Transcript
Sami Alouani (00:00) hey, what’s going on guys?
Nick Scallion (00:02) Morning morning. Alright. Looks like eight people in the waiting room. So I’m going to let them all get in here cool.
Sami Alouani (00:22) Morning folks?
Kevin Riley (00:24) Morning, Nick. Can you hear us?
Nick Scallion (00:26) Yep. We got you. Good, great. I’m seeing a bunch of other folks trickle in here. So can give a couple minutes before we get started, if you think that’s a good idea. Okay, cool.
Kevin Riley (00:53) Did anybody not, did anybody… not accept Nick? Any of these, did Tammy… petrie? Accept?
Nick Scallion (01:06) There was sorry, I don’t know if someone just tried speaking up. There was question marks for both tammys. And then I’m trying to see, I see Mary’s on. And then there’s quite a few cell numbers that dialed in where I can’t actually tell who that is.
Kevin Riley (01:22) Can, who everybody?
Sami Alouani (01:23) This is Tammy petrie.
Kevin Riley (01:24) Oh, okay. Great. Thank you. Yep.
Nick Scallion (01:29) Looks like Sean just joined Tracy’s on Kate, Carol. Most of the folks that were invited have joined at this point.
Sami Alouani (01:42) Hey, Kevin, Tammy biglin won’t be on. She was out sick today, so.
Kevin Riley (01:47) Okay, great. Thanks… cool.
Nick Scallion (01:52) Well, I think everyone else that I saw on the invite list is actually here. So on the medallion side, I’m joined by, Sammy, you maybe want to just give your quick intro and then we can align on the agenda with everyone.
Sami Alouani (02:04) Yeah, excellent. Good morning, everyone. I’m Sammy alwani, I head up our technical solutions and implementation team.
Sami Alouani (02:11) So basically, you know, the goal here is for us to start planning for execution together with my team so that we can hit the ground running and get you all the value that Nick and team have discussed with you during the sales process. I’m joined by Greg on my team as well. Greg’s here to shadow and just listen in on the conversation but looking forward to it cool.
Nick Scallion (02:32) And so we had had a kind of light implementation scoping conversation back in January, but we know that some things are moving around a little bit on the filing side. So typically on these conversations one, we want to sort of set expectation on what the implementation process looks like from a holistic perspective. But then also kind of give you some idea of sort of the roles and responsibilities for each parties. And so one major element of that is the data import, right? So we need to have your provider payer and facilities data in order to be able to act upon that, right? Get folks enrolled et cetera. And so part of that information was already provided by Tammy. P. I think on the frmc side, I think Sammy had a chance to review that. So really going to try to make sure you folks know kind of what information we’re going to need to get into your medallion instance, so that this is a really seamless process once we go live if you will. So that’s sort of the agenda that we had planned here, folks. But anyone on the fireland side, please let us know if there’s anything else we want to add in here to make sure we check all the boxes that you want to use this time for?
Kevin Riley (03:39) Other than, you know, Sean, I see you’re on. So Sean, if there’s any sort of technical technology… related information security et cetera, please, you could ask those questions, Sean Stefani?
Nick Scallion (04:05) Perfect. And yeah. So feel, yeah, Sean, feel free to chime in with those. And then I can also actually just sync up with you on the side as well. If you don’t have access to our trust center, we may have provided that already. But basically we use vanta for all of our security and data privacy items. So I’ll go ahead and stop there.
Sami Alouani (04:23) All righty. Can you all see my screen? Yes. Okay. All right. So let’s jump in here. So first and foremost, just wanted to give you kind of the next point the, very highest level of what implementation means at medallion and what the team that you’re going to have at your disposal is going to be ultimately doing and how the pieces all fit together. So to start off just kind of going over, the team composition here. You’ve got you’re, going to start have a dedicated implementation manager. And so this person is going to be your quarterback for onboarding all of the things, right? So we’ve got several products in the mix here. We’ve got, you know, several goals I know we want to achieve for you all. So the implementation manager will be that kind of point person for everything in the beginning. So they’ll be onboard throughout the implementation and adoption and monitoring phase to make sure that you will get to stability. You’ll also have a technical solutions team member, and this will be a dedicated person that’ll serve as your technical subject matter expert throughout the implementation. So they’ll be, they’ll again be dedicated person. You’ll have a name and an email and a face, and we don’t do you know, pooled technical solutions during onboarding. So we take a lot of pride in that. And so those two folks, as far as the timeline you’ll see here, they’re kind of here from the beginning as a dedicated function. And then from the ongoing perspective, once you’re implemented you’re stable. We’re all in a good place and we’re flexible with the definition of that. Of course, it’s not like you hit this date and your implementation manager fades off into the sunset overnight. But once we get to that kind of mutually agreed upon level of stability, you’ll have an ongoing and unlimited amount of customer and technical support from our customer and technical support team that can help you with system login issues. And hey, I need help with this specific enrollment process from a provider’s perspective, for example. So that’s more of like your in platform support for your users and less about your admin support. So that’s kind of the breakdown of the initial and ongoing with an implementation lens. But if you look down at the last two here, you’re going to have both an account manager and an engagement manager who will be with you throughout the lifecycle of the partnership. So these people are there from day one. The reason they’re there from day one mostly is so that they can understand all of the. Context that goes into implementing and standing you all up. It’s really important that those team members have that context to support you from an ongoing perspective. But your account manager is ultimately going to be your business partner if you will, making sure that, you know, we understand what your goals are, how we align and squeeze out as much possible value out of medallion as we possibly can. And then your engagement manager will really be your day to day kind of boots on the ground, support your subject matter expert when it comes to all things operational. They’ll be running most of your weekly meetings whereas, you know, account managers will be running things like qbrs and business reviews. But I’ll pause there. Does this structure make sense as far as the medallion team, what they’ll be doing and kind of the phases that they’ll be engaged?
Sami Alouani (07:27) Yes. Excellent. Okay. All right. Moving on here. So what do we need from you all during implementation? So ultimately we’re going to need at least one person from the operations team that will be, you know, kind of your lead and your point person, somebody that is going to understand what your day to day operations look like today, somebody that’s going to be an expert on, you know, your payr, enrollment, policies and procedures, your legacy credentialing packet information, you know, like what verifications need to be done during credentialing, that kind of thing. So again, we don’t need a full team necessarily. I understand a lot of times we’re looking to supplement, but we do need like a point person that our team can go to for that subject matter expertise as far as how you all do things. So we can implement together. Next is going to be a technical and data lead. Sounds like maybe we’ve got, you know, Sean and team on the call today to serve this to fill this need. But ultimately, this the biggest thing during implementation that we need this team for is the data transformation exercise that we’ll be talking about a little bit in the latter half of this call. If you also for example want to do things like integrations, we can work with, you know, your team to scope those out and ultimately determine, you know, is that something you all do? Is that something we do et cetera. But for implementation, the kind of basics that the bare minimum is going to be the extract and transformation of your legacy data into the structure that medallion needs it in to implement. And then last but not least, ideally, we have a project lead. So, you know, sometimes this is the same person as the operational lead. Sometimes it’s somebody maybe at a level higher, but ultimately somebody who can be, you know, the account management point person. You know, if things are, you know, escalated or we need some additional support or, you know, it goes both ways there. Generally, we would like to kind of clearly identify who a project lead is. So we can have those conversations. Any questions on the necessities of your team here and what the roles look like? No?
Kevin Riley (09:24) Sammy, I think on the technical… and data lead, I’m trying to just, you know… understand, I mean this is, I think we’re going to talk about this subsequently. And again, I think Tammy and Mary are going to be the most knowledgeable. Well, look, I’m not viewing that as like a sort of a technology and it thing per SE. This is just, this is you need the information, right? And the manner in which we feed you the information maybe is a technical matter. But is that sort of what the distinction there is?
Sami Alouani (10:10) You’re spot on Kevin, that’s a really good distinction. So ultimately, we just need the data, right? By the end of the day, there’s a deliverable. We’ll talk about what that is historically though we found that depending on what your volume of providers, facilities, historical enrollment is, it’s typically more, you know, more cumbersome than what we would consider something that can be done by hand. And so that’s why we generally like we’ll advise that we need some sort of technical support to get the data. But you’re spot on if you all have that information, maybe you just require some manual massaging and you don’t need to pull your tech team in. That’s totally fine. Yeah.
Kevin Riley (10:43) Because I’m assuming my understanding is we already provided at least in part some information. So it’s about how it’s organized so that you can take it, and upload it. So just making sure that, hey, it’s not free form. But if, you need a 20 pieces of data organized in a certain way, that it is organized in that way such that when it is delivered to, you can take it and efficiently upload it into your systems. Is that the way to think about it? It?
Sami Alouani (11:18) Is that is the goal and we’ll talk about the nuance a little bit. So you’re correct, we have received some data from you all, but to be honest, it’s a small fraction of the concepts that we need. And so it’s the, so for example, like the provider data that we’ve received, where you all have given us, you know, and I’ll share my screen and show you guys kind of the delta between what we’ve received and what we need here in a moment. But the provider data, it is done. It looks done. I mean, frankly, we can take that run with it, trigger caqh imports, et cetera. It’s things like the historical enrollment information, right? Where we need to understand, you know, for dr smith as of today, they’re enrolled with these 20 payers at these 10 locations. And so, you know, there’s a structure there where that specific combination might be 40 rows of data. And so that’s really where, you know, the historical enrollment information is where we would generally see the technical team involvement. But the way you’re thinking about it, Kevin is exactly right.
Sami Alouani (12:15) All right. And then next is your implementation timeline. I’m actually going to leave this screen. This is just a, this is a screenshot, but I actually have a more in depth plan that we will give you all access to here. Let me share my other screen. And so… this is your implementation plan. And as a matter of fact, I’m actually going to share a link to this.
Sami Alouani (12:44) I apologize. Here we go. I’m going to share a link to this in the chat and so you all will be able to use this throughout the implementation to see a live view of what we see. So we will on the medallion side use this to update all of the individual components of the implementation. And what I just shared in the chat. You’ll be able to see kind of, you know, this bar represents today. At any point in time, you’ll be able to see what phase we’re in. And then you can even do things at a more granular level and understand, you know, for example, when we’re in the scoping phase, what task exactly is going on right now? What’s done, what needs to be done, who’s responsible party et cetera. So this is the goal here is for maximum visibility into what’s going on at any time. But that said, we’ve got a couple of phases of implementation here. So the first and most important is gonna be the scoping and preparation phases. You know, arguably one in the same frankly. But the goal here is for us to understand, you know, kind of like what I mentioned, we would work with your operations point person on is, you know, hey, what payers are in the scope here. We have our methods of submitting apps to payers. You have your methods of submitting apps to payers, what is the overlap there? What are the deltas? What are the deviations? So we can, you know, accommodate our processes accordingly for credentialing, you know, what are your requirements, what verifications are necessary? Can we look at some of your legacy and historical cred packets such that we can at least mimic if not, you know, provide something at a higher caliber. So the scoping and preparation is really just extraction of that operational knowledge that we need to implement you effectively. And then next is the configuration phase. And so you’ll we’ll basically take the learnings of scoping and preparation and we’ll build your system and your operational processes accordingly into medallion. And I do want to pause here to kind of talk about this inflection point. Because what this really means is once we’ve got all the information about how you all operate today and meshed it in with how medallion plans to operate and have a configured system. This is where you can, you have a fully functional instance as at least as it relates to, you know, net new providers. So at this point, generally, what we’ll see is that customers start kind of drawing a line in the sand with their legacy system and say, hey, after this date of configuration all net new providers we’re going to load starting in medallion and then everybody that’s in flight, everybody that, you know, is still, we’re still working on, you know, existing requests for we’ll continue to work in legacy system until the rest of the implementation is done and we have that historical information transition. So that’s a really important inflection point here. And while there’s more to do in the project after this point, this is where you’re really going to start seeing value. I want to pause there is that is everything gelling up until this point?
Kevin Riley (15:26) I think so Sammy, we’re going to need if Nick shared, we’ve got Tammy P is going to be transitioning from us. So we’ve got about two or so weeks give or take. So we’re going to need to do that scoping… quickly.
Sami Alouani (15:55) Understood. Yeah. And we can, you know, we’re happy to move as quickly as possible on our end there especially with the scoping to your point. And let me ask you a question. There is Tammy’s role overseeing both the enrollment and credentialing functions or just one or the other?
Kevin Riley (16:12) Tammy, you want to respond to that distinction?
Sami Alouani (16:15) Yeah, it would be both. Okay. Gotcha. Yeah. You know, in an ideal world then we’re probably going to need, you know, another point person that we can work with there for what we don’t capture in the first two weeks of implementation, but we hear you loud and clear on the need to kind of concentrate as much as we can up front in terms of getting the information that we need from you all so we can take it back?
Kevin Riley (16:39) For sake of… for my sake, and probably others, the distinction between a basic question, the distinction between credentialing and enrollment.
Nick Scallion (16:53) Yeah. So I think tell me otherwise, Tammy, but my understanding is you folks are today exclusively doing payroll. Do you have any delegated payer agreements as it stands today?
14197227305 (17:05) We have no delegated agreements right now. I know Mary has dealt with some of that in the past. Yeah, but on the frmc side, the hospital side, no?
Nick Scallion (17:19) Yeah. So it sounds like all direct enrollments at this moment, Sammy got.
Sami Alouani (17:23) It, I’m more. Yeah, I’m talking more on the, you know, the actual like, so are we talking just hospital side here? And maybe that’s context that I’m missing? I’m thinking more like ncqa credentialing. Is that that’s.
14197227305 (17:35) not, oh, I got you. No, not on the hospital side.
Sami Alouani (17:39) Got it. Okay. Nick, maybe something you and I can take… offline there. But if the goal is just, you know, hey, we want to support you all from a delegated credentialing perspective such that we can do delegated roster generation down the line once you have delegated agreements that’s not. Yeah, that changes the equation here a bit. And then we can focus on just direct payer enrollment. Yeah, thanks for that question, Kevin, that’s important context. Okay. So after this kind of configuration phase, this is, and by the way we’ll talk about overall timeline, I just want to kind of preface with this is kind of frankly hopefully worst case scenario is this out of the box 16 week timeline? We generally can move a lot faster in every single one of these functional areas with your help, of course, and I can talk a little bit about how we compress that momentarily. I just more so want to kind of give you an overview of what the phases look like first. But during this technical implementation phase here, this is really that data ingestion migration and ingestion, right? So whether your technical team is involved in getting us that information or not, generally, you know, that’s one of the more time consuming parts of this project is extracting and delivering that data. And then of course, our team ingesting it. This is one of the areas that is also the most ripe for compression in the sense that, you know, we have, we generally estimate around six weeks in this phase, but there are things we can do for example, like start this part, you know, from day one, which it sounds like you all are already working towards.
Sami Alouani (19:11) And so not only can that be done concurrently with some of these scoping prep and config phases, but we can do it a lot quicker generally if, you know, if we are all both on the same page and have the right expectations set. So, this is really the biggest area of, you know, if we do it in parallel and we can do it in less than six weeks, then, you know, your implementation timeline goes from 16 down to 10 just from that motion.
Sami Alouani (19:32) But that’s the time we reserve here. And then if we, you know, as we’re implementing and you all are getting more familiar, you know, with what medallion does and you get more, you know, you have more ideation on how can we, you know, continue to increase automation and maybe integrate our systems to speak with each other. This is also a place where we can do that scoping together and determine like, hey, you know, maybe you want to integrate your HRIS system and automatically bring new providers into medallion. Like what does that? Look like, right? So that’s what that phase is reserved for and then last but not least again training, we say two weeks, this is more like a day or two in most scenarios, but we give some buffer for things like train the trainer model depending on how many admins you have. And then once that’s done, we can consider a full launch. So before I pause for, you know, phase questions, like I said, 16 weeks out of the box, we can easily get this down to eight to 10 weeks especially if we’re just talking delegated or direct enrollments rather with your help. Any questions about this timeline, what it’s comprised of what we need from your team at a high level, what you expect from our team?
Kevin Riley (20:48) I don’t think, Sammy, I just given the current variables at play, we’re trying to figure who all the right, who all the resources are, right? Again, Tammy is transitioning, Mary has moved into a new role, and so she is balancing and probably that’s an artful term there. So hopefully she’s not squeamish or rolling her eyes when I say that. But we are trying to be as mindful as possible to get to the point where we need to, we’re sort of building this plane as it’s in the air even though it hasn’t left the ground yet. But we’re going to be because we have a couple different variables in play here to make sure we have, who are going to be our operational in house leads for… all of this for the institutional.
Sami Alouani (21:51) For.
Kevin Riley (21:53) our ambulatory group, firelands physician group. And then also our out, we have a fairly large outpatient behavioral health group as well. So I kind of put those in those three domains. There’s probably others technically. But yeah. So just for your awareness?
Sami Alouani (22:16) Yeah, very helpful. Oh, I’m sorry, go ahead. Oh.
Tracey Campbell (22:20) I was just going to say if I could add, I guess my concern is anybody who’s coming due for recredentialing in the gap between when Tammy departs from firelands and when your company would take over, you know, how do we handle anybody who’s due for recredentialing as well as any new providers since we’re constantly hiring in new staff.
Sami Alouani (22:41) Yeah, that’s a great question. Actually, I’m going to flip back to the project plan before we move forward. So, and was that Tracy who asked that question? Awesome. Okay. Yeah, Tracy, that’s where this inflection point really becomes important, right? So until just to be totally transparent here until we hit this configuration phase. So again, right now, we’ve got this at like, you know, what is this? Seven weeks? It’s going to take a lot. We’re going to move a lot faster than seven weeks, right? But just hypothetically, for the, to answer your question for the first oops, for the first seven weeks of the project, the goal is for anybody, any net new providers and any providers that need to be recredentialed would be done in whatever process you have today in your legacy system. At this point of inflection. When the configuration is done, medallion is fully stood up. You know, from an instance perspective that’s where we would start saying, hey, all new providers will migrate into medallion directly, right? No new providers in legacy system after this date. And then once we have all of your historical data ingested, once your admins have been trained on, you know, the recredentialing processes, then, you know, towards closer to the end of implementation is when we would start saying, hey providers that need to be recredentialed or re enrolled with payers that’s when they would start migrating over. So it’s really a phased approach. But, you know, for your purposes of planning, you should definitely plan for at least the first couple of weeks of the implementation for all work both net new and recredentialing to be done in your current processes. So.
Kevin Riley (24:14) Tracy, that’s going to be the plan that you and I have been talking about involving Ryan here along with any of your resources sort of collaborating together to keep that boat afloat.
Sami Alouani (24:32) yeah. And for what it’s worth too, I mean, we’re your partners here. And so we understand that not everything is going to be one size fits all. We understand that, you know, the organizational shifts that are in play here and the variables that you all are calculating against. And so if it gets to a point where it’s like, hey, look, I’ve got, you know, I’ve got 100 new providers because I just bought a facility or whatever that scenario is and we need them in by this date, you know, we can kind of make exceptions and work some edge cases with you there. So just, you know, keep an open line of communication with us and we’ll work with you. Of course, this is more of a just directional guidance so we can set expectations but we are absolutely here to support you.
Kevin Riley (25:09) All right. Thanks. And just to say Sammy that, and Nick, this is where I’m getting at you’re trying to put a frame around like if we need some subject matter expertise guidance, right? On actual enrollment… that you guys are an outlet for that, right? I mean, so it’s not you’re not just, this is not just a, this is not just a credentialing, an enrollment management information system, which is one of the things it is, which is great. But you’re also providing subject matter expertise behind it that we can tap into. Is that fairly stated that?
Sami Alouani (25:59) Is absolutely fairly stated and you’ll get that through a number of channels. Frankly, the primary channel is going to be an initial channel is going to be your implementation manager, right? So they have subject matter expertise specifically as it comes to like what that transition process looks like from your, and that’s not just management information to your point, that is processes procedures, you know, actual enrollment, right? And then you also have that dedicated engagement manager who for context, they all come from operational backgrounds, right? So, every engagement manager at medallion has experience in the seats of your operations team that’s where they come from and that’s where we get them from. So you’ll have that operational subject matter expertise throughout the whole project and that’s actually a really good transition into maybe a double click into like what is the, this isn’t really the data we need per SE. This isn’t the, what I’ll talk about the data import template. This is part of the payr scoping process. And so this will maybe Kevin give you an idea of how we approach like when we take your processes versus when we inject our subject matter expertise. What we’ll do is we’ll go payer by payer here. Ultimately, we want to understand what is your payer mix, what is the scope of your payer mix? And then how do you all operate and function with those payers today? For example, we’ve got medicaid state X… we’ll do a mapping between what you all call medicaid and what we call medicaid. We’ll understand the lines of business here, your commercial government, medicare, etc, do you have current group enrollments? Yes or no. Those are some things that generally and then your priority support. These are things that are pretty basic that’s pretty basic information that anybody should be able to provide us. But beyond that, there’s more nuance here then we ask, do you all use rosters? Can we on the medallion side leverage automated rosters to bulk submit applications for these payers based on your agreement? If you’re not sure that’s where we can help you. We can ultimately understand, hey, like 90 percent of our customers that submit applications to this payer, do allow rosters? Our recommendation is whether you do today or not we should use them right? Then we’ll go through things like your enrollment processes in medallion, we have what we call our payer directory, which is kind of the default kind of standard approach to application submissions for every payer. And so if you all are at a point where you’re like, hey, you know, I don’t really know or I don’t really have a preference on the specifics of how an application is submitted for this payer medallion. I trust you guys, please use your subject matter expertise to do it however you best suggest.
Kevin Riley (28:29) Excuse me. That’s.
Sami Alouani (28:30) where this comes in, right? With the goal being for this payer, do you have specific custom processes in mind or should we trust medallion’s process out of the box, right? And that’s where if you all, if there are gaps in subject matter expertise, our team will help inject and fill those gaps. So I’ll send this sheet over today. I’ll have Nick send it as a follow up. And my suggestion just to really kind of keep on keep the foot on the gas with Tammy’s transition is let’s fill out as much of this as you all can to start. And then that’ll give us a heads up on the payer scoping process.
Kevin Riley (29:05) Let me, Sammy, should we distinguish, should we, or how would we distinguish here between whether we’re talking about institutional enrollment matters versus providers… or is that?
Nick Scallion (29:20) It’s probably going to be, do you have different tins Kevin for the two different? Is there different tins for the different groups?
Kevin Riley (29:27) Yeah, yes, there is. I mean the, yes, the hospital and the outpatient BH are under one tin. Okay. And then firelands, physician group is, has their own tin, got it.
Sami Alouani (29:45) So, this is generally the approach here is for the physician side for the institutional or facility side, there is generally less, you know, flexibility in terms and that’s not from us, right? That’s from payers in terms of how those facilities enroll. So we don’t have as much of an in depth kind of enrollment scoping template there. And that’s something we can work through with your team during implementation. So my suggestion is because there’s a lot more variance in the provider side when it comes to enrollment. I would focus on the physician group when you’re filling this out. And then of course, you know, if you know, that’s not the case and you all have some, you know, special kind of edge case facility or institutional enrollment processes, we’ll uncover those during implementation together. But provider side is definitely going to be the priority.
Kevin Riley (30:31) Okay. And then I’m assuming you distinguish on for medicaid with the medicaid managed care plans, right? So in Ohio, we have caresource and a whole bunch of other plans. So, you know, the individual plan… level as opposed to just a right? Okay. That’s.
Sami Alouani (30:53) exactly, right. Yeah. That’s exactly now, of course, if it’s just, you know, traditional medicaid government that’s medicaid government, right? But then, yeah, the traditional plans you’re exactly right? You would list each one of those out and then you would tag it as a managed medicaid here. When it comes to the line of business.
Kevin Riley (31:07) Got it. Okay. Yeah.
Sami Alouani (31:08) Great question. So, yeah, I think before we transition into like the more management information system side data that we need, this is a really good inflection or stopping point rather just really want to make sure we’re all on the same page of the overall approach to implementation, the, you know, kind of nuance and variable that you all have when it comes to kind of the internal organizational transitions that are going on and what we think and suggest you all work on from day one, as far as the scoping are we all kind of on the same page there. And of course, we’ll send this out after the call.
Sami Alouani (31:45) We’ll take no news is good news there and assume that we’re kosher, but hey.
Kevin Riley (31:50) A lot of consumption here, Sammy. So I’m sure there’ll be more reflections afterwards… I.
Sami Alouani (31:57) Mean, yeah, a firehose is a good metaphor. Right now. We understand that this is a lot. So, of course, this won’t be the last time we speak and we’re here to serve as resources as you all are planning. So, you know, definitely don’t need to have all your questions ready and answered right now. So, but that said, I’m going to go ahead and shift gears a little bit to our more of the traditional managed or management information system data and share that screen, bear with me.
Kevin Riley (32:31) Okay.
Sami Alouani (32:32) Can you all see my screen?
Kevin Riley (32:36) Yeah, yeah, it’s a.
Nick Scallion (32:38) Little, yeah. But maybe do a little bit of this. Yeah, there you go. Stay with that my.
Sami Alouani (32:43) One ask of you all, my one favor here is that when I’m zoom for some reason, when I go tab to tab, it doesn’t respect that zoom. So if you all will just like slowly creep your head towards the camera, when you can’t see something, it’ll let me know to zoom it. No, I’m kidding. Just remind me when I need to zoom. Yeah. So generally, this import template hopefully shouldn’t be totally unfamiliar to at least everyone on the call. But for those of you all that haven’t seen it. As you can see here, there’s quite a bit of information. We need what you all have provided us so far. Is, this is just the provider data. And again, you’ve given us basically everything we need here. This sheet at first glance looks good. Of course, my team will take a look at it and let you know if there’s anything missing. But the goal of this sheet is that very high level provider profile information, right? Like just enough information in other words to trigger a caqh import to bring in all the rest of the stuff about the provider themselves, their work history, their education history, their license information, their board certifications, all the things that you imagine live in caqh. And so again, this checkbox, you guys have done what we’ve asked here so far and we’re good there.
Nick Scallion (33:50) I think the caveat I was going to say too and Kevin, you might well let’s get to your question as well. But same thing, the caveat being that for only one of the two groups, we got the provider information.
Sami Alouani (34:02) Gotcha. Yeah. And I guess, and would that be for the physician group? I imagine that we got that information we.
Nick Scallion (34:08) Got it for frmc. So Tammy might lean on you for what exactly that means for where the delta might be just in terms of if that’s an institutional or on the provider group side. Okay?
Kevin Riley (34:24) Well, Tammy, I don’t know if you heard that or not.
14197227305 (34:30) Sorry, I heard part of that. So we, yeah, because you, it was a question about the typical providers because that was what I sent to you guys.
Sami Alouani (34:40) Right. The question was Tammy, was that from the physician group or from the institutional side of the house? The?
14197227305 (34:45) Provider list that was from the hospital and outpatient behavioral health?
Sami Alouani (34:52) Are there any other groups? Sorry, I’m not as familiar with your group structure, yeah.
Kevin Riley (34:58) That’s what I was saying. Tammy, there’s another right that’s one basket, two domains under there, the hospital and outpatient behavioral health. And then the separate one is our main ambulatory group or physician group, right? So, firelands physician group. So, Mary, did you provide or compile anything at the time when we were dealing with this back a few months ago?
14197227305 (35:22) I have the roster. I haven’t sent it over yet.
Sami Alouani (35:24) Though.
Kevin Riley (35:25) Okay. All right. So you have it sure.
Sami Alouani (35:28) And that’s actually a good opportunity to talk through this. So like for the physician group, right? I imagine that’s where we’re going to be doing direct enrollment on behalf of the providers, right? With the payers for the institutional side, the hospital group, for example, maybe a bad assumption on my part, but are we going to be doing direct enrollment there, or are we just enrolling the facilities themselves?
Kevin Riley (35:53) I don’t know what the distinction is. And again, remember under the frmc, we have the outpatient behavioral health. So we have two different provider groups, outpatient behavioral health, provider group, and then firelands physician group. So two different provider groups. And then the third part is the hospital itself. And I’m assuming we’re going to maintain ultimately under this management system that we would maintain the enrollments in the future for the facility through this system. I don’t know. You let me know if that’s correct? Yeah.
Sami Alouani (36:39) That’s a really important nuance. So there’s the way and pardon me for, I’m going to break apart the way you’re thinking about your structure for just a moment to kind of mesh more into the medallion skews just for the sake of conversation. So for the medallion skews, we’ve got like provider payer enrollment, right? And then we’ve got facility enrollment. Those are kind of two different functional products in the medallion. So the way I’m thinking about it is your physician group and your behavioral group, your outpatient behavioral group. Those fall into the provider payer enrollment bucket in medallion, and then your hospital is going to fall under the facility product.
Kevin Riley (37:12) You got it. Perfect.
Sami Alouani (37:13) Okay. So given that, what I’m asking really is that, you know, for the hospital side, we don’t need the specific providers, right? Unless, of course, they belong to one of your provider groups, but we’ll get that data through the provider group.
Kevin Riley (37:26) Okay.
Sami Alouani (37:27) Cool. Just wanted to make sure there. So then here, really the provider data we need is any individual provider, dr smith, dr, John, whomever that we are going to do a direct payer enrollment for. Of course, if there’s a provider that is not part of your medical group, that just so happens to practice at the hospital, we don’t need their information here. Okay?
Kevin Riley (37:47) Yeah, yeah. I got it. Hey, Tammy, just real quick. I’m trying not to get too many technical bunny holes but is any of those providers that are where we do like they might be an fpg provider or maybe Mary, you know this, but they’re doing one of our specialists. They’re doing a read like an ekg read or something. And my understanding is that… I don’t know where that billing happens from, if that happens under the medical center or under fpg. But are those separate enrollments, do you know?
14197227305 (38:23) So for on the hospital side, we.
Sami Alouani (38:27) individually.
14197227305 (38:28) Enroll cardio, we enroll our vascular surgeons, and we also enroll our docs all for vascular reads and ERS, ekg interpretations. So we have always enrolled them. It’s not that that’s a huge number or anything, but that is, you know, a group of people that we enroll under the hospital tent.
Kevin Riley (38:54) Okay. I just wanted to clarify. So it’s a little bit more because like dr George, right? One of our cardiologists he’s enrolled as an fpg provider… presumably, but you’re also telling me that he’s also enrolled as a provider under frmc’s tent.
14197227305 (39:14) So he’s enrolled that’s correct?
Kevin Riley (39:17) Twice that?
Sami Alouani (39:18) Is a perfect transition point into the next concept here, which is the mapping between providers and groups. So in this case, so well not to skip over these groups and practices. But this group sheet actually is just one row per tin. So based on what I’m hearing right now, we’re going to have three rows. We’re going to have one row for the hospital facility. We’re going to have one row for the outpatient behavioral. And we’re going to have one row for the fpg for the group information, very high level info. Just need to know the tin, the group’s npi, the name incorporation state whether they’re I think, I would imagine all the behavioral group will be behavioral, and the other two will be medical taxonomy and primary specialty, super straightforward high level info there. And then for practices, this is going to be the physical practice locations. And so this is the list of practice locations that we would submit to a payer for the purposes of enrollment. So, you know, if dr smith practices both in the, you know, I don’t know how many locations you have in the fpg group, but whatever the locations are there, plus the locations that we would need to enroll for the outpatient behavioral health, that’s what we need here. This is different from facilities and the hospital side. I’ll get to that in a.
Kevin Riley (40:27) Second. Okay. And.
Sami Alouani (40:31) then this is the provider practice group mapping. So this is Kevin, the question you were just asking about your cardiologist and this is really important because if we need to enroll that cardiologist both under the fpg practice locations, but also enroll them under the hospital tin, we would expect two rows here, one row for the provider’s, affiliation with the practice group. And then one row with the provider’s affiliation with the hospital group. And then blow that up based on the number of actual practices underneath the group. So, for example, if dr smith or your cardiologist, dr George practices at two outpatient locations under fpg, where they do consults, and then they practice under the hospital where they do consults, technical procedures. We would expect three rows here, three rows of data. We would expect one row for each of the two outpatient locations under the fpg group. And then one row for the hospital under the hospital tin.
Kevin Riley (41:27) Okay. So it’s not just their home sort of practice. I got the distinction between, you know, the hospital, the two, right? But the third is, hey, if they’re doing any other, if you have a specialist who’s doing outreach clinic, right? Where they’re generating a professional fee, presumably that would have that location on it. We need to, that needs to be its own separate line.
Sami Alouani (41:53) Bingo exactly. And another way to think of it, Kevin is like work backwards from billing, right? Like if I’m billing Aetna, I need to be able to capture every possible location dr George would have. I need to capture every possible location. I would send on a claim to Aetna for dr George. That’s another way to think of it here yep.
Kevin Riley (42:11) Yep. Okay.
Sami Alouani (42:13) Excellent. All right. Moving on real quick. This is facilities. So this is just, we’re going to have one row for the hospital that’s basically it. So this is not necessarily a group, but it’s just the hospital that we would be doing enrollments for. And I don’t know if you have multiple hospitals. If you do it’s one row per hospital.
Kevin Riley (42:28) We do now. Yeah, we just acquired a hospital last year. And so, Nick, I don’t know that we’ve talked about that, but the bellevue hospital, it’s known as… it’s not going to have all well, actually, it probably does have, it might have some professionals, Tammy like those specialists we’re talking about… we’ll circle back to that, but we do have an additional hospital that has sort of been maintaining, you know, so I’ve held them out on their own. Now, most of the professional side has transitioned over to firelands… physician group. So they don’t have they don’t have a, they don’t really have a separate active… physician group. Tim at this point, gosh. Okay. But there’s no, really all the providers should have been transitioned at this point.
Sami Alouani (43:20) That’s another you’re hitting on some really important distinctions here. So the goal here is not necessarily at a tin level but rather like for those institutional enrollments that we’re going to perform, we need to know which institutions we’re going to be performing enrollments for. So if perfect, okay, got it all, right, next, we can skip malpractice insurance for now. That’s kind of optional if you don’t have it in caqh, external accounts. Not important right now. Recredentials, not important. Right now. This is the meat guys. If we can leave in 15 minutes with being on the same page about this concept, we’ll be in a really good spot. So this is the historical provider enrollment. So this is not facilities. This is just the providers, the individual providers, we need to understand for every provider, what payer are they enrolled with or enrolled in under what tax id? In what state, with which practice locations. So, for example, if dr George is enrolled with Aetna at three different practices, and again facility is separate, this is just the provider groups.
Kevin Riley (44:28) Understood. So if.
Sami Alouani (44:30) he’s enrolled with Aetna in three different practice locations, we expect three rows of data here for dr George. And then if he’s also enrolled with blue cross at those same three locations, we expect six rows here. So it’s the provider times the number of payers they’re enrolled in times the number of practice locations.
Sami Alouani (44:52) And groups technically actually times the number of groups. So if they’re enrolled with the same payer in multiple groups, we need multiple entries there.
Sami Alouani (45:04) So just to kind of go through the data concepts themselves, so the providers in, from email and mpi is our primary identifier for a given provider, this is where you’d list the payer, the state, the status here. Generally, the vast majority should be par here as a status or par linked group rather if you wanted to send us for whatever reason, your historical like non par enrollments that are no longer active, technically, we can house those. I don’t necessarily suggest it, but you can, if you like your effective and revalidation dates, effective date is non negotiable, but revalidation, we understand, you know, while we have it listed as required here… we know that sometimes payers don’t send you the revalidation until like 90 days before that revalidation comes due. So it’s required in the sense that if you have it, send it, if you don’t you can leave it blank. The payer id is the same thing here. So, I’m actually just going to go and mark this one optional payer id only in the scenarios where, you know, you want to link out for example to your billing system or your RCM and want to, you know, call a payer in medallion, what it’s called somewhere else. Like we can link those external ids here. But generally optional, the enrollment method is almost is for you all going to always be direct enrollment. So you can just drag and drop that value. The line of business here, we talked about a little bit earlier. This is just one true false telling us which line of business a given row is, but.
Kevin Riley (46:30) What is line of business? Well, I’m sorry, what do you mean by line of business?
Sami Alouani (46:35) Yeah, financial class. So, are you commercial medicare advantage, managed medicaid? Traditional? Oh.
Kevin Riley (46:40) Okay. From a line of, from an insurance angle? Okay. Gotcha. All right, correct.
Sami Alouani (46:46) Exactly. Yeah. That’s a good. Yeah. Sorry for the confusion there. Yeah. So from the insurance angle, what type of coverage or what type of payer relationship are we talking about? And then last, but not least the practice information and the group information. So just the name of the practice npi, the tin of the group npi and name, and that’s it. So again, just to summarize all, this is where, you know, it seems conceptually simple, but this is where we see the amount of rows really blow up and that’s just because of the granularity that we need to receive the data in order to ingest it.
Kevin Riley (47:18) Well, Sammy, just out of curiosity, if we’re providing, you know, payers, and another thing I mean, isn’t the assumption… slash presumption that the provider is enrolled with… each payer identified for like firelands, physician group. In other words, if I tell you that I got Aetna anthem mmo, you know, et cetera.
Sami Alouani (47:48) I was going to ask the same question, Kevin, it’s a great question and it’s not just because of the relationship from the provider to the payer, right? If that’s all we needed, totally fair. You can say, hey, you know, I’ve got dr smith, he’s enrolled with us and you can assume that means he’s enrolled in all 10 payers, right? That would be easy problem is think about things like effective date. How do I know when dr smith was enrolled in Aetna versus cigna versus et cetera. Right? So now, I need you to list out each one of those, not just to tell me their relationship but to tell me information about when that relationship was established. The other thing too is dr smith may be enrolled in Aetna and cigna but not in all practices. That’s a thing that is a dangerous assumption, right? We don’t necessarily know that dr smith practices in all of the different locations. And therefore, we don’t know that dr smith is enrolled with every payer in every location. So it’s a really great question. We don’t need it just to know what payers are contracted with, what providers, we need to know information more granularly about those contracts. I want to make sure that answers both of your questions though because it’s a very good question… yep.
Kevin Riley (48:56) So, Mary, do you have, I know we only have a little bit more time. So I want to be cognizant of time. But Mary, if you’re able to quickly, do you feel like you, I know you have a lot of records, you keep a lot of information. Do you have this information organized in a way? It may not organize this way, but that we’d be able to take that and populate this?
14195575547 (49:24) The majority, yes, obviously some of our older physicians were, that were loaded, you know, long before I started doing credentialing, you know, I may have to reach out to the payer or whomever to get the effective dates. I mean, it’s definitely going to be a task to complete this portion of the roster because we’re talking about, you know, 110 Ish providers with 25 payers that, you know, most of our providers go to multiple locations. So it’s… it’ll be a task that’s for sure, but I think I can compile the information one way or another. Yeah, we’ll.
Kevin Riley (50:08) get together, may as well sit down and look through some stuff. I want to understand that a little bit just, but fair enough. And Sammy, I’m assuming and, you know, listen, if we don’t have a piece of information, you don’t have a piece of information, it’s not going to prevent you from uplet, right? It’s just like I don’t know if I didn’t if I didn’t have the, if I don’t have the effective day for enrollment for dr jones for anthem… and… he’s been here for a long time, him or her then… because we do have a, her, dr jones. So, it is, you know, then therefore, what relative to you guys, it’s like, okay, it’s just a piece of missing information, right? We can try and take it now, but for purposes of our, we shouldn’t let like if I was missing that one piece of information, maybe it’s incomplete, but it’s not incomplete in the context of holding up, moving, this train forward, yeah.
Sami Alouani (51:10) It’s a fantastic question. I wish I had a blanket answer for you but it’s complicated and the reason for that is let’s I’ll give you an example. So there there are two different types of things effective date to your point. Totally, it’s just a road bump. We all that means to us is we don’t know when it’s effective. That doesn’t impact our ability to import it. It doesn’t impact our ability to revalidate once we know they need to be revalidated, you’re exactly right? That’s not going to break anything. However, let’s say that you don’t include the practice information or you’re missing the group, right? If you, if you can’t tell me what group that enrollment is under, that will break things because we can’t import something without knowing what group the enrollment is related to. Because again, if a provider is mapped to two different groups, the hospital group, or, the hospital tan, and the fpg tan. And you tell me that they’re enrolled in Aetna. I don’t know, which group they’re enrolled in Aetna in, so that would potentially break something yeah.
Kevin Riley (51:59) I get it, that probably won’t that distinctly won’t be an issue, I don’t think, but.
Sami Alouani (52:06) Generally speaking, we will avoid, we’ll import everything we can and anything we can’t we’ll be very clear with you on what we’re missing and why it’s important that, we get that we actually have a really cool, a really neat tool that Greg actually on the call developed that will go row by row and do that validation for you. And it’ll give you like a results column that says this row is fully ready to import. We’re good to go. And this next row is not ready to import. And here’s why. So you all can go track down the things, that need to be tracked down. So we’ll tell you don’t have to like do that analysis of if I’m missing this, what happens? Just send us what you’ve got and then we’ll run it through that tool and then we’ll give you back the feedback that you need to track down what needs to be tracked down. And we actually have run the provider list that you all provided us already. We’ve run that through this tool that I’m talking about. And we’ll send that as a follow up to this call. So you get a flavor of, you know, how we’ll work with you to, you know, make iterations on the data that you send us. Does that answer your question? Kevin? Yeah, awesome. Okay. Really quickly going to move on here. With a few minutes remaining. The next concept should be really similar to what we’ve already talked about. But the next tab here is your group enrollment. So very similar data to what we require at the provider level. But just for those three tins, the hospital, the outpatient behavior, and the fpg tins, what enrollments are done already at their group level. So this one is a lot easier to extrapolate than the providers. So like your question of, well, if I know the fpg is enrolled with Aetna and these five payers, why can’t you just assume and extrapolate the rest of the information. You guys can do that if you want here. Because the likelihood of fpg not having a given practice location enrolled under the group enrollment, doesn’t make any sense. So this one should be a lot easier to fill out. But it’s the same data elements just again at that group level. And then we probably don’t have to talk about this one today. But we also have this concept of enrollment requests. I would say we can potentially.
Nick Scallion (54:10) put a.
Sami Alouani (54:11) pin in this one for the time being, we can talk about it more once implementation kicks off. But at the highest level, if you have in flight requests or credentialing requests that are being actively worked that you wanted to transition mid in flight from your legacy system into medallion, this is the data we would need in order to take over an in flight request. Again, hopefully, we get to a point where it’s like we draw a clean line in the sand. Any requests created before this day or work to completion in legacy, any enrollments created after this day or work to completion in medallion. But if not, and we’ve got some overflow and we need to migrate some in flight requests. We can do that here. But again, I wouldn’t worry too much about this. So yeah, how are we feeling? Any questions at a high level? And again, this won’t be the last time we talk about this. You’ll have a dedicated person from my team that will work through this with you as we implement.
Kevin Riley (55:10) So, Nick, you’re going to send, or Sammy or Nick, you’re going to send these lists again to us after… the meeting here? Yeah.
Nick Scallion (55:22) We’ll send the full document, this one here. And then to Sammy’s point, Greg already ran through the… document that Sammy provided us a couple months back and I think there’s just going to be a couple pieces on that provider document that need to be fixed to be import ready. But yes, we’ll send both of those as attachments.
Kevin Riley (55:44) All right… Sean, any questions from you from an information security? I mean, this seems that this is a, you know, some of the users we identify as, you know, the administrative users have usernames and… passwords… and it’s not really bi directional, right? So this is again sort of a static. We’re feeding the solution which is online and then accessing and managing from that as… far as I can tell and understand this. So, Sean… anything from you in?
Sean Steffanni (56:35) Terms of no… nothing that we need to get into on this call, I mean, there’s I do have questions but it’s more around, you know, the data. If we’re going to be migrating data from a current solution, I don’t even know what that solution is, and I don’t even know if we have the access to do the migration, if we need to contact the vendor to get data out to put into this one, I don’t.
Kevin Riley (56:57) think we are, I mean, Tammy and Mary, we’re not currently using any third party software, is that correct?
14195575547 (57:06) Correct. It’s. All manual, just spreadsheets and stuff yep.
Kevin Riley (57:10) All right. So that answers that question.
Sean Steffanni (57:14) Also, but are we planning on taking all the data, the historical data that we have and importing it into medallion or?
Kevin Riley (57:23) Yes, based on those spreadsheets that he was just going over? Okay?
Sean Steffanni (57:29) And I guess I just need to understand what’s if that’s going to, if anything that that’s going to entail for our team or if we’re just turning the spreadsheets over and they’re doing the mapping and ingesting everything independently here?
Kevin Riley (57:42) Yeah. And I don’t think it is Sean, because again, I think the mechanism in which we convey all the substance in the format that they’ve outlined, Tammy and Nick, I’m assuming you have some sort of upload. Yeah.
Sami Alouani (58:01) Exactly. I think if we get the deliverable of what I just showed you with populated data, that’s all we need from you. All I think it’s just a matter of, you know, if you guys, for example, don’t have a legacy system that has this data in a structured manner that you can extract and programmatically transform Sean. I would say that my two cents, you know, as a third party here is that your team probably isn’t needed, but, yeah, that’s the goal. If you can get those spreadsheets populated, that’s all, so.
Kevin Riley (58:29) We’re not extracting it, Sean, from any other type of system… where that is housed or database, right? Okay. I mean, so.
Sean Steffanni (58:43) Is that just going to be keyed in then by somebody on that side?
Kevin Riley (58:47) I think that’s something we’re going to discuss. I think we have a lot of the information like in spreadsheets, which is what Sammy just presented may not be organized in the same way. Yeah. So there’s going to be, yeah. So it’s going to be a manual process. No doubt. The question is how do we garner… the resources to do certain aspects of that versus, so that’s something we got to work out but yeah, I think a lot of the information at least the core information is already on spreadsheets, but it is probably, you know, our column a is not medallion’s column a and so on and so forth, right? Right?
Sean Steffanni (59:37) Right. So, yeah. So it’s just going to have to be mapped over. I just don’t know how many records we’re talking about here, if it’s you know, just the current list of providers that we have credentialed or, and obviously, I did catch what Sammy was saying about, you know, each record per facility per provider, per payer, and that kind of thing and having three, four rows in the, you know, for each provider possibly. So, I mean, I just don’t whatever we need to do to support, that work, or if it has to be done manually. I just need to understand that and then, and we can work like I said, we can work that out offline Kevin, but I just want to make sure that if there’s anything else that I know about that I need to know, I know, but I haven’t heard anything that would be more that… would require more effort on our side, right? Yeah. Okay.
Kevin Riley (60:31) All right. Okay.
Nick Scallion (60:33) Folks. Well, I’ve got these two documents I’ll send over to all the attendees today, happy to answer any questions that you’re going to have, in the interim and then we’ll get a formal kickoff call scheduled here, folks with the assigned resourcing on the medallion side, to get implementation started. So excited to get there. There’s going to be probably several questions, you know, probably resulting from, this call which is fine. I want to make sure we address those and have a good attack plan. So anything else before we let you all run?
Sean Steffanni (61:06) Nothing for me?
Kevin Riley (61:09) All right. Thank you all.
Nick Scallion (61:11) Very good, folks. Bye.
Sean Steffanni (61:12) Now, thank you. Bye.
Nick Scallion (61:14) Bye bye.