Transcript
Jake Shubert (00:14) hey, everybody. How’s it going?
Tracy Pion, Wood River Health (00:19) Hello. How are you?
Jake Shubert (00:21) I’m doing good… Hannah. Great to see you again.
Hannah Marston, RI Health Center Association, RI (00:24) Thank you too. Yeah.
Jake Shubert (00:28) How have your last couple of weeks been? Not bad.
Hannah Marston, RI Health Center Association, RI (00:32) Busy crazy. How about you? Yeah.
Jake Shubert (00:34) I can say the same here. It does not feel like it’s been two weeks, two and a half weeks since we last talked. No time.
Hannah Marston, RI Health Center Association, RI (00:41) Is flying? Yeah.
Jake Shubert (00:45) And Tracy, how are you?
Tracy Pion, Wood River Health (00:46) I’m good. How are you?
Jake Shubert (00:47) Doing, good to meet you.
Tracy Pion, Wood River Health (00:49) Nice to meet you.
Jake Shubert (00:56) Looks like Carol is joining right now.
Hannah Marston, RI Health Center Association, RI (01:03) And Jake, I invited Melissa from our team just to Melissa campbell from our team to join the call as well.
Jake Shubert (01:12) Yeah, that sounds great. I think we’re waiting on one more person on your side, and then we’re waiting on josh on our side and we can get started.
Jake Shubert (01:35) Hey, Melissa. Great to meet you.
Joshua Levitan (01:39) Nice to meet you as well, Jake.
Jake Shubert (01:41) Carol. Great to meet you as well.
Carol Jurczyk (01:52) There you go. Thank you.
Jake Shubert (01:55) Sometimes it’s just, I don’t know why my zoom has people join on mute. And then it’s impossible to find the mute button. So, thanks for bearing with me on that.
Hannah Marston, RI Health Center Association, RI (02:09) I have dual screens and I kept putting it over on my left screen and it kept popping back over on the right.
Tara Booth CCAP (02:14) Here I.
Hannah Marston, RI Health Center Association, RI (02:15) Look like I’m not looking at, I don’t know, maybe I don’t look like I’m looking at you either way.
Jake Shubert (02:20) No, that’s funny. Yeah, it’s always funny when you’re talking to someone with dual screens and based on the setup, they’ll just be like staring in one direction the whole time and you’re like, yeah, I don’t know. It’s just a, it’s a funny setup.
Jake Shubert (02:37) And maybe while we’re waiting on josh, we can just get started with a little bit of introductions over here. So just for all the new faces on the call today, my name’s Jake I’m out in Portland, Oregon. I’m on the partnerships team over here at medallion and have had some conversations with Elena and then most recently Hannah about seeing if, you know, there’s a way for us to help with streamlining credentialing. I’m excited today to learn more about all the operations that you guys have going on and help answer any questions you guys have, share more information about medallion. Josh will be joining us soon. I think he has another call. He’s running a little bit late from, but josh is my technical counterpart. So for all the technical nuts and bolts, he’ll be here to help as well. And then maybe on the next call, if we want to do a demo, if you guys want to see the platform, josh would be the one who’s actually running that demo. So I want to make sure he’s on the call today. So he’s you know, up to speed fully on what you guys are looking for. And there’s josh right now. I mean, I’ll pass it over to you guys for some interest. Hannah. Obviously we’ve met before but maybe we can just go sort of around the room and maybe Tracy if we want to start with you.
Tracy Pion, Wood River Health (03:41) Sure. My name’s Tracy keown, I’m director of financial operations at wood river health. And I’m excited to learn more about what you have to offer us.
Jake Shubert (03:51) Awesome. Sounds great. Maybe Carol if you want to go next.
Carol Jurczyk (04:04) I’m sorry. Did you say Tara or Carol?
Jake Shubert (04:07) Either one works. I said Carol, but the order of operations doesn’t matter. I’m.
Carol Jurczyk (04:11) sorry. So yeah, I’m looking, we are currently looking for some help with our credentialing because we just lost our single credentialing specialist in December and we’re just trying to figure out if it’s worth hiring again or not going outside, trying to figure that out right now.
Jake Shubert (04:38) Yep. That’s super helpful. And now, Tara, I’m.
Tara Booth CCAP (04:41) Tara, I’m from I’m the billing manager of red sea cap. We currently do a manual process of paper applications and electronic applications for credentialing. And it is a hassle to deal with. So, yeah, we’re looking to get a better streamline as.
Jake Shubert (04:58) Well, perfect. And then last, but not least Melissa.
Joshua Levitan (05:04) Sorry, Melissa campbell, I’m with the Ria health center association. Awesome. Perfect.
Jake Shubert (05:10) Well, everyone, thanks so much for hopping on the call today. And I know it’s tricky to coordinate calendars among like seven different people. So, Hannah, thank you so much for managing all that and getting us all together, kind of our agenda for today’s. Call. We got 45 minutes set out for today and really what we want to do is we want to make sure we’re taking the time to understand about each health center and what you guys are looking for, but more importantly, also understanding what the current state looks like today. So understanding how credentialing is currently being managed and what sort of, you know, that entails from there, we want to make sure we’re sharing information about medallion, who we are, what we do, how we work. And then also like I said, answering any questions you guys have along the way, I think at least from myself and josh, our goal for today’s, call is to make sure that we understand each organization’s requirements that we guys are looking for enough so that we can do a demo on the next call that is very much tailored to what all of you guys are looking for. That’s really what our plan is for today’s? Call, does that sound good to the group of you guys seeing some head nods? Perfect. And then, josh, I know that I kind of did an intro for you before you hopped on. But if you do want to introduce yourself at all, josh, I want to make sure I pass it over to you.
Joshua Levitan (06:19) Yeah, pleasure to meet the new faces. Hannah, great to see you again. First and foremost, apologies, I will be off camera. I am a couple days removed from a kidney stone procedure. So the heating pad is my best friend. And therefore, if I’m being honest, I’m actually kind of sat upright in bed right now as opposed to sitting at my desk. And therefore, I think it’s best to keep my camera off, but I appreciate you all bearing with me. I ride shotgun here with Jake in a more tactical context. So I’ll be participating in today’s conversation asking questions and then leading demos, moving forward. Also as a quick aside, my mother, Amy Zimmerman, levitan worked at the Rhode Island. She was at department of health in Rhode Island. And then, ohhhs, I might have put an extra H in there, ohhs for 30 years. Does a little bit of consulting work. I think still with Hannah and the team over there. So I have some familiarity with Rhode Island. I grew up in Sharon mass, so just over the border but excited to be chatting with all of you today.
Jake Shubert (07:28) Awesome. Thanks, josh. Cool. We can jump into things. I see Ruby is joining right now, which is great. So I was trying to think before this call like what the best way to structure this is because obviously there’s like a holistic conversation but also individual conversations of understanding each organization and how you guys are managing things today.
Jake Shubert (07:46) So what I was thinking is maybe the way to best structure today’s. Call. I’m certainly open to feedback. But the idea that I had was maybe sort of just going down the line and getting the broad strokes of how you have to manage your credentialing today and what you’re most looking forward for in a solution and then try to reserve the back part of the call to talk a little more about medallion and specific questions and then set up next steps from there. Does that seem like a good arrangement to you guys or? Yeah, I’m seeing some head nods. Okay, perfect. Well, Carol, maybe we’ll start with you since you mentioned the credentialing specialist leaving in December and you gave some helpful context there. I’m guessing from that description, it sounds like you guys are probably managing credentialing internally today, off of things like spreadsheets, but is there any software tools you’re using today? Or is it mostly a spreadsheet driven process? So?
Carol Jurczyk (08:29) We have a combination of both. We do have a software system we are using right now. It’s not the best for us but we do use a software system. We went to the software system because we were only on spreadsheets and notes and all of that. So we do have some electronic control over our process, but our credentialing is totally and it’s not like this everywhere but it’s the credentialing privileging and enrollment are all handled here. In the revenue cycle. We work with our HR team, but they don’t other than recruiting. They have nothing to do with any first person confirmations, we get all of that through here. So we’re looking more for that front end assist where we get them get their licenses, get the onsite… verifications. The only thing our HR department does is background checks, but we do everything else we do, Sam, we do npbd, we do all of that checking and then of course, all the payer enrollments as well. So right now, so we do have pieces that are on our electronic system… which is helpful because the information goes out to them and they can upload it into a portal for us. So that’s what we’re currently doing. It’s a lot of work for one person. She was great, but it’s a lot of work. So we just don’t know which pieces we want to rehire for or what we can. And we’re looking for cost effective solutions for either hiring, splitting it up or doing a full on outsource type of thing that’s.
Jake Shubert (10:41) extremely helpful. And when that one person was in seat, so, you know, rewinding to like November December or so, were they managing the entirety of the operations? Because, okay, got it. And with that person no longer there, like how are things being managed today? Is that something that you’re taking on or the other folks on the team chipping in sort of curious what it looks like with that person gone? So, right?
Carol Jurczyk (11:02) Now, because she is very good, she is working per diem for us at night. Got it to help us to continue on just the front end stuff, the back end, the insurance enrollments, and all of that is being taken on by other members of refcycle here in my department. So we.
Joshua Levitan (11:25) did split and what are you defining specifically as the front end piece? Like the collection of data? Yes?
Carol Jurczyk (11:31) So the collection of our application, all of their licensing and credentialing information, resumes, not resumes, references.
Jake Shubert (11:44) We.
Carol Jurczyk (11:44) collect all of that here, go through it and then do all the first person checks with their education with their nppd… everything. Sams, oig, we run all those here.
Joshua Levitan (12:02) Those checks. Are you considering that the front end or the back end?
Carol Jurczyk (12:06) We consider that the front, okay?
Joshua Levitan (12:09) And then the back end is you’re talking about that more as that’s like the revenue cycle function in terms of like pair enrollments rosters for delegated entities, et cetera. Okay. That’s helpful.
Jake Shubert (12:20) And then cal, are you able to share the software solution the team is using today?
Carol Jurczyk (12:26) Yeah. Right now, we are using Healthstream got.
Jake Shubert (12:29) It. Okay. Yep, that makes perfect sense. And I’ll try to just ask a couple quick hitters here and then we’ll go to the next group. And obviously, Carol happy to circle back because I know at least a lot of follow up questions are popping up in my brain, but I’m hearing this kind of like, you know, three separate parts of the workflow right there’s. The initial provider onboarding, credentialing of all of those sanction checks and references, there’s, the actual privileging workflow. And then there’s the enrollment with the payers as well. Just sort of curious maybe.
Carol Jurczyk (12:57) Bucketing.
Jake Shubert (12:58) Those out. Excuse me, bucketing those out for the initial credentialing that the provider onboarding you’re describing how long is that taking today?
Carol Jurczyk (13:09) Well, that all depends on the provider. So.
Jake Shubert (13:11) Yeah, that’s fair. It takes.
Carol Jurczyk (13:14) We try to get it done within a few weeks or a month depends on where they’re coming from. If they’re already in the state, it’s a lot quicker. We can get things done fast if they’re coming from out of state, where they have to apply for their license and csrs, they have to update their deas, and all of that depending on how quickly the provider can get into all of it. It could take a couple months. It depends. So we usually have a pretty good leeway. We usually have at least I want to say, well, for example, we just got a new provider hired and it initially came out, I think today yesterday… and she’s due to start on may. So.
Tracy Pion, Wood River Health (14:08) It’s just.
Carol Jurczyk (14:08) A matter of them getting things done quickly. We have to stay on them to make sure they get all their applications in place. Yeah.
Jake Shubert (14:17) Got it. And then last question, I’m sure we’re saving up time for everyone else as well. Kyle, just when you guys do have all the information you’re submitting your enrollments out to your payers, just sort of curious. And I know it’s going to vary payer by payer, but is there like a rough sort of, you know, average turnaround time you’re seeing with your payers today? Yeah?
Carol Jurczyk (14:36) It goes depending on the payer anywhere between two weeks and 45 days. So. Okay, awesome.
Tracy Pion, Wood River Health (14:44) Cool.
Jake Shubert (14:44) Thank you, Carol so much, and maybe we’ll jump over to let’s say Tracy, if you want to go next. I’m going to ask some of the questions that we asked Carol, I guess just to start like, how are you guys handling the credentialing process today? What does that look like right now for you guys? We?
Tracy Pion, Wood River Health (14:59) Have been outsourcing our credentialing for about six years. We have two different organizations doing that for us. The first one was a big fail. The second one actually did well until they started outsourcing. And during that period which has been the last eight months, we’ve seen a steady decline in the production. We’ve had providers even start without being credentialed with any payers, and that’s a problem when we had four months to prepare for them to come. They also are responsible for doing our PSV for our HR director. So that has also kind of fallen by the wayside. So, she’s doing most of the upfront stuff that Carol was talking about. Our HR department does handle all of that, and then we pass it over to the credentialing agency and they do all the payer enrollments. So we’re looking to have a little more control and a little more progress.
Jake Shubert (16:06) I guess.
Tracy Pion, Wood River Health (16:06) At this point, we’re working closely with the agency that we currently have, and they’re trying to fix their issues, but we’ve lost a lot of revenue as a result of the payer enrollments not being complete. So.
Carol Jurczyk (16:21) That’s where.
Tracy Pion, Wood River Health (16:22) we are standing currently?
Jake Shubert (16:25) Yeah, that’s really helpful. I guess with that production dipping in the last eight months, do you guys know what percent of enrollments aren’t being completed? What does that production dip actually look like and quantify? To?
Tracy Pion, Wood River Health (16:37) Well, we’ve had a significant provider turnover and that was not helpful either. So we have about four or five providers who are just doing the payers that they can actually see.
Tracy Pion, Wood River Health (16:53) And I’m constantly asking for updates. Where are we at? Who’s approved? If the approvals come through? Me, that’s great because I know they do supply me with a spreadsheet once a week now… but they’re still just outstanding. And I’m like, well, where is it, what’s going on with it? I’m kind of blind and I can’t answer those questions to my superiors and that’s kind of difficult as well.
Jake Shubert (17:20) Yeah, yeah. I know that must be really frustrating and it actually leads me to my next question because you mentioned sort of being blind when working with this outsourced vendor. What does visibility look like for you guys right now? Is there a, I don’t know like a platform where you’re seeing what’s going on? Is it kind of like a black box you send stuff to? And you’re just waiting? What does that look like right now for woodriver about?
Tracy Pion, Wood River Health (17:42) A month ago, they gave us access to their platform so we can see where the enrollments are. But it’s basically just says in progress or started or submitted. It doesn’t really give any other details besides that. And then the spreadsheet that they provide to me on a weekly basis is just an excel sheet of all of our providers and all of our payers. Okay?
Jake Shubert (18:06) That makes sense. And with this being, sounds like.
Joshua Levitan (18:08) The implication is on the scheduling team, right? Because your scheduling team has to work extra hard to make sure that providers who are in network can only see those patients. Sounds like you’re probably having some denied claims if the scheduling team messes up.
Tracy Pion, Wood River Health (18:23) Absolutely. Okay.
Jake Shubert (18:25) Any other?
Joshua Levitan (18:25) Like, obviously, it doesn’t make you look good to your superiors. It’s probably a horrible experience for the providers that are coming on board. Any other like board level like high level pain that you’re seeing from this, which that sort of quantifies the issue?
Tracy Pion, Wood River Health (18:43) No, that’s pretty much it. It’s been a painful process for the past year… or so this.
Joshua Levitan (18:50) Vendor, is it like a local cvo type company? Is it an RCM company? Like who are they, and what?
Tracy Pion, Wood River Health (18:56) Are, they are a credentialing company? They are based out of Kentucky. Okay. Are.
Joshua Levitan (19:02) you comfortable sharing the name?
Tracy Pion, Wood River Health (19:04) Advantum health? Okay?
Joshua Levitan (19:05) It’s funny we’ve heard a lot about this from advantum customers recently. Do you use advantum for RCM as well?
Tracy Pion, Wood River Health (19:12) No, we don’t okay. Interesting.
Jake Shubert (19:15) Look, there’s a.
Joshua Levitan (19:16) Lot of, I don’t like to talk bad about other companies. There’s a lot of people. This is a hard area for anyone to figure out. We’ve heard a lot of that from advantum. We hear a lot of people that actually use them for RCM. And then this just kind of gets tacked on. And then they have the similar experience that you’re having on the credentialing side. Yeah, we.
Tracy Pion, Wood River Health (19:31) were extremely happy with them for the first like two years we were using them, but we’ve had a big decline. Makes sense.
Joshua Levitan (19:40) I’ve heard their name more times in the last four months than I ever have before. Yeah, definitely unfortunate.
Jake Shubert (19:46) Though, I guess Tracy maybe just a couple of quick questions. When we talked about with Carol, right? There were the three buckets. There was the, you know, initial credentialing, primary source verification. There was the privileging there, was the pay enrollment. If I am hearing you correctly, I’ve heard you bring up the initial primary source verifications, that credentialing, obviously, you’re part of the pay enrollments as well. Is there a privileging part of your workflow as well, or is that not as relevant here?
Tracy Pion, Wood River Health (20:08) That’s part of our HR director’s responsibility, but she does use advantum also, but she’s been doing most of the work on her front end stuff on her own because it wasn’t getting done in time.
Joshua Levitan (20:20) So she can’t trust the advantum PSV. She clarified, she does the psvs herself that’s correct. Let’s say advantum was working and they were giving you the psvs. What happens then? Is she sticking that information in a packet and bringing it to committee herself? Yes.
Jake Shubert (20:34) Okay. And that?
Joshua Levitan (20:37) Packet build process that’s like a manual thing. So, she or someone on her team has to take all these psvs compile them in a packet, write up some notes and send it over before every committee meeting, something like that. Yes.
Tracy Pion, Wood River Health (20:49) That’s exactly what she does. Okay?
Jake Shubert (20:52) Yep. And also the idea of an outsourced company, the idea is often to take a lot of the work and administrative tasks off of the internal team’s plate. Obviously with some of the things in the last eight months, sounds like that’s not happening. So like how many folks right now are sort of needing to be involved with sort of making up for this credentialing work for these gaps for the lack of progress. Like what does that look like internally right now?
Tracy Pion, Wood River Health (21:15) It’s just me and the HR director, but it’s taking a significant amount of time. Yeah.
Jake Shubert (21:20) And maybe last two questions, some of the ones we asked Carol first, sort of the manual compiling of that, the PSV and the credentialing packet. Do you know how long that’s taking the HR director today?
Tara Booth CCAP (21:33) I, I’m not.
Tracy Pion, Wood River Health (21:34) Really sure. Yeah.
Jake Shubert (21:35) That’s totally fine. We’re just curious and then last thing just with your enrollments with your payers, obviously, there’s been those gaps existing today, but do you know, like on average sort of what your turnaround times look like with your payers today? Our turnaround?
Tracy Pion, Wood River Health (21:48) Times are looking more like 60 to 90 days. Okay?
Tara Booth CCAP (21:51) That’s helpful.
Jake Shubert (21:53) Tracy, that was extremely helpful. Thank you so much. Maybe let’s move next to Tara. Is it, is it Tara or Tara? I want to make sure I’m pronouncing your name. It’s, Tara. Okay, cool. So, Tara, you’ve now heard the rodeo twice. I think, you know what questions are coming, but I’m just sort of curious. How are you guys managing credentialing today at ccap. So.
Tara Booth CCAP (22:14) All our credentialing is managed in house between myself and our HR team. So the HR team will gather all the documents, do all the provider onboarding check, Dea, ncpd. They then once they gather all that documents, they then pass that on to me. And then I go ahead and start all the payer enrollments during that process as well. They do the privileging. We have a credentialing committee here at ccap and we do the privileging there. And then, I start the process of the payer enrollments which is a pain by itself. There’s always changes to applications. So it’s either going to be electronically or a lot of papers. And then when the papers are paper applications need to be filled out. Some of those can take quite some time for me, to do on top of managing revenue cycles. So.
Jake Shubert (23:13) Yeah. And I’m sure that’s your favorite part of your job is filling out that paperwork. I can just feel the passion coming through the screen for that. Okay, that was really helpful. So, I heard sort of similar, to Kyle and Tracy, right? Those three buckets of initial credentialing, privileging, payer enrollments, you mentioned yourself and your counterpart doing that today? Are there any, is that entirely off of apologies? If I missed this, is that entirely off of spreadsheets? Is there a software you’re using? What does that look like?
Tara Booth CCAP (23:40) All spreadsheets?
Jake Shubert (23:41) All spreadsheets? Okay. Got it. Okay. So with that being the case, you mentioned the payer enrollment sort of, you know, formatting, filling out portals, filling out paper applications, even that by itself was a pain. I’m just sort of curious like once you have the data you need from a provider, how long is it taking today to compile that information and actually send the application out the door? Because I know that’s a lot of work like Carol.
Tara Booth CCAP (24:06) Said it all depends on the provider, if they’re providing the correct information… and then waiting if they are from the state, it does move a little bit faster. And then if they are from out of state, that could take some time. I know our rules for Rhode Island licensing is a little bit different than other states. And then our Rhode Island department of health sometimes moves a little slow with processing their out of state applications. So sometimes that process can take 30 to 60 days to even get a license active. Yep, I have seen times where it’s taking longer than that, which gets the provider frustrated. We also have lost some providers because of that and not getting them onboarding quick enough. And then once we get the applications all submitted that.
Jake Shubert (25:03) Depending.
Tara Booth CCAP (25:04) on the payer, sometimes it can take up to 90 days, okay?
Jake Shubert (25:08) Up to 90 days that’s helpful interesting.
Joshua Levitan (25:10) Thing, Tara, that you just mentioned that we’ve heard a few times here which is out of state providers that are accepting jobs in Rhode Island for the first time. Not just to you but to everyone, how common, is that 10 percent of the workforce, 50 percent of the workforce?
Tara Booth CCAP (25:28) I couldn’t give you a percentage, but it is up there. Okay? I think for.
Carol Jurczyk (25:34) Right now, it’s been at least for us, the majority of them are coming from out of state?
Tara Booth CCAP (25:39) Or just?
Carol Jurczyk (25:41) Finishing up their residency somewhere and they’re not in Rhode Island. So those are the majority for us right now? Unfortunately, yeah, we’ve.
Tara Booth CCAP (25:50) had a lot of new providers onboarding and across the.
Jake Shubert (25:57) Team. So for the whole group, do the majority of your providers have caqh profiles? Yes, we,
Tara Booth CCAP (26:03) make sure that they have their caqh and then they provide me with the logins and then I manage them. Okay?
Jake Shubert (26:10) Great. That’s super helpful. That’s good to understand. Okay, awesome. Well, you’ve answered a lot of the questions I had sort of preemptively I guess I’m sort of curious for you. Maybe a different sort of kind of question since you’re doing a lot of this work manually today, like when talking to us or any sort of, you know, possible vendor like what would an ideal workflow look like for you or what are sort of the things you want to make sure you’re taking off of your plate so you can spend more time on other tasks. I.
Tara Booth CCAP (26:39) Think it’s just the process of the applications is what takes up the majority of our time.
Jake Shubert (26:46) Okay. That’s helpful. Cool. And then to be conscientious of the clock here, I’m going to sort of jump over to Ruby. First. Great to meet you. I don’t think we got to do introductions before, but it’s awesome to meet you.
Ruby L. Ascencio (27:00) If you.
Jake Shubert (27:00) don’t mind sharing sort of the same way the rest of the team did. We’d love to understand sort of how you guys are managing credentialing today? Yes?
Ruby L. Ascencio (27:08) It’s nice to meet you too. So we are also handling credentialing 100 percent in house and we collaborate with our human resource team. They do the privileging piece and then they pass it over to us. We also work closely with our medical director and our health center leadership so that they can tell us what the start dates are when they expect them to be onboarding and seeing patients, and then as soon as the privileging is complete, we start the credentialing process. Like others mentioned, the state can take a little bit long, you know, so that holds us up with like NHP and a couple of the other payers from starting those enrollments and we do manage the status with a spreadsheet that we share with the organization just on where they are. We also track the average days to approval. That way, we know going forward because we get the question a lot like how soon will these be approved? And so by tracking that, we can give some estimates up front… that pretty much sums it up. Yeah, that’s helpful.
Jake Shubert (28:02) And then with managing internally today, is that spreadsheets only, is there a software you’re leveraging just spreadsheets? Okay, cool. And for the folks managing internally today, like how many people are involved in the, you know, managing and owning and handling the work of the credentialing process today? Yes. So in the billing.
Ruby L. Ascencio (28:20) Department, it’s two people but they both have full time jobs so that we have waves that come in right? There’ll be nothing credentialing related. Then attestations will come in, then new providers will come in and then there’ll be nothing. So it’s kind of a situation where everything is calm, the storm hits. And then we get past that and everything’s back to normal.
Jake Shubert (28:40) Okay, cool. And with handling things manually, I’m just sort of curious like maybe similar to Tara, what are sort of the most, you know, most common pains or struggle points that you’re running into today?
Ruby L. Ascencio (28:51) I would say the biggest challenge is probably just getting providers to quickly get us the information that we need right away because we can’t get started without that. So making sure that they’re giving us access to mpegs, making sure we have their caqh, information, things like that. Okay? And once we’re past that point, it’s pretty smooth. And then it’s just waiting on the payers, right? Because a lot of times it’s like you send it and it goes so black hole and so just staying on top of them to make sure that they’re working on your applications. Yeah.
Jake Shubert (29:18) Absolutely. And I guess to that point, like on average, what is your turnaround times looking like with payers today?
Ruby L. Ascencio (29:23) I would have to look at that spreadsheet too to provide you that insight. I don’t know off the top of my head. Yeah.
Jake Shubert (29:28) That’s totally fine. Cool. Josh. Any questions for Ruby or just for the whole group that we’re missing before we jump into some more information about medallion? Yeah, Ruby, you?
Joshua Levitan (29:38) Actually brought up a concept that I think is interesting that I’ll post to the larger group, which is about, you know, specifically within pay enrollment once we send that application over to the payer, a little bit of a black box. I’m curious Ruby from your perspective as from everyone else’s how often are you following up with payers if at all? And if you are following up with them, like do you find you have better results if you’re you know, calling the payer every week saying, hey, what’s the status of this enrollment? Absolutely?
Ruby L. Ascencio (30:07) We definitely, we try to follow up within three days just because at that point, you get it right in front of them if they’re not looking at it already. And then after that, we follow up weekly. Okay. We weren’t doing that, you know, when we first started, we were not doing that and we kept finding that we were three weeks in and then just then finding out that they haven’t even touched the applications or in some cases, they want us to use a different process. So then it was a waste of time. So we decided to be proactive about that. Yeah.
Joshua Levitan (30:32) That makes sense for everyone else. Is that similar? Yeah.
Joshua Levitan (30:44) Great. Melissa, that’s a really interesting question as well to the dental piece. I’d love to hear a little bit more from the group on that.
Ruby L. Ascencio (30:56) I can just speak for myself. Recently, I had an issue with one of our payers where we followed their process. And then we didn’t hear back from them. We had been told that they were working on it. So then we left it alone and then come to find out they had changed their process, didn’t post it online anywhere or send out notifications. And so then at that point, they had made our effective date after our initial submission. So I had to fight for that for about two months to finally get them to go retroactive after being denied originally for that date because it was no fault of our own, but that’s really the only item I can think of.
Joshua Levitan (31:36) One last question from my side here.
Jake Shubert (31:39) Do any of you have?
Joshua Levitan (31:40) Delegated contracts on the enrollment side?
Joshua Levitan (31:47) Oh, okay. All direct enrollments are any of your provider counts over 100?
Jake Shubert (31:57) Yes… we do so. Carl.
Joshua Levitan (32:01) This might be an aside that we can have with you, but have you explored delegation in the past?
Tara Booth CCAP (32:08) No, okay.
Joshua Levitan (32:11) I asked about the provider count. So typically, it changes payer by payer, it’s general rule of thumb though that they’ll offer delegation once you hit 100 providers, and then we’re talking about taking turnaround times like we remove the PE process entirely. We use your existing committee that you’re doing for privileges.
Jake Shubert (32:29) Once you?
Joshua Levitan (32:30) Approve someone through a committee, you just submit a roster to the payer and it can bring credentialing times to, you know, a week, five days, something like that. That would be nice. Yeah, it’s yeah, it takes some legwork to get. And oftentimes the payers won’t offer it again unless you’re over a certain threshold of providers.
Jake Shubert (32:50) So it’s.
Joshua Levitan (32:52) nice because it piggybacks off the committee process that you’re already running. You have to operate to ncqa standards as opposed to jco standards, but ncqa… standards are lighter than jco standards. So everything you’re already doing for joint commission or CMS or whatever your privileging standards are, is going to meet ncqa and you can see some significant cycle time reductions. I think Jake, we’ll hold that as maybe an aside with Carol in the future but wanted to just get a general sense from the group there.
Jake Shubert (33:20) Yeah. So it’s a great call out and Carol, happy to talk about that in more length because we do help with a lot of the delegation process if it is of interest, but definitely a lot of value in delegation overall. Cool. Well, first off, thank you for the whole team for sharing so much information. And also that was like, I feel like really efficient. So I’m you know, we got time and stuff in the call. I think we nailed that. So let’s share some more information about medallion, then we’ll use the last couple of minutes here and talk about next steps. And if you guys are interested in showing you what the platform looks like. So I will share my screen here if zoom permits. Can you guys see my?
Joshua Levitan (33:54) Screen while Jake is doing that? Also hopefully you guys all learned something from each other. I know a lot of what Rekha provides as sort of working groups. Maybe this is an informal one. So appreciate you bearing with us as we sort of tick down the list of questions here. But hopefully there’s value in this conversation in terms of you all connecting about this process and learning from your peers.
Jake Shubert (34:14) Yeah, absolutely. So to share some more information about medallion, I’m not sure if anyone here is familiar with us but I’ll handle sort of the big picture here. So, medallion, we are a digital first company and we’ve been built from the ground up to manage everything you’re seeing here on this slide. And I think josh sort of called this out with Tracy your situation with your outsource vendor advantum, where sometimes there are companies who kind of just do credentialing and enrollment on the back burner. It’s not really what they specialize in. They just outsource all of it, whatever it might be that’s not who we are. This is all we do as a company. We’ve been built solely for these workflows. And what we really do is we’re a tech enabled platform that streamlines and automates every step of the process from bringing a provider on board doing their initial credentialing and primary source verifications all the way through, you know, privileging, enrollments, licensure, revalidations, so on. And so forth. And the idea is that there’s tons of busy work, administrative tasks involved in every step of that process from all the sanction checks, to compiling a credentialing packet, to filling out payer portals, or enrollment applications, or following up with the payers, all these steps that can become more efficient. And we’ll show you what this looks like on our platform. But our goal is to take as much of that busy work off of your plates as possible and then downstream lead to better outcomes. So we have industry leading turnaround times with payers. And the idea is can we take a lot of this work off of your plates while providing you guys with way more visibility than you would get in blackbox, a full provider data management tool. You guys are directing the strategy of what needs to be done. We’re executing a lot of that work. And then you guys are getting your providers in network credentialed privileged et cetera. Faster. Again, we’ll show you what this looks like in a demo and add a lot more context there, but zoomed out. This is what we do. Happy to pause here. Any questions from the team. Does this big picture make sense?
Carol Jurczyk (36:17) Just one, I know the, you know, the ncqa and the jco and all of that. But, are, you, do you have other fqhcs that, you know, to follow the hrsa guidelines on credentialing as well?
Joshua Levitan (36:32) Yes, definitely. And if any of you are considered rural health centers, we work with a lot of rural health centers in that regulatory landscape as well. Yeah.
Jake Shubert (36:41) Josh beat me too. The only thing I would add there is like kind of for obvious reasons, the same things that you guys have brought up on this call today. Like a lot of fqhcs are dealing with sort of, the pains of these processes. You know, whatever the opposites, of the fruits of the labor are, right? Just like a lot of the manual work and those pains. So, it’s pretty common for us to work with fqhcs rural health centers, so on and so forth. So, primary care associations, yeah, very common for us. Any other questions here from the team?
Jake Shubert (37:11) Okay. I guess big picture is something like this. Like all I mean by these workflows providing better outcomes, is this something that would be interesting to you guys? No, it’s awesome. Well, what we can do then is we can schedule our demo, josh, anything else you wanted to share about medallion or any other questions we can use the last five or so minutes we have for?
Joshua Levitan (37:33) No, I think, I just want to make one comment which is like, you know, sometimes outsourcing is a scary word. Sometimes it’s embraced, you know, it depends. I think, you know, what we’ll see in the demo is that medallion is doing a lot of work on your behalf.
Jake Shubert (37:51) But, the work that.
Joshua Levitan (37:52) we’re trying to do on your behalf, as Jake said, is the mundane repetitive like we can use an API connection to check the Sam or oig database. We don’t need someone to go and log in and do that, right? What we don’t want to do on your behalf is control your strategy or remove you from this process, entirely, right? Like in terms of, you know, obviously something like a committee, we are not your committee in terms of like what payers we’re getting enrolled with, and like having a relationship with your providers. Like we don’t want to be the primary contact for your providers. We have a portal. They upload information. We’re going to remind them if there’s a license expiring, or if we need a new document from them, we’re going to make your life easy by, you know, texting them, calling them, sending them emails, saying, please upload this document, but we’re not trying to own that relationship, right? So, you know, when it comes to this like outsourcing concept?
Jake Shubert (38:45) You know, the,
Joshua Levitan (38:46) industry existed up until medallion was sort of three things, right? It was, which all of you have described, which is like you’re sort of managing this process in house. You built tooling, whether it’s in excel or wherever to do this entirely yourself. Then there’s the idea of tools.
Jake Shubert (39:03) That.
Joshua Levitan (39:03) assist you in doing this but are really much more like task management and so that’s kind of like what we would consider healthstream. And then there’s sort of like a, I don’t have a choice but to throw this over to the fence to someone who gives us no visibility and like it’s kind of a black box and that’s tracing more of like the advantum and we exist entirely to break down all of those norms and say, like, where can we remove low value work from your team so that you can either focus on your primary job or not have to hire someone to just sit there and do like data entry, but still give you the right amount of strategic oversight and involvement in the process that you are in control of your organization, that you can answer questions from executives that you have, like you have agency and really like the outcomes that we’re trying to drive from that which I think our questions got to is number one, like reducing cycle time, right? So there’s patient care access there, right? Like patients need to be seen quicker we get through people through credentialing, more patient access. There is number two, you know, speeding up revenue generation right there’s. Regulatory at the federal level, cuts that are not good for patient access or for anything in your world right now. So like dollars are tight, we want to make sure that we can bring revenue in as quickly as possible by getting providers like working as quickly as possible. And then in addition to that as well by, you know, lightening the load on all of you so that you either, you know, get some nights back with your families that, you know, instead of sitting on the Sam website or you can focus on really optimizing RCM which is all of your sort of core functionality in a much more direct way. So a little bit of the landscape over there, like I think sometimes when we talk to people, we are paradoxes, we’re really the only ones operating with this way. And sometimes that can be scary. And we’re not immune to the fact that sometimes these conversations represent a significant amount of change from whichever side of the spectrum you’re on currently. But we’re you know, we’re really trying to be a strategic partner with all of you and an extension of your team in these functions. And I think obviously the demo will make this a lot clearer. But just sort of wanted to lay out that caveat or that baseline… you know, in this conversation, yeah.
Jake Shubert (41:27) That was great. Josh. Thank you. So, as far as scheduling next steps, I thought it might be easier to do that right now as opposed to playing email tag… looking at calendars. I think we should reserve an hour for the demo. So we want to make sure we’re touching on questions from the entire group and touching on the totality of workflows here. So, looking at scheduling, we can look for next week or if it’s easier, maybe the week after, but is it going to be possible for everyone to look at their calendars and see if we can find a suitable time?
Jake Shubert (42:05) Is there a day either next week or the week of April six that would work best for the team?
Carol Jurczyk (42:15) April six?
Carol Jurczyk (42:25) That’s a good week, any day except Thursdays?
Jake Shubert (42:29) Okay. That’s helpful. Tara. I saw you come off mute as well. Is there a day that week that works best for you?
Tara Booth CCAP (42:36) April six is a good week. I am good for either Wednesday, Thursday or Friday.
Jake Shubert (42:41) Okay. So, let’s look at Wednesday or Friday, then… let’s see. Tracy, would either Wednesday or Friday work for you?
Joshua Levitan (42:49) Yeah.
Tracy Pion, Wood River Health (42:50) That would either one of those would be okay?
Jake Shubert (42:52) Okay. And then Ruby, how about you? For me? Friday?
Ruby L. Ascencio (42:56) Works well anytime except two o’clock two to three?
Jake Shubert (42:58) Okay. So let’s focus on Friday then. Would the team be available? Looking at josh’s calendar as well at one P. M eastern on Friday, April tenth?
Joshua Levitan (43:10) I can.
Ruby L. Ascencio (43:10) Only do half an hour because I have a meeting at two.
Jake Shubert (43:13) Okay. Let’s see. Okay. Maybe what… if we moved it up, Ruby by half an hour. So, what if we did, 12 30 Eastern Time?
Joshua Levitan (43:26) Yeah, that’s fine.
Jake Shubert (43:28) Kyle, are you, looks like you have a conflict? Yeah.
Carol Jurczyk (43:29) I do.
Jake Shubert (43:31) You’re all good 12?
Carol Jurczyk (43:32) To one, I’m booked.
Jake Shubert (43:34) 12 to one. You’re booked? Okay. I think.
Ruby L. Ascencio (43:36) I misunderstood one to two would work.
Jake Shubert (43:38) Oh, it would. Okay, great.
Ruby L. Ascencio (43:39) Yes, I think I misunderstood.
Jake Shubert (43:41) No, no, you’re totally fine. Okay, great. Well, I will send over that calendar invite. I think that worked for the whole team, right? Tracy, that worked for you as well. Yes, cool. And Hannah, Melissa, was that okay for you guys?
Joshua Levitan (43:50) Okay. Seeing some head?
Jake Shubert (43:51) Nods, perfect. So, I will send over that calendar invite, if the team, if you guys do have any questions or anything like that, before April tenth, just let us know, give us an email, shoot us a call. We’re happy to help answer questions, async, but, that call will be really, just really focused on the demo. Excited to show you guys the platform and looking forward to chatting.
Joshua Levitan (44:09) In a couple weeks? Okay?
Carol Jurczyk (44:11) Cool. Sounds good. Awesome.
Jake Shubert (44:14) Great to meet everyone. Thank you. Bye.
Joshua Levitan (44:17) Thanks, everyone. Bye.