Transcript
Kyle Bettencourt (00:00) hey, good afternoon, Doris.
Kyle Bettencourt (00:17) Hey, everybody. Hey, Noah. Hey, Doris. Can you hear us?
Dgprince (00:23) Yes. Sorry. I was just talking on the way on mute.
Noah Laack-Veeder (00:26) Well, said, what did we miss? I’m trying to.
Dgprince (00:31) Get my video to work. For some reason. It doesn’t.
Noah Laack-Veeder (00:37) do you have one of those like covers on it?
Dgprince (00:41) Yeah, it’s open for some reason. Wow. Sometimes it doesn’t want to work on zoom. I don’t know why. Let me try it again.
Kyle Bettencourt (00:54) Never knew. I’ve been having zoom issues all week. So I… can certainly relate. Hey, Kristen and Nicole, and Ron, looks like everybody else was able to join as well. Good afternoon. Everybody. Thanks for hopping in.
Noah Laack-Veeder (01:08) There we go. There we go. Hey, Doris.
Dgprince (01:12) Had to select the right camera. For some reason. It’s trying to connect to my laptop instead of my cameras. I apologize, everybody, no.
Kyle Bettencourt (01:18) I’ll get it out of problem. Well, cool. I think so. We’re good from the medallion side. Are we waiting for anybody else from the sentara side as well?
Dgprince (01:30) I think we’re good. I invited Ron, Nicole and Kristen to join us.
Kyle Bettencourt (01:36) Excellent. Well, so we got a pretty good sized group. So why don’t we just like kick off with some quick introductions on as to who I have on the call. And then I’ll kind of go through high level agenda of sort of what I have planned. But we can kind of kick to you guys and learn a little bit more about what you’re hoping to get from the call as well. So I’ll kind of start it off from the medallion side. So, yeah, nice to meet everybody. My name is Kyle betancourt. I work on the sales team here at medallion. Obviously reached out to sentara, looking to have a conversation around credentialing and enrollment. Sounds like there may be some interest in learning more around what medallion could do to help sentara out with those functions. And so, yeah, excited to chat with you guys. I’ll be kind of your main point of contact from this call, moving forward from the medallion team. And I’m also joined by Noah. One of our solution consultants, Noah. I’ll let you give a quick intro of yourself. Yeah.
Noah Laack-Veeder (02:29) Hey, everybody. Noah, lead solution consultant here based in Madison, Wisconsin. And you can think of me as the technical point of contact. So great to meet you all.
Kyle Bettencourt (02:39) Thanks, Noah, Doris. Would you mind kicking off from your side?
Dgprince (02:42) Yeah, definitely. My name is Doris prince. And again, I’m one of the directors here in the revenue cycle department. My primary role and functionality today is over the credentialing team. We just recently brought our credentialing back in house for me and outsourced from, I don’t know how many years now, Kristen nine, 10 years, almost 10 years. Yeah. So definitely excited to see the technology that you have and I wanted to send it over to. Ron punted it to me and for that, I’ll punt it over to Ron. Let him share with you who he is.
RXTAPNIO (03:17) I’m Ron tapney, I’m the VP of revenue cycle, him and coding. So I have the back office functions for HP and PB as well as the him and coding cdi space. So, yes, Melinda sent it off to me and I said, well, this looks like a Doris prince thing. So, here we are.
Kyle Bettencourt (03:38) Awesome. Thanks, Ron and Nicole and Kristen.
KRISTEN C JACKS (03:44) Hi guys. I’m Kristen jacks. I’m the credentialing manager here for our medical groups reporting up to Doris and.
Dgprince (03:49) Ron.
Kyle Bettencourt (03:51) Awesome. Nice to meet you, Kristen. Hello?
NICOLE D BEAUCHAMP (03:54) I’m Nicole, I am the systems analyst for the credentialing team, reporting up to Doris.
Kyle Bettencourt (04:02) Excellent. Well, that sounds great. Well, thanks again guys for making some time.
Kyle Bettencourt (04:06) We’re definitely excited to chat with you guys. So, you know, as far as typically how we like these kind of initial calls to go, we’re more than happy to give you the overview of medallion and kind of everything that we do. But generally, we like to spend kind of like the first portion just learning a little bit more around kind of how you guys are handling credentialing and enrollment today and sort of what’s you know, kind of the current state of the business of sentara, excuse me… you know, as far as like kind of why I initially reached out. You know, I saw that you guys have a pretty large footprint as it stands. I think it’s 12 hospitals today, over 500 separate sites of care, 34,000 employees. I think over a 1,000,000 and a half patients that you’re serving, and it looks like you guys have some pretty significant growth initiatives. And I’ve also heard Melinda discussing some initiatives around like a touchless revenue cycle. And so, you know, we wanted to reach out because, you know, generally at your scale and your kind of growth initiatives, what we find is that puts a lot of pressure on credentialing functions. Sounds like just kind of based on your email back Doris, it may have been good timing as, you know, we’re learning today that you guys are kind of bringing things back in house. So I guess I would love to maybe just hear kind of like where things are at today? What was kind of like the driver behind bringing it in house? And, you know, what, you know, challenges I suppose are you guys facing if any, as you’re looking to take things back over from the outsourced cbo? Yeah.
Dgprince (05:40) Definitely. I mean, one of the things we wanted to have was more control. I would say being outsourced, we didn’t have as much control with it as far as like updating the system, making changes in the system. You know, it was pretty much proprietary to them and their work processes. So again reporting was very limited for us and also just the… overall performance wasn’t where we needed it to be. It wasn’t fast enough, you know, for us, to meet the demands and needs that we have here for sentara. So our current state currently, again, we just brought everything back in house as of October. So starting in January, our internal teams are now doing all repair enrollment for all of our 10 medical groups that we manage under sentara, trying to think of what else again. It’s all very new to us and very new. What we’re really trying to look for solve for, is there any AI technology? And I think that’s kind of what Melinda was hoping that you all had was maybe some AI technology that we would be able to leverage to help that burden from a staffing perspective, you know, just like caqh maintenance and all those things. So, you know, now that it’s here, definitely what I see and I’ll speak personally for myself is that just the maintenance alone from a credentialing standpoint is a very laborious task in itself, you know, because caqh, you’ve got to update it, make changes. And then with the growth and the expansion of all of our medical groups, it’s the volume too the short turnaround times influx, you know, do it now get it done? Now? We’ve got to hurry up and get it done because we’ve got a patient care need or an access issue, those type of things. So, yeah, again, trying to learn as much as we can find out what’s out there and see if there’s things that we can leverage to help us in this process.
Kyle Bettencourt (07:32) Yeah, that sounds great. I mean, I think, you know, kind of everything that you mentioned there initially sounds pretty in line with what we can do to help you guys out. And so like the best way to think of medallion is we’re sort of an end to end platform. We can operate as an extension of your existing credentialing team to help automate a lot of the functions around really sort of the full cycle of provider operations, right? So that starts from the onboarding experience to the credentialing to payer enrollment, but also sort of your ongoing recredentialing and ensuring your licenses are valid. And, you know, you guys are maintaining compliance. And so we are, it’s a technology platform, but we do leverage AI and automation along with humans in the loop to help initiate a lot of the key workflows around these processes. And then, you know, ultimately kind of the main value drivers or reasons that people partner with medallion. I think like one reducing turnaround times is something that’s huge, which sounds like it’s top of mind for you guys, you know, two, being able to allow their team, helping… them become more efficient, right? Not being weighed down by just the administrative burden that’s kind of required with these processes. And, you know, being able to automate some of the repetitive tasks for you guys. And then three like overall provider experience is another big thing that we hear with folks is just giving them, you know, a quicker onboarding experience, you know, requiring less of them to actually get onboarded. You know, we offer a bi directional caqh sync which, you know, ultimately we can allow our providers to basically just provide their name and email, and we can get like 70 percent of their provider profile uploaded in the medallion platform. So there’s a lot of like really cool things that we can do. And I’ll let Noah kind of dive into some of the specifics. But yeah, that’s kind of the high level of sort of how we operate now. I’m curious what were the, what are the turnaround times today? Or from your previous cbo that you guys were seeing on like the end to end process from like onboarding to enrollment? Yes. So.
Dgprince (09:38) From onboarding, we kind of owned the onboarding. So the initial onboarding process was managed by us. And then we would then create a packet to send over to our third party vendor for them to then do the pay or enrollment pieces of it. So the onboarding we always managed internally and part of that’s because so many of our such a large specialty driven group that we have so much hospital privileging that we have to do as well. So, you know, Kristen and her team have always done the onboarding and then passed it off to the hospital for them to do the privileging piece. And then the pay or enrollment piece. When I say pay or direct pay or enrollment went to our third party vendor. But then the delegation piece. While we sent it to our third party vendor for them to do the primary source verification piece, the actual delegation and rosters and all that was managed by Kristen and her team to send over to our delegated payers. And we had eight, seven or eight of those. Is it eight Kristen? Okay. Eight, eight. That’s what I thought. Eight delegated payers that we do rosters, you know, the monthly rosters for bulk uploads to them for enrollment. Depends that onboarding process. Again, we are currently using axuall that’s our ewallet that we’re using along with credential string, which is our credentialing software solution. Prior. Previously, it still takes I would say 30 days for you to get all the documents and pieces, or on average, 20 to 30 days for us to get everything that we need from the clinicians before we can actually start submitting that payer application. We’re seeing it come down, you know, the longer end to it because again, we haven’t been in this new role long. So we’re seeing it that the ewallet is helping us to be able to gather some of the information. And there’s still some of those pieces like caqh, you know, login information, getting all that information where it needs to be surrogacy coverage of insurance. We have a ton of locums that come through our system. So, you know, locums, you got to work with a locums agency, got to get all the information, got to gather everything, get everything that you needed to do in order to start that payer enrollment process. And our third party vendor, it was taking them upwards of 35, 40, sometimes 60 days wasn’t it Kristen for them to complete the primary source verification pieces.
KRISTEN C JACKS (11:58) Yeah, it’s not longer. Yeah, especially during new grad season, you know, heavier times of year that require a lot more volume, correct? Months, you know, start. Yeah.
Dgprince (12:10) And currently, it’s taken us 15 to 20 days by using Healthstream to do our primary source verification. So definitely a significant, you know, improvement there from where it was and.
Noah Laack-Veeder (12:23) then just a quick follow up question there. So like primary source verifications are going to be different based on whether we’re doing delegated credentialing for a payer and just doing ncqa versus doing the point commission for more of a medstaff office like is the ncqa piece, the piece that’s taking 15 days still?
KRISTEN C JACKS (12:41) Yeah. The biggest thing that takes long. I’m sorry, Doris. I didn’t mean to jump.
Dgprince (12:44) In, no, no, go ahead, no, please. Yeah.
KRISTEN C JACKS (12:46) The, the biggest piece that takes that seems to take the longest is education verification. We had that biggest issue with our vendor. And I do think even on this side with our new cvo, you know, getting response directly from those facilities, especially if they’re not using the national student clearinghouse, things like that just takes a little bit longer. And that usually is what takes the longest they’re a new grad because they are getting inundated with requests, right? For verification. So education is usually the biggest. All the ones that are web crawlers. Obviously, those come back, you know, very quickly. Anyone can do those kinds of things. It’s it’s those institution ones I think that are sticking point. It seems to be across any type of cvo you work with in my, you know, in my opinion.
Dgprince (13:31) And if they’re across multiple states, the other thing that we’re running into now too is we have again a very high volume of locums currently fill in a lot of positions. And then you’ll see that they’re across 25, you know, across multiple states. So when they’re trying to do all those verifications that’s also taking longer as well for them to go through all of that.
Noah Laack-Veeder (13:52) So if I’m understanding the kind of the workflow so far, there’s that data collection piece, that onboarding, and then there’s the credentialing and hospital privileges. So there’s going to be like the, are you all doing joint commission and ncqa credentialing or are you just doing ncqa? Our?
KRISTEN C JACKS (14:08) Hospitals are under dnv. Okay. And we on the payer side are ncqa?
Noah Laack-Veeder (14:14) Okay. So then you’re sending, are you just sending the hospital apps over to the facilities or are you sending?
KRISTEN C JACKS (14:21) Yeah, we share a consolidated application with our hospital cvo. So we are trying to data collect at one time from the applicant and then it splits off, right? So our hospital cvo does their pieces of things with the data that was collected. And then my team does our pieces of things with the payer side of what was collected. Yeah.
Noah Laack-Veeder (14:41) Is there a dependency in your organization to do these things in sequence? Or can you start enrolling without getting the I’m just going to call it the internal credentialing completed?
Dgprince (14:52) So we start immediately. Yeah, go ahead.
KRISTEN C JACKS (14:54) I’m sorry, go.
Dgprince (14:55) Ahead. So.
KRISTEN C JACKS (14:56) There are certain things you probably know, right? That we have to collect and have to have up front to initiate that payer enrollment. So we try to have a complete package before we initiate our direct enrollment. But what’s happening simultaneously is you have direct enrollment, then you also have the primary source verification occurring for our delegated plans as well as simultaneously our hospital partners going through primary source verification with the privileging pieces of things. So a lot of things are happening honestly, a little duplicatively to be honest, a lot of things are happening simultaneously but it’s different departments, different teams for different reasons, if that makes sense? No.
Noah Laack-Veeder (15:34) That makes complete sense. Yeah, it’s like, I think you guys are kind of unique in a good way that you’re actually doing these things in parallel. A lot of organizations are, you know, every organization has different reasons why, but they’re kind of artificially making the process longer by creating these stage gates. They’re like we’re going to wait until this is done, then we’re going to do this. Oh, yeah. So it’s good to have these kind of like three paths. And then is it fair just from a very general standpoint to assume that the teams, I guess Kristen, are you doing all? Is your team doing all three of those things? The payer enrollment or kind of how’s what’s that split look like?
KRISTEN C JACKS (16:11) Yeah. So, you know, our side is at the moment responsible for the direct payer enrollment, all that caqh maintenance stuff. I think that Doris mentioned earlier in the call that’s giving us. I think the biggest heartburn at the moment, all of that maintenance, the new initial setup, we are initiating a request to our Healthstream partner. The Healthstream want, you know, cvo to do the primary source verification since they are ncqa accredited. And then simultaneously, there’s a different team, different department within sentara, who’s doing all of the hospital based cvo, the verifications, our medical staff offices. It’s separate teams. We are working collaboratively but it’s two different teams doing things in the perfect world. Perfect scenario. You have one practitioner who’s going through hospital privileging, pay your enrollment and everything is clean done beautiful by the time they hit their start date, right? That’s the perfect world scenario that, you know, we live in. So we try to parallel as much as possible if we were able to initiate direct enrollment and credentialing without having some of those pieces, you know, in place, I would love to. We have had bad experiences in the past of trying to initiate direct enrollment with a payer while we’re still pending certain things because then it just pauses the application. It causes delays. So we try to package everything to my enrollment team so they can literally hit the ground running, get everything submitted and then just wait for those effective dates to come in. Yeah.
Noah Laack-Veeder (17:41) That makes a lot of sense. Yeah, from a workflow perspective, it seems like kind of where we can help a lot is kind of these efficiencies and kind of taking off some of these.
Noah Laack-Veeder (17:50) You said caqh management there’s not a maintenance there’s not a team that I talk to who doesn’t want to not do that anymore. Like everybody wants to upload that on a quarterly basis. Like how many of those attestations are you having to do?
KRISTEN C JACKS (18:04) We are responsible for upwards of 3,000 practitioners. So 120 days every 120, you’ve got to reattest.
Dgprince (18:12) Yeah, we got about 707 50 every 90 days. Yeah. If you were to split it up, if you were to split it up, you’re like, yeah, yeah.
KRISTEN C JACKS (18:20) It’s a lot and that’s just the maintenance which is maintenance isn’t bad. But then all day every day you’ve got brand new practitioners.
KRISTEN C JACKS (18:26) We are growing by leaps and bounds, right? Trying to initiate a brand new C a QH. What we’re seeing again, Doris and I and team are not the experts. We outsourced this for many years. So bringing it in house, we are seeing the time it takes to truly set up a C a QH account, right? And just to maintain it effectively, it affects all enrollment downstream. Every commercial plan uses C a QH. So if we don’t do it right from the start and manage it correctly, revenue, it affects revenue. So, yeah.
Noah Laack-Veeder (18:58) Tell me more about that. Is that, are you all experiencing like delays to revenue today? Are you experiencing some claims denials or?
KRISTEN C JACKS (19:07) I mean, yeah, Doris, you, can, you’re better?
Dgprince (19:09) Yeah. From a claims denial perspective, we got a little bit of everything going on. I would say you’ve got some of your payers who are site specific. So we have, you know, anthem tricare and medicaid who are very site specific. If you do not add that location to the application and a claim goes out the door, they’re going to deny it. Yeah, the other payers, not so much, you know, as long as the provider’s enrolled everything’s there where it needs to be, it pretty much rolls on but you’re you know, caqh, it does have to align. So if we have a difference, if someone has a typo, if they put the information wrong in caqh, and then the direct enrollment goes out, then they go look at caqh. If there’s a mismatch, they will reject that application. We’re not seeing a ton of that, but we have had it. I mean, you know, again, all of our staff are fairly new in doing it. So again, we’ve had a few mistakes here and there, but I have noticed that I don’t know like maybe three or four denials that we’ve had or not denials or rejections or the application was rejected because when they went out to check caqh, there was information that matched our application. We submitted, you know, that type of thing. So it gives us a picture that information matches.
Noah Laack-Veeder (20:18) Yeah. And then.
Dgprince (20:19) For denials, one of the biggest things that we’re having issues with our denials is more so the payer than us with them not loading the data in which we submit to them. So, a good example of that is taxonomy code. You know, it’s clear as day on the application when we submit it, it’s right there. But then they may load internal medicine in their system because the provider may have already been enrolled with them with another organization and may have started out as internal medicine, but now they’re pulmonary critical care, they’ve gone back and, you know, finished their additional education training and certifications. So now they’re pulmonary critical care, it comes through the market par and leave it as internal medicine, that type of stuff, if that makes sense. Makes.
Noah Laack-Veeder (20:59) Sense. Yeah. But on.
Dgprince (21:00) the surface?
Noah Laack-Veeder (21:00) Yeah.
Dgprince (21:00) On the surface, it looks like it’s credentialing. So it always comes to us and then we start having to troubleshoot and figure out how to fix it and then back into it and figure out, well, it’s more a system issue on their side versus a true credentialing issue. Yeah.
Noah Laack-Veeder (21:13) And then how easy is it in those situations to like find a proof of enrollment? Is that like a hard thing to find? Is it a needle in a haystack or is that really easily available?
Dgprince (21:21) To be able to find what we submitted, is that what you’re saying? Yeah.
Noah Laack-Veeder (21:25) So like let’s say you have to dispute this to say, look like we submitted this correctly, you did the wrong taxonomy. Like this is a you issue, like how is that process difficult today to find that information?
Dgprince (21:35) Not really. I mean our delegated rosters are there. So we have those, and then our payer applications, keep me honest here. Nicole. But as the staff submit them or whatever they save a copy, correct into Healthstream that we have proof of?
NICOLE D BEAUCHAMP (21:48) Yes. Okay. Yeah.
Dgprince (21:50) That’s what I thought. So. Yeah. So we try to be smart about that, knowing that you do have to have that proof, you know, to go back and say this is how we submitted it. This is how you register it in your system. So we shouldn’t have denials, we shouldn’t have loss in revenue. We need to fix your system to mirror what we submitted type.
Noah Laack-Veeder (22:06) Thing makes sense. That makes sense.
Dgprince (22:08) Yeah. So we store all those images and that history and everything within Healthstream. So it’s at ease at the fingertips of everybody to find. Yep.
Noah Laack-Veeder (22:15) It makes sense. And then I talk to a lot of organizations, a lot of organizations that move to credstream to medallion. And a big thing that I hear from them is that like look, it was great. It’s serving our needs. But as we’re growing like the automations just aren’t matching our speed like it’s I see you nodding. Is that kind of what your experience is today as well, or?
Dgprince (22:34) It’s to me. And again, I am by heart and by trade, typically a revenue, I tell Rhonda this all the time, a revenue cycle leader. And if Healthstream told me once, they told me 100 times, this is not an Ar system and I said, I know it may not be, but I expect it to act like one because it definitely is driving our Ar. So to me, it’s kind of clunky. I don’t know how to describe it any other way than that. I feel like it’s a little clunky and a lot of repetitive data entry is what I would call it, you know, just the way it’s set up and the way it’s built. And to me it just feels clunky compared to Ar systems and other applications that I’m used to working in.
Noah Laack-Veeder (23:16) That makes sense. Kristen and Nicole, do you agree with that too or anything you would add?
NICOLE D BEAUCHAMP (23:21) Yeah, absolutely. I mean, it’s they’ll have the same field, the same data field, but it’ll be called something different in a different screen and documents are not, they, they’ll upload into Healthstream, but then you have to go into different places to find them. You can’t easily, just attach it to all of the screens that you need. So, yeah.
Noah Laack-Veeder (23:49) And then, okay, go ahead, Kristen, I see you copied.
KRISTEN C JACKS (23:52) Yeah, no, I was just absolutely, I think, I agree. I, in my opinion, I don’t think it was, it’s as automated as I think we expected it to be coming into it. I think that’s the biggest thing. It is very in my eyes still manual. Is it better than the extremely manual that we came from? Absolutely? But it’s still manual in a sense of just not what I expected it to essentially turn out to be. It’s a good system. It’s doing what we need it to do. It’s just, yeah, it’s just a lot. It’s overwhelming for the team at time learning it because there’s a lot of ins and outs and a lot that Nicole, you know, had to build to get it to where we need it to be. It’s just, it can be overwhelming that’s you know, my thought anyway, yeah.
Noah Laack-Veeder (24:38) That makes a lot of sense. And, you know, Kyle and I have hundreds of these conversations and it’s typically kind of you get to an inflection point where like you’re growing so fast, you have so much work on your plate that it’s like this is this was a good tool, but really it’s we need more automation. I mean we need to save time in our day. So it sounds like you’re at the point right now where credstream really isn’t saving you all a whole lot of time. Is that a fair assessment? I mean?
KRISTEN C JACKS (25:04) I don’t think it’s necessarily fair to again Doris. You could definitely speak up for this. We weren’t doing the work really heads down prior. So I can’t really compare to say, hey the way we were doing it prior to what we’re doing now, do I think it’s one of those things that it’s just, I don’t know Doris. What are your thoughts? Nicole your thoughts? It’s hard to compare.
Dgprince (25:23) It’s better than it was. Yeah, it’s better than it was because we were on excel spreadsheets. To be honest, I mean, an organization this size, our credentialing department was literally on excel spreadsheets. We managed everything in excel. So now we do have it in a centralized location. It is all stored in a similar data. It is better for us because again the hospital and us share the same instance. We just had our marketing department who’s also sharing the same instance with us. So again, it’s becoming more like a repository for sentara, a physician data. So again, it is better, but is it what I expected? I’m gonna say no, you know, I expected more if that makes sense.
Noah Laack-Veeder (26:03) 100 percent. Yeah.
Dgprince (26:04) So really, you know, just really trying to leverage, you know, again, what I don’t wanna do is have to have a team of 60 people to do the work that we need to do. If there’s technology out there that we can leverage to help us to do the job, you know, and do it more efficiently and better. And everything else. Cause again time is money, you know, every time that we miss a deadline. So if we miss the physician start day by five days, if it’s a surgeon, if it’s a neurosurgeon or a cardiothoracic surgeon, or anyone else like that, you know, it’s tens of thousands, hundreds of thousands of dollars that you easily lose in a couple of weeks. So, the biggest thing for me is, how do we do it as efficiently as we can and as timely as we can? And even in those short turnaround times, you know, is there an opportunity for us to say, okay, put this at the headline, but we’re still not going to miss a deadline for the ones that we put that short turnaround time, when in front of, does that make sense? Oh?
Noah Laack-Veeder (27:01) 100 percent. Yeah. And just, you know, I think Kyle’s got some really good slides to kind of show you a little bit. So like how, what’s the turnaround time on average, you said the partner before it was like 360, 90 days, like how long is it taking for those direct enrollments to get completed? Like I’m talking like the ones where you don’t have delegated agreements with?
Dgprince (27:24) I think it varies in the calls out there. I mean, we’ve got some payers that turn around fairly quickly. Then we have other payers that are kind of dragging their feet a little bit. So we’ve got some that are as fast as 30 and some that’s like 60, right? And some that are maybe 90. It’s a little all over the board. I think. Yeah, and going back and forth follow up, yeah.
Noah Laack-Veeder (27:44) The payer follow up piece. Yeah, I mean, a lot of organizations when I ask that question, they’ll tell me like with all the payer follow ups and back and forth, like their average is around 120 days.
Noah Laack-Veeder (27:54) So it’s you know, if you guys are closer to 60 90 that already looks good. But if you’re like it’s actually closer to 120 that’s typically the industry average the.
Dgprince (28:03) Biggest thing you really have to do with direct enrollment. You have to make sure your caqh is, you know, updated first the data there is accurate and it’s accurately reflected. Then in your application, if you don’t you’re going to hit every bit of that like you said, you’re going to be at 120 very easily. But it also means that, you know, you’ve got that in between person. So we got our initial onboarding, and we’ve got our caqh person who’s now, we’ve come through the onboarding, we’ve got to make sure that we’ve got someone who’s updating caqh accurately. And then it splits off for delegation and it splits off for the pay or direct payer enrollment. But making sure that timing is accurate and that we’re working together so that we don’t hit those roadblocks is key.
Noah Laack-Veeder (28:48) Yeah, I’m totally aligned with you.
Dgprince (28:51) That.
Kyle Bettencourt (28:51) makes total sense. And I do have just kind of a question on just sort of the overall scale just even kind of backing up a bit. So obviously did a little research ahead of the call and I kind of have some numbers up here on sort of what we understand about sort of the current state today. But so… you mentioned 3,000 practitioners today? Is that sort of the full scope of the network that you guys are managing or… what was kind of like the overall number of providers that you guys are managing credentialing and enrollment with?
Dgprince (29:23) We just pulled that number yesterday. Nicole. Can you remember it? We were looking at it… I want to say it was 23 18. Something like that just shy of 2,500, we’ll say.
Kyle Bettencourt (29:36) OK.
Dgprince (29:37) But again, that’s with, you know, actively doing payer enrollment. I think we have some pass throughs like our anesthesiology group which is growing because that’s managed by a third party vendor as far as the payer enrollment and the Ar piece of it. So again, we’re growing very fast. Yeah.
Kyle Bettencourt (30:00) And so, yeah, I was curious kind of about the growth. I think I saw something around like doubling your apps as one of your initiatives. But what are you guys expecting growth wise over like the next 12 to 36 months as far as onboarding providers in general?
Dgprince (30:15) I mean, Ron, I’ve heard the 40 percent out there happen to you. Oh, wow. Yeah, yeah.
Kyle Bettencourt (30:22) 40 percent growth targets for new providers, yes.
Dgprince (30:27) That.
Kyle Bettencourt (30:27) is a significant growth for sure. And then.
Dgprince (30:31) last year, we did right at a 1,000 new provider requests. And while we did not hire a 1,000 fte bodies, we did process a 1,000 new provider applications because again, we have many of our divisions that are very heavily using locums, you know, how that is? You may have 100 come in 60 may go out. You have a new 40 coming. You know what I’m saying? That kind of thing so that, you know, the team has the work, but it doesn’t necessarily mean that we have the provider here full time all the time, but we are processing a ton of applications and have to pair and roll and manage that piece.
Kyle Bettencourt (31:13) Yeah, that makes sense. And it.
Dgprince (31:16) Has steadily grown over the last three years. I mean, three years ago, we were like 300 and something we were at 400. Then we went 558 or 68. And then this past year we went to a 1,000. So again, that was in 20 25. So 20 26 is definitely going to surpass that.
Kyle Bettencourt (31:34) What’s driving that growth? Just out of curiosity, I.
Dgprince (31:39) Think it’s just demand and need. Yeah. And then our service lines are growing as well. Some of the things that sentara is doing is bringing service lines back in house. So, I think that’s the other piece, got it. Okay?
Kyle Bettencourt (31:56) And then just last question, what is the size of the team that you guys have in house today to manage these functions today?
Dgprince (32:04) There’s 21 staff… total, that includes Kristen and joy and Nicole and myself as part of the I’ll call it leadership and the rest are credentialing specialists.
Kyle Bettencourt (32:19) Got it. Okay. And as far as this scale and growth, I mean, are you guys also just considering adding to that teams? I think just kind of based on some of the numbers that we’re talking here, it’s definitely a full plate for everybody there. So, yes, correct. Okay.
Kyle Bettencourt (32:35) Excellent. Well, that’s yeah, that’s super helpful. And so we’ve kind of prepared some initial numbers just to kind of like throw out some Roi projections on sort of what we think we can do compared to where we typically help customers with, you know, similar scenarios. But, you know, again, like this is kind of the ultimate problem that we’re looking to solve here with medallion, right? Is sort of the web of credentialing and enrollment processes, right there’s, all that disconnected teams systems workflows that you’re trying to manage. It’s very hard to keep track and keep organized all the different licensing and documentation, right? And then the numbers that we have up here on the right are just sort of our standard turnaround times and, you know, resubmission rates and just kind of benchmarks if you will that we see, you know, across the industry. So you’ve already kind of given us some pretty good information on this. But as far as where you guys align to that. But yeah, again, as far as what medallion provides, we’re sort of that end to end platform, we can act as an extension of your existing credentialing team and ultimately help you guys manage that full end to end process for provider onboarding, payer, enrollment, delegated payer enrollments, along with your licensing and ongoing recredentialing across your provider database. I think what’s going to be very interesting for you guys or helpful is our integration level with caqh. So we are the only organization that exists today that has a bi directional sync with caqh. I think I mentioned this at the start of the call, but, you know, essentially what that allows us to do is send an onboarding email for new providers and ask them for basically a name and email address. Once we get that information back from your provider, we can populate on average, 70 percent of that provider profile. And then what’s great about medallion is we can leverage at that point then AI and automation workflows to point out exactly what pieces of information are still missing from those providers, and then automate, the outreach to complete those provider profiles. So on average, we actually reduce onboarding turnaround times generally, we’re seeing within one day to actually get an ncqa compliant file for new providers. And so what’s great is now that we have, you know, all of the information that we need about your providers sort of centralized into one place with full visibility, we can then, you know, again leverage more AI and automations to initiate, those other key workflows around your licensing around your paying enrollments. And, you know, your re, credentialing to maintain compliance on the back end there. And so, we’ve done over 4,000,000 primary source verifications completed with medallion. We maintain over 99 point five percent accuracy across all of our files. And our median provider onboarding time is four point three days by leveraging medallion.
Kyle Bettencourt (35:29) And so, you mentioned turnaround times as kind of one of the primary goals and that’s kind of like one of the big areas that we see as far as driving value for our customers. And so, I kind of put this slide together here making, you know, a good amount of assumptions, but, you know, generally, on average, what we see is a 30 day reduction and that’s pretty conservative. Sometimes, it can be upwards of 60 days of reduction to getting providers actually billable and generating revenue for their… healthcare orgs. And we could do that by obviously, you know, increase that onboarding time, leveraging the platform to expedite the payer enrollment aspects. But just kind of like based on these numbers that I have down here, sort of doing a breakdown of guesstimates of your provider mix, you know, we’re estimating about 104,000 dollars per day of lost potential revenue that these providers could be generating for sentara, you know, times that over 30 days that’s you know, three point, you know, one, 2,000,000 dollars of revenue acceleration that we could potentially provide?
Kyle Bettencourt (36:38) So, I guess I’ll quickly pause. Is this… any initial questions on sort of what I’ve covered so far? You know, one and then two, I’d love to just kind of hear your thoughts on like this slide here. And, if this is resonating or if you have any questions on sort of how, we came to, these numbers can?
Dgprince (36:56) You go back to the first slide real quick. I think I had a question on that page?
Kyle Bettencourt (37:00) Yeah, absolutely. This one here?
KRISTEN C JACKS (37:03) Go back, no.
Dgprince (37:06) I’ll go forward. I’m sorry, I mean back.
Kyle Bettencourt (37:09) The.
Dgprince (37:09) next one, this one here?
Noah Laack-Veeder (37:11) Yes. Okay.
Dgprince (37:12) So again, you said the on board, I’m sorry, you said the state wide payer of enrollment. I thought I heard you say a timeline in there, how quickly you’re able to do it. So again with doing that, I know some of the things that really trips us up or holds us back is, you know, the Coi, coverage of insurance, those type of things, getting information, additional information that’s needed to get to that payer enrollment. Do you see those same challenges of where you’re having to get all that information? Because I saw where you were? I don’t know if it was in this, I thought I saw where you were like turning it around from the provider pretty quickly.
Noah Laack-Veeder (37:46) To.
Dgprince (37:47) getting the application sent out.
Noah Laack-Veeder (37:50) Yeah, Doris. That’s a really good question. It actually came up. It comes up often. I think there’s kind of the there’s two paths, of physicians or practitioners. One, they’re brand new, right? So then they might need some. I mean we’re just talking to an organization earlier where they want to even assist them to get their license, which is something that we can do. So like there’s a license part of it, there’s a Coi, part of it. And obviously those are going to extend the timeframe. There’s another path where they’re an existing physician. Maybe they already have a caqh profile. They’ve been around for a while. Those timelines can be extremely fast for medallion. And on average, you know, we can get those things done in a single business day. Kind of the piece here that, you know, is impossible to automate is if it’s someone brand new and they don’t have their data anywhere. We have to collect it, right? They don’t have a license. They got to get a license. And medallion can assist with that. But after we get the information, getting the primary source verifications completed, getting those applications created for delegation, getting those rosters submitted, enabling your committee to make those determinations, quickly, sharing data to your privileging or internal credentialing teams that’s extremely quick with medallion. But there’s definitely going to be nuance depending on who the provider is, whether they’re new or existing. But one thing I will mention and we can show this in a demo, but that caqh maintenance has been a big issue or it’s an issue for every organization. But ultimately, the workflow for a brand new physician could be look, you just have to create a caqh profile like that’s it, what we’ll do is we’ll collect all your data using medallion to work with you. And then we’ll actually update and populate everything in caqh automatically for you and quarterly a test on their behalf. And with that caqh integration on our side, both ingesting data from caqh and exporting it out. We can also automate those quarterly attestations and the pieces where we make sure that data matches caqh before we submit an application among 100 other checks that we could be doing at scale. So not all of this is going to be shown here. But ultimately, the reason why we’re able to get these timelines is really based on the things that you were calling out, making sure that we’re getting data in our system. Making sure that we’re double checking it, making sure that we’re updating any downstream systems and then making sure that if there are payer follow ups required, Nicole, that you’re kind of mentioning, we’re actually using AI and eugenic agents to either call the payers in parallel. So we can do like a 1,000 phone calls at once versus having to wait one by one to do each phone call. And we can use email scraping where if you have a credentialing inbox, we’ll scrape the emails coming in and then result and send those to your team saying these are the things that we need to accomplish. So, those are where the efficiencies really lie and then kind of the timeframes, if it makes sense, we can do a payer analysis based on the states. Where if you go here are the payers that we have here are the different states, we can tell you what our turnaround times are for those states as well to make an apples to apples comparison. Can I?
KRISTEN C JACKS (41:02) Ask a quick question about ncqa. It says here on this slide, you provide an ncqa compliant file in, you know, what a day one day. So, is medallion ncqa certified? Or are you just following? You guys are actually accredited by ncqa? So you’re primary sourcing? Okay?
Noah Laack-Veeder (41:21) Yeah. So some of the credit stream they’re like an ncqa accredited, you know, organization like we are as well. Yeah. Okay.
Dgprince (41:29) And that’s the reason we haven’t been able to do that in house is because our hospital, you know, CDO is not ncqa accredited, neither are we. So again, that’s the reason we leverage the Healthstream, CDO, who does our primary source verification for us with that? And then, I know we maintain all of our master accounts for caqh. So like all of our tax ids, our main ones, we maintain all of those.
Noah Laack-Veeder (41:54) Yeah. And.
Dgprince (41:55) that’s something that we even did when it was outsourced. We maintain all that while our third party vendor maintained the providers or kept the providers current?
Noah Laack-Veeder (42:05) Yeah. Okay. And I do.
Dgprince (42:07) Have a question, sorry, go ahead. Oh.
KRISTEN C JACKS (42:10) Sorry. Go ahead. I just.
NICOLE D BEAUCHAMP (42:12) Wanted to ask about the caqh, the bi direction communication. Does that mean that we would not have to maintain the username and password anymore, so.
Noah Laack-Veeder (42:22) We only need the username and password to update information to caqh. We don’t need it to bring data into caqh. The way to overwrite data is you have to have some authentication saying, yes, this is who this is, so we can leverage username and password to bypass that. So ultimately, how customers do it is they’ll store caqh as kind of like an external account in the system, and then we can leverage that to update those profiles on provider’s behalf, and then also do those quarterly attestations.
Dgprince (42:57) Okay. You’re still using you’re still using that login id or that?
Noah Laack-Veeder (43:01) Password just for the updates and the attestations mostly because, there’s no way around that because, right. Yeah. But to ingest data, we actually don’t need username and password just to overwrite data like read only, we don’t need it, but to overwrite we would need it. Yeah. Right. Okay. Does that answer your question Nicole?
KRISTEN C JACKS (43:24) Yes, it does. Thank.
NICOLE D BEAUCHAMP (43:25) You. And.
Dgprince (43:27) Then my question was around the expirables that may be happening in caqh. Is that something where you run that and take care of that as well? Or is that something that our team’s okay?
Noah Laack-Veeder (43:38) Yeah. So we’ll track the expirables, a lot of customers leverage us for license renewals, as well as for revalidations? Are revalidations? Something, I mean, because you, with such a large volume, I mean you’re going to have re, credentialing revalidations coming up? Like, do you have a significant amount of revalidations that are happening today?
Dgprince (43:59) Yeah, they’re like on a monthly basis, right? Chris, when I’m spread out, yeah.
KRISTEN C JACKS (44:03) So, we have to do re, you know, re cred with all our delegated payers. So yeah, they’re spread out amongst each month. We do a few. But then obviously, as you know, with direct enrollment, we don’t really know a lot of times when a practitioner is going through reval, as long as caqh is up to date and it’s seamless, and we aren’t even notified it’s when something needs to be updated or something in caqh where the payer will reach out and go, hey, you’re going through a reval, this needs to be updated. So on the direct enroll side, if all is well, we won’t even know when they go through, you know, a re cred, but on the delegated side, yeah, we separate, we parse it out. So we’re not completely overwhelmed each month with re creds for our delegated plans. Yeah.
Noah Laack-Veeder (44:45) That makes a lot of sense. And kind of how I think about medallion would be same kind of thing like just revalidations are going to be handled. And really, the only reason something would come to your plate is if we’re missing something?
Dgprince (44:56) Right. Can I?
KRISTEN C JACKS (44:58) Ask how, you said you have a brand new practitioner coming in, you’d have to collect? How do you guys go about collecting the information from the practitioner? Yeah.
Noah Laack-Veeder (45:07) I’d love to hear what your methods are for like someone who’s brand new. But typically what we’re doing is and I can show you this in the demo but is, you know, if it’s documents, whether or it’s like resumes and things like that, we can take a scan of that and then use OCR technology to start pre populating things. Ultimately, what no one can automate is the situation where their data doesn’t exist anywhere yet. So like that’s the piece where if it doesn’t then there’s going to have to be a manual component. But typically, what our customers will do is they’ll say, look, I’m trying to provide my providers with a white glove service. They’ll send their information. Maybe it’s an email, maybe they’ll log into medallion. Maybe they’re just like on the phone with, you would be entering their information on their behalf. The only requirement for a provider is that they do have to sign their attestations. But with medallion, it’s kind of like this one way or like two way mirror where you as an admin can see their information, you can opt it on their behalf. For a provider. They can only see their information. So ultimately, it’s typically what the customer support model is for their providers. The best situations are we want our providers doing as least as possible. So for those brand new grads, you’re just entering information into medallion first and then we’re kicking out everything into caqh, automatically reducing the kind of dual entry that you’re going to have to do down the road? How do you typically work with those providers and get their information today? Is it like via email? Do you have them give it to you? Like, how does that work? Yeah?
KRISTEN C JACKS (46:49) We actually have a tool called axuall. It’s a clinician virtual wallet. So we established with this organization a, they call them recipes. So like a list of the documents, the application, all the things that we need from an applicant goes into this virtual wallet where they log into it and provide, you know, everything, that they need to give to us in today’s world. And then that information gets, you know, moved into our Healthstream system. It sits kind of on top of Healthstream and, you know, it falls into there. And then for the teams to do the appropriate work with, we used to be in a very manual like literal emails attachments back and forth which was painful but we actually still email and do things at times too with our applicants as well because that clinician wallet is great for initial stuff coming in, but there’s a lot of information that’s still pending in their process. So we have to reach out, you know, individually to ask for it if they’re still pending their licensure, their Dea, a lot of gap information. I was curious to see in all this timeline that you guys have here, you know, how you manage those things. There’s so many parts of the credentialing process that is so outside of all of our control and it’s really in the hands of what’s provided to us. You know, like asking for gap information, their malpractice claim information, you know, the reasons why things are, you know, what came up? If something pops up on their file, we have folks who balk a little bit about getting a caqh login information, which is probably why Nicole had asked that question as far as are we needing it? Because they will balk at that? All of this sounds awesome. It’s just it’s for it’s been doing credentialing a long time. I’m very interested to see how some of these things can streamline. Not saying again, I’m just, I’m very much a glass is half empty kind of gal, no, no.
Noah Laack-Veeder (48:45) You’re I mean, everything, the details matter. So I think as a next step, like I know this was kind of just introducing it. We are super excited because we think there’s a big opportunity here. Now, there’s a lot to understand still for from both sides, right? Like, yeah, you have a very large complex organization. So we’d have to kind of just like get to know each other more. And then I can also just, you know, typically as a next step, we can do an initial demo just to show you kind of more of a general use case of how this is used. And if that generates some excitement, what we typically do after that is go okay, let’s kind of think about your nuances, the unique situations like how many percentage of folks are going to be new versus existing and really baking that all out. So it looks real. But, if you’re open to it, I’d love to schedule that initial demo. Would would that sound like a good next step for you all? Yeah?
Dgprince (49:38) Yes. Yeah.
KRISTEN C JACKS (49:39) I’m very interested in the bi directional caqh piece, so that’s a very interesting thing that, I would at least like to understand more but.
Noah Laack-Veeder (49:49) And more so Kristen for the like the time savings aspect of it and the accuracy, yes, yes.
KRISTEN C JACKS (49:55) Absolutely. I mean, again, I know there are things that are challenging for our team today. So, I’m very interested and excited to see if there’s technology out there that can support and help us because even with the, what we’ve established thus far, like we’ve said all along, it’s better than where we were, but it’s still things that are, you know, manual. And again, credentialing is a lot of hurry up and wait. It’s that’s always been the way of credentialing, right? You hurry up and get whatever you need trying to do as quickly as possible and you’re kind of sitting duck waiting whether it’s on the applicant, the payer or verifier anywhere in between. So it’s you know, I’m personally interested, in understanding at least seeing a demo what you guys got? Yeah, for sure.
Kyle Bettencourt (50:38) Well, that sounds good. Would it make sense to just take a look at calendars while we’re all on the call here?
Kyle Bettencourt (50:47) And… so no, and I, we can do as early as let’s see Friday… morning potentially. I think next week is generally open for us as well. If there’s a time that works good for the group?
Dgprince (51:10) And Ron, I don’t know about your calendar, don’t.
Noah Laack-Veeder (51:16) try to schedule around my calendar. You’ll never. Okay?
Dgprince (51:22) Yes, I know you said Friday but what time on Friday? Are you looking at? I know Kristen, you’ve got, your big meeting on Friday. I.
KRISTEN C JACKS (51:29) Mean, yeah, I’m you know, I can either do the first thing in the morning or I can’t do until after 12 Eastern Time. So I don’t know where you guys are located. Yeah, we.
Dgprince (51:39) could do eight or nine eastern, but that’d be way too early for you guys probably. And then if not, then we could do it later in the afternoon, like it at one, maybe our time?
Kyle Bettencourt (51:50) I think we could do nine eastern. We’re about Central Time, so we could do, does that work for, you know, at eight a. M Friday? Yeah.
Noah Laack-Veeder (51:58) That should work. Yeah, because.
Dgprince (52:00) We already have a standing meeting, the three of us, Kristen, Nicole and I at nine. So we’ll just move that to later in the day and we can use our nine if that works for you guys, Nicole and Kristen.
Noah Laack-Veeder (52:08) Yeah, it’s fine. Cool.
Kyle Bettencourt (52:13) Well, yeah, let’s plan for that. I’ll go ahead and send an invite out to the same group here and we’ll plan to do a more in depth walkthrough of, the actual platform. And then I guess any other questions for us while we’re still on today? I?
Dgprince (52:29) Think so, and you’ll send us the slide deck that you were going through before I rudely stopped you and had to go back?
KRISTEN C JACKS (52:34) No.
Kyle Bettencourt (52:35) No, we appreciate the, yeah, all the information is definitely helpful for us and we’ll be sure to, you know, tailor the demo to.
Noah Laack-Veeder (52:42) Be.
Kyle Bettencourt (52:43) relevant for you guys. And then, you know, kind of what we’ll do as well on Friday or kind of moving from Friday? What we can do is kind of work on putting together a bva or just sort of like a business value assessment sort of on like, you know, financially, what would this actually mean for you guys by reducing turnaround times, you know, not having to add to the credentialing team, things of that nature. So, but yeah, I think first things first, let’s make sure the software is, you know, a fit for what you guys need in place and then we can we,
Dgprince (53:12) can go from there. I know we talked about payer enrollment but I wouldn’t be doing sentara good if I didn’t ask, do you do both? Do you do hospital privileging as well? Do you dabble in that at all? Is it truly just, you know, payer enrollment or is it both?
Noah Laack-Veeder (53:26) We can, we can do it all. Obviously like payer… enrollment is a little less organizational dependent. I’d say it’s more payer dependent. So with that, like there’s definitely just more scoping and walking through that we’d have to do. But yes, it’s a service that we absolutely provide mostly because you said it’s like look, we’re all pulling from the same data. I think some of my colleagues said like copy and paste. So yeah, we’d be, are you all using credstream for that as well today?
Dgprince (53:55) Yes, yes. Yeah, yeah, we spent probably, I mean, the hospital spent a couple of years before, you know, we were looking for a tool to bring in a house when, you know, our prior VP realized we were on excel spreadsheets. I think she about had a heart attack, but anyway, she was like, my goodness, this is large. You guys are on excel spreadsheets. We’re like, yes, we’re still on excel spreadsheets. So as a system as a whole, we went to credentialstream because the hospital was already using Healthstream which converted to credentialstream. And the rest is kind of history. But we did spend a good year working through all of the applications because we have a third party system or we have a phos in three of our markets, as well as the hospital across 12 hospitals, you know, msos for everyone, their own committees, their own macs, and all those type of things. So they worked very hard to consolidate all of those under a singular leadership. And while we all worked very hard to make sure that we went from three, four, five different applications that the clinicians were having to fill out throughout the process, down to a singular one. So that we share that. So we share that with all of our employed medical groups, sentara medical group, clinicians that are hired and brought through the process. But of course, the hospital still has that large community group that they still have to manage new privileging for and everything that our team has nothing to do with it. But again, I just want to make sure I ask those questions and leverage that and hear things from that perspective as well. Yeah.
Noah Laack-Veeder (55:25) We can absolutely kind of walk through that and I think, yeah, as we kind of talk more and more about this, if it makes sense to talk to that organization more as well and kind of either have like we can do that, but definitely kind of thinking about your organization. There is so much work being done in credentialing so many different customers… of the data and all that we’d have to make sure in some organizations, what they’ll do is they’ll kind of do medallion for some of it, use other tools. For others, we can have some sort of bridge in between lots of things that we can discuss. Okay. Yeah. And.
Dgprince (56:01) Again, I know we’re trying to make sure we have a source of truth that sentara can use. And today that’s credential string because our health plan uses it as well as the hospital as well as us. So again, just trying to make sure I understood that piece. Okay? Thank you. Makes.
Noah Laack-Veeder (56:17) Sense. All right. Awesome. I look.
Dgprince (56:20) Forward to talking to you guys on Friday. Thank you.
Kyle Bettencourt (56:22) Yeah, we’re excited to continue the conversation. And, yeah, great to meet everybody and have a great rest of your week.
Dgprince (56:27) All right. Thanks guys. Thank you. Have a great day. Thanks.
Kyle Bettencourt (56:31) All.