Transcript
Cliff Marg (00:00) all right. Let’s try and just hammer through it and move… on with our lives. I will say at least they’re very pleasant people. You’re also on mute.
Hassan Zahir (00:15) Appreciate it. Yeah, let’s just do it and move on with our lives. I’m with it. We can hammer through.
Cliff Marg (00:21) 30 minutes would be good.
Hassan Zahir (00:23) Okay. How detailed are they going to be? Okay? Just wanted to make sure I’m you know, presenting this.
Cliff Marg (00:35) Hi, Antoinette. Hi, James. Hi, good.
JAHI006 (00:38) Afternoon.
Cliff Marg (00:40) How’s your day going so far?
Antoinette Flores (00:43) Pretty good. We’re closer to the weekend, so.
Cliff Marg (00:46) Yeah, office is looking a little dark in there, James.
JAHI006 (00:50) Well, you know, I am… hail like skim milk and even a little bit of light can have deleterious effects on my health. So, you know, like when I’m not when Antoinette’s not here. I like to keep it dark.
Cliff Marg (01:07) Okay. I like it. I like it. Cool. Well, looking forward to the conversation today, we have 45 minutes scheduled. I think we’ll probably need closer to 30, but I think ultimately like, you know, kind of heard you guys loud and clear the other day just in terms of your challenges, it sounds like mainly just being a result of very manual process, managing a provider network of about 100 or so that may grow somewhat meaningfully. And so, as you kind of think about how Antoinette can handle that scale, it really involves, you know, finding some ways to become more efficient and automated with regards to, you know, doing some of the primary source verification and credentialing and getting applications out to payers. So I’ve looped in Hassan who I’ll let do a quick introduction. And then we’ll kind of take it from there.
Hassan Zahir (02:00) Pleasure to meet you both. My name is Hassan Zahir. I lead the solutions consulting team here at medallion. I’ve been at medallion for what will be two years on April’s first, April first. And that feels like a little bit of a cruel April fool’s joke to have started a job on April first. But excited for the call today, I was just asking cliff when you two were joining just what level of detail you think we want to go into today. I’m excited to show you the platform. I’m excited to show you the capabilities, but I want to make sure that for this stage, I’m showing what’s most important. So you don’t necessarily want to get into the weeds unless you want to get into the weeds. So just excited to be here, walk you through kind of talk about our platform, how it supports other organizations, how it supports other fqhcs and happy to talk about some of those fqhcs who we support and how they’re using the platform as well if that’s meaningful. So, yeah, the biggest thing that I always ask is that this is collaborative that you tell me like I want to understand this. I want to understand that don’t need to know this today. Do want to focus on that today. So that’s my ask of you. But I’m excited to walk you through the platform and show you what medallion has to offer.
Antoinette Flores (03:14) Excellent. Thank you.
Cliff Marg (03:17) Antoinette one question I did have for you as we were talking, as I was talking to Hassan, so we talked about like just the need for, you know, doing the primary source verifications as kind of the initial credentialing and verification for new providers? Is there any like privileging of providers at external facilities? Is that at all part of what you’re doing or what your providers need?
Antoinette Flores (03:42) Not to any external.
Hassan Zahir (03:46) Internal, right? You have to since you’re fqac, they have to have internal privileges. Is that correct?
Antoinette Flores (03:51) Right. So we, yeah our providers go through committee review… and.
Hassan Zahir (03:57) You’re doing that as part of like your initial credentialing… process. So you’re doing your psvs, getting the packet together. Is there like dop forms or what’s the process for privileging?
Antoinette Flores (04:11) Yeah. So we do the initial applications, of course. So those are the privileging forms. We do the oig, Sam verifications, primary source for licenses, Dea, board certification, BLS… immunization, what else is there? Of course, liability insurance? So we put together a packet for initial applications and then when the providers are onboarded, then two years after that, they go through a reappointment to our internal committee. Okay? Perfect.
Hassan Zahir (04:44) I need to make sure of that. I wanted to make sure that I was onboard for like what the workflow and the process should look like. So a new provider starts, they go through what we’ll call it the credentialing process which includes the initial appointment or the initial privileges two year cycle, which is in line with what we expect. And then of course, that includes the payer.
JAHI006 (05:08) Enrollment.
Hassan Zahir (05:09) And then once they’ve once they’re going through that process, is it okay? Or is it a safe assumption that you don’t start the payer enrollment process until after they’ve gone through committee and they’re there to start? Yeah. So onboarding, credentialing, them, getting the initial privileges once that’s done, then that initiates the payer enrollment process. Do you have any delegated agreements today or is everything initial or I’m sorry, individual applications with the health plans?
JAHI006 (05:39) No delegation. We are way too small for that, okay?
Hassan Zahir (05:43) I heard cliff mention approaching or wanting to approach 100 providers and generally that’s that minimum threshold when organizations start looking to see if they’re eligible for delegation with the health plans based upon their group contract. So I just wanted to make.
JAHI006 (05:58) Sure. I know that we don’t have that and I don’t know what, you know about Minnesota, but we’re kind of a cloistered health… payer environment or have been. Historically. So, like most of our biggest payers are actually just very like regionally focused on Minnesota. And prior to coming here, I worked for a much larger health system that, you know, with like 12 hospitals, 60 plus clinics. And it was only like in the late 20 teens that like they were exploring… delegation and it’s just, yeah, it’s just not anything that we… of things that we have bandwidth for getting into the delegation sphere. It’s not there. We’re not there. We’re not there. It’d be lovely if we could be, but we’re not, so that’s.
Hassan Zahir (06:59) fair. And I appreciate that. Candor, what I would love to do is go ahead without further ado and jump into the medallion platform. So let me go ahead and share my screen. Like I’ve been doing every day since 20 20. Can everyone see my screen? Okay. Yeah, I can see it. Okay, perfect. And what you’ll see is we’re looking at the medallion demo environment. This is a demo environment. It’s kind of shows just a little bit of customization there. You can see like I’ve got the hennepin county. And let me make sure I’m saying that, correct? Is it hennepin? Yep. Okay. So I’ve got the hennepin county logo up there. We’ll walk through some of the flows as far as how providers get into the system, how the credentialing privileging process works, how once that’s completed, then an enrollment request can be made. I just want to highlight the fact that medallion is an end to end solution. And so, Antoinette with the goal of a platform like medallion, is to allow you guys to go through that growth and to have that provider growth and not have to necessarily worry about linearly adding… like headcount or bodies to support the growth, but be able to take advantage of a platform in the automation within the platform to be able to support that growth. And so, I’m going to walk through the platform from kind of that perspective. Always happy to do a deep dive demo. Sorry?
JAHI006 (08:29) I just had a quick question on that. So out of based on your organization’s experience, what have you found to be like, for users of this platform, what have you found to sort of be like, the, I guess like, the practitioner cap that like a single person would be able to manage? You know, because, like we said, we’re kind of in that 100 range right now? But with growth like, so like what? Yeah. So just wondering if that question makes sense and what you, yeah.
Hassan Zahir (09:08) Definitely makes sense. And is resonating. It’s a great question to ask James. It’s two part one, I’m going to give you an answer. But first, I’m going to preface the answer and I’m going to preface the answer that it depends on the workflows that are being done and how many of those workflows are being done because medallion supports this for like licensing and cross state licensure, and direct enrollment and delegated credentialing for ncqa requirements and like initial credentialing for the initial appointments. And so it does depend on what SKUs are in scope. Generally speaking, we see this, it’s normally like in the ballpark of one individual can support around 200 providers or so. When privileging is in scope, if it’s just like payer enrollment, then we can see that up to like 500 providers. And I’m going to show you the reason why, and all of the places where there are going to be efficiencies and automations that allow Antoinette or whomever the medallion administrator is at other organizations to really be a lot more efficient. And so hopefully I accomplish that. If I don’t accomplish that, then hopefully you see enough that it warrants another conversation. I.
JAHI006 (10:25) appreciate that. And also curses to you and all of your caveats.
Hassan Zahir (10:31) All right. So, we’ll go ahead and get started. What it looks like in medallion, is medallion starts off as or at its core, I should say we’re a provider data management platform. We want to be a single pane of glass or that single view of all of the provider data in the system. And we can get this data in a multitude of ways. First and foremost, for existing providers, we can import that data. And we have a standard data import template. And when individuals come to us with the challenges that you have and they say, hey, my organization wants to utilize medallion, we say, okay, what system are you on? And let’s figure out how we get existing data in. We can do that through a bulk import with steady state. We can do this in a couple of different ways. The most common way for an organization, your size is a new provider is hired and we invite that provider to the platform. Really easy to get a provider into the platform. Five pieces of data. The provider’s email their first name, last name, their estimated start date, and then what’s the provider type, what profession they are. Again, we support multiple fqhcs today. So this will be those medical providers. This could be a dental provider, whichever provider type. We map the different requirements to it. And I can keep scrolling for a while and go through all of those provider types. But what you’ll see here is you have the options to send an invitation email. We do recommend that you send an invitation email but maybe not right out the gate. The reason that we say, maybe not right out the gate is you can start the process. You can pull in providers… information that you may already have, and then send the invitation email. For the purpose of this demo, I’m going to say, let’s go ahead and we’re going to send an invitation email. What happens is they will receive an email that doesn’t look too dissimilar from this. It’s going to say, hennepin county is partnering with medallion to really simplify and expedite your enrollment and credentialing process. It lets them know kind of who we are and what we do so that they know that there’s a partnership between the two orgs. When they receive that email, click, get started and it’s going to look like this. It’ll say, hey, this is the medallion portal. It’ll say, hey, welcome. Pretty much just level setting on how to get data in a couple of things that I want to highlight here is first and foremost, always can fill out that profile manually, meaning that there will be a provider portal where the provider can go in and key in their information. The reality is that’s what we don’t want them to do. What we want to be able to do is have them upload documents. And this says resume. But we have the ability to extract data from essentially any document that is uploaded. We have a standalone automation AI model where we can extract 99 point nine five percent of the data from all of the documents that are uploaded with 99 point nine percent accuracy. And so what that means is a license is uploaded or if even like a driver’s license is uploaded, or anything along those lines are uploaded, we can extract the data from those documents. And we use that to complete the provider’s profile. We also have an integration with caqh. We are the only… participating. Org. There are some companies in the space where they have API connections to caqh and they can pull in the information from caqh. We are a participating organization with caqh however, and what that means is it allows us to facilitate the process of getting provider information in without having to utilize their username and password. Their caqh id is going to be in every email they’ve ever received from caqh. And they should know their social security number and their last name. If they don’t then we’ve got much bigger problems. What that allows us to do is to pull in the data for a provider from caqh. We will get if they have an up to date and attested to caqh profile because that is kind of the requirement. We’re not going to pull in if they haven’t updated their profile, if they haven’t attested to it within the last 120 days. But if they have, then what we’ll do is we will verify that information and then pull that information into their provider profile. This is what that profile looks like in medallion. Once we’ve imported the data from caqh, the important thing here is that you don’t have to chase down the provider for all of this information in order to put them through the credentialing process because we’re going to pull in as much of this information as we possibly can from caqh. And then we’ll show the percentage of that profile that’s completed. And then what is missing you’ll get the basic info tab. The provider will see this view as, you can tell this is kind of the my profile view for the provider. Momentarily. I’ll show you the administrative view, but they’ll be able to see all of their information. Anything that was pulled in professional history, their training, their work history, any hospital affiliations, any existing payers, generally, this is like medicaid, medicare, that’s listed in caqh or any commercial plans where caqh is used for the initial application or the revalidation from a payer enrollment perspective. We can track continuing education credits. We’ll track external accounts. Medallion also does have the ability for example, to update their caqh information. So not only can we pull that data down, but once a organization is utilizing medallion, then we can push data back into caqh. It ensures parity, and it makes sure that provider’s caqh profile doesn’t fall out of attestation or isn’t up to date as they, as you add practice locations, maybe we update those practice locations in medallion, and then those practice locations are pushed to caqh once they ensure that this data is correct, and they validate this information, then they can agree by signing this attestation. I said something earlier Antoinette where I said, you probably don’t want to send the email out to them initially. The reason being the reason why I say that is that you also can make the enrollment request for them. So you can say, hey, this provider is going to start and they’re going to need to get a network with these health plans and you make that enrollment request. So when they first log in, not only are they verifying this information required for credentialing, but we will also make sure that all of the data that’s required by those health plans, that they’re verifying that information or supplementing what we were able to pull in from caqh. So the goal is the first time they log in, they supply what is missing and attest to the information that is in here being accurate. And then it’s pretty much hands off for the provider. From that point. I know it’s a whole lot of me talking. I want to understand how this looks to you. Does it seem like this will be beneficial? Do you think this will be a time savings?
Antoinette Flores (17:57) Oh, for sure, time saving? Yes, most definitely. So right now, we are sending emails to initiate the practitioners to go in, either give us their credentials for caqh or update their information on their own. Is there a way that reminders can be sent? So let’s say I send the invite to the provider. They’re not being responsive. Is there a way I can remind? Because that’s kind of the nature of the beast, right? One.
Hassan Zahir (18:22) 100 percent. And so we refer to those providers as non responsive providers. Oh no. And we have standard cadences for follow up communication to go out to the providers if they have not logged in or going into the portal. We also even if they have logged in and we find out, okay blue cross blue shield of Minnesota requires that we have a copy of just something. I’ll just throw it out there like a BLS, right? And that for whatever reason wasn’t in there or you’re at fqac. So you would need that anyway for your process. But let’s say they’re missing that, then we will send reminders out to them for that purpose. And so we have the ability to send an email. And then we also have recently rolled out our conversational AI, which means there is like AI that’s going to call and say, hey, I’m calling on behalf of hennepin county on a recorded line. You need to log into the portal and complete the uploading of your basic life support documentation so that we can continue the credentialing process. Do you have any questions? And again, that’s something that we can demonstrate to you or demo to you on a subsequent call?
JAHI006 (19:38) Given our passive aggressive culture here in Minnesota, that would be damn near perfect. Oh.
Hassan Zahir (19:45) My gosh and so we absolutely support that. Once everything is done here and Antoinette, it sounds like that would be an improvement in getting away from the manual process, getting away from those emails, having a portal. Then the provider would just come in and they would attest to that information. And what this is going to allow them to do is going to auto populate in here, their name, their npi. And really what this is doing is saying, hey, I am going to allow you to pull information down or upload data to caqh. I am going to allow you to request information or request that my profile is utilized for getting enrolled in health plans. I am going to sign this and I agree that this information that I’m saying is in my profile is correct. They’ll click here. They’ll add a signature. I do want to highlight in addition to the ability to add the signature there. We do have the mobile experience. Everybody is on their phones nowadays. We want this to be responsive. They could log into their profile the exact same way as opposed to, you know, using their mouse, they would just add the signature and then they would use their finger and they would be able to sign it all the same. Very nice. What happens is they would attest to that. They would hit save, and then they would save and finish this. And then they would be notified. Okay. You’re done? Now, your profile is complete and we can perform those downstream workflows on their behalf. And so like if I came back and I went into Naomi Ely’s profile, you can now see we have this green checkmark because her profile no longer requires that attestation and it is complete. And we’re able to make the request for credentialing and the request for payer enrollment. I’ll pause there. Again, that’s kind of the experience speeds up the process. No more chasing providers down, no more sending out emails, no more. What do I have? What’s missing? What’s expired, the system does all of that on its own. You ask the question about the follow up, if there is a task. And I didn’t mark this task complete, but you can see if there is a task or something that needs to be done. Then there’s going to show up. You’ll see every provider and all of the tasks that need to be completed by the providers. So, you know, what’s outstanding. And this is like the whole view. You’ll see the tasks that are specific to just the providers. So this provider needs to perform this. This provider needs to perform that. And then we’ll also show you the admin tasks, this could be like group information or group Coi or anything along those lines where an administrator needs to upload that because that’s going to apply to all of the providers. And then we track all of the expirables that need to be tracked, board certifications, and those sorts of things are tracked by default. If you want to track anything else in that provider profile, you can upload a document. Providers again, can do it through a QR Code in their smartphone. They literally can snap a picture of the QR Code, snap a picture of the document and it’s going to upload it directly into their profile. They’ll say what it is, and then we can track the expirables. So no more, when does this happen? And when does that happen? No more spreadsheets of this or that it’s all right there at your fingertips.
Antoinette Flores (23:06) Okay. So is there some type of reporting or like something that I can pull just to be able to? I mean this is a good view. But when I think about it, we had a demonstration with another company. One of the things I appreciate is that what they had what they call widgets, but it kind of just shows like graphs and kind of where things stand at a glance. Is there any type of visual one?
Hassan Zahir (23:29) 100 percent. And so there’s dashboards and analytics for everything that’s in the medallion platform. And so we can do that for everything, licensing for payr enrollment, for credentialing for any of the tasks that are outstanding, we can customize these dashboards. Again, keep in mind, I am in a demo environment. And so it’s moving a little slow for me right now. The real world experience wouldn’t be bloated with a whole bunch of demo data and 20 people using the same demo environment concurrently. I’m going to slow it down. Sure we can look at any of those outstanding tasks. We can customize these views. We can make it. So whatever data it is that you want to show up is going to be able to show up. And we can do that not just for the outstanding task or what’s outstanding for a provider from onboarding. We can do that for payr enrollment as well. Again, this is like, okay, this person needs this in this environment, this is the task, this is the task description, what needs to occur. So we can do this kind of like in this style or we can do it more like in the visual style with like graphs and bar graphs and dashboards, more like what we’re going to see here for payr enrollment. We have the ability to use two separate analytics engines to be able to just present whatever it is that you would like to be able to see.
Antoinette Flores (25:00) Did.
Hassan Zahir (25:01) that answer the question? Yes?
Antoinette Flores (25:03) For sure?
Hassan Zahir (25:05) Perfect. And so once we have that provider’s profile completed now, we can say, okay, now, we need to initiate some of these downstream, excuse me, some of these downstream workflows. What you’re going to see here is that we’ve got a modal button for all of these applications, where you’re going to be able to make a request, what’s going to be different here versus how it’s likely occurring now? Is all of these primary sources, we’re going to verify them automatically. And so I’m going to show you a couple of different views here. I’m going to try to be quick on how quickly we’re showing them because I am going to be conscious of time… but it starts with making a request. We can do the new initial appointment, which is going to say, hey, I need to get this provider. In this case, I’ll stick with dr Naomi Ely at your location, whatever… privileges they need to be assigned as part of their initial appointment. I’ve got one that’s open. So I can’t make that existing request for her. You also can see we have capabilities for organizations where they need to do third party hospital applications and get providers privileges at third party sites, but we would choose who that individual was. Once I select it, I’m going to choose an entity just to kind of highlight what this flow looks like. So I would choose a provider. I would choose where we need to get them their initial appointment. I can add any notes I can go in and choose the privileges that need to be selected from their dop form. We can load those dops in there. We’ll then start the process of getting that in progress. We’re going to kick off all of those primary sources that need to be verified. And they’re going to move from in progress to ready and you’ll be able to see visually really quickly. Like, okay, this one is got something that’s come back on it. This one is, okay. I can do whatever I need to do. I can send these to the appropriate committees. We do have an in app committee review process. And so you can assign individuals to the application to be a part of the committee that will allow you to do asynchronous committee reviews. Our partner organizations will use that typically use it for like the step one or level one files that are clean files, not the ones where you know, something has come back. If something is coming back. Then generally, they go through their standard committee process where they meet, but you can move those to whichever committee you want to move them to. They will also have the full credit packet. I’ll show you like once these load, you have access to the full packet. So I can launch one of these packets and you’ll see I’ll get the full summary of it. Not only do we run the psvs but we put the packet together for you. We are ncqa certified, but we support organizations who need to meet whatever standards they need to meet. Obviously, hrsa as an fqac, also for joint commission CMS guidelines. Regardless of what requirements you have for that packet, we can do that within that packet, you can add notes and information including adding attachments. You can tag individuals who are members of the committee as well directly within that packet when we go. And we look at the information in that packet. We’ll be able to see again just a demo environment, but we’ll have like evidence documents. We’ll have the source. We’ll have the source URL, we’ll be able to show you who verified the license and the information. So we will automate the PSV. But according to hrsa and… ncqa requirements, there will be the manual verification. And so when we go back and look at the summary, we’ll be able to say, okay, this was the way that it was verified. And then we’ll have the human who’s also a part of like the full review process as well. So we’ll do the quick verification through the automated process. And that allows us to have those contractual slas that cliff probably spoke to you about. One thing that makes medallion unique is not only do we automate this work, but we contractually commit to how long it takes us to get this work done. So you would have that full packet. A member of the committee would be able to come in and cast their, sorry, they will be able to come in and cast their vote. And so you can set the different types or ways that you want to vote. You can reject it. You can approve it. You can pin your vote because you want to wait until the committee gets together and have a conversation or you can say, hey, I need to wait for other committee members to vote. We also can do multi step committees if that is necessary, a requirement of yours. Once the votes have been cast, then they’re going to go into closed status. You’ll be able to see what the final disposition of it was, whether they were approved or rejected. Maybe they were never voted on in an archive, maybe a provider left before that happened. And then we’ll track all of those existing requirements, privileges that they have. So we’ll know that they went through the process. We’ll know what types of privileges they have. We know if this is… temporary privileges, permanent privileges, when their expiration is, when their reappointment start time is, and then a reappointment deadline is as well. I can go further in here. I do want to make sure that we save time for sure.
Antoinette Flores (30:54) I have a question if we can go back just a little bit on the primary source verification document. So our committee currently, as part of what they request is that the oig and Sam That we have time stamped within 180 days of the reappointment or initial appointment that they have like somewhat of a screenshot or a visual from oig and Sam to show that it’s you know, that they’re it’s clean. There’s nothing that has come back. So, is that one of the forms or proofs that you guys can produce in this process? We can.
Hassan Zahir (31:33) We can, we can 100 percent produce that I’ll show you really quickly for let me jump into… John white’s profile. I’m going to jump into a profile for another provider that I use for incomplete profiles. But what happens is 100 percent, we can include that, we can customize the packet to meet the requirements that you have, but that is included as part of the evidence. And then it’s also a part of the provider’s profile. I really need to start my computer because this is running super slow for me. So I apologize about that. It’s all good. But what you’ll see here is that.
Hassan Zahir (32:19) When the provider’s profile decides to load for me, I may switch just directly to the quick web version of this for… time’s sake. No, even that’s running. So it’s probably my computer needs an update. But what happens is for the verifications tab under the provider’s profile, you’ll be able to see every primary source verification that was one or that was run. We’ll timestamp it, you’ll see who the person is. You’ll see everything that was done. So the full history of every PSV that’s run on a provider actually can verify all of these right now as well because we have the automation, but we will do the source of it, who verified it. When we verified it. We can show the verification evidence, which is what… if we needed to be able to show that for any of these sources again, I’m in a demo environment. So the reality is this is not a real provider and I don’t have verification evidence for that provider because they’re not a real provider. But in any instance, you can view the verification evidence for any of these providers, and we can include that verification evidence into the packet. But you’ll see here everything that you’re interested in seeing whether it’s the education, the malpractice, the board certs, the state licenses, prescriber licenses, national practitioner, data bank, the peer references, and then we have all of the sanctions that would be relevant as well. Oig, Sam, ofac, deafmaster, and even if there’s any custom verifications that you want to include, then we can partner with you to understand what those are and.
Antoinette Flores (34:05) Is that continuously monitored? Like?
Hassan Zahir (34:09) Yes, these are ongoing sanctions checks. This is ongoing monitoring. So npdb is continuous. And then the rest of these are designed to run at a set frequency required by whatever standard we’re doing this for. In most cases, it’s that they’re running on a monthly basis.
Antoinette Flores (34:28) Right. Okay. So you had said something earlier about mapped requirements based on provider type. Can you say more about that?
Hassan Zahir (34:37) Yeah, for sure. And so what happens there is that’s more so along the lines of the enrollments with the different provider types, like for example, there’s a lot of states right now that are requiring doulas to be enrolled with state medicaid plans. I want to say it’s like 19 of them or there’s 12 and 19 that are like active. And so for a doula, it’s a certified provider, but they’re not a licensed provider. So the requirements for them getting enrolled with medicaid in the state are completely different than the requirements for an MD or a do to be enrolled. And so that’s why we track the various requirements based upon the provider type. And then what, you know, what the workflow would be also if you had non, if you had non licensed providers, but they were credentialed and you still need to run Sam and oig on providers, then we wouldn’t have to run all of the other sanctions on them, but we would need to run the ones that were required by, to run on those. So a couple of different places where you’ll see that be surfaced.
Antoinette Flores (35:46) Oh, okay. Very nice. So our providers are medical, mental behavioral health. So just to kind of give you some idea of the type of licensed providers we’re yeah.
Hassan Zahir (35:56) So like I think of like vts and how rbts, are different from, you know, like bcbas and, you know, like just all those different requirements, our operations team tracks that they log it when I jump into the payers tab here really quickly. I’ll jump into, let me jump into one of these and kind of give you an idea of what I mean, how we track that from like an enrollment perspective. Again, you’re looking at a demo environment, but this is still a little bit of a peek behind the scenes for each of the health plans. We have a full team that tracks like all of the, all of the requirements, any other known as names like, you know, how, what the services are, what are the lines of businesses? Are they ineligible or eligible profession types? And then we have the full process guide where I could say for medical or for behavior?
Antoinette Flores (36:52) Okay. Nice.
Hassan Zahir (36:53) What the requirements are, this is like the secret sauce and so we don’t expose this, but this is what drives or this is the underpinning of our automations. So we know what the prerequisites and dependencies are. We know what the conditions for those prerequisites and dependencies are, we know the best application method, are they going directly? Are we going to availability? Is there a multi step process, multi factor authentication? And what are all the login steps or the application steps? What happens if they don’t have their medicaid, ied, yet? What are the dependencies? What are the follow up? How do we contact them? What is the frequency in which we can perform outreach once that enrollment application has been submitted? And so medallion takes all of the information from that provider’s, profile into a net. You make the request for that provider to be enrolled with a health plan, or for multiple providers to be enrolled with a health plan? You’ll choose the corresponding group? You’ll choose the state where the enrollment needs to occur. And then you’ll select that payer, or those payers. This doesn’t have to be kind of like just one to one. We can do this kind of one to many. We can do this across the various lines of business… for this health plan. For like the initial group contract. And then on the provider level is where I want it to go. On the provider level, I can choose who that provider is. I can choose their corresponding group. I can choose their state. Again, just protections in the platform that the person has to be in network. I’m sorry, has to be licensed in that state. We’ll be able to see where there’s existing group contracts, not existing group contracts. And this was the point I was trying to make where we can do this for multiple health plans concurrently. So you can have a new provider start and you don’t have to do five separate applications. It’s one request. Medallion will then map all of their information from their profile to the application. You will then from that point in time, see under enrollment requests, all of the existing enrollment requests? We give you visibility? Like into, do they support like roster submissions as opposed to individual applications? What types of forms are available? Can we do this fast? Is this out of state? Is this a priority enrollment? We’ll track the request status. Excuse me, what stage and what’s the status? Is it with the payer? Is it with our team? Is it within the timeframe that we say that we’re going to be able to get it done? Are there any dependencies? Like a? Medicare or medicaid id, all of the notes, we will actually do the submission and the follow up, you make the request, you identify the provider, which health plans they need to be enrolled with. But we take a lot of that manual work of mapping the data to the application off of your fingers, and then we map it all the way through the process. And once the process has been completed, then you’ll see it show up under enrollments. This will also show up under the provider’s profile. You’ll see the revalidation dates. If you want to have auto revalidation enabled, you can make the request for the revalidation. If medallion does the work… as opposed to just importing from like existing enrollments, then you’ll also kind of get the chance to see like any evidence documents or anything that are associated with that enrollment again, just kind of like a demo or a sample of like how that could look. But we do store all the evidence. So in case you ever had a denial for being out of work, all of that stuff is there. And now, I feel like I’ve been talking way too much. I said I wasn’t going to, no, this.
Antoinette Flores (40:41) Is good stuff.
Hassan Zahir (40:43) And I wasn’t going to show all of these things but I feel like I’ve been talking too much. I don’t know if this is resonating, if you see how this could be beneficial to you, if you see this as a value add or not. So I would want to stop talking and kind of just see what you’re thinking?
Antoinette Flores (41:01) Yeah. So regarding the payor enrollment, so make sure I’m understanding this. So what I would do is initiate the request for a payor? I mean, for a provider to be enrolled with a particular payor, is it depending on the payor that medallion will see the process all the way from the initial request to completion? Or is it that depending on the payor then we would then have to either go into availability or do whatever is necessary? No?
Hassan Zahir (41:30) So, medallion tracks those requirements for how it’s done. But medallion would see it end to end for all of the requests. And that’s what I was trying to allude to early in the call is that medallion is end to end. So you own the request, you own, which provider, you make sure that all of your groups are in here. You make sure that your tin structure is correct. When a new provider starts, you onboard that provider, you make sure that all the data is in there. But when it comes to those repetitive tasks like performing the primary source verifications or mapping the provider information to an application and submitting the application, you own the request, but medallion automates the process.
Antoinette Flores (42:12) I see. Okay, very nice. Antoinette. I guess Jim, did you have a yeah.
JAHI006 (42:20) I.
Cliff Marg (42:20) was just going to ask how this compares. But before that, James to answer your question on just kind of like the payers that we’re working with. It should be all of them. I will say like, you know, new payers are kind of popping up every day it seems. And I.
JAHI006 (42:32) would say probably not every payer in Minnesota because we have especially in the medicaid medical assistance space. There are some regional mcos that are like where they serve like maybe four or five counties in rural Minnesota. Sure. I would guess probably not all of them. But again, I’m just thinking where the bulk of the dollars are. I would love to get confirmation that you guys are set up to recognize blue cross blue shield of Minnesota health partners and medica. And of course, Minnesota, yeah.
Cliff Marg (43:15) So I’ll check on those. But what I was going to say is we basically have a team of, you know, 20 or so people internally at medallion whose full job is researching and making sure that we’re up to date on requirements. And if a customer is requesting enrollments for a payer, that we don’t have the full process mapped out. We’re doing it in real time so that’s kind of how we would approach that. Okay? A quick.
Antoinette Flores (43:43) Question. I’m sorry, I know.
Cliff Marg (43:45) We’re at time. I’m just kind of looking for your feedback on like, you know, medallion compared to other demos that you’ve seen so far. And then we can chat through next steps briefly and kind of timing.
Antoinette Flores (43:55) Yeah. Before we do that, I wanted to ask and I’m sure considering you guys can do all of these things so far that custom documents for our internal committee review. Is that something that you guys offer? Like, so when I’m thinking about preparing for our committee review for reappointment or initial, we put together obviously a packet and we’re sending out to the providers for them to complete their privilege and form. And I would love to be able to obviously have that be something I can do from here and send to them for them to complete and sign. Right now. We’re just using of course, Adobe signature fillable form. So wondering if that’s something that you.
Hassan Zahir (44:42) Definitely, could… that would be a, we would consider that to be like a custom task. How I showed you like the tasks that exist, those are the default tasks you would partner with your engagement manager through onboarding and we would get the form. And then that would be something that’s a part, of the process for providers. That form needs to be completed that’s a part of the task before their profile was considered done. And so would love to show you a little bit more about custom tasks. If we move forward, cliff is trying to get us out of here because I’ve got another meeting. I’m a little late for, but we 100 percent could do it Antoinette.
JAHI006 (45:21) All right. Well, san, thank you so much appreciate it.
Antoinette Flores (45:24) Absolutely.
Hassan Zahir (45:25) James Antoinette, I appreciate these calls where there’s feedback where there’s interaction. And like I said, I was hopeful or optimistic that you saw enough things there that you liked to want to continue the conversation for?
Antoinette Flores (45:38) Sure. And so.
Cliff Marg (45:40) I’ll kind of leave it to both of you, we don’t necessarily have to schedule next steps right now. But in terms of timing and kind of what would be most helpful and you all kind of finalizing an evaluation, what are your thoughts there?
Antoinette Flores (45:53) Yeah, I think I’ll let James speak to the timing piece. If I could, I would say we should make a decision by next week. But the reality is we, as James can explain more that we’re part of the county. So I understand that things don’t move that fast. Yeah.
JAHI006 (46:10) Things don’t move that fast and the county has its own, you know… because anytime you’re dealing with covid, what is public data? And, you know, like we have responsibility like we have like our hipaa related responsibilities. But then as a government entity, we also have like a separate unique set of responsibilities for protecting, you know, data… that we have to. Yeah, it’s there’s a process that things go through and, that can take some time. One of the big things, for us too is that like we don’t actually acquire a ton of software. So, this is not a process that we go through all that often. And one of the things, that we have to do is like we engage like our like northpoint has it’s like we have a like an it business relationship manager with the county’s it team. Like we’ve engaged that person, to start this process to make sure that we’re doing everything we need to, you know, like cause I don’t want to get, I like I don’t just to be safe, like I don’t want to make sure that so that we can move as quickly as possible. I want to make sure that we’re following, you know, step one, two three, you know, and sequentially and so forth. I think relatively speaking, this is something that is a priority for us, but we also haven’t gone through this enough and maybe we as an organization have, but I haven’t, to be able to know exactly how fast it can move like the it review process this year, like it’s going to take however long it’s going to take. But it’s not something where like it’s… not something where we’re going to be able to like… realistically, we’re not going to be there in like two or three months… but I think that the expectation is that whatever direction we go in Antoinette’s going to be on this system before the end of this year. So I think… that would probably be the best way that I could frame it. So the sooner that we can have some of the salient pieces because like I said, I like, I don’t know if I mentioned it, but like or if it was real clear I majored in sociology and then studied a lot of philosophy and religion when I was in college like this it thing ain’t my jam. So, you know, we’re just trying to kind of look at this from, you know, Antoinette’s bringing her expertise and her credentialing work to this review. Process I’m bringing my ability to provide moral support to Antoinette to the process but, you know, like we’re kind of like approaching it from like more the human slash user angle and not the it angle so that when decisions get made like we want to be, we want to know like what we’re looking for in a solution and be able to contribute meaningfully to any evaluation of like value. And, you know, like we’ve said like cost is a part of that equation, but it’s not the entirety of that equation. So that’s really where we’re at now and we’re just grateful for your support and willingness to work with us and do this presentation so that we can contribute meaningfully on that front as early as possible.
Cliff Marg (50:03) Sure. So I guess, do you want to, do you want to then try and coordinate like some next steps via email? I assume, you know, you guys will want to get some sort of sense for pricing. James. I tried to share like just kind of ballpark but there will likely be some inputs that we need from you also.
JAHI006 (50:18) Yeah. And like I said, well, I don’t like I’m not able to provide a lot of those like right away, I’m in that classic position of like, I know who to go to get that information. So.
Cliff Marg (50:32) Yeah, yeah, that’s perfect. So I can send some of that information via email.
Cliff Marg (50:36) We can work on that. And then we’ll kind of follow your lead in terms of speed and next steps. Yeah.
JAHI006 (50:43) And I appreciate that. Well, I’m going to do my part to try to move things along as much as possible… because.
Cliff Marg (50:48) Yeah. Well.
Hassan Zahir (50:50) What I’ll say there Antoinette and James is like if there was something that you didn’t see today, where you say, hey, I wish medallion did this or did that and that would keep us out of being your top pick. I would love for you to let me know because I think that’s probably functionality that we have that we just didn’t happen to show today.
JAHI006 (51:08) Because.
Hassan Zahir (51:09) I want us to be your top choice and if you have any questions, feel free to reach out to me. Well.
JAHI006 (51:13) Hasan, out of curiosity, how long has this platform been? Like, when was it released? And I would imagine it’s been improved iteratively over time, it.
Hassan Zahir (51:26) Has so a couple of things there, James one medallion has been a LinkedIn top LinkedIn startup the last two years as far as recognition, but the platform itself is over six years old. We’re backed by Google ventures by optum, the healthcare company, optum, by sequoia. So, when you think of like the largest players in technology and the largest players in healthcare, those are our backers. There were a lot of legacy platforms that really just were a little bit too clunky and kind of cobbled together throughout acquisition. And the likes and medallion has been built from the ground up. We are a series C startup and we are to the point where we don’t have to take another dollar ever if we choose not to take a dollar. So we are completely solvent as an organization. And any other question that you would have, we’re more than happy to share?
JAHI006 (52:20) No, I think that like it’s one of the, my opinion of the platform is that it looks like it’s not as you mentioned, it doesn’t seem clunky, but at the same time, there is a level of refinement, like it’s been around like it’s old, but it’s not too old. It’s you know?
Hassan Zahir (52:44) Yeah. There’s experience behind the platform.
JAHI006 (52:47) But.
Hassan Zahir (52:47) we’re also really nimble and have the ability to iterate on the fly. Yeah. Oh, very nice. It’s the reason why like the Michigan primary care association chose medallion. And so all of the fqhcs that are part of the Michigan primary care association are utilizing medallion. We’ve got swope healthcare in Missouri, who’s the largest minority owned fqhc in the country. Who is a partner of medallion? And so, we pride ourselves in being able to be a platform that it doesn’t matter if you’ve got, you know, 100 providers or if you’ve got 10,000 providers, we want to be able to treat you the same cool. That’s great awesome.
Cliff Marg (53:30) Well, yeah, I’ll shoot you an email, give me until end of day today, and then we can continue the conversation from there.
JAHI006 (53:38) Outstanding, cliff Hassan. Thank you both so much. Yes, thank you. Too. Very appreciated on this side of the internet.
Cliff Marg (53:42) Likewise, have a good one.
Hassan Zahir (53:44) Have a good day. Bye bye.