Transcript
Jake Shubert (00:00) hey, Sam. Oh, you’re on mute?
Samantha Bouchard (00:08) Hey, how’s it?
Jake Shubert (00:08) Going, it’s going good. They’re both here. So I’m going to let them in. Awesome. How are you feeling?
Samantha Bouchard (00:16) A little bit better. I sound pretty rough though.
Jake Shubert (00:20) Yeah, not as bad as yesterday though.
Samantha Bouchard (00:23) On the mend on the upswing?
Jake Shubert (00:25) Okay. That’s good. Yeah. Hey, Tanya. Hey, worth how?
Worth Williamson (00:30) Are you? Hey, happy Friday?
Cuffie-Farley,Tonya (00:30) Hi. How are you doing?
Jake Shubert (00:32) Happy Friday. Happy.
Samantha Bouchard (00:33) Friday.
Jake Shubert (00:34) How have your weeks been?
Cuffie-Farley,Tonya (00:37) Busy.
Worth Williamson (00:37) Yeah.
Cuffie-Farley,Tonya (00:39) How about you?
Jake Shubert (00:40) Same here. Any fun weekend plans coming up?
Worth Williamson (00:46) Not really… just.
Cuffie-Farley,Tonya (00:50) Hanging out with some of my girlfriends.
Worth Williamson (00:52) Watching some hoops?
Jake Shubert (00:53) Nice worth. Are you a unc fan? Are you?
Worth Williamson (00:59) Where do you fall from both? My team in Georgia? I went to Georgia undergrad and then unc grad school. So, I’m over two. Yeah.
Jake Shubert (01:09) I was going to say yesterday was not ideal. Yeah.
Worth Williamson (01:11) Georgia got boat raced last night. I’m glad I didn’t stay up for that.
Jake Shubert (01:14) Yeah, I didn’t watch the game. I saw the score and it seemed like it was never even competitive. No, yeah, that’s tough.
Worth Williamson (01:21) And then Carolina looked like middle school church ball, the last part of the game, I.
Cuffie-Farley,Tonya (01:28) Mean, it was terrible.
Jake Shubert (01:30) Yeah, that game, I did see and I mean, yeah, that was, you guys were up like 15, 19, something like that?
Cuffie-Farley,Tonya (01:37) 19. Yeah.
Worth Williamson (01:38) Yeah, biggest comeback ever.
Cuffie-Farley,Tonya (01:40) Wow. I realized that it was worth. Rodney was just yelling at the television. I mean, he yelled and he yelled it’s not working, Rodney, they can’t hear you is.
Jake Shubert (01:52) That, your husband Tanya.
Cuffie-Farley,Tonya (01:53) Yes, he was so upset. He was so upset.
Jake Shubert (01:57) I gotta admit, I will do the same thing for my sports teams too. I somehow think that I can have an impact and it hasn’t worked yet. But maybe next time that’s funny. Did you fill out a bracket at all Tanya.
Cuffie-Farley,Tonya (02:10) He probably did. But his main thing last night was, yeah, he’s probably on a chopping block now. I was like, my goodness. I said, just go to bed. We don’t need a man getting fired but they are talking about it. I was like, wow, I.
Jake Shubert (02:28) can’t say, I’m surprised after yesterday? Awesome. Well, thank you both for hopping on for today’s. Call. We set up 45 minutes. Does that work for the two of you?
Jake Shubert (02:40) Still? Yeah. Okay, perfect. Well, our agenda is pretty straightforward. Let me share my screen sort of what we’re thinking about is if you remember when we met last week, we started showing the demo of our platform. We walked in pretty good detail throughout the provider onboarding workflow, but weren’t able to get to hospital applications or the actual like payer enrollment piece.
Jake Shubert (03:03) So we’re going to spend the vast majority of today’s call just jumping right into that before we did just, I think Sam had a couple of questions on sort of your processes like the process map that we had built out. So for call flow, I think I’m just going to pass it right to Sam, make sure she can get the question that she has answered. So we can best inform the demo. We’ll go right into the demo from there. And then I did prepare like a little bit of a turnaround time analysis based off of the turnaround times you guys have shared with us and thank you, Tanya for that. So if we have time happy to go through that as well. And then to end, we can talk through any next steps. And, you know, what the best path looks like from here. Does that seem like a fair plan?
Cuffie-Farley,Tonya (03:40) Absolutely. Cool.
Jake Shubert (03:42) Tanya, was there anything else that you guys wanted to add to that agenda or anything that I missed?
Worth Williamson (03:45) No, that’s good. And then, you know, if you could just… yeah, maybe in that next steps just kind of an overview on pricing and all that kind of stuff. Because I’ve seen some stuff that it’s more kind of per provider per month or, you know, how does that work?
Jake Shubert (04:04) Yeah, that’s a great call out. We could totally go through that work when we get to next steps. Yeah.
Worth Williamson (04:10) But at least what I’ve seen it’s very different than what we’re used to. So.
Jake Shubert (04:15) Yeah, from my understanding of like credit streams, pricing models and stuff I think we price with like a different model. So definitely want to make sure that we review that, right? Cool. Well, I guess Sam, I’ll sort of hand the keys over the car to you and we can jump into the process map and the demo from there.
Samantha Bouchard (04:32) Sounds good, Jake. I hope it’s a really fancy, nice new car.
Samantha Bouchard (04:40) You’re handing over the keys. Hey, Tanya. Hey, worth. Hi, you should be able to see my screen. I got a little bit of a cold going on but I sound worse than I feel, which is good. So well, if I have to cough, I’ll go on mute. So, Tanya, based on everything that you provided me last week that we chatted, I sort of cleaned it up into one of our swim Lane diagrams. So really broke down the actual areas where we have like the human intervention. So bucketed you and your team under cred specialists. Then we have provider interaction. And then I put C suite here just for that one step when you have that spreadsheet going to your, you know, CEO and coo for approval. So just kind of want to walk through this… see if I captured everything correctly, make sure I have a solid understanding of your process and if I missed anything, please chime in. So I’ll kind of zoom in on this. So essentially your provider accepts the offer, you all send them an email with the link. They’re going to enter that information into the link. Is that like just a shared folder? I was curious what that link led to?
Cuffie-Farley,Tonya (06:07) It leads to like they’ll we’ve already built their profile and Healthstream and that link takes them straight to that. Okay?
Samantha Bouchard (06:21) Got it. So at that point, your team’s going to review the data, identify any gaps. If there are gaps, kind of circle back to the provider, like send them an email provider addresses gaps. So far. So good. Yes. Okay. So then the next step you all are doing is checking… to see if caqh is updated. If it’s updated, you’re populating that spreadsheet for C suite. If it’s not updated, you’re going ahead and updating caqh and then sending that. So I’ll pause here, but we captured that this whole process typically takes around two weeks. You aim to have it done in like a week and a half. But sometimes just given the providers, it can take up to two weeks. Yes. Okay. So question I had about this spreadsheet that you’re being sent. Now that’s not like any type of committee approval, Tanya, saying like this provider like has the credentials to be able to get privileges, right? It’s really just them telling you the locations?
Cuffie-Farley,Tonya (07:47) Yeah, it’s not about any committee approval. Okay. Yeah.
Samantha Bouchard (07:53) And have you ever run into a situation?
Worth Williamson (07:57) Yeah. So we’re not like a payer or a facility with like a credentialing committee or anything like that. So we’re I mean, we’re dealing with the facilities and the hospitals and stuff like in those sorts of things.
Samantha Bouchard (08:12) Yeah, I didn’t think so. Worth, but I was just curious if there was anything additional that they were reviewing on that because typically, what we’ll see for some organizations that do hospital applications is they’ll run almost like a pre app even before they hire the provider with, you know, license checks. You know, obviously, you’re doing a background check as part of HR, but they might check like oig, Sam, npdb for any sanctions just so that, you know, when it goes to the hospital and then they run the joint commission credentialing on the provider to give them privileges like, you know, that they’re going to pass those. So, I was just curious like I know I had asked this previously and it didn’t sound like you were all running any primary source verifications, but I just wanted to double check Tanya, if like HR was potentially running any of those at the time of hire.
Cuffie-Farley,Tonya (09:06) I don’t really know what HR does, but when the providers come on board and we’re speaking with them, we do ask that question, you know, are there any claims out there that we need to know about? Because surely, as you’ve stated once it goes to the facility, if we check, no, and it is, then you have a big interruption. So that is a discussion that we have with each provider before we send the pre application out to the facility, be it novant or atrium or whomever else.
Worth Williamson (09:39) Yeah. And I think, our compliance department does the data bank checking and all that before they send an offer and all those types of things.
Samantha Bouchard (09:51) Okay. That’s helpful to know just because that can be something like automated in the process with medallion. So like kind of back to this provider accepts offer letter. We could potentially automate some of those checks worth rather than have having them check manually. So, yeah, just wanted to kind of circle back on that, but it sounds like, you know, all of that’s happening probably like around or before the time of hire, making sure the provider is who they say they are. Tanya’s, doing an additional check, making sure that they don’t have any open claims. So she’s not incorrectly answering the paperwork. You’re sending this to the spreadsheet, this spreadsheet to your C suite after you get that malpractice and they’re going to approve those additional locations which can take around one to two weeks per discussion. And then from there, Tanya, your team is submitting that pif, waiting for the real application to come through and then completing the hospital application, and then in parallel, kind of starting that PE process for the hospital application like this, submitting. The pif. Obviously, you’re waiting for the real application to come back. But if you had to estimate Tanya, how long would you say that these three steps are taking?
Cuffie-Farley,Tonya (11:17) It really just depends of course, how early we send the pif to them, they’re gonna look at the effective date of the provider, and that’s how they determine when they’re going to send the real application. So if we send it to them way in advance, it will wait. But like let’s just say because we’re trying to get all the paperwork out, at least, you know, three months in advance if we can. So they’re always gonna look at the effective date of the provider and that’s how they determine when they’re going to send out the application to the provider?
Samantha Bouchard (11:54) Okay. Yeah. That makes it really hard to estimate them. So you’re doing this around 90 days ahead of time. Okay? And then, so you’re completing that hospital application and then manually populating the payr enrollment applications, filling out the portals, submitting the applications, and then following up with the payr for par status. Are you all calling or emailing or checking portals on par status or are you waiting for them to send you the notification?
Cuffie-Farley,Tonya (12:31) No, we’re doing all those. We’re following up by calling checking portals, emailing. We do all the above.
Samantha Bouchard (12:39) Okay. So that must take a pretty significant amount of your time. I would imagine.
Cuffie-Farley,Tonya (12:44) It takes time. Yeah.
Samantha Bouchard (12:49) Okay. And then you’re waiting on those, the hospital to reply with the privileges, getting that par status, anything that I missed here?
Cuffie-Farley,Tonya (12:59) I’m following up with the hospital as well, you know, just like give it over to them and just wait on them. There’s follow up that has to be done with them as well. Okay?
Samantha Bouchard (13:18) And for the payer enrollment, just like submission… the like populating the applications, getting them all out for a single provider kind of, you know, outside of like the payer turnaround times, what would you say that time frame is if?
Cuffie-Farley,Tonya (13:38) Everything, I mean, if it’s a totally, if we have everything we need for the provider, and we could just go ahead and do everything. I would say, it would probably take around… three to four days to get everything out. We would just take one, one perfect provider and, you know, submit all of their paperwork because some of the papers, it’s not even paperwork, but we’re usually submitting everything online. But certain carriers have to wait for you to get an approval from another carrier before you can send it out. So there’s some time frames in there where you just have to wait like to get the medicaid approval before you can send out, you know, different South Carolina medicaid, they want you, we need a North Carolina medicaid done first. It’s just certain order that it has to be done in.
Samantha Bouchard (14:32) Yeah, absolutely.
Jake Shubert (14:34) And Sam, we only have four minutes for today’s. Call. I want to make sure we don’t have to rush through the demo. Yeah.
Samantha Bouchard (14:40) You can.
Jake Shubert (14:40) Go, yeah, maybe we can just jump into the platform, Tanya and worth, I want to see if you guys have any questions before we jump into that?
Samantha Bouchard (14:47) Yeah. Let’s switch over and Tanya. Thanks so much for just walking me through that. Just wanted to make sure I summarize that really clearly after our conversation last week. So can everybody see my screen now? Yes. Okay. Awesome. Great. So as Jake mentioned last week, we covered medallion core.
Samantha Bouchard (15:19) So this single pane of glass for all of our data management, we looked at the Dea expirations, the additional monitoring, how we’re tracking all of that information, really making it seamless for you, Tanya. So that you never have to wonder like is something going to expire? And you have that clear visibility. We showed you how we onboard providers really seamlessly through our caqh integration, taking down that overall onboarding time from on average one to two weeks to two days. And I think one thing that came up from that conversation was just, you know, you were really impressed with how we just need that caqh id and how that would significantly decrease a lot of the time it would take for the additional practice mergers. So like the one that you’re working on for July. And then we talked about caqh management and how medallion can support taking on those attestations, making sure caqh is up to date. So, you know, as worth has mentioned really taking away some of like the busy work so that you and your team can really work to like your highest level. And then lastly worth, we looked at our analytics and our report builder, how we’re able to like export that data really easily. And I know that really jumped out to you just from, in comparison to credstream and some of the challenges you all have with the data access? So was there any questions on like anything we did last week before I jump into just how you would submit a hospital application request and a payer enrollment request?
Cuffie-Farley,Tonya (17:02) None for me? Okay?
Samantha Bouchard (17:05) Cool. Well, let’s get into it. So, Tanya, just thinking about your process, you’ve gotten the spreadsheet approval from your CEO back and you know, the locations that you’re looking to request the hospital applications. So that’s the point in the process that we are at you or a member of your team would come here, select new initial appointment. You would select the provider you’re looking for. And then here during implementation, we would load in all of your entities. So the atriums, the other partners that you’re working with, they’re all going to be selected here. And we’re also going to load in on the back end what their process is for hospital applications. So where the pif’s needed, if it’s a payer form, if the provider gets a portal link, what that portal link looks like. And then we would program our technology to be able to pre fill out those forms, pre fill out those portals with the data that’s already in the system. So you would come here, select the provider, select the… entities that you’re looking to get those privileges, which can be anywhere from one entity to it sounds like five or six if there are specific.
Cuffie-Farley,Tonya (18:34) In.
Samantha Bouchard (18:35) this case, there’s not going to be any like dop forms needed. But essentially like this would outline like a high level line item of the process you would click submit. And from there your work is it ends. And so what medallion is going to do is we’re going to complete that pif on your behalf, really follow a similar process to what you’re doing today. But we’re going to take out the manual duplication of all of this data. We would identify if there’s any additional tasks or missing information which we would surface in our tasks to the providers as well as to you as an administrator to fill in those gaps. And then once we have that application complete, we would follow the same process where, you know, have the provider review, make sure everything looks accurate, and we would get that sent over to your partner. We do also support partner follow up, but we understand that, you know, you have your own relationships with your partner and so we would work with you on like what’s the best cadence or allowed timing for partner follow up, but ultimately really taking a lot of that heavy lifting off of your plate, giving you visibility each step of the way from a tracking perspective. So I’ll pause here and then we can look a little bit into like the visibility piece. But Tanya, I’m just curious if you had any questions or if you could see, you know, where this really would take some heavy lifting off of your team?
Cuffie-Farley,Tonya (20:20) Yeah, I don’t have any questions but yes, I do see where… it would be a good thing. Is there?
Jake Shubert (20:27) Something that’s appealing to you so far? This sort of like differentiated workflow?
Cuffie-Farley,Tonya (20:34) Yeah, most certainly. Okay.
Jake Shubert (20:36) And worth, I saw you come off mute as well.
Worth Williamson (20:38) Yeah. How is that working with filling… out the dop forms and the different things like that? I mean, is that something that we would provide y, all those forms or how does that?
Samantha Bouchard (20:53) Work. Yeah. So during the implementation Rourke, if you have a huge dump of the forms, we would gladly take those so we can program. So we’d work really closely with Tanya and the members of your team to just make sure we are following your exact process. If you don’t have an application, we would take on the maintenance of that on an ongoing basis. So it’s really not something that like if they change their process like that’s something that medallion would act proactively outreach for update in our system and just instantaneously start following that new process. So, yeah, it’s a joint approach when it comes to the partnership. Like we would take anything you have, but also have the ability to determine and pre program your partners if you brought on a new partner, like what those, what that process was? How does.
Worth Williamson (21:50) that work now, Tanya, with the dip forms of the providers, filling those out? Is that right?
Cuffie-Farley,Tonya (21:56) We fill them out. They’re supposed to, but we end up doing it a lot of times and working with them. But we basically fill them out to make sure they’re filled out correctly. Okay? Trying to stop the back and forth between, you know, them between them, us and the facility, right? Yeah.
Samantha Bouchard (22:19) And so we would fill those out. We would surface those forms in a task. And so Tanya could still see those and fill in any gaps should she want to or the provider. So it’s a much similar process to what you have today. Just medallion leveraging a lot of our automations to kind of populate that information with the existing information that’s already in our system. And then another really cool thing is you’re going to have kind of a list of every single hospital… application that was sent, what that outcome was for the privileges. And then something that a lot of my prospects really enjoy is you’re going to be able to see all of the existing privileges for that provider. So everything that you are submitting for you’d have a list of the privileges when they became active, what that expiration date looks like as far as any reappointment requirements. And then you’d also be able to do a privileging lookup across your entities. So, you know, if you’re ever looking to kind of like place a certain patient with someone that has privileges to do what they’re looking for. Likely in your case, a lot of the privileges are probably pretty consistent across, you know, each type of physician. But essentially, you could look across your entities and do a filter to then see, you know, who has like what, where those privileges exist across your entities by provider?
Cuffie-Farley,Tonya (24:02) Samantha. So how is it that you get the provider to like sign off? Because that’s the main thing with us. The provider has to actually be the one that submits the application.
Samantha Bouchard (24:18) You know what I’m saying? Yeah. So we would do the submission like on their behalf, so that like the link that they’re getting, Tanya, we would have a task in the system to actually forward that information to us so that we could complete it on their behalf. And then when they create their profile and medallion, like they’re giving us the authority to do that for them. Yeah.
Jake Shubert (24:46) I think that’s the huge part of the process, Tanya and worth is like on the initial, excuse me on the initial implementation when we’re onboarding your providers like Sam mentioned in the profile, they are signing off, giving us the like submission authority on documents like this. So I think that takes out like a huge step in the process. And it sounds like Tanya that’s something you’re dealing with today, but that’s like really important to streamlining these workflows.
Cuffie-Farley,Tonya (25:12) Okay. Thanks.
Jake Shubert (25:14) Did I answer your question?
Cuffie-Farley,Tonya (25:15) Oh yes. Okay.
Jake Shubert (25:17) And worth, I wasn’t sure if you had a question as well.
Worth Williamson (25:20) No, all good. Okay. Cool. Okay. Great.
Samantha Bouchard (25:25) Well, just in the spirit of time, I want to make sure you can see our payr enrollment module as well, sort of a similar look but slightly different. So essentially, Tanya, like today, your team is managing all of the, you know, payr requirements across all of your current payr’s and this is just kind of like a glimpse and a little bit of a look like behind the scenes. So at medallion, we have a dedicated payr research team. They maintain all of the payr requirements across all of our payr’s over across the United States. We’re going to clearly outline exactly what that application method is, what the steps are, what those required documents are. But essentially, this is all built into the system. So what happens when your team would come here, click make a request, you would select the provider that you’d like to enroll. You would select the group that they’re associated with. So the 10 you’re looking to link them to, you would select the state that you’re looking to do the enrollment for. And then we’re going to surface all of your group contracts here at the top. So it could be as simple as like if you have 15 payers and you’re enrolling them in everybody, you would just check this box and it’s going to surface all of the group contracts that you have today. We’re going to let you know if an enrollment’s already processing, so that you don’t resubmit and go to the bottom of the barrel. But we’re going to make it really easy for you to own the strategy and medallion to own the execution. So once you make these submissions, you click a couple more things line of business and associate the practice locations, hit submit. And that’s again really where your work ends. And medallion really leans in and takes over. So essentially, we are taking all those requirements that I just showed you in the individual process guides. The technology is going to look across all the payers you requested instantly surface if there’s anything needed. So opposed to how this is going today. You’re kind of like looking at a payer seeing if you’re missing information, doing the comparison, outreaching to the provider. All of that, all of that back and forth kind of gets reduced and streamlined due to the technology. And then where our technology also comes in. I have this cool video that I can show you just kind of highlighting our RPA technology which is where we can log into portals for these payers and pre populate these applications, you know, in 30 seconds. So of course, my internet’s going to be slow, right? Now, but essentially, you can see the point. So Tanya and worth here’s a glimpse of some of the work Tanya and her team are doing behind the scenes. And you can really see how technology really leans in here to decrease the amount of time and effort.
Samantha Bouchard (28:40) In addition to, in addition to the submission portion, we are also going to give you visibility each step of the way. So you can see here if anything needs your attention, where it’s processing, if it’s the payor, we’re going to show all of that information as well. Tanya, everything’s going to be linked to the individual line. So the date it was submitted, the application would be linked there. A confirmation of the portal submission would be linked there. So you’re going to have… visibility into all the work that went into that individual line at the tip of your fingers. And then once it’s with the payor, we are going to do all of that payor follow up, Tanya. So rather than your team having to pick up the phone, we have portal checker, portal scrapers like this. So this is a medicare example where daily we’ll go in and do a portal scrape so that we’re pulling down that status of approval for you as soon as it’s available. And what that obviously allows you to do is to release that to scheduling and get patients to then see providers faster. So that helps, I know your patient experience is very important to you all at cinta, and you always want to make sure you’re matching a patient with a provider that’s obviously in network. So they don’t have any issues as well. And so this would really support that scheduling piece, also accelerate the revenue because you’re going to be able to release those claims as soon as that status comes in. And so in addition to the portal scraping, we also have AI phone calls calling the payers. So just taking all of those, that time your team is spending on the phone or writing emails off your plate and giving you visibility into each step of the way. So I’ll pause here, Tanya, worth any questions on what you’ve seen anything that stood out to you?
Cuffie-Farley,Tonya (30:49) Okay. I’m just not trying to play devil’s advocate but I have to ask, yeah, please because nobody is perfect. So what happens when something should be going on and it’s some kind of I don’t know glitch or something like that? Like will we, you know, be contacted or just as… you were just showing through the demo, that’s what we would see like that somebody was not moving forth, how they should be, like, how does that work? Because we all know what happens? Yeah.
Samantha Bouchard (31:27) No great question, Tanya, and you’re 100 percent right? And so that’s really where the visibility comes in. Like we’re also doing like a dish. So we’re going to check with caqh to make sure caqh is before we even submit the application. We’re going to check to make sure caqh is already up to date because we want to instantly avoid a rejection for something that simple. We’re going to check validate, npas, we’re going to validate their taxonomy code. So we’re doing all these checks behind the scenes making sure, you know, we’re eliminating any possible scenarios for like a rejection. If something comes back where the payer needs additional information, if it’s something that we can obtain, we will close that out for you if it’s not, something like if it’s something that we need an administrator perspective on, we would create a task that you would see in this task module assigned to you letting you know we need something from you or if it’s something that’s additionally needed from the provider, we would task, but we would surface that with a visual cue here. And then the tasks are linked to this needs attention. So when you’re kind of coming in with like your morning coffee to take a look at status, you would probably look at the analytics tab, but you could come here as well and kind of get a pulse on where these line items are.
Jake Shubert (32:49) Okay. Thank you. Yep. And just one other quick add. I think Sam covered that really well is like Tanya, we do have a 99 point five percent acceptance rate on our enrollment applications because of sort of the quality insurance and the all the QA built into our platform that Sam outlined. But to your point like, yeah, it would be, it would not be truthful to say like it’s going to go perfect every single time like this is healthcare. There’s there’s going to be flags that happen. So just want to call out that. In addition to all the tasks and things that Sam just mentioned, you guys will have a dedicated account team at medallion. So one of those folks will be an engagement manager who it is their job to be your point person for day to day operations. So they will reach out to you or you can reach out to them directly. If you have questions. If there are flags things you need to work on together. If we need additional information from you, you’ll have like a direct person from medallion reaching out to you. So just want to call out from, the support model. We’re making sure that you guys, are fully staffed on our side. Okay, great. I think worth, you might have had a question too.
Worth Williamson (33:53) Yeah. I think, how did, how does it work? So this is all like new provider stuff enrollment… how does it handle like the ongoing stuff because, you know, we have a whole credential, I got sent an email address and so, you know, we get 50 80 100 emails a day into there. So, like, can I share my screen real quick? Oh,
Jake Shubert (34:23) yeah, yeah. Go for it.
Worth Williamson (34:34) It’s like here here’s, an example. Can you see that,
Samantha Bouchard (34:39) It’s like.
Worth Williamson (34:41) This provider right here. So they’re saying, you know, reappointment application here’s. What, you know, they need this kind of stuff?
Jake Shubert (34:52) All.
Worth Williamson (34:52) that, so we get these, you know, all the time. So went to the provider, went to our credentialing email address. It’s copied at people at this facility. And so, you know, what our answer is. Hey, we’ll work with the provider to get all this stuff. You know, all that, you know, those sorts of things. Is this kind of a routine… thing that’s handled as well? Yeah.
Samantha Bouchard (35:22) Absolutely. So for any net new providers worth, we’re going to actually be that contact. We can do a supplemental contact if your team also wants to be notified of those emails. But we have a whole like email workflow orchestration behind the scenes that will like attach the emails like to those individual lines and things. But essentially for the crossover, so what you’re mentioning today is we would, yeah, so we would ask that you all just start forwarding all of these emails as they come in to our credential box. You can probably set up like an auto forward so that we can start maintaining them for you. But then at implementation, we’re also going to bulk upload any existing appointment information that you have. So we can store all of the reappointment dates in the system and have all of that information so that, you know, we’re kind of kick starting that reappointment process, you,
Jake Shubert (36:26) know, you’d.
Samantha Bouchard (36:27) be able to kick start that reappointment process based on all of those dates, right?
Worth Williamson (36:32) And then,
Jake Shubert (36:34) just to add, sorry, go ahead. No, go ahead. Oh, I was going to say it’s also a similar process on the enrollment revalidation side. So we’re going to bring in that historical data upon implementation. If you guys know your revalidation dates already or, you know, generally like around when those revalidation dates are, we’ll store those in the platform. And then we’ll also do those revalidations automatically ahead of time to make sure that, they get processed. So, we do take that work on as well.
Samantha Bouchard (37:00) Yeah.
Worth Williamson (37:02) And this kind of stuff like, you know, she renewed. I mean, does this get automatically input somewhere? You know, this, South Carolina calls this CDS form which is like a DNA or Dea. So, is that all kind of stored in there with you guys? And if people… are asking for it, it’s just a… send the CDS to this facility, that kind of stuff. Yeah.
Samantha Bouchard (37:34) Exactly. All of that’s going to be stored in that document section that we looked at together. And then with some of our ongoing monitoring, we’re able to, you know, pull down some of that information as well.
Cuffie-Farley,Tonya (37:49) Yeah. Okay.
Worth Williamson (37:51) All right. Thank you. Yeah.
Samantha Bouchard (37:53) Yeah. And I think this is a good example of like where, you know, Tanya, you know, we’re… still having Tanya and her team like own the strategy, own the support. They’re doing the monitoring, right? It’s just taking some of those lower level mundane tasks kind of off their system off their plate through the automation and just allowing them to work at their highest level worth. So definitely, yeah, still need Tanya’s like, you know, expertise. And as Jake mentioned, the… engagement manager, you know, would primarily work with Tanya and they have a background in credentialing enrollment, privileging all of that. So I think Jake, I’ll just end quickly. Yeah, sure. I don’t want to give you a minute to show, but I know like the statuses are currently being sent to your scheduling system today. And so just kind of on the note of like the revalidations when it’s needed for payer enrollments, as well as the reappointments, all of your enrollment data is going to be stored in this enrollments tab. And you can see we’re going to highlight like by location where those are active and so worth like we have an unlimited number of administrative seats that have access to this. So anybody at your location’s could be able to like log in and filter down to like check par status as needed. But then we also have that bi directional open API that would allow us to send this par status information directly as it comes into your team. So kind of facilitating the same level of service that you all have today when it comes to the scheduling piece. So I just wanted to highlight that. Cool.
Jake Shubert (39:57) Thanks, Sam. I guess just to double check real quick, Tanya. And worth, do you guys have a hard stop in five minutes? Are you able to go a little bit over? I want to be respectful of your time but just wanted to check.
Cuffie-Farley,Tonya (40:09) I’m good to go over a little bit.
Jake Shubert (40:13) And worth, how about you? You might be on mute worth?
Worth Williamson (40:19) Yeah, I can go to one. Okay?
Jake Shubert (40:21) Cool. I’ll try not to be too greedy with time but just wanted to double check, I guess just first question. Obviously, there’s always more of the platform that we can show you guys, but I think you now have gotten like a pretty comprehensive overview, just sort of curious like for big picture feedback, like how do you guys feel about the platform, the technology?
Worth Williamson (40:43) I think devil’s in the details, but it seems like a lot of that, the automation stuff seems nice that’s there that you’ve been able to show. I don’t know Tanya. Yeah.
Cuffie-Farley,Tonya (40:58) Definitely, from what we’ve seen, it looks like it would be a big help. Cool.
Jake Shubert (41:06) That’s awesome. And.
Samantha Bouchard (41:08) then sort of.
Jake Shubert (41:09) To that end, like what Sam was just talking about too is… like obviously like the goal here is to be able to optimize Tanya and your team and make sure we’re taking like the mundane stuff off of your plates?
Samantha Bouchard (41:21) I’m kind.
Jake Shubert (41:21) of just curious like Tanya, have you thought at all about like with trying to give you some time back in the day? Like what are sort of the things that you would like to be able to tackle? That maybe you aren’t able to tackle today because you have to fill out these forms manually and do some of this, you know, outreach just sort of curious if you’ve thought at all about that.
Cuffie-Farley,Tonya (41:40) I’m not going to say like I thought about it just where this is concerned. But we just, and as worth has already stated, we do have a lot of work that’s just like busy work and Dan and Amaya, it takes a lot of time. Just even with the acquisition that we’re doing right now, we’ve been getting in a lot of paperwork daily like all day long and they’re having to log it and make sure it’s where it’s supposed to be. And then they’re sending me a spreadsheet to let me know what we have. And then I’m having to send that spreadsheet out so that, you know, the other people know what we still are needing. So, whereas we have providers who are onboarding right now and you know, they need attention. So it’s like you’re kind of stretched in a lot of different directions. And so for me right now, just because of what we’re doing right now that’s where I was like, yeah, this could be helpful.
Jake Shubert (42:43) I appreciate you sharing. And yeah, when I asked that question, it’s not even I’m not necessarily even asking from the medallion perspective. I was just curious if there was ever like stuff for you and your team, Tanya, where you’re like man, I wish we had time to do this. Maybe it’s like trying to get delegated or whatever it might be. I just was curious if there was anything like big picture strategic stuff that had to be on the back burner because of the amount of time and paperwork you guys are doing today.
Cuffie-Farley,Tonya (43:05) Worth and I definitely have talked about the delegated credentialing before. And one of the first things we said that’s going to take a lot of time. Yeah, I.
Jake Shubert (43:18) guess, sorry, Tanya. I was going to say like, yeah.
Cuffie-Farley,Tonya (43:21) I was just saying we recognize that we don’t have the time to do that. Basically right now, we don’t have the time that’s.
Jake Shubert (43:29) fair and worth maybe flipping the same question to you. Like is there stuff for the team that you would love? Like with a little bit more time in their day that, you know, strategically that the business can move towards or time can be spent towards thinking big picture?
Worth Williamson (43:44) Well, I think that’s always the goal and just to get rid of like we’ve all said these checking boxes and doing the busy work from the payers or all that kind of stuff. And, you know, but still ensuring that things get done. I know, you know, Tanya hates it with her team kind of from June through October is like their worst time of the year because we have a lot of providers starting usually in August and September. And so that is their, you know, busy season for lack of a better term with the new providers. And then, you know, then it’s always the, you know, what’s the status, what’s the status, what’s the status, why is it, why?
Jake Shubert (44:34) You know?
Worth Williamson (44:35) When is their medicare approved or why is that blue cross South Carolina approved? And those sorts of things? So, you… know, and what that ends up, what that necessitates is, okay, well, Dan, you got to pick up the phone every other day and call blue cross and figure find out what’s going on and those sorts of things. So if there’s a way to, you know, whether it is more of a dashboard or something to be able to look at what’s… going on and the status of those things. And then at the same time, they have to monitor the, you know, the existing stuff that like I just showed you the stuff that comes in every day and those sorts… of things, you know, just the other day, there’s a couple of providers that they got the… you know, this is your final notice kind of letters from one of our facilities, you know? And while we’ve done everything on our part during that process at the end of the day, it’s up to the providers to, you know, it says right in the email, you need to do X, y and Z and so a lot of times they’ve either skipped it entirely or done X and y or X and Z and have missed a step somewhere along the way. But then that takes, you know, just those things the other day, it ends up, you know, I see that email. So I’m like Tanya, do we need to do anything about this? And Tanya’s emailing the providers and the practice managers. And so it ends up getting a lot more people involved in those sorts of things. Yeah.
Jake Shubert (46:19) Undoubtedly. And I guess not to throw like a big curveball here. But have you guys talked to any of your payers about delegation before? Like do you know if any of your payers are interested in having you guys be delegated?
Worth Williamson (46:31) I mean, we looked at it once who, what payer was it? Tanya? And it?
Cuffie-Farley,Tonya (46:36) I can’t remember who it was, but I.
Worth Williamson (46:38) know there were a lot of requirements that got put back on us.
Cuffie-Farley,Tonya (46:41) Yeah, yeah, but yeah, not right now.
Jake Shubert (46:45) That’s why I was asking because like again, I don’t want to throw too much of a curveball here, but just to bring it up because it sounds like it might be relevant, medallion is also an ncqa certified cvo, which means that what we do if you guys do have payers who are interested, in having you guys be delegated, we help with all the policy and procedure setup. We actually have templates built out that you guys can just use, because we are an ncqa certified cvo, you guys would not have to build out any ncqa credentialing standards. You would already have those baked in. But just by working with medallion, we help with the electronic committee setup. We process all the credentialing files especially with a three day SLA and a one day average for credentialing files. So, again, not trying to like come out of left field on this. But if that is something near term, long term that you guys are interested in, we take tons of that operational work off of customers plates. You pretty much just need to have an npdb id, which you guys would have no problems with since you have some high level providers like MDS on your team. And you also would just need to reach out to the payers to understand if they are willing to go down that route with you. But after that, we take on a ton of the bulk of the work from your organization. So you don’t have to try to spread thin or worry about the bandwidth there. We, we do all of that. Yeah, I think.
Worth Williamson (48:01) That was the issue. Like those things that you mentioned. I mean, we would have had to have like a credentialing committee and all the stuff that is not really relevant to what we’re doing. Yeah.
Jake Shubert (48:13) That stuff can take like two years to build out. So, totally understandable. So, yeah, just thought I’d bring it up. We’ve helped some groups get delegated agreements within three months. So again, if it’s worthwhile to talk about, we totally can, but.
Worth Williamson (48:26) Yeah. I mean, as we get bigger, it may make sense, you know, because we’ve kind of… committed here over the next, you know, five plus years to, you know, if our current revenue is X, basically two and a half X in the next five or six years. So, you know, that only happens from external growth and we can’t get that adding five brand new providers every year or 10. You know, we’ve got a, you know, we do have this acquisition coming on board this summer or really starting now. And so that’s just kind of phase one for that, yeah, of many more. Yeah.
Jake Shubert (49:12) One of the best ways to get revenue from like the current provider set is obviously delegation because your turnaround times shrink to like a day, you know, right, cool. Well, just to actually just jump into the turnaround time comparison real quick. And then we’ll try to touch on pricing structure and then just next steps, hopefully we can do that all relatively quickly here. I’ll try to be brief. Yeah. So, Tanya, you were able to share time as a blur. I think it was a week ago, maybe it was two weeks ago, who knows? But at some time relatively recently, you shared some of your turnaround times with your existing payer base. Tanya. You shared six payers. I took united in North Carolina and medicaid in North Carolina out of the chart just because candidly, we had like pretty much the same turnaround time. There wasn’t like much to compare on those two. But for four of the six payers that you guys did share and we’re happy to do this with more payers if it’s relevant. But medallion had pretty substantially better turnaround time. So across these four payers, cigna, medicare and blue cross blue shield in North Carolina and blue cross blue shield in South Carolina. Cinta’s average turnaround times were about 105 days. And ours across these four payers were a little bit over 67 days. You then pair that with some of the process improvements for provider onboarding, where most of our providers get onboarded in two days or less. And it leads to pretty dramatic improvements in getting providers billable. What you’re seeing at the bottom of the screen candidly is just some back of the napkin math. Definitely happy to make changes here to make it more accurate for cinta. But what we try to do is do a little bit of an equation of like, okay, if providers are getting billable, you know, 49, 50 days faster. What does that mean from revenue acceleration perspective? So just thought I’d share this around turnaround time improvements, but I guess maybe worth, I’ll start with you just sort of curious for any thoughts or feedback here.
Worth Williamson (51:07) I’m glad y all suck with blue cross South Carolina too.
Jake Shubert (51:12) Yeah. There’s just some.
Worth Williamson (51:14) Toughness to track it’s not just us.
Jake Shubert (51:16) Yeah. You know, we’d be lying if we said like there’s a way to make that process insanely efficient. We do the best we can, you know, getting it from 180 down to one one is still great. But I mean, they’re a tough one. Like there’s no way around that. Yeah.
Worth Williamson (51:31) And so those are real numbers from y, all. Yes.
Jake Shubert (51:34) These are real numbers we’re doing today with other customers doing these enrollments with these payers today.
Worth Williamson (51:39) Yeah. Okay. Yep. The average revenue in one day for a provider is more… like, I… don’t know five… 1,000 a day. So, I mean, obviously, that’s going to make your Roi look that much better. So, I think if you just conservatively leave it there at a 1,000, that’s fine. Okay?
Jake Shubert (52:06) That makes sense. Yeah. And to your point, like the point of this slide wasn’t to be like exactly accurate from the math, it was more just to be like, if we’re sort of thinking about this the same way? Like, is this how you guys are thinking about like the economics and return on investment from improved turnaround times?
Worth Williamson (52:25) Yeah. And, you know, and again, most of that, you know, we try, and if we start that… you know, the credentialing process at 90 days. So really those, you know, medicare and blue cross North Carolina are done. Yeah, they’re ready to go medicaid, North Carolina is typically ready to go and they’ll a lot of times, they’ll let us, they’ll backdate stuff as well. You know, and cigna, I don’t know that it’s that maybe it is four months, Tanya, uhc and Aetna are pretty standardized that we don’t have a whole lot of problems with them. And if I’m wrong on this, Tanya just chime in but, you… know, I think the big for us, the big things are the blue cross, you know, when is that, when is that? And is, if, is those are just in terms of the payer mix and all that, those are the… especially when they throw in, they include the medicare advantage stuff with them. So, you know, that’s a big between medicare and, the blues that’s going to be 40… or 50 percent payer mix right there data.
Jake Shubert (53:52) Okay. That’s helpful. Well, then, I mean, I have a lot of like.
Worth Williamson (53:57) But that, but that does make sense. I mean, generally, I mean, the, it’s not like the providers, the new providers are twiddling their thumbs on stuff with empty slots. I think we’re able to fill up their slots, but it’s you might be able to get that new patient appointment tomorrow instead of in 10 days, that kind of thing.
Jake Shubert (54:19) And then one thing the slide doesn’t represent is like the process improvements on, the privileging the hospital application side, like if we can get things out the door faster, get them privileged faster. Like what does that mean as well? So, cool. Well, I have like a lot of follow up questions that are popping up in my head but again, I want to be respectful of the five minutes we have.
Jake Shubert (54:36) So let me just talk about our pricing structure, if that sounds good to the two of you. Sure. Okay, cool.
Jake Shubert (54:43) So, pricing structure wise, and where it sounds like you might’ve done some research here. So apologies if it’s repetitive at all. But the way our structure works is there are really like two core components to our pricing model. The first, if you’re familiar with just like buying software in general, is there’s like a software fee like a platform fee that we charge based on the number of providers whose data we’re storing in medallion. So this is really the fee to use medallion as a provider data management tool. And that powers all the downstream automations that you saw Sam demo today. And then the second piece is that we charge based off of the services we’re providing. So based on the normal number of enrollment applications that we are sending out the door or the number of hospital applications or revalidations, right? What we like to do is get a ballpark idea of what those volumes are sort of looking like year over year. And then that’s how we base, our pricing. So it’s really just the overall software fee and then the services that medallion will be providing in addition to that software. Does that make sense from a structured perspective? Yeah. Okay. And what next steps can look like here is.
Worth Williamson (55:47) If it’s.
Jake Shubert (55:48) helpful, like Sam and I, we can send over some questions maybe via email just so we can start trying to scope out what that would look like and then come to whether it’s the next call or the call after with a little bit of like a pricing estimate that we can work on and make sure we’re getting the inputs accurate and then getting feedback directionally, on pricing. If that sounds good. Is that something you guys would be open to?
Worth Williamson (56:09) Yeah, I think… yeah. And I, you know, I think, yeah… I think we’re obviously going to be very sensitive to costs and if it’s you know, at least the chat, gpt research and all that is, I mean, it’s a, not an inexpensive proposition. Yeah, based on what I’ve seen. Yeah. So especially with, you know, we’ll be pushing 200 providers and if it’s you know, X amount per provider per month, you… know, that might be, and especially compared to you.
Jake Shubert (56:53) Know our credential.
Worth Williamson (56:55) stream, which is basically just, a license fee and I know it’s not apples and apples, Between what y all do versus Healthstream basically just, a database more or less. Yeah. That type of thing. Yeah.
Jake Shubert (57:09) You hit the nail on the head. I, you know, obviously, we don’t know what pricing will look like yet because we don’t know the scope of work, but, I will say like we’re definitely going to be more expensive than credit stream just because of their different offerings, right? So, you already nailed that one, right?
Worth Williamson (57:25) And then,
Jake Shubert (57:26) just before we look at calendars for next steps, sort of curious, like, and we’re going to sort of hit out, on price sensitivity, but like, what does the evaluation criteria look like today? Sort of curious? Like how are you guys going to go about making the decision? Is there anyone else who needs to be involved in that decision making process? Just sort of curious what like, that internal process looks like?
Worth Williamson (57:49) Yeah, we would definitely our CFO Mitch Clark would be involved and, you know, probably, our it director Jeremy woodall as well. I know this is more of a cloud based solution. So there, there’s nothing really touching our networks so to speak, but we would, you know, he would be most interested in your, all the security and hipaa, and all that kind of stuff. Y all’s set up with that. And whatever. I’m sure y all have all the super duper… certifications and everything with all that. But he, they, we’ve encountered this before with some other stuff, you know, they’re hyper focused on that. And, you know, we’ve done demos with some what I thought were some good products and then they, you know, came back and said it’s not secure enough or it doesn’t have this, you know, certification, you know, blah blah, yeah. With that. So they would be interested in that. The good thing is, you know, this doesn’t touch… epic which is our main software system. So anything, you know, anything that touches epic, it ramps up the complexity and how things get looked at on our end. So that’s definitely a positive. Yeah.
Jake Shubert (59:20) Not, not fact that… I guess as far as next steps, Tanya and mark, do you guys want to look at some times for next week? The week after? What would be easiest for the two of you?
Cuffie-Farley,Tonya (59:40) I’m actually free for the same time next week? Yeah.
Worth Williamson (59:44) We can do that. I’m.
Jake Shubert (59:45) actually going to be out of office next Friday?
Cuffie-Farley,Tonya (59:48) Shame on you. Yeah.
Jake Shubert (59:50) That’s on me. I should have thought about this ahead of time.
Cuffie-Farley,Tonya (59:54) Any chance? Sorry, I was gonna say, what about the third?
Jake Shubert (59:59) The third? So April third? Yeah, yes, that should work… two. Okay. Would you want to do the same time on April third? So, yeah, yeah.
Cuffie-Farley,Tonya (60:10) That’s fine. Yeah. Okay. Perfect.
Jake Shubert (60:14) I will send up that invite. I will, Sam and I will also email over some like scoping questions so we can try to do like a pricing estimate and get some feedback on the next call. If that sounds good to the two of you.
Worth Williamson (60:25) Only other.
Jake Shubert (60:25) question just with price sensitivity being in mind, is there any like budget or general ballpark that you guys are trying to work within? I just want to make sure that we’re being like as aggressive as possible on our side.
Worth Williamson (60:36) Well, I don’t you know, again, I think it’s hard to, you know, if you compare it to what we pay Healthstream just from a licensing standpoint. I mean, that’s less than, you know, we’ve been on that for I think three years and, you know, our annual renewal stuff is less than 25 a year. Yeah. So… I mean, if it’s if we’re talking, we’d have to do some significant Roi work that, you know, to, if it’s gonna be a lot more than that, just to say here’s, why it’s worth it, you know, that sort of stuff. Yeah.
Jake Shubert (61:19) I think that’s how we’re thinking about things too is like showing pricing on our next call and then getting the sense of like, okay, should we work on Roi stuff and map this out? And if this comes to a good place, then we can go to leadership and see or if it comes to not a good place, then we can part ways as friends, you know? Yeah.
Worth Williamson (61:35) Okay.
Jake Shubert (61:36) Cool. Well, you guys are super generous with your time. Thank you so much hope you both have a great weekend and we’ll chat in a couple of weeks all.
Worth Williamson (61:43) Right. Very good. Thanks so much have.
Jake Shubert (61:45) A good one.
Worth Williamson (61:46) All right. Appreciate it. Thank y. All. Bye bye.