Transcript
Jordan Tantleff (00:00) good on brother.
Jordan Tantleff (00:06) Hey… how’s the afternoon treating you? Great. Got a lot more for the rest of the day or not really?
Joshua Levitan (00:16) This call and then an hour break and then a call with the company in New York that Mike and I are working. It’s been a thorn in our side.
Jordan Tantleff (00:26) Essen right.
Sebastian Zuluaga (00:27) Yeah.
Jordan Tantleff (00:29) What’s up, Dave? What’s.
Dave Wallach (00:30) going on?
Jordan Tantleff (00:32) Not much man?
Jordan Tantleff (00:40) Got plans for the weekend Dave?
Dave Wallach (00:45) Thinking, no, we.
Joshua Levitan (00:47) might go to rutgers.
Dave Wallach (00:48) To watch a baseball game that’s it? Nothing else? What about you?
Jordan Tantleff (00:53) College regular season start already?
Dave Wallach (00:55) It started like a month ago. Yeah.
Jordan Tantleff (00:56) Guys.
Joshua Levitan (00:57) I’m going to run to the bathroom real quick as they’re joining here. Just got off another call.
Jordan Tantleff (01:02) I got no plans went out. I was out to some dinner with some friends last night in the city in west village, which is good. And then probably just hop around hoboken and watch some of the March madness games today.
Dave Wallach (01:15) I think you need to calm down a little bit between your vacation, vegas, Vermont. You need to slow down.
Jordan Tantleff (01:22) I know luckily Vermont was relatively tame. Yeah, just like skiing. My legs were definitely sore, but that’s an out of shape problem.
Dave Wallach (01:34) What about? Is this recorded? Yeah, it’s recorded. Yeah… I’ll save it for another conversation.
Jordan Tantleff (01:46) Makes sense. See, Sebastian’s here would have been here.
Jordan Tantleff (02:00) Hey, Sebastian, how’s it going?
Sebastian Zuluaga (02:08) Hey, Jordan. Hey, Dave. Hey, josh, how you guys doing?
Jordan Tantleff (02:12) Doing well. Can’t complain on a Friday? How’s your week been? It’s been busy. This is good. Makes the weekend that much more worth it.
Sebastian Zuluaga (02:22) Let’s hope so. Yeah.
Jordan Tantleff (02:24) Any plans for the weekend or just some RR?
Sebastian Zuluaga (02:29) R, R, got some birthdays to attend?
Jordan Tantleff (02:33) That’s the best though. Just keep it easy the.
Dave Wallach (02:37) Best from where you’re based out of?
Jordan Tantleff (02:39) Miami here in south Florida.
Dave Wallach (02:41) You’ve got something to do in Miami?
Sebastian Zuluaga (02:43) There’s always something to do. It’s a busy weekend here too. We’ve got Miami music week and ultra festival is in town. So, there’s going to be traffic. It’s.
Jordan Tantleff (02:54) funny. One of my younger brothers is actually in Miami right now. I’m sure he’s doing all that fun stuff. I think he just played at a, is it trump Doral, the golf course down?
Sebastian Zuluaga (03:04) There? Doral? Yeah, I.
Jordan Tantleff (03:06) don’t know how he got on that. I don’t know how he pulled it off but it’s a nice one. Yeah, he’s not good enough of a player to be on that, believe me. But anyways, happy you’re able to hop on with us here today. I know there’s some new faces on here and obviously we’ve met but I’ll let josh and Dave introduce themselves quickly here before we kind of kick things off.
Dave Wallach (03:26) Go ahead, josh. Yeah.
Joshua Levitan (03:27) Pleasure to meet you, Sebastian. I’m based up here in Boston, so I could use some of the sun that you have. And I used to love edm but have never made it to ultra. Probably for the better. Still do love edm but past the age of going to things like that, I ride shotgun here along with Jordan, but in a little bit more of a technical context. So I’m here to talk about the technology, the process, the industry, if we get to demoing and actually looking at medallion, I’ll be leading those conversations.
Sebastian Zuluaga (03:59) Sounds good Sebastian.
Dave Wallach (04:01) Nice to meet you, Dave wallach, based in New Jersey near the jersey shore. I lead one of our enterprise sales teams here. Jordan’s a member of my team and Jordan told me about your first conversation and I wasn’t double booked. So thought I’d join the conversation and see if I could contribute perfect. Perfect.
Jordan Tantleff (04:19) And Sebastian, you want to do a quick intro on your side?
Sebastian Zuluaga (04:21) As well? Oh, yeah. Yes, that’s probably important here.
Sebastian Zuluaga (04:23) Sebastian, I’m the chief of staff at pediatrica, basically, I sit between all the departments making sure that if someone’s doing something over here, it doesn’t impact someone over there. And if it does that, we’re working accordingly to minimize that to the extent possible. So sitting across ops, RCM finance clinical sometimes and everything in between. So credentialing… is another one that comes up from time to time. So, yeah, if Jordan hasn’t mentioned it already, we’re a relatively new organization launched in 20 25 four. Sorry, all our acquisitions happened in 20 25. So we’ve grown from effectively four practices from the first acquisition to 21 as of today. And so a lot of growth, a lot of practices, a lot of moving pieces. 19 of those are in Florida. Our home office is here in Miami, and then two of those practices are in Texas.
Jordan Tantleff (05:22) Perfect. Thank you for the context there as well. And Sebastian really the goal for today is really three things first, I know we had some connection. I had some connection issues on the first call. So I just want to kind of sanity check what I heard from you around pediatrica, how you guys have grown through those acquisitions, how provider onboarding and credentialing kind of fits into that second kind of walk through what infrastructure could look like as you start to kind of standardize these operations and prepare for that next phase of growth that you guys are looking into. And then third actually give you a look at how medallion kind of works in practice and that’s where josh will kind of give you a look and feel of the platform and kind of explain how specifically how groups in a similar model are improving time to revenue and reducing operational lift during kind of the onboarding process. Assuming all that makes sense. What I’d love to figure out is whether it’s worth quantifying kind of what this looks like for you especially as you guys do start kind of ramping up acquisitions again. I know you guys are kind of past that more aggressive growth that you kind of cited in 20 25. But as you start to look forward, just kind of discussing what that might look like before I jump in though. Does that kind of align with what you’re hoping to get out today? Or is there anything else? Yeah. Look.
Sebastian Zuluaga (06:39) I’m trying to we’re in data collection, data gathering phase. So I think that’s pretty aligned with what we’re looking to look or I’m looking to kind of uncover here as I think I mentioned Jordan, you know, we’re pretty AI forward in a lot of the capabilities. We try to leverage it where we can. We’re working with a number of other organizations that leverage it. And so we want to just be on the cutting edge when it comes to that. So, yeah, feel free to educate me as much as you can on the product here and I’ll take it to the team and we’ll evaluate kind of amongst ourselves and determine kind of next best steps if any.
Jordan Tantleff (07:12) Absolutely. That makes perfect sense. So at a high level, just thinking my screen is sharing here… when groups like pediatrica are scaling kind of through acquisitions, provider onboarding tends to become one of those things that quietly drives or slows everything downstream. So the goal here isn’t necessarily just credentialing. It’s really about three outcomes, shortening the time between when you acquire or hire a provider and when they’re actually generating revenue second, reducing some of the friction we had discussed last call, any delays or kind of rework and operational overhead kind of required for these processes. And then third really putting an infrastructure in place that is tech forward, AI enabled, that actually scales with you instead of needing to kind of revisit this every time acquisition volume picks back up. So just kind of want to start off here about kind of my understanding about where things are today and obviously feel free to kind of hop in and correct me if I’m off anywhere here. But from what you shared, you guys have grown pretty quickly through those acquisitions now across Florida and Texas with about 50 to six, 50 to 60 providers today, your team handling mostly the provider intake and data collection. And then it gets handed off to an outsource vendor to actually pick up the credentialing and enrollment processes, turn around times today ranging anywhere from 60 to 180 days depending on the payer. And I know last time we talked about as well, you guys are looking to kind of invert the payer strategy and going towards more towards a medicaid focus as commercial. So we can certainly discuss that as well. And as of today, I believe there are some limitations around kind of visibility into enrollment statuses across practices and payers. And at the same time, you know, as you’re kind of going through this evaluation phase, just starting to think about kind of standardizing and consolidating these processes across the organization where I’d love your help in, you know, kind of pressure testing, kind of the current state is, you know, where does the process I guess feel like it’s working well today? And where does it start to kind of break down especially as volume increases or the acquisitions kind of pick back up?
Sebastian Zuluaga (09:24) A loaded question. But if I were to hit it straightforward, I’d say the fracture?
Jordan Tantleff (09:30) Is.
Sebastian Zuluaga (09:31) probably that we have our RCM person leading it for us, which is pulling away from their core function, which is on the road with cycle management. But it just makes the most sense logically that they oversee the crunching piece and ensure that providers who are billing with payers that we’re in network with. So that’s what I would say. I think there’s definitely room for improvement there.
Jordan Tantleff (09:56) We also.
Sebastian Zuluaga (09:56) struggle with data collection right now just given that RCM is leading it. That’s also part of a challenge that they’re faced with in terms of being able to collect the documentation caqh making sure they have everything to be able to submit those applications or projects. So there’s a little bit of a breakdown. There just got an email inbox actually echoing that for providers that we’ve been employed with us for quite some time, that we’re missing just one or two pieces of information that we just haven’t gotten yet. Other than that everything else is kind of out of our control. We don’t think we’re going to be a delegated crunching organization. Medicaid is a governmental kind of government agency… if you will. And so those delays are kind of somewhat expected or anticipated at least. And we’re seeing those across the board especially in Texas where we’re probably feeling a little bit more. But, yeah… that’s what I would categorize as some of the pain points that we’re having. Yeah, makes.
Jordan Tantleff (11:00) sense. And I know we talked about kind of the two sides of the coin where we kind of reduce turnaround times is, you know, shortening down the enrollment or time to parse, as well as kind of the front end data collection piece with the caqh integration. We have, I know we’ll get into the demo here and you’ll actually see how that kind of import works and how we pull that provider data. I think you’d mentioned that the provider intake or data collection phase is taking place roughly two weeks. Is that what we kind of talked about last time or is it a little bit longer than that? I?
Sebastian Zuluaga (11:32) Don’t I couldn’t even quote it really honestly, we started as soon as they signed an employment agreement but it kind of falls off, you know, again we don’t have a dedicated credentialing person to be able to provide these kind of visibility and reports. So it’s all coming from the RCM person who is also scrambling to make sure we’re collecting the monies that we’re owed. So visibility is an issue here, but I’d say, yeah, call it two weeks, maybe a month, yeah.
Jordan Tantleff (11:58) Absolutely. And we can kind of work to quantify this in later steps if it makes sense just to get an idea of where we can kind of consolidate, you know, timeframes around that, but kind of looking into desired future state. So if we fast forward a bit especially as you guys start ramping, you know, acquisitions, again, what we typically see groups move toward is something closer to what you’re seeing in this box here. So infrastructure that can, you know, support continued acquisition growth without constantly revisiting these current processes or even, you know, in some cases adding additional headcount to kind of manage these workflow workflows, and then more automation on the front end. So, your team or, you know, in this case, your RCM lead isn’t kind of being pulled away from their main responsibilities and chasing down, you know, data manually moving towards, you know, more faster and predictable onboarding timelines, and really a centralized view of kind of provider status across, you know, practices locations and payers by market.
Sebastian Zuluaga (12:58) Okay. Yeah, I’d like to. So I mean, yeah, we’d love to see the, how behind all that, you know, obviously we want to improve time frames and turnaround time for all phases of credentialing. So we’d love to kind of see what that looks like on your end. Yeah.
Jordan Tantleff (13:14) Absolutely. And we’ll show kind of the workflows in the demo here. And then one step we can also take is getting a list and I know you guys are moving towards medicaid, but if there are commercial payers that you guys are kind of keeping those contracts with, we can do pretty much like a benchmark comparison of where we see our average turnaround times with those payers by market and kind of do comparisons on, you know, if there’s an opportunity to kind of shorten up those windows that you’re looking at today. Okay. I’ll just.
Joshua Levitan (13:40) add to that, even with the shift to medicaid mcos are going to be really important. So we should compare the turnaround times on mcos as well.
Jordan Tantleff (13:51) And then kind of moving into the negative impacts here. So like when we look at, you know, environments like, this risk isn’t just operational as you know, it tends to show up in a few ways. Slower integrations of these kind of acquired practices and revenue ramp are impacted by any delays tied to credentialing, which also funnels into delaying provider productivity and billing readiness. And then any lack of visibility into these workflows can kind of create challenges in managing coverage and network status across locations or markets that you’re operating in. So, and if those things were to improve, you know, what we typically see and kind of the outcomes that medallion is looking to drive, is that, you know, through faster provider onboarding, we can accelerate revenue realization, you know, EBITDA performance post acquisition and really create just more predictable onboarding timelines that will improve, you know, time to revenue forecasting and cashflow for pediatrica and then overall just creating, you know, more visibility into these processes and where we are in these workflows for improved operational planning and staffing decisions. Any questions? I guess here, anything I might be missing on how you’re kind of looking at this and potentially evaluating, you know, partnership with whether it’s medallion or, you know, someone else? No, no… perfect. I’ll flip here. I know kind of most of our conversations have been around the credentialing and enrollment piece because that’s typically where, you know, a lot of organizations somewhere to pediatrica kind of experience their first pain points and start to see it downstream. One thing I do just want to kind of make clear though is that medallion does manage the entire provider lifecycle from, you know, provider data management to ongoing monitoring. Like we’ve talked about the enrollment workflows are, as well as kind of cvo credentialing if we were, and you mentioned we’re not looking at delegated credentialing but if that does become something that you guys are strategically moving towards that’s something we can pick up as well as any licensing or caqh management workflows. I think when we last discussed, you weren’t sure if I guess the RCM lead is he responsible for kind of managing the caqh profiles of the provider network or is that something that the outsource vendor takes on as well?
Sebastian Zuluaga (16:15) Not sure. It’s a, she… I’m not sure. I’m not sure. Okay. Do you guys do contracting as well to an extent?
Joshua Levitan (16:26) Yes, we will help get the contract like with the paperwork process of that. Yeah, where we remove ourselves from the process intentionally is around sort of like the strategy and the actual dollars. Okay. So like we start the process, submit the forms, get that process going, make sure it’s moving timely. The second that leads to like, hey, here’s a rate table. What do we think of this? We tap your team or if you’re working with like a payer contracting consultant, we tap your team back in and you do that. And then once you’re done, we take the paperwork process through until the end. Okay?
Sebastian Zuluaga (16:58) Perfect. That’s good to know. Yeah. And josh.
Jordan Tantleff (17:04) I’ll hand it over to you if you have any more kind of in the weeds type questions here before we kind of transition to the platform and demo and give Sebastian kind of look and feel of how it looks operationally.
Joshua Levitan (17:15) Yeah. I think the one piece I want to touch on would be the acquisition strategy. So you’ve mentioned you’ve grown through a lot of acquisition. So far. I imagine you have multiple different tins that you’re managing from different businesses that you’ve acquired or have you consolidated.
Sebastian Zuluaga (17:30) Just three.
Joshua Levitan (17:32) Okay. When you and I know again, we might be in a pause but it could pick up at any time when you.
Sebastian Zuluaga (17:37) Think about acquisition.
Joshua Levitan (17:39) In the future, I imagine you’re going to be acquiring an organization that already has contracts and already has existing tins? Do you expect or have you seen in the past that leads to like a big influx of credentialing work? Like if you try and move providers from one tin to another, or is that not so much an issue?
Sebastian Zuluaga (17:58) So there’s two. So I guess one, there’s two ways to acquire an organization. One is through a stock purchase agreement, and one is through an asset purchase agreement. As you most likely know, we predominantly do asset purchase agreements. The only time we’ve done stock purchase agreements was when we first entered into Florida and Texas. Subsequently, all the other ones have been apas. So we had, that does trigger the credentialing process for us to get them enrolled into our tin. So effectively. There is tin migration there, but.
Joshua Levitan (18:30) We don’t.
Sebastian Zuluaga (18:31) foresee like it’s always going to be a credentialing issue going forward because we’re going to be doing asset based deals. So it’s always going to have there’s always going to be a moment in time where we’re going to need to credential them onto our tin. And in the meantime, we have an msa where we’re able to continue services. Yeah.
Jordan Tantleff (18:48) Yeah. Okay.
Joshua Levitan (18:50) That’s what I thought that’s what we see a lot with businesses like yours. The reason why I wanted to touch on that very specifically is because what we see with organizations like yours is that creates peak and valleys in the amount of work that credentialing needs to do. And I’m assuming you’re moving tins for a number of different reasons, but potentially because of the tin that you’re moving everyone to has better rates if that’s the case. Yeah. So then there’s revenue benefits to doing that piece quickly. So you’re not losing revenue because everyone’s continuing to operate, but you can increase revenue by making that tin transfer happen quicker. So, two points that I want to keep in mind with our conversation, the first point is that in some ways I think it’s fair to think of medallion as like a utility, right? Like we are the power grid. And so you can draw work units of work, credentialing pay enrollment from us when you need. And when you don’t we’re helping 400 other customers. Yeah, as opposed to a model where if you’re doing this yourself, you might need to very quickly staff up around your acquisition events to make sure the tin transfer happens quickly because it has the direct revenue implications that we talked about with higher rates. But then if you have a valley in acquisition events and you have a valley in credentialing events, you’ve either hired people that now are not working to their full capacity or you have to offload temps. And then the next time that happens get new temps retrain them and go through the same process. Yeah. So it’s always more of a soft benefit than just like we’re going to cut cycle times down by 50 days. And that means that there’s 50 days of more revenue. But I think it’s very important given your model to think about that like power grid utility aspect of medallion and how that factors into your model in the next 12 months, in the next 36 months. Yeah.
Sebastian Zuluaga (20:36) Yeah. You guys keep going back to all the value drivers now. I’m curious what the price is that’s usually in my experience when we’re talking about all the value drivers, that usually means there’s a high sticker price at the end. So curious to see what that number is you want.
Joshua Levitan (20:51) To talk about that now or you want to take a look at the demo, let’s.
Sebastian Zuluaga (20:53) Do the demo, let’s go in order? All right?
Joshua Levitan (20:57) Great. So we’re going to look at the demo in three parts. First part is getting data from providers and storing that data. It’s the foundational element there’s a crack in the foundation of your house. Everything on top of it is suspect in this first part. We’re going to look at medallion from two perspectives. First is the perspective of a provider who you just hired. We’re going to look at their, the process they actually go through. The second part, we’re going to look at the sort of data management from an administrative aspect, some of the, you know, what the RCM team might see, right? Yeah, for the rest of the demo, we’re then going to be in that administrative part of medallion, the second part, the management.
Sebastian Zuluaga (21:37) Side, right? Correct? Like.
Joshua Levitan (21:38) The admin or operations side, the second part of the demo is then going to be action, right? So we have data. Now, we’re taking action with that data. In this case, we’re going to focus on payer enrollments, right? So, how do we take the data that we have, use that to submit an enrollment to a payer, get that in as quick as possible with the highest possible quality follow up on that, to take that cycle time of that. You used to take us 100 days to get enrolled with that. Now, it takes us 60. The third part of the demo is reporting and analytics. All along the way. We’re collecting data. How can we service that data for someone like yourself as a chief of staff to have actionable insights into the business? I will warn you, Sebastian, I’m a long winded individual. Dave’s going to probably laugh when I say that. So caveat that if we don’t get to the reporting analytics piece, we can certainly follow up on it later. And I will try and be brief so that we can get there. That is the roadmap of the demo here. Does that sound like a good plan to you? Yeah.
Sebastian Zuluaga (22:36) Let’s do it awesome.
Joshua Levitan (22:37) Okay. So starting off here, square one, you hire a provider, there’s an onboarding process that they’re going through where we’re getting data there’s. Obviously probably an HRIS, whatever a payroll, all that good stuff. Part of that process becomes medallion. Provider, gets an email. We’re going to take this email. We’re going to co, brand it your logo text that you collaborate with us on hey. Provider. Credentialing is essential to you being able to work for us. Pediatrica uses medallion to help with credentialing. Please take a couple of simple steps here to give us your data. From there, we start the onboarding workflow. This is exactly what it looks like if you’re a provider, welcome to medallion, create a profile. And this is one of the first to your point value drivers or pieces of automation that we’re going to use instead of asking the provider to type in 400 fields of data and upload 50 documents. We know that 90 plus percent of providers in this country have a caqh profile. Jordan was asking you about this a little bit before. There’s two elements we’ll talk about in caqh which is getting data from caqh and then also updating caqh. Yep. But the first thing we’re going to do, right, make the provider’s life as easy as possible. So we’re going to connect to caqh.
Sebastian Zuluaga (23:59) When you say connect, you mean, OK, got it. Got it. Yep. So we have a,
Joshua Levitan (24:03) proprietary relationship with caqh that allows us to via API directly pull information into medallion. All we need to kick off that process is the provider’s caqh id. OK, there are other organizations that can sort of do this but they actually require the user, the username and password of the provider to caqh. And sometimes the provider forgot their password or they’re like, why do you need my password? It’s a password et cetera. So we just need this id. Obviously, that’s a sign and last name. Then we go ahead and we verify caqh. We link to caqh. We’re going to grab all the data and then the provider is going to move to their profile. The provider has a great caqh profile. We might be green at 100 percent… not always the case. Wish it was a lot of times, the caqh profiles might be a little bit out of date. There might be data gaps in that case. Providers can just come in here. This is the portal, right? This replaces like a 20 page PDF or a bunch of emails or a Google form or something like that, right? My wife’s a physical therapist. I sat next to her on the couch when she was doing this for her most recent company. When she just switched jobs, it was literally 40 emails and a bunch of fillable PDFS and it was awful. She was not happy. She could not watch secret lives of mormon wives because she had to fill out PDFS. So they put in the data right here or they validate what we already grabbed from caqh, what they already grabbed from caqh. We also want to continue to make this process easy if it’s like a new provider right out of residency who doesn’t have a caqh or if they need to update things. So caqh manual update, and then OCR technology. So click upload, scan this. Then if something pops up on your phone, take a picture of your resume or upload it from your computer, we’re going to take your resume, a license document, whatever it is. OCR technology is going to read that document and then put the information from that document in those fields. So for example, your resume would upload directly into professional history. All along the way. We’re going to identify gaps.
Dave Wallach (26:13) Josh, I’m going to go off mute quick enough. Sebastian. Do you think that digital interactiveness would be helpful for your providers to help? Maybe speed up the process a little bit?
Joshua Levitan (26:23) I sure hope so. I.
Sebastian Zuluaga (26:25) sure. Hope. So you can lead them to water sometimes but you can’t make them drink. Yeah, there.
Joshua Levitan (26:29) You go. Yeah, yeah. But to that point, right? We also want this to be intelligent. So instead of just saying give us a bunch of data, we are going to identify gaps in my demo environment. We don’t have any, but let’s say there was a work history that was missing or a license that was missing or down the road, we need the provider to sign a document or take an action. Those all show up in tasks. On the overview page of their portal. We can log in here in perpetuity for as long as they are with the organization. There’s status updates that they can get in here. And this is our method of communication with them. We will take this one step further. If there’s a task, we will follow up via email. Increasingly. We are also using AI phone calling and SMS bots to supplement the email and the task notification that’s optional. Not every business wants to use it but it is available and we’ve got really great results with it is.
Sebastian Zuluaga (27:19) It included in the pricing.
Joshua Levitan (27:22) No, it’s a slight add on. So the process that is the process for the provider, right? Intelligent gap identification, quick onboarding, get this out of email, get it into a portal. On average. Sebastian, this is the takeaway here with the 100,000 plus providers that are using medallion right now. We collect data in two days… all the data, all the data in two days. Yeah. Look, it’s an average, right? So 50 percent take more than that, 50 percent take less. You will have providers that do this in an hour. You might have providers that are a little bit older, school less technology savvy that take seven days. The hope is, or what we’ve proven out though is that our averages is better than averages of any other tool, whether that’s another vendor or whether that’s a PDF process, et cetera… that is the first decrease in cycle time from when you hire a provider to when they can bill. Is this process right here of collecting… data, last quick point here before we move forward. This is all optimized for mobile. Many providers increasingly are interacting with medallion only via mobile. They can also E, sign documents directly in here, complete attestations and agreements, all on their phone in one single place. Take a pause there. That is the first half of the first part, getting data in. We talked about the value drivers there. Any questions from you or any comparison to how you know, your teams are currently doing this? No.
Sebastian Zuluaga (28:59) No, I don’t think we’re doing it as sophisticated as this today.
Joshua Levitan (29:05) But this.
Sebastian Zuluaga (29:07) Seems great.
Joshua Levitan (29:08) Okay. Awesome. Moving forward here, we are switching to the administrative side of the portal. So this is what your internal teams see. This is a database. It replaces a spreadsheet. It replaces older databases. It is easy to use. It is intelligent, it is powerful and you have everything all in one place. So for any provider Naomi, who we’re just looking at, you can see like high level, the status of their data, some quick bits of information, what practice locations they’re at, if they’re affiliated with one or multiple tens, when we click into Naomi’s profile, we have all sorts of detail… in this detail is everything you could possibly need to know about Naomi… first point here. If you have an older, I shouldn’t say older, a less technologically savvy provider who does not really use the onboarding process. We just talked about not to worry. The admin can do all of this for them. So someone on your side can change data. And I apologize. This is, I use a demo tool that helps me put your logo right here. And that’s why we’re getting a little bit of latency. The admin can put in data, can use that document scanner, can link, caqh can do all of those things. The admin also has the ability to view the licenses that the provider has. We’re going to track expiration dates in here. We’re also going to verify licenses. We’re also going to notify both admins and providers for something like a license expiration. We can tie providers to practice locations. We can see the enrollments that provider currently has, or any enrollment requests that we are processing for them. In addition, we’re going to manage information on groups… take your tins and all of the data we need. There. Similar profile to this and facilities. If you have any sort of like facility billing component of it, what does the group section look like? Group section is a little bit simplified. It’s a little bit less information, but you set up every tin with profile, same type of thing. You can tie providers practices and payers to it. You have the overview which is like tasks that you need to take at the group level, and you have all of the data that’s required for a group. Now, again, this is the database piece, right? But also actionable. So we talked about those tasks that we’re sending to your providers. Your admins can see all of them. And you can see how long they’re taking. If this task for Naomi here is 30 days aged medallion has put a notification in her portal and emailed her 10 times and potentially called or texted and she hasn’t done anything. There might still be a need for someone on your side to get involved here and to escalate this. So, you know, where that escalation point is. You can also just generally see all of the work that is being sent or all of the information that is being sent and what’s being asked of your providers in one single place. So, you know, the communication that we’re having. This is the first part of the transparency theme that we’re going to talk about a little bit through the upcoming minutes here. In addition to this, there are also sometimes admin tasks. Think about this as like a cli for a tin needs to be updated, that’s going to be routed to your admin. And we’re also going to track literally everything that can expire. We talked about like medical licenses expiring a little while ago, but there are all sorts of other expirables that if they go wrong, things bad things happen and those are all tracked here, board certs, like even like a license, you name it, intelligent notification and outreach to the necessary parties. Built into all of this. Told you I’m a long winded Guy. I’ll take a deep breath here. This is end of scene one. This is the database, the provider data management, data, onboarding questions from you or Jordan or Dave if you have anything to add. So.
Sebastian Zuluaga (33:07) There’s going to be, I guess I’m thinking from integration standpoint, there will need to be probably a week or two where we just get our structural docs and licenses in here as part of this process too.
Joshua Levitan (33:24) Yes, but the onboarding process that we just walked through is not what we’re going to do for your existing providers. If you were to sign up with medallion tomorrow, we’re going to do that in bulk and handle that very differently. Yeah. But yes, there is set up. Our implementation timelines are 10 to 16 weeks and most of that time is transforming data and validating data before we upload it into the system. Good data in means good results, setting up. Medallion itself takes about a day training you on medallion takes about a day getting data into medallion. We are methodical about and that’s where, you know, the most of the time the 10 to 16 weeks comes.
Sebastian Zuluaga (34:06) Is that burden placed on us? Or do you, would you be?
Joshua Levitan (34:11) I’m going to think through the?
Sebastian Zuluaga (34:12) Workflows on our end, right? Like obviously we have the data, you, we need to get it in there. But putting it in there, you know, there’s learning curve from our end to, hey, where does this go? How do we navigate? So, I mean, where do you guys come in the handholding process? Yep?
Joshua Levitan (34:27) We’re going to do bulk uploads on the backend, right? So you’re not going to have to go into every profile and add everything in. Okay, we need the data in a certain structure. We’ll usually, if this conversation goes well, we continue to talk in two or three meetings from now, you’ll meet our head of technical solutions and implementation. We’ll want to talk to someone from your it side to understand what’s the structure of your data right now, how can we export that from a current tool or transform that into the proper schema in order to pull this into medallion? But if the data isn’t easy to get into the right schema, we run a bulk upload in the background. It’s if the data is of a concern, the 10 to 16 weeks can be dramatically reduced by a lot of our customers who actually start working on validating and transforming data before they even sign a contract with us just to reduce that implementation time. And one of the reasons why I do want to be like very transparent about the fact that this is a lift in time is oftentimes it’s not just transforming the data but it’s making sure like it oftentimes forces a process in your business where you validate that the data that you have is currently accurate, yeah that the enrollments are accurate, the practice locations are accurate, that there’s not things leading to denied claims. That is obviously something that is very hard for us to help you with, right? Because we don’t know everything about all of your existing enrollments. And so there is certainly somewhere from a small to large lift. I mean, you’re not a huge shop, right? So it’s not going to be a large lift, but it’s something that we want to focus on it and be, really intentional with, because again, like if we have, if we enroll existing, if we put existing enrollments in here that are wrong, the wrong expiration date or the enrollment is tied to the wrong practice location. We’re not going to know once it’s in medallion and you’re going to get denied claims. And we don’t want that.
Jordan Tantleff (36:24) What’s most of this data kind of living today for you all Sebastian?
Joshua Levitan (36:27) It’s probably living.
Sebastian Zuluaga (36:28) across PDFS in an excel file somewhere.
Joshua Levitan (36:30) Yeah. If I were to guess, yeah, honestly speaking, it’s actually probably easier for us to transform it into the schema that we need when it lives in excel. There are some legacy 30 year old archaic credentialing vendors who have a data structure that makes our teams want to cry, that actually takes a lot longer to work through than spreadsheets. So, yeah, we’re not.
Sebastian Zuluaga (36:55) Using, we don’t have a crunching software. It’s all done excel. Yeah. And, and so, I mean, I’m sure we have it, it’s just making, I mean, it’s a scavenger hunt. Yeah.
Joshua Levitan (37:06) And if you’re really like, if you are, if you’re currently having a lot of, denied claims and like you’re not like you wrote down an excel spreadsheet that someone’s enrolled, but you don’t think that’s true. Based on the RCM side of the house, we have services and I know you’re going to ask, so I’ll just say it upfront like this is an additional add on service, but we have additional add on services to actually try and verify the enrollment that you think you already have, and confirm the date, the exact enrollment, the group like confirm all of that information. If you need it to give you like that peace of mind that when you make this transition point, you are starting with good data. Obviously, if we find like you think you have an enrollment, you don’t through that process, we can then just go ahead and automatically process the new enrollment for you, which we’ll see in the next part of the demo. But we have a assistance and services in that realm as well.
Joshua Levitan (37:59) Just giving myself a quick time check here. We have, 20 minutes left and I want to be respectful of your time. So if you have no further questions about this piece, I’m going to move on to the middle section of the demo, which is the meat which is doing something with the data.
Joshua Levitan (38:16) All right. So, right now, your team is likely going to, some sort of portal like an availability portal or filling out some sort of PDF for a state medicaid, to get a provider enrolled, they probably spend, correct me if I’m wrong here, but an hour to two hours for each application. Each provider might need 10, 15, 28 seven applications. That represents a lot of time. It’s a lot of manual data entry. And if you make a mistake, the payer can deny you. Our approach here is that we are an end to end vendor. So we are going to submit the application for you. Using our automation. We are also going to manage follow up for you. We are going to call email, you name it or scrape portals from payers to track the process. Along the way. What your team is responsible for is… the vision, is the strategy, right? So, keep in mind the process we just talked about, you know, an hour in availability or two hours in a PDF, whatever it is. Instead of that, what someone on your team is going to do is come up here and say, request new payer enrollment… provider, who… is associated with this tin, in this state with… let’s just say all of the payers that have group contracts with this tin… and then to select lines of businesses, I’m selecting commercial. But for you, this would probably be a lot more than managed medicaid… to associate practice locations.
Joshua Levitan (40:16) To answer two questions about if we want this enrollment to show up in the payers directory, when people with that plan, search for a doctor, and what we want to request, the effective date to be there’s, a section for notes. And then your team hits submit… you can… do it in bulk based on multiple providers. And as you saw here with multiple payers, that is what replaces the process right now of going application by application with an excel spreadsheet on one side of your screen and an availability portal on the other and copying and pasting all the way through. Submit is the magic button. It triggers our process to run in the back end. Our process is a technology first process. So, for something like Aetna that has an availability portal, we have bots that essentially log in and do exactly what your humans do, but they do it a lot quicker and they don’t make mistakes. There are certain state medicaid boards that require a wet signed paper form. We handle that too. We will map the data into that PDF. We will send, that PDF to the provider with a prepaid postage label and say, sign this and send it back. We will handle any variation of the payer enrollment that the payer uses. And we already know how the payer accepts enrollments because our team has cataloged 11, that 1,100 payers across the country. We do the research on. Is it a paper form? Is it a portal? Is it a roster? You name it. We keep that guide updated all the time. We know if there are specific differences based on provider type, whatever possible combination and permutation of information on how to get an enrollment in. We have cataloged and that is what trains the automation that we deploy. When you hit the submit button.
Joshua Levitan (42:29) Any questions on that? No, no questions. Okay. We have slas in place that Jordan can talk about later. So we are in the boat with you. If we miss slas on how quickly this stuff occurs, there are ramifications for us contractually. I think you’re starting to see here the picture of why we describe ourselves as an end to end platform. As I described this. A piece of this is visibility and follow up. So when we are back in this portal that we started here, we can see all of our providers. We can even see our facilities or groups and where they are in the process. Now, medallion’s handling the follow up. Like I mentioned before, we leverage AI phone calling bots. We have humans in the loop. If there’s an escalation… we use email, we scrape portals and we have follow up cadences. So that map those guides where each pair process is mapped. Also includes the best follow up cadence for that specific pair. Maybe Aetna gets better results if we call three times in the first five days. But if we call blue cross blue shield in the first five days, we know they haven’t even looked at it yet. And so we don’t really start the follow up until week two. But then we go really heavy from week two to week three. Whatever that is. We’re sort of constantly AB, testing recording results and retraining on that follow up process. But this isn’t a black box for you and your team along the entire way, right? You come into this portal, you have a lot of information, but what’s most important here? Domino’s pizza tracker, where is the at a high level… dependencies with this enrollment? So an example of a dependency would be we need to enroll in the state medicaid before we can enroll in an mco. You can come in here and see are there tasks? Most of these are medallion tasks, but we’re showing you what we do next. In the process. We see notes. Some of these are written by our agents. Sometimes these are written by humans. If we had to bring one of our specialists in for an escalated situation that needed special attention. We even track this so far as to make visible to you the emails that we are sending and receiving to payers as part of the follow up. I don’t have an example, but you would literally see everything right here that we are sending and receiving and read our emails. As if this was like a CRM type thing where you can read people’s emails, right? It’s going to be screenshots confirming that this was submitted. There’s going to be data added in here when the provider gets to par status. So if there’s a welcome letter that confirms that Sebastian was enrolled with Aetna on may 20 seventh, we are posting that here for you. So that if you get a denied claim on April first from Aetna and you go to adjudicate the claim, you have the proof right here to adjudicate that claim denial.
Joshua Levitan (45:45) What we see from a time standpoint, right? We have slas to govern what we can control, which is how quickly we get the application out the door. Obviously, there is variability after that from payer to payer. We know this, you know, this right now, certain payers take double what other ones do. What we typically see is about a 30 to 40 percent reduction. Sometimes a lot more especially for businesses like yours that are doing this completely manually in excel between how long it took you to get enrolled in Aetna… of Florida in your old process to our process. So we shave time off the front end, right? Collecting the data. Now, if we shave an additional 30 days off, the process provider is billing 30 days sooner… medicaid allows you to backdate… there’s, a little bit of a different situation there, but where we see the importance of speeding up medicaid and medicare as well or any of the governments that allow you to backdate, I meant to say medicaid, not medicare. My apologies. We’re talking about a pediatric group here. So medicaid usually allows you to backdate, but if it takes you 50 days currently, and we can get that to 30 your… Ar, your cash flow even though it’s not like new dollars in the door, but we are bringing those dollars into the business by getting the enrollment done quicker so the backdated claims can be dropped quicker and.
Sebastian Zuluaga (47:13) you have less?
Joshua Levitan (47:14) On your Ar books at any given point in time for the government payers… let’s take another deep breath here and… let you poke away with questions.
Sebastian Zuluaga (47:29) No look. That was great. I don’t really have many questions. Makes sense. The way you outlined it seems like a really nice solution. I think there’s going to be a steep learning curve.
Joshua Levitan (47:44) Folks.
Sebastian Zuluaga (47:44) On our end, just by nature of a new platform website, et cetera, what do you have available? And this might be in the reporting, if it is, you don’t need to kind of switch screens or share it with me now, but I’m curious to see what you have available for our front desk and practice managers, right? That’s probably one of the biggest disconnects that we have is… like this. This is great for someone who’s kind of overseeing credentialing and can see who’s in who’s out, but we, what’s the tool that we can then equip our practice individuals say, hey reference this if you’re if you have questions around who’s in network and who should be seeing who? Yep, do you have something available that you can?
Joshua Levitan (48:27) Share a couple different approaches. So we could give those people very limited access to just the analytics and medallion where they could check a report or a list or look up a provider and they’ll have a, you know, they won’t be able to request the actions, right? We could email them reports on a cadence via excel. It’s kind of the least techy option, but some people actually really like it every day they get a new report or we have a open API. And the one of, the second most common integration that we do is exactly what you just said which is integrate into like an RCM or scheduling or practice management tool. If you have something like that, so that the par, effective date for each provider for each payer is just natively in that tool. So you could block scheduling in that tool based on like scheduling logic. Okay?
Sebastian Zuluaga (49:15) That sounds interesting. But if you could, I guess as a follow up, send, that excel or what that report, excel report looks like. I think that would be a good reference point for us.
Joshua Levitan (49:27) Yeah, definitely.
Sebastian Zuluaga (49:28) Think about it. Yeah, of course. And I told you I was long.
Joshua Levitan (49:32) Winded and we have 10 minutes because you want to talk about cost and Jordan wants to talk about next steps. So the analytics piece, we can certainly touch on if we need. But I’ll send that, as a lead behind. Perfect.
Sebastian Zuluaga (49:40) Thank you. All right. Lay it on me, Jordan. I.
Jordan Tantleff (49:43) know you had 10 minutes, like, what we typically do with groups and as a next step is build out a simple model, to quantify kind of current onboarding timelines, how that translates into time to revenue and what that would look like as kind of volume acquisition increases.
Jordan Tantleff (49:59) I understand you want an idea of pricing like happy to give, you know, like T, shirt size pricing based on if we’re able to gather just a few inputs from you based on like what provider growth metrics look like, you know, year over year, you know, on average, how many providers are in network… or how many payers providers are in network with that can kind of give us an idea and I can kind of, start to share with you.
Sebastian Zuluaga (50:22) It’d be hard to give you provider growth that one’s probably a tricky one. So I would just use kind of six CS like the benchmark, I think I’ve mentioned we typically start with like payers for each provider that we bring on board. We’ve got about 360, categorized as projects, that are in the crunching process today,
Joshua Levitan (50:46) And let me think.
Sebastian Zuluaga (50:48) What else is there that I have?
Joshua Levitan (50:50) And I think that’s.
Sebastian Zuluaga (50:51) it, so I’d.
Joshua Levitan (50:54) probably say.
Sebastian Zuluaga (50:54) 80 percent of our providers are fully credentialed, 20 percent are in that process.
Sebastian Zuluaga (51:03) So that’s.
Jordan Tantleff (51:05) what we have, okay. What I do is start kind of piecing this together if there’s any kind of gaps that I need kind of answered. You know, we can kind of shoot emails back and forth to try and kind of close that gap. If you’d like, you know, I think it’d be best if we try and get some time on the calendar. I don’t know if next week, two weeks and just kind of walk through kind of pricing and what that would look like and answer any questions you may have.
Sebastian Zuluaga (51:29) I’d prefer to, if you guys send me something. So I can just share this with the team, and, get their reaction even if it’s just as you categorize it, T shirt size, right? Just so we have a sense of magnitude, I.
Joshua Levitan (51:46) think, Sebastian, something to note here is, you know, you, I think you said you have two people doing this right now or you have the RCM person who’s doing this right now as a function of their job. This is often an opex reduction play, right? Like for many you?
Sebastian Zuluaga (51:58) Don’t have anyone in the credentialing department now. So this would probably be, we probably need someone to manage this or find someone with the bandwidth internally to oversee this.
Joshua Levitan (52:07) Yeah. Or my point was, you know, if the person in RCM that’s doing this is spending 20 hours doing this now, maybe they’re spending five, right? In that freeze, that’s a lot of time for other work.
Sebastian Zuluaga (52:17) They’re probably spending three and they need to be spending 20, so.
Joshua Levitan (52:22) Gotcha. More focused on them setting things up for success in the future than reducing currently.
Sebastian Zuluaga (52:27) I hear you. I hear the point you’re making there’s definitely some efficiencies here that we could tap into from a bandwidth.
Joshua Levitan (52:34) So, yep, I hear you.
Sebastian Zuluaga (52:40) So, is it typically a monthly fee? Is it per project fee? What’s the?
Jordan Tantleff (52:47) You guys price this usually we would contract to, you know, a minimum of three years and there’s usually, you know, a forecasting kind of exercise of, you know, what the anticipated growth may look like. And then depending on kind of what, you know, services you may be using, you know, we touch on like caqh management, you know, licensing. I’m sure, it might not apply to you all, but we would kind of scope out how many units of each, how many payer enrollment applications we’re sending out over the course of the year? And then kind of back into some volume based discounts from there, yep.
Joshua Levitan (53:16) But it’s Sebastian, it’s value based pricing, right? So there’s a very small fee to have each provider for a database piece. And then on top of that, it’s value based, so literally like a cost per application. There’s value in each additional application. So that’s how we’re going to.
Dave Wallach (53:29) Mark how we’re pricing this.
Joshua Levitan (53:31) Out.
Sebastian Zuluaga (53:38) Let me try to give you some numbers.
Sebastian Zuluaga (53:51) To be efficient with everyone’s.
Dave Wallach (53:55) time here. So, I know you guys want to.
Sebastian Zuluaga (54:01) Be thoughtful about how you propose pricing.
Sebastian Zuluaga (54:09) So, I think it’s just Texas?
Sebastian Zuluaga (54:21) If the file I have here is directional 3,000 is?
Dave Wallach (54:27) The number of total projects?
Sebastian Zuluaga (54:30) And pending projects or like, you know, is.
Dave Wallach (54:34) that how you guys?
Sebastian Zuluaga (54:35) Think about them. I call them projects, you’re.
Joshua Levitan (54:37) talking a project like one enrollment? Yeah, yeah.
Sebastian Zuluaga (54:39) Yeah, like 3,000?
Joshua Levitan (54:40) Sebastian to Aetna in Florida? Yeah, exactly how we think about it.
Sebastian Zuluaga (54:45) So, 3,000 is the number we have that complete and pending in total. And there’s obviously things in between there.
Jordan Tantleff (54:54) Okay. Give you.
Sebastian Zuluaga (54:56) A sense of kind of what we’ve done. I know it’s really helpful to where we’re going.
Dave Wallach (55:02) I mean, I think directionally we can get.
Jordan Tantleff (55:03) Ballpark from here and I think it’d be helpful just to get, you know, get your arms around what that might look like. Okay?
Sebastian Zuluaga (55:13) Cool. Is that something you’ll be able to send to me?
Dave Wallach (55:16) Yeah, we can send that.
Jordan Tantleff (55:17) Over we can, you know, design questions. We can set up time to kind of talk through that and kind of just make sure we’re on the same page and, you know, fine tune those volumes as needed but I think that’s a good starting.
Sebastian Zuluaga (55:28) Point. Yeah, if you want to send me because I don’t again, 3,000 is what we’ve done. I don’t know what tiers you guys have, but like 500 projects, 1,000 projects, 1,500 projects. If that makes sense to you guys. Like those would probably be good tiers for us to look.
Dave Wallach (55:44) At, can I just ask quick clarification question? Let’s say 3,000 projects. What is the time frame of those? Is it all time or is.
Jordan Tantleff (55:54) that, oh, let’s.
Sebastian Zuluaga (55:55) see, I don’t know if I have that data, but probably you.
Dave Wallach (56:01) Guys started.
Jordan Tantleff (56:01) November 24, right? So, a little over. Yeah.
Sebastian Zuluaga (56:04) Yeah, it was November 20 24… when we first started, and actually that excludes the first four about the 10. So those are already kind of credentialed. Yeah, I think all time.
Dave Wallach (56:17) But all time has.
Sebastian Zuluaga (56:18) Been the last, you know, 18 months for us.
Dave Wallach (56:23) Gotcha. I think we can work off that, Dave as long as you and josh are comfortable with that.
Jordan Tantleff (56:30) Number, yeah. And we can like Sebastian was saying kind of give like, I guess like different scenarios, there are like tiers of, you know, those volumes and what that would look like. Yeah.
Sebastian Zuluaga (56:40) Yeah. It feels a little.
Joshua Levitan (56:41) High on gut 3,000, but you were also doing a lot of 10 movement, which would make sense. Yeah.
Sebastian Zuluaga (56:45) Yeah, exactly. So again, 80 percent complete it’s about it’s. About at least 20 pay projects per provider. We’ve on board. Yeah, assuming that we on board, you know, at least 10, right? Working there.
Joshua Levitan (57:00) Yeah. And then you’re counting for attrition and just like a little bit of like sort of, yeah, normal stuff. There are no explosive growth.
Dave Wallach (57:07) Yeah… we can.
Jordan Tantleff (57:10) We’ll do some number crunching on our end. I’ll send that over to you, and then we can kind of work out if we need to kind of hop on a quick call and talk through any of that. But I appreciate your time today. I don’t know if you have any other questions for us before we kind of?
Sebastian Zuluaga (57:23) No, I think this was great. I think you guys know where you guys fit into the process very well from reduced days of billing to Ar cash, you know, pickup that you get. So, I think it’s very well presented. I think the solution is pretty nice. I think we could definitely benefit from it. Just find the person that can drive it. I guess is the other piece which we would need to think through. I think there’s going to be a learning curve, but I think once that’s done, I think there could be a lot of efficiencies that we could tap into. And then again, we pride ourselves on being very tech forward. So this kind of fits into that sweet.
Dave Wallach (57:57) Spot absolutely… nailed around that there. Yep. Cool. Well, thanks Jordan.
Sebastian Zuluaga (58:05) Thanks, josh, Dave. Appreciate the time. Enjoy the weekend. And then I’ll wait to hear from you Jordan.
Jordan Tantleff (58:10) Sounds good. Thank you.
Sebastian Zuluaga (58:12) Have a good weekend. Bye.