Transcript
Nathaniel Walma (00:18) In it. Hey, cliff. How’s it going?
Cliff Marg (00:22) Good, man. How are you doing?
Nathaniel Walma (00:24) Cool. Sorry, we’re not a zoom company. So I’m.
Cliff Marg (00:33) it takes a minute.
Nathaniel Walma (00:34) Yeah.
Cliff Marg (00:36) You guys use teams, Microsoft shop?
Nathaniel Walma (00:39) Yeah, we got teams with everything. It’s always such a struggle. It’s better than we’re doing some ad D, product and they use WebEx, that is, I.
Cliff Marg (00:53) Know. It is funny. Honestly, even if you are a zoom shop, it’s still a pain in the ass for a lot of people. Sometimes my computer just has a complete meltdown for no reason. It happens. What’s happening in el Segundo, what’s it like today?
Nathaniel Walma (01:10) It’s nice so far, calm Wednesday morning, nice and sunny so far.
Cliff Marg (01:16) Do you go to the office?
Nathaniel Walma (01:19) Yeah, I’m in the office a few days a week.
Cliff Marg (01:22) Yeah. Okay. Cool.
Nathaniel Walma (01:24) I usually work from home back week, but Monday, Tuesday, Wednesday we’ll come in.
Cliff Marg (01:29) Nice. That sounds great. Yeah. Well, cool. I mean, you know, we’ve got 30 minutes. I don’t know that we need the whole thing.
Cliff Marg (01:37) I think honestly like excited to chat a little bit more about current state credentialing and just share a bit more on medallion. I think ultimately like end goal is see if there’s something here. I think based on the little bit of conversation we had, it sounded like credentialing kind of increasing bandwidth was top of mind for the organization anyway. So, I think, yeah, I’ve got like I can kind of kick things off with like a handful of questions just to kind of understand current state and then happy to share a little bit more about medallion if that sounds good.
Nathaniel Walma (02:06) Yeah, absolutely cool.
Cliff Marg (02:09) I guess the first thing is just like, I think I remember you mentioning credentialing kind of newly rolling up to finance would be good to just hear like kind of current state, how many people that is, that kind of runs credentialing. And then what I guess ultimately like what credentialing means to you all, my guess is that it means just like submitting the individual payer applications to each payer, but sometimes it can also mean like doing some more of like the primary source verifications up front as you’re onboarding a new physician, some organizations will have delegated contracts with some of their payers. So any context you can share there would be really helpful.
Nathaniel Walma (02:50) Yeah, it’s not exactly that credentialing rolls up to finance. Credentialing still rolls up to legal. It’s more that as part of finance, we are very conscious, well, one, as a small lean organization, everyone does a lot of things.
Cliff Marg (03:06) Yeah, yeah. But finance.
Nathaniel Walma (03:09) We are right now like we just signed an enterprise cloud contract like just finance as a team. Andrew and I are very focused on how we can improve processes in general across the company, whether or not it’s things that are under our ownership umbrella or not. Yep. So that is something where for credentialing, we currently have two headcount that are like pure credentialing resources. They sit under the HR team Adjacent, you know, somewhere in the HR org, but it’s HR legal bodies and they are the ones who are like manually truly manually going into our system and doing the credentialing with the providers for a payer at a payer level, we’re credentialed at a site level. So it’s not so much that we need like when providers come in, we don’t have like a backlog of like being able to bill for that provider. It’s just like making sure that the provider is actually like credentialed and enrolled and all of those things.
Cliff Marg (04:32) Got it. So you’re billing only at the like facility level. You’re not billing at the provider level at all, correct? Okay. Got it. That’s interesting. And I guess what’s your take? And so even before we go there, when you talk about credentialing of providers, do you have a sense for like what all goes into that? When a new provider starts, I assume that is mainly things like verifying their licensure and making sure that they are in good standing. No sanctions on any of the yep.
Nathaniel Walma (05:06) Okay. Yep. It’s all of those checks we have guys because I’m not directly involved in the process. I don’t know that there’s some acronym there’s some platform that I know that we are on. That is some like some four letter acronym that’s some like standardized, I know platform that, yeah, we look up that providers are typically licensed on and that we can just call and use that. But yes, that’s exactly what we’re doing with them. And I know we typically say that there’s like a three week lag best on getting providers credentialed this way. Got.
Cliff Marg (05:45) It. And do you know what it is that takes up to three weeks specifically?
Nathaniel Walma (05:52) Medicare. Yeah. Medicare is the longest.
Nathaniel Walma (05:57) Three weeks was like the best case scenario. I think legal wants like always, she was like 45 days, 45 days is like what I want.
Cliff Marg (06:07) Yeah. Okay. That’s helpful. And I guess what’s your take on? Just like how the current state is going? Like, it sounds like. I think you mentioned you were there was conversation about budget being set aside to add another fte at some point during this year? Like is your take that it’s generally going well, but, you know, we do need, you know, there’s enough providers coming in where we need another body or is there anything that’s like not going well, from your perspective?
Nathaniel Walma (06:36) Yeah. I mean, I think it’s that well, clearly there’s the demand from the team that they want the additional body and resource to help out. I’m just thinking that we have two bodies on our current system software. I spoke with Andrew about medallion when you’d reached out a while ago, and he said that he’d years ago, I think considered you guys and I’m like, well, it’s probably a very different.
Cliff Marg (07:05) Very.
Nathaniel Walma (07:06) different product now than it was then. So would like to reconsider just to see if it’s something that as we’re going about this year, thinking of like, okay, if we need additional capacity or if we need additional resources, could that be got by just using different software or expanding upon our software rather than hiring new people? Yeah.
Cliff Marg (07:28) Yeah. Okay. That’s totally fair. Is it ncqa? Is that what you guys have access to? You mentioned like the four letter acronym that helps kind of maybe check some of those. Okay. Yeah, that.
Nathaniel Walma (07:40) Might be it. Yeah.
Cliff Marg (07:42) Not super important. Just curious there.
Nathaniel Walma (07:44) This would absolutely just be like an intro conversation just to see like what you guys have. And then I’d speak with Andrew about it. We’d loop in the DMS of our Cao and then go from there.
Cliff Marg (07:54) Yeah, yeah, totally fair. It absolutely.
Nathaniel Walma (07:58) Depends on like pricing and I don’t know what works with things and all that.
Cliff Marg (08:04) Yeah. And I’m happy to even give you some of that context. Yeah, today, just so you can have it and take it back with Andrew and team… one other, just kind of like high level question. I’m curious how many providers does Exer, have today? And I guess, do you have a sense for, I don’t know how many new providers or if there’s any plans on opening new clinics over the next year or anything like that?
Nathaniel Walma (08:34) Yeah, we have current headcount on providers is.
Cliff Marg (08:40) Let.
Nathaniel Walma (08:41) me remember, my HR work should be something like 300 to 350. And yes… opening new clinics this year. Aside from any potential M a activity, we’re planning for… we opened one clinic in January. Well, we opened, it was really end of December, but we opened a clinic at the end of last year. We are intending to open a clinic very imminently. And then we’re intending to open seven additional clinics through the rest of this year.
Cliff Marg (09:27) With.
Nathaniel Walma (09:28) plans to continue opening the current pace, nine clinics a year.
Cliff Marg (09:34) Okay. That’s awesome. Yeah, I think that’s kind of like the biggest indicator of fit. And I think like even hearing that there was consideration of adding another fte like that’s. Typically, the business case for medallion is predicated on a couple of things. It’s like one four, I guess four groups. I would say, actually, it’s more common that some of the urgent cares that we’ll work with will actually bill at the provider level, maybe the facility level as well. But typically that conversation is like how much faster can we get your providers billable and just kind of generating revenue? The other factor is like looking at opex. So if you’re saying we’ve got two people today, we’re going to hire a third, like typically scaling with automation and with software in general is going to be more cost effective than adding ftes. And then it gives organizations kind of the peace of mind and comfort that like, you know, what happens if someone quits or retires, or, you know, having to go back and hire and train. And just like keep eyes on the credentialing organization. Typically medallion is like what we see with customers is an organization with up to like 500, maybe 750 providers can scale with one fte operating medallion because it sounds like a lot of what you all are doing potentially manually today are things that medallion would essentially automate, right? And so if you think about like just what medallion is, essentially, we are an AI powered provider data management system. So a proper place where you can store your provider data, all of your facility data, group level, data, tax ids, et cetera. And really what we’ve done is we’ve kind of mapped out the enrollment process for any payers that you all work with and need to get a network with. And so, and so what ends up happening is new provider starts, you know, we’ll do everything that we need to gather any sort of provider data. We’ll automate all of those primary source verifications, making sure that, you know, everyone is in good standing. There’s no sanctions popping up on Sam, oig, npdb, medicare opt out things like that. And then, and then your team would basically set like with a couple of clicks inside the platform would be able to say, hey, we need… I guess that’s probably all that you would need on the provider level. But if, when you’re opening up a new clinic, you’d be able to say, hey, we need, you know, this clinic to be now enrolled with these payers. And medallion has essentially what we call like payor process guides. So, everything that is required for all the payers that you work with, and because we’re capturing all of that data on the group and tax ids et cetera. Up front, we’re able to just automate the process of like taking that information, mapping them to an application, getting them out to the payer. And then we use a lot of AI to do like payor follow ups. So both via phone call, via email, and just kind of following that through until you know, your facilities are essentially in network able to bill there.
Nathaniel Walma (12:55) Okay. Noted. Yeah, that, I mean, even if we’re not billing providers under that’s, still something for new sites? Yeah.
Cliff Marg (13:06) Yeah, it’s still work that has to be done, right? It’s like that, that’s probably at least half of the work, that the two people are doing today.
Nathaniel Walma (13:18) Yeah. Under credentialing, yeah. Yeah. I know new site credentialing is something that our VP rev cycle takes a lot when that happens as well.
Cliff Marg (13:29) Yeah.
Nathaniel Walma (13:30) And I think, and I know medicare because it’s a government contract ends up getting treated slightly differently than the other payers. I don’t know if we bill at a provider level because we’re required to, for medicare or not. I know that we hold claims for new providers until the credentialing process is fully completed for medicare specifically. Yeah, but we don’t have to, for other payer contracts, yeah.
Cliff Marg (14:01) Yeah, that makes sense. And I think one of, the benefits of medallion is like, you know, we are doing this kind of credentialing work. Yeah, at scale. So we’ve got about 350 plus customers at this point, really throughout the country, but like obviously, one of the bigger populations is going to be in California. And so just because of the volume of enrollments and credentialing work that we are doing, typically, we’re able to help compress that turnaround time… probably, for medicare, I would imagine like turnaround times are pretty tight there. But then also, if you’re talking about just how long does it take to get a facility billable? I think that’s like one of the big value drivers for us is like making sure that if you are, you know, acquiring a clinic, or, you know, opening up a new one organically like getting those to produce revenue quicker is kind of, the name of the game.
Nathaniel Walma (15:01) What is your… pricing model?
Cliff Marg (15:09) Yeah. So there’s kind of two components. One would be there’s just like a software fee for like all of the it’s really the providers that we’re storing, on the platform. So, you know, probably, I don’t know anywhere from like 50 to 80 bucks per year per provider. So nothing crazy there. And then it’s really like a per unit of work. So, we would want to work with probably, you know, your head of RCM just to understand like, hey, if we are opening up like nine new clinics in the next year, like what does that mean, from, a credentialing volume both for providers as well as for, those clinics? And then it’s yeah, just a, per credentialing event. Essentially, my guess is that the cost would probably be in the 50 to 100,000 dollar a year range… without having a ton of information at this point, like, in not understanding like how many payers you all work with and that kind of thing?
Nathaniel Walma (16:22) Yeah.
Nathaniel Walma (16:37) Yeah. I mean, it’s something that is… interesting because even if we’re bringing on like… what is effectively a minimum wage body doing the resource, you know, fully loaded to the company that’s still 75 grand definitely.
Cliff Marg (17:02) So, yeah.
Nathaniel Walma (17:05) Let… me take some of this stuff back and… speak with Andrew, speak with Laura Lynn, who’s our VP of rep cycle. Yeah.
Nathaniel Walma (17:24) And also speak with Deanne who’s our Cao on the status. I’m also just trying to think about like future proofing ourselves in the event of things like M a events.
Cliff Marg (17:41) Yeah. Where, if.
Nathaniel Walma (17:45) we have the ability to scale with a piece of software that would cost ourselves a lot less than a crap load of temp resources to try to get something done for a short period of time that’s not going to carry forward or be useful prior to that event. So.
Cliff Marg (18:06) Yeah, yeah. Having to think about like throttling resources during like really busy periods, I think that’s like a really strong use case for medallion. And yeah, I think based on what you said, like with initiatives around just like becoming more… I don’t know, AI focused and kind of looking at ways to create efficiencies. I think this sounds like it could be potentially an easy win. But yeah, I’ll maybe shoot you an email, Nate, just kind of highlighting some of the things we talked about and like some of the functionality of medallion and some of the value drivers. And then, you know, I can check back with you in like a week or so. Yeah.
Nathaniel Walma (18:43) As well if you have like a powerpoint that’s got any like product demo or anything in it as well, screen grabs or visualization or things.
Cliff Marg (18:54) Like that. Yeah, we definitely do.
Nathaniel Walma (18:57) Okay. That’d be great. Thanks cliff. Yeah.
Cliff Marg (19:00) Sounds good. All right. I’ll shoot you a note, give me just till like the end of day to day and then I’ll circle back in a week or so. Sounds good. All right. Thanks, Nate. Appreciate it. Thank.
Nathaniel Walma (19:09) You have a good one.
Cliff Marg (19:10) You too. Bye.