Transcript
Bradley Eral (00:00) go on, haasen… you’re on mute. I,
Hassan Zahir (00:04) was about to say, I’m muted how you doing, sir?
Bradley Eral (00:06) Good man. How are you?
Hassan Zahir (00:08) Good man. Just trying to scramble a little bit with everything that’s been happening with josh.
Bradley Eral (00:13) Yeah, crazy stuff, man. Hope he’s all right, appreciate you stepping in.
Hassan Zahir (00:20) Yeah, for sure. Anytime.
Bradley Eral (00:25) What do you got cooking this week?
Hassan Zahir (00:29) Eagle telehealth with Phil, trying to really like get that moving stepped in and been helping on essence since josh has been down a little bit, was on site there last week, actually was on site with eagle too, and trying to push both of those forward. I think essence is still, very, slim chance of this quarter, but, very unlikely still. And then eagle should be a good Q to opportunity. And then just all that kind of stuff.
Bradley Eral (00:56) That’s awesome. You’ve been grinding. I appreciate everything you’re doing, but hope you get a week at home here soon, bro. Here’s. Pauline, by the way. Okay?
Bradley Eral (01:15) Hey, Pauline. Yeah, Brad and Hassan here with medallion.
CSPPM L. Pauline Sabitsch (01:23) You can hear me but I don’t think you can see me. I’m sorry, still, yeah, still having camera problems. I’ve got a text message from it here that I, there’s some kind of update I need to do after my, after I’m done with meetings, so.
Bradley Eral (01:39) Oh, not a problem. We, can, we can turn you off camera. Make it easy.
CSPPM L. Pauline Sabitsch (01:42) Okay. Sounds good.
Bradley Eral (01:45) But how’s the week been treating you so far?
CSPPM L. Pauline Sabitsch (01:47) Oh, you know, as to be expected. So, just busy. How’s your week been treating you so far? Same?
Bradley Eral (01:54) Deal. Busy. Hard to believe. It’s only Tuesday, but it’s been good. Busy is busy is good in our world? Yeah.
CSPPM L. Pauline Sabitsch (02:04) Yeah. I know it is hard to believe it’s only Tuesday. It feels like it’s been a whole week already?
Bradley Eral (02:08) Exactly.
CSPPM L. Pauline Sabitsch (02:12) All right. So, let’s see. So, looks like we’re having a caqh coordination demonstration is what we’re doing today, yeah.
Bradley Eral (02:20) The, the two things we’re going to hit on today. Obviously caqh management, how we help your team or your providers, set up their caqh profiles, manage them, test them on a quarterly basis, just like take the burden of that entirely off your provider’s plate. And then also like the downstream implications that come with it as far as, you know, ensuring enrollments are done accurately, right? And then the next piece we’ll talk about is, hey, how do we, once you get to a point where there’s going to be delegation and delegated agreements? How do we support those efforts and setting those up? And then long term support, the audits that come with that and of course turning around and cqa compliant cred files. But with that said that’s kind of what we had from a general perspective, is there anything else from your side, Pauline that would be helpful to hit on today?
CSPPM L. Pauline Sabitsch (03:06) No, I think that’s really just it just seeing what you have and how you can help me.
Bradley Eral (03:11) Perfect. Well, we’ll do that here and then we’ll Rachel will be joining as well.
CSPPM L. Pauline Sabitsch (03:17) No, she has, a training that she’s in right now. Okay, perfect. I think she’s getting some cme or ceus good?
Bradley Eral (03:23) For her just want to make sure I’m not kicking things off and leaving her behind. But with that said, I know you haven’t met Hassan. So, so josh, who my, our other SE, who was on the previous call? He’s out sick today. Hassan runs our solutions consultant org nationwide works with, you know, obviously a variety of our customers and folks looking at medallion. So he’ll be a great resource for now and throughout the evaluation. But with that said, I know you haven’t met him yet. So Pauline, all of you quickly introduce yourself, all of Hassan, introduce himself and we can jump right in.
CSPPM L. Pauline Sabitsch (03:54) Hi, Hassan. My name is Pauline. I’m the RCM manager for wellstead mental health. And we are a growing psychiatry platform getting started with this new credentialing process here. We’ve been pretty much well actually everything has been on a spreadsheet system for now. And so we’re just trying to get ourselves a little bit more professional and put together and make things easier on me as the credentialing process is going to be segued on to my realm once Rachel is no longer consulting with us.
Hassan Zahir (04:26) Awesome. Pauline. It is a pleasure to meet you. I’m actually just going to come off video for this portion. I know your video is not working but for introductions, I just think it’s a little bit more of a personal touch since my camera is working. But Pauline, it’s a pleasure to meet you.
Hassan Zahir (04:41) My name is Hassan. I do lead the solutions consulting org as Brad said here, but I’m not just somebody who leads the org. I’ve worked at medallion as an individual contributor as well for like two years and so super familiar with how the demos go in the platform, but also, I like to be the Guy who helps our team think through difficult situations and circumstances and also helping guide prospects to where they want to be able to get to. So these kinds of conversations where it’s just conversational, we’re talking about capabilities. It doesn’t feel like we have to sell you or anything. These are the ones I love the most. So I want you to feel free to ask any question about how we do caqh management, what that downstream impact is, how we ensure parity between the applications because I think that all of that is important.
Hassan Zahir (05:31) Happy to walk through the process with you today. Just honestly happy to be here and be a part of the conversation.
CSPPM L. Pauline Sabitsch (05:38) Well, thank you. Very nice to meet you. And I’ll let you know that I’m generally the type of person is that I have to see the whole demo and I don’t come up with my questions probably until a day later with it. So yeah. So I may have a couple of immediate questions, but most of my more in depth questions come at a later date. It does take me a little while to process what I’ve seen.
Bradley Eral (05:57) No, I’m the same way Pauline, it goes without saying, obviously as these questions arise, say tomorrow or a week from now, you can either email them to us or we can obviously set up a follow up session just kind of walk through some of these in more detail.
CSPPM L. Pauline Sabitsch (06:11) Okay. Awesome. Thank you.
Bradley Eral (06:15) With that said, Hasan, the floor is yours.
Hassan Zahir (06:18) Okay, awesome. So what I will do is I am going to share my screen. Give me 30 seconds or less to get this pulled up.
CSPPM L. Pauline Sabitsch (06:28) Alright. I’m counting.
Hassan Zahir (06:29) Alright… I wanted the form fill and then pull and so I just want to make sure I’ve got everything up so that once I start sharing my screen, it’s kind of comprehensive and we don’t have to jump back and forth between the screens but I am at about 27 seconds at this point in time. So I should stop talking.
CSPPM L. Pauline Sabitsch (06:57) It’s okay. I wasn’t really funny.
Hassan Zahir (07:01) And so, can you see my screen? Okay? Pauline?
CSPPM L. Pauline Sabitsch (07:04) I can, yes, sir.
Hassan Zahir (07:05) Alright. So I’ve got some videos that I want to kind of show that support the process. But first and foremost, I want to kind of walk you through the process. So as you can recall from the original demo that josh did, he talked about how we are able to get providers into the system, correct? He walked you through kind of like that caqh integration and how we’re able to pull all of that data. And so what happens is we do that process and we end up with the providers with completed profiles once they have attested to the data and verify that it is up to date and correct. You can see that we are able to capture those caqh ids and pull those providers in and that’s us pulling the data down from caqh. But now, what becomes important is the ability to maintain parity between what’s in that provider caqh profile and what’s in medallion. So that when we’re using caqh for application submission or utilizing caqh for revalidations, that there’s not any issues. And we don’t get a denied enrollment or a denied re enrollment. And so, with medallion, we have a service called caqh management. As I scroll to the right, we’ll maybe I have to jump into the provider profile. Nope as I scroll to the right, you’ll see we have caqh management and we have this box, we can enable caqh management for all of your providers or for a subset of providers who require caqh management, for example, like behavior techs, or someone like that who doesn’t have a caqh profile. Obviously, they could have a profile in medallion, but they wouldn’t need caqh management because.
CSPPM L. Pauline Sabitsch (08:53) they’re not.
Hassan Zahir (08:54) A provider type that’s in caqh? Is that tracking Paule?
CSPPM L. Pauline Sabitsch (08:57) Yes, that makes sense. And.
Hassan Zahir (08:59) So we don’t want you paying for something that obviously doesn’t make sense and that you’re not going to use, but we want to make sure that there is parity between what’s in that provider’s profile and what gets pushed up to caqh. So when those enrollment applications, like I said, and re, enrollments are enabled and it’s really easy, we can click the box and enable caqh management. I’m in a demo tenant for a demo provider. So I can click away all I want and it’s not going to enable caqh management… but you can do it that way or we have the ability to kind of do it in bulk. And so we can enable caqh management for providers as they start. We can always come in and enable or disable caqh management from the provider’s profile or just from coming to this provider’s page and then choosing the provider who you want to have caqh management enabled for or disabled for the caqh management.
Hassan Zahir (09:52) SKU follows the provider SKU, meaning if a provider let’s say you have 50 providers and you had turnover of 10 and you hire 10, you’re still back to 50 providers. So the caqh management from the 10 who are lost now gets applied to the 10 who are there. It’s a common question that we get asked. So I just wanted to go out in front of it and let you know that caqh management, it just matches the number of providers that you’re performing caqh management for it’s. Not one of those things. If you had it for a provider and they left, then you would have to get new caqh management for another provider. You would just be able to change the previous caqh management to that provider. And.
CSPPM L. Pauline Sabitsch (10:35) with that, do I understand that? Then there’s a per provider fee for the caqh management or do we get like a bulk price for 50? And then we add on after that?
Bradley Eral (10:45) Yeah. So it would be per provider and obviously, like what we do is forecast how many providers we do this for in years one, two and three. And the way we structure our contracts, we call it skew flex, but essentially what that means is like across all these different things you’re going to be purchasing from medallion, we’re never going to get like right on the money as far as how many caqh management is what you use in years two and three.
Bradley Eral (11:11) So there’s flexibility as far as you can pull from out years. If you overconsume you can roll over unused credits if you underconsume you can use credits that were originally allocated to this towards enrollments. So it just ultimately provides complete flexibility.
CSPPM L. Pauline Sabitsch (11:27) Okay. Understood. Thank you.
Hassan Zahir (11:29) Yeah, absolutely. And so what does that mean for medallion? What that means from a caqh management perspective is that from the provider’s profile, everything that is a data element that’s eligible for caqh will get pushed to caqh. And so that’s going to be obviously the overall basic demographic information. If a provider happened to change their name, let’s say she was a woman who got married and decided she wanted to take her husband’s, last name, we would be able to push those updates. We would be able to push the updates for updated licensure. Anything that exists, we have the ability to do it. There is one requirement… in addition to signing the attestation, we do require that the provider does supply their username and password for us, updating caqh. That is not a requirement for us to pull data from caqh as a participating org, but I want to make sure we’re always being transparent. We do require the provider to put that information in. We do store it encrypted, and it’s just saved in that provider’s profile. So it’s not like they have to do anything afterwards, but we do require that they enter in that username and password. And then again, that information as far as the password as you can see is stored encrypted. Okay?
CSPPM L. Pauline Sabitsch (12:56) Does the system recognize if they’re not able to access that anymore? Because for instance, maybe they changed the password and send them a notification to provide the updated password?
Hassan Zahir (13:04) It does. And so that’s a great question. And I’m glad that you asked it. Medallion in this section known as intake or internally we call this mission control. This is not exposed to customers. But I’m happy to give you this view, Pauline, because I’m logged in as an admin as a super admin. And this is like something we don’t often share, but we’re friends. So I’m going to share this one with you Pauline. And this is a behind the scenes peek. This is how we track all of the provider requirements. This is how we track all of the group requirements, the practice requirements. We’ll track caqh requirements. And part of the requirements for caqh is that we will see if we, if they have a completed profile or if there are profile updates that are pending. If there are profile updates that are pending, we make sure we pull those down into medallion and then we will verify that their username and password works. And so you can see that this marked as failed by the automation on January. The last time we attempted to update it. We know why it failed because this is a demo environment and this is not a real provider. But you can see here that if that does fail, what happens is in that provider’s profile, they will get a task. And so if I navigate to the overview section of that provider’s profile where tasks are assigned out to the providers, you can see here there’s a couple of tasks for Naomi in a real world environment. In addition to like these sample ones, there will be a task that says update caqh username and password. And so, there will be a task there that’s associated with it, and they will be notified. And then that’s going to go out under all tasks. And so as an administrator who’s starting their day, they would be able to see we saw those ones that we just saw for Naomi for completing those two tasks. But there would be another task there that exactly existed. I guess she had three total and we see three total here. But there would be another task that says update caqh. I don’t know if I’ve got one in these, this list of 35 tasks here. But that’s absolutely what happens. It would show up under all tasks. And if an admin wanted to see all of the outstanding provider tasks, it would show up right there as well as part of Naomi’s profile being completed. There would be a task to update the caqh username and password.
CSPPM L. Pauline Sabitsch (15:35) Okay. Understood. Thank you.
Hassan Zahir (15:37) Absolutely. And so then what happens is medallion’s automations run. And so we have the ability to both pull data down from caqh, which is like what you saw in the initial demo, right? Not only do we have the ability to pull in like the profile, but we can pull in the documents, the education, the work history, the hospital affiliations, like all of the things that you’re seeing us go through on the screen and we don’t have to pull those in indiscriminately. We can choose which data elements to pull in from caqh, but we also have the ability to then write to caqh. This is going to be just kind of like a quick form field example, but I want to show you this video just as an example of how the automation works. So we’ll navigate to that provider’s profile. We’re going to go in and update whatever it is that needs to be updated. In this case, we’re updating the practice locations that a provider practices at. And you can see that the automation is entering in the data. You can see caqh. Obviously, this is sped up which I’m sure it looks familiar to you and we’re able to update that. So whatever data it is that we need to be able to write back into caqh, our automation has the ability to do that right back into caqh. All of this information is logged and attested, if there was an additional error, we would identify why that error existed. Is it something that we can fix by an additional update? Or if that needs to be a task that’s assigned back out to that provider as well. So even if it’s something unrelated to medallion, but it is related to caqh. We can then generate a task for them as well if it is all up to date or there’s nothing that medallion needs to update further, the medallion will attest to that profile as well. So not only are we going to update the information, we’re going to attest to the profile being up to date and correct? Because the provider gives us that right through the attestation form in the medallion platform. And from there on, we will continuously maintain parity between what is in their medallion profile and what’s in caqh.
CSPPM L. Pauline Sabitsch (17:48) All right. Understood. Thank you.
Bradley Eral (17:51) Yeah. And Pauline, remind me like as you take on this responsibility as a whole, how is the caqh management done today? Is this on the provider’s side? Are you doing this on behalf of your providers? Like what does that look like today?
CSPPM L. Pauline Sabitsch (18:04) Well, so I’m not currently doing this in my role, I did it previously in my old role for my providers. So, yes, I would manage it manually for my providers and Rachel is now managing that manually utilizing a spreadsheet. Yeah.
Bradley Eral (18:21) Okay, perfect. And then I guess, let me ask you this and we have no religion on the matter, right? Everything is kind of a la carte if you will. But as you look at how you’re building out the team and now taking on the responsibility is caqh management, something you would like to continue to do as you’ve had in the past where you’re.
CSPPM L. Pauline Sabitsch (18:38) managing, oh, no way. No way we’re talking. I think we’re probably going to be up to 70 this year and they’re talking about adding 100 more next year. Yeah. Okay. No way. No, how.
Hassan Zahir (18:52) Much time do you think is being spent doing it? Because I mean, I know just from setting up demo caqh profiles, how time consuming that can be, how much of a time suck has that been for you in the past? And I guess for the team today?
CSPPM L. Pauline Sabitsch (19:05) Oh, it’s a tremendous time suck. Just the amount of time it takes to go through all the pages and manually update information, not to mention having to get information directly from the providers and continually remind them to provide what you need.
Hassan Zahir (19:21) Exactly. And that’s why we pair that task system with the caqh updates. So we can essentially take the human out of that process. It’s like, hey, the provider is tasked with something, they provide that document via the provider portal. That data is updated in the medallion profile, medallion updates, caqh. And you can rest assured that there’s not going to be any conflicts when any updates need to be made to, you know, a re enrollment or an initial enrollment, especially as you’re growing at the clip that you’re growing at. And so just that’s the reason we wanted to show that holistically. And I love those questions. You said sometimes you wait for questions but you ask some great questions around the task.
Hassan Zahir (20:07) And so,
CSPPM L. Pauline Sabitsch (20:08) sometimes a blind squirrel gets a nut.
Bradley Eral (20:11) Story of my life.
CSPPM L. Pauline Sabitsch (20:13) Yeah, mine too. What?
Bradley Eral (20:15) I’ll say Pauline is and you’ll see this throughout like obviously both demos now, but like our ultimate goal is let’s take off things such as caqh management, like what’s the blocking and tackling of the work, take that off your plate to free up your time for more strategic work as you build out this RCM function as you scale, right? So that’s ultimately, our goal is give you time back and just make the, yeah, the boring work easy for you or no work at all if you will.
CSPPM L. Pauline Sabitsch (20:42) Promises promises.
Hassan Zahir (20:47) And so kind of in a nutshell, that’s how we manage caqh again kind of to recap everything that we’ve shown, you have to choose which providers you want caqh management enabled. For once it’s enabled for them, we will update those provider profiles. We will automate the process of updating the providers. We’ll update those provider caqh profiles. We’ll automate the process of attesting to those caqh profiles. And then that way when applications and re enrollments need to be completed, there’s parity and it avoids any conflicts or delays in provider in network or revalidated with, you know, the health plan as it stands. I’ll pause there. I know we wanted to briefly or do a light touch in discussing kind of delegated capabilities especially as you continue to grow and go beyond the direct enrollment route. But before we transition there just want to pause and say, hey, what you saw today from a caqh management, did that answer all of your questions? Did I miss the mark? Anywhere? Is there anything else that maybe you want to get an answer on that? Wasn’t in the process that I’ve shown so far well?
CSPPM L. Pauline Sabitsch (22:05) I do have one question if we go ahead and we get the caqh management. Does that make the general I’m assuming that would make the general onboarding process much easier?
Hassan Zahir (22:17) Well, the general onboarding process, yes, definitely should be much easier. We’re already going to pull the data down from caqh. But being able to out of the gate, see the differences between what’s in medallion overall and what’s in caqh. I definitely think that it accelerates that process. And we see organizations who have medallion with our standard onboarding and caqh management onboarding in a matter of hours per provider, just a couple of hours per provider, as opposed to the days that it’s been taking them pre medallion.
CSPPM L. Pauline Sabitsch (22:52) okay. All right. Understood. Thank you.
Hassan Zahir (22:55) Absolutely. And then, so the next piece that we were going to discuss today as I understand it was the delegated credentialing offering and kind of what that looks like. Happy to start this conversation wherever it makes the most sense. Pauline, I’m imagining you’re familiar with what delegated credentialing is and the likes, I imagine that based upon your provider size or your provider count at the time, you maybe weren’t eligible for delegated credentialing, but that’s something that’s boring. So, I’m just not quite sure like where you are and I want to meet you where you are.
CSPPM L. Pauline Sabitsch (23:32) Okay. So that would be at the very beginning because I am familiar with what it is and the theory of it, but it’s not something that I have any experience with whatsoever.
Hassan Zahir (23:40) Okay. So we’ll do that. We’ll lay the foundation and then we can kind of build from there. We may want to have another call as things progress, but I’ll just kind of start at the beginning and you keep me honest here. Is that a deal? Well?
CSPPM L. Pauline Sabitsch (23:56) I don’t know. I don’t know enough to keep you honest. So I’ll rely on you to be honest. How’s that? Okay?
Hassan Zahir (24:01) That is fair. And so, delegated credentialing is where essentially, as opposed to having to send in every application… you are able to perform a compliant credentialing process internally and submit your results to the payer. What encompasses a compliant credentialing process is that you need to do it in a ncqa certified manner… and you need to have policies and procedures and committees and bylaws stood up that the health plans accept. And so, step one in the process is always the fact that one of the requirements for delegated credentialing is that providers are cross referenced against the mpdb. And so, if your organization does not have an mpdb dbid, and you have goals of getting delegated credentialing, I would say first and foremost, that’s the thing you need to write down is like priority number one that’s independent of medallion or any other organization that’s just if you want to be able to do delegated credentialing, you need an mpdb dbid, okay certain organizations are eligible, certain organizations are not in the mental health space. You would need to have like at least a single MD or do employed. I know sometimes mental health organizations, and sometimes therapy organizations like they’re full of mental health providers. They’re full of therapy providers, but not necessarily an MD or a do. So I do want to pause there and ask if you, do you employ? Oh, yeah, we got lots of MDS. Yeah, that’s what I thought, I just wanted to make sure. So that would make you eligible for an mpdb dbid. So that’s kind of like step one, that is one of the primary sources that needs to be verified and getting set up with an mpdb id can take like it can take a few months. And so that would be like step one. And if you would like, Brad and I, after this call, we can send you some documentation that we oftentimes share with customers. Oh yeah, that’d be great. I’m like, hey, this is the steps to take. So that’s like number one, number two, you need to run this compliant process. So you get your dbid because that’s the hardest thing to get you’ll need to set up bylaws policies and procedures and committee structure, medallion supports with all of those things. So, we have a service called delegated setup and support. And we’ve done this with, you know, 100 or so organizations across the country and we help them establish their policies and procedures. We can help you establish your bylaws, we can help you with how to set up your committee for reviewing these credentialing packets once you’ve run all the primary source verification. And so it’s like this is what we’re planning to do. We’re going to set up a structure. And then we’re going to run a compliant process. Now, running that compliant process is also where medallion helps the most. That is where through the credentialing application in medallion, you are able to run primary source verification on any of these providers. I’ll actually take a step back and go back into Naomi Ely’s profile because this is going to show you all of those primary source verifications or those primary sources that need to be verified. And that is going to be your sams, your oigs, your ofac, that’s verification of license, board certifications, doctors who are prescribers verifications of Dea CSR and we do that in an ncqa compliant manner, which means that the health plans will accept that medallion is what’s known as an ncqa certified cvo. And so that is what health plans look for. Is that again, you’re doing this in an ncqa compliant manner, you can see here even though this is a sample provider. First and foremost, like I mentioned is, you know, we’re going to go through and do all these sanctions. We’ll verify their mpi number from mpez, medicare, opt out, the state disclosures. We’ll look at any work history gaps. We’ll verify their malpractice insurance, their work history, any hospital affiliations, board certifications, education, and training, their state licenses. Again, those prescriber licenses, and then oig, Sam, ofac, mpdb and then that encompasses what needs to be done from an ncqa compliant perspective. And so medallion automates all of these checks. So you can say, hey, medallion, I want to partner with you. I’m going to go and get my mpdb dbid set up. Medallion is going to assist you with getting your policies and procedures and your committee in place. If you want to change any of your internal bylaws, we can help consult on that. And then you’ll say to the payers. Hey, we are establishing this ncqa compliant process and we want to be eligible for a delegated agreement. They’ll say, OK, share with me your policies and procedures, share with me your committee setup, prove to me that you have an mpdb dbid, so you can run those checks and you’ll share that with them.
Hassan Zahir (29:45) And they say, okay, now, you need to run this compliant process for X, period of time to prove to us that you can do it and that period of time, Pauline, for some payers, could be three months. For some payers. It could be six months for some of the blues and some of the other plans. It could be a full year that they want you running that process. So it is important that you’re still doing, your direct enrollments. But once you’ve run this process for a period of time, what happens is you have these credentialing packets that come back, you have a committee and we can help you with that committee structure they go in and they review the results of those primary sources that were verified. And they will say, yes, this person has passed all of the requirements. They have no issues with their credentialing and we are going to approve them to work for us at wellstate and in wellstate. And then they’ll… be able to essentially be in network that day. So, essentially, as opposed, once you have this process in place as opposed to submitting an application, waiting for it to get received by the, health plan process and get health plan approving it. And that taking 90 days, 120 days or even more, you can run someone’s primary source verification on day one, that their profile is complete, you can put them through the committee process. We have a in application committee process. So you could actually vote on a provider in the application. And then you can get them added to the roster that you would then send to the health plan. And the day that provider is approved and added to the roster, not even the day that you submit it to the health plan, but the day that provider is added to the roster, that provider is then in network. So you can imagine this process can go from taking 120 days to taking three days, four days, five days… regardless for those health plans where you’re able to get delegated agreements in place. It’s going to be just not incrementally. I mean, it’s going to be magnitudes faster in which you’re able to get providers in network. You really just, I mean, you know, when a provider signs on, you don’t have to tell them that their start date, you know, is 90 days out or 120 days out. You can say that their start date is, you know, 21 days out, 30 days out or even sooner depending upon, you know, the provider, their specialty, their availability, you would be able to do this in such a faster more efficient manner. But it does require that you have the ability to have your own mpdb dbid, so that we can perform that check on your behalf. You do need to have your policies and procedures in place, you do need to have your committee in place and you need to reach out to the health plans to request delegation, say, hey, we have this many providers now and we’re continuing to grow. And as opposed to doing individual applications, we are requesting delegation and they will tell you if their panels are open for delegation, more than likely because of being in the mental health space and your rate of growth, I don’t foresee you getting pushback from any of the payers where they would challenge whether or not they wanted to offer you delegation.
Bradley Eral (33:16) Yeah. So in summary, as you know, Pauline, right? But like the big benefit of delegation is essentially accelerate revenue for your providers, taking it down from that one, 20 days down to one day. And ultimately, you know, getting your revenue producing assets and also, you know, the ability for you to enable care for your patients earlier and then have to get there is what Hassan just outlined and we’ll document that obviously that was a ton to throw at you. We’re going to we’ll send over a follow up with that documented. But, with medallion, we’ll take that process off your plate on the compliance aspect, helping you with policy procedures, all the audit support. And just know there’s another way you could do this which is to do it on your own. But why we see folks not take that option is, you know, first you have to get that ncqa accreditation which is expensive and like just a process litter with red tape. So there’s like about 12 months of work. Then you have to do everything. Hassan just mentioned that medallion will assist with. So ultimately medallion offers a lower cost, faster option to stand up delegation. But 100 percent you guys could do this on your own. It’s just an option that we see many of our clients either refuse to take or after going down that path and realizing all the upkeep that comes with it, end up partnering with medallion just to make it easier.
Bradley Eral (34:35) But let’s pause here. Obviously, this was a lot to throw at you. Any questions on delegation at this point or how we assist? Well?
CSPPM L. Pauline Sabitsch (34:43) Yeah, actually. And just a general question. And this shows a little bit of how little I know about it, but how many people are required to be on this committee?
Bradley Eral (34:53) Oh, that’s a good question. Yeah.
Hassan Zahir (34:55) Generally, generally, they want an odd number of individuals, five or more. You want a representation of the different provider types who work at the organization, and then some form of administrator from the organization. Again, these are just in general terms and then the odd numbers. So that obviously your committee doesn’t ever have a tie if there was a question on a provider or not. But medallion again helps you set up all of that. We have. Excuse me, we have all of the documentation for this is how you would structure a committee based upon, you know, the provider types that you have. This is like the size that we recommend. This is how we would recommend you have like a backup member if someone is on sabbatical or out sick or on, you know, FMLA or any of those things. And so that’s really like a huge benefit of medallion. As Brad said, you don’t have to worry about ncqa accreditation on your own. Medallion has ncqa accreditation and so our accreditation or certification rather, and that would extend to you. We can help you with those policies and procedures. We can help you with the committee setup. Because we are already ncqa certified. You wouldn’t have to go through that year process of getting ncqa accredited, and then an additional year of running the compliant process. You would just start running the compliant process. And oftentimes, because we’ve run it the process on behalf of so many of our customers, it expedites the time in which it takes you to get accepted for delegated agreements. I always say up to a year because I would love to kind of under promise and over deliver as opposed to the opposite okay. All right. And.
CSPPM L. Pauline Sabitsch (36:39) So with this just kind of from a daily operational aspect of this committee, I’m assuming that they would have a committee login to the medallion website that they would just go to approve or not approve providers that’s.
Hassan Zahir (36:56) exactly. It, they would get notifications. They would log in when we talked about kind of like on the adding providers, when josh was showing you this. Sorry, I’m going to go back to the providers tab. When we talk about inviting providers, we also can invite someone who’s just an administrator. So an administrator will log in. They don’t have to deal with all of the sections of the platform. They would just be an administrator, someone who logs in. They would go in, take a look at the committee or credentialing, see who’s been assigned to a committee. And then they can cast their vote. Some organizations have the committee meet in person for what we call like level two files or where something came back. Maybe there was something recent on a malware practice that they wanted to be able to discuss in person. They could do that. But for anything that came back and all of the psvs were clean, they can just approve them in platform. And then at the end of the month, the updated roster is generated by medallion and then that’s sent over to the payers. Okay?
CSPPM L. Pauline Sabitsch (38:04) So in this case, it could be likely that I necessarily would not have to personally be part of the committee, but I would have kind of like a management oversight over information that they’re providing.
Hassan Zahir (38:15) Exactly. It could be that kind of way where the committee members just log in and you can say, hey, make sure again because it’ll go back to the day that they’re approved. So you can say, hey, every Wednesday, you know, everyone needs to log in and make sure that they voted on everyone who’s ready for committee or depending upon, you know, your hiring cadence that’s exactly how it could function, Pauline, is that you could be the administrator kind of the, you know, the project manager or the quarterback of the process if you will. But you wouldn’t have, you could be a part of that process per SE?
CSPPM L. Pauline Sabitsch (38:46) To be part of the process? Okay? Understood. All right. Thank you.
Hassan Zahir (38:51) The other piece there and again, try not to throw too much information all at once. But I’m sure we can have additional conversations is that each payer requires a roster structured in the way that they can ingest it. And so as opposed to that being something that would fall on you, part of medallion’s offering is that we will auto generate those rosters for you in the format that the payer requires, and then provide those to you to be submitted on your standard monthly cadence.
CSPPM L. Pauline Sabitsch (39:24) Okay. Understood. That sounds nice. Yeah.
Hassan Zahir (39:29) When we talk about kind of like those time saves and the headaches just kind of like what’s the delta or who’s been updated or what’s the new practice location for this provider, as opposed to demographic updates, medallion owns that entire process. Those are added to the roster that’s submitted to the payer. So just again, just reduction of manual work because the delegated process is significantly faster. But there, you know, there is some new work that comes about from it.
CSPPM L. Pauline Sabitsch (39:58) Okay. Right. Understood. And.
Hassan Zahir (40:02) So, I know we’re throwing a lot out there, Pauline, but I just wanted to kind of level set and say the net of it is that all of those things that are required, medallion can guide you through the process. We’ve got a lot of experience supporting other organizations, getting them set up, getting them… their committees in place, helping them get their committees in place, helping them run a compliant process, helping them with the roster. And then new providers are just added to the roster and it’s significantly faster. And it’s probably the best way to support your growth that you’re experiencing now and that you’re expecting in the future?
CSPPM L. Pauline Sabitsch (40:46) Okay, right. And you said that you have some documentation that you can send me about getting set up for the beginning process of the delegated credentialing within a PDB. We do dbid?
Hassan Zahir (41:00) Yeah. Make sure that we send that in the follow up email. I’ll make sure that I get that over to Brad.
CSPPM L. Pauline Sabitsch (41:06) Okay. And Brad, have we received in writing information about the pricing structure yet? No?
Bradley Eral (41:13) Not yet. What we’ll do is a follow up today. If you feel like there’s some good alignment we’ll send over essentially an excel doc of like what are the inputs that we’ll need to inform two things, of course, the cost and then also what’s the expected benefit to your team?
CSPPM L. Pauline Sabitsch (41:29) Okay. All right. That sounds good.
CSPPM L. Pauline Sabitsch (41:36) And I don’t think I have any other questions then I think unless you have something else that you think I need to see, I think that I kind of would just like some time to digest that and see that documentation that you have to send over and the worksheet to see what we need to do about getting some pricing?
Bradley Eral (41:52) Perfect. No, I appreciate it. So let’s do this. I’ll send over both those items. And as long as I have you, what we can do is look at calendars maybe two weeks out to give us time so you can collect the data and I can turn around, you know, do the analysis on the benefits and of course, the proposal.
Bradley Eral (42:08) How does your calendar look? The week of April six? Which is crazy to say we’re already in April, but how does your week look the week of April six? For we can block out an hour. We’ll need probably like 45 minutes, but I can walk through the proposal and investment summary.
CSPPM L. Pauline Sabitsch (42:25) Okay. So let’s see. I’m definitely not available on the six. The seventh. I am available anytime but with a hard stop at three 30.
Bradley Eral (42:37) Three 30 and then remind me what?
CSPPM L. Pauline Sabitsch (42:40) Time? Is it Eastern Standard Time?
Bradley Eral (42:42) Okay. Perfect. Thought. So wanted to make sure how does bear with me.
Bradley Eral (42:54) How does two to three eastern on the seventh? Sound?
CSPPM L. Pauline Sabitsch (42:57) Sounds good. Okay.
Bradley Eral (42:59) Perfect. I’ll send over that invite and a quick follow up from today goes without saying if questions come up between now and then, you know, where to find us, but we appreciate the time and can give you a little bit of time back today. Okay?
CSPPM L. Pauline Sabitsch (43:11) Alright. Sounds good. Thank you so much. I really appreciate you taking the time and giving me the education and I’ll look forward to the next steps.
Bradley Eral (43:19) Absolutely. Thanks for calling. Okay?
CSPPM L. Pauline Sabitsch (43:21) Alright. Thanks guys. Bye. Alright. Bye bye.