Transcript
Josh Brunell (00:00) we meet again, we meet again, this time, we have three people waiting in the waiting room.
Mike Barrett (00:05) Perfect.
Josh Brunell (00:08) By the way, I have not yet met with a similar situation, spoke to RCM and CIO leaders at the conference. Didn’t get a lot of info. So, let’s start with discovery before we show any platform if any. Yeah, sounds good. Cool.
Josh Brunell (00:36) Hi, Jessica. Hi, Mike. Hello. Good morning. How are you doing good? You, doing well… Jessica? Nice to meet you.
Josh Brunell (00:59) I think you’re muted.
Josh Brunell (01:08) And then Mike, I see the six one nine number. Do you know who that might be?
Mike Barrett (01:15) I don’t off the top of my head. I’m guessing it might be Jessica’s okay?
Josh Brunell (01:28) Cool. We’ll let her get her audio all queued up. And then when she’s in, we’ll kick things off.
Josh Brunell (01:42) So, Mike, where are you located? Are you in like downtown San Diego? Or where do you live?
Mike Barrett (01:51) We’re in city heights. It’s like central San Diego. Yep. Thanks.
Mike Barrett (02:05) Okay. I see the cell phone dropped off.
Josh Brunell (02:11) Yeah. Let me just check my email in case she’s messaging me.
Josh Brunell (03:36) I’m going to email Jessica because I pinged her and I don’t think she’s getting the audio all keyed up. Do you guys use zoom, Mike, or do you guys use teams?
Mike Barrett (03:47) We use zoom. She didn’t know zoom.
Josh Brunell (03:51) Okay. Sometimes I talk with folks who switch from one to the other. And yeah, I was just going to say if you needed us to spin up a teams call… we could.
Josh Brunell (04:11) And Jessica oversees the are.
Cc Jessica Manzo-Rodriguez (04:14) you guys able to hear me now?
Mike Barrett (04:15) Yeah, we can hear you now.
Josh Brunell (04:17) Yeah, we can. Okay.
Cc Jessica Manzo-Rodriguez (04:18) Sorry about that. I don’t know what’s going on.
Josh Brunell (04:22) All good. It’s Monday. We’re surviving.
Cc Jessica Manzo-Rodriguez (04:25) Definitely. Thanks.
Josh Brunell (04:27) For joining Jessica. Excited for the conversation and Mike, thanks for teeing the call up and helping get this coordinated. It was nice meeting your team at himss. And Jessica, did you have the opportunity to connect with Mike to kind of just discuss high level what the call is going to be regarding?
Mike Barrett (04:45) No, we did not. Sorry.
Josh Brunell (04:48) All good. I can share a little more there and then maybe we can just align on the overall agenda. But yeah, had the opportunity to meet some of your team, Jessica at the himss conference and at our booth, and then later at our event. And essentially, we were getting to talking with some of the team. And it sounds like there was some potential challenges that you and the team that’s responsible for credentialing and payer enrollment for the organization, there’s some challenges that you’re running into regarding process and technology. And so, yeah, I wanted to just see if the platform that we provide and the services that we provide can help deliver better outcomes for your team, make your job and day to day a lot easier, more streamlined and give you the visibility you need to obviously be feeling… confident in the work that you’re doing there. So happy to share a little bit about medallion before I jump in. Maybe we can start with introductions on our side if that’s okay with you?
Mike Barrett (06:02) Sure. And Susana’s jumping on the call in like 30 seconds. And there she is.
Josh Brunell (06:08) Perfect. Good morning. How you doing? How you doing today? Awesome. We were just diving in. We were just getting started. So we just wanted to start high level with the agenda before we dive into any sort of like platform demo. Just wanted to get a better understanding of some of the current state of the organization in particular. I know we’ve spoken about, hey, you know, the processes that we’re dealing with are challenging. We’re running into delays and we’re looking for platform technology to help make us more efficient. Very highest level. We’d like to just dig in a little deeper understand where some of the operational challenges might exist today regarding your current credentialing and payer enrollment process, share a little bit about medallion our thesis and how we’re kind of… helping similar organizations, fqhcs drive better outcomes related to these processes and then show you in a demonstration and make sure there’s alignment. And if at any point on the call today, any of you feel like, hey, yeah, this isn’t a fit based on how we work. Just let us know. Happy to put time back in your day and part as friends. But I think based off of at least the high level conversations we had, there might be some value here. So before we dive in, just want to make sure. Does that work for the team as far as agenda goes?
Josh Brunell (07:37) Yes, cool introductions for Jessica. I don’t think we had the opportunity to meet at himss, correct. Correct. Yeah, nice to meet you josh brunel on the. Sorry. I just, I don’t see, I know we met quite a few of the folks. I think it was Susanna and obviously Mike, we met at the conference, but yeah, account executive here, been with the company for over a year now supporting folks in both southern California as well as across several states. Worked with some fqhcs in the past. So, yeah, excited for the conversation today. I brought with me, Sam, my technical counterpart. She’s going to help provide a lot of the, you know, technical, you know, overview today with the demo. And she’s happy to answer any process related questions as well. But Sam, I’ll let you introduce yourself.
Samantha Bouchard (08:37) Nice to meet everybody. I think josh hit the nail on the head would be supporting the demo and any technical or product questions that you might have. I am located south of Boston, Massachusetts, so far away from you all and much colder weather. So jealous of josh’s orange county sunshine and your San Diego sunshine. But it’s nice to meet everybody and looking forward to the conversation.
Josh Brunell (09:08) Thank you, Samantha… and Jessica. I know you didn’t really have the opportunity to speak with Mike, but have you heard of medallion or did you happen to go on our website or have you partnered with us in the past? I?
Cc Jessica Manzo-Rodriguez (09:23) Did go onto the website and I was briefly looking over and also, I believe Mike had sent over some files or a PDF about the company. Okay?
Josh Brunell (09:37) Okay, perfect. Yeah. Would it be helpful before we like start diving into your process? Just give you like a quick high level what we do. Sure. Okay… we can super quickly. We’ve been around since we started as a provider data management platform, helping organizations secure state licenses and license renewals for their organizations… and have since evolved into supporting many other kind of processes from the point of hire of a provider, all the way through to them being billable, like credentialing, payer enrollment, both direct payer enrollment, as well as managing rosters as well for like delegated agreements. But I think like the best way to summarize our company is that we’re a tech first automation platform that helps to increase efficiency… decrease turnaround times, reduce the amount of manual work that your teams are dealing with in this process and help be much more efficient and accurate. And so in thinking about the different kind of areas of our platform which we can dive into any of these today. But those that I would imagine are probably all of these could be top of mind. But yeah, I would just love to, I think maybe pass it back to you and understand like, hey, what technology are you using today if any to manage this process? Where are you seeing? Maybe areas for improvement with that? Or maybe from like a workflow standpoint. And then we can kind of share, you know, how we do things a little differently, which is typically through an automation first strategy of whether it’s collecting provider data upfront, getting that submitted to the payers visibility from a reporting standpoint, would love to just understand like, hey, what does your typical process look like? And where are you looking to improve it? Okay? Do you oversee both credentialing and payer enrollment? I do. Okay. Which one of those would you say is like the most… challenging?
Cc Jessica Manzo-Rodriguez (11:59) I think it’s probably payer enrollment. I believe… that’s where it’s a little bit like a little tricky. Okay.
Josh Brunell (12:14) Yeah, I can imagine where would you say you’re spending the most time when it comes to payer enrollments?
Cc Jessica Manzo-Rodriguez (12:23) Well, the thing is the platform that we’re using right now, we transition to where they’re processing the, you know, like the credentialing, and once we get a clean file and it’s been presented to our board, then they start the payer enrollment. But I have noticed that there is some companies like, or insurance companies like blue shield or united… healthcare where there’s a little bit of a lag from when the provider starts to when we get an approval.
Josh Brunell (13:02) Got it. Yeah. And, you… know, that’s pretty common. And this is, I’m just going to show this slide real quickly just, as a talking point. And maybe we can talk into the specifics around what you’re seeing from a turnaround time standpoint. But we usually see like when it comes to the process of like generating a committee ready credit file about two weeks to get that to a committee to get reviewed. And then once that happens or once the provider starts from there, it’s another few days before you’re able to get the actual payer enrollment application sent out. Would you say like as far as like a timeline goes, like how long does it take for that? Is a vendor doing, the credit files? Like putting, doing the primary source verification or is it your team?
Cc Jessica Manzo-Rodriguez (13:54) So, I’m putting it together and then I send it off to our, to the company and then they do the second, like they do their own packet. But I’m not really having a there’s not a long turnaround time, honestly within three or four days, they’re sending me the packets.
Josh Brunell (14:13) Back perfect. So where the time is probably where you’re looking to maybe cut down the time is the actual time spent on the enrollment piece and getting the providers through that process. Correct? What are some of the I guess challenges you’re running into on that side? Is it on?
Cc Jessica Manzo-Rodriguez (14:36) I honestly think it’s, our providers like to have a direct point of contact. So although let’s say I’m looped in the email or I’m there telling them, okay, we need signatures here, signatures there. Unless I’m like physically telling our provider then they’re not, I think that’s where the lag is at it’s. Not necessarily the company. It’s our providers are more comfortable seeing an email or seeing a request coming directly from me. So that’s but I’m like the middleman that’s where the turnaround is taking a while.
Josh Brunell (15:12) Got it. Okay.
Samantha Bouchard (15:15) And sorry, I just had a question about that, Jessica. So, who’s like who’s so, how many members do you have on your team that are like potentially putting together those emails of things that are needed? Or are you putting together those emails yourself?
Cc Jessica Manzo-Rodriguez (15:32) So, the company that we use is the one that’s putting the email together and they’re looping me in for the provider to go ahead and complete what they need to. But if the provider’s not being responsive to them, that’s where I’m stepping in.
Samantha Bouchard (15:49) And what vendor are you using today, Jessica?
Cc Jessica Manzo-Rodriguez (15:55) We’re using compliance watchdog?
Samantha Bouchard (16:04) What about like at the time that you’re hiring a provider and you’re bringing them on how long is it taking you to collect all of their provider data and getting it over to your vendor?
Cc Jessica Manzo-Rodriguez (16:19) So, the thing is that there’s a process that we follow. So the provider will meet with HR first HR. Once they complete their process. Then the file gets sent over to me. Typically, it’s taking me less than a week to gather all the documents from the provider. Once I gather everything and complete a file, then I send it over to watchdog, and then watchdog typically is turning it around less than a week.
Samantha Bouchard (16:51) And then they’re giving you the file back, it’s going through your internal committee because you guys are an fqhc. And then from there, you’re moving on to the payer enrollment process… correct? Okay?
Cc Jessica Manzo-Rodriguez (17:06) And our board meets once a month. So I gather all those initial creds and then are re credentialing for them. And I present, we present it.
Samantha Bouchard (17:18) And on average, like how many payers are your providers getting enrolled with?
Cc Jessica Manzo-Rodriguez (17:26) So, at the time, once I get a clean file and our committee says it’s okay to go ahead and go through. We’re starting off with medi, cal and medicare first that’s always the priority. And then after they start with all the other insurances.
Samantha Bouchard (17:47) Is that like 20 25 plans? I know fqhcs can kind of have a lot of contracts?
Cc Jessica Manzo-Rodriguez (17:53) Yes, roughly. Okay.
Samantha Bouchard (17:57) And all of that then is going back over to watchdog?
Cc Jessica Manzo-Rodriguez (18:02) Correct.
Josh Brunell (18:06) Is watchdog doing both the submission as well as follow up with the payer enrollment applications? They?
Cc Jessica Manzo-Rodriguez (18:15) Are, but again, there is insurance plans that will still contact me directly just because that’s just how they’re used to like blue shield. They’ll contact me directly if they’re missing something or if something isn’t like a follow up, they’ll just email me directly even though watchdog was introduced and they were informed that this is the contact person for certain things. They’ll still go directly to me. So I don’t know if that’s a representative side or.
Susana Acosta (18:44) I think that’s across the board because I have heard that because I joined some fqedc meetings and they said that a lot of the payers like for example, CHG Molina blue shield, our main health plans here in southern California, they’re not really responsive to their party vendors, credentialing or enrollment. So, I think they just have a hard time working.
Cc Jessica Manzo-Rodriguez (19:11) With their.
Susana Acosta (19:12) Party. Yeah.
Josh Brunell (19:13) I think so. There’s a few ways we can walk through it. I think how this process can be a little bit more streamlined. And especially on the communication piece. Does the like… does watchdog have like the concept of like a portal that you guys are using to house all this information and get visibility into the status of everything or is everything solely email based?
Cc Jessica Manzo-Rodriguez (19:40) No, they do. We do have a portal. I don’t have a problem with watchdog and how they do their management or anything. The problem. I think it’s with the insurance companies. They just don’t aren’t really responsive to third party vendors. So even though watchdog did everything they needed, they would just go directly to either me or to Susana. Or they’ll go to our like Tom. They just there’s one company zymed that will not work with them at all. They just go to me. So it’s just, I think that’s where we’re having the disconnect.
Josh Brunell (20:21) Yeah, that’s interesting. I think, you know, we could walk through. I think the way that we would handle that is a little different in that like any emails calls basically any communication that’s occurring on the payer side, whether it’s in or out. Like we would be able to track within medallion’s platform. And then as the administrator can obviously include you in that thread if you’d like or not, but like you would have visibility into it even if you’re not having direct communication with the payer, like you can track essentially and have a paper trail of all the communication between the medallion platform and the payers… that we’re doing the enrollments to. So it might be easier to show and kind of walk through what that process looks like. But yeah, it sounds like one thing that you’re trying to get away from is just like, hey, the constant, hey pinging to you and then you sending it to watchdog and then watchdog having to follow back and you kind of be that intermediary, like we can help you avoid that. If that’s the goal. Okay? Outside of that, yeah, go ahead.
Samantha Bouchard (21:38) Sorry, josh. I was just curious like what type of visibility that you have into like the work watchdog is doing? Like if there is a delay for, you know, one of the like the blue cross payer, like do you, are you emailing watchdog to say, like what’s the status of this? When was it submitted? Or do you have visibility into like the day that it was sent over? And like what was on the application and all of that?
Cc Jessica Manzo-Rodriguez (22:05) Well, they loop me in so they’ll send weekly reports and it basically will tell me like the status like application submit, like on a spreadsheet application submitted or this is pending things like in that nature. But also when they are sending like the initial request for the provider to be credentialed, I’m being looped into there. So I can see it as well. Yeah. And then they do have a portal. I am able to view like the applications that they submitted, but not necessarily what status is in without seeing that spreadsheet that they sent to me weekly.
Samantha Bouchard (22:54) That’s really helpful. Josh. You know, I feel like I have a good handle on kind of the overall flow if we do want to transition into the platform. But I don’t know if you have more slides.
Josh Brunell (23:06) Yeah. Let’s do it. I’m going to stop my share here. I will say like one of the things too as Sam pulls this up like just to keep in mind is like… a lot of the industry and what we see for vendors like watchdog or others like they may have a technology used to track the process but not necessarily to deliver a lot of automation. And then on the other side of it as well is because they don’t it’s really up to your, you know… there’s really not a lot when it comes to like their commitments as far as how quickly that they’re going to be doing these things. I’m not sure with watchdog because I’m not as familiar with them as some of the other vendors but in the space, but do you have like contractual slas, do they have contractual slas in place of like how quickly they’re responding? They’re submitting work like in place to hold them accountable from a financial standpoint?
Cc Jessica Manzo-Rodriguez (24:08) I wouldn’t be sure just because I wasn’t shown the contract. I’m not sure if that’s something Mike knows.
Josh Brunell (24:15) Even not necessarily just more so like, hey, our contract says you need to get these submitted within X days, these pay enrollment applications after we make the request. Like things like that. Do you, it sounds like you don’t have visibility into Jessica but Susana and Mike, is that something that’s in place today?
Samantha Bouchard (24:35) I don’t know. I.
Josh Brunell (24:37) Don’t I don’t think we do. Okay. We’ll talk about that after the demo, just like what one of the things about medallion is, yes, we have this technology, but we also make sure like we are contracting the outcomes and outcomes that we will deliver. So you have visibility into what those slas are, the commitments that we’ll have in getting this work out the door and done in a, in the amount set time that we say that we will contractually so.
Samantha Bouchard (25:06) Awesome. Well, I want this to be interactive. So Jessica, Mike, Susanna, if you have any questions at all, please feel free to stop, ask questions. We can dig into any areas deeper. Can everybody see my screen? Yes. Okay. Awesome. Great. So, you know, as josh mentioned, medallion’s a comprehensive end to end partner that efficiently manages data collection from the time you hire a provider, until you’re billing for them and doing enrollments all the way through validation. So where we kind of start here is our core offering which includes our provider data management platform. And then we also have analytics and report builder for this demo. I really want to show you kind of three areas. So I want to show you how we accelerate the onboarding process, how we use AI and automation to process payer enrollment and credit applications fast with less errors. And how we give you visibility each step of the way and provide you those high level metrics that really allow you to plan your business operation and capture the accelerated revenue that we’re able to provide through our processes. So what you’re seeing here is our provider… directory. So everything in medallion starts with a provider record. Jessica, as you know, you have to collect all that data to be able to do any of these downstream functions. So we’ll look at what that provider onboarding process looks like. But essentially, we’re going to store all of your group contracts, your tins, your practice, we’re going to associate all of that data in layers, so that within a few clicks, you’re really able to see which providers are associated with which practices and which locations, making that really easy for you from a reporting perspective. And essentially, I like to start here because this is really table stakes, you know, is having a platform that makes this data easily accessible, easy to find, easy to work with. So as we get into the rest of the demo, this data architecture here is really what’s going to lead us to fast turnaround times and limited work on your end to get a lot of this done. So when you hire a new provider, you would come into this modal here and fill out a couple pieces of information to invite your provider to the platform. From there, they are going to receive a welcome email which this would be customized to your branding and your onboarding language. We’ll then walk them through a customized onboarding flow. And this is where medallion really differentiates the data collection piece, Jessica. So we have a direct connection. It’s bidirectional. It’s proprietary with caqh which allows us to, with just three pieces of data, their caqh id, their social security number and their last name populate up to 70 percent of the provider profile. So instantaneously kind of pulling in all of that documentation that’s you know, well maintained and established in their caqh profile and reutilize it. I’ll pause here, Jessica, do you maintain caqh profiles for your providers today?
Cc Jessica Manzo-Rodriguez (28:41) I do, are.
Samantha Bouchard (28:44) you doing like the quarterly attestation, updating the practice information, all of those things?
Cc Jessica Manzo-Rodriguez (28:49) Yes, for all of our providers, okay?
Samantha Bouchard (28:52) So that’s pretty, that’s a pretty time consuming process. Once I get to the provider profile, we can look at ways that we can help automate some of that. Is the caqh id, something that is readily available at the time of hire that you typically have from providers?
Cc Jessica Manzo-Rodriguez (29:11) Once I send their initial email, they do provide me with that information.
Samantha Bouchard (29:16) Okay. Great. Yeah. So one thing that we find here is, you know, we don’t need their username and password. That can be a lot trickier to track down especially if like the reset email goes to like an old administrator or something. So with just that caqh id, we’re able to pull in all of that information into the provider’s profile. Curious for your thoughts on that integration. Can you see how that would significantly decrease some of your onboarding time today? Yes. Awesome. Yeah. So with that integration, we obviously have the opportunity you can manually enter the information nobody wants to do that. We do have a CV, a resume parser that uses OCR technology that can pull data in from their resume into the profile as well. But our most recommended and highly utilized integration would be that caqh integration. So you can see here, we have the provider profile. This is going to have links to all of their external accounts, all of the document storage, which is really important. And if we ever need additional documentation, a provider can scan this QR Code with their cell phone, take a picture of say, their diploma on the wall. We’re going to import it. We’re going to use that OCR technology. So if you’ve ever used like turbotax for your W ii, it’s going to take all the information on that and put it into the proper areas of the profile. So with the caqh integration as well as some of these additional features with the OCR technology, we’ve really reduced the overall onboarding time for a provider from, you know, anywhere from five to eight business days or longer down to on average two days with this process. Jessica. Curious how this compares to the process that you’re doing today. It sounds like you are pretty efficient capturing a lot of this information. But just kind of curious to hear your thoughts.
Cc Jessica Manzo-Rodriguez (31:27) I mean, I’m so once the, you know, the provider provides me with their, they’re giving me their username and their password, and I’m manually doing this for every person coming into la maestra.
Cc Jessica Manzo-Rodriguez (31:39) And also once they are here, I’m the one that’s you know, doing the attestation every 120 days and updating licensing when things expire. So I mean this does sound like it would be helpful.
Josh Brunell (31:54) Yeah. And I guess just to get a better understanding like how many providers do you all have today? And how many are you typically bringing on in a given year?
Cc Jessica Manzo-Rodriguez (32:05) I… know that right now we have more than 120 providers right now. They are hiring a lot of dental providers and NPS and pas to the point where I have maybe three to five, you… know, within a week or so. It’s just been back to back right now. Yeah.
Josh Brunell (32:30) And I can imagine that like going through the process of obviously maintaining all those attestations and all those caqh profiles. And then also at the same time having to deal with like re, credentialing or pay enrollment, like revalidations, like having to keep track of those and then expiring licenses. Like all those things that you mentioned like it can be a compounding effort. And so, yeah, like I think our goal with this is just like a set of having to collect all like put it on you to collect all this data every time a new provider is going on. Instead we give you a starting point of like, hey, we have 70 80 percent of what we need. Maybe we need a couple areas where we can fill in the gaps where we need to ping a provider. But this gives you, I think a much better starting point to where you can obviously reduce that time to get all this into a system for then you’d be doing the other things which are, you know, getting them credentialed and enrolled, of course with the payers, yeah. And.
Samantha Bouchard (33:39) Then I think josh, you know, one of the things we heard from Jessica is that like there’s a lot of task management that are kind of floating around in emails and like it’s kind of can be a little bit challenging to know like what does the provider necessarily need to sign? And then when Jessica’s coming into play, and so, Jessica, this is a view of what the provider’s profile looks like. So if there are any outstanding tasks which we’ll talk about how these get generated. And I’ll show you your administrator view providers are going to have complete visibility in their own portal as well to their profile and to any tasks that are outstanding for them. So I could see this view specifically really kind of improving some of the task management that you’re facing today in a lot of emails and spreadsheets.
Josh Brunell (34:30) One other thing too here, Jessica is like we can automate a lot of this too. So where you’re not having to constantly email and ping a provider, maybe when something needs to get escalated, you obviously have the full visibility in all this. So you can, you know, make that call and email if you want. But like we have automated ways to get on top of the provider to make sure that we’re getting the data that we need in an ample amount of time.
Cc Jessica Manzo-Rodriguez (34:55) Okay.
Samantha Bouchard (34:56) Yeah. Well, I know, I just want to be cautious of time. So we talked about how we can utilize caqh streamline the onboarding process. We do have caqh management. We’re offering Jessica, which essentially because our integration with caqh is bi directional, any changes that you make in medallion, we can push into caqh on your behalf. And we can also take care of the quarterly attestations, ensuring that the date is up to date. So really the purpose of this integration is so medallion becomes your source of truth for all information. And then we’re just feeding that data into caqh supplementary rather than like, you know, kind of some of the systems today, you might have a spreadsheet that you’re entering data, then you’re kind of entering data into caqh, potentially another data source this way, like you enter data once and then we will take it into caqh where it needs to be so that the payer enrollment applications can go through and process.
Samantha Bouchard (36:08) Awesome. So once a provider is hired, we know that the next step is to get the credential to get your ncqa. I’m sorry. Do you credential to the joint commission standards or ncqa standards today?
Cc Jessica Manzo-Rodriguez (36:27) I believe it’s the ncqa. Yeah.
Samantha Bouchard (36:30) I think so too just wanted to double check. So essentially… when you are looking to create a new provider gets hired, the next step is to request initial credentialing. So you would come here, go to existing providers, you would select the providers. This is a demo environment. So it seems like it’s acting a little bit wonky right now, but essentially, you would submit a request into. I think what might be happening is it thinks I’m sorry, I’m just going to log in again really quickly.
Samantha Bouchard (37:21) Sorry, hold on one second.
Samantha Bouchard (37:30) Gotta love the demo environments they like to act up on us sometimes. All right, here we go. Let me share my screen. So sorry about that. This is what I wanted to see. I wanted to see some data before it was kind of blank. I think it still thought I was hijacked as a provider kind of showing you that view. So essentially your provider completes their profile, next step that you’re doing today is kind of putting all that information together, sending it over to watchdog here, you would come here, request initial credentialing, select the provider or multiple providers that you’re looking to credential. And then you would click submit… requests down below. We have technology built into the system that is going to automatically connect the primary source verifications and instantly start putting them back. And you’re going to have visibility into all of this. Jessica. So what medallion does is with this integration and the technology we have behind the scenes, we’re able to produce an ncqa accredited file in one day from the time you hit request, and we guarantee three days. So that sort of circles back to the outcome piece that josh referenced where we’re not only just taking this request, we’re guaranteeing you we’re going to have a ncqa accredited file to you in three days and typically it’s just one.
Cc Jessica Manzo-Rodriguez (39:13) One other. And then at the end, I would be able, sorry, at the end, I would be able to either download the file and it would be a completed packet, correct?
Samantha Bouchard (39:23) Yeah, exactly. So once it goes through, we do have a human in the loop to review that file because ncqa standards do require that a human touches the file. We’ll produce this file with a 99 point six percent accuracy rate. We’ll have a human kind of touch the file, review it. And then you’re going to have visibility into the packet. You can download the packet here, but you’re also going to be able to tap through it and see all the information. Again. This is a test environment. So, not the best, but you’ll be able to see all of that information directly in the packet. And then where I think this would make a pretty like significant improvement to your overall workflow where you said your board meets once a month as the files are ready, they get moved to the committee. So if it comes back clean and there’s no issues, they’re going to move into the committee directly in the platform itself. So you’re going to have the ability to look at clean needs, review files. So these five providers that you’re hiring right now, you would see them in this committee, and you can actually give your committee members the ability to vote asynchronously directly into the platform. And all of this is audit tracked and reportable at any time. So really supporting your overall like fqhc and committee standards… yeah.
Josh Brunell (40:52) And one area we typically see this add a lot of value on is like for those clean files that we know there’s no issues with, we can get them through the door quicker and then kicking off that payrollman process even sooner in your case, and then really just using that time where you’re maybe doing that meeting or, you know, that’s happening monthly just to talk about things that maybe need reviewer to be double clicked on… or everything can be done asynchronously as well. Like do you have the ability to approve, reject, add notes and collaborate in year two? But we just see this typically helping avoid that, you know, a 30 day, 20 day, 10 day delay, right? We could just look at the file here and now and then make that decision. So… what are your thoughts here?
Mike Barrett (41:40) Are you able to send that as like an email for approval? Yeah.
Josh Brunell (41:46) They would get notified. Yeah, the administrator would get whoever the committee approver is. They would get notified once there’s a clean file and they could either look at it, you know, get that notification via email and then it would take them in here to be able to perform that vote.
Mike Barrett (42:03) No, I mean could they, could you like send the whole packet to a board member and they just click? Yes, approved. They?
Samantha Bouchard (42:12) We can download the packet, Mike, and it can be like attached if that was the case. But the best way would be to have them log in and they can just check that approved button. You can also add notes here too. So if multiple eyes need to be on it, they can write any notes or questions that they have. And I’m not sure if Jessica facilitates that, but essentially, that would all be there. So by the time they’re looking at the file they can, their eyes can be directed to anything that they need to look at really streamlining this process. And like, you know, sometimes these committee meetings can take, you know, 30 minutes an hour. And what this does is really streamlines that overall time. So if you do need to meet, it should be like a quick like 10 minute meeting to kind of go through anything outstanding Mike.
Josh Brunell (42:59) Is the question coming from? Maybe you don’t want those committee members having to log into a separate system to do this? And so you just want them to see it via email?
Mike Barrett (43:09) Yes, no, I’m not sure how the process works. I just know sometimes if we need like emergency one, our CEO emails the board to get vote. So I figured if we can automate it, she doesn’t have to do that anymore, but there might be a different process that I don’t know about. I just know she has to email them sometimes for like emergency ones… the.
Cc Jessica Manzo-Rodriguez (43:30) Way that it works right now. Let’s say I send over a file, right? Compliance watchdog says it’s a, so I meet, yes, we meet once with the board, but I get a file and then depending on what, whether it’s our medical dental or our wellness department, there’s a director for each one. So depending on what the doctor’s specialty is, then that director has to sign off on the packet. And then at the, you know, end of the month, I present it to our committee, which is those three directors. Tom and myself. I present it to them. And then at the beginning of the following month, they present it to the board of directors. But like how Mike was saying, when we do have those urgent ones, I will get the packet together. The director for the specialty of the provider will sign it off. And then our CMO sends it to our CEO. Then our CEO sends it off to the board of members and they approve it… that’s how that process is.
Samantha Bouchard (44:34) Yeah. So that could all be facilitated in here, Jessica. So right now, I have a needs review and a cleans committee. But we can essentially make all of the committees that you mentioned. So there can be an emergency committee. There can be, you know, based on their specialties, like the committees that you say, and then each of the voters can be individualized to those particular committees. So during implementation, we would definitely train you all and like support any like workflow change management. But, and I’d be happy to set up like a customized demo with like those different committees. So you can really visualize what that would look like. But I think overall like this would just give everybody kind of visibility into what’s outstanding rather than and from like an audit and compliance standpoint, everything’s really gonna be centralized in this one location opposed to any emails and things. Yeah.
Josh Brunell (45:33) And for the,
Cc Jessica Manzo-Rodriguez (45:34) so can a director sign the packet from this platform, we?
Samantha Bouchard (45:40) Do have enotary options. What would be the purpose of them? Like they’re signing off? Would that be similar to approving?
Cc Jessica Manzo-Rodriguez (45:52) Yes. So the director of that department is basically approving that they’re okay with the file. They reviewed the file, and they’re basically attesting that, yes, the file is fine prior to me sending it over to the board or prior to them presenting it to the board of directors. Yeah.
Samantha Bouchard (46:12) So that’s really what this approval stamp would do. So like only that person can log in. So we can have multiple approvers here. So the first approver would be the member that you’re talking about from the committee, they would click approve. They can add a note and say reviewed file. This is approved by me. No further questions. And then the second approver on that could be the members of the board that you’re referring to. And all of this is to ncqa standards. So if you were ever audited, we would support that and provide proof of all of the time stamps for compliance purposes.
Mike Barrett (46:52) So when they click approve, it gets time stamped, it’s auditable. You can see the IP address they approved it from, and who logged in, what time all that information?
Samantha Bouchard (47:02) Exactly.
Josh Brunell (47:07) This is also too, like if they’re ever on the go too. I don’t think, I think Sam had mentioned this, but like platform is mobile friendly as well. So if they’re on their phone or on their laptop, we can, they can facilitate the approval process. Do you?
Mike Barrett (47:23) Have an app or they just log into browser on their phone?
Samantha Bouchard (47:27) It would be the browser on their phone today. Yeah.
Mike Barrett (47:31) Any plans to make an app? It?
Samantha Bouchard (47:34) Is on the roadmap for sure especially for like this credentialing piece and then the provider like profile pieces, but it does work. You know, it is optimized for mobile in the browser view. Yeah. So ultimately, Mike, you know, what this does is if you know, from the process that we’ve heard you’re getting that file back from watchdog, Jessica’s doing her review, she’s sending it through the appropriate channels, then if for some reason you missed the board meeting, you’re potentially doing an emergency or it’s getting bumped out, right? That’s a significant time lag before starting payer enrollment. And so with this, you know, it definitely would be a little bit of a change of process for you all, but a positive one which really would allow these files to flow more quickly through the process, which then allows the payer enrollment piece to get out the door. And then we all know the sooner you get par status, the sooner you can bill, the sooner that revenue is accelerated, more patients are accessible, you know, through that par status. Any questions on this before I just quickly move over to payer enrollment or josh, what are you thinking? I know we only have 10 minutes left.
Josh Brunell (49:01) I guess as far… as this workflow, do you all feel like this would be an improvement to what’s happening today on the credentialing side before we jump to enrollment?
Josh Brunell (49:28) Maybe I’ll point that to you, Jessica. I’m.
Cc Jessica Manzo-Rodriguez (49:30) sorry, I thought I was talking, I was on mute as far as like, you know, when a provider is coming on board and caqh, I do believe that’s helpful. Maybe the, you know, how the committee will work, it’s something that the board members would possibly have to review and see how responsive they are to that because, you know, they’re not used to having to do it like this. Maybe that’s something Mike would be able to answer and the,
Mike Barrett (49:59) two that do it are not very tech savvy. That’s why I was asking if there was an app.
Cc Jessica Manzo-Rodriguez (50:07) Yeah.
Samantha Bouchard (50:07) And honestly, Mike, what some of our clients do is like Jessica can like pull this up at the board meeting and essentially like everybody could log in at the same time. And then as she’s kind of going through the minutes or the files, everybody can kind of just pull them up directly here. So, I don’t know Jessica, if you’re like printing them out and like wheeling them in. I’ve heard of that too, like that people still just like the paper packets or if it’s just like you’re pulling up individual emails, but this can also kind of fit into your current process and just ultimately like reduce the overall time that you’re spending.
Mike Barrett (50:45) The board meeting, we probably do a little different because I go to the board meetings. All it is they send them beforehand and all the packets and they review it. And then the CMO just reads off the names and they approve each one verbally. So they just go and credential and they’re like we have the following five providers and they all approve it and then they do the recredentialing, five providers. They approve it and it’s done. It takes like two minutes. I wish there wasn’t a board one that fast.
Samantha Bouchard (51:15) But credentialing with.
Mike Barrett (51:16) the board approvals is quick because they send them a week ahead of time. So they review it and then they just all give a verbal yes. So logging in would probably slow that down. So we would probably stick to the part of them just voting, yes.
Josh Brunell (51:30) I mean, yeah, what it sounds like? I mean, when you’re doing those votes though, do each one of those individuals, it sounds like they sign something or is it just the CMO signs off on behalf of the individuals after they vote?
Mike Barrett (51:47) Yeah, the board members don’t have to sign off on them individually. They just vote and it goes in our minutes. So there’s signatures in our minutes.
Josh Brunell (51:55) Got it. Okay. Yeah, so.
Samantha Bouchard (51:59) Sometimes what we see in that case, josh and Mike is that we’ll just have a single voter in medallion. And so like, you would send out the link, say review the files that are in this bucket which can all be clicked through here. And then just your CMO would kind of go down and click, approve. So that’s another option that, we see as well. Or sometimes we can see like Jessica could be the approval in medallion and then you still follow your main process. So this really just helps facilitate it and you still get access to the technology. And then you just have Jessica like everything stored in your minutes as they are today. But we would just make Jessica the approval so that no one has to interact with the technology here. But it does move into the closed bucket. And the purpose of it moving into the closed bucket is so that all of those recredentials automatically get stored. And so Jessica, you have visibility into when those files were approved, when their recredential date is. So that can either be auto generated or you can request provider recredentialing on, you know, the two or three year cadence.
Cc Jessica Manzo-Rodriguez (53:16) Okay. Yeah.
Samantha Bouchard (53:17) So, there’s a couple of different options. We see people really, we try to make the technology as flexible and the setup as flexible as possible just because we know like some of these processes might work well for you today, but there’s other ways that the technology can kind of come in to just like organize and streamline the overall data storage and things like that. All right. Well, the next piece that I had to cover is our payer enrollment offering, which is really where we store every single payer process guide across all of the payers of the United States. We leverage a few different technologies to be able to submit payer applications faster with less errors. And we do tracking all the way through until we get that par status which we surface to you right away, giving you visibility each step of the way. I don’t think I’m going to be able to cover that in five minutes, but curious if that’s something you all would still be interested in seeing or, you know, just kind of your overall thoughts, on the discussion today?
Cc Jessica Manzo-Rodriguez (54:38) I’m sorry that’s for the, to view the payer enrollment side?
Josh Brunell (54:41) Yeah. Like once you have that cred file approved and you’re able to start on that work, Jessica, we would, what we are. We were just wondering if you’d like to reconnect so we can walk you through what that process looks like in medallion to request a pair up pair, enrollment application, how our platform helps to automate the process of filling and sending those out to the payers. And then what the automated follow up looks like?
Cc Jessica Manzo-Rodriguez (55:06) Would that be something I believe that would be helpful?
Josh Brunell (55:08) Yeah. Go ahead, I.
Cc Jessica Manzo-Rodriguez (55:10) Believe that would be helpful. I’m not sure that’s something Mike and Susanna would like to do as well.
Susana Acosta (55:19) Yeah, I don’t mind being part scheduling something for the enrollment on the payer side. Okay? Yeah.
Josh Brunell (55:28) Happy to use the time we have just to maybe schedule some more or later this week. Let’s see, and.
Mike Barrett (55:36) I can just roll this over later. I have nothing next unless you guys have another meeting booked?
Samantha Bouchard (55:42) We have the board meeting at 12 30.
Josh Brunell (55:49) At 11 30 or 12 30.
Samantha Bouchard (55:52) 12 30. Okay?
Josh Brunell (55:55) I mean, Sam, do you want to stay on for another 10 minutes?
Samantha Bouchard (56:00) Yeah, I can stay on, okay?
Josh Brunell (56:03) Yeah, I can too. I just have like an internal meeting which I could push back a half hour, so.
Samantha Bouchard (56:10) Okay, cool. Awesome. Let’s just do it. Yeah, let’s keep the momentum going here.
Samantha Bouchard (56:16) Awesome. So… now that you have your approved credential file, sounds like the next step in the process is getting those payer enrollments kicked off. So today, Jessica, you’re putting all that information into emails kind of like making that request here in medallion, you would come in here. You would request a new payer enrollment. What I’m going to show you is how with just a few clicks, we’re able to capture your request. And then medallion takes over all of the steps from here while giving you visibility each step of the way. So you would select the provider. You’re going to select the tin that they’re associated with. You’re. Going to select the payer. We’re going to have some guard rails in place telling you where this provider is licensed. We’re not going to let you submit for a request that’s already in progress. And we’re going to also surface all of the group contracts that you have under that individual tin. So with one click, if you want to kind of enroll them in everybody across the board, you can go ahead and make that selection. There’s a few other practice locations and some optional application details that you can fill out. But essentially, from here, you would come over kind of review what you’re requesting and hit submit, and that’s where your work ends. And medallion really takes over. So we are going to use our technology to look across all of the requests that you made as Jessica knows, you know, she does this all the time. One payer can ask for a blue ink signature that’s usually like the medicare or the medicaid’s or some payer might need, you know, a specific like… specific education background or things like that. And so we’re going to look across all of those requirements that we have built in the system. We’re going to instantly surface if there’s anything additional. So that time in the process where Jessica is kind of facilitating some of this with the providers that would create tasks if needed. But essentially, we are going to use our technology to validate that caqh is up to date. So we get a, we don’t get rejections for having anything missing there. We’re going to validate npez. We’re going to validate their taxonomy codes, doing these simple checks just to try to reduce any chance of error. And then we are going to use portal RPA technology which is going to automatically complete portals instantaneously. We’re going to map all of the payer forms. And we’re going to give you visibility each step of the way. So the report that you’re getting weekly, Jessica, you’d be able to log in here. And we also have a view of this in our analytics tab and you’d be able to see where each individual line is. We’re going to attach the application. So you have visibility into the application, and we’re going to then follow up with the payer all the way through to completion.
Samantha Bouchard (59:33) So once we get that par status which could be through email, through our AI phone, calling to payers through calling them themselves. If that’s the only option we’re going to surface that par status to you as soon as it’s available from the payer themselves. And where the outcomes come into play is that we have a guarantee that from the time you request the application, we are going to have that submitted within 10 day SLA, on average five days.
Samantha Bouchard (60:05) So between the decrease in time from provider onboarding down to two days, the time we’re able to reduce the credential file creation and help facilitate that approval. And then the payer submission, we’re ultimately going to get your payers to par status, quicker, accelerate that revenue for your team and take on a lot of the, you know, task management and monotonous tasks that can be associated with this. I just talked for a while so I’ll pause Jessica. Anything that stood out to you or anything that you had additional questions on? No, no. Do you have this type of visibility with watchdog… today?
Josh Brunell (61:01) When.
Cc Jessica Manzo-Rodriguez (61:01) we initially transitioned over, we were told that it would look something like this, but I think that either the system wasn’t working. So then we just stuck to the excel sheet that’s how the excel sheet started. And I just never circled back and requested for this to be fixed or corrected?
Samantha Bouchard (61:26) And are you giving those reports to anybody else in the business? Like is there like a time like how does like revenue cycle know to release claims like when somebody is par status today?
Cc Jessica Manzo-Rodriguez (61:45) Usually it’s just me and Susana communicating via email. And again, sometimes the spreadsheet doesn’t really reflect what’s going on necessarily and that’s when the emails will come into play with me reaching out directly to watchdog, like, hey, what’s going on with this? Or, you know, if something Susana reaches out to me in regards to unitedhealthcare, I directly contact the person that I have at compliance watchdog, and then they complete, they reach out to the insurance company and then they report back to me and then I provide that information to Susana.
Josh Brunell (62:22) So, so instead of so I think one of the areas too, which I don’t think Sam had mentioned, but like for those payers that have, you know, payer portals or sites that we can access instead of having to go through that process of playing telephone, where you go to, watchdog goes to the payer checks, the status goes back to, you know, you. And then you go to Susana. Instead, one thing that we can do is we can actually do portal scraping and where we’re getting that status directly from, those payer portals, bringing them into medallion. And then you too can have full admin visibility and access anytime and be notified even to when a provider say via email reaches par status so that you’re not having to go through that intermediary every time. Yeah.
Samantha Bouchard (63:10) That’s the page I’m on right now, Jessica and Susana, if you can see it. So it’s our existing enrollment tab and our RCM like the team members of our clients within the RCM space. Some of them will integrate with our open bi directional API to get this status into like a scheduling system or into their billing system. So they know instantaneously when to release. But I also think we have plenty of RCM leaders that just log in here specifically. And this is like the tab that they come to. So we’re going to show and this is all searchable. Filterable. You can set up your own filters and then you can pull reports on it as well. But this is essentially gonna show by location, the payor and those practice locations and the lines of business that were associated with that enrollment, you know, all the way down to that effective date and that revalidation date as well. So this would significantly decrease some of the back and forth. It sounds like that you all are experiencing today.
Samantha Bouchard (64:19) Susana. Is this something that would be helpful for you rather than emailing Jessica to just kind of have at your fingertips to log into?
Susana Acosta (64:29) Yeah, this will be helpful because, yeah, I did tell her that text messaging between Jessica and Abby. Like, is this provider good to go? Hold on. Let me double check.
Samantha Bouchard (64:42) Jessica, you sound like a miracle worker. I will say it sounds like you’re keeping a lot of balls in the air?
Cc Jessica Manzo-Rodriguez (64:49) Yeah. And,
Josh Brunell (64:52) Jessica, do you have a team supporting you too or is it just, are you the?
Susana Acosta (64:57) She has other stuff, but she’s the go, to me. She’s the go to.
Cc Jessica Manzo-Rodriguez (65:03) Yeah.
Josh Brunell (65:05) Got it. I was going to say, I thought you were a one woman army here and that would have been pretty impressive. Cool. I know we’re over time. Thank you for giving us the extra time. I mean, you know, typically… the areas that we’d go through from here would be like, hey, now that we’ve had a deeper understanding of your process like maybe reengaging and diving into any specific areas of the platform that you may hey want to validate. Like does this fit our workflow? It sounds like the committee piece, for example, Sam had offered, like we can put together a more custom demonstration that maybe could support your workflow in a little detail. If, if you’d like as a good next step. And then additionally, I’m sure, like would like to better understand too, like just overall, like what would you all need to see that maybe we haven’t shown that would make you feel confident and comfortable at least continuing the discussion and looking and comparing us versus watchdog from like an evaluation standpoint. Do you think this is a… meaningful improvement based off what you’ve seen so far and worth discussing further?
Cc Jessica Manzo-Rodriguez (66:27) I mean, I think it was beneficial seeing the presentation and seeing how your platform works. I’m not sure if Mike, you know, feels someone else should… have made a presentation or if it could be tailored to that specific area where Mike may have more questions? I’m.
Mike Barrett (66:50) good. Right now, Jessica’s good with it. If we go further down the line, maybe we’ll add Tom Vu, who does a lot of compliance and make sure it meets all his requirements. But I would say the first next steps is, can we get like a pricing model to see if it’s like even within our budget before we continue going because we are a non profit, we’re at a very small budget right now? Yeah?
Josh Brunell (67:14) Yeah, of course, this is what I would probably recommend. So I’ve gotten some of the data points just on this call, I’ve noted down as far as that would help me put together a pricing estimate. But if it’s okay, could I follow up via email with a couple additional questions just to validate like overall scope? And then we can reconnect review the proposal together… and then determine from there, like, hey, if this is within reason, we can continue conversations, get Tom involved and go from there. Does that work Mike?
Mike Barrett (67:50) Yeah, that’s perfect. Cool. I will.
Josh Brunell (67:52) Get those questions over to you that I’ll follow up with via email on my recap. And then as far as like time to reconnect, let’s… see.
Josh Brunell (68:09) We could be Wednesday or Thursday for, we could probably spin something up if we could get the questions back like in the next day or so we could, I could spin it up same day and then we could connect on Wednesday or Thursday if you’d like for, to review a proposal or initial kind of drafted proposal.
Mike Barrett (68:29) That works for me. Any.
Josh Brunell (68:32) Time in particular, we could do.
Josh Brunell (68:45) Sorry… we could do nine 30 on Wednesday. We could also do 10 30 on Wednesday as well as… you’re looking for afternoon. We could do.
Mike Barrett (69:03) 10 30 works for me. Does that work for you, Jessica?
Cc Jessica Manzo-Rodriguez (69:07) That works. I just have a meeting at 11 on.
Josh Brunell (69:10) Wednesday. Yeah, we’ll be, I don’t think, I don’t think we need a full hour, probably 30 minutes, just align on like some of the inputs that you’ll share over via email after I follow up with those questions and then we can review the pricing and then go from there. Okay, cool. Awesome. Well, thank you for the additional time. Jessica. It was nice meeting you, Mike. Susanna. Nice talking to you again and I’ll follow up later this afternoon. I have a couple back to back meetings coming up here, but I will follow up this afternoon with those questions. And then if they’ll just be a couple of data points we need to put together that proposal that’s good.
Mike Barrett (69:53) And a quick question for you, if you were going to do anything with our golf tournament, I need like head counts by Wednesday.
Josh Brunell (70:00) Yeah, I’m actually meeting tomorrow with to see if I can, what kind of budget I’m working with on a personal level to put towards that. So, okay, let me meet. Let me meet with my I’m meeting with my head of finance tomorrow, just to discuss.
Mike Barrett (70:18) Okay. Sounds good. Thank you. Yep.
Josh Brunell (70:20) Of course. Thanks, Mike. Awesome. Well, thank you. Thanks, everybody. Thank you. Bye, bye team.