Transcript
Jeremy Walker (00:00) hey, Khaliq. How’s it going?
Khaliq Ur Rahman (00:02) Hi, Jeremy. I’m fine. How are you?
Jeremy Walker (00:05) I am, doing well. Thanks for joining us today.
Khaliq Ur Rahman (00:10) I think we need to wait for Derek.
Jeremy Walker (00:14) Yes, yeah, we will definitely do that. Where are you calling in from today? Khaliq?
Khaliq Ur Rahman (00:21) I’m from offshore.
Jeremy Walker (00:23) Okay. Nice. Hopefully this is a convenient time for you and we didn’t keep you up too late or wake you up too early.
Khaliq Ur Rahman (00:31) No. So, my work time is the pacific times.
Jeremy Walker (00:37) That’s awesome. Hey, Derek. Good morning. How are we doing all?
Derek Kamajian (00:44) Is good in the hood? How’s everybody doing today?
Jeremy Walker (00:47) We are good. Yeah, Khaliq was just letting us know that anytime he’s working is a good time. And so I was telling him, hopefully we’re not keeping him up too late or waking him up too early, so.
Derek Kamajian (00:59) Khaliq’s a good man and he’s taking care of business, and hopefully we make his job 50 percent easier with some software instead of spreadsheets, right? Khaliq?
Khaliq Ur Rahman (01:07) Yes.
Jeremy Walker (01:08) That is the goal. Awesome. Well, Derek, just by way of introduction, would love to have Mallory introduce herself and then Khaliq, if you want to do the same. And then we’ll kind of kick things off from there. So Mallory go for it. Thanks.
Mallory Smith (01:23) Jeremy, Derek Khaliq, it’s a pleasure to meet both of you today. I am based in Nashville, Tennessee. I’m a solutions consultant here at medallion. So I’ll be running through a brief overview of the demo platform, answering your technical questions, and really just painting the view of what a partnership with medallion would look like.
Khaliq Ur Rahman (01:40) Thank you, Mallory. So I am currently working as manager, credentialing and provider enrollment at insight therapy solutions. And we are looking at some options that we can use instead of our spreadsheet for majorly the provider enrollment tracking. So we have a lot of pairs and our providers are licensed in multiple states and we want to have some tools to better track those applications. So the enrollment is major concern for us for credentialing. We have a little bit of issues, but the insurance enrollment is the major area we are exploring some softwares.
Mallory Smith (02:27) Well, the good news is, that is what we offer. So, I’m glad we’re having this call.
Jeremy Walker (02:34) Yeah, I appreciate that context. And I know Derek, we talked on Friday briefly about kind of having two next steps. And so today we’ll be primarily focused on, I know you said Derek last week was, you know, the CEO is thinking about value in kind of two ways. One is how much faster can we get providers enrolled with, you know, with these payers and how quickly can we, as we add payers, you know, bring in additional revenue from those payers? And then the second part is understanding the provider’s life cycle. If you were to partner with medallion from the moment they sign a contract to how the onboarding process starts. You know, how we do background checks, caqh checks, licensure, and then all the way through to them being live and in network with your providers. And then also looking at caqh management and even revalidation of providers. And so some of that, we’ll demo on the conversation today, but just wanted to make sure that if we use that as the agenda for our conversation, that was a good place for us to use this time.
Derek Kamajian (03:33) Yeah. I think that sounds great. I’ll defer to Khaliq as well, especially if he wants to look at a different area of focus. And since I’m unable to invite, do you have an AI note taker or something that you can send out after the meeting is done?
Jeremy Walker (03:50) Yes, this call first and foremost, we’ve got it recorded and then I can either send you the transcript or the actual call recording, whatever’s I would say that probably the call recording is a better bet. But yeah, I can definitely follow up with that.
Derek Kamajian (04:03) I’ll take both if you have them.
Jeremy Walker (04:05) Okay. Sounds great. Awesome. Mallory. We’ll kick it over to you and I’ll come in here and there with some questions and, or added color. But Mallory, this is your show.
Mallory Smith (04:17) Okay. All right. Thanks, Jeremy. I’ll go ahead and share my screen.
Mallory Smith (04:29) Okay. Are you able to see it?
Jeremy Walker (04:31) Yes. Okay.
Mallory Smith (04:32) Thanks. So I’ll go through in first level set on what we’re going to see today in the platform. So Jeremy did catch me up to speed on how you’re currently managing everything with a spreadsheet. You have the provider’s name, basic demographics, red or green if they’re enrolled with the payer. So I’m going to show you how you’re able to track the information in the medallion platform, as well as how we’re able to have guaranteed slas on turnaround times, submission, and quicker turnaround times with the payers themselves. My plan for today just to walk through would be the provider onboarding experience. So first we’ll talk about how we get you up to what I like to call current state. And then we’ll move over to how do you add new providers? From there, we’ll talk about ncqa level credentialing that will perform all of those sanctions monitoring, ensuring that there’s no compliance issues, adverse events that have occurred. We’ll then transition to payer enrollment. So I know that’s the main focus of today’s demo. And then finally we’ll wrap up with reporting. Is there anything you’d like for me to change about that flow today?
Khaliq Ur Rahman (05:38) Okay. No, that’s good.
Mallory Smith (05:41) That’s good. Thank you. Okay. So the screen that you see here, this is the medallion platform. It was built from the ground up in 20 20. It is a proprietary platform. We are open ended bidirectional when we think of apis connecting to and from, with the sheer volume of providers that you are going to be growing into. I would absolutely recommend apis in the future. I know that the main phase here is going to be to focus on enrollment, but whether that’s connecting to your HR platforms, connecting later downstream to your credentialing or your billing systems, your scheduling systems definitely ways to increase efficiency there. When it comes to getting your information to steady state, what we’re going to do is basically supply you with an import template with the volume of providers that you have. Now, it sounds like they’re already on a spreadsheet. So I really see it as easy as just taking the spreadsheet you have now moving the columns around to match our formatting. And then we’ll get that information imported. So what I’ll start with the provider onboarding experience is that we have all of your current providers loaded and this would be for new providers that you’re inviting to the platform. So there are ways to do individual as well as bulk invite. So if you were to do bulk, we would just need the provider’s name, email, caqh id, npi, from there, what that’s going to do is automatically connect to the caqh website and Khaliq. Are you familiar with caqh? Do you currently manage that for the providers? Yes, we are managing for all the providers. Okay. Thank you. So this is something that can be automatically done with medallion. We are a participating organization with caqh. We are the only vendor in the space that has a true bi directional partnership. So what that means is that we can import without needing the provider’s username and password. I know that’s sometimes hard to track down. They often don’t remember it. I hear you loud and clear. The other great aspect is that any information in the medallion platform will automatically be pushed back to caqh when it’s time for the provider to reattest and medallion will reattest on behalf of the provider as well. So all the provider really has to do is just log into caqh once a year, ensure all the information is accurate. We can handle the rest just automatically through the technology… when inviting providers to the platform, whether it’s in bulk or individual role based access control. So Khaliq, you mentioned that you manage a team if you have certain team members, you would be a team manager obviously or an admin. If you have certain teams that manage certain states of providers, certain provider types, certain functions, whether it’s credentialing enrollment and so forth. You do have the way to delineate how they’re shown in the platform and that way your team is seeing the information most relevant to them. So we would of course have role based access control and then last email name, start date, provider type that’s all that we really need in order to be able to send out an email to the providers to initiate that process. What that email would look like. We do allow white labeling. So when it comes to white labeling the email that goes directly to them, you would have your logo right up at the top. You’d be able to see you control basically the messaging of the body itself. So whatever message you want to provide to your team and to your new providers, from here, the provider would then be able to get started on the process. One caveat that I want to throw out is that you can either link the provider caqh for them, get their profile with 70 75 percent completed before they even log in, or you can have the provider link their caqh. So it’s completely up to you on how far you want to manage that. We’ve seen teams really do 50 50 where they’ll connect the provider caqh. They’ll fill out as much as possible, and then they’ll have the providers put the finishing touches. We’ve also seen much more independent practice, physician groups. I’m thinking in thousands range of providers that they will just send out an email. And then we will actually be the back and forth communication with those providers. So either way you want to work this, but from this onboarding flow itself, the provider would receive this email. They’ll then click get started. It’s going to bring them into the platform itself. Insight therapy is partnered with medallion to help with licensing credentialing enrollment. They’ll click get started, kick start their profile. So we do have multiple data ingestion methods. So if we go ahead and click continue, caqh is going to be our most popular. I would say that 85 percent of our customer base uses this just because it’s no additional charge for you. So you’re able to connect without having the provider’s username and password. It does complete 70 to 75 percent of the provider’s initial onboarding profile. From that profile, we’re able to complete their credentialing as well as their payer enrollment. So it’s very comprehensive. It’s not two separate processes, other options, resume scanner, they’re fresh out of school. They don’t have a caqh profile just yet. They’re able to upload a copy of their CV or their resume, scans it into the system, helps populate the profile as well. Any questions with that. No okay. And then that last piece of course would be manual or API integration. So we do have customers that will connect their HRIS system so that it pulls in the provider’s demographics just as an option. If we go with caqh, the provider’s caqh id their social last name, we’ll verify it. We’ll confirm and link directly to that profile. And then again, 70 percent of their profile is complete. They’ll then be able to go into that process itself. So when the provider now goes to their profile, it would look something like this. So this is the provider view. So we have provider view admin view how our team views it. Everything that I’m showing you in the platform today would be your view of the platform itself too. So while we do step in and help out with some of the essential groundwork such as the application population and the submission process, and so forth, your team still gets full transparency. You get to see every note, every email, every task that’s occurring. And your team can use it to communicate with the providers. So there is a checklist to the left. We have the check marks to let us know that the information has been gathered. There’s also some really nice features too such as the document QR Code scanner. So I’m not sure if you’ve ever had a provider. They’re on the run. They don’t necessarily have time to find a printer, scan their document over, email it to the, admin, uploads it to the system. It’s always a whole process. If they are on the go, we have a mobile friendly option. I’ll show you that in just a minute. But essentially, they can scan the QR Code with their cell phone. They can take a picture of their diploma up on the wall as an example. It then saves it into the platform as a PDF. It even helps name it. So a lot of great benefits when you’re thinking of the provider onboarding experience so far they’ve received an email, their caqh can be linked by them or it’s already linked for them by your team. And then they’re uploading the documents. They have the QR Code scanner. And then here is the mobile view, this is what it would look like if they were to do it from their cell phone or their tablet. So they’re able to open up their profile, see that the agreements need to be signed. Everything is electronic signature integration. So they would review the documents, itself, add in the signature, save, it scroll down to the bottom, save and finish. And that is ultimately the provider onboarding experience. Because of these features, we now see an average of two days to get a provider onboarded. A large majority of that is from caqh because it does complete so much of that profile. But customers across the board, we’re seeing about two days average. Okay. So I’ll pause there for just a minute. I know that you have some big expansion opportunities coming up. How many providers are we looking to add in the next year? Would you say?
Khaliq Ur Rahman (13:52) So I’m not sure about that. Currently, we have 70 providers that we are working on and they are licensed in multiple states. So I would have to.
Derek Kamajian (14:06) Khaliq, I can jump in. So Francesca’s goal is within the next three months to have a system to get into all 50 states. So we’re doing a departmental review, setting these systems up, getting some software. So the growth can be anywhere from, you know, 100 to 300. It depends how aggressive we get in the next year, but we can’t do that with our spreadsheets right now because Khaliq and I will go super bald. So we need to make it a little Symplr and reduce the back and forth time.
Mallory Smith (14:41) Of course. Well, we can’t have that. So appreciate the insight from you both there. That gives me a good range as far as I would. In that case, I would definitely recommend just the bulk invitation. So having the provider’s basic last name npi caqh id, it’ll connect the caqh profiles for them. Okay? Thank you for that. Were there any final questions about the provider onboarding experience before I transition over to credentialing?
Khaliq Ur Rahman (15:12) No, not from me. All right?
Derek Kamajian (15:15) Khaliq real quick question. Are you getting all the provider’s information like their licensure, and then sending them over. Are they just emailing it to you? And then you’re putting in your own file folders?
Khaliq Ur Rahman (15:26) So we are using the join our team forms. So the provider fill out their information and upload the documents and you can download that from your.
Derek Kamajian (15:37) Forms. And then on average, are they… responding quickly or what’s the number of days that after they’re onboarded, they’re getting you that information?
Khaliq Ur Rahman (15:49) So it takes some time. So because you send them a link and then it’s up to them when they fill this out.
Derek Kamajian (16:00) And just a side note and thank you Khaliq for that. All the providers we’re working with are most of 99 percent of them are all 10 90 nines. So these are all contracted providers.
Mallory Smith (16:12) Okay. No, thank you. You actually bring up a good point. So in addition to allowing the provider to complete once they click the link, connect their caqh and so forth, we do have conversational AI that it can send calls and text messages to the providers directly. These are automatic notifications that go out every couple of days so that we are able to see the specific metric points that we track are when the provider was first invited to the platform, when the provider clicks the link to access the platform. And then when the provider completes onboarding. So if you’re looking to track KPIs, you’re able to see that we also assist with the onboarding follow up through our conversational AI partner. If you want to have a future demo where I have the AI system call you and you have a conversation with, it is very intuitive. I was absolutely impressed myself. I’ve been in this space for roughly 10 years or so just dealing with operations, provider data management and I thought I was talking to a real person. So I asked it at one point, what is the malpractice insurance? Where can I find the Coi face sheet? And it walked me through every step. So it’s pretty intuitive when it comes to that aspect. Okay. All right. Appreciate the intel there. So where we can move next, this is our credentialing section here. So of course, with this being a demo environment, I just wanted to give you a visual on how things will be progressing throughout the platform. Khaliq, what would be expected from your team is that you would access credentialing? So now that you’ve invited the provider to the platform, they’re linking their profile. They’re completing everything, signing the documents. You would then head over to the credentialing tab to the request option provider, initial credentialing and then you would select the providers that need to go through ncqa level credentialing. Now, I did have a brief question. Are you currently following ncqa when you think of credentialing or are there certain checklists that you’re running through?
Khaliq Ur Rahman (18:14) So we have our own checklist, we verify licenses and degrees on our own, and then there are some background checks that our organization conducts.
Mallory Smith (18:29) Okay. Thank you. Would you be comfortable sharing that list with me just so I can make sure that our level of credentialing, it fully encompasses what you would be needing?
Khaliq Ur Rahman (18:38) So I would get that from our HR. So basically the onboarding is handled by HR, so, and would be shared.
Mallory Smith (18:49) Okay. Thank you. Okay. So then Derek, you had asked earlier, it sounds like Khaliq, you send the provider a link via email and then it takes them depending on how fast they act on the email. Is that your team sending the link for just the initial onboarding experience? Or is it just your team handling the enrollment and credentialing aspect? How do the two overlap? Is what I’m wondering?
Khaliq Ur Rahman (19:13) So the HR and onboarding team sends the links and they get the initial documents, like what’s in the job form. And when we have received the information, we start the enrollment and credentialing. And if there is anything missing, we need to reach out to provider via email or call to get the missing information. Okay? Thank.
Mallory Smith (19:39) You then it would be pretty synonymous with how we would do it then. So your HR team can absolutely have access to the medallion platform. You can set everyone up at insight with access to the platform. There’s no additional charge for that. So if you wanted to continue that your HR team invites the providers, they link the caqh, they send out the link completely up to you. You’re able to still see everything that’s happening in the back end. And when everything was of course sent. Okay, thank you for clarifying that. So when it comes to requesting credentialing, this would definitely fall within your team. So making the request, you’ll then have full transparency on the request that we currently have in process, the type of provider that’s going through the credentialing process. If you’re able to send me that link, sorry, I keep clicking that if you’re able to send me the checklist that you currently verify or HR team verifies, I’ll be happy to compare that to ours just to make sure that it is comprehensive. But ultimately, we have a three day SLA for ncqa level credentialing. So we’re looking at an appropriate timeline. You’ve invited the provider to the platform. Two days later, they’re fully onboarded. Three days later, they are now credentialed. We would put them in the ready area. You would be able to see if they have any flags if they have any adverse events. If they do, you would see this yellow flag here. And then finally the committee that votes is everything internal too. Now, I’m not sure. Do you currently have an internal committee that reviews the files of the providers that you hire, is there a process?
Khaliq Ur Rahman (21:21) No. So the issue is that we don’t have delegated contracts for now. So what we do is we issue the basic information. So during the enrollment process, we don’t run into issues for some accrediting related issues. So we don’t grant credentialing approval. So when we say verify the information, we verify that much information. So we should be sure that during the enrollment process, we don’t run into any issues?
Mallory Smith (21:53) Okay. Thank you. Okay. So if you were to credential the provider to get them ready to be enrolled with payers, let’s say that you found a malpractice case or you found a license sanction? What do you do with that information? Do you contact anyone? Or do you just note it?
Khaliq Ur Rahman (22:14) So, we request the providers to provide the explanation that’s usually needed for the enrollment. So if there’s an adverse action, we get the provider a written explanation that’s usually needed. And if somewhere asks for additional information, then we request the providers, okay?
Mallory Smith (22:37) Thank you. So what I’m understanding is that you’re not necessarily credentialing your providers to make sure that they should be hired that they aren’t going to bring compliance risk. You’re really credentialing and verifying these elements to ensure that the enrollments with payers go smoothly. Is that correct?
Khaliq Ur Rahman (22:55) Yes. So there’s some HR background checks that I am not fully aware of what they contain but for the documentation side for enrollment. So we are not approving the credentialing for the providers. Okay? Thank.
Mallory Smith (23:13) You, in that case, you can do ncqa credentialing with medallion or we can leave it off. It’s completely up to you. If you want to have an HR representative join a future call, if you think this is the right move forward, I could ask them if they would be interested in the committee voting feature, if they would be interested in the sanctions monitoring of the providers. It sounds like they do background checks already. We do have a direct integration with checkr background. So maybe you’ve heard of them. There’s also sterling talent solutions in the space. So there is an integration with background checks already. So if that’s something you want to pursue, we absolutely can.
Jeremy Walker (23:51) One thing I wanted to just add to the conversation is as a side benefit of ncqa level credentialing is, I know you mentioned delegation that you don’t have delegation yet, but medallion is an ncqa accredited cvo. And so we have clients that we’re able to partner with as a subdelegate to achieve delegation on their behalf. I told the story Derek last time to you about family care centers, we were successful in getting them seven delegated current contracts in the first six months of the partnership with medallion. And so as you guys grow, the longer that you’ve been doing ncqa credentialing for the easier that process of delegation is. And so just something to think about as we continue conversations and scope this out further. Maybe it is worth the investment today to do it to ncqa standards just to make that process of delegation easier down the line.
Derek Kamajian (24:48) Thank you. And one more wrench in the gears before I forget and Khaliq, correct me if I’m wrong, but the insights therapy solutions actually has two different llcs and they’re processing their providers. And I think maybe that’s dependent on state through… those two different and I believe each business has its own group npi number. Khaliq. Is that correct? Yes?
Khaliq Ur Rahman (25:14) So, we have two entities. So like two groups… they have different tax ids and npis. So this was done because of the state requirement where we needed a medical director that need to be a physician. So in those states, we have a tax id and npi that is different from insight therapy solutions. In those states. We are currently working on getting our contracts under that, our tax id.
Mallory Smith (25:49) Okay. So you’re doing tax id consolidation at the payer level?
Khaliq Ur Rahman (25:53) Yes. Okay.
Derek Kamajian (25:56) Thank you. Would that be two different instances of this of the medallion software or we?
Mallory Smith (26:01) Would essentially set it up as two different groups of what you can see here. So one type two npi, one tax id, how many practice locations and states are part of that? So as far as how that’s structured in the platform, no issue there at all. It sounds like you’re already doing a change of ownership and getting the tax id consolidated under the other one. So really my question would be based more around for the providers that you’re adding to those states that do have a separate LLC. Are you submitting to have them linked to both contracts? Or are you just submitting to have them linked to one contract? And then you’re going to roll back that tax id over?
Khaliq Ur Rahman (26:44) So currently, what we are doing is we are adding to one contract in a state. So some states are one tax id, and others are the second tax id? Okay?
Mallory Smith (26:57) Thank you. Then that doesn’t affect any of our volume projections on what we’ll be looking at. Thankfully, it sounds like the tax id. The second one you have now won’t be around for very long anyway. And in that case, we could just basically absorb it. So whenever it does become the same tax id, you would go back to having one group, one, group, two, one group, npi, one tax id, and then all your different states and practice locations listed there. Does that work? Yes?
Derek Kamajian (27:28) Khaliq, I don’t know if, is it in the plan to dissolve or combine or I don’t know if that’s in the plan? I.
Khaliq Ur Rahman (27:35) Think it was mentioned that at the end we would be go for imcpa but I don’t know if that is in short term or very long term. So currently we are working on both tax ids.
Mallory Smith (27:50) Okay, perfect. Then the way that I’ll kind of picture that is that you’ll have a separate group for each of your tax ids. And we can keep it that way for future state. If you have any payor contracts that absorb those tax ids, I would go into this… group here. I would go to their payers existing agreements. And then we would just have the payor contracts listed here with the appropriate tax ids. If you do consolidate to one. So everything, the good news is that everything can be stored within the platform as you currently have it or whatever future state may look like for you. Okay? I appreciate the insight there. No pun intended. Okay. If I head over here to payers, I know that we focused want to focus mostly on payor enrollment for today. So just like how your team would go into credentialing and request the credentialing application. We also have an SLA or a service learning level agreement for enrollment. We have basically guaranteed contracts stating that we have to get your applications out within 10 days of whenever your team requests the submission. So when your team accesses the platform and they say request details, who do we want to submit for? We are comprehensive. We’ll do individual group and facility enrollment. Sounds like with your mental health, it’s going to be mostly just individual and group enrollment. And then with providers, you would select the provider or providers that you want to go through the enrollment process. From there, the system is intuitive. It will identify the groups that the provider is already associated with. So this is all part of the onboarding process. The payer states everywhere the provider already has a license. So I do want to ask some questions regarding licensure. I know that you’re looking to quickly expand is the goal ultimately to have all your new providers, see patients in all 25 states through telehealth.
Derek Kamajian (30:00) We have two options there’s, some compact licensure states and we haven’t made the decision. If we’re going to invest those resources and get a smaller number of providers within those states. So 10 providers can now see patients in 30 states or just go through the model and hire four to five providers in each state that are already licensed in that state and then move through that model. We haven’t picked yet. We’re kind of building a case for both. Okay?
Mallory Smith (30:30) Thank you. So in that case, we do offer licensure services. So if you decide to go the route that you would rather cross state license, your providers hire a high volume of that nature. We are fully comprehensive. So it doesn’t matter what the provider type is or the state. We are also able to see if it’s imlc interstate or nplc for allied health providers. So that would be comprehensive. Just like it is with credentialing and enrollment. You would let us know and make that request within the platform that you want this provider credential or license. With the following states, we would submit everything through to completion and we even have electronic fingerprinting. So part of the arduous process of getting provider license is they typically have to go and get fingerprinted in person. They only have to go one time with medallion. We then save it in the system. We have a partnership with printscan that has locations across all 50 states and I think surrounding territories. But once we have the provider license, we could let you know from there too. So Derek, if you’ll just keep us updated on which strategy your team ends up going with, we can help from either aspect. Okay? Thank you.
Jeremy Walker (31:42) For now, Derek, we’ll centralize the focus on credentialing payor enrollment. And then again, you just keep us informed and that can sway the numbers either way awesome.
Derek Kamajian (31:54) Thank you. And I know that. So my weakest understanding is mass scaling of credentialing. So this is a great system to be able to help with that. I think that the group only has one or two national contracts, I think with cigna or maybe one other one. All the other ones they’re going by provider by state.
Mallory Smith (32:14) They are, so your conversation with Jeremy last week, from what I picked up on, it alluded to the fact that we could be looking at you hire a new provider. They’re already licensed in their primary state. We only need to enroll them in those state plans.
Derek Kamajian (32:30) It could.
Mallory Smith (32:30) Be that you’re hiring a provider and you want them to see patients in five different states. So we need to take the number of applications and basically multiply it by five. So that’s what we mean. When we said like volume projections, it could vary rapidly kind of based on where you’re going with it.
Derek Kamajian (32:47) And then you guys submit all of those or the system submits all those applications directly with the payor?
Mallory Smith (32:53) Yes, yes. We would track every single one of those. The request can be done in bulk. So for each provider, you would just let us know which states, which plans for each state. And then as we walk through this request process, we would handle that comprehensively. So really the scoping would matter more from just the pricing standpoint. What kind of opportunity are we looking at here?
Derek Kamajian (33:16) Yeah. And that’s where we’re kind of working reverse with the marketing team to see what kind of backlog of patients have called us, how many thousands of patients called us in a state that we’re not processed yet? And in what payors which we have that data? So that’s kind of going to be our roadmap to be able to pick the expansion. And then that’s pretty amazing. Khaliq, would that be helpful to be able to click the provider and then click the plan and then submit? Yes.
Khaliq Ur Rahman (33:43) That’s great if we have that option.
Derek Kamajian (33:50) And then, are we, currently, what does the manual process look like to be able to communicate with the payer?
Mallory Smith (33:57) Oh, goodness. Yeah. So I’ll I’m sorry, were you asking Khaliq or me?
Derek Kamajian (34:03) Khaliq for the manual of what they’re currently doing?
Khaliq Ur Rahman (34:07) So currently, our manual process is application are usually submitted online and then we follow up by emails or calls to the insurances and.
Derek Kamajian (34:18) Then how cool. And then how long does each one of those manual applications? How much time does it take per provider?
Khaliq Ur Rahman (34:25) So the estimate is about 60 days, so.
Derek Kamajian (34:31) How much labor time does it take you if you hire a new provider in Florida? How much time does it take to apply to one plan to one payer plan? So.
Khaliq Ur Rahman (34:43) When we have all the documentation, applications can take about some application that are manually need to be filled. So you can say that one hour in some applications that just require basic information, you can do that in 15 minutes.
Derek Kamajian (35:00) Okay. So let’s just say 15 to 20 minutes per provider per state per plan. So it’s like if I’m a new provider, I want blue cross, I want cigna and I want this and I’m in Florida, it’s 1,515 15.
Khaliq Ur Rahman (35:17) Yes, for some applications are longer, you can say half hour, two hour, but that’s the time, okay?
Derek Kamajian (35:24) Those are the naughty payers. And then with this system, Mallory, if I have five new providers I just hired in Florida, we already got their license licensure up to date. Caqh is good. Now, we want to get with the plan blue cross. How long does it take to submit those five?
Mallory Smith (35:39) Yeah, absolutely. So we do have an SLA of 10 days, but ultimately, we’ll get the request out within three or four days and that’s really where the economies of scale come in. So you’ll have, if you have the provider, just with one state perfect, we’re going to meet the timeline. If you have a provider with six states, we’re going to meet the timeline that way too.
Derek Kamajian (36:00) And then how much labor time does it take if I’m a system admin in medallion to submit for those? Great.
Mallory Smith (36:07) Question, no time at all. All you have to do is basically make the request, and then our team and the software itself takes it over. So if I were to paint the picture chronologically, we have your team submitting the request, identifying which provider, which state, which plans, where they’re going to be practicing, any application details. We have an internal payers directory that’s fully mapped out from an automation workflow perspective. So our system will go through auto, populate the application, attach the supporting documents, automatically submit whether it’s via a portal submission or a PDF and email. And then our team will also follow up. We have agentic AI to assist with the follow up. If you are calling Aetna just to confirm or basically process an application, make sure it’s in process. It could take anywhere from 10 to 25 minutes because you’re on hold, you’re having to provide them with the information. We use agentic AI to assist with that follow up as well as emails. So email parsing, any email that comes back to us automatically gets attached to the enrollment request line that you’ll see here. So you’ll see the emails back from payers. Our team will respond back to the payer within 24 hour turnaround time on that. And then we will follow up automatically every two weeks until that is complete. So that would be more of, the timeline itself if you were to partner with us, so.
Jeremy Walker (37:32) Derek really quickly. Let me, let me just because I think I know where your head’s going with this, you’re trying to compare the delta of, OK, my team’s time, the labor, how much labor is actually spent on enrolling one provider with let’s say four plans to make the math easy, right? That’s an hour, 15 minutes per plan times four plans, right? So that would be an hour within medallion. The benefit is a, that whole process is going to take less than a minute because all you have to do is once the inviter is invited to the medallion platform, caqh is going to pull in most of that information and then actually enroll submitting. The enrollment request is selecting the provider, selecting the state and then selecting the plans which should be done in less than one minute. So if you’re comparing the time of labor difference between the two, we’d be happy to help map this out specifically and actually put us on the clock, right? And say, hey, how much time did it actually take? But the benefit is instead of doing each provider individually one at a time 15 minutes each, you just select all that apply to that provider at once, click submit. And then the rest is in medallion’s hands. That’s amazing.
Derek Kamajian (38:34) And then this would give the tools to be able to scale rather than having to hire 15 more people. So I think that’s the most important piece.
Jeremy Walker (38:43) Yeah. So we did a quick analysis on like the current number of enrollment requests that your team is doing today, and then divided that by the team that you have, which is three individuals and the math actually checked out again in the most bullish opportunity where you guys actually are adding 75 new plans. You’re bringing in 25 new providers. I think the math checked out to be about 17 full time employees. So you’d have to be at 20 total, adding 17 from the three where you’re at today, just to keep the volume up with where it is going to be. Obviously, as we’ve talked about potentially trimming down some of the enrollments per provider because we’re not looking at all payers for each provider, but maybe just regionally, their specific states, those numbers might come down a little bit. But the delta is right. Any dollar that you invest in headcount could have been two dollars invested in medallion, right? So it’s a much more efficient way to scale.
Derek Kamajian (39:36) And then, and forgive me because again, my knowledge base is growing with this, but do we need to have a pre existing contract with the payer to start the submission? If we hire a new provider there?
Mallory Smith (39:47) Does need to be a contract in place, but we can assist with that contracting process. So we are comprehensive. We’ll do individual, we’ll help you establish new group enrollments as well as facility.
Derek Kamajian (39:58) But we already have whatever contracts that we have right now, so we can start with those. And then if we really had a big influx of cash and wanted to just be super proactive, we could get all these providers. If we know that a provider is able to get licensed in a compact state with 30 states, you could proactively get them credentialed with all the payers that we already have contracts with in those states immediately after hire.
Mallory Smith (40:24) Correct. And.
Jeremy Walker (40:27) Starting the clock all at once, right? So if it takes the payer on average 31 days or whatever it is, all of those clocks would start at the same time versus having to manually go in and maybe it takes three days to submit all of those, right? So that’s the other benefit?
Mallory Smith (40:45) Can I ask what your average plans per state right now would be?
Khaliq Ur Rahman (40:51) So, Nevada is, so we have 17 contracts. And if you go for the sub plan, we are contracted with four.
Mallory Smith (41:03) Or five major.
Khaliq Ur Rahman (41:04) Plans for this and for… other insurances, we have contracted with about 200 insurances and that does not include sub plans. So I would need to take a look at sub plans. So to come from that, no.
Mallory Smith (41:22) Absolutely. Yes. So if you wouldn’t mind providing just a state by state breakdown when we’re looking at scoping this appropriately for volume, the two asks that I’ll have for your team is essentially to find out if you want to take providers that are already licensed in that state, enroll them just in that state or if you would like to enroll them in these surrounding states based on interstate compact licensure, and then how many plans per average you’ll see per state. So you mentioned 17 that’s absolutely what we’ll see. Typically, we’ll see somewhere between, I would say 12 and 20 plans per state sub plans. Since you do bring that up, we only charge for the application at the highest level. So if it’s for instance Aetna, you would be charged one Aetna application. But that would also cover all the lines of business that are part of your Aetna contract, whether it’s ppo, hmo, fee for service, there’s medicare advantage that’s a part of that. So one application per plan would be what would need to be submitted.
Mallory Smith (42:30) Alright. So appreciate the dialogue there. Where we can go next is with the enrollment process. I just want to give you another visual with it. Once you’ve made the request, you basically let the system platform know what you’re going to notice are all of these visual components. So if they’re roster eligible, if they’re out of state enrollment, who is the specialist following up on it? How often do we need to follow up on it? If I were to look, this is an example of our viewer processing guide. So we have this built out for over 1,200 states across 1,200 plans across the nation. And ultimately, what this would look like is our process guide, lets us know it’s a new provider enrollment for behavioral health. Since you’re talking about mental health for this provider, you would view the prerequisites and dependencies, the application method, if it’s a two step multi factor authentication process or not, how to complete the application, what forms to use, where to mail it? If it is a paper application, the required documents, how often the team and the agentic AI will follow up on it? And then of course, escalation pathways. So for this one, repeat every five days until completion, how you can follow up on it. Any additional notes? We have this built out for over 1,200 payers, just to give you an example of how the system and the automation works within it.
Mallory Smith (44:00) So we’ll auto populate the apps, get them submitted, follow up automatically. You’ll have the visual status tracking bar that you see here. And then you’ll also have the ability to store your notes. You’ll see our notes. You can have the back and forth communication with providers. Providers can see the current status and where they’re sitting with the payor as well. And ultimately it all rounds back out to reporting. So, Khaliq, you mentioned that analytics high strategy that’s going to be important for you. So if I were to come here to our analytics tab and look at payor enrollment, this is going to give you that high scalability when you’re thinking of just the economies of scale. So new enrollments, these are standard analytics. You do have the ability to build your own if you’d like. So how many new enrollment requests have been received? How many completed enrollments this month, this day, this year? What is the status transition time? So what I would love to see happen rather than your team having to manually complete the applications and then submit them and follow up on them and make the phone calls and spend the time doing that. You could then go back and see how can we streamline efficiencies here from request to intake is taking one day. No issue there from app submitted to enrollment, completed about 20 days. How can our team make that faster? How can we make the onboarding process faster for providers? So allowing your team to focus more on the higher strategy pieces of it rather than the actual application completion and submission?
Mallory Smith (45:39) Okay. So, I know we’ve talked about provider onboarding experience, credentialing to ncqa standards, and of course, the enrollment process. I would love to wrap today’s, demo. Oh gosh. We are right on time. Do we have a few minutes or should we cut it short? I’m sorry, Derek, you’re on mute?
Derek Kamajian (46:01) Sorry about that. Yeah, I have time, Khaliq, do you have five more minutes to hang with us?
Mallory Smith (46:05) Yes, yes. Okay. Thank you. Sorry about that. Jeremy usually gives me a quick time trial. I just got to talking. Oh, okay.
Derek Kamajian (46:11) This is all beautiful information. This is very helpful. So, thank you.
Mallory Smith (46:15) Yeah, of course. Perfect. I love that it’s resonating. So then we’ll just go ahead and wrap up with reports. Then first, we do have 10 to 15 standard reports that would be included with the platform. These are reports that I’ve just created within my time here at medallion just to give you an idea. So there’s the current pay or enrollment status report, if they are participating or not, what’s the licensing status, are they eligible for a Dea within that state? Are these prescriptive authorities we’ll have to apply for? If we do the interstate compact, just examples like that. And the biggest value that you’ll find with reporting, these can be sent automatically from the system to anyone on your distribution list. So if you have leadership following up with you every single day asking for updates. If you have your individual providers reaching out to you, these are reports that can be automatically sent from the system to their inbox as often as you need them, whether that’s daily, weekly, quarterly. However that would look… the other aspect is just building your reports. I came from a software background that had to do crystal reporting and SQL server reporting. And I felt that I had to learn code just to be able to create my own reports in the system. This software itself is a huge game changer for that. So to build a report and see it in excel spreadsheet format, I would simply look for the status of the category that I’m wanting this one would be payr, moment request in the order that I select the items that’s the order that’s going to build the columns in the report. So I could say state… payr, the lines of business, the provider, their npi number. I could know when the last staff note was entered. And then I could then find practices status itself. How many days it’s been since submission, transition… it to the right. I now have a report in that format. So the biggest value points that you’ll find with reporting, you have standard reports that come with it. You can also create your own reports and then you can automatically schedule these reports to be sent to anyone that needs a copy of it as often as needed. You have the ability of also just filtering within the window of what you see here as well as exporting as an ad hoc query and then saving it so that you can come back to it, edit it at a later date and so forth. Okay. So, Khaliq, I’m just curious from your perspective, I know you currently track everything with the nxl spreadsheet is this, would this be a nice addition to tracking? Where do you think you would spend the most time when it comes to reporting?
Khaliq Ur Rahman (49:08) So the issues that we are having is first is the, there are a lot of plans. So when any client calls for an appointment and they have an epo or ppo or POS plan, so for the spreadsheet in the spreadsheet to add all those plans, that makes things complicated. So for example, we have a contract and provider is for eight commercial plans and is not for two plans. So there we need to add about 10 rows or columns to show that. Okay. So… if that’s not added, then the front desk would need to reach out to us to verify whether the provider is with that client plan. So that kind of things that we need to have in a tool that. So if someone I sent a report, they should be able to check whether the provider is for that particular plan or not. So like if I start adding all the plans in this spreadsheet, that would have become very complicated.
Mallory Smith (50:27) Okay. Thank you for that insight. There are two things that I would recommend if you were to partner with medallion. One example of what we could do is first you could grant access to your front desk scheduling staff so that they can just see medallion automatically. You can give them read only access. So they can’t change it or edit the information. The other option we worked with a large wound center, if you will. They have about 35 to 40 states. Their scheduling team was very much struggling when it came to. I don’t know if the provider is participating with this plan or this line of business. So we actually created a report for them that they could look it up based on their zip code. So if their zip code is going to pull up a list of all the participating providers that do see this plan, they do see this line of business, they have been effective. So there’s several different things we can do from a reporting perspective to make it easier on your scheduling staff as well.
Derek Kamajian (51:26) Khaliq nailed it. It’s a large area of opportunity. When a patient calls, we’re proactively scheduling them without doing a full eligibility check. And then as Khaliq pointed out in the front desk and the billing team, even if the eligibility comes back as positive and their insurance is covered, there’s some parameters around telehealth and behavioral health that if they’re not marked off depending on provider licensure or license type or how long the visit needs to be or what needs to be covered during that visit, we’re getting some… codes and bills that are not covered. So we’re effectively seeing the patient for free sometimes. And then that manual review would be very nice for the front desk to be able to type the state or search by state and then insurance type and then see what providers fit that criteria. That would be super helpful.
Mallory Smith (52:20) I appreciate that, Derek. I’m curious for those that you do have to write off because there was a telehealth restriction or something of that nature. How much of a quantifiable impact are you seeing to the business?
Derek Kamajian (52:32) Yeah. I just had a meeting with billing last week and they’re getting on Friday, they’re getting that information for me. So it’s two it’s members that are scheduled without actually having proper coverage. So even if the eligibility comes back, those patients need to be either canceled or rescheduled. And then number of denied claims because we didn’t hit the particular targets. Those are two items that need to be cleared up. I’m setting up a meeting with another software company that apparently uses AI to do that. The deeper dive aside from availability of that eligibility check where you just put in that patient’s insurance. And then it spits out all the parameters that need to be met to be able to conduct that behavioral health visit that’s something that we’re doing this week. So to be able to pair that with… this, that would be very nice, right? So you do your eligibility check, see those parameters. And then once we understand those parameters, we just double check the state and the provider roster with this. Yes, they’re licensed in this state and they take cigna, right? That would be nice.
Mallory Smith (53:37) Absolutely. Yeah. I’m solutioning far too much because I’m thinking of like API integrations and how we can make that work. But I’ll pause on that for now.
Derek Kamajian (53:46) And that would be, the bee’s knees and then be able to compare that with an actual, the provider scheduling software which apparently there’s two there’s the emr. And then there’s we have a separate software that the providers are using for their own scheduling that’s not being set up to date. So now, the third bucket is patients are being rescheduled because the provider schedule wasn’t up to date and they couldn’t work on six o’clock on Friday, right? So all of these I think can be solved with software solutions.
Mallory Smith (54:16) Absolutely. I appreciate the insight there. Okay. So, Jeremy, I’ll pass it back to you. I do apologize for going over a lot of time today, but I appreciate the additional time. If you’re interested in seeing a secondary demo, if you want more of a walkthrough then please just let us know.
Derek Kamajian (54:34) Thank you very much for your time.
Jeremy Walker (54:36) Appreciate the extra time. I’m going to go ahead and into the business case that I’ve already prepared. I’m going to do a little bit of thinking and planning around the fact that it takes about 15 to 20 minutes per plan today per provider and see what kind of numbers, we could put in for the business case. Obviously, we’ll need you to make some edits to it, but just to get it in a good spot for tomorrow and then we’ll do more discovery on kind of the magnitude around write offs because that’s also another source of value when you go to your CEO, if you’re seeing, you know, half a 1,000,000 dollars in write offs today, and that somehow can get reduced by marrying some of these systems together to 100,000 right there’s.
Jeremy Walker (55:17) There’s part of the business case as well. So, I love your minds thinking about value return on investment and excited for our conversation tomorrow. So more on that later.
Derek Kamajian (55:26) Awesome. Me too. Thank you so much guys. And Khaliq, thank you for joining you’re. Going to be a pivotal person here and number one champion to be able to scale this. And I think, Jeremy, after we work on the business case and talk, we can run it by Khaliq, and see if the numbers are making sense of not the financials but those time and labor investments to see if that plugs in with operations appropriately sounds.
Jeremy Walker (55:49) Great. Yeah. Looking forward to that, Khaliq. Thanks again for your time as well. Thank you. Take care, everyone have.
Derek Kamajian (55:55) A beautiful day guys. Thank you too.
Jeremy Walker (55:57) Bye.