Transcript
Mike Manson (00:00) what up, man? Noah? What’s happening?
Noah Laack-Veeder (00:08) What’s up, dude?
Mike Manson (00:11) Living the dream. Hey, I hear you got a meeting booked with a tier two, which is good.
Noah Laack-Veeder (00:17) There we go. Hey, dude. We love meetings.
Mike Manson (00:19) We love meetings.
Noah Laack-Veeder (00:21) Do you need me to help you with that at all?
Mike Manson (00:25) I’ll dig into it, but, yeah, potentially, have you join? I’ve got Alicia here. So I’m going to let her in sweet.
Mike Manson (00:36) Hey, Alicia. Welcome.
Elisha Burton (00:38) Hey, good afternoon.
Mike Manson (00:41) How are you doing today? Good?
Elisha Burton (00:42) How are you?
Mike Manson (00:43) Doing great.
Noah Laack-Veeder (00:46) Trying to think, has it been a week? No, we been?
Mike Manson (00:49) A couple weeks, I think.
Noah Laack-Veeder (00:50) Been a couple weeks, right? Yes. Well, hey, what’s changed since then? Anything exciting happening in the life Alicia?
Elisha Burton (01:01) No, not really. We got a couple warm snaps and now it’s back cold again, so.
Noah Laack-Veeder (01:06) Yeah, yeah. Can you remind me where are you located again?
Elisha Burton (01:12) We’re on the coast of North Carolina.
Noah Laack-Veeder (01:15) Yes. Yep. Well, in Wisconsin, rumor is next week, it’s going to be 70, so.
Elisha Burton (01:21) Oh, wow.
Noah Laack-Veeder (01:24) Fingers crossed. That’s.
Elisha Burton (01:25) probably not normal for this time of year up there, huh?
Noah Laack-Veeder (01:28) No, yeah, it’s welcomed for sure. Yeah, I’m sure. You’re not heading to the beach in kind of the cold spell right now?
Elisha Burton (01:38) No, I did make it out a couple weeks ago though. So, that was nice.
Noah Laack-Veeder (01:41) Oh, you did. Nice. That’s.
Elisha Burton (01:42) awesome. Yeah, nice. I just sent Jeff a text to see if he’s able to jump on cool.
Noah Laack-Veeder (01:52) What’s in your typical beach pack? Do you like bring some food, drinks, blankets? Like what do you bring to the beach?
Elisha Burton (02:02) Oh, you know, we just went out to kind of walk and see the ocean and enjoy the nice weather. We didn’t really sit or anything?
Noah Laack-Veeder (02:11) Got it. Makes sense.
Mike Manson (02:16) Gershon, how are you, sir? I’m.
Garrison Goodman (02:18) good. I was going to say my wife works in a school and she’s got spring break next week, so we’re going to head to the New Jersey shore here, which is supposed to be in the forties but it’d still be nice to get out and smell the ocean and eat some seafood.
Noah Laack-Veeder (02:36) yeah, maybe doing some cold plunge Gershon, oh, for.
Garrison Goodman (02:39) Sure. I always get in, yeah, I try to, I do, and the, you know, there’s time of year when dogs aren’t allowed and it’s too cold for everybody. So, we’ll get my dog out there running. He’ll be happy there. We go chase the birds. I,
Mike Manson (02:55) didn’t do it. I didn’t do it this year, but last year, I was actually pretty consistently jumping in the ocean here in Boston, like in February. Yeah, I was getting up early getting a workout in and diving in and it’s a good way to wake you up for sure.
Garrison Goodman (03:10) It’s even too cold for the sharks that time of year.
Mike Manson (03:12) Yeah… it’s good. Yeah, Alicia, let us know if we should wait for Jeff and Joni or, yeah.
Elisha Burton (03:26) I don’t he must have got caught up in something. And I know you said that you didn’t see either one of them except the meeting. So… I’m gonna be out the rest of the week after today. So, I don’t know if you guys want to try to get something on the books for next week. I can look at our calendars really quick and see what works.
Mike Manson (03:49) Yeah, I mean, yeah, we can reschedule for sure.
Mike Manson (03:52) I guess like while we’re here, curious kind of what’s transpired on your end internally, I’m guessing you’ve had some internal… conversations. I don’t know if you mentioned you had a chance to glance over the proposal, we share like any general feedback on that…
Elisha Burton (04:13) I’ll be honest, we got a lot of different projects going on right now. So we’re in the process of evaluating vendors to change clearinghouses, we’re in the process of evaluating some other vendors for some contract work. So, this one has kind of got, I think that the clearinghouse has taken our first priority right now. We definitely are, you know, we know that we need some help with credentialing. But like I said, there’s just like a lot of things going on right now. Yeah.
Mike Manson (04:49) Totally hear you. I guess like, is Joni, is she at least aware of the conversations that we’ve been having or?
Elisha Burton (05:01) I thought she was on our last call, was she not?
Mike Manson (05:03) She, I’d accepted, but I think she got pulled into something.
Elisha Burton (05:06) Last. Oh, okay. Yeah, she’s definitely aware, you know, and she’s she knows that we need help with credentialing. So, okay. Yeah. And I know you sent that proposal to all of us, so, I’m sure, at some point she’s glanced it.
Mike Manson (05:23) Okay. And as far as credentialing, I like, I know, for your team, it’s very much a focus on how are we dealing with payers and trying to reduce claims denials and trying to get folks enrolled with the payers specifically and trying to get the, trying to get that done faster. I think is what we talked about as the two kind of pain points. I was, as I was doing some more homework, on carteret. I was just looking through some of the other folks I thought might be interesting to get into the conversation like Molly marsh her name came up. She looks like she runs medstaff services, an overseas… like the in house credentialing is that, I know you mentioned the two teams are kind of separate right now, but would it make sense to reach out to her and kind of get her opinion on this stuff or?
Elisha Burton (06:18) I don’t I think she deals more with like cause we have a group that contracts with us. And so, I feel like she deals with the contract physicians. I’ll have to check with Jeff on that, cause I’m not real sure. I haven’t had to deal with her at all since I started.
Mike Manson (06:32) Okay. Yeah. I mean, it looks like she, she’s been with you all for a good tenure and started out as a cred specialist, and now it looks like she’s overseeing the medical staff credentialing. So, just curious… if it would be valuable to have her.
Garrison Goodman (06:51) Yeah, at least you’re saying she only does credentialing for contract workers. I.
Elisha Burton (06:56) Mean, I’m going to be honest, I really don’t know that’s why I’ve said in the past, like I’m not probably the best person to answer all of your questions. I’m just trying to help facilitate these conversations.
Garrison Goodman (07:05) Well, yeah, thank you for taking the brunt of the coordination task as.
Mike Manson (07:12) You all are.
Garrison Goodman (07:13) Heard in cats there internally? It makes sense. I can’t remember how our conversations got started but we’ll get introduced to folks who are like, hey, we know we need to solve this, but we got a few other projects that are lined up first. So, if you had to think about like an order of events of how you expect things to go so that we can be ready when you are, what do you think that looks like timing wise? I.
Elisha Burton (07:41) Really am not sure because there’s so many different pieces that go into it and there’s contracting and there’s you know, legal has to get involved with contracts and all that sort of thing. So, one thing I have learned since stepping into this role is that it always takes longer than I think it than I want it to. So, I think Wednesday at 12, if you guys have some time next week, Wednesday at 12, we should be free.
Garrison Goodman (08:10) Okay. So with the clearinghouse initiative, you’re not that’s not like a months long initiative. That sounds like something you’re wrapping up sooner then? Yeah.
Elisha Burton (08:20) We’ve been evaluating companies and, but then we’re going to have the process of going live with the new clearinghouse which you know, always takes some time. But, yeah, we’ve got several different things going on right now.
Garrison Goodman (08:34) Yeah, that makes sense. And yeah, when you guys think about changing out the credentialing department and moving forward with the new solution, what is the estimated time that you all, are thinking that you would have to allot to that? I?
Elisha Burton (08:53) Have no idea. I’ve never done this before. Okay, just being honest. So I don’t know. Yeah.
Garrison Goodman (08:58) That’s helpful.
Mike Manson (09:01) Jeff. Yeah. Hey, Jeff.
Jgloe (09:05) Hey, how are you?
Mike Manson (09:06) Good. How are you doing good? We were just talking to Alicia. We were just about to potentially reschedule this for next week. Do we want to reschedule when we can have Joni join? Or is it worth?
Jgloe (09:23) I don’t think she’s going to join or she wouldn’t just be us anyways even if we rescheduled. Okay?
Mike Manson (09:31) Okay. Fair enough. Yeah. Well, okay. We can kick things off then. So what we had planned today is wanted to see if you’ve had the chance to review the proposal and take your feedback on that.
Mike Manson (09:47) I know Alicia was letting us know there’s several projects that are in flight right now. So I understand priorities are kind of shifting a little bit but wanted to see, I don’t know Jeff if you had the chance to look through what we share with you as far as the proposals go. Yeah?
Jgloe (10:02) I looked at it at a high level. I probably just need to… yeah, like look in here… try and figure out how this is. I mean you got 40 providers and then you got payer enrollments. So, I mean not… every provider is currently not enrolled with every payer. So how would that work? And then moving forward too? Because not every year you’re not having to do a payer enrollment every year, you’re just having to have the provider in the database until enrollment starts the next time. And a lot of times you don’t even get, I mean, and you all know this better than me but I feel like when we connect someone to blue cross, we never have to do a revalidation or anything… medicare. It seems like that one seems to be to go along and we aren’t having to do reassignment… of benefits. That often. It’s not like we have to redo that all the time.
Noah Laack-Veeder (11:16) Yeah, maybe one thing I’ll just add really quick assuming I think what we’re trying to do is get the proposal, but like maybe just anchoring a little bit more on kind of the active problem that we’re trying to solve. And I think that can inform kind of what the scope needs to be. So, from last time, I think what I gathered was we have providers working, but the delays and lack of visibility in the enrollment process, is preventing some folks from being billable. And so what we’re trying to figure out is how can we ensure that those individuals are getting billable?
Noah Laack-Veeder (11:52) So that proposal and those counts that we’re proposing to you, it’s more like, hey, how many providers do we think need to be enrolled and billable with certain health plans? And then if that’s the case, how many health plans do they need to be enrolled in? So I think what we did is we took an estimate based on what we talked about last time to go with those numbers. But just generally speaking, is that kind of the problem that we’re trying to address with this initiative?
Jgloe (12:18) It is. But like I was just saying, I mean, you get a provider enrolled initially, what’s your ongoing cost then for that provider? Because they aren’t going to need five enrollments every year. So when you have 40 in there and then 350 enrollments per year at 80,000, I mean, what is it really going to be year two after they all get through their initial enrollments? And like I said, it’s not like we’re starting at scratch and no one’s enrolled either. And it’s hard for us because I mean, I’m sure it’s hard for you because we don’t have definitive numbers for you either… but just trying to get a basis as to, I would think that our year one cost would definitely be higher but I would think that our year two would settle out because the payor we have the enrollments completed and we aren’t bringing on 40 new providers every year.
Mike Manson (13:11) Okay. Yeah. I think that’s where we just need to, I went with a linear number just based on our last conversation. So I think where we started was there was like we had like 400 providers, but then it turns out I think a lot of those are temp resources. So I guess we would just need to anchor on how many providers are, do you need to have in the system? How many providers are you going to be adding, you know, rough number annually? And then of those new providers that are coming on board, how many health plans would they get enrolled with? So if you’re saying it’s not 40, but maybe it’s 15 providers coming on board in year two, how many plans would you need those providers enrolled with as how it would get to the year two number?
Jgloe (13:59) You know, I mean, there’s no way to answer that. I mean, you could assume that some doctors are going to leave and they were going to have to get new ones enrolled. But to know that 15 doctors are going to be added to our site. I mean, it’s an unknown because we don’t know if they’re going to leave or not. So, I mean, we can make some assumptions. But just looking at this, I mean, 40 is probably a good number 50 for the number of providers that we’re going to have that we’d probably maintain in the system as more of a more permanent based type providers. I don’t know about the telehealth ones that I mentioned before because there’s so many of them. We need to reach out to our telehealth company and ask them if there’s some kind of supervisory billing we can do and just have to maintain a handful of them. But say… we have this 40 that we get initially enrolled. What do those 40 look like in year two? How do they roll over to year two?
Mike Manson (15:09) Yeah. I mean, if you’re saying it’s just static and we’re not adding any new providers, then year two, you wouldn’t have this line item here.
Mike Manson (15:22) So, I guess, yeah, we, I mean, do you have any kind of historical data to look at? Like, hey, this is what we added over the last, you know, if you look back the last three years, this is how many providers we onboarded or?
Mike Manson (15:42) And I would assume you, I would.
Noah Laack-Veeder (15:44) Assume.
Mike Manson (15:44) You would at least know how many plans the providers are getting enrolled with, right? Just based on the contracts that you have.
Jgloe (15:51) Yeah. I mean, I’d say… I think we’ve discussed this five to six, probably. Okay, including medicare. Okay? And then.
Mike Manson (16:08) Stuff we said, yeah, just doing quick math.
Noah Laack-Veeder (16:14) Mike, maybe I can just share my screen just to make this visual sure kind of start brainstorming a little bit, yeah.
Noah Laack-Veeder (16:24) Yeah. You’re bringing up like really important questions and I think ultimately with the proposal, we just want to make sure we’re as close as we can get because I know it’s going to be impossible to predict some of these volumes. So that’s totally fair. But so how I would think about this, can you see get started faster on your screen? Yeah. Okay. So there’s kind of two elements that you saw here. There’s this core piece and there’s going to be the payer enrollments. So what core is made up of? Is there’s going to be like a number of providers that are already enrolled? So let’s say like enrolled providers, and what we do is we just house their information in the tool, which kind of that’s what that core seat is. But there’s also going to be like newly hired providers. So typically, when we’re working with customers, they’ll say, yep, we have let’s say 40 enrolled providers today, but over the course of the next year, we’ll be hiring like five providers. So just kind of stopping here. We have that 40 being that it sounds like that’s the enrolled providers, like how many new newly hired providers are you expecting in the next year?
Jgloe (17:45) I mean, that’s where, I mean we can just say we can pick a percentage and say we’re going to have 20 percent turnover or something. Okay?
Noah Laack-Veeder (17:53) That’s fine. So it’s 20 percent that’s like five providers you’d say?
Jgloe (17:57) Yeah. Okay.
Noah Laack-Veeder (17:58) So, yeah, good call. Newly hired or like churned. Yeah. And so then with the payor enrollments we don’t need to take into account this 40, it’s going to be a multiplication of the number of new or churned providers like just pretty much like providers who aren’t enrolled yet multiplied by the number of plans. So, you said it was like six to seven, right? Correct? I think I just heard you say that. Yeah. And I can, I’ll actually, it’d be helpful. I can just put them on here. So it’s do you want to say those again, it was, you said medicare?
Jgloe (18:41) Yeah. I mean, medicare medicaid? Yeah, I mean, the medicare’s yeah… your hmo plans, but usually when you do like your commercial products, you do the hmos with those. Yep. Yeah, blue cross Aetna. Cigna.
Jgloe (19:04) United. Yep.
Noah Laack-Veeder (19:13) Any other ones? I?
Jgloe (19:14) Mean medcost, possibly medcost? Yeah. So then that gives us what seven right there? Yeah.
Noah Laack-Veeder (19:23) Okay. So that sounds about right. So it sounds like we’re looking at and again, this is, I know we’re kind of getting in proposal world right now just kind of thinking about how many. So, it sounds like around 35 new enrollments a year. Yeah.
Jgloe (19:41) I mean, it could be that or I mean we might bring on a whole bunch of, I mean more apps or something like that. I mean, so, I mean, turnover, I mean, it’s just, it’s hard to predict but yeah, let’s just go with this with the.
Noah Laack-Veeder (19:56) That makes sense. Yep, that makes sense. So ultimately, we could even come up, with a range, right? But then kind of this is let’s say this is year one. Then usually year two, how organizations will tell us is like let’s just assume that we’re going to have like a growth rate of, I don’t know either equal to whatever year one was or maybe a little bit bigger. And so then it would be, you know, whatever the year one was, which is 45, right? For enrolled providers. And then another, you know, five to 10, year two. So then year two, we would be the similar, we just assume the same growth rate each year. It’ll still be about 35 new a year. And so when we’re thinking about the multi year piece there, then it sounds like we would need to have 35 being that continuous number year over year like directionally, does that sound about right? Just for now? Yeah.
Jgloe (20:59) I think that makes more sense because I mean, it’s not like you’re going to take the 45 existing providers and re enroll them with all seven of the payers again.
Noah Laack-Veeder (21:07) Exactly. Maybe in like three years, there could be a revalidation, some organizations. It’s just done. Yeah, I think last time, maybe something that we didn’t talk about as much was like, and maybe Alicia, I’m not sure if you could comment on this but the caqh management and quarterly attestations, is that something that your organization is having to do today?
Jgloe (21:29) We do it for a handful of providers for.
Noah Laack-Veeder (21:33) A handful. Do the other folks do it themselves?
Jgloe (21:40) I’m assuming the doctors are doing it. Okay? I mean, there’s not a lot of caqh that we have to do for enrollment. I think it’s one. That kind of sometimes you go in there sometimes and they ask for the caqh number. Sometimes they don’t.
Noah Laack-Veeder (21:55) yeah. Typically the commercial there’s some requirements around those quarterly attestations, but I think last time I heard that ultimately, the solution we want is your organization to be as hands off as possible and also make it. So the providers are as most hands off. So one thing that we didn’t include that I think could be a good idea would be that caqh management where from a hands off perspective, you’re like I don’t want to do this. I don’t want my providers to do it. Medallion would be able to do all of those on your behalf. Ultimately, it just prevents any issues happening downstream for payers that require caqh, which again, if caqh isn’t updated, a payer requires it, they could deny claims just from something like that. So I think it, unless you think there’s because again anchoring on that problem of just or the opportunity of being as hands off as possible. Is there a reason why you think we shouldn’t include a caqh management piece in the proposal?
Noah Laack-Veeder (23:03) I mean,
Jgloe (23:04) we can look at it but I mean it’s not an issue for us right now. I mean, there are like I said, some payers that sometimes ask for it, but most… of our, I mean what we’re trying to get done is just connecting a payer or the provider to our contract. You don’t even have to go through. You don’t have to go through a whole verification credentialing step for that being provider based on most plans. If we cross, you just go in and you fill out. I mean a web form and you’re done, but making sure that that’s done and followed up on that’s where we struggle. I’m just getting that initial application filled.
Noah Laack-Veeder (23:43) out. Yeah. And I think we’re aligned there. I think last time and maybe Alicia you said this, I think to your point, if, this process can be two things. One, it can be labor intensive. And then number two, if it’s done incorrectly, it can take a long time or it can lead to claims denials. And I guess just kind of anchoring back to the problem that we’re trying to solve. Is that, is that happening today? Are we having claims denials? Are we having long turnaround times or is it labor intensive? Is that, is that kind of, I just want to make sure I’m anchoring to the right problem. Is that, is that what you’re seeing the opportunity being?
Jgloe (24:24) Yeah. I mean that’s why we reached out?
Noah Laack-Veeder (24:26) And then, so with that being said, if you don’t know that’s totally fine. But do you kind of have a gauge into the number of claims denials from credentialing… today?
Jgloe (24:42) We could probably identify it. I mean our biggest line of business is medicare… and those are the easiest. I mean those are pretty simple. Those, I feel like we’re doing good already. It’s the commercial ones that we aren’t getting done 100 percent every time.
Noah Laack-Veeder (24:58) Just to.
Mike Manson (25:00) add context to that. Like the reason for those questions is, you know, when you’re looking at the.
Noah Laack-Veeder (25:06) Costs of.
Mike Manson (25:07) Our proposal, we’re trying to help build an Roi that makes it make sense. So if you’re going to Joni or you’re going up the chain on your side to ask for funding for this project, you know, I think we’ve identified where we can help, but it’s like, okay, medallion’s going to cost X amount of dollars, but we had 300,000 claims denials written off last year because of not, you know, bad follow up. That’s a lot different conversation. If you’re saying, hey, you know, cost of medallion is X, it’s going to save us a couple 100,000 dollars over the course of year one. That investment makes a lot of sense for the business. So, I think that’s just kind of why we’re asking these types of questions. Yeah. So.
Noah Laack-Veeder (25:56) With that said, I think you were mentioning that with the commercial pieces like the works not getting done, like what is the impact? Are we not able to bill for those providers? And like, do you have like a rough estimate of like the impact there? I mean.
Jgloe (26:10) Yeah. I mean, it turns into where they’re just out of network or they’re just not linked to us and they’re going to be processed as out of network or we can’t get paid for those hospitalist services. I mean, that’s what we’re looking at mainly is hospitalists?
Noah Laack-Veeder (26:23) Yeah, that makes sense.
Jgloe (26:25) And like our oncology, our medical oncologists at the provider based clinic. I mean, we’re not talking about any in office visits or anything like that, it’s just the inpatient setting and then the outpatient hospital setting.
Noah Laack-Veeder (26:43) That makes sense. So then if we just wanted to kind of estimate it, right? So should we just estimate that the new commercial enrollments without a solution like medallion or others wouldn’t be getting done?
Jgloe (27:02) I mean, it’s probably on a new provider. I’d say it’s probably 50 percent, 50 50 that it gets done versus not getting done or the initial application gets submitted and there’s just no follow up to make sure that it’s completed.
Noah Laack-Veeder (27:15) Got it. Okay. So then that would be around like… just trying to do some quick math. So it’s like, I mean.
Jgloe (27:23) Our main objective is to our Roi that we’re going to be looking at is how much would it cost for us to do this in house versus having someone else do it?
Jgloe (27:35) I mean, we… have denials, we have claims being delayed but with like medicare, you can post date it to when they started. Like I said, I mean that’s our biggest line of business on the inpatient side. So those are going to be the claims… that we eventually can get paid for as long as we get them out within the timely filing limits… but we’re just trying to get someone. I mean, in lots of the credentialing it’s not like you have. I mean it might be where you just have to resubmit a roster when the new provider’s adding to show your current roster of who you’re billing for. It’s not going through a whole credentialing caqh process. It’s just submitting a roster because lots of times on provider based your credentialing is accepted as the credentialing for the payer too.
Mike Manson (28:25) Yeah. I think a lot of the ways our customers have evaluated medallion in the past and it’s exactly what you just said. Jeff is looking at what it would cost to hire a team to do this in house versus partnering with us and letting us take it off your hands. I think there’s absolutely the benefit of speed and getting folks enrolled faster. There’s calculation you can do about, you know, if the average provider bills 1,500 dollars a day and we can get them into network 60 days faster. That’s 60 days of additional billing per provider, but then also like the opex piece. So I think, you know, based on the volume that we’re talking about it would based on what we know about our other customers, you’d probably have to go out and hire another one to two full time employees to staff this kind of volume which, you know, we see the average cost being around 60 K per enrollment specialist.
Jgloe (29:28) And what happens when someone’s gone and then the missed ones? I mean, that’s why we want to, that’s why we would like to basically outsource it and just have an admin person on our side.
Mike Manson (29:40) That’s exactly it. So, I think, I know we had talked about doing a demo today. I don’t think it shouldn’t be a long demo, but I think that’s a good transition. Maybe Noah just to show like this is what the workflow is. This is what would be required for the team at carteret because I think that’ll start to make sense, Jeff and Alisa for like, hey, it’s really, we think probably, you know, 20 hours a week if that on your side, if you were to partner with us and really it’s just, you know, hitting, you know?
Jgloe (30:14) Hitting submit on an enrollment application and then we do.
Noah Laack-Veeder (30:17) The rest of the work. Yeah, I’d love to do that. Maybe I could even kind of, yeah, let me just share my screen. I think I have a good idea of where, we should go and, we all have the full hour still correct. Yeah. Okay. Excellent. All right. Can you see requests on your screens? Another, another process map?
Noah Laack-Veeder (30:48) Can you all see this? I can. All right. So I just want to talk about kind of like if you did hire those individuals, like what the process typically looks like. And also I just love to get some insight if you, if this is similar to the process you are all doing today, but typically when we are working with organizations without a tech solution today, like this is how it works. They’ll have kind of an admin or HR or kind of Alicia someone else kind of just jumping into to help. There’s going to be a provider aspect to it. And there’s going to be a payer aspect to it. And kind of what the process typically looks like is that you’ll collect some preliminary data maybe through a form or spreadsheet et cetera. And then you’re going to be determining which group contracts to link that provider to. And that group info is sometimes mysterious. It’s kind of hard to find. And if you’re working with a new payer, you’re going to have to research payer requirements to figure out what it’s going to be needed to do this. And then you’ll start applications. If there are any gaps, you’ll have to one acknowledge those and find them as an organization. And if you do you’ll reach out to the provider in order to work with them to resolve them. And until those gaps are resolved, you won’t push the application forward. And then after that application is kind of put together, you’ll do a manual QA, and then you’ll submit it. So all of this is usually done by an fte. And if you can imagine like having a lot of these on your plate among other responsibilities like this work can really add up. And then from the provider side, they are kind of a bottleneck where they’re gonna have to keep helping you through this. And until the provider really helps get all this done, it’s gonna take time. So usually what we find is that this process to get applications out the door can take around 40 days at its worst. Organizations that have this more dialed in usually around 15 to 20 days. And then there’s the whole aspect of payer follow up. So as the payers are reviewing it, if they find the issues, they’ll email it to you typically to an inbox, then the person managing this would resolve the issue, try to follow up with payers. And they’re gonna also have to get status from the payer. So they’re gonna have to track that. And then if there are any resubmissions here, they’re gonna have to resubmit them. But ultimately, what you’re seeing here is that this is a pretty manual process pretty resource intensive. So just pausing here, is this pretty similar to the process that you all are following today or is it materially different than what you’re seeing here?
Jgloe (33:29) I don’t really know. I mean, I can go out to blue cross’s website, united’s health site, availability, fill out an a 55 R, I mean, in about 30 minutes and be done with it.
Noah Laack-Veeder (33:40) You said you’re doing that today?
Jgloe (33:42) I mean, if I were to, I’ve had to do it, I mean, and it doesn’t take 15 days to figure out how to do.
Noah Laack-Veeder (33:48) Yeah. And then would you, I guess, would you have to also collect the provider data? I?
Jgloe (33:55) Mean, we, it’s already done on the credentialing side, our hospital department that does that. Oh.
Noah Laack-Veeder (34:02) So the hospital department’s the one getting all the data?
Jgloe (34:05) Yeah. I mean, we have to credential them and privilege them. Sure?
Noah Laack-Veeder (34:08) What about, like, so the commercial payers, the ones that aren’t getting done, how would, how does the team do those today? Do you think it’s a process that’s different than this?
Jgloe (34:20) Yeah, completely. Like I just said, I mean, I can go out to the payer websites and get, I mean, those three that I have, I mean, our highest volume ones and get it all done in about half an hour. So that’s what we’re just wanting is someone to go out and do that part of it. So we said this new payer go out and fill out the forms on the websites and, or submit the roster if it’s a roster update. Sure. Yeah.
Noah Laack-Veeder (34:45) So, I guess with that being said, let me just show you what medallion would be for you all then. Yeah, it is pretty much that you would just tell us like, hey, I want a new payer enrollment for let’s say, dr, Michelle anderson for the group and do you have one tin or multiple tins that you’re currently doing just one? Just one? Okay. So you just have one here. You’d select that, tell us the state and then tell us which payer. So let’s say, I want to do cigna, just type it in here. It is. And then you select the line of businesses that you want, right? You can do all, do them all. And then you just tell us which practice locations. Are there multiple practice locations typically associated with these requests today?
Jgloe (35:24) No, like I said, it’s the hospital, so.
Noah Laack-Veeder (35:25) Just one usually. Okay. So then yeah, it would just be enroll all, just be one you click next and then that’s it for your team. You don’t have to do any of the work of populating the applications. You don’t have to do any of the QA. So I think in your process, you probably would also be doing a little bit of QA that’s happening. You probably know the outreach schedule for these different and all the requirements for these payers. But ultimately, for you, we’re handling all of the payer follow up automatically. And then you would just, and based on our averages whether it’s if it’s medicare. It’s gonna be pretty much immediate. But for commercial payers, we’re usually seeing end to end taking less than 50 days, you would just get notified when this is completed, and then you would be able to access the proof of enrollment to say this is all good. So ultimately this would be the process for, you click request. We do all of the work for you. And then we are also the differentiator with medallion is we are doing this in such scale. We do about 200,000 enrollments a year. So the turnaround times that we’re getting are best in class. And as Mike and garrison’s talked about, we’ve got contracted slas, that will guarantee that. So sounds like the solution you’re looking for is one where you just kind of tell us what you need and all that work is done. Is this matching kind of what your ideal solution looks like?
Jgloe (36:56) Yeah, I think so. I mean is there more even a, I know you had to select the different payers but is there just a option in there to say select all payers that we have set up in the system? So it’s even more sort of a one click type thing. Yeah.
Noah Laack-Veeder (37:11) Absolutely. Yeah, there’s a, I think just from this one, like you could let’s do this. Like if you select in your examples and it’s 110. You have those payers. Like I would do this since I don’t have any open here. Like there’s an option, a checkbox to enroll with every payer in this one. So you check one box and we’ll process the seven at once. So yeah, it’s truly two clicks. And then again, if you, one thing to kind of also think about is like if you do want to track status, we have all the status here. And also if you want to see enrollment status by these different locations, you only have one but just want to show you we track if you end up having multiple locations at any point, we have the status for at the location level as well. So automated tracking. The last thing too. If you do need to report this out to anybody and say, like, hey, how’s the operation going? We’ve got a dashboard kind of out of the box. Ultimately how this is used is saying, look, I have to give a status update about how our operation is going. I don’t have to pull this data. It’s already here. So you’ll be able to see like what the volumes look like, month to month. And then the most important metric like how long are these things taking end to end?
Noah Laack-Veeder (38:31) So, yeah. Anything else, that from your perspective, in terms of a solution you would need to see or think about for it to kind of match the use case you’re looking for?
Jgloe (38:44) I mean, I think that’s mainly it, I just want to make sure that like your proposal is showing what we really need it for. We don’t need it for the payer enrollment portion of it. We just need it for the linking of the already enrolled payer or already enrolled physician. I mean, there might be times when we have to enroll the physician, but like I said, most of the time it’s just filling out the web form, get it completed and it’s done, there’s no credentialing or anything like that needed.
Noah Laack-Veeder (39:17) Yeah. Typically, how we think about that like that initial contract is what we call a group enrollment. So having like the organization then enroll with the payer, and then the second piece is the provider link. So that activity. And just for terminology, we call payer enrollment payers, the same thing as what you might call linking the provider. So when we show you that it’s the same idea. So I think we’re aligned in terms of what the proposal needs to reflect there, it would really only be those provider linkages that you need, correct?
Mike Manson (39:53) And then it’s doing.
Jgloe (39:54) that the off chance that we do have to say it’s a brand new physician out of school or something like that. And we do have to go through some more of the credentialing side with the payer, like I said, typically, they don’t require it, but you never know, they could change the rules any time.
Mike Manson (40:11) Yeah. I think like one of the big value adds with going with us is that we’re handling all the required follow up, so not just completing the initial application, but then, you know, as, you know, there’s lots of follow up with the payer that needs to be done… in order to get that provider… and network, which is what we would take off your hands. Okay? Is that, that’s what? And correct me if I’m wrong, Jeff, but that was my understanding when we first started the conversations was where the problem was? It’s like, hey, we’ve got, you know, someone on staff that’s sort of doing this in house today. They have another full time position and they’re sort of doing this ad hoc and we’ve got, you know, lots of follow up that’s slipping through the cracks because it’s sort of being done manually and not a real structured process. And there were some issues with revenue leakage because of that. But correct me if I’m wrong. Is that what we’re looking to solve for? Yep? Okay. I had asked this to Alicia at the top of the call. I think before you joined, I know you’ve… got a lot of projects going on. It sounds like I know when we last spoke, you mentioned, hey, we’ve got an in house team that are doing the privileging and the medstaff credentialing, but I mean would it make sense to engage someone like Amali marsh in the conversation to look at this more end to end or what are your thoughts there?
Jgloe (41:50) No, not at this point.
Mike Manson (41:54) Can I ask why that is? I mean?
Jgloe (41:57) They’re already using there’s a new system and I mean, it’s a separate separation of duties. They do the other side and then they’ve never done the payer side of it. So we’re trying to do the payer side of it. I think.
Mike Manson (42:12) Where we’ve seen our customers be most successful is where they’re partnering end to end and it wouldn’t be us, they would still have, they would still have their duties to do. But are you saying they just brought in a brand new system to do that or?
Jgloe (42:27) Yeah, they, I mean, in the past year or so, they brought up a new system for that, but it didn’t do the payer side of it.
Garrison Goodman (42:34) So, yeah, it sounds like, hey, there’s some confirmation on the numbers that we just went through. You need to see a revised revision of that. I know that there was a few other projects that might have priority as well. Is this aligned for what you’re looking for? Are you jumping for joy there? Is this, you know, are you ready to move forward? Can you maybe help us understand how you’re feeling and thinking about how you’d like to go?
Jgloe (43:01) I mean, we’re ready to move forward whenever I just feel like we’re all over the place on what to… do the pricing and how to get the pricing to be reflective of what we’re going to actually utilize and accurate pricing.
Garrison Goodman (43:18) Okay. Well, it sounds like we had a few data corrections on our side, so we’ll get that corrected. We can probably do it today, assuming you get that corrected and you agree to the volumes, what would happen after that?
Jgloe (43:34) I mean, you’d send, I guess your msa… statement of work. Whatnot okay. I’ll say that we don’t sign long term contracts at our organization. We try and keep everything at a year… and then we have certain thresholds that if it’s over a certain amount that we then have to take to the board for approval, which then delays everything even more… because it’s nicer when you don’t have to explain to them what we’re trying to do and just be able to get everything approved as we need to.
Mike Manson (44:13) Do you have insight to what that threshold is?
Jgloe (44:16) That’s not, I mean super low, but I mean, I’ll tell you when you send your updated proposal, if it meets that threshold or not.
Garrison Goodman (44:27) Okay. We’ve got a minimum of 50 K. So we’ll structure it to, but I think you guys are going to be over that anyways, but, you know, is that going to be a blocker for you?
Jgloe (44:43) Like I said, I mean, it goes all in terms. So I mean if you had a 50… K for two years, it would have to go to the board. Okay?
Garrison Goodman (44:54) Okay. All right. Well, we can work on this here pretty shortly. And then, you know, it sounds like you, once we got that you agreed on the numbers, we’d get the documents over to, you would submit that up, that, the changes that go direct to finance. Are you going to have to present to them? What is the internal process there? Yeah.
Jgloe (45:16) We’ll take it to our internal finance.
Garrison Goodman (45:19) Committee. Okay. Do you expect any pushback? Are they expecting something coming along the way?
Jgloe (45:26) No, I don’t think so. I think, I mean something that’s been brought up and would go over good as long as I mean, it all makes sense and the software is going to do what we need it to do or the service is going to do what we need it to do. Okay? And then in terms of we all are going to be able to do it, it’s just coming to the right numbers and the providers and the enrollments. And then… like with a, like I said, the ongoing cost will be just to basically keep that provider in the database year… over year and then trying to add on the new ones, which is unknown. I mean, all of our credentialing for our medical group, where the majority of the physicians are, that’s done with our local staff. They have, I mean, we’ve taken over practices and they have that down. So that’s why we’re just looking at it on the hospital side. Yeah. Okay.
Garrison Goodman (46:23) We’ll get that over to you in terms of your internal process. How long do you expect that to take? And then when would you want to kick off implementation with us? That process? Is it too involved? There’s just going to be like some back and forth on aligning on data? And then, of course, you know, getting any existing provider data into the system as well. When would you like to work backwards from?
Jgloe (46:51) I feel like we can, I mean, if we get the project rolling, I mean, we can get the reports. And like you said, I mean, we’re going to have to load the data into your system from some export out of the current system we’re using probably to make it the easiest. I don’t think that would be too intensive to do.
Noah Laack-Veeder (47:09) Yeah. You’re right? I think we’re gonna be able to move really fast. Yeah, sorry, garrison you go forward. It’s.
Garrison Goodman (47:13) better coming from, you know, I was gonna say like it probably takes on average two to three weeks but it’s like a couple hours here and there that’s going. Yeah, just confirming things. So.
Noah Laack-Veeder (47:22) Maybe I mean just kind of working backwards like we can move as fast as you want to ultimately, I think given your structure and kind of given your availability to give us what we need. I mean, like that’s if we agreed on something in a month, we could get ready April first. So it’s like April first, a timeline that you’re shooting for being live like in your ideal state. Like when do you want to be live? Given it’s only going to take us about four weeks to get live?
Jgloe (47:55) I mean, yeah, the sooner the better, the sooner we can get it into a formal process and get off out of our hands with like you said, I mean, our payroll, the person that’s over our payroll is the one doing this now.
Jgloe (48:09) Yeah, I thought that people in payroll would be doing anything with payer credentialing or payer enrollment. So yeah, just trying to, we’re ready. It’s just to be getting that price and… feel like it should work?
Garrison Goodman (48:27) Okay. Well, we can, we’ll go, we’ll work on that today and then do you have, you know, 15 minutes, to run through the updated proposal tomorrow, or Friday?
Jgloe (48:46) Possibly it’d probably be good just to get a quick glimpse at it. And then you said maybe schedule 15 minutes, yep. So maybe when you shoot that overshoot some times over too and see what those if there’s any of those times work? Okay? All right. We’ll do.
Garrison Goodman (49:05) Anything else that you can think of that would be helpful for you, your internal conversations outside of, the updated contract?
Mike Manson (49:17) We’ll have the msa included in it as well. So you’ll have the terms, okay?
Jgloe (49:21) And I was going to just say we typically try and use our baa, so when you, I can send that to you all so you can review that we’ll.
Garrison Goodman (49:30) we’ll send over a snippet, but, we don’t typically need to sign one because there’s no.
Jgloe (49:36) There’s no patient information. Yeah.
Mike Manson (49:37) There’s no pa, no PII, phi, or,
Noah Laack-Veeder (49:40) phi.
Mike Manson (49:41) Phi, yeah, does.
Jgloe (49:42) That probably make that a little bit easier. Yeah.
Noah Laack-Veeder (49:44) Normally customers skip it because we don’t deal with phi. So, I think if you, if you don’t see a compelling reason, I’m.
Jgloe (49:54) trying to see, I mean, I don’t know like some of the pair of websites, I mean, like united, in order to do their enrollment, you have to go on to their website. Same with Aetna. You have to go on to availability and patient information is going to be in this portal in those portals. Yeah.
Noah Laack-Veeder (50:08) And I just say we, how many customers we work with Mike and garrison, is it like just over?
Garrison Goodman (50:13) 400?
Noah Laack-Veeder (50:14) Yeah. So, yeah, none of them are doing the beas, and they’re working with those just because of the, we just don’t deal with phi. So, I think it’s very, it’s an overall.
Garrison Goodman (50:21) Blurb so that you can pass that to your.
Jgloe (50:23) Internally, yeah, perfect. Which is.
Noah Laack-Veeder (50:27) Good for us in terms of speed.
Jgloe (50:28) Exactly. Yeah.
Garrison Goodman (50:32) Okay. Well, we have some work to do on our side. We’ll get things going and we’ll shoot that over to you. Cool. Thank you all.
Noah Laack-Veeder (50:39) Right time. Thank.
Garrison Goodman (50:40) You so much.
Jgloe (50:41) Thank you bye.