Transcript
Lewis Elder (00:00) hey, Sam. Hey.
Samantha Bouchard (00:01) Lewis, how’s it going? Oh, it’s going all right. Just so you know, I told Hasan, he didn’t have to join this one just to get him signed up. Yes.
Lewis Elder (00:08) I actually, I messaged him the exact same thing. I was like, hey, I had you added as optional, but feel free to skip.
Samantha Bouchard (00:16) Okay, cool. Okay. They.
Lewis Elder (00:18) Are in the waiting room, so I will let them in. Okay?
Lewis Elder (00:34) Hey, folks. I see the oak orchard team has joined. Can you all hear me?
Oak Orchard Team (00:45) Yes, we can.
Lewis Elder (00:47) Okay, perfect. Is this everyone in one room? I’m assuming, yes. Okay, very cool. Great. And that is, I think it from my side, I might have one additional colleague that’s hopping on kind of halfway through. She has a call that goes until the half hour, but are we waiting for anybody else from the oak orchard side or is this everybody? No?
Oak Orchard Team (01:14) No, we have everyone.
Lewis Elder (01:15) Okay, perfect. Well, thanks y’all for joining. I will get started with just some brief introductions. I know. So I’ve met Tasha and Taylor from the last call, but I’m excited to meet the additional members of the team and I will begin by introducing myself and my colleagues here. And then I’ll let the oak orchard folks introduce themselves. But good to meet and re, meet everyone. My name is Lewis. I work on the account team here at medallion, I’m based out of Pittsburgh, Pennsylvania. I think you guys are all in Rochester. And then I have Sam and Jake on the call as well. Sam is from our kind of our technical team and Jake is from our customer ops team. Sam, I’ll let you say hi and add in any additional, you know, info I may have missed. And then Jake, you can round us out.
Samantha Bouchard (02:03) Yeah. Hi, everybody. I missed you on the initial call that you had. I had my manager Hasan covering for me since I was out of office, but it’s nice to meet you all. I am Lewis’s counterpart from the product expert, technical solutions side of the house. So really here to kind of review the platform with you, answer any questions that you have and make sure that, you know, you’re all a good fit for our offering. So it’s really nice to meet you and looking forward to the demo today.
Oak Orchard Team (02:35) Nice to meet you too. Yeah.
Jake Shubert (02:37) Hey, team. Great to meet everybody. My name is Jake like Lewis mentioned, I’m on the customer ops team. I’m happy to help in any way I can on this call and learn more about oak orchard. And I’m based in Portland, Oregon.
Lewis Elder (02:48) Awesome. Thanks. And that’s it from our side. If the oak team wants to just run us through some quick intros, that would be great.
Oak Orchard Team (02:56) Sure. I’m Tasha, I’m the HR director here at oak orchard and we’re looking to combine to have a one unified system between HR and finance. And I am Taylor, I’m our senior HR generalist, I’m chetna Chatterjee I’m the state financial officer, I oversee finance and revenue cycle functions, and I’m Amanda Carter and I’m the revenue cycle manager and I’m working on credentialing right now. Perfect.
Lewis Elder (03:26) Is that everybody? Yep, that’s it. All right. Cool. I can’t see. So I’m flying a little blind. Sorry, no worries. No worries at all. Perfect. So, and I know, we have an hour scheduled. Does this time slot still work for everybody?
Oak Orchard Team (03:41) Yeah, yep. Okay. Perfect.
Lewis Elder (03:43) Awesome. So I have a quick kind of agenda and then you guys tell me, if this feels right?
Lewis Elder (03:50) Or if there’s anything else you want to add in. So what I’d like to do since we have some additional folks on the call that weren’t on last time is kind of restate the kind of the problems that oak orchard is running into, you know, what you guys are looking for in a solution, my understanding from talking to Tasha and Taylor was that when we think of kind of the two main functions which is like provider credentialing and, you know, payer enrollment that split amongst your two teams, I think it was HR handles kind of the credentialing and provider onboarding piece. And then the finance team handles the payer enrollment piece. Is that correct? Yes. Okay. So I’d like to kind of dig more into that, do some additional discovery work there. And then of course, we will kind of bridge that with a medallion overview for any of the folks that are new to the call and new to medallion as a concept. And then for about the second half of the call, Sam will walk us through kind of like a lightweight demo kind of show some of the insides of medallion, what it actually looks like? A bit of the product? And then from there, we can kind of assess and see if it makes sense to schedule any next steps. But does that sound about right as an agenda? Is there anything missing there that you guys want to make sure we cover?
Oak Orchard Team (05:03) This chat now. I would definitely want to learn more about what medallion does and which industries are you in and the state? And do you serve fqats and things like that? Absolutely?
Lewis Elder (05:18) Yeah, we will certainly cover that. We can spend a good amount of time on kind of, you know, who medallion is, what we do, type of customers that we serve. So maybe I’ll start with a very quick overview of who medallion is and what we do. And then I will kind of let the oak orchard team restate kind of what you guys are looking for. What brought you to the call. I know Tasha was the one who originally reached out and then we’ll use all of that context to kind of tell you more about medallion and color the way that we talk about, you know, ways we could potentially be a good fit. But at the highest level, medallion is essentially a company that helps provider groups automate everything in the provider lifecycle. So from provider onboarding, provider, data management, credentialing, your providers, enrolling them with different payers. We are like a tech enabled platform. So we have technology that handles the bulk of that work. And then we also have employees that work for us that do any of the kind of required manual processes. With the idea being that we can do it, you know, much faster than you would be able to do in house. You can have kind of a unified single pane of glass view of all of the work that you’re doing. And then, you know, reduce your need to as we do work with a number of fqhcs and other provider groups where they’re you know, you guys are experiencing growth, you’re trying to hire new providers and you’re kind of facing this decision of like do we hire additional people to handle this credentialing and pay enrollment work? Or do we look at like a software tool, like something like medallion? So that’s kind of what we do at the high level. Of course, we’ll get into further details. But just to, you know, set the table a little bit for you, chetna, and we can kind of discuss further.
Lewis Elder (07:06) But does that make sense? Just high level? Absolutely. Okay. Perfect. Then Tasha, I may kick it over to you and the team to what we heard last time. I can actually share. I’m going to share my screen. I put together just a quick slide… of kind of what we heard from the last call. So you guys tell me if this is if this is correct. So when we talked to Tasha and Taylor, you guys were not currently using any tools for your credentialing. Hey Louis.
Samantha Bouchard (07:46) Yes, I’m sorry. Do you want to put it into slideshow mode? It’s just a little hard to see.
Lewis Elder (07:51) Yes, thank you for that. Perfect. Thank you. Yes, absolutely. So you guys were not using anything. I think you’re just doing everything on spreadsheets, pen and paper, you know, physical folders in the office. You have about 170 current providers, you know, nurses, dentists today, that would need to be credentialed enrolled, looking to hire 10 doctors by the end of the year. Currently, you have about 15 job listings on the website between like RNS, NPS, dentists, and I think four, currently, four postings for different physicians. So I’ll pause. There. Is that a good kind of estimate of the current state? Yes?
Oak Orchard Team (08:30) From the HR side, yes. As the finance side, you guys don’t have software right now, right? Oh, no, from, no, there’s no software we are using like some spreadsheets to manage this.
Lewis Elder (08:41) Okay. Got it. Okay. Awesome. And I’d love to hear if, whether it’s you, chetna or anyone else on the finance side, we talked with Tasha and Taylor a bit about what the credentialing piece looks like for them. You know, I’d love to hear more about what does the, because you guys are handling the payer enrollment, what does that process look like for you guys today?
Lewis Elder (09:01) Or like, you know, what’s working well? What’s not working well? You know, what makes you interested in evaluating a solution generally? Yeah.
Oak Orchard Team (09:09) I can start and then Amanda can pitch in. I think what, what’s happening right now? It’s a, it’s a manual process and based on communication between the teams. So once the provider’s hired and the information center were to finance has say about 15 to 20 payers for each area, each type each line of business, we have medical providers, behavioral health, dental optical. So typically, we are very regularly hiring the three lines BH, behavioral health, dental and medical. And that is a very manual process. We have to fill in 15 to 20 forms. We have to email those payers. We have to go into their, sometimes their dashboards sorry their platforms and then fill in information. And then of course, we have the caqh. So all of that takes, you know, we do take at least one week or two weeks to put in all the information and then it takes the payers side. It all depends on where they are in terms of approval timeline. So they have meetings and all that. It’s kind of not in our control. But then if we can cut the front end of it and the information goes in to the payer faster, then they could get it in their system faster for approval. So that’s where we are right now, Amanda, anything else? Yeah, that’s what chetna said, pretty much covered it, you know, and then sometimes you’re chasing down any additional documents that you may need or any other signatures that you may need. And I feel like that just kind of, you know, puts things like at a standstill as well or waiting to hear back from payers, you know, emailing them. And then, you know, three weeks later they email you back that you need additional information or you didn’t cross the T or, you know, something simple and you’re kind of starting all over again too.
Lewis Elder (11:08) Right. That makes sense and rings true to what that process that’s kind of why, how big of a pain in the butt that process is pretty much exactly why like medallion was founded as a company. And, you know, why we can exist and have success in the space. You may not track this. But I’m going to ask just because I’m curious if you do know or have an estimate. Do you know it takes you said about one to two weeks to gather that info?
Lewis Elder (11:32) Do you know about? And obviously the timeline is payer dependent, but do you know about how long it takes from when you submit to when the providers become billable? We typically see groups when they’re doing it themselves. It can take like 90 to 120 days like that’s like the average range. But I don’t know if that, you know, feels right to you guys. Yeah.
Oak Orchard Team (11:53) That does, it can definitely take up to 120 days. Got it. Okay. Some of the payers could be, we, since we work with them and they are like our larger payers, it may be that we can call them and say, can you please make that faster?
Oak Orchard Team (12:07) And they do it in three, four weeks or depending on where the meetings are, they, we could just quickly get them done or if they provide us all the credentials at them. It’s just a matter of transferring. So there could be different situations, but of course, medicaid is not in our control. That’s the longest that’s the six month process right now. Yeah, it definitely depends on if they’ve ever been credentialed anywhere else, you know. So it depends if you’re doing like a brand new credentialing form which might be like four or five pages versus maybe just a quick link letter that you can do in, you know, four minutes or so. Got it. Yeah, I.
Samantha Bouchard (12:46) just had a question Lewis that’s really helpful information just how long it’s kind of taking you all to get those applications out the door. Excuse me, what about the initial data collection for providers? Like I know some of this is going to Tasha and Taylor’s team to do like the, on the credentialing but then all that data then gets passed to you and there could be gaps like if we had to look at just from a time you’re going to bring on a provider till when you have everything you need, what’s that time frame looking like?
Oak Orchard Team (13:21) So, it’s so hit or miss. I mean, I’m sure you guys know, I mean, in my experience, it can take a while for providers to get their paperwork to us. So that’s really, that is a big hang up on our end. And then oftentimes with that, it kind of stalls when the payer side can start their process. So it’s very, it’s hard to say some providers are great. Some providers, they take forever and you have to consistently follow up. So, I mean, it can sometimes take a few weeks to get everything we need on our side. Yeah.
Samantha Bouchard (13:58) That’s what we typically hear like sometimes like two weeks for like the perfect provider up to 30 days or more. Does that sound like it resonates?
Oak Orchard Team (14:09) Yes, it does.
Samantha Bouchard (14:12) Perfect.
Lewis Elder (14:13) Sorry, I actually have one quick question as well.
Jake Shubert (14:16) Chetna. If I heard correctly, it sounds like you guys are dealing with caqh quite frequently. Are you guys managing the caqh profiles on your provider’s behalf? Just wanted to kind of learn more about the caqh process?
Oak Orchard Team (14:28) Yes.
Samantha Bouchard (14:30) So, yes, we’re managing it.
Oak Orchard Team (14:32) Yes. So, yeah, they would start their initial caqh, and then we would go in and update everything, you know, take out any past employers, any past credentialing information, any past, like insurance information, and then we would update with all of our current staff. But that even sometimes is at a standstill too. Because if there’s missing stuff that the provider needs to do or waiting, you know, to get the okay from them to delete information, you know, we don’t know if they’re still working anywhere. So we don’t want to go ahead and delete anything off. If they’re also working at any other facilities or anything too. So.
Jake Shubert (15:12) Yeah, that makes perfect sense. Thank you. Got it. And.
Samantha Bouchard (15:15) Those attestations. The quarterly attestations, are you maintaining those for them once they’re part of your organization? Yes, great. Awesome. Thank you. Is.
Oak Orchard Team (15:28) That, can I ask you? Is that normal? What you see? I mean, I’ve seen that in other organizations, I always wondered how they let us do it on their behalf, but I have seen that in other organizations. So I don’t know from compliance perspective or anything. But it’s basically, they, we, when we signed the contract with them, they gave us the permission to do it. Yeah, yeah, yeah, yeah.
Samantha Bouchard (15:54) Chetna. We see it honestly across the board where it’s such a barrier to the enrollment piece. I mean, it’s honestly something that your team really must take on or that you’re looking at really ballooning out these timelines even more. So we do see it frequently. And when we get into the demo, one of the things we can talk about is we do offer we have a bi directional connection with caqh and so we’re able to pull data down and also update data directly in caqh so that medallion can really be the source of truth and that we can take some of that burden of the attestations and data updates off of your team. So when we get into the demo, we can certainly dive into that as I think that service would be extremely valuable for you all.
Lewis Elder (16:42) Thanks, Sam. Another piece that I would like to talk a little bit about and we covered this a bit with Tasha and Taylor is kind of the typically the way that we think about, you know, when a group is evaluating medallion, it’s kind of looking at the current state like and then it becomes a couple of questions. It’s like, you know, what is your reason for doing anything for, you know, changing from the status quo? And then of course, the second part of that is like, you know, what is the potential reason for using medallion is a medallion, a good fit? So yeah, talking about kind of the former, there of, you know, why do anything, why change from the process that you guys have today? This is kind of the few bullet points that I put together from the first call. I’ll kind of run through these. And then I’d be really interested to hear since we have some of, we have both sides of the house on the call. You know, if, you know, where really the driving force is on your side. So, Tasha mentioned that, you know, at this point, you guys are getting to a point where you have almost like, I don’t know if you actually do, we’re getting to this point of having a waiting list of more patients and providers. I know you have growth goals this year to hire, at least, you know, 10 or so physicians. And then like an unknown number of, you know, RNS, NPS, dentists, behavioral health technicians, and you’re looking to onboard those providers faster and of course, risk potentially some of that growth with the slow provider onboarding turnaround times. Tasha mentioned that there was about, you know, one point 9,000,000 or so in past due bills. I.
Oak Orchard Team (18:14) Don’t know if that number is right? No, that’s not right. That’s a total receivable is that number. And if you’re thinking of credentialing related, that could be four to 500,000 perfect.
Lewis Elder (18:28) That was actually, we, Sam and I chatted about this before the call and we wanted to ask because what portion of that is actually due to, you know, credentialing and payer enrollment? And so you’re estimating that, you know, it’s about four to 500 K that is directly tied to, you know, delays in credentialing and payer enrollment, right?
Oak Orchard Team (18:50) And most of it, so, the reason they, you know, what has happened in the past is because we’re an fqat and we get the wraparound payment and we are eligible to submit to medicaid for, you know, medicaid covers it basically. But a lot of our receivables due to credentialing delays, get a 40 28. Is that section under which we can bill them. So we don’t lose it, but it’s a delay. It’s not a good. What’s actually interfering with the process is that the providers can’t start seeing patients?
Lewis Elder (19:25) Exactly.
Oak Orchard Team (19:26) That is the biggest thing the revenue piece is actually taken care of. So even when they see it and then they’re not credentials somewhere, we will get the money paid. Somehow. We will get it paid. But what will happen in that one to two months is that the patients are getting letters from their insurance companies. Your provider is not credentialed. So why are they seeing you? We will not cover all that. Patients get frustrated. What are you doing? So that is the biggest part in this. The delay causes that patient experience. I would put that on there in y now and you can say in one point 9,000,000, you can say four to 500,000 is the prevention related and patient experience is the big one.
Lewis Elder (20:15) Got it. Yeah. Got it. That’s helpful and makes sense. And to give you kind of some additional context, we medallion is typically a good fit for groups that want to, do, you know, one of three things or a combination or all of three things. So what we help groups do is essentially accelerate revenue. So get your providers billable faster. So it’s kind of two use cases there. It’s like are you missing out on revenue or if you’re able to backdate it’s? You know, are, you know, having to wait three, four, six months for that billable revenue? So our kind of first goal is to accelerate that revenue by getting your providers billable. Now, the second is, you know, helping with your either reducing your opex expenditure or helping keep it flat. So obviously, you guys are at a kind of a inflection point where you’re thinking about, you know, do we need to hire additional people to solve this problem? And what medallion is a good fit for is companies that would rather solve it with software and, you know, not have to throw, you know, a ton of opex expenditure at it. And the third is like you just mentioned kind of reducing patient and provider abrasion. So getting your providers enrolled faster billable faster both to improve their experience. Then of course, like, you know, to improve the patient experience, so they aren’t having to wait for the providers to become billable. And so you don’t have a bunch of providers sitting on the bench, you know, waiting to be able to treat, but that’s really helpful. Chanda. Please. If there’s any other, you know, information there that comes up, please shout it out. And then the other thing that we talked about was obviously manual processes. I’m sure it’s a ton of work for you guys right now. I wanted to talk about claim denials or do you, is that a issue that you’re running into at all with a like I don’t know if you have a, yeah.
Oak Orchard Team (21:57) Yeah, you could lump that, but that has to be built because that’s where the receivables… are because of those denials because the providers are not enrolled with the payers? So that’s where we would get the denials but that’s together. Got it.
Lewis Elder (22:17) Makes sense. Do you have a sense for like what percentage of claims that you submit get denied?
Oak Orchard Team (22:23) I mean, any provider that’s not credentialed will get denied.
Oak Orchard Team (22:26) So, I would say that for 600,000, whatever, four to 500,000 dollars of that receivable is related to that. In terms of numbers. I would say how many new providers are right now, we have one, two, three four, hang on Maine, wise bell, sesame sheik. And now, so come Monday, we’ll have six new providers. Oh, wow. So, and like some of them have been credentialed with some payers thus far, and some of them are still pending.
Lewis Elder (23:09) Okay. Makes sense. How?
Oak Orchard Team (23:12) Are you, I had a new provider who started two months ago, who’s still pending on some payers? Yeah. Got.
Samantha Bouchard (23:17) It. Yeah. And, how does that work? Like, are they getting their, you know, salary even if they maybe have time that they aren’t seeing patients because of the credential? Yes, they would still get their salary, yes.
Oak Orchard Team (23:31) Okay. And then, sorry, there’s a ramp up period anyway that we plan for? Yes. Yeah. Okay. Yeah.
Samantha Bouchard (23:39) And then from like a scheduling perspective, how are the schedulers getting information to know? Okay, dr smith just started, he’s par for these payers. And then, you know, next week these payers come in like how are you all communicating that with the scheduling team?
Oak Orchard Team (24:02) That’s a good question. Yeah, we’ll have to get back to you on that. Yeah.
Samantha Bouchard (24:06) Okay. Yeah. Well, one of the things we’ll highlight in the demo too is just how, you know, we have unlimited number of administrative seats. And so we do have like a par status tab where anybody could kind of have access to that and what a lot of our clients will do is if you have a scheduling system, you can easily like export that data either through a file or through our API into the scheduling system just to really streamline like that overall process too. So we’ll definitely touch on that.
Oak Orchard Team (24:38) I know we have an excel sheet which has all the providers’ names, and then like all of the payers, and then if it’s pending or if they’re credentialed? So, just recently, the office managers just had access to that, but anything else as far as scheduling?
Lewis Elder (24:57) Okay. Awesome. That makes sense. So what it sounds like it’s the provider and patient abrasion, that is maybe the biggest driver for looking at, you know, changing the status quo? Is there anything else right now? That is just like, I don’t know. I’m just interested from, you know, qualitatively from your side, what’s driving the need to make a change, right?
Oak Orchard Team (25:24) As far as the HR side, like I can only hire so many HR people, the credential, and we have a lot of movement and a lot of growth happening. And when you, there’s so much happening at once, you’re just mistakes are going to happen even when you’re trying your hardest. If we can automate a lot of this. And also, we want to make it an easier transition for providers coming on because we’re we see that we’re asking a lot of duplicate information versus if it, we can all go to the same platform, then we can see who’s done what. And then we’re not asking the same information over and over.
Jake Shubert (25:58) Yep. And, and on the HR side, how many folks would you guys have to hire to be able to support the growth the organization’s going to be able, to achieve here soon, right?
Oak Orchard Team (26:08) Now, I have a minimum of 10 providers, and that’s just doctors, And how.
Jake Shubert (26:13) many people to manage the credentialing workload? Would you need to hire?
Oak Orchard Team (26:17) I haven’t even figured out that number yet. Yeah.
Jake Shubert (26:20) But just curious. Yeah. And then, I’m also sort of curious from the provider experience that you just mentioned kind of like duplicate questions documentation, what is the onboarding experience for providers? Like right now? Like are they having to email, text, receive, phone calls, send all the documents? Like, have you guys gotten any feedback about sort of the provider onboarding experience from their pov?
Oak Orchard Team (26:42) So we actually recently made it. So all of our credentialing forms are through. So we use paylocity for our onboarding system.
Lewis Elder (26:51) Great. So.
Oak Orchard Team (26:53) We actually just created. So all our credentialing forms that they normally have to fill out. Instead of emailing them, we added them electronically into paylocity since they’re already filling out like other onboarding forms for HR? So we did it so that’s a little bit easier so far. I actually haven’t heard any complaints about that and they like it. But it’s still a lot of back and forth, the emailing back and forth between HR and finance for payer enrollment. So we’re just trying to minimize that as much as possible.
Jake Shubert (27:22) Yeah, 100 percent that’s really helpful. Awesome.
Lewis Elder (27:27) The, the only other part here and this will kind of bridge into I’m going to talk some about, you know, how we do, what we do under the hood. But before I do, are there any questions so far from, the oak orchard side or anything that we haven’t covered that we should know any problems that you guys are running into or things you’re really hoping to solve for or wondering if, you know, medallion has a, you know, solution for it?
Oak Orchard Team (27:50) No, not yet. No correct.
Lewis Elder (27:52) Sure. Then the other part of the question, like I said, it’s kind of like looking at the current state, thinking about, you know, why do anything, why make a change at all? And then it’s kind of like, you know, why use medallion specifically? And what really what medallion will enable you guys to do is do an unlimited number of providers, credentialing enrollments onboarding, that can be supported by just one full time person. So whether that is like, you know, Tasha takes it over, Taylor takes it over. Somebody on, the finance team takes it over instead of managing all of the workflows you’re you know, across two different teams and hiring, you can just have one person manage medallion. And we’ll of course, get into more detail as to like how that would look and how you would do that. So you can, you know, get a better sense for how we make that possible. We also, one of the things that I think will be really relevant for you guys especially given your current state is like, our typical turnaround times for both like provider onboarding and payer enrollment like our, you know, getting a committee ready credentialing file. We’re able to like onboard a provider in typically like a few days as opposed to a month. And we can get, a committee ready credentialing file in our average is like one day we SLA it to, I believe it’s gut check me here, Sam and Jake, I believe we SLA it to three days for a committee ready credentialing file. And we often see that lead to significant like revenue acceleration by getting your providers to par faster. We also, you know, reduce, the error rate, et cetera. And, and reduce for claim denials and eliminate the need for you guys to go out and hire and train a bunch of new employees which obviously comes up with its own set of not only like actual costs but then that’s a burden on Tasha and the team who then have to train them onboard them. And there’s going to be a lag between when somebody’s hired and when they’re you know, fully ramped and able to, you know, work at the speed that you need them to work. So, I’ll keep moving on. Let me know if any questions. So like I mentioned, this is everything that medallion does. So we do provider data management, monitoring, payer, enrollments, delegated payer, enrollments, credentialing, privileging, licensing. I know Tasha and Taylor, I think you guys did mention on the first call that you guys do like privileging to hospitals or hospital applications. Can you tell me a little bit more about that? Is that something you’re interested in like looking?
Oak Orchard Team (30:15) At, yes, we would definitely need that. Okay, I don’t know our current process to be honest with you, but I know we would need that.
Lewis Elder (30:23) Is that a different team that handles that?
Samantha Bouchard (30:27) Technically?
Oak Orchard Team (30:27) No, right now, we have our credentialing specialist in HR. She was not able to be in this meeting but she typically handles the HR credentialing onboarding and privileging on our team. Got it. What is involved in your privileging services? Can you give a little quick?
Samantha Bouchard (30:47) Yeah. So we have, there’s two sides to it. Chetna. We have hospital application support. So like starting like the pif, the provider identification form with your partners, we’d load all your entities into the system and then really follow whatever process they have for accepting that provider application. If it’s you know, a secure link, a portal, a form, we can support that. And then we’d follow up with your partners until those privileges are granted and store that information. We also have the ability to run a joint commission accredited file. So, it sounded to me like with your onboarding process, that initial file that you’re running just for being a fqhc, is that an ncqa standards or hrsa standards? You’re not running any like peer references or work history checks with that, right?
Oak Orchard Team (31:43) Yeah, probably not.
Samantha Bouchard (31:45) You do both. Yeah. Okay. Yeah, that’s helpful to know. And then just yeah, so we can definitely, I don’t know if we’ll have time to demo the privileging offering today, but we can definitely schedule a second one for that. I did have just one question before we get into the demo. Have you all considered any delegated agreements for your, yes for your payer contracts?
Oak Orchard Team (32:14) Yes, we have, and I think this was prior to my time here two years before the CFO had started the work on that delegated credentialing and I think there was there’s not too much information as to what would help us in terms of reimbursements. I believe the reimbursements are different. Also, we are on a capitated model with one of our largest payers, so that I’m not sure. But these are the words that are coming to my mind. That was the reason we couldn’t really pursue that. But if you have a department that could help us with making decisions, that would be wonderful. Yeah.
Samantha Bouchard (32:56) So, we are an ncqa accredited cvo, which means we can be your subdelegate if you are able to obtain delegated agreements. And the big value there chetna is you go from this 90 to 120 day turnaround time to one to three days with medallion to really increase that revenue. So that’s helpful to know that that’s something that you’re interested in. I think Louis and I can just note that down and we can spend some more time on it. But just for today, my focus for the demo is we’re just going to look at medallion core which is our provider data management platform. Then we’ll look at how you all would create your onboarding credentialing file, what that committee structure looks like, what the ongoing monitoring piece looks like with that? And if we have time, we’ll also get into the payer enrollment piece. So that’s what I was kind of planning on covering today, if that sounds good for everybody.
Oak Orchard Team (33:54) Perfect. Sure. Perfect. Awesome.
Lewis Elder (33:57) And Sam, as you pull that up, I just want to show just a couple, I’ll spend like one minute as Sam gets that pulled up, just talking about some of our… kind of our averages and I can send this material to you guys after. But just so you have a sense and Sam will probably touch on this through the demo. But I think these especially considering your current state, these will be like market improvements. We have like a one day average for an ncqa committee ready file with a three day guarantee, a five day guarantee for a joint commission ready file five day average to submit applications to payers with a 10 day guarantee and a 99 point five percent credentialing file accuracy rate to really reduce that claim denial piece. If there’s you know, if they’re ever getting denied because of like errors. And then the last thing that I’ll show and then I’ll fully hand it off to Sam for the demo. This is kind of the way that we think about things. So this is, these are not like specific numbers to you guys, but we think about it in terms of like if medallion is a good fit for a group, it’s like, can we accelerate enough revenue and make it have a significant enough financial impact on your business for it to make sense for you guys to spend money on something like a medallion? So when we look at like the industry average, so, you know, submission to par status, like I said before, it’s like industry average is between like 90 to 120 days. So just benching it in between is at 105. Our average from submission to par is 52, which creates an additional 53 days of billable days. The industry average for provider onboarding is about 14 days. I think it’s like you guys mentioned, it could take up to like a month or more in your current workflow that we can significantly truncate as well. With the average for us being two days creating an additional, you know, 12 days of billable days. And then you just kind of break that down into, you know, 60 you know, 53 plus 12 is 65 additional billable days with medallion. If you’re estimating an average revenue by a provider to generate in a day of a 1,000. Then you’re looking at, you know, 65,000 dollars of, you know, either additional revenue or accelerated revenue.
Lewis Elder (36:06) And then, you know, multiply that across 10 providers. So just to give you a sense of kind of the way that we think about quantifying the problem and we can of course, work with you guys to come up with some, you know, specific inputs for you all to kind of estimate the impact that medallion could have. But I’ll pause there and kind of let Sam go into some of the platform overview and demo. Any questions before we do that, did you?
Oak Orchard Team (36:33) Talk about your clients and the type of industry you serve. Yeah?
Lewis Elder (36:36) Yeah, absolutely. I can spend a minute on that and then that’ll be a good bridge. This would be a good slide for that. So, we work with all types of groups. So we work with, you know, provider organizations, telehealth, groups, hospital systems, payers, themselves, any healthcare organization that has a need to enroll in credential providers. So, and I can send over. We have like a case study page that I can send over. So it could be anything from, you know, like a, you know, orthopedic specialty network to a primary care network to, you know, a large healthcare health system like Tampa, general payers, et cetera.
Oak Orchard Team (37:14) Okay. Yeah. Awesome. Sorry, New York state and fqat. Yep.
Lewis Elder (37:21) Yeah, we definitely. Yeah, we work in all 50 states. We work with over 900 payers. I actually gave. Yeah. So like, yeah, we’re totally agnostic there. We can certainly work with any of your local payers in New York. Okay. That’s good, cool. I’ll stop sharing and pass things over to Sam.
Oak Orchard Team (37:42) Yes.
Samantha Bouchard (37:43) Thanks, Lewis. Can everybody see my screen? Yes. Okay, great. So what you’re seeing here just is the, this is the administrator view… that you would all have access to. We have unlimited administrator seats. But essentially, this is our core offering. So our core offering is really made up of a really easy to use data architecture that allows you to store your providers, your practices, your groups, all the information needed for payer enrollment in a really easy to access fashion. So you have like all your tins here. You have the practices associated with those tins. You have all of your practice locations. And then you’re able to actually see the providers that roll up to those locations as well. And all of this is, can be reported on with a couple clicks. But essentially, you know, this data architecture as you all know, like the data is the key foundation to being able to do these downstream functions. And so we are like purposely built to collect data very easily and then be able to use our technology to… decrease the amount of time it takes to populate these applications to produce a credentialing file, ultimately getting this information out the door quicker, which is going to accelerate revenue for your team. So what I want to start with… and what I want to focus on in the demo today, excuse me, I’m like getting over like the cold of the century is… how we accelerate the onboarding process. So we heard a lot of the challenges from you all today that you’re experiencing today. So I really want to show you how we simplify that, how we use our AI and automation to process payer enrollment and credit applications quicker and with less errors due to the checks we’re able to do behind the scenes. And then how we give you visibility each step of the way through our metrics reporting to really allow you to plan your business operations like the scheduling component, like the billing component chetna that you’re dealing with today and then ultimately capture that accelerated revenue. So I want this to be conversational. If you all have any questions at all, please feel free to jump in. But we’re going to walk through this essentially as if you all have a new provider that’s starting. So it sounds like today that, that’s kind of starting in paylocity. We can certainly have an integration with paylocity that this information comes here or you could consider switching to this as the starting point for the credentialing and enrollment piece. But we’ll definitely dig through that a little bit more. So your provider’s hired, you’re going to enter five pieces of information about the provider and they are going to be sent a welcome email. We are able to update this email with your logo with your onboarding language, really clearly identifying exactly what they need to complete and by when, so that your team can be most effective with their operations. And then from here, we take them, the providers through a customized onboarding flow. So we’re able to kickstart their profile in a couple of different ways. I’ll go from like the least preferred to the most preferred. They can manually fill out a profile or you as administrators can do that on their behalf. We definitely want to avoid that. You can upload a resume which we have OCR technology. So, if you’ve ever used turbotax where you like scan your W ii and then it just goes into all the right places that’s what that technology does with a resume. But our most preferred method is to get the data directly from caqh through our proprietary integration. And one thing that’s different about this integration than some of our competitors is that we don’t require username and password. So, all of you who have had to capture this information from providers, know that if the username and password was set from like another administrator and then it needs to get reset, it can just be a huge headache and very time consuming for providers to get that information. But typically the caqh ids coming across like in their headers or their emails, it’s pretty simple for them to find. And so with just caqh id, social security number, and last name, those three data points, we’re able to connect with caqh and import 70 percent of the data needed for our profiles. So I’ll pause there. Just want to check. And I’m not sure if this would be an Amanda or a Taylor question, but is this information that you all, you know, are, have easily accessible at the time that the providers are coming on board?
Oak Orchard Team (42:45) The caqh id? Yes. Typically, they’re able to provide the id, the username and password. That is always a struggle, but.
Samantha Bouchard (42:55) They won’t need that. Yeah.
Oak Orchard Team (42:56) Yeah. As far as this information, we typically can get this pretty easily, okay?
Samantha Bouchard (43:02) That’s great to hear and that’s you know, typically what we find so, with those three pieces of information, what’s going to happen is we’re going to pre populate their profile with all that information from caqh. So, right out of the gate, I’m sure you all can see just like the time savings that you’re experiencing from having to go into caqh, update that information, kind of put it into all of these, pay your applications into all of these portals, right? So we’re going to collect all of this information once and then we’re going to utilize it for all of those downstream functions. So this is what the provider portal view looks like. I just like to show this so you can kind of get a sense of like what your providers would have visibility into. So if they have any tasks. So Amanda I heard you mention like if additional documentations is needed, if there’s a wet signature required, right? A lot of that can be really hard to track. These tasks are going to be surfaced here so that the provider has visibility into what’s outstanding. But then on our administrative page that we’ll go back to you’re, also going to have visibility into what’s outstanding. So no more kind of like trying to track this in spreadsheets or in emails.
Oak Orchard Team (44:14) I do have a quick question. Yeah, Lewis, I believe you brought this up last time when me and Tasha spoke if we require wet signatures for anything you said that you guys send that out? Am I correct on that? Yeah.
Lewis Elder (44:29) The example that is kind of notorious is it’s New York. I don’t remember if it’s medicare medicaid or both. But I know that they require like a blue ink signature notarized and what medallion can do is go ahead sorry.
Oak Orchard Team (44:42) Yeah, it’s medicaid.
Lewis Elder (44:43) Yeah, medicaid. So, one of the ways that, you know, in addition to like we said, we automate everything that we can, but where there needs to be like manual human intervention, we’re experts in the space. So we intervene there. So what we will actually do is we will send a notarized form with we will actually send the blue pen as well and return postage to the provider. So all they have to do is sign it and then just put it in an envelope, put the return postage on it and then drop it in the mail.
Oak Orchard Team (45:10) Okay, perfect. Thank you. I also have a question though about the caqh. So if they enter in all their information, like they enter in their caqh id, who is going to go in and update their caqh? Is that going to be on us? Is that going to be you guys? Is that going back on the provider, like just to make sure that oak orchard is now on there with all of the right information, the locations, the liability insurance, and to take off all of their old employer? Yeah.
Samantha Bouchard (45:44) That’s a great question and a great segue into our caqh management offering. So what we really want is medallion to be your source of truth. So as you’re adding, you know, and linking them to like all the oak orchard practices and groups… that should be done once. And then what we do is with our bidirectional connection with caqh, we would go in and update all of that information directly. So we’re getting a similar Chet and I heard you have like permission to do that. We’re getting similar attestations from the providers as well like giving us the permission to do that information to do those updates. And so we would also take over your quarterly attestations for your providers. And then, you know, as you know, where this really comes in is as you’re submitting a payer enrollment application, all the information that’s on that application has to match in caqh, or that’s going to be an automated request, it’s an automatic rejection. And so we’re also making sure that the parity is there before submitting that application as well to ensure that we are not going to get a denial for anything that is not matching.
Oak Orchard Team (46:55) Okay. So when a provider starts, you would handle their initial caqh as far as updating with all the oak orchard stuff and taking off all the old information. Yeah, exactly.
Samantha Bouchard (47:08) Awesome. So this is really the provider profile. We also do have a mobile view here which just kind of enables the providers to quickly sign the attestations from their phone. So, just another way that we’re trying to really streamline this for providers overall and reduce kind of the headache and the back and forth. One section, I’ll just kind of talk about because… we did talk a lot about just like the documents and like requesting additional documents. So, this is a document store. So, all these documents that are in caqh are going to pull here. And then similarly, we would store like your malpractice insurance which would get updated in caqh. But if you need another document from a provider, what they can do is scan this QR Code, scan the document and it’s automatically going to pull in. So, just reducing that overall email back and forth, things getting lost challenges, we really designed this in a meaningful way to help the provider experience, which sounds like it’s also very important to oak orchard. And then to do this faster. So, we heard from you all this can take, you know, 14 days for like the provider of the year, 30 days more if they’re you know, doing what providers do, which is hopefully seeing patients and not dealing with all of this administrative stuff. We have found that with this technology that we’ve put in place, we’re able to reduce the onboarding time to an average of two days. So that would be a pretty significant improvement for you all, you know, in addition to the overall administrator experience as well as your provider experience… curious to hear like how this compares to like what you’re doing today, if you all have any thoughts on what we just kind of went through?
Oak Orchard Team (49:09) I mean, it looks like it’s pretty user friendly and… yeah.
Oak Orchard Team (49:18) I’ve.
Samantha Bouchard (49:19) actually talked to, so I came over from our implementation team into solution consulting and I got the pleasure of like talking to a couple of different providers over the course of that time. And one of my first questions is like what was the onboarding experience like? And he’s like from the millions of these that I’ve filled out, you know, this one, was the was much easier and like much more user friendly. So we definitely do hear that. And so I think, you know, hearing it from the provider’s mouth is always, the, you know, best way to get that information, too. Awesome. Well now I want to transition to the next phase in the process which is your hrsa cred file. So how just curious for the peer references and the work history. How far back are you all checking for that?
Oak Orchard Team (50:14) Your references? I am not 100 percent sure honestly.
Samantha Bouchard (50:19) Okay. That’s fine. Sometimes it’s like between three and five years. It just curious that one thing we’ll want to obtain from you all as we continue discussions is just like a redacted copy of one of your files just so we can do that with our operations team. But what that would really look like for you all. And so I want to make this really clear like by working with medallion, we are an end to end partner. So what we need from an administrator perspective is you all to own the strategy, which providers do you need to add to the platform? Which credentialing files do you need for providers, which payers do they need to enroll with? That’s really where you all own the strategy of your business. And then medallion’s going to execute on that. And so that’s really kind of what I want to show here is you are going to as an administrator come and make a request for actually… you know what? I’m going to show you this from our credentialing tab. We have a couple of different tabs here for this. But let’s talk about this from credentialing. So you would come, you would select provider, initial credentialing, you would select existing provider. They’re already going to be in the system, and then you would select the provider or providers. You’re looking to run that initial cred file for you would submit click submit request. And really from there your work is done. So this is really where medallion is going to take on. We have automated connections with primary sources, Sam, oig, we would pull down npdb instantaneously check the npi and you’re going to have visibility here each of those into exactly what that looks like. So we’re automatically going to kind of show you where we’re kind of connecting. This is a test environment. So ideally, in real life, this would be more green because we’re going to pull those back from our connections, but we’re going to do all of these checks on your behalf. We’re going to do that work history check. We’re going to do the peer reference calls ultimately producing for you all a… hrsa compliant file. You’re going to have visibility into the file. All right there’s just a couple issues going on. I think with this environment right now. So my apologies, but you would be able to tap through this file to kind of see everything at glance, if anything is flagged for any reason. You have the ability to kind of like add a note on that. We’re going to draw your attention to it and then we can set up your committee information directly in the system. So do you all have like a clean committee today and a needs attention committee? How are you structuring that?
Oak Orchard Team (53:20) There is a committee. Yeah. Okay. Yeah.
Samantha Bouchard (53:29) So sometimes we hear that people are printing out these files and like wheeling them down to a boardroom and kind of putting them in front of them or they’re doing some sort of email exchange. But what we’ve really established here is an audit ready traceable credentialing offering. And so we can, the voters can log in, they can review the files asynchronously like ahead of a meeting. So if you’re a board meetings only meeting, maybe once a month, you can kind of push that up to kind of get files through faster. And then all of the voting can happen directly in the system. And so this really supports like your committee meeting minutes where this is all audit ready for compliance purposes.
Oak Orchard Team (54:20) So once, so Sam, you would, so if we gave you all our processes, exactly what all we need in terms of family source and how do we do our privileging and all of that, then you will build that into a, for us or is it like a standard platform or will you customize it for us? Yeah.
Samantha Bouchard (54:43) So each individual which we call a SKU, chetna is essentially like an action really and medallion. So like creating a hrsa file that would be like one request in the system and then creating the payer enrollment request that’s a separate request. And then if you need a hospital application for them, I can show you where that takes place as well. I know we are almost at the top of the hour. So I don’t want to rush too much into the payer enrollment piece just given the time here. So perhaps we could… just kind of finish up on the credentialing. I know this is typically done by Tanya and… pasha. Pasha. Yeah, thank you. I knew it was two TS. So curious like your overall thoughts here with like the automation, how we’re able to produce these files with an SLA of five days. So really drastically cutting down the work of you all kind of manually checking these primary source verifications. Putting together these packets would love to hear your thoughts on how this would kind of simplify your flow overall.
Oak Orchard Team (56:02) So I don’t know if I got the answer to my question or I don’t know if you guys, I think.
Samantha Bouchard (56:06) We have to like do another meeting for payr now?
Oak Orchard Team (56:08) No, no, for the even for the privilege and peace.
Jake Shubert (56:11) Thing. Yeah, the.
Oak Orchard Team (56:13) customization part like you will show me where to go, but will you build it for us or it is something that you’ve already built and you can’t change and we have to work with that.
Jake Shubert (56:23) Yeah, chetna. I can take us to start and Sam, I can pass it back to you. So every customer we work with has different requirements that they follow, right? So the platform has to be customizable across our foreign customers in order for us to support them. So what we’ll do as part of this process is we would love to get sample documents that you have, understand your sort of custom rule set and requirements that are necessary for oak orchard. And then from there, that would be, you know, if we’re fortunate enough to partner together that’s going to be mapped inside of the platform. So it’s built out specifically for oak orchard. So, yes, that is absolutely something we support. Okay?
Samantha Bouchard (56:59) Yes, thank you for asking that again, Jen. I’m sorry that I kind of just went down a different path there. And Jake, thank you for chiming in, but yes, Jake is 100 percent spot on. Part of the reason we would get that redacted packet is so that we can do that validation internally, but we do produce hrsa standard files, ncqa files, joint commission files. And so what we tend to find is that our clients are just running a combination of primary source verifications under those standards. And so we’re already producing those accredited packets across our client base. So I would presume jetna, that you’re going to fall into the standards that we already have built out? But like Jake said, we can certainly modify the primary source verifications if there’s anything additional that you’re running? Sounds?
Jake Shubert (57:51) Good. And I guess not sure if this is a question for you, jetna, or maybe Tasha, but would it be possible over email to share with Lewis, Sam, myself, like a sample credentialing packet or just whatever collateral you guys had? That way we can begin the review on our side?
Oak Orchard Team (58:07) Like a sample, like what do we need? Yeah, we can get that together awesome.
Jake Shubert (58:12) Thank you that’d. Be a huge help. Great. And.
Samantha Bouchard (58:16) Then I’ll just end on like the recredential piece. So obviously, with these files, you all are kind of like running these every two or three years to ensure that you are tracking the recredentials and so we’re going to track that deadline for you, surface that to you. And we can actually either automate the recredential or you can come in here and request that yourself, so really reducing anybody falling out of compliance, ultimately speeding up this process for you all using it in automation and then giving you full visibility and audit tracing into each step of the process. If there ever was a need to kind of pull down any of that… I hope that, you know, from the onboarding experience through to this very first piece of your process, you found the information helpful. And then I would love it if we could set up more time to look at payer enrollment as well as hospital applications. There is an ongoing monitoring piece. I know you were curious about as well. And then we do have analytics and reporting to dive into. So quite a bit more in the platform, but I hope you found the time valuable today.
Oak Orchard Team (59:29) Yeah, absolutely. And, and,
Lewis Elder (59:31) I think we, as we look to set up that next call potentially, we can do that now in the minute that we have left, but I’ll kind of defer to you guys. Do I don’t know what your, can you tell me about a better sense of like what your timeline is on this? I, I’m asking because like if this is something you’re looking to evaluate and decide on quickly, we can set up time, you know, with relatively short turnaround, or otherwise, you know, I’m just trying to get a sense of, when to get things done.
Oak Orchard Team (59:54) Do you have tomorrow?
Lewis Elder (59:56) I don’t.
Oak Orchard Team (59:57) think we have tomorrow available, but we can ask… well, Sam.
Jake Shubert (60:07) You’re leaving for your disney trip tomorrow, right?
Oak Orchard Team (60:09) Yeah, I’m.
Samantha Bouchard (60:11) going to be out of the office tomorrow, Sam?
Jake Shubert (60:15) Is taking her kids to disney for the first time? Oh,
Oak Orchard Team (60:18) nice. We’re.
Samantha Bouchard (60:20) excited. I will be back on Thursday. The second. I don’t know if you all have time that day where we could resume conversations in?
Oak Orchard Team (60:33) The afternoon? Yeah, I think we have, yeah, are you?
Samantha Bouchard (60:39) All free at two P. M eastern? Yes?
Oak Orchard Team (60:42) Yeah. Yep. Okay. Perfect. Easy peasy. Yes.
Lewis Elder (60:47) I’ll send an invite for then I’ll also send you guys a recording of today’s, meeting, so you can kind of rewatch part of Sam’s demo, sure.
Oak Orchard Team (60:56) And.
Lewis Elder (60:57) then I think so we have some follow ups that we’ll take from you guys, Tasha and crew. It may make sense for us to grab like 30 minutes between now and next Thursday. What I’d like to do is get some additional kind of inputs from you guys because I can start building essentially what’s like a pricing quote for you all obviously as you can imagine like the way medallion prices is based on the amount of work we’ll do for you. So like how many providers and all the different services. So, yeah, yeah, if you’d be open to that, we can schedule like a 30 minute call.
Oak Orchard Team (61:25) That would be my question that before we spend more time, yeah, get a sense of the pricing, yep.
Lewis Elder (61:30) Yep, perfect.
Oak Orchard Team (61:32) Do you want to do it on? Monday? Yeah.
Lewis Elder (61:36) I’m not going to disney. So I’m free as soon as tomorrow, so I can do tomorrow Monday, whatever works best, you suggest a time and I’ll move stuff around on my end.
Oak Orchard Team (61:48) Do you have an opening anytime? Okay? Monday afternoon?
Lewis Elder (61:52) Yeah, I can do Monday afternoon, when works?
Oak Orchard Team (61:55) Do you want to do two o’clock then too? Yeah, two’s.
Lewis Elder (61:58) great. All right. So I’ll send an invite, and should I include the full group from this call? Is there anybody else?
Oak Orchard Team (62:04) I think all of us here is fine. Yeah.
Lewis Elder (62:08) All right. Perfect. All right. Thank you guys. So much. I’ll send out those two invites and a follow up email as well.
Oak Orchard Team (62:13) Perfect. Thank you all.
Lewis Elder (62:14) Right. Take care, folks. Bye.