Transcript
Nicolle Hepp (00:00) hi, Robin. Hey.
Robin Redd (00:01) How are you?
Nicolle Hepp (00:02) Hi. How are you? Good to meet you.
Robin Redd (00:05) You too. Thanks for the quick turnaround on the meeting.
Nicolle Hepp (00:10) Yeah, of course. My name is Nicole malkery. So, typically, I surface any of these website inquiries that come in and we just have a quick 15 minute sync to ensure that we’re aligned in the kind of solution that you’re looking for. And then I’ll be able to share a bit more about medallion. If everything’s aligned, then I can get you on a 30 minute deeper dive with an executive, seeing as it’s Friday. We can do it as early as next week and then we can discuss further about what exactly that solution would look like for you guys.
Robin Redd (00:41) Okay. Sounds good. That’s great, pretty straightforward. So, I’m actually manager of accreditation and regulatory affairs, but my background is in credentialing. Okay? That was my first career. So, for 15 years, I worked at different levels of credentialing kind of from the bottom all the way up. So as far as the understanding of what we need, I feel like I’ve got a pretty good grasp on that. So I just want to let you know since my title doesn’t really connect back to my original background just to kind of help, you know, who you’re talking to that’s.
Nicolle Hepp (01:18) super helpful. Yeah. So, you know, the ins and outs of credentialing.
Robin Redd (01:21) Yeah. And so I also know enough to know that it does not make good sense for us to try to build it from scratch at this point. So that’s honestly, as far as I’m concerned, that’s not really something we’re considering. So we don’t really need to make the case between the cost savings between doing it yourself or outsourcing. I think we’ve already kind of made that initial leap. That certainly, it makes more sense at this point to use a CDO partner and it is important that our partner be ncqa certified, you know, 11 functions.
Robin Redd (01:57) So I limited my, you know, my due diligence search to those that fell into that category. So that’s kind of why I wanted to reach out… for our most immediate or current needs. We have a network that kind of sits between 2025 100 providers. So that’s kind of what I guess whether you do tiered pricing or how you do it. That’s kind of what size we’re looking at right now. So really what we would be looking at initially is it’s a, it would be like just kind of out of the gate network, initial credentialing and ongoing monitoring. I mean, re, credentialing will come obviously, but we wouldn’t have anybody that’s going to fall into that category, you know, until year three. So what I would be looking for is, you know, I guess the per provider pricing for credentialing… initial and re credentialing, and then what, you know, if it’s priced separately, what ongoing monitoring looks like. And what, you know, I know that you’re ncqa accredited or certified. So the time frame is going to be within 90 days. I mean, I do realize that if you have a different time… frame that you typically work within, you know, certainly feel free to share that. But I am, for our purposes internally, I am assuming 90 days. Is that a fair assumption?
Nicolle Hepp (03:29) Well, so let’s back up a little bit. All right. And I’ll get to, I’ll share all about medallion in just a few minutes. I just had a few questions, so I can really guide my answers here. So you already have the providers, right? So around 2,500, but they’re not being credentialed. So is this like a new initiative or where?
Robin Redd (03:52) Are they being, so it would be a new initiative? We have a network that we are contracted, but, we’re not delegated for credentialing so that’s a whole different arrangement. But we have a targeted group that we already know about that we would be reaching out to recontracting and doing a full credentialing on before we use the network for anything, if that makes sense.
Nicolle Hepp (04:18) And how many providers are in that targeted group?
Robin Redd (04:22) In the 2000 to 2,500?
Nicolle Hepp (04:25) Okay. So that’s a smaller group than the entire network?
Robin Redd (04:29) Yeah. So we have, we’re a managed services organization. So we have delegation for lots of different things. Credentialing is not one of them at this point. Okay? And we are looking to stand up our own network. So that’s why we’re that’s what my goal is right here is to kind of look at the time frame and the cost of standing up a network, okay from the ground up. So, but we, but that said it isn’t a, the… time frame is a little shorter than usual because we’re not network development is not like a shot in the dark. We already have a targeted group of providers that we know, we would contact initially. So without going too much into the detail of that, let’s say within the next, you know, 60 to 90 days. We had probably not all of the list, you know, probably not all of the providers that we would want to have credentialed but a good portion of them. So it would be phased but not by much. I mean, the major lift would be up front. And then I’m sure there’d be some stragglers coming in. But just so you kind of know, the relative size or number of providers we’re talking about, you know, it’s not 100 and it’s not 10,000. We’re we’re sitting more in the 2000 to 2,500 range is where we anticipate our need being okay. Does that make sense? Yes.
Nicolle Hepp (06:06) It does. And just to confirm because everyone kind of uses credentialing, they everyone has their different definition there. So.
Robin Redd (06:15) I find that within my organization all the time, right? It’s not credentialing. So.
Nicolle Hepp (06:21) We typically hear there’s two buckets. So there’s provider credentialing the ncqa credentialing file that we spit out. And then there’s also payer enrollment credentialing with the payers. Are you talking about both or one of these? We’re.
Robin Redd (06:37) talking about the, I order a file from you. I get back an initial credentialing file. I take it to my committee. We send out the letters, we’re building a network and then maybe we contract with payers. Okay? So, we own the network. We’ve contracted with the providers. We’ve credentialed them and then we choose to have business arrangements with payers. The other potential would be we have a contract with a payer who delegates credentialing to us now that’s a different scenario. But we’re talking about scenario one right now scenario.
Nicolle Hepp (07:15) One, okay. Got it. Absolutely. And in terms of medallion, so I can share a little bit here. So we are an end to end solution. So always, you know, great to hear that you guys are deciding to go with an outsourced vendor that’s definitely where we qualify ourselves as. But in addition to being that operational outsourced vendor, we also have the software in place. So with our software, we’ve been able to automate about 80 percent of primary source verifications for credentialing, all ncqa certified. And with that, we can actually produce a three day turnaround for credentialing files. So really condensing that timeline, like you mentioned, right? You keep.
Robin Redd (07:58) Them constantly, yeah.
Nicolle Hepp (08:00) We do this at scale so that’s, our main focus is how can we do this as quickly as possible and for as little cost as possible for our?
Robin Redd (08:09) Partners to keep them continuously serving. I actually worked for a cvo. We went through the cvo certification years ago. So, I do like know where that kind of economies of scale and critical mass hits is like you just want to keep them constantly, keep them refreshed so that you’re ready to just drop it exactly yep.
Nicolle Hepp (08:30) And then where we’re gonna still have at least some level of interaction with your team and your organization will be certain admins that you guys will have. Really, you don’t require much. I think it’s around like a 1,000 providers to one admin at this point and that would just be taking your direction. So, okay, we have a new provider joining the network. They need to be credentialed, submit really medallion takes on the rest of the work. And then we give you guys the platform for full visibility, ongoing monitoring. There’s automated reminders, things like that you can access and just, you know, see the provider network as a whole. So.
Robin Redd (09:05) For the ongoing monitoring, how does that work? Does it send an alert if there’s a, if there’s a finding or? Okay? Because right now, I, I’m actually handling that right now for, we have lots of buckets for a different bucket of business for risk management purposes, not for credentialing, I’m actually doing ongoing monitoring for another group of our physician staff and I would like not to be having to do that for 2000 to 2,500 providers. So I just want to make sure that for the ongoing monitoring, I’m not like downloading a giant excel spreadsheet of names and having to sift through them and match them up for duplicates and that kind of thing. So.
Nicolle Hepp (09:50) Yeah, that can certainly be a lot to manage. So exactly. So we have automated reminders for things like a provider that needs to be recredentialed soon and you can customize really what kind of reminders that you want. But yeah, the sole goal here is to take away that kind of management that’s very manual for yourself and your team and just have it all live in the platform. So just when you log in, you can see what’s going on at a glance instead of manually keeping track in spreadsheets and such. Fantastic.
Robin Redd (10:22) Yeah. Music to my ears. Yeah, that sounds great.
Nicolle Hepp (10:25) Yeah, especially coming from credentialing, you know, the manual processes is so tedious. Yeah.
Robin Redd (10:32) So, in terms of the like an application, do you use caqh? Do you have an interface with them? We?
Nicolle Hepp (10:41) Do we have a bi directional integration with caqh? So on that front end, we are able to pull in caqh information as long as the provider has a profile and we just need three pieces of information in order to get that into our platform.
Robin Redd (10:57) That’s what I was going to ask you. I’m sure the, is the mpi, one of those?
Nicolle Hepp (11:01) It is.
Robin Redd (11:02) Okay. What else do you need?
Nicolle Hepp (11:05) And then I think it’s just first name and last name. Okay. I’m not 100 percent sure on that, but certainly something that makes.
Robin Redd (11:14) Sense. I mean, that’s.
Nicolle Hepp (11:15) a later date. Okay?
Nicolle Hepp (11:23) So, I know we’re coming up on time here. Do you have any other additional questions or I can get you booked for that secondary call next week where you can have 30 minutes to really, dive deeper into this?
Robin Redd (11:36) Yeah, I mean, I think that would be great. And then I can ask more specific questions. I mean, really, it’s going to come down to, you know, a big part of it is going to be, pricing and, you know, how nimble, you know, what kind of lead time is required to set up an account and get, you know, basically get started just so I know how much lead time I need to build in. Is there a time frame sorry?
Nicolle Hepp (12:03) Yeah. Is there a time frame you guys are looking to get a solution up and running?
Robin Redd (12:08) Not, at this point. I think some of the information that I’m gathering right now will dictate our timeline on that, whether we choose to do it. Now, wait a little bit and then do it. It’s I’m… in the fact gathering mode right now. I’m not making the decision about when we want to start the race, but I need to make sure that we’re allowing enough time to stand up and network properly? Like, you know, you’ve working where you are, you know, that sometimes the visionaries and the operations people are not always in sync with the timeline.
Nicolle Hepp (12:48) Yes, yes.
Robin Redd (12:49) I’m trying to be the reality check that says, you know, here’s what it will cost. And this is how much time we would need in advance of any movement forward. So, yep.
Nicolle Hepp (13:01) Absolutely. Is there going to be other people involved in the decision making process that you would want to bring in to the next call?
Robin Redd (13:09) Not, no. I mean, I think they’re they’ll trust what I bring forward to them that’s I’ve been tasked with doing that. I’m right below the clinical ops VP. So she’s absolutely, I have more background in it than she does. So, I think we’re just, yeah, I mean, her job is to look forward and see what the marketplace timing looks like. Mine is to just tell her, what it’s going to take to get there.
Nicolle Hepp (13:39) Get the right solution for you guys in place, right? Right. Yeah, absolutely. Well, so, does next week make sense for that call? It does, or what’s your timing? Like?
Robin Redd (13:53) We have time I’d like to get, I’d like to get my due diligence completed by the end of next week and then get my recommendations made either by the end of next week or early the following week. I guess earlier in the week is better. I don’t know how quickly or how much availability you’ll have, but I.
Nicolle Hepp (14:15) mean, I’ve got as early as Monday.
Robin Redd (14:18) I have a lot of availability like between 10 and two.
Nicolle Hepp (14:23) And what time zone are you?
Robin Redd (14:25) Eastern good question?
Nicolle Hepp (14:28) Eastern… what time zone is this?
Nicolle Hepp (14:37) Oh, let me switch to eastern here. Sorry, one second. Okay. And you said between 10 and two?
Robin Redd (14:47) Ideally. Okay.
Nicolle Hepp (14:48) Yeah. I have any time between 10 and two. Do you want to look at? Let’s say 11? Sure?
Robin Redd (14:59) Great.
Nicolle Hepp (15:01) Do you?
Robin Redd (15:03) Know who I’ll be mating with yet?
Nicolle Hepp (15:04) Yeah. Her name is Erica Lloyd. I’m going to send this over to you. Okay?
Nicolle Hepp (15:15) Right now, you, let me know if you receive it.
Nicolle Hepp (15:24) I had Robin red at guidehealth. Com.
Robin Redd (15:28) That’s right? It hasn’t popped up yet, but I’m sure it will hold on.
Robin Redd (15:42) It just popped up. Okay?
Nicolle Hepp (15:44) Wonderful. Yeah. So you’ll be with Erica, she’ll have 30 minutes with you to dive deeper into any additional questions. Is there anything you want me to let Erica know before I let you go here?
Robin Redd (15:56) I don’t think so. I mean, I think we’re fairly straightforward. I mean, at some point, you know, I mean, we’ve explored different things we’ve discussed, you know, software platforms and all kinds of things. But honestly, for these needs, I think the more it just sits with you and we have access to get the data back and forth that we need. I think that’s the Symplr solution at this point. It certainly makes me happy. I guess the only question would be like… you know, the things that come after, you know, the handoff, let’s say you’re handing files back off, you know, then there’s going through the committee and tracking that information. And then there’s the provider directory and the things that kind of follow. So, I know that, you know, from a standpoint, of like just ordering a file? Is that kind of where the functionality ends? Are there any additional options for things like that or is that like does that just need to sit on, sit in our database at that point?
Nicolle Hepp (17:01) No. So we actually have committee workflows built into the platform as well. So really, I mean anything that you need to ensure that your providers are credentialed correctly will sit in the platform. So.
Robin Redd (17:16) We basically just have access to the platform limited to our providers. Our provider list is that kind of how it works?
Nicolle Hepp (17:26) Yeah, it would be whatever providers you want to have live in medallion.
Robin Redd (17:32) Okay. Okay. Well, that’s actually helpful. Yeah.
Nicolle Hepp (17:37) Committee members can log in and actually attest in the medallion platform as well.
Robin Redd (17:42) Okay. All right. Yeah.
Nicolle Hepp (17:46) There’s a lot of reporting analytics. You can customize any sort of reports that you want for your provider network.
Nicolle Hepp (17:53) Like I mentioned, the automated alerts. So there’s a lot of cool functionalities that you can certainly see a demo and they can walk you through how that looks like at one point. Thank.
Robin Redd (18:04) You very much that’s good information. All right. Well, I look forward to meeting with her and I appreciate your time and your quick reply.
Nicolle Hepp (18:12) Yeah, of course. Glad we could hop on today and have a great weekend. This was great.
Robin Redd (18:15) You too. Thank you. Bye, Robin. Bye bye.