick. It’s like no one. No.
Samantha Bouchard (00:37) One wants to be here. You can just hear them sneezing and like swallowing their nose.
Jake Shubert (00:42) Yeah, it’s the best. It’s the best also, I guess before they hop on since they cut to 30 minutes. Should we do just delegation for the demo today? Obviously, we’ll see how fast it goes, but, yeah.
Samantha Bouchard (00:57) Let’s just plan on that. And then, because I think they’ll have a lot of questions. So, yeah, we can get into PE if they want.
Jake Shubert (01:04) Cool. And here’s, Brent a lot of men.
Samantha Bouchard (01:12) I got my medallion coaster out Jake.
Jake Shubert (01:17) I don’t use any of that stuff. Unfortunately, the most recent swag bag was not the best. Hey, Brent, how’s it going? Good?
Brent Koskosky (01:25) How are you doing?
Jake Shubert (01:26) Doing good. Me and Sam were talking about medallion sent like, you know, some like gifts to all the internal employees, and usually, we get really great stuff, and we got some good stuff earlier this year, but the most recent thing was like this kind of coaster no one wants. And then like a candle that has no scent. And yeah, I just, I don’t know what to do with that. Yeah.
Brent Koskosky (01:52) Yeah, you’d have to hold on to it a long time for like a white elephant gift, but,
Jake Shubert (01:57) there you go. Yeah, hold it till December. Yeah, it.
Samantha Bouchard (02:00) Is funny though a candle with no scent, I’ve like honestly never heard of such a thing.
Jake Shubert (02:07) Yeah. Also, Brent, am I remembering correctly? Were you traveling at all recently?
Brent Koskosky (02:12) Next, tomorrow, I fly out.
Jake Shubert (02:15) Tomorrow, I forgot. Where are you going?
Brent Koskosky (02:17) I’m going to Florida.
Jake Shubert (02:19) Nice a little vacation or?
Brent Koskosky (02:22) Yeah. With my family.
Jake Shubert (02:23) Where in Florida?
Brent Koskosky (02:26) It’s called Panama city beach, okay?
Jake Shubert (02:28) Sweet. I was asking because Sam’s actually, well, you’re doing a disney trip, Sam next?
Samantha Bouchard (02:33) Week, yeah, next Friday, hopefully, the good weather continues, looks like it’s going to be nice weather, right? Brent.
Brent Koskosky (02:40) Yeah. My wife’s been tracking it over the past few weeks and it’s been, it’s improved week over week. I just have to, we fly out at seven usually like right near Wisconsin. Usually we go to Milwaukee. Yeah, it’s a smaller airport and you can just freaking walk on the plane. Yeah, but we’re going to o, hare and, you know, tsa, lately, we’re going to leave here at like three a. M. I don’t I like, I don’t know, we even like reserved parking at the airport and everything. I just like overabundance… of caution trying to get out of here.
Jake Shubert (03:14) I’m the same way I, so I live in Portland, Oregon, and our airport used to be kind of the same way you’re describing Milwaukee. Like it was security was super quick. You just watch there 30 minutes for your flight, get on the plane. You’re great. And they did a big renovation project at the airport. And now it’s like stunning. The airport is beautiful, but it’s 10 times less efficient than before. Like I now have to actually like properly plan for my flights. And, yeah, it’s a bummer. I prefer the uglier but more efficient airport.
Brent Koskosky (03:45) I pull.
Nicole Campbell (03:47) In the, I also live in Portland, Brent, so Jake and I are very close but I definitely have done recently, AKA last week got to the airport 25 minutes before boarding and just.
Jake Shubert (03:58) I.
Nicole Campbell (03:59) mean, and it worked out fine, but I definitely cut it way too close in Portland because I get way too comfortable and I’m just like just stroll in. It’ll be fine.
Samantha Bouchard (04:09) That is like driving with two Miles on empty when there’s no gas station in sight Nicole.
Brent Koskosky (04:18) Yeah. I used to work for, I went to Illinois state and I used to work for the football team and we literally walked on the tarmac in normal Illinois onto like a two row plane and it was like an 80 seater and we all just held on for dear life. It was fun. I was in college, so I.
Jake Shubert (04:40) was about to say that sounds pretty great. And I think matt will be joining us today too. Is that correct?
Brent Koskosky (04:46) Yeah, we should, we can probably just start without him. Okay? He’s got some stuff that came up. Yeah.
Jake Shubert (04:53) No worries. We can do that. So, I know we moved the call from about an hour to 30 minutes. Also wanted to ask, did you have a hard stop at the hour mark?
Brent Koskosky (05:00) Brent? I do. Okay. Yeah.
Jake Shubert (05:02) No worries at all. What we’re going to do is kind of condense the plan that we had for today because obviously, we have half the time then whenever we don’t cover today, happy to meet, you know, whenever you’re back from pto and, you know, sort of cover the rest of the topics. So our plan here, the main gist of today’s call is to do a demo of our platform since we didn’t get to do that last week. We just have one slide that we want to share before the demo to sort of help explain about kind of what the path to delegation looks like even before you work with any sort of vendor to make sure we’re trying to be as like consultative and helpful as possible. And then we’ll jump right into a demo of the platform show you sort of the delegation cbo credentialing side. If we have time, we could show some other parts of the platform, but my guess is with like 20 minutes, we might not be able to get to that. But like I said, we schedule next steps for next week or the week after that sound pretty good to you. Yep, that sounds good. Okay. Cool. Well, let me share my screen then. Cool. Can you see this? Okay? Brett? Yep. Okay. Perfect. So like I was sort of mentioning in the interest of being a good partner and trying to be like as consultative as possible. We wanted to share the best practices for what you, matt and the whole team can work on in parallel to evaluating us or any other vendor that you look at. So just to be clear, like you don’t need to wait on an evaluation or any sort of like vendor decision before you start doing the things you’re going to see on the bottom left of the slide. And we’re obviously happy to help work with you on these steps too and help where we can. So I want to touch on these real quick. And then Sam, if I’m missing anything definitely please let me know. But here are the two main things to call out. Brent. The first is getting an npdbid which is a great acronym to say. I encourage everyone to say it at least once out loud. It really rolls off the tongue. But getting an npdbid. This is a requirement for a delegation, it sometimes can take a bit of time to achieve and starting the process as soon as possible is really going to help streamline things downstream, help cut down on the time overall, it takes for you to get delegated because you guys because soar, does have high level providers on staff like MDS, you should have no problem getting an npdbid starting that process was definitely something we would encourage on the second piece, we talked about this last call but it’s just beginning to reach out to your payers and see which ones are open to soar, pursuing delegations that from there, we start understanding requirements. You guys can sort of know what the scope of work looks like here’s. Matt. And then really we can jump into things, you know, whether it’s with us or anyone else sort of full steam ahead. Those are really the two points of topic. Hey, matt. How’s it going?
Matthew D (07:45) Hey, Ron, thanks for the flexibility today. Sorry about that. It’s been a, our CEO is out sick for the first part of the week. So everything just got pushed, no.
Jake Shubert (07:53) You’re totally fine. Just sort of the brief 30 second like tldr of what you missed on the call was not much.
Jake Shubert (07:59) We’re just going to condense the plan we had for the call today. Since we only have about 20 or so minutes. So we’re just going to jump through only this one slide. And then we’ll do a demo of the delegation parts of our platform. And then we can set up some time for next week or the week after to jump through other pieces of the demo, pricing estimates and things like that. If that sounds good to you, matt. Cool. Okay. And then here, matt, the only thing that we talked about on this slide that you missed is just we wanted to call out things that you guys can be working on now without sort of making any evaluation decision on a vendor that can cut down your delegation timeline. So we’re trying to make sure here we’re being like consultative for you guys and helping out where we can on sort of the pre delegation process. So, Brett, yeah, it’s really this npdb id and then reaching out to your payers. Any questions on either of these steps, Brett or matt?
Matthew D (08:49) The one thing I thought I’d heard about. Okay. Yeah, the forming of the committee that’s the thing is like how, where do you find? Like the requirements for what the committee needs to have? Is that or is that something that we work with you guys on?
Samantha Bouchard (09:02) Yeah, we have some committee structure guidelines that we will provide to you, matt, and can certainly like support that process.
Matthew D (09:13) Cool. And then is there and is there like a requirement for like having that be done for like several iterations? Is it like a monthly iteration, a quarterly, a yearly? Like what’s that, what do you typically see from payers on those requirements?
Samantha Bouchard (09:27) Yeah. So that’s really going to vary like payer by payer. It’s really going to be sorry, my dog’s barking. It’s really going to be all inclusive of like… the audit like the files in general, right? So they’re going to, they’re going to back check your files that you’ve worked with to ensure like everything is to ncqa standards. And then they’re also going to like, you know, check that like that went through like the proper committee process which we’re going to have all audit, you know, traceable through the platform which I can show you in a minute. Cool. Yep.
Jake Shubert (10:07) And, yeah, you’ll see the committees too when we should do the demo today as well. So that should be, that should be helpful. And on the npdbid part, like I called out earlier, matt is like the core requirement there is having high level providers on staff like MDS. I’m pretty confident that is the case for soar, but, you guys have some MDS that you employ, is that correct?
Matthew D (10:26) We, from a, and sorry, what box am I looking at here for?
Jake Shubert (10:30) That? Oh, all the way bottom left?
Matthew D (10:32) Bottom left. Wait, the npdb id allows that one. Yeah. And wait. So, what, what’s the purpose of an MD there? Yeah.
Jake Shubert (10:42) So, for npdb id to get approval for that, typically, one of the requirements that’s needed is having like a high level provider on staff?
Matthew D (10:51) Gotcha. Yeah. Well, our CEO is an MD, so that actually probably.
Jake Shubert (10:55) Checks the box. Cool. Yeah.
Samantha Bouchard (10:57) I think, that same requirement like applies to the committee as well, matt. So like there needs to be like he would likely head the committee as well, but we’re going to show you in the platform like how we make voting and review, and all of that super straightforward. Yeah, so.
Jake Shubert (11:14) Yeah. The purpose of the slide was just to show some of the things that can be done independently to help streamline the delegation process and cut down the overall timeline. I guess matt and Brent, like is sort of reaching out to npdb and reaching out to some payers, is that something that you guys would be, you know, open to doing in the short term so that from there, we can understand what the requirements are going to be and sort of, you know, make this process smoother overall? Yeah.
Matthew D (11:36) I’d maybe not like this like Brent and I have spring break and then I want to talk to our CEO on this, who I reported to just on like, this whole thing and so, and he’s out the following week. So if we did this, it might be like kind of a lull until the start of April, but I think that makes like starting around then like, perfect sense.
Jake Shubert (11:55) Cool. I thought that sounds great. Without further ado, I will pass over things to Sam to jump into a demo of delegation in our platform.
Samantha Bouchard (12:03) Cool. Yeah, thank you. Can everybody see the screen? Okay. Awesome. So we’re landing here on our provider directory. This is really our core platform that we use to collect all the data that allows us to then, do you know these downstream end to end functions, we can spend more time on this and kind of circle back to like what our provider onboarding looks like and all of that at a future call as well as like our analytics and our reporting capabilities, but just in the interest of time and where we’re heads down on the delegation topic. I just really wanted to really show you how we handle the delegation credentialing directly in our system. So if we look here at our credentialing module, this would be where a member of soar, would come, one of your admins and what they would do after they’ve been onboarded and hired and you’re kind of starting the payer enrollment process is, they would also initiate a provider for initial credentialing. So they would come here, select the provider that they’d like to get credentialed hit, submit requests. And from here, we are going to run them through our primary source verifications to ncqa standards. So what we’re doing is… once your team makes that request, matt and Brent, their work ends and medallion’s really going to take over automating the primary source verifications to ncqa standards. We’re going to create the ncqa packet. And then downstream, we’ll look at the committee function. And then downstream, we would provide those rosters for you in the agreed upon payer format that goes ahead and gets that provider enrolled. So you can see here right out of the gate, we’re going to, you know, start to have direct connections with the primary sources, pulling some of those back instantaneously. Some take a minute or two. With ncqa. We do have a human in the loop that will review all of the files for quality assurance. The file once complete is going to move into this ready bucket and you can see that we’re going to give you visual cues if anything has an alert. So like if npdb was flagged for some reason… we would notify you of that. And then your team would come and decide like which committee it needs to go to. So, typically, our clients will have a clean committee where the clean files just kind of go through and get a quick vote. Others would have needs review if there was a sanction or something that needed to be reviewed in more detail. We’ll send this over to our clean committee. And from here, your committee so whether that be your CEO and some supporting team members can quickly come and view asynchronously. So they’re gonna have access to the file directly here. You can also download a copy. But there’s going to be, you know, all the information about the items that we checked, validating, their npi. It’s going to be their npdb is going to be linked really. Any information, just confirming that the provider is who they say they are, is all going to be nicely stored here. And what this really means for you is that when your delegated partners ask, you know, to kind of confirm that delegation at the time of audit, they’re going to say, give me these files that’s when you can work with medallion, we can download it. All of it’s. Going to be audit traced, audit. Trackable. So it’s going to support all of their requirements from like a policy and procedure perspective. They would have the ability to vote and approve typically for the clean files. It’s like, approve, right there’s. Really nothing that needs to pay attention to. And then it will sit in our closed bucket here. So again, for just like audit and compliance purposes, you’re going to have an outcome date of every single file that went through the process. And this outcome date would be the date that it was voted on by your committee. And this date is extremely important because that’s the date that your payers are then going to backdate to. So when we talk about payer enrollment and you have the… this is where medallion is going to produce that ncqa accredited file in on average one day. We’re going to get all of those primary sources done. We’re going to commit to a three day SLA, and then you all have the ability to come in here, make that vote. That outcome date, gets placed on the roster and then the payers are going to backdate to the outcome date listed here absolutely. And.
Matthew D (17:09) So, can you actually pull open again? Just the files that are like the documents that you all do collect? Yeah… attestation, orchestrate, defensor. And so like I’m just seeing on there, is there education and training, can you just click on that one for a moment? How do you, where do you, where do you, so you pull that from the ceqh profile?
Jake Shubert (17:30) You’re saying?
Samantha Bouchard (17:31) Yeah, we’d pull it from caqh, and then we would validate it through an ncqa approved validation source. So like student clearinghouse is like a common one that we would validate, that education. So.
Matthew D (17:47) We like, one of the things that I’ve noticed is that like even licenses as well, like not every pay provider we have like… pay like they, we don’t manage their ceqh profile. They do. And not every person upload the licenses or like education like diplomas et cetera, to that to their ceqh profile. And so like what happens in those instances?
Samantha Bouchard (18:12) Yeah. So we.
Matthew D (18:14) can’t control for that. And then like, you know, we’re kind of in this slog now, just like chasing the individuals down and it’s like the long tail that takes so long, yep.
Samantha Bouchard (18:22) So we’re gonna have our individual profile that’s gonna highlight anything that is needed to complete the file if something like that is missing. Like typically, we can just come to the student clearinghouse and do a search for their education like with their name and npi number. And so that’s gonna be enough to validate it on ncqa standards. Same with the licenses. We’re able to do checks like directly with our API to various like licensing sources. So you don’t necessarily, this is like a test environment you don’t necessarily need like a copy of their degree per SE. It would really just be that like it’s showing up on the student clearinghouse… which yeah, most of the education will.
Samantha Bouchard (19:03) And then we have a couple others that we can check as well to produce that result. Gotcha. Yeah. But good question. Yeah.
Jake Shubert (19:11) And then also not to come across as like the used car salesman Guy, but just for what Sam was saying about the credentialing SLA with three day SLA, one day average, we are the only vendor who offers that. So the three day SLA and one day average is.
Matthew D (19:25) pretty.
Jake Shubert (19:26) Unique to medallion. A lot of it is because of sort of the API connections that Sam just tied into of getting that data up front. So just want to make sure I mentioned that.
Samantha Bouchard (19:34) Yeah. So like we’ll come across other prospects matt and Brent who like might be checking these manually and to produce like an ncqa accredited file can almost take up to 30 days. So with our caqh integration plus the integration directly with these primary source verifications, we have that three day guarantee as Jake mentioned, which ultimately streamlines this process significantly and then reduces that par date, drastically from like a standard payer enrollment, which it sounds like you guys have a good grasp on. Cool. So curious, matt Brent, like not knowing much about, you know, the delegated cred part or our platform, like was this what you expected to see? Did anything, does it seem like easy enough to use and adopt into your current tech stack? I.
Matthew D (20:31) Do I’m wondering because like this would be done for a subset of our payers? And so then the question becomes like, how do we kind of like get data out of here to link with like our broader system that would track that? And I’m curious, do you guys have like an API connection that would allow us to pull, you know, pull out from here into like our ecosystem to kind of have these confirmations all in one place that we need to kind of power the rest of what we do from a billing side as well?
Jake Shubert (20:57) Yeah, we do. We have a fully open API and not to get ahead of ourselves, matt Brent, but if it’s helpful, we could even share our API docs if you want to look at them.
Matthew D (21:06) Sure. I mean, honestly, I’d love to take a look and then the, is it bi directional? Yes. Yeah, we could like hook up the HRS. And yeah, that’s actually really cool. Okay, good. I didn’t think I asked that Brent. And then the other one is I asked in the last discussion like there’s like the biggest payers that are kind of the most painful specials though that are like center level. And I’d love to get those into here. The biggest one that I’m thinking of is health first Colorado. It’s the state run medicaid program. So it’s not an mco. And I’d asked if you guys would be able to look into seeing if that would be some like someone you’ve worked with in the past for this?
Jake Shubert (21:45) Yeah. And so, matt, I did do a little bit of research on that ahead of the call, the question I had because it does sort of change things a little bit is like when you’re asking about health first, Colorado, are you specifically asking about our experience with them doing non delegated enrollments or are you asking about like if delegation is possible with them?
Matthew D (22:04) The latter to start? Okay?
Jake Shubert (22:07) My understanding on the.
Matthew D (22:10) Second.
Jake Shubert (22:11) Piece of if delegation is possible with them, is they are like a managed medicaid, is that accurate?
Matthew D (22:21) They’re not like a they’re not like a they’re not, I would say no, like, they’re not like a they’re not like a mercycare who’s like doing like managed medicaid on behalf of the state and like commercial plans, like they truly are like just that all they do is medicaid for the state. Like they are a state entity doing medicaid for the state.
Jake Shubert (22:38) Yeah. Okay. Sorry. I phrased that question poorly. I guess like Sam, my understanding of the delegation process for medicaid specifically is that is not something that can be approved because it’s a government payer. Sam, is that your understanding as well? Yeah.
Samantha Bouchard (22:57) So, today, matt, medicaid and medicare do not offer delegation however, like if you get delegated with a blue cross and they have like managed medicare plans, it can trickle down to those enrollments.
Matthew D (23:13) And that’s a lot of what we do in Arizona. I think Pennsylvania is set up that way too, if I’m not mistaken. So. Okay. And then the other question for you on this is tied to… oh my goodness. Oh, you mentioned like backdating effective dates? Like most payers do not allow that for that today. Like why is it that? Like this is different where they actually allow like the backdating?
Samantha Bouchard (23:41) So, it’s not technically a backdated because of the way you think about it. If you do a typical payer enrollment by the time they’re getting your application, they’re running an ncqa file on your providers at the payer level. And then that file is going through a committee. And once they get that committee date, that’s really what aligns to your par date. And so by you becoming a delegate of that payer, they’re saying when, you know, we trust you to perform this to these standards. And when you approve this file, that’s your par date. And so, yeah. So technically it’s just, you know, you are all taking on that function on their behalf. So like back date probably isn’t the best term because essentially it’s like it’s just by the time they get the roster is like you said the roster?
Matthew D (24:30) Once.
Samantha Bouchard (24:31) a month, but, you know, that if you approved it on three two, that you can start like you can hold the claims until they obviously get that roster. But like everything after three two is going to be approved.
Matthew D (24:43) Yep. I got you. Cool. Well.
Jake Shubert (24:46) I want to be respectful of time, matt, those are great questions. What we had originally planned for the back half of this call was doing the rest of the demo, which is going to show how non delegated enrollments work as well as provider onboarding. And then also maybe talking through some like pricing estimates, sort of evaluation criteria, things like that. You mentioned Brent, I know you’re going out of office to Florida and matt, you mentioned like spring break would reconnecting end up next week or the week after? Like when would be sort of the best time for us to do the rest of the demo and have that conversation? Yeah.
Matthew D (25:16) Yeah. I don’t want to drag this out either. So I appreciate you asking. I’m happy to connect. I don’t want to like overbook myself just because half week next week is the week of the thirtieth too far out for you guys.
Jake Shubert (25:29) No, that should be okay.
Matthew D (25:30) Okay. I mean, I think sometime in the week of the thirtieth, like I can tell you my Friday academic week actually is very open. So I’m happy to do Friday again if that works for y all and we can do the same time?
Jake Shubert (25:40) Yeah. So 11 pacific 12? Yeah, actually, that works for us. Let me just double check with Sam’s calendar. Yeah, that actually should work. So we’ll do the same time on that’d. Be April third. Yeah.
Matthew D (25:49) Cool. And I appreciate the flexibility today. I apologize for kicking this down a bit more. Oh, no.
Jake Shubert (25:54) You’re totally fine. And I guess just Nicole while you’re on before we jump, any other questions you have from your side that we’re missing? Yeah.
Nicole Campbell (26:02) Nothing, no, like top of mind questions. I think one thing especially because like we really want to help be good consultants and partners long term when everyone’s back in office like CEOS back in town, if there’s any off sites that make sense for us to align to where you’re having leadership conversations, we’d be happy to come out and have these conversations in person with the team as well. So, I want to just put that for matt and Brent as a bug in your ear as you’re thinking of like April and beyond. So maybe we can start to align. Yeah.
Samantha Bouchard (26:32) Sounds great. Cool. We’ll.
Jake Shubert (26:35) also note over the invite for the third, Brent, have a great time waking up at three a M and going to o hare, but I hope that I hope your actual vacation’s great. And if any questions come up in the meantime things you need whatever it might be, just let us know as always.
Matthew D (26:48) Cool. Yeah.
Jake Shubert (26:49) I think that’s pretty much it.
Matthew D (26:51) Cool. Thanks for the time y all. And I’m looking forward to the next discussion.
Jake Shubert (26:54) Yep. And also note over the API docs too. So I’ll.
Matthew D (26:56) do that as well. I appreciate that. Thank you.
Nicole Campbell (26:58) Have a great trip. Bye.
Jake Shubert (27:00) Bye.