Transcript
Philip Stefani (00:00) morning, Noah morning. How are you?
Noah Laack-Veeder (00:05) You know, doing good. You know, what today is Phil, max velocity day on the track. Let’s go.
Rob Horrar (00:14) It’s a big day. It’s.
Noah Laack-Veeder (00:15) a big day.
Philip Stefani (00:16) Huge day, huge and you’re looking forward to it. I imagine.
Noah Laack-Veeder (00:20) Yeah, the kids love it, dude. It’s sick.
Philip Stefani (00:23) Just like sprinting full out?
Noah Laack-Veeder (00:26) It’s so fun. Yeah.
Philip Stefani (00:29) I bet… dude. When you are finished with the demo, can you just pass to me for like gathering the general feedback? I want to own that and then transition to let’s.
Noah Laack-Veeder (00:46) Try to get this demo done fast. Yeah, yeah, I’ll also that’s one thing I’m talking about. We kind of have it, but like if you want to jump in, dude, I always look at zoom participants like just get off mute and that’ll be my signal. How’s that sound?
Rob Horrar (01:02) Okay.
Philip Stefani (01:03) Works for me. What’s up garrison?
Garrison Goodman (01:07) Gentlemen, what’s.
Noah Laack-Veeder (01:09) up big red?
Garrison Goodman (01:10) How we doing good?
Philip Stefani (01:14) Excellent. All right. We got rob in the waiting room. Kyle, usually a couple minutes behind.
Philip Stefani (01:30) Hey, morning, rob.
Rob Horrar (01:34) Good morning. How are you all today there?
Philip Stefani (01:37) We go doing well. How are you?
Rob Horrar (01:39) I’m doing well, just waiting on Kyle.
Noah Laack-Veeder (01:42) Yeah, rob, I was telling Phil, you know, we were talking about track last time today is max velocity day for my team. So we’re going 100 percent so it’s going to be fun.
Rob Horrar (01:56) I had over the last weekend, I had a little Reunion with about 12 of my fraternity guys and one of them was my good friend and we ran track together and we were in a little town and had a vrbo, and we were coming back from dinner and I said, hey, you want to race and he was the sprinter. He was the 100 yard Guy. He said, look, dude, I’m stuck in second gear and I think I’d pull a muscle. So we actually, there were three of us on, that ran track. So, none of us were of the ilk of the idea that we were going to relive our youth with a sprint.
Noah Laack-Veeder (02:33) Yeah… but, you know, rob, you would have won, right?
Rob Horrar (02:38) See that’s why I wanted to race him because back in the day he beat me in, you know, yeah, but, you know, that’s good. I didn’t like that. It was almost called puke day in some cases, especially when you’re doing the 800.
Noah Laack-Veeder (02:59) Yeah, I do. Yeah. I know the feeling. Yeah, the taste of metal in your mouth. Not a good, not a good feeling.
Garrison Goodman (03:06) Yeah.
Noah Laack-Veeder (03:07) Garrison’s like what’s that I’m like I,
Garrison Goodman (03:09) know, I mean, like I was a football Guy in college, so we did not do long distance, but every year when we would finish, you know, summer conditioning, we had the sioux test. We were the fighting sioux at the time and that was on the field. You go… you know, you’d start at the goal line. You’d go 25, back 50, back 75, back 110 110 and you had to do it in under three minutes. And I mean, from my back down to my calves would just be lighting up. You mentioned the puke test. There wasn’t even a test. It was just guaranteed it was coming up.
Rob Horrar (03:47) We call those suicides. Yeah… that’s funny. Yeah, I was wish I could wish I had, that stamina these days?
Garrison Goodman (04:00) I wouldn’t even try.
Rob Horrar (04:04) My last, my, I did, so, I did a marathon. I did one and… I don’t know if you’ve ever done that before, but I finished it and of course, the training of it was eight months, you know, it was pretty.
Philip Stefani (04:17) Long.
Rob Horrar (04:18) Loved loved the training, but the actual event, I finished it and I said, okay, that’s going to be a check off the list type of thing. Yeah.
Kyle Brinkworth (04:27) Yep. Noah.
Garrison Goodman (04:28) Just ran one on his birthday. I’m more of like a steak and a whiskey on my birthday kind of Guy, but, you know, Noah.
Rob Horrar (04:35) Decides, to,
Garrison Goodman (04:36) run, you know, from.
Noah Laack-Veeder (04:37) State to state rob you and I have a lot in common. 800 people doing marathons and retiring. Yeah, that was, I ran Boston and I said that’s it, I’m done with marathons no more.
Rob Horrar (04:48) For me, it was more about wear and tear on the knees.
Rob Horrar (04:51) You know, I didn’t want a knee replacement before I was 50… but all good. I don’t Kyle was in the car, I think.
Kyle Brinkworth (05:02) I’m here. Hey?
Noah Laack-Veeder (05:03) Kyle, oh, yeah.
Kyle Brinkworth (05:06) I was listening to you guys to lament about the running here. So, I married into a running family and it, you know?
Noah Laack-Veeder (05:15) Oh, so now you’re a Turkey trot kind of Guy, is that?
Kyle Brinkworth (05:19) We’re, the, yeah, 100 percent Turkey trot, and then did a handful of half marathons and I was like, yeah, my brother in law ran like cross country and track, like in a D, I program my other married in, brother in law the same. And then it’s like the, you know, high school track and field coach and all just, I mean, he ran like, what was it like at 57 Miles some race a couple of weeks ago, just for the fun of it? Like, and there was only like, it was like less than 20 people entrance, it was ridiculous. So, so I’m not one of them that’s for sure.
Noah Laack-Veeder (05:56) Okay. Some.
Philip Stefani (05:58) People, I do have fun that’s funny. Cool. Well, we can get started but always love talking about running. I know we got 45 minutes on the calendar. Does that still work for both of you? Rob and Kyle?
Kyle Brinkworth (06:12) Yeah, I have a hard stop after that. So all.
Philip Stefani (06:15) right. We will, we will make sure we’re covered with everything by then. So, in terms of the agenda, just want to run through real quick problem statement, just make sure that that’s what we’re attached to for the demo today, get your eyes on the platform and your feedback on the workflow specifically for rbts. But I do want to highlight like everything that NOAA is about to show in the platform. Also applies to like any enrollments that you’d want to do with bcbas or any of your billing providers, and then want to get your feedback on kind of the workflow specifically and then run through, hey, this is how we think this makes sense for rbts. We think there’s also a case to be made for doing some of the more or some of the other billing providers more holistically, but really just want to get your feedback on kind of what makes sense, from your perspective. Is there anything in particular outside of that, you were hoping to cover? No. Okay. Sounds good. So real quick, just on this problem statement, we want to make sure we’re tracking what is most important to you. So, Noah garrison and I, we had a chance to go back over the notes. It seems like for the rbt enrollments, like it’s not the timeline itself necessarily that you’re having trouble meeting you’re. You’re actually hitting that timeline pretty consistently. The issue is how resource intensive it is to manage to that timeline. And essentially, you’re having to provision ftes on the credentialing team who you thought would, you know, just be focused on the bcbas and other billing providers. They’re now having to focus on the rbt piece. The success rate is pretty high, but, it’s just resource intensive to hit that timeline. When you do miss it, if you do miss it, there are write offs associated with it. But primarily, what we’re looking at is just cutting down on, the resources associated with this piece. Are we tracking that accurately? Is there anything you’d want to add or edit about this? Yeah. Okay. Perfect. Well, yeah, excellent. Yeah, I’ll pass to Noah and we’ll get into the platform.
Noah Laack-Veeder (08:21) Yeah. Excellent. So, yeah, what I’m going to show you is just what a provider’s journey could look like within the platform and ultimately just showing you what this is going to look like and how we feel it’s going to cut down on resource constraints. So, let me just jump right into it.
Noah Laack-Veeder (08:43) All right. Can you see Michelle anderson on your screen? Yes. Excellent. So what you’re seeing here is what we call a provider profile. And if you’re thinking about Michelle being an rbt in your organization, there’s going to be data that we need to proceed with credentialing, right? For providers that have a caqh profile, I know that’s not the case with the rbts. We can leverage caqh to get this information, but how we do this with your rbts would be one we can ultimately integrate with paylocity. So if there’s information from paylocity, we can use API integrations to pre populate Michelle’s profile. It could be paylocity. It could be Salesforce. I know that we talked about there not being that robust integration yet. But ultimately, depending on which integration we want to use, we’ll pre populate this with the data that we’ve already got. And then if there’s any data that’s not in here, we can either use a resume scan or other OCR technology to pre populate it or we call them the provider admins. They can do work on behalf of the provider, where they can go in here and start updating information or adding documents for providers. Providers can do it themselves too. They can upload things. They can scan this QR Code and upload documents from their phone. But typically, what happens is providers will work with an admin on your organization side to finish up the data collection piece. So just to wrap it up, ultimately, how we’re envisioning this workflow working? Is we get the data from paylocity or Salesforce use an API integration to get into medallion. It will highlight any gaps that need to be completed. And then once everything’s done, we can proceed into the next step. So, rob and Kyle.
Kyle Brinkworth (10:27) Yeah, quickly on that one. So how does the, in this case, Michelle see the either get to the QR Code portion or like they get a link that’s dropped to them to do that? They have to have a medallion login? Like how does that portion work? Yeah?
Noah Laack-Veeder (10:43) So the ideal workflow that we want would be let’s pre populate as much as we can before Michelle logs in for the first time. So what her experience would be, she’ll get an email. She clicks, get started and I’ll show you this later in the demo, what that provider view looks like, but she can only see her profile her tasks and then her licenses and payer enrollments. She can’t see everybody’s stuff. Ultimately, she’s got her own view in the platform where she could update things. But the truth is Kyle and rob, most of our customers are having their admins do the majority of work for their providers, where providers, the only thing that they need to do is just do the attestations to get this work completed.
Rob Horrar (11:26) Yeah. You know, Kyle, that might be a resource we don’t have because I think it’s really the center managers are not going to do that, right? It would be when we rely on the rbt themselves to provide a lot of the documentation. So, the biggest issue is we have that gathering all of the necessary items from the rbt so it’s complete and we can submit it to the state and so they would be responsible. And then the oversight from the local center manager. And then ultimately, our credentialing team could see what’s still outstanding. We want to prevent the rbt from being assigned any patients before any of this is completed and submitted. So that would be, I’d be interested to see how you, how we track what’s missing?
Noah Laack-Veeder (12:16) For sure. So what I’m showing you here is kind of what that provider view looks like. Do you see welcome Naomi on your screen?
Rob Horrar (12:23) Yeah.
Noah Laack-Veeder (12:24) There’s a mobile version of this too, which just think of it as just literally like a phone representation. But what it would show is like look your profile as 100 percent. And if there are any tasks that are outstanding. So, for example the Indiana medicaid background check or the fingerprinting for medicaid those would be surfaced to Naomi as saying like these are blockers before we can move forward. But our admins would also be seeing that we’ll send alerts reminding these providers. But ultimately, like if we’re getting stuck on things, we want to make sure that the admins are you call this, center managers have awareness of that. So when I say kind of normally organizations work on behalf of their providers, it’s not a full time role. Ultimately, it’s like, hey, there’s a couple of things outstanding here. How can I help this provider speed this up? Which is usually by like picking up the phone or, you know, walking over to them is kind of how that works. But does that, does this help you understand a little bit more about what that provider view looks like? Yeah. And so back to that question, rob and Kyle about that kind of the rbts doing the work themselves today, there’s from what we talked about, there’s kind of tracking happening maybe in Salesforce, correct? Or is there any tracking of this today for the providers or?
Kyle Brinkworth (13:47) Salesforce today, the rbts really can’t even see it. It’s more the center managers can see it and partner with the credentialing team to do so. Got.
Noah Laack-Veeder (13:56) It, so it sounds like the visibility for rbts today, they don’t have visibility into this. It’s kind of like the center managers sending them an email or kind of hoping the rbts remember, is that kind of how that’s working? Yeah.
Kyle Brinkworth (14:06) Generally. Yeah.
Noah Laack-Veeder (14:08) So the difference here is that they’ll know what they need to do. Ultimately, there’s going to be dependencies on rbt to get all this done. We think we’ll speed it up by summarizing this, but zooming out to the kind of broader process. There’s going to be efficiencies with the payor follow up and traceability as we kind of go further in the process as well. But kind of seeing this provider experience. Is there any other questions you have before we move into the enrollment process?
Rob Horrar (14:39) None for me? Okay?
Kyle Brinkworth (14:41) I do have one question actually just on the specific access fingerprint piece, how does that actually then flow through? I don’t know if that’s a live thing in the demo or how does that circle back to the provider actually driving to where it needs to go?
Noah Laack-Veeder (14:56) Yeah. So if they click into this, what I try to do is like really represent what this could look like. And obviously you might have like a task template that you’re working with your providers on. But whether it’s Indiana or Arizona, I know they have those very specific vendors and they can do one or two things. So if you look at, this kind of goes through for a provider, they can click on that task and see the steps. So what we try to do is make it. So if they click into this, they know the steps to do this activity on their own, but from an admin as well. If they’re coaching a provider, they can also follow these steps. Ultimately, they can click this link, go to the, this is kind of a demo. So I can go right to it, but it would open up to this website for the Indiana and then for Arizona to kind of get through and schedule all that. And then when they’re completed, they can quickly go in here and just do done, right? I did this. I scheduled it or it’s still pending, they can choose the status, but ultimately, again, rbts need to know what’s outstanding. We also think we can expedite this with templatized tasks to tell them what they need to do. Ultimately, they still need to go through these vendors to get it done. So this is how we’re expediting it in the best we can early on with that provider experience.
Rob Horrar (16:15) So, I’m just sort of thinking out loud, Kyle, and correct me if I’m wrong, but we have almost 30 locations in Indiana and each center is, you know, once you get an rbt, they’re assigned only to that center. So it would probably make sense if there are 30 different, I guess… tabs. So the center manager knows who is in their list and they don’t we have issues where it happens rarely. But when it does, it’s a problem where you hire an rbt and then they want to put them in another center. This would almost prevent that from happening. In my view. Is that say if we’d almost have 30, each center location would have and it would roll up I guess to credentialing? Yeah. So you’d almost have guardrails from an rbt starting at another location rather than the one they’re trying to be. We’re assigning them to? Is that there, Kyle? Yeah.
Kyle Brinkworth (17:12) I guess that’s a good question maybe to Noah then. So like if you’ve got multi site providers that cause coverage and, or say, hey, we want to enroll across all the pieces, like how does that… potentially work? Because right now, so like in your paylocity API, you would assign it to Carmel location and it would roll up through that side. But then how does that then get to the other end where you would say, okay, if an rbt is in this location, we also want to add them to the four nearest locations or something like that. Is that something that the credentialing team would have to work with explicitly? Or how does that work?
Noah Laack-Veeder (17:50) Yeah. So let me just make sure I’m kind of understanding the question. So with the multi location piece, is it true that they would still only need to do like one Indiana medicaid background check and fingerprinting, right? Correct? They just have to do this once, yes. And then the next. So then the next step would be okay. They did this. Can I have like if I’m a center manager, can I just have a view of my individuals that need to go through this process? And then ultimately, hey, we want them to be enrolled in. Let’s say five locations? How can we make sure that information is all in here? So Kyle, just to confirm the location information that’s in paylocity today or that’s like a, or Salesforce or that’s like something that needs to be decided before they get enrolled? Is that, do you know what I’m asking.
Kyle Brinkworth (18:36) I think, yes, it pseudo lives in Salesforce, but I don’t know that it’s abundantly clear.
Noah Laack-Veeder (18:44) Okay. Yeah, fair enough. So let’s say there’s kind of two aspects like one. Let’s say it is like… clear in Salesforce, we can ingest the locations via API. So like that could be preloaded. The other thing is if you need to add folks, you’re seeing Michelle anderson in her practices, correct on your screen, yep you can copy from another provider. So let’s say that that’s an interesting option that some people use, but you could also add practices that are kind of associated with the group. So if you’re enrolling via like group contract, there’s gonna be locations associated already. So you can, as an admin, you can say I want Michelle anderson to be part of arbor health partners as well. You click it and then we’ll add it to that provider. So ultimately how I see this going is if it’s in Salesforce, great, it’ll be pre populated in the system. If we think we need to have additional practices associated with that person, you can add them to that provider before we submit the enrollment. Let’s say you forget, we can process a demographic update to add that location down the line as well. So there’s a couple options there. But Kyle and rob thinking about how that’s happening today, how are we adding the, or how are you, how are the center managers, or are you all kind of thinking about adding locations before you submit them?
Rob Horrar (20:19) That’s a good question. I would tell you. It’s it might be more organized than I think it is.
Kyle Brinkworth (20:26) Yeah. There’s a couple of structures where if depending on the provider type and, or the location that are, you know… they are just known structures of like, hey, these people are going to be supporting locations that are close by. Typically, it’s not across the board but it’s there’s probably more, you know, we do this just because it’s in somebody’s head versus actually like systematically built out.
Noah Laack-Veeder (20:58) So what I’m hearing is like there is a structure in place, maybe it’s not like… in a technology so to speak, but ultimately, what we can do in implementation is say like, look if you want to base it on their location, have these five locations automatically assigned to them. That’s something that we can do as well, right? So let’s say you forget great at it. But ideally, what this would look like is a new providers in the system. We kind of take that out of the head of that individual and just pre populate in the system. So, and I’ll show you how this all carries forward. But ultimately, I think what you’re asking is, hey, how do we make sure we don’t get some issues down the line by not associating a practice when we start doing these enrollment applications? Am I thinking about that correctly?
Kyle Brinkworth (21:42) Yeah, I think so. Yeah, I.
Rob Horrar (21:44) Think you are, I think you’re right? I think if this is something, we go, the call out would be this if we go down this road with you all, there would be some functionality. We would need to do what we just said, multiple locations for an rbt. And there’d need to be visibility where we didn’t have to do it five different times. That would be the same documents populating. Yeah, yeah.
Noah Laack-Veeder (22:11) And we can, we’ll accommodate that. Some organizations like it’s kind of ad hoc they’re like we don’t know yet. So, but if you have like the process, we’ll just have that be part of the algorithm so to speak. So, yeah, let’s talk about that then. So we got all this information in, we got the practice locations assigned. Let’s submit the payor enrollment request, that’s the piece here. And so, yeah, with that, let’s just jump into payors here. So the process here, there’s a couple things that we talked about that are going to be necessary when you submit an enrollment one, collecting the data we talked about. Then it’s submitting the application. Then it’s quality checking the application. And then it’s monitoring all of the follow up ongoing until we get par and then tracking the revalidations and kind of kicking off that workflow again. So there’s a lot of work that’s necessary. So with medallion, the process is you’re just going to request the, this is an RV team. It’s Michelle, you’re going to request the enrollment. So I need Michelle as part of this group. And ultimately, if you, how many tins do you have? Is it just one or how many tins are providers typically associated with?
Kyle Brinkworth (23:22) Yeah, it’s changing today. It’s generally one. Okay?
Noah Laack-Veeder (23:26) Cool. So what typically happens is you’ll disenroll this individual with all plans under that group. And I’m sure that’s how it’s happening today. Are you actually picking and choosing which plans you want them to be a part of? Well.
Rob Horrar (23:41) This, only, this issue is just for medicaid, just the medicaid plan. Yeah. So.
Noah Laack-Veeder (23:47) The only one that would come up would be medicaid here. Obviously, this has like all of them but like let’s just do cigna just so you can see it. We choose cigna… commercial. But in your case, it will literally only say the one tin and then it’s going to say the states that you’re eligible for, and then medicaid, right? And so then we do next. And then this is where we select the practice locations. So if you’re like I want to prevent any issues, I just want to be all encompassing you’ll just enroll them with each location assigned to them. So there’s no double checking necessary. It’s like, I just want to make sure all the locations we loaded in here. They’re going to be enrolled in, right? Then that’s the process of requesting enrollment. What medallion will take over is the application quality assurance. So we’ll actually double check that all of the requirements that payers will be looking for are good. So, for example, something that a lot of teams struggle with is just making sure they know the rules and regulations and double checking that all of the data is matching all the downstream status sources. We’ll check that automatically. So that works off the plate. The application preparation and submission is done automatically through medallion. And then all of the follow ups that are going to be required for this are also going to be handled by medallion. So let’s say a payer reaches out, they’re saying, hey, we have this outstanding item. We’ll use our artificial intelligence to scan that email. And if there is a task that’s necessary for a provider, it would be routed right back to that provider. But if medallion can just do it, we’ll just take care of the follow up front. And then the last piece I’ll say is the tracking of everything. So making sure that all of the statuses are being updated, we track those as well. We have integrations with the payer systems. So when status updates to par, we’ll send you a notification immediately saying this person’s now in network in the context of medicaid and the managed medicaid plans. Some allow us to do it in parallel. Some have a clear dependency that medicaid number is assigned first. Before we do the managed medicaid, we will submit that managed medicaid as soon as the medicaid number is assigned. So ultimately they, oh go ahead Kyle.
Kyle Brinkworth (26:06) Expand further on that one though because I think that’s so, is that an automated process or is that a flag? Yes. Then somebody has to go. Okay.
Noah Laack-Veeder (26:14) It’s automated. Yep. So how it works is you’d request both at the same time. And then it’s more like if the algorithm is, hey, does the payer allow us to do both at the same time? We will, if there is a clear dependency that we can’t submit or if we submit early, it’s going to delay the timeline, we will automatically submit. What was that? Which?
Rob Horrar (26:32) Is the case? We have to have the number yep.
Noah Laack-Veeder (26:35) So we will, as soon as we get the number that managed medicaid application will be sent out. So, what that, the result is kind of us making sure we get those timeframes there’s no lag in between that par, effective date.
Rob Horrar (26:51) Actually, actually, I think I’m wrong on that. I think it is. So, here’s the situation when we submit, when the fingerprint comes in, we submit that rbt to ihcp which is in the medicaid application. Yep, the medicaid Indiana medicaid which is also a provider recognizes that date of submission as the effective date, the MC, then we submit once that once we submit, then we push to the mcos and, they half most, half of them recognize that date of submission and the others the first of the fall of the following month. Yep. So there’s a, and that’s really the difference. So, what you’re saying is you’re querying the state to see database which we have to do on a daily basis automatically. When that, when ihcp says, they’re assigned? Yes, yes.
Noah Laack-Veeder (27:59) Yes.
Rob Horrar (28:00) And then, so you’re telling me that you would produce that roster for the mcos to push out as well? Yeah.
Noah Laack-Veeder (28:08) Yeah. So, how is like, what is I’m guessing that’s a pretty resource intensive process today? Yeah.
Rob Horrar (28:17) Well, all the follow up of what’s missing is, and then clarity from the center manager on when to be able to use that rbt? Is that… about primary? And then, our revenue cycle needs to know when they can start sending claims. Yeah, because we’re holding claims since there’s retroactivity in all of this?
Noah Laack-Veeder (28:44) Yeah. So it sounds like with that process, the instantaneous feedback if we could route it to the revenue cycle team, there wouldn’t be kind of an Ar backlog. Is that how you see that surfacing? No, I think what?
Rob Horrar (29:01) This is going to reduce is that risk where we’ve got an rbt that has started assuming we have a date and they’re not yet and that date has changed and, we write off those claims.
Noah Laack-Veeder (29:13) Got it. So it sounds like go ahead, Kyle, no.
Kyle Brinkworth (29:16) I, this maybe I’ll add this part because this may inform how you address the next part of the question because I think it’s important on the like effective dates and your point earlier on like depending on like immediately kind of like gets out of this part… as soon as it’s submitted. And that submitted date is right now again the case that they will actually utilize and they’ll backdate to that date. So help me maybe think about like how that would relate then to the system of like recognizing to kind of rob’s point of like when they could actually be utilized. Is the I’m assuming in your in the system, right? Like we can derive this payor does it by application submitted date. This payor does it by when it actually is submitted. And like how then we think about like being able to tie our scheduling tool to credentialed or non credentialed providers. So I think that that’s maybe the broader ask is that rob anything else that I’m not saying? I guess in that your broader question?
Rob Horrar (30:14) I have a thought to add to that and that is more importantly when we can or can’t bill. I think that’s that is the last piece of it.
Kyle Brinkworth (30:25) Right. Yeah. So that’s so I’ll maybe expand on that piece too is like look if I can see this patient and I’m just waiting if hopebridge wants to decide to take the risk to see this patient if it’s okay that the payor allows it, but I can’t yet bill those records. So there’s like almost a two step of like, yes, they’re eligible but can’t bill. And as soon as we have the confirmation, then you can actually release those claims. So it’s like a two stage piece. And I’m sure that there’s something like your structure or thoughts around that for other that you’ve done with other organizations would be helpful because my understanding of that, that’s not like a unique thing even in billing providers. Yeah.
Philip Stefani (31:01) I can jump in here. Actually, Kyle, on that billing piece is the data point that you would need essentially just the effective date for that provider with that payor?
Kyle Brinkworth (31:12) It would be the effective date, yes, but we need to know also then the date that they actually process that effective date. An example, if I submitted an application on three one, I’m technically effective on three one, but they don’t process it until three 31, I can’t actually recognize you as effective until three 31, even though they will backdate and pay claims from three one to three 31. OK?
Philip Stefani (31:41) Got it. Yeah. So the way that we track these, we’ve got two different pieces, one would be the effective date, which is what we’ve been talking about. And then.
Kyle Brinkworth (31:50) what.
Philip Stefani (31:50) you are talking about in addition to that is the submission date or the process date. So medallion is tracking both of those. What we have seen from other organizations is essentially like if you recall in the platform, all those different columns that Noah was showing us, those are all dynamic data points and can be sent out via API. If you have a rep cycle platform or something like that. So effective date and submission date are often what we see ported out of medallion via API into rep cycle. Once the effective date or the submission date is received, that’s what tells the rep cycle team that they can start billing. Usually, that is how it’s solved with medallion. But curious if that answers your question.
Kyle Brinkworth (32:35) Yeah, I think so. Rob. Yeah.
Philip Stefani (32:39) Yeah, I think that’s.
Rob Horrar (32:40) right. I think it would just have to be mapped and the various stakeholders have to be trained on what dates to look at for their respective billing date or whatever. Yes. Yeah.
Noah Laack-Veeder (32:52) And just to kind of summarize this, how I think medallion is helping this kind of broader visibility. I don’t maybe challenge is too aggressive of a word, but it sounds like getting those submission and those effective dates can be a challenge and it’s manual. So you’ll have those data points automatically surface within medallion. And the idea would be we can use API connections to get them down to the downstream systems. Ultimately, how we feel with how that could help is if we’re writing off claims because of a delay in this, we’re going to be directly tied to that. And so rob and Kyle kind of thinking about, you know, generally like do you have a measurement of like how many claims are getting written off because of that lag today?
Kyle Brinkworth (33:39) Yeah. There’s some, the more the larger item is that the lost revenue from not being able to actually, you… know, put them to work. Essentially that’s the bigger item is because hey, we don’t have all the things that we need whether it’s for credentialing side and, or the provider side. And it sits there and we can’t process it.
Rob Horrar (34:02) And we’re paying their salary, right? Correct?
Philip Stefani (34:06) Okay. That’s super helpful. So there’s essentially two sides to this one would be you’ve got the provider lag period where they’re not enrolled yet. You’re paying their salary. And then on the claims piece itself, some of those are getting denied because of the timeline discrepancy. And so both of those would have impact if you could solve those pieces.
Kyle Brinkworth (34:29) Okay.
Philip Stefani (34:30) That’s helpful. I know we’re limited on time. So I do want to go through a couple of these other pieces. I think just broadly speaking in terms of the workflow that we looked at comparing to, you know, you kind of walked us through how it’s happening today with, you know, the rbts are providing the information themselves, but they don’t have much visibility into what they still have to share with hopebridge. There’s also an issue with getting applications kind of out the door pursuant to the different requirements, I guess compared to how that’s happening today, what is your feedback on what we went through today with medallion in terms of comparison?
Rob Horrar (35:04) One piece we’re missing is the follow up that needs to happen when we have an rbt that has not still has one thing to submit. You know, we’ve got different people making phone calls to get that paperwork in. Where does that take place in this contemplated… system? So rbt we’re still waiting. It’s showing up. It’s a red flag on our report. It shows it’s still waiting on this piece of information for this rbt. How does that? I guess there’s a stoplight report that goes to, can be sent to a center manager? I’m just that is a lot of the back and forth. I submitted it. No, you didn’t I faxed it. I sent, emailed it, you know, those types of things. Yeah. So.
Kyle Brinkworth (35:59) What are your follow up notifications within the platform direct to the provider or from the administrative perspective as well? Yeah?
Philip Stefani (36:06) 100 percent. And I know we actually didn’t have a chance to dive into this too much because we just kind of wanted to show the wave tops of the workflow and, you know, basically the outcomes and, you know, assuming we’re barking up the right tree here, we would spend time on your specific sops and kind of how they would modulate with medallion. The short answer is we’re tracking exactly that kind of.
Rob Horrar (36:24) Fair point. Phil, there’s there is some, there’s some minutiae here that Kyle and I are, you know, the team that’s working on it would probably have some more connectivity on this too, but no.
Philip Stefani (36:36) We, we love the details though in just short answer to your question, like we’re tracking those outstanding items. And then essentially the administrators would have visibility to what is outstanding still as well as the rbts. And that could be escalated within the platform in terms of direct communication to the rbts on those points as well as like, you know, exactly like you said, a stoplight report, like what is still outstanding sorted by how long has it been outstanding? That sort of thing would definitely want to dive in on that deeper. So, you have comfort in terms of, you know, how we’re tracking those pieces down. But yeah, like I said, like focus of today, we wanted to align on the outcomes which is essentially like automating the process for data collection, attaching those to the applications, getting those applications out the door in a more predictable manner and then giving you tracking into those as they move through the process. I think overall, yeah, it sounds like there’s some outstanding details to go ahead you.
Rob Horrar (37:34) Have to cut to the chase. I assume that you are willing to propose a price structure to do just this project?
Philip Stefani (37:47) Yeah, exactly. Yeah. So… just, yeah, to cut to the chase, this is how we took your current setup to be. You’ve got six individuals doing the PE for all of the billing providers. It sounded like you had peeled off two for rbts. And then we just wanted to align with you on kind of how that element of the team was growing. If you’re maintaining the current ratio, it sounds like, you know, by 20 28, you’d maybe add one person to that workflow but, is this aligned with kind of how this looks today?
Kyle Brinkworth (38:32) I mean far off, can we just anchor to? So the bottom section, the well, the credentialing team, your, the bottom.
Philip Stefani (38:45) Section is just the piece that is peeled off for rbts. Yeah.
Kyle Brinkworth (38:49) For clarity, the right hand side is the annual credentialing volume that’s what you’re saying is done with, yeah.
Philip Stefani (38:59) With two, two individuals, yeah.
Kyle Brinkworth (39:05) Rob, any, there’s a few things that are just like maybe generally off, but, well.
Rob Horrar (39:12) Just to be just to be clear verifiable is not doing anything for rbts, right?
Philip Stefani (39:18) All right. I just, I was putting, I think.
Kyle Brinkworth (39:20) You only got that. Yeah, the inclusion of the manager is probably not, a fair structure… but I don’t know how you’re doctoring that in. So, yeah.
Noah Laack-Veeder (39:32) So maybe back to rob, you said kind of like the proposal around just the rbts, is that like 130,000? Yeah.
Kyle Brinkworth (39:39) It’s less than that, but we’re not that far off like.
Noah Laack-Veeder (39:42) Okay. And then the table below is just projecting out. And again, I think we mentioned the manager piece, that can be that, but we’re still envisioning that team having to grow up to three resources. Given your volume. Does that sound like around direction? I mean, obviously, we’ve got to fine tune the numbers but directionally, do we think we’re are we aligned? Yeah.
Kyle Brinkworth (40:05) Yeah. And I think when we were looking at the manager, it’d be like part time like you’ve got a team of six eight and you’re yeah, two people. So, yeah, you’re just applying the ratio. Yeah. Again, we’re in at this stage, just spitting distance. Yeah, perfect.
Philip Stefani (40:20) So, yeah, I mean, in terms of what we put together, you know, based on the workflow, we just looked at, there is a world where we do that just for the rbts. We also think, you know, it would be very interesting to look at this for all of your billing providers because all of those impacts that we just went through extend to those providers as well. And for billing providers, there’s actually additional… automations that are not available for rbts that I think provide additional impact there. So in terms of your entire credentialing function, there is the ability to, you know, if you are adding headcount for all of your billing providers, avoid the need to add that team and potentially even expand, the ratio that a single fte, is responsible for. So, yeah, we were curious if you’d be open to looking at this for all of your billing providers.
Kyle Brinkworth (41:14) It’s it’s not obvious to me how it works with the existing CDO and verifiable and I just, I don’t know enough about it but I don’t know that we’re gonna want to do make… a quick switch on that front to rob’s kind of prior points.
Kyle Brinkworth (41:33) But, yeah, I mean, main pain point today, I think is, the rvt piece. Only the one thing we didn’t cover on the rvt side is still like how we connect to the bacb because that’s the other like core item that I don’t know that we’ve explicitly said that you guys can handle or not handle for.
Noah Laack-Veeder (41:49) That question, Kyle, are you asking if we can handle the babc’s enrollments as well that?
Kyle Brinkworth (41:55) You need to in Indiana specifically, you need to like grab the bacb confirmation data to attach to the application?
Noah Laack-Veeder (42:05) Yeah. Okay.
Kyle Brinkworth (42:11) I think it’s great, right? You’ve taken the approach more so on like the standard billing provider aspect, which I think is like again makes sense. We don’t terribly… struggle with that today and we’re getting better with the existing structure that’s in place. I think there’s been a lot of assumptions made with the existing platform and the rbt side explicitly like what we can and can’t do. And that makes me a little bit nervous. But again, I think that the reason for the conversation is absolutely like the rbt is our pain point not to say that it couldn’t grow into something further, but that’s… like if we let’s say that we did do the right hand side and I can’t do the rbts. Like then this has just honestly pissed me off.
Garrison Goodman (42:57) Yeah, no, I think that makes sense. I think our approach was like, hey, we can solve rbts, but if there’s a way to consolidate vendors that doesn’t interrupt operations as you guys are thinking delegation and getting some of the things that you’ve already done, that was our thoughts. And I think I hear what you’re saying is like, hey, we’re open to it in the future. We kind of want to walk jog run with this, but we did just want to explore it because I know the concern before was, hey, we’re approaching delegation. We’re doing some things in flight. We just kind of had some conversations internally. We’re like, hey, I don’t think that would interrupt anything. And so we just wanted to explore if that was the only friction point, which… was the approach towards delegation with some of your payers. Is that the friction point of looking at medallion to manage things holistically?
Kyle Brinkworth (43:56) Yeah, I think so. Yeah, right. Because I think we’re the verifiable structure we’re like again meaningfully down the path with on that end. And I recognize that it’s like cbo and the delegated side, but that’s what gives us pause is like, how do we not have a lot of different moving pieces here? The rbt is like very segregated. So we’re comfortable with like having a separate tool that would handle that just because of how the structure works today. But all of a sudden, if we’re roping on two separate tools one again which we’ve already engaged like and it gets messy like that’s where it just doesn’t make sense for us at this time to like really pursue that.
Garrison Goodman (44:37) Okay.
Kyle Brinkworth (44:38) I think.
Garrison Goodman (44:40) I think we hear you. And so, I think there’s a possibility here. It sounds like.
Kyle Brinkworth (44:45) You all,
Garrison Goodman (44:46) are comfortable with the solution? You just need us to probably come up with, hey, what does the proposal look like?
Kyle Brinkworth (44:54) Yeah, I think it would be helpful to just really flush out that like one of the main like because even today I’m in like a broader, you know, teams chat that shows, hey, so and so is active on the bacb. And our credentialing team says, well, they’re missing X, y and Z and it’s like that just takes hours per hours every week to just say this person shows active on the bacb. Does it actually have all the filled out material so that they can take a little screenshot and attach it to the application? So that’s one where we just, we want to very clearly know where you guys would can help, not help, et cetera.
Kyle Brinkworth (45:39) Yeah. So I.
Philip Stefani (45:41) think, yeah, we can definitely map out specifically on that workflow where we would be involved and kind of what your team would still be doing. And I think in parallel with that, we can show, you know, hey, this is what we think it would cost to actually do this work for you. Those are probably the two kind of open items and I can follow up with like what inputs we would need to put that pricing piece together. I’m trying to think, is there anything else garrison? Did you have anything else on this? No?
Garrison Goodman (46:13) Not the moment. I think we just need to because we weren’t sure how exactly you wanted this to break out. So now we just have to go confirm things on our end. Like I said, we’ve worked with a lot of Abas but it is a little bit more unique where we’re just doing rbt. So we just have to come up with the right structure internally so that we can track things appropriately.
Kyle Brinkworth (46:34) Yeah. But I also think it’s important like the Aba landscape is fundamentally changing. And so our concern is that we meet with people that say, yeah, no, I do Aba, it’s the same thing like here’s a really great example. It’s on a totally different side, but it’s like, yeah, we do benefit checks. We do benefit checks all day long. We do it. It’s like tell me how you’re going to do an Aba benefit check in your automated system? And literally everybody that’s come back said, well, no, we can’t do that. So, we work with four different providers all saying, yeah, we can do this that and then it’ll all be all in the same way. So not suggesting that this is going to go that route. But I think the Aba behavioral landscape is a fundamentally changing. It’s different in a lot of those pieces. So we want to be eyes wide open to like what exactly you guys are committing to that you can accomplish for us. We also recognize like we’re not trying to be overly dense here about, I don’t need two systems to do the whole thing, but we are materially down a path that’s not going to solve our rbt item. So we wanted like, can we do both? Which is not like a huge deal for the teams because they’re wildly separate today anyway. But then over time, if the rbt side really works with the dally, and we recognize there’s longer term benefits to some of the stuff that verifiable may or may not do. And that just opens the door for, you know, a longer relationship in that side. But like the rbt piece is like, that is where we need to solve. Yeah.
Garrison Goodman (47:58) Thanks for that.
Rob Horrar (47:59) And to be clear, it’s also a Florida issue for us and an Oklahoma issue. These are much smaller markets for us. Yeah. But we fully expect other states to adopt rbt enrollment going forward, but this is not going to stop in three states. So the opportunity is that and, you know, who knows what the future holds?
Kyle Brinkworth (48:20) Yeah, thanks for.
Garrison Goodman (48:22) The clarity on that. It really helps us communicate internally as to what your business is facing, where the burning need is. And also like, hey, what does the long term relationship look like? Yeah.
Kyle Brinkworth (48:32) Because the only other thing like in 30 seconds is like our team can do like we can rededicate resources to building out a much more comprehensive like linear structure to help with maybe the provider specific items. What we can’t not what we can’t do, but we don’t think it’s in our best interest to prioritize all the other connections that you guys have already built. But there’s still that X factor on like let’s say again Indiana medicaid, like how would you actually submit the application? And that’s where this relationship is like, of interest to us because again, we can do the provider stuff. We’ve got tools that we can build out without much of a problem. But if I get 50 percent of it, it’s not huge. I’d rather have a conversation with you guys to help us get the entire piece. If it’s not, then we’ll just prioritize kind of where we initially started with is the prior provider documentation, you know, portal that we can kind of build on our own?
Rob Horrar (49:22) Okay. Well.
Garrison Goodman (49:24) Yeah. I think just give us a day and we’ll be able to come back to you and it might even be worth scheduling for early next week to.
Rob Horrar (49:33) Play it safe. I.
Kyle Brinkworth (49:35) got to drop. If you can send some times, I’ll… give you maybe a day real quick like the, I don’t have anything until Wednesday… well, and Wednesday through Friday of next week, I can be fairly flexible, but Monday, Tuesday, I can’t rob, I don’t know if you got the same thing, but if you want to send over some times when you’re ready to do the proposal, we can probably do that. Yeah, yeah.
Philip Stefani (50:00) I can send over some times and then there’s one or two inputs that we need just on like kind of the volume of and what states those are happening in and we can build that out pretty easily.
Kyle Brinkworth (50:10) Awesome. Okay. Thanks, guys. See ya.
Rob Horrar (50:12) Appreciate it. Thanks, thanks.
Garrison Goodman (50:14) Guys.