Transcript
Fatima Nunes (00:06) Hello? Good morning.
Mallory Smith (00:08) Good morning, all.
Fatima Nunes (00:10) Right. They just joined. Are we good? Can?
Mallory Smith (00:12) I just say really quick? Pink is definitely your color. Oh my God. Your face is glowing.
Fatima Nunes (00:16) Really?
Mallory Smith (00:16) Absolutely within your palette. Yes. Okay.
Fatima Nunes (00:18) Thanks. Okay. I’m going to let them in. Okay?
Fatima Nunes (00:34) Hello? Hi, Neil. Hi, Scott.
Neil Brennan (00:36) Good morning. Hi. Can you hear us? Okay?
Fatima Nunes (00:40) I can hear you fine. Can you hear us?
Scott Call (00:42) Yep, you’re good. Awesome. I appreciate you both. Yeah, thank you. I always check because I sometimes have, we work at a, our platform is Google and Google doesn’t always love zoom or teams. And so sometimes our sound gets off, but, yeah.
Fatima Nunes (00:58) We’re good. No, no worries at all. We were actually on a call yesterday, me and Mallory and they send us the invites because they can’t use zoom. So they use teams only and they say, hey, we’ll join, but you won’t be able to hear us or see us. It’s like, well, that won’t be very productive. So, we’ll just use teams then. Very cool. Well, appreciate you both joining. I know we have the next 30 minutes blocked off for our call today. Does that still work?
Neil Brennan (01:27) You bet. Yes. Okay.
Fatima Nunes (01:29) Great. So, I guess we’ll just jump into it, right? By way of introduction, I’m Fatima, I sit out of Miami, Florida, probably a lot closer to you, Neil out in Maitland. Is that where you sit out of Neil? Yes. Nice. And Scott, are you, I saw Texas, what part of Texas are you in?
Scott Call (01:48) So I actually work in Maitland. So I’m here now, but I fly back on weekends, so I live in just north of Dallas, but I’m here just about every week in Florida. Okay?
Fatima Nunes (01:59) Nice. Wow. How do you like it? I mean, that’s a, what is that three and a half four hour flight?
Scott Call (02:05) No, it’s not bad. It’s two two and a half depending which way you’re going, so.
Fatima Nunes (02:10) Okay. That’s not too bad. Good. Awesome. Well, yeah. So maybe we can all catch up while we’re all in Florida, but I’m down here in Miami, part of the enterprise partnerships team here. Really what that means is I work with many of your peers across the country to help them determine, you know, if medallion can help drive some efficiencies and speed to their current credentialing and pay enrollment processes. So ultimately, I think the goal for today is to really learn a little bit more about your credentialing evaluation, what’s important to you and then share a little bit more about medallion and really to help you determine, you know, is there enough alignment for us to keep talking? Does that sound like a good use of everyone’s time?
Scott Call (02:51) Yes, you bet. Absolutely. Okay.
Fatima Nunes (02:53) Great. And then I do have on the medallion side, I have Mallory smith joining us. She’s one of our lead solutions consultant and if we were to move on to the demo stage, she’d be running point on that. So Mallory, I’ll let you introduce yourself.
Mallory Smith (03:08) Yes, absolutely. Thanks, vajma. It’s a pleasure to meet you both today. I’m actually up in Nashville, Tennessee, Scott, I have to be honest with you. If I had to fly every week, I would have the highest grade compression socks and I’d be like, I am so paranoid about like vascular health. So anytime I see a vein in my leg, I’m just like it’s from my flight. I just know it’s from my flight… but I love that. I love that dynamic. My husband’s father, he did the exact same thing. He works in the cattle industry. So he would fly out every single week. You make a lot of sacrifices for your family, but I think ultimately it pays off in the end. So, but yes, pleasure to meet you both today. I’m just here to support from a technical perspective. Thank.
Scott Call (03:52) You for that. Yeah, it is a lot of travel but I’m used to it now and it just seems like it’s kind of what we do. So, I mean, I actually, you know, I tell Neil here that I think my wife’s actually glad to get rid of me a lot of the time, so.
Fatima Nunes (04:06) You know.
Mallory Smith (04:08) Is it?
Fatima Nunes (04:09) The time for you to go to Florida yet. That’s funny. Well, we can talk about this all day, but my husband, he works for the department of state. He travels a lot and it is kind of nice. Sometimes, you know, you get a little break. They come back. You’re so happy to see them every time they’re back. So, I’m right there with your wife.
Scott Call (04:27) Yeah, yeah.
Fatima Nunes (04:29) And I know we did a little bit of LinkedIn research on the both of you.
Fatima Nunes (04:32) We understand a little bit about your roles, but we’d love to give you an opportunity to better introduce yourselves and then we can take it from there.
Scott Call (04:40) Okay. Go ahead, Neil. And then I’ll intro myself and then Neil, if I’ll let you, if you don’t mind doing the overview and kind of what we’re looking for that’d be great.
Neil Brennan (04:49) Sure. Yeah. So I’m the director of credentialing at new season. I’ve been here about nine months. I’ve got a team, an in house team of about five credentialing… specialists. And then we have two vendors, one vendor that handles provider credentialing enrollment, one vendor that handles facility enrollment and re creds and refiles, the new season is we’re trying to by the end of the year possibly go to delegated credentialing with some of our payers. However neither Scott nor I have delegated credentialing experience. I kind of have an overview of what it all entails but I don’t you, know, how to deploy it and keep it going and running and everything. And you can read and read all this stuff about it until you actually, you know, do it all. So we’ve been looking for, we were looking for either a fte to bring on board to help roll that out or we’re looking for a consultant to roll that out. I think that’s where candy came in and made the introductions from us, to you all. And then, so we’re looking for another vendor that can help us with delegated. And depending on the workload and how impressed or how wonderful delegated goes, we really would like to cut down to just one vendor… in the future so that we’re only dealing with one for, you know, provider credit, facility, credit and delegated if possible. So yeah, that’s kind of our goal that’s what we’re looking around, you know, talking to different people right now, trying to get everything together because I know we have to probably be doing delegated for four to six months before some of the payers will fully sign on to that. So the sooner the better, we’d like to have this as a goal at the end of the year rolled out. So we probably need to be making decisions pretty quick.
Fatima Nunes (06:32) Yeah, absolutely. To make sure I understood everything there, Neil, what you have an in house team of five folks, one vendor that’s managing the provider cred and then one that’s handling the facility cred there. And then the, you know, goal by end of year is just establishing delegation with as many of your I’m assuming top payers as possible.
Neil Brennan (06:52) You guys?
Fatima Nunes (06:53) Have a high level understanding of how delegated credentialing works. I’m assuming the benefits of that, but really looking for a true partner that’s going to be in the weeds with you, help you establish all the processes procedures, get all of that stood up. And then ideally in a future state, you just have one partner that’s going to be handling provider cred delegation and then facility credentialing. Did I capture all of that correctly, right?
Neil Brennan (07:21) That’s exactly right. And I forgot to mention also, we have about 95 clinics in 20 states.
Neil Brennan (07:27) So just want to give you a estimate of how big we are and we’re adding, we’ve got like seven to 10 additional locations that we’re building this year that we’ll be able to launch by next year. Are.
Mallory Smith (07:39) those regional or are they just kind of based on what’s the strategy there for expansion?
Neil Brennan (07:47) Scott, what is the de novo expansion strategy? What do they look for? Is it just the volume? And if there’s a need and for competitors and things like that? I mean, I’m not sure.
Scott Call (07:57) Yeah. So we’re in 20 different states. As Neil said, it’s about 325 providers, but only probably 200 of those would need credentialing.
Scott Call (08:10) Some of them are billable, right? Lower licensed folks, social workers, and other caregivers that are not billable. So we don’t credential them. But the decision to expand is really based on individual markets. Where do we already have a footprint? Where do we not, we look at where our competitors are, where the greatest needs are those kinds of strategic decisions. We have a whole business development team that analyzes markets and kind of makes those decisions of where we go next. So, but yeah, we’re opening a fourth location in Texas. This year, we’re opening, gosh, another two or three in Florida. We already have 33 in Florida. We’re looking at Michigan. We’re looking at, yeah, several new markets as well. So, yeah, we’re expanding quite rapidly.
Mallory Smith (09:07) Oh, that’s exciting. Congratulations. Yeah.
Scott Call (09:10) Thank you. It’s a lot of work as you.
Neil Brennan (09:12) Would imagine.
Scott Call (09:13) It.
Fatima Nunes (09:13) sounds like a lot of work. Okay. That’s all super helpful to understand… you know, typically when we hear organizations are looking to move towards delegation, it’s usually coming from leadership where they’re saying, hey, we need to, we’d like to accelerate revenue. We want to make sure we’re onboarding these providers as quickly as possible so that they’re billable sooner, right? So, with that in mind, is that really what’s driving the initiative to establish delegation with payers? Or is there something I guess really what’s driving that?
Neil Brennan (09:47) Yeah. So, Scott, if I can, I’ll talk first please. Yeah. So, we, in the past, in 20 25, we had a really bad we had, we used to only have one vendor for credential and they were, really bad and it was taking six, sometimes eight, nine, 10, sometimes 12 months to fully credential providers with all payers due to this. This vendor. So Scott early on in the last year figured out that this vendor, was bad. He’s the one that said, hey, let’s go out and try to find, you know, other vendors. I think it was a great idea to get two vendors and put them against each other just out of the bad luck that we’ve had with the one to try to see which one would be better. And so, I think it’s always been talked about, hey, how can we accelerate credentialing to go faster? And I think now we’ve got a really good provider enrollment vendor that’s doing a very good job. However, of course, exactly like you said, driving the money and faster is always top priority for the higher ups in the C suite. So, yeah, this has always been kind of like on the back burner. But I think this year we’ve got the right people in place and the right teams and the right financing. I think we’ve got it in the budget. So we really want to try to do that this year because of the speed of it coming from the higher ups. Yeah. And I want to learn more. This is an opportunity for me to learn about delegated because I’ve been doing credentialing for 1,215, 15 years. And I’ve always been with organizations that have talked about wanting to do delegated. And then once they find out the process, right? And the money and the time and everything, my former places, my corporations, they would always back away and back out of it. But I think new season is really interested in this and we’ve been, Scott and I have been tasked to, you know, find the right people and roll this out so that’s what we’re trying to do. Yeah.
Scott Call (11:42) And I’ll add, thanks Neal. That’s really helpful. I would add that our specialty and I don’t know how much behavioral medicine your group does at medallion, but we have, and I think it’s a function of the fact that we do opioid use disorder treatment.
Scott Call (12:01) We do, you know, addiction medicine, but our turnover rate of providers is very high. And so that as well is a motivating factor for us. You know, we have probably what 10 a month, Neal that we’re replacing out of those 325 that I mentioned, so quite a high rate… and that as you would imagine results in timely filing delays and denials from our payers, right? So we really want to bring that down. We also have quite a high percentage. I’d say 35 percent of our payer mix is straight medicaid. And then gosh, probably we have also a very high managed medicaid mix as well. So, you know, all of those require individual practitioner credentialing. And even though we have a high percentage as well of facility based contracts, and so we try to bill at the facility level as often as we can, a lot of those managed care, those medicaid agreements still require individual practitioner credentialing.
Scott Call (13:12) So, and then I’d also say that Neal mentioned the two vendors that we’re working with. Now we’re not necessarily looking to replace the one. The better of the two. Anytime soon. They are doing a great job for us however they’re quite expensive. And so, you know, we would like to bring on potentially another group like medallion that could help us, you know, fully with delegated. And then potentially as Neal mentioned down the line, move over to them. If you know, they come in with lower costs and those kinds of things. So, you know, we’re working into the direction of our CFO who is very cost sensitive as you would imagine. And we had our current vendor provide us with some pricing for delegated and they came back very high. So that’s another reason that we’re talking to others.
Fatima Nunes (14:15) Okay. No, that all makes sense. And I think going back to your point around high turnover, right? If you’re losing providers, I think we have a customer that came on board last year in opioid use treatment and they said high turnover sometimes by the time they turn over, they’re not even in network with the payer yet. And so it’s just lost revenue on salaries on just claims getting denied. So it’s a mess. Totally hear you there. I do have questions and I know Mallory has some questions here. I do want to clarify. So it sounds like you’re happy with the vendors you have. Now they are slightly more expensive than what you want, but ultimately they’re getting the job done. So really the big focus would be bringing on a third partner like a medallion to really support this delegation initiative and.
Scott Call (15:04) then.
Fatima Nunes (15:05) run all those primary source verifications for your providers, and then down the line, if it were to make sense, then kind of bring everything to one vendor and consolidate all these different functions. Did I understand that correctly?
Scott Call (15:18) Yes, exactly. Yeah. Now, I will just add again, sorry, I keep adding… our second vendor. We are tapering them down and that brings up a point. They outsource almost everything outside of the United States and that’s been a little bit of a problem. So it’s important to us to keep our vendors here in the U. S. On shoring them. They do a good job. But, you know, we’ve had to sort of teach them along the way about managed care and for us to have to teach a vendor. I mean, it’s just, you know, we don’t have time to be doing that and they’ve made some mistakes and, you know, things that we’ve been able to work through but it just, we’d really rather keep that U. S based if at all possible.
Fatima Nunes (16:09) Absolutely. You’d be surprised how often we hear that. They and I have a question around the vendors. Now that you bring up offshore, we hear oftentimes hey, it’s a lot cheaper to have a team out in Pakistan and India handling this. Sometimes you have 20 offshore people handling this, but maybe there’s like a skill gap there or there ends up being a lot more work on like Neil’s team of vendors oversight, making sure everything’s accurate, which of course ends up taking a lot of manpower there. So, the vendors that you have, am I understanding that correctly that these are more like traditional like offshore vendors or is it vendors that are within the US, but they off, they outsource their services to an offshore team? Did that make sense?
Scott Call (16:55) Go ahead, Neil? Yeah, yes.
Neil Brennan (16:56) Yes. So, so the provider enrollment vendor is completely in the U. S, in Colorado. They all, they’re all Americans. They all speak perfect English. The vendor that we’ve been using for facility credit is the LLC is based in Florida and the management is in America. However the specialists that they use are outside of the United States. So there’s been especially like you mentioned, like, you know, for my team, it’s like oversight and making sure there’s a communication barrier. At times. There’s also been some like Scott said, some type of training where we’ve had to basically help them do what we’ve tasked them to do simply because I think they haven’t experienced it before. So the management team within the US pitched a really good demo of their team being with, you know, here in the US. But then come to find out they actually outsourced it to people.
Fatima Nunes (17:51) That.
Neil Brennan (17:52) don’t have the experience and don’t have, the knowledge to give us what we need. So we’ve already stopped giving them new things and we’ve just been giving them the provider credit vendor which can do facility credit by the way, more things. So we’re already, you know, trying to level that off. So, yeah, that was part of the decision was just based off of their productivity and accuracy which we knew, right? We went out and got two vendors because we had a terrible, we had one terrible vendor. So we went out and got two vendors and we knew that one was going to end up being, you know, outperforming the other and that we would eventually be going for that one. However now that this year has come up about doing delegated, yes. Yeah. To your point earlier, we’re looking for a new vendor that can just handle delegated. But it’s not outside the realm of possibilities by the end of the year or the next year. We’re really pleased with the vendor that’s doing delegated to have one vendor handling it all because we’re already having, you know, weekly meetings with two vendors and, you know, that takes time from my staff, takes time from me. You know, there’s all these email communications between two vendors. It would be wonderful just to get everything down to one vendor eventually, but that’s not the top priority. The top priority is rolling out, setting up and rolling out and then maintaining delegated along with committee work and everything that goes into it absolutely. And.
Mallory Smith (19:17) You know, if I could just kind of validate some of the things that you said there. So my gosh I’m sorry.
Neil Brennan (19:24) You’re late?
Mallory Smith (19:26) I’m out of wework today and I don’t I guess it doesn’t think I’m here. I’m just going to do this on the call. So earlier you had mentioned it’s taking sometimes up to 12 months to get your providers enrolled with insurance and I want to, I want to dig in there just a little bit if we can, when you say 12 months, typically, we’ll see if you’re in the industry, 30 days to onboard, but up to two weeks to get an application out the door and then the submission to completion part of that. Can you kind of delve into a little bit more detail on what does that 12 months? Like why is it taking so long? Is it the onboarding? Is it the payer? What’s the issue there?
Neil Brennan (20:05) Yeah. So that was in reference to the bad vendor that was taking up to 12 months that we got rid of. I think that a lot of that was, there was a bottleneck. I’ve only been with new season for about nine months. Scott’s been here a little over a year or so. So. I think there was a bottleneck between HR and my team getting the data to the vendor. That was a problem which we’ve now resolved. But once the vendor got the information and started doing the enrollments, you know, it was, they would, it… would get 90 days into it. The payer would come back and say, hey, you’re missing something or something’s invalid or this wasn’t submitted correctly. And then it starts the whole process over. So there was a lot of that going on which ended up taking, of course, we all know, right? Like two or three years ago signal was taking after 12 months or nine months and they were blaming it on covid for a long time. They were the slowest one. So, you know, a couple of years back that may have been valid. But yeah, I think it was due to errors that were, they were having to resubmit and start things all over or they would say they started something when they actually didn’t start anything. We caught them in a lot of lies which has caused some loss of revenue. Thank you.
Mallory Smith (21:22) So regarding delegation, then it sounds like hopefully that issue is not going to happen again for you. I love this good vendor, bad vendor thing that we have. Have you ever seen the good place on? I think it’s netflix. I recommend it if you haven’t… it’s along those lines. But so it sounds like that’s not necessarily a common issue. So I do want to focus on delegation for my next question. Then obviously, there’s a lot of benefits when we think of delegated credentialing. The first being from a financial aspect there’s, severe revenue acceleration that comes from it. So whether if it’s taking 90 to 120 days, sometimes six months for enrollment, we are able to credential and get the provider rostered within 30 days. So there is a huge element to delegation. My question though because the way we’re able to do that is to credential your providers to ncqa standards. Are you currently doing any internal credentialing efforts for primary source verification before enrolling in payers?
Neil Brennan (22:24) Not really our vendor handles that. Yeah.
Mallory Smith (22:26) Okay. So it’s a vendor handle thing. Do you know if they follow ncqa standards?
Neil Brennan (22:31) Yes, they do. They’re accredited to that and they’re a member. Yeah, part of that. Okay? Thank.
Mallory Smith (22:36) You, then this would be pretty similar. Then essentially for us, we would basically be a subdelegate for you. So we are ncqa certified. So if we were to pursue a delegation relationship for you with a payer, we would credential your providers to ncqa standards and then be able to enroll them in the roster on a monthly basis. So I think you would see immediate effects when you think of just value actualization from it and accelerating that revenue.
Scott Call (23:01) On that note, I have a question, so we can certainly hand you a list of our top payers, right? By volume and by revenue.
Neil Brennan (23:09) Would you.
Scott Call (23:10) initiate that conversation with them about delegated contracts? Would that be on us or how does that normally go? Yeah, yes, of.
Mallory Smith (23:16) Course. So it’s typically from payers that they require the conversations to be with your team since you would be the delegated entity, but we’re lockstep with you every part of the way. So we help you, we give you templates, policies and procedures. We’ll review those with you. We’ll let you know when to have the conversations with payers, what to say during these conversations, we’ll review the emails back and forth. And then whenever we do get an agreement in place, the payers will then turn to us and want to review the credentialing history. The comprehensive audit of all of those files. There’s an annual audit. There’s monthly rosters that are part of that. So we’re taking care of every single aspect there, but to initiate the conversation that would be with your group since the delegated agreement lies with you as the organization. Great. Okay? But we would… I think.
Scott Call (24:07) We definitely want to schedule a demo. If that’s the next step. We definitely would like to get pricing from you. As Neil said, we’re anxious to get going, you know, with that look back period that he mentioned that’ll cost us some time and we’d love to have this up and going as quickly as, you know, we realize it’ll take several months, you know, six, eight months or so, but we’d really like to get that moving absolutely.
Fatima Nunes (24:36) And so just with that, and I can give you a little bit of an outline of how we work around pricing and then the demo and schedule those before we get off the call. So around timeline, what does your timeline look like for making a decision? It sounds like it’s pretty urgent, but do you have an end date that you’re working against?
Scott Call (24:57) Not like a deadline but, you know, we’d probably be making a solid decision here within the next 10 to 14 days. Okay.
Fatima Nunes (25:07) That’s helpful to know. So what I would suggest, let’s absolutely get you on that demo. It’s a one hour product demo. Mallory will show you. I guess I’d take a step back, right? Medallion is a full end to end platform. We’re at our core provider data management platform. And we support every part of this process that you just described. So when we talk about the direct payer, enrollments, the delegation, the delegated credentialing, privileging, hospital applications, licensing for providers, everything, what’s cool about it? It’s all in the same platform. It’s just in different tabs, right? So think full visibility into everything, full reporting analytics dashboard. So your team, while medallion is doing the work, your team is going to have access to all of the data in real time which I understand is very important. It’s something that we hear often from organizations that are using multiple vendors. They’re like, hey, they’re good. They’re bad, but we just have no visibility. So it’s so difficult to report to leadership to track the status of things and all of that. And so let’s absolutely. Let’s schedule that one hour demo. And Mallory will mainly focus on the credentialing piece to show you how easy it is to make the requests, the workflow in the platform. And then, and then if we have time, right? We could show you a little bit more of like everything else that’s on there. In parallel. What we can do is we’ll send you a short set of scoping questions to help us gather to help us put together a pricing proposal, right? To better understand volumes around provider counts kind of the scope of work. And then we also help outline the expected Roi. So I guess in the immediate next step, we can go ahead and schedule that one hour demo. And I’m pulling up… calendars here. If you have your calendars pulled up, maybe we can look at I’m trying to see here since you’re looking to make a decision the next 10, 14 days. I’m thinking as soon as possible whenever we can find an open slot for the hour demo.
Fatima Nunes (27:05) Yeah, that sounds great. Let me see here is tomorrow out of the question or do you have some availability on Fridays? Yeah, unfortunately.
Scott Call (27:15) Tomorrow’s out for I’m on pto tomorrow. So we’ll have to push to next week. Yeah. Sorry about that.
Fatima Nunes (27:21) No, that’s okay. That’s okay. I’m looking at mine and Mallory’s calendar. So we do have availability Monday. We’re Central Time. So Monday after two PM, we’re pretty open from two to four eastern and then Tuesday the 30 first, we have some availability nine am, eastern to 10 am eastern. Do either of those work? If not, I can continue looking further in the week. I think Monday at three PM.
Scott Call (27:54) Eastern works for both of us. Perfect. Let’s see that’s exact time I was going to offer up Neal, so that’s, great minds. I.
Fatima Nunes (28:02) Figured you’re looking at the same thing I am. I’m looking at both of our calendars. So you’re.
Scott Call (28:06) probably looking at both of our calendars. Yep. Yeah, exactly. Okay, perfect. I’ll go.
Fatima Nunes (28:11) Ahead. I’ll send the invite out and then we will follow up with a list of scoping questions as soon as you can get us answers to those, you know, some questions. I understand you might not have the data with you, just send us as much as you have. And then we’ll start working on a pricing proposal in parallel. That way after we meet next week for the demo, we can go ahead and schedule 30 minutes for that pricing proposal review. But I think that’s all I have on my end. Is there anything any questions that we can clarify with the last probably 30 seconds that we have here?
Scott Call (28:42) Anything else, Neil from you? Question wise? I don’t have any. Yeah, I would say that the more quickly you can get us the pricing questionnaire, you know, we’ll get that turned around quickly and back to you. And that would be really beneficial.
Fatima Nunes (28:57) Absolutely. We’ll get that over to you by end of day, if not first thing tomorrow morning.
Scott Call (29:03) Sounds great. And then Mallory, it sounds like we’ll see you on Monday sounds?
Mallory Smith (29:06) Like it, looking forward to it.
Fatima Nunes (29:09) Great. Well, great to meet you all. Enjoy your day off tomorrow, Scott and safe travels back home. Thank.
Scott Call (29:14) You so much appreciate you both. Great to meet.
Fatima Nunes (29:17) You, Neil. Bye bye.