Transcript
Hassan Zahir (00:00) yo, what’s up, sir?
Cliff Marg (00:06) How we doing?
Hassan Zahir (00:07) Good. How are you today?
Cliff Marg (00:10) I am great. Nothing but sunshine here.
Hassan Zahir (00:14) Man, the weather here has been so bipolar. We were like 86 like three days ago, but now it’s like, I don’t know 50 degrees or something.
Cliff Marg (00:25) Did it snow recently? Did someone say that?
Hassan Zahir (00:29) I don’t know, maybe like in Cleveland or something the other day, like, it literally was crazy. It was like 86 here and 46 in Cleveland. Oh, wow. It was like the most insane thing I’ve ever seen.
Cliff Marg (00:39) No wonder. Nobody likes Cleveland.
Hassan Zahir (00:43) Yeah, it was a bit insane.
Marissa Letendre (00:49) Hey, guys.
Cliff Marg (00:50) Hello, friends. How are ya? Can’t complain? How are you guys doing? Good, lovely.
Manan Bhavsar (01:03) Okay.
Cliff Marg (01:04) What’d you say I?
Marissa Letendre (01:05) Said hi to Hassan. I haven’t seen him in a while.
Hassan Zahir (01:08) I don’t know. I’ve been everywhere. Trust me. I.
Marissa Letendre (01:12) Can imagine. I’m.
Hassan Zahir (01:13) happy to be home and on this call because it’s been a couple of weeks.
Marissa Letendre (01:18) Yeah, for.
Cliff Marg (01:20) Sure. Where’d you go? You went to New York or Atlanta or something?
Hassan Zahir (01:23) Yeah, went to New York, went to Atlanta, then I had to take a personal trip and then get back home. Like just… well, I’m.
Marissa Letendre (01:33) glad you’re home and I’m sure you’re incredibly busy. So, I appreciate you being here.
Hassan Zahir (01:39) No, absolutely. That Atlanta airport is what was crazy for me. Oh,
Marissa Letendre (01:42) my God, I can’t even imagine right now.
Cliff Marg (01:45) Why with like the tsa issues.
Cliff Marg (01:49) it’s so funny. Everyone’s like I flew to Arizona on Thursday and I woke up to a text from my mom at like… it was like get to the airport early, like major issues with tsa, which was kind of, I had like heard of it, but I was like kind of scared and I woke up way too late, got to the airport, completely empty. And then I landed in Phoenix, completely empty. And I’m going online, I’m like looking at tiktok and tiktok is showing like lines out the door for Phoenix and I’m like, huh, where was that? Where am I?
Hassan Zahir (02:25) You saw the?
Marissa Letendre (02:26) Lax yeah.
Hassan Zahir (02:27) Yeah. Oh.
Marissa Letendre (02:28) My God. Okay. They.
Hassan Zahir (02:30) Were doing the same thing. Like for like laguardia had other issues with that accident, but like when I got to laguardia, I was like, it was fine. Like I literally left at two o’clock like I left where I was at two o’clock got to the airport at two 30 or three o’clock got to the airport at three 34 or five 30 flight, and had plenty of time to get through, go to the delta lounge, hang out, but Atlanta was absolutely like, you know, forgive my language, but it was a complete shit show.
Marissa Letendre (03:00) Yeah. Oh, please. You can swear in front of me, hudson. I’m the queen, I,
Hassan Zahir (03:07) don’t know if cliff was recording this and then, you know, I have to make sure.
Cliff Marg (03:11) Not very gentlemanly hudson. Oh, please, as.
Manan Bhavsar (03:15) Marissa will tell you. She is from Boston.
Marissa Letendre (03:18) I am not from Boston. I grew up in southeastern Massachusetts and Rhode Island.
Manan Bhavsar (03:22) Pretty much Boston. Marissa, that’s fine. It’s the same thing close.
Cliff Marg (03:28) Bostonians are mean, is what I’m told. I don’t know many of them.
Marissa Letendre (03:33) Oh, look at somebody nodding their head.
Manan Bhavsar (03:38) Yeah, Marissa is definitely a bostonian.
Cliff Marg (03:45) I don’t see it. I don’t see it.
Marissa Letendre (03:46) I’m so nice. What are you talking about?
Manan Bhavsar (03:49) You are nice, Marissa, for a bostonian, you are nice. This is, this is fair.
Cliff Marg (03:56) All right. Well, we’ve got some time today, Marissa. The two things that we’re going to talk through one is like the re, credentialing and like how that would work. And, you know, what kind of future state should look like.
Cliff Marg (04:09) And then the second thing was just like looking at some maybe pdm functionality. I think Hassan is going to lead both of those conversations. But anything else worth talking about today?
Marissa Letendre (04:21) Enrollment money? Okay?
Cliff Marg (04:23) I won’t have an answer for you today, but we can at least handle like the scoping maybe like a V1 scoping piece of that. So we can make some moves. Cool. Okay. Hassan, I think like probably the best place to start is like just trying to get a better understanding of how re credentialing works today and like what it’s triggered off of it. Sounds like that is a verifiable workflow. But like if you can start there, then maybe Hassan can kind of prescribe what future state should look like?
Manan Bhavsar (04:56) For sure. Is that for Hassan?
Hassan Zahir (04:58) No, that’s for you guys, for you, what does re, create look like today? And then we’ll kind of do a compare and contrast.
Manan Bhavsar (05:05) Yeah. So, it’s pretty much automated right now where we have Hubspot workflows that are running in the background that are based off of just re, credit cadence and it is connected to verifiable, where we update information in verifiable, after we get like we have a re cred form. So we send that out to the providers through Hubspot workflows. We collect information. We have our vas that work those tickets, that information that gets updated to verifiable. I feel like there’s something that I’m missing here. What am I missing? Marissa? I think that’s pretty much it.
Marissa Letendre (05:51) Yeah. So.
Manan Bhavsar (05:53) We have like, the credit form, the request form operates through chat form. So it’s a separate form platform that we use, that’s how we get the input into Hubspot. And then that gets fed into verifiable.
Marissa Letendre (06:08) But we have to download the packet too. We just create the cover sheet on our own.
Manan Bhavsar (06:12) Right, right. Right. So, once we get the information, then that gets uploaded automatically to a Google sheet that we use, that then generates the packet. So, there’s some manualness that we’re doing on the backend to generate the packet itself, make it pretty and then send it off to committee.
Hassan Zahir (06:36) Okay. Does… do you have a workflow diagram that exists anywhere? Yes. Could you share that workflow diagram by chance? I’m, listening and I’m tracking it, right? And it’s like you have like where you’re starting Hubspot… and just like trying to track all of that in my mind honestly, like I think I could track it better visually.
Marissa Letendre (07:04) I have it. Manalan, if you don’t have it open.
Manan Bhavsar (07:08) I have it. I just want to, I’ll share my screen real quick and I can kind of walk you through.
Marissa Letendre (07:17) I think he needs a copy of, you need a copy of it. Hasan, right? I,
Hassan Zahir (07:21) mean, a copy would be ideal, but like at least just seeing it represented visually. Like I’m a somatic learner. So like I just want to make sure I’m tracking it and kind of what the inputs are, where it flows, what Hubspot is doing, what verify? Yeah.
Manan Bhavsar (07:34) I’ll give you, I’ll send you a PDF too. Okay? But here, let me share my screen. It’s, it’s a little dense. Oh, yeah, yeah.
Hassan Zahir (07:47) And so this is like perfect because we use lucid here and, my brain was going like, okay, can I make a lucid diagram that kind of highlights current state versus future state with medallion? So, yeah, if you could send me a PDF like this helps, but obviously I can’t zoom in on everything here. So, yeah, yeah. So.
Manan Bhavsar (08:05) Yeah, I’ll just send you a PDF, but just to go through the general structure of this, like we do have a diagram key of like what the different things indicate… we have some lanes based off of, the action. So these items are provider actions. Things are happening in Hubspot deal, advancement within Hubspot, contact properties are being updated. Tickets at the vas are working different va initiatives to address ticket updates, what’s happening in verifiable, et cetera. Et cetera. So, I mean, I’ll send it to you. We don’t need to spend more time on this until like, I guess you have an opportunity to go through it, but it’s pretty much what I said, but a lot more laid out.
Hassan Zahir (08:47) Obviously, the details are what’s here, but this gives me an idea from a swim Lane perspective of kind of this is the application and this is who’s owning what in each step yep?
Manan Bhavsar (08:57) Okay. So I’m gonna stop sharing. I’ll send that to you. Do you prefer email?
Hassan Zahir (09:04) Email will be ideal? Cool because we don’t have, or do we have a joint slack?
Marissa Letendre (09:08) No, we don’t but we should.
Manan Bhavsar (09:10) We should.
Marissa Letendre (09:11) I agree. I never leave you guys alone, so it might be a bad idea. I.
Hassan Zahir (09:16) Promise you Marissa like I respond to slack messages like all of the joint slacks that we have 90 percent faster than email because the slacks pop up and they’re on my screen. I’ve got my second monitor right here and I keep slack up and open. And then when it’s like emails, like I think today from eight 30 eastern to five 30 P. M eastern. Like I’ve got one half hour block where like I’m not in meetings and so like just trying to find time to go and check in emails. Yeah.
Marissa Letendre (09:47) No, fuck emails. Yeah.
Hassan Zahir (09:49) Like end of the quarter, checking emails is tough.
Marissa Letendre (09:52) Yeah, I can’t believe it’s the end of the quarter. I don’t know how.
Hassan Zahir (09:58) Okay. That helps me out a lot, kind of like kind of figuring out where… the process starts, how it’s tracked, how it’s flowing through verifiable, what the integration is for you guys to be able to get that packet ultimately together for the recreate?
Hassan Zahir (10:22) Let’s I’m going to share my screen. I’m going to show where for transparency like we’re rolling out a new demo platform. So like allows me to customize things and change things and not break anything in product. So I’m going to share my screen. You guys are going to be my first friends that see, this platform that we’re using. We’ll talk pdm, we’ll talk recreate and kind of talk about like, how we’re doing it and make sure that there’s like some alignment. But I do want to be able to go through your process and then make sure that there’s one on one alignment to how medallion is managing the recredentialing process.
Marissa Letendre (10:56) Well, sounds good.
Hassan Zahir (10:59) Okay. And you, can you all see my screen? Okay? Yep. All right. So, so first and foremost… the one thing I want to highlight just because cliff mentioned like some pdm sort of questions as far as like what that means for payer enrollment. Everything that’s required for medallion to perform payer enrollment is available as part of the provider profile. So it’s a part of our pdm solution. So if you, if your team’s there for payer enrollment, we’re performing payer enrollment out of medallion being the pdm solution. Everything that they would need is going to be in here because it’s everything that we need. If that, if that makes sense, the difference is then we’re auto mapping this information and performing our flows where they would use this as the source of record or the system of record and use that data to complete their workflows. So I’m going to start with just kind of like the provider in the provider profile before I go to like credentialing, recredentialing, if that’s fair. Okay, perfect. So I’m going to jump into dr Naomi Ely. And once this loads, you’ll be able to kind of see like everything that we store from the provider profile through the group profile, all of the information that’s required for the enrollments including like all the practice locations, all of that information. Again, this is what the medallion platform is using. So all of the data that your PE team would need is going to be in the system. So first and foremost, like just all the basic information, the professional information, professional history, licensing information, even if there’s existing enrollments that were pulled down from caqh, for example. And we said, okay, they had their medicaid or medicare enrollment and that was in caqh. We can pull like that information into the system. So like if you need your obviously, you know, depending on the commercial plan, you may need that medicaid id or that medicare id in order to start the commercial enrollment. That information is all here is going to be grouped by the sections. And you’ll see we’ll have like the full profile with everything that goes in there. Any of the documents that may need to be used for enrollment of certain health plans required like the driver’s license… like they would for like a license, all of that information they will have access to. So everything that exists in that provider’s profile is going to be here. I’m going to show you this behind the scenes, look the difference in what we capture and track that’s our secret sauce that they will not have. Access to, are those payer guides? Because that’s kind of like how we do our proprietary one to one mapping of what’s in their profile versus what we track and update as a requirement to get an enrollment with a given payer. And so we’ll track like provider requirements, group requirements, all of these things because these are the requirements that tie to this given enrollment with blue cross or blue shield of Arizona or blue cross, blue shield of this place, or, you know, in any payer, unitedhealthcare Aetna. And like, so we track those various requirements and that is sort of like an intake. And so when I showed you how medallion has these group profiles under the payers. And so I’ll jump to one of those payer guys here. In a moment. This is like the only thing that’s not there. It’s like there’s no exact way of saying from medallion. Medallion has this guide and these are all the requirements for this payer. And this profile has all of these requirements. They’re just going to have to go into that completed profile, pull the information out. And if there is missing information, then they would have to create a new tab to ask manually for that provider. I’ll pause there because I know I’m throwing these terms around and you may remember some of the stuff, may not remember some of the stuff, but medallion tracks all the requirements on a per payer basis. The way that we do that and we have that information is that we have payer guides in the system. So I can go to any of these payers and I can look at the full guide and I say, okay, medallion tracks and updates this information across these disciplines… and just a demo environment. So this isn’t all populated out, but it’s like we track the application method. We track if there’s multi factor authentication or a two step process, all the application steps, the required documents, the follow up instructions, what is the outreach cadence and schedule? And how do we escalate and follow up again? This is populated for a real environment. But remember, I’m in this little new demo space, so that’s not populated, but we track all of that. That is what they will not have access to but everything as far as the provider themselves, and all of the data that they need to complete those applications. Nothing changes. So they have access to every piece of information that is required to complete an enrollment application. So I’ll pause there just to kind of highlight again, what you do have is access to the entire full profile. What you don’t have is the medallion proprietary information. That says this payor requires, this and this is the best way to submit.
Marissa Letendre (16:46) we don’t have that because we don’t have the enrollment module yet, right? Correct? Okay. And can we hook up like workato to it to automate some of that through… like a third party through the API? So.
Hassan Zahir (17:03) I would need to understand more of what that workflow looked like. What you could absolutely do is you could, the medallion API is bi directional. So one way or another, we just need to understand like, okay, the data from medallion goes to where you need it to go, which analyzes that data, which then supports the completion of the application that can occur 100 percent? Yes.
Manan Bhavsar (17:31) Can we, so, I know you mentioned like the information that we do have access to, I’m, assuming that like for example… as a proof of concept, while we’re testing out enrollments, and if we don’t have the enrollment function built in, the things that we do have access to, those are things that we can do on behalf of the providers where they don’t have to like fill out those applications, right?
Hassan Zahir (17:55) That is correct. You can still do that on behalf of the providers. You’ll have access to all of the data required to fill out an application. And when the provider on boards, we can have specific tasks for them. Like I can go in and I can create a new task. Like I can look at task here, but like I can go into a provider’s profile and I can create a new task for a provider or I can create a new task for an administrator Manan for whatever data is missing. So I can create a new task for a provider that says this provider is missing this information for this health plan. And now, before that health plan application is submitted, then that needs to be done by the administrator or by the provider. We have the templates to support that as well. So it’s just more so like a matter of like how do we want to structure this? But like everything that could be potentially required, a task can be created to support that.
Manan Bhavsar (18:57) Okay. And that’s something that we can automate through workato, because you’re saying the API is bi directional, so we can automatically create tasks the.
Hassan Zahir (19:07) API is bi directional before I committed to saying, yes, you can automate the task. I know you can automate the movement of the data from the profile. Before I say you can automate the task. I don’t want to tell you the wrong thing there. I’ve never personally been a part of a cycle where the task needs to be automated via the API. Let me review the API documentation and partner with Sammy. You remember meeting Sammy? Yeah, we’ll partner with Sammy to get you that answer because I don’t want to tell you something instead of false expectation… because there may be a requirement that a task needs to be manually created. And when I say manually created Manan, what that means is that we could bulk create all of these tasks. It’s not as if you have to go to every provider every time and say do this thing, you could say for every provider who’s onboarded, medallion needs to auto, create a task for every this for this payer, and we can put kind of like some guardrails in there, but that’s more of like an operational workflow. We can.
Manan Bhavsar (20:18) Create a workflow that we can base it off of all the providers that are credentialed in this state that are this license level, create this task. We can make it as specific.
Hassan Zahir (20:30) They have to have that task and that’s part of onboarding. And so we can make it every time a new provider is created, that task is associated with them. Yes. Or we can upload a document that says create all of these tasks, essentially import these tasks for these existing providers. But what I don’t know that we can do is I don’t know if we can have or got to say medallion via API, create these tasks for these providers that I do not know.
Manan Bhavsar (20:57) Okay. If we can, that’d be great because, well, let me ask another question first because I think I need to understand this better too. So say that we… and this is all assuming we don’t have the enrollments function, right? So say that we, our partnerships team launches with a new payor? We get the contract and we’re scoping out the payor, how do we then transfer like the scope of the requirements and all that for that new payor over to medallion? Because I think what you said previously like that, is that like what the information that medallion has about? Like what’s required is proprietary, I guess like until we have the enrollment function, was I hearing that right? Or is that? Yeah?
Hassan Zahir (21:46) It looks like you’re hearing that correct? That’s kind of like the secret sauce and why people come to us because we’ve got this team that’s always tracking those changing requirements. And then, you know, how we best submit this or what’s the fastest route or the follow up says every 10 days. But if we do the first follow up at day 12, because most of the time the results come back at day 23, our second follow up occurs at day 24. So even those every 10 days, like when do we do that first one? Like all of those sorts of things we consider to be proprietary to us?
Manan Bhavsar (22:18) So, but if we wanted to like, we were launched with a new pair, we wanted to add that new pair into… medallion as a pair that we want to enroll providers into. How would that work?
Hassan Zahir (22:33) Yeah. And so that’s where I think like we need to get some clarification. So, medallion is a pair functionality and logging pairs pair requirements that is part of our enrollment functionality. Okay?
Manan Bhavsar (22:47) Got.
Hassan Zahir (22:47) It, any additional functionality for that? Like we can track, you would be able to go in and say, for a given provider, even if you don’t have the enrollment functionality, you can complete your enrollment and you can push via the API that this provider is in network. So we can go to pairs and we can go to enrollments. And via the API, you can just push and add an enrollment and say, okay, this payer’s enrolled with this health plan. This is their status, these are their locations, lobs, ids, prior status, effective dates, revalidation, dates, you can push all of that in via the API. But what we don’t have access to is like the ability to say, hey, this is like this payer and this is this information on this payer, and this information on this payer, that is a part of the enrollment functionality.
Manan Bhavsar (23:38) So say we do have the enrollment functionality, and then we add a new payer. How would that work?
Hassan Zahir (23:43) If you have the enrollment functionality, you add a new payer. It’s essentially like from the payers list, we would create a new payer. You would just tell us who that payer is. Sorry, you would tell us who that payer is. We would create that payer in the system. We would load whatever group contract information needs to be associated with that payer. We would load. Then like a process guide, payer guide for that payer, it would detail all of the information. Sorry, this is a change, not the guide. It would load all of that information for that payer, you saw like the history anytime we update that payer, change that payer, we can do essentially anything from this. We have the ability, you would just notify us and then we would create that process. What happens is and I might need to jump out of like this demo environment. What happens is then… we have specific rules and guides like based upon an organization’s requirements for how we want to handle a given payer or a set of payers, or additional payers. We essentially, you tell us what that information is and we auto map it for you. And then we date it in. If there’s like again, you know, use this email address versus this one or follow this process versus their standardized process because this is what’s in our group contract. We map all of that in the system itself.
Manan Bhavsar (25:12) Got it. Yeah. So that makes sense because I think that was like the next question, it’s like obviously, it’s not going to be the same for everyone in terms of like we might have a special relationship with a payer, we may have negotiated something when it came to enrollment. So like how do we communicate that? And it seems like we can do that upfront. And then you guys would build that into the enrollment process?
Hassan Zahir (25:33) Yep. And then as you add additional contracts, the same way that you shared that upfront, we can add it the same way at any given point in time. We have a template for doing that. We’ll share that template with you. And then that just gives us like the customization to be able to do it. Like I’m in this demo environment, I am not going to show a given provider, but I will show like for example, a customer.
Hassan Zahir (26:02) Where, if we had like rules for like a request, then those rules show up like and so like we know, for like enrollment requests for a given customer, if there’s a given rule or if there’s like process or if there’s any specific rules that we have to follow for a given customer… this one, this customer may or may not have those rules that show up. But we have customizable rules that kind of just show here. And it’s like, okay, follow said customer’s project plan when executing these enrollment requests because this is what has to happen first and this happens second. And we have that map then that flows through the system. So that’s just kind of like the way that we would be able to manage that.
Manan Bhavsar (26:49) Yeah. And last question on this… from my understanding from when we discussed this previously, like it’s pretty hands off for us. So like if we wanted to make any changes to an application or update a status or add documentation, it seems like that’s something that would be a medallion thing and not a grow thing. We wouldn’t have the functionality to do that. So if that is true, and also if that’s not true. I’m assuming we’ll have like a dedicated person that we’d be able to communicate with on a day to day basis with any like updates when it came to enrollment questions or application updates.
Hassan Zahir (27:33) That is correct. So like the actual status updates, medallion would own those, but you as a grow admin, you would have the ability to go in, you can ask notes. You can have notes that go directly to the medallion team. You can share public notes. Like there is the ability to have a certain level of control over an enrollment request. Medallion is going to like update like the status and the state we’ll track like dependencies and like any notes that were put in there. But for example, like you could come and view these notes. You could add notes here. You can, we share like internal notes on these sorts of things. But you do have the ability to engage with your, to reach out to your engagement manager. I don’t want to say engage with your engagement manager, but you can engage with your engagement manager. You can jump into any of these open enrollment requests at any given point in time and you can send a note that’s going to show up or post directly into that request line. Or you can send it, to medallion like to your engagement manager directly here. So it won’t show up necessarily in the notes. But it’s kind of like if I wanted to add, I need to figure out like who’s here. Let me add someone in the system and I could go in and just like add someone. I mean.
Manan Bhavsar (29:05) I’m assuming this is a perfect use case for us to have like that group slack channels where we can help engage with them probably more efficiently. Yeah.
Hassan Zahir (29:14) That, I mean that would be like the ideal solution and that’s what we do that’s what I ask, cause we do that oftentimes like through the pre sale cycle. We do that through the contract negotiation. Like, hey, can your team look at this? It’ll get this done faster as opposed to going through those formal email channels. But yes, but you have, you would have literally not just a account manager and engagement manager, but you would be of the size, you would have a dedicated account manager and a dedicated engagement manager.
Manan Bhavsar (29:40) Got it. And I said that’s the last question one more and I’m pretty sure we discussed this but I’m forgetting what was said about it, say that, I mean, obviously, you know, we’re going to get a contracted tap from most payers of like when we’d expect them to get providers enrolled by if there’s a like right now, we track at risk and off track applications. I’m assuming you guys are probably like have some way to track applications that are getting close to, that we’re setting?
Hassan Zahir (30:18) Yeah, we do for sure. Yeah, what happens, if,
Manan Bhavsar (30:22) like for example, cause I mean, obviously, once you’ve submitted to the payer, that’s on the payer, but like if there’s any delays with submitting applications, like what’s the accountability there? And, for medallion, yeah.
Hassan Zahir (30:34) So what I’ll do is I don’t know I have it enabled but like this is only cause we’re friends and you can’t tell anybody that I’m showing you this. Okay? Like we have internal SLA tracking. And so this is how the platform is gated. So behind the scenes, we have public facing reporting and non public facing sections… modules reporting. And so we have internal dashboards as you can imagine that go to the leadership for the enrollment team and so across all functions. If so, if there’s a chance that we’ve got a customer who’s approaching an SLA breach or missing an SLA, that is kind of like first and foremost, why is there a dependency that’s not been met, right? It’s like, okay, yes, we’re not going to hit this SLA, but it’s because of this dependency or because of incomplete profile or these sorts of things. If we’re going to miss it or we risk missing it, then the same way you can see like these out of state enrollments, like we have tags. And so, if something is coming up where there’s a concern, it will auto tag it as a priority enrollment. And so I could go in and add a tag. And again, this is like who’s tracking this? What’s the payer? What’s the status? Why is it on hold? Like I can go through and add specific tags to make sure that one of our operations specialists is keeping an eye on what’s going on there it could be because, you know, and there was an update or a change to a form or something like along those lines, it could be a host of reasons why something was approaching like, that SLA for one reason or another. And then their internal visibility because obviously we put dollars at risk and.
Manan Bhavsar (32:23) we.
Hassan Zahir (32:24) don’t want that to be the case. Yeah.
Manan Bhavsar (32:27) Yeah. That’s a, I ask that because that’s what like, you know, when we, if we transition to the enrollment function within medallion, that’s going to be like one of the main things. Obviously, we’re going to make sure we’re staying aligned, with Brenna and Derek of it’s our task, right? Like if we’re falling behind on tats, then at the end of the day, there should be some sort of like way we can track that, see why get an understanding of.
Hassan Zahir (32:54) Yeah, there definitely is to like on the front end like that’s the back end for us to hold ourselves accountable. But through payr enrollment, like we have the standardized dashboards, we can run enrollment reports that are like specified reports. So like you can get a daily SLA report from the payr enrollment. That’s the one thing about this new tool that I do need to look at the analytics take a while to load. Yeah, we can run a customized report for turnaround times. We can run a custom report for SLA attainment, and then we can do this again kind of like you’ve got the standard like completed ones and we’ll be able to show you. Okay, this is a completed date, but we can modify this data. Like what was the submission date? What was the completed date? How long is this taking on average? When I go into the report builder for this purpose? Then I can say, okay, show me all of my payr enrollment requests. I want to know who the payr is. I want to understand the lines of business. I care about. The different request types. Is this the initial or the re enrollment? I want to know when was the… request made? What is the current status? Even though the request was made on this day? When was the application submitted? How many days has it been since it’s been submitted? And then if it’s been completed, what is the effective date? Like you can just build these out in any kind of way that you want to build them out. Once you’ve got it structured, then we will be able to know, okay, this request at this date, this is the status. This is when the application was actually submitted. How many business days is it in line with what our slas are? You can export that report, but then also you can save that report and run it on a cadence. So it’s like if you want to know, you know, your weekly amount of anything that may be slipped in SLA or is close, anything along those lines, you can name that report, set the cadence for it depending on who should get that report. Is this a daily report? A weekly report? And then also our account managers are number one going to be your go to for that. All of our qsrs have that level of reporting, but we can customize this data and this reporting in app for you however you want to see it. But also all of those data elements that are available here for you in reporting are also available to you via API. So if you want to push this into a different system, if you have an internal dashboard, then we support you being able to do that as well.
Manan Bhavsar (35:28) Cool. Perfect. I mean, we probably still use this to some extent, but I’m imagining we probably, we use hex so that’s probably where you’d want to visualize this. That’s helpful. No, I think this is good. I know we kind of talked about this a while ago. I just the refreshes is good.
Hassan Zahir (35:46) Yeah. I know there’s so much that we can do and there’s so much that’s in there. And like I said, the biggest thing I wanted to highlight is that from a provider data management perspective, your enrollment team would have every piece of data available to them. It’s just a matter of for a given provider, is that up to date or for a given payer? And to your point, when we onboard, what we recommend is saying, hey, if there’s a chance that they’re going to be enrolled with health plan X, let’s make it so that at their onboarding, there’s a task for them to complete the requirements for health plan X. If medallion is doing the enrollments, we’ll say, okay, yep you got these group contracts, health plan X, y and Z, they’re getting enrolled, they’re at this location, they’re this provider type. So when we onboard, all of those requirements are tracked. So they log into the system. One time, all of those requirements need to be pushed in, met, completed one time, they attest to it. And then they don’t really have to worry about it going forward especially if we’re doing like caqh management. And if renewals are, you know, managed through caqh, it’s kind of like hands off. At that point, you get your reports and your reporting and, you know, you’re kind of going with it. If there’s an internal team doing it, then all of the data is there. But we will need to figure out like what is the best way? Is it via API and pushing that information somewhere else so that you can follow your workflows or whatever the best case may be? But the data is all available to you. Perfect.
Cliff Marg (37:23) Let me jump in real quick. Do you guys have a hard stop in seven minutes?
Manan Bhavsar (37:28) I don’t.
Cliff Marg (37:29) okay. I just want to, I just want to circle back to the recred conversation. It sounds like, I mean, give Hasan some time to look at that really easy to digest lucidchart, and then come back with like, you know, maybe here’s what it looks like with medallion, which I think is going to be a little bit more straightforward, but it sounds like we need to be considering the volume of recred, if that’s going to be managed properly in medallion.
Cliff Marg (37:59) So that’s I think that’s one that’s the one big outstanding question for me is like what that volume like annual volume of recred looks like?
Marissa Letendre (38:11) I think it’s like about 5,000 probably.
Cliff Marg (38:17) 5,000 a year? Yeah. Oh, that’s not anything crazy. Okay. I was scared it was going to be like, well.
Marissa Letendre (38:24) It’s going to scale year over year, but.
Cliff Marg (38:25) It’s yeah, yeah.
Marissa Letendre (38:28) Like assume… like,
Manan Bhavsar (38:31) a third of our provider population at most each year is probably a good estimate. Yeah.
Hassan Zahir (38:37) And that’s how we normally calculate that is a third of your provider population. And we take certain liberties to account for the fact that you’re going to have new providers joining every year and some providers churning every year. So, like not all of those providers who are credentialed in year one are going to be due for recreds in year three because of the percentage. And so we’ll take that into account to try to maximize the cost. Essentially how medallion manages this is we will perform the credentialing and you tell us to how you want us to define the recredentialing date. So typically, the recredentialing date is going to be based upon the day that provider is approved via committee. A lot of times the group contracts that our customers have that’s how they structure those delegated agreements that the day that it’s approved via committee is the day that we track for recredentialing. We do have some I won’t say oddball customers, but some customers that they say, well, we submit the roster and the payer then gives us the roster acknowledgement, and they’ll list the provider id and they’ll list the recredentialing date. And depending upon contracts, they can say it starts the first of the next month. But then that limits you from being able to backdate to the day that provider was approved via your committee. So most of the people, who we work with the recred date is based upon the committee approval date that’s the day that we log. And then we’ll track that recredentialing start date and that recredentialing deadline to make sure that there’s never a lapse in the recredentialing we can set it up just like this. And then essentially, what happens is that creates like an automatic request for recredentialing initiate the recredentialing and everything kind of goes as planned. So it’s mapped in the system based upon the initial credentialing. Like I said, if you do get an acknowledgement or return file, and there’s something that for a given payer, you need to say to us, maybe we need to modify the recredentialing date, we can do that. But typically, if we go off of the day that the provider was approved, passed through committee because we give ourselves that 90 day buffer for the recredentialing deadline. We don’t see any issues honestly. I think our reported recredentialing accuracy rate is 100 percent in our reporting system.
Hassan Zahir (41:10) It might be like 99 point nine. Something and change, but it reports as 100 percent because of the fact that we track those dates, we auto initiate the recredentialing and just essentially we go from there. If a provider is terminated, they just need to be terminated from their provider profile. Again, something that we can manage via API or in the system, we would just deactivate that provider. But again, you can send an API request in bulk to deactivate multiple providers to avoid having to do that manually.
Hassan Zahir (41:51) So probably a bit easier with… medallion to go through, perform that recredentialing, get, the full packet that’s required the same way you get a full credentialing file and normal credentialing, we’ll put together the full packet for recreate it’s. Just going to move from the scheduled recreate into the ready or into the request tab. It’ll go to ready and then follow whichever process we need to follow to support you.
Hassan Zahir (42:25) Sounds good. All right.
Cliff Marg (42:26) So action items for this. I mean, Marissa, does it make sense? I mean, Hassan will spend some time looking at that, and if we have something similar Hassan, do we have something similar? We can send them just in?
Hassan Zahir (42:38) Terms of how, yeah, for sure, I’ve got like our standard credentialing lucid diagram is how we typically say, hey, this is your current state. This is the entire future state with medallion. This is the timeframes that we are attributing to this and that. And so we can definitely send that over in advance. But now, what I would like to be able to do is kind of I’ll mark yours up. I’ll probably recreate it in lucid, mark it up, share with you kind of like current state, potential future state with medallion. But after this call, I can send over as a matter of fact, I can stop my share now and I can pull that up and share the link with you. Cool. Yeah. Okay.
Cliff Marg (43:19) That sounds good. And then Marissa, should, I mean, I can work with Kyle to just understand like how that would impact cost. But if it’s only 5,000 a year for this first year, it’ll scale, you know, linearly, I don’t think it’ll be a huge impact.
Hassan Zahir (43:33) Sounds good. Okay.
Cliff Marg (43:34) All right. That’s helpful. Let us let us know if anything else comes up this week. Otherwise we’ll touch base Monday after the big.
Hassan Zahir (43:43) The big day. Yeah. Sounds good.
Cliff Marg (43:46) All right. Thank you both. Thanks.
Hassan Zahir (43:48) Appreciate it.