Transcript
Mira Guha (00:00) hey, Jack. How’s it going?
Jack Koonce (00:01) Good. How are you?
Mira Guha (00:03) Doing alright. Just one of those days. Yep, Oliver, I think is stressed out because he’s just sitting right next to me. He just came over. Remind me your dog’s name. You don’t have the one. We.
Jack Koonce (00:18) Have Nora and Sadie, the golden retriever is Nora. Aww. Yeah.
Mira Guha (00:23) Cute. The.
Jack Koonce (00:26) Food bill’s, not fun, but, you know what can you do?
Mira Guha (00:32) What we do for our pets?
Jack Koonce (00:35) I know our lab had a pretty bad hip dysplasia. I mean, she still has hip dysplasia but we did the whole doggy PT and everything. Oh, my.
Mira Guha (00:45) Gosh.
Jack Koonce (00:45) She had pet insurance, so they paid for 70 percent of everything, but still expensive, but our dog is like, she’s so much happier and like herself now, it’s like it was worth it worth every Penny of it. I’m.
Mira Guha (01:02) going to admit, Hillary, I’ve heard that we eventually will probably need to do that with Oliver.
Jack Koonce (01:07) The hip dysplasia or PT?
Mira Guha (01:10) Yeah, he’s in good shape right now though. Hi, Hillary. How are you? Can you hear us okay?
Hilary Hartje (01:19) Yes. Hi. Good afternoon. Good.
Mira Guha (01:22) Afternoon. It’s still morning here in Denver, but how are you? Oh, good.
Hilary Hartje (01:25) Good. I grew up in Denver, so it’s oh, cool. I’m good.
Mira Guha (01:29) Where are you located now?
Hilary Hartje (01:31) I live in Missouri.
Mira Guha (01:33) Oh, gotcha. Okay. Cool. My sister was in st Louis doing an internship for washu for a while and it was really fun visiting her. Yeah, awesome. Well, I’m hoping not to take up too much of your time. I wanted to first kick off by saying, I know we’re just meeting for the first time. We just got introduced but we’re actually doing another transition. So, Jack here is actually going to be the one stepping in as your account manager, hopefully, not too much of a difference since we haven’t really kicked off ourselves yet, but just wanted to make sure you knew who your person was for anything high level strategy commercial, all that good stuff. So, I’ll let him introduce himself real quick. Okay?
Jack Koonce (02:09) Hey, Hillary. Nice to meet you. My name is Jack kuntz, I am in the Raleigh North Carolina area and so I’m a little newer to medallion but I’ve been in the medicare medicaid space for about eight nine years now. So as I kind of get a little more up to speed, you know, you’ll start seeing my face more, my name, more anything you need, you can come to me and my goal is to be as high touch or as low touch as you need me. So I don’t want to bother you, but if you need anything, I’m your Guy. So looking forward to working with you. Awesome. And he.
Mira Guha (02:44) Might actually be more helpful than I would have been related to some of the medicare medicaid stuff that I think we were talking about potentially looking into for enrollment work. So I did want to just like quick housekeeping go over something real quick and I’m going to kind of run it today. And Jack, you know, chime in just because you might have more information on something that I do, but I just wanted to go over current kind of account consumption. I didn’t prepare a deck or anything for today just because we’re doing this transition here. And then just chat a little bit about how our enrollment solution works. Does that work for you? Anything else we wanted to cover today?
Hilary Hartje (03:20) I know that’s great. Okay.
Mira Guha (03:21) Perfect. I’m going to show my screen real quick. So just wanted to take a quick look at your account. I think I sent an email about this when Steph introduced me. I’m not sure if y’all ever spend a lot of time in this tab but it’s kind of where I and a lot of the ams live pretty frequently under account. And then usage, this is where your consumption dashboard lives. You have our SKU flexibility, which basically means you committed funds to a contract for certain SKUs, but you can move them around. Doesn’t super apply here since you’re just using us for like the software piece of things. Only thing I just wanted to flag that I think is helpful to keep an eye on.
Mira Guha (03:56) And that’s part of what like Jack will also be doing with you going forward especially when you are meeting is just where we are right now, pretty even purchases for the first two years of the contract here. About 54 55. We were really low in year one with I think just low provider count and kind of making up for it in year two. So just wanted to flag, we’re trending pretty high. And as you can see right here, it really just has to do with the number of providers we have active. So especially if we do want to look at adding enrollments to your contract, we’d probably recommend and that’s something like Jack will help bright size, maybe factoring in the increased provider growth into that.
Mira Guha (04:31) So really just wanted to flag that, make sure you weren’t blindsided as we get closer to that affecting consumption. But any questions? Okay. Cool. Yeah. And your dashboard’s really simple compared to folks who are using us for managed stuff because it’s just providers, but any other data will be in there. So I’m going to go ahead and stop sharing my screen for a second. But I’d love to hear a little bit more for the rest of our time today about kind of what you’re looking to do when it comes to provider enrollment credentialing, if you’re doing any today. And if so what that kind of looks like?
Hilary Hartje (05:04) Yeah. So currently, today, like predominantly our enrollment is for our RDS, so registered dietitians. And so we have like a few direct contracts that we work with nothing too big. And then we have vendors that we partner with that we have to share like their profile data, and then, they enroll all of those individuals and manage those contracts. So that’s currently where the predominant amount of contracting work is, we don’t currently support medicare or medicaid… and, our physician or our clinicians. So our physicians, MDS, dos, and nurse practitioners, they currently do not do any billing while we work with insurance companies that’s it’s primarily in a prior authorization capacity for writing prescriptions. So we don’t we are not currently billing and we’re looking for as like the landscape changes to add also our clinicians to like enrollment specifically with medicare. Now, I have like extensive like experience with medicare. I’ve worked on the peer side and then also for various group practices for, you know, 15 years. So this is like, my tenure with weight watchers is the longest I’ve gone without working in the medicare space. But for like a large enrollment work. We’re wanting to see like what is our best plan of attack? Especially moving forward with like clinicians that we’re not like actively, we’re… not currently actively enrolling them in anything. Okay?
Mira Guha (06:57) Gotcha. That’s good to know. It sounds like you already have some background which is helpful. Sorry. Did you say that? Like the way this for the folks that are currently enrolled mostly are your RDS? It sounds like are you doing that in house or is that being done through a different vendor, different software?
Hilary Hartje (07:14) So a portion are being done in house. We have specific direct contracts, but the majority of them are being done with like external vendors that like help do the scheduling and things like that, and then manage the contracts with the payers got.
Mira Guha (07:35) It so sounds like most of the focus here might be getting some of the clinicians MDS dos, NPS with medicare medicaid?
Hilary Hartje (07:44) Right. And then I mean just also for like a business case scenario like we most likely, even though there’s like a prior authorization requirement, we most likely would also enroll our RDS in medicare as well if they currently are not okay, good.
Mira Guha (08:02) To know that’s just kind of helpful background and something I’m sure Jack will be kind of digging into a little bit going forward for your use case. I’m going to be kind of approaching the demo today from a pretty high level because I am not an expert in that space, but I can just kind of tell you how the actual product works, what we offer. And then I think Jason is your engagement manager, so he would be in your regular calls helping kind of oversee the operational aspects of that, going over any questions hopping in platform. And then our operations team and enrollment would actually be doing the legwork of the submission, the work, all that good stuff. Okay? But that is helpful information. And then, you know, they make sure everything makes sense for you and what you’re doing and I can send over some general details about processes and stuff like that. But for today, I’m just going to go ahead and just show you how it works. If we were to turn on managed enrollments for you. So this is our demo. Org. I talk quickly, feel free to jump in and interrupt me if I brush over something or you have questions. So what we would do is we go ahead and you would, if you purchased enrollments, we turn on basically two tabs for you in the platform which would show up here, one being payers and one being groups that will automatically turn on groups is the term we call any entity with its own tax id npi, you might call it a PC, whatever that is specifically for just the affiliation with the enrollment, the contract you might be going for. And the nice thing is because we’re already managing your provider providers. It’s going to be a pretty quick and easy process. We’ll need more information potentially to just kind of start requesting enrollments for them. Okay? So you’ll see this tab show up and I’ll show you kind of how to navigate the different pieces of it. The first being, this is just kind of the overview payer list. So once you start actually creating enrollment requests with different payers, sounds like probably going to be specifically medicare medicaid for specific states. Those will go ahead and list out here. And you can just see a general summary of how many requests there are and kind of what bucket of status they fall into. So that’s more kind of high level overview. You can also just like click on Aetna and it’ll take you to any Aetna requests, so you can filter it that way or just go to where all the kind of data sets for any requests right here. This is just going to pull up everything which is then filterable. So this will show any requests that have been made, information we store that can be filtered includes the name of the payr, the state, if we’re the ones owning it. If you want us to work on some of them, but you want your team to do all the legwork on the other requests, you can still store that information, use it kind of more self serve. And then we won’t touch it and you won’t get charged for it. So it just really depends on how you would wanna operate there. But this will just indicate medallion’s doing the work and you’re paying us to do that work. Other information we track is if it’s a provider enrollment versus a group enrollment. So maybe if you’re trying to obtain a new contract with Aetna, you put in the group enrollment, and then the payers are gonna be linking to it. So we’ll just kind of designate the difference there. Our team does something called discovery when a request comes through that’s kind of like an audit to understand like if that provider or group has a history with that payer, just kind of helps us as far as figuring out next steps and the best process for moving forward with the enrollment. And then from there information like who the provider is, this is kind of a compliance thing we can ignore for now, the group that’s affiliated with, we ask for practice locations affiliated with the group which is stored elsewhere. And then all the meat and potatoes being kind of the request status where it sits in the process. Any notes, lines of business? So, medicare medicaid, traditional, all that good stuff which you can request. So all of that is stored here. Any questions, kind of just on the general. And then I can go through with the actual process of requesting perfect. So we are able to assist with obtaining new enrollments. We can assist with demographic updates. If something changes provider name, address, things like that need to be changed on the payer side. We can facilitate that or a revalidation once that is required for an existing enrollment. So if you want to go ahead and request medicare medicaid, enrollment, any type of enrollment, you’ll go ahead and click on that big blue request button and it’ll open up the request module. This is where you’ll determine if you want it to be something we work on versus for you, it would say weight watchers, the name of your organization, if it is a group enrollment, a provider enrollment, or if you bill as a facility, we’ll determine how you choose that. And then I’ll go to the groups. In a second, but the groups that you enter information for will populate here, you’ll determine the correct one that’s affiliated with the request, the state, and then you can go ahead and start searching for whichever payer you’re most interested in. If that’s medicare of Alaska, anything like that. And if you ever have questions on what the correct one is, based on what you’re looking for, that’s something, you can probably ask our team and they can help you navigate that request. And then if you would like, you can add providers as well to be affiliated with that request too. If you’re doing a group. So you’ll just go ahead. It’ll prompt you through all the steps and build out the request over here so you can see what it is you’re actually requesting. Okay, cool. And I’m not going to actually request it because our product team will get mad at me. But any questions on just this process here?
Hilary Hartje (13:26) No. So just so I’m understanding like especially where it ties to like the group and medicare. So like let’s say we have six different entities depending on state and we were like enrolling in all 50 states as a group. We could submit that and then also then submit with our individual providers that’s correct? Okay. Yeah. And.
Mira Guha (13:55) I can show you in a minute, but you can also under the group profile include affiliated providers, but you would need to submit different enrollment requests separately depending on what that goal is to like enroll the providers with the group. Okay?
Hilary Hartje (14:10) But.
Mira Guha (14:11) you can affiliate them together. Sorry, I don’t know why my email’s blown up. Any other questions?
Hilary Hartje (14:18) No, okay.
Mira Guha (14:20) Perfect. I’ll just go ahead. I think this section is really helpful. Ignore the fact that it says client logo. I just thought I would use the general deck. So I’ll go ahead and send over a cleaned up version of this after our call. And then again like Jack can kind of work with you on next steps as needed to help kind of with the scoping and whatnot. But this is just kind of gives you an idea of how it works because we’ll need some stuff from you. Then we take it. Sometimes there’s follow ups we have to do with your team. So we just like to make sure expectations are set properly. So yeah, initially, what will happen is we will basically gather data from your provider or your group. I’ll go back into the group profile in a little bit. We generally need at least 80 percent that’s even on the low end of their profile completed in medallion. I realize I haven’t taken a look at your current providers and how their kind of profile set. You have the ability to use our caqh integration to help pull data into medallion and complete profiles more quickly. But we basically ask for a ton of information up front just to get ahead of delays in the process where we have to keep going back to you to ask for stuff. And most payers will require things like caqh. I also just have a list in here. I can send over of general things we’re going to need. So from there, provider does need to log in to a test. We do have the release forms that basically say we are giving permission for medallion to do this work. We attest that everything in here is correct and up to date, it is a liability thing that we require. The provider logs in and does that similarly group profile has to be completed as much as possible. From there, you can do that. What I mentioned of affiliating the group to different practice locations and providers. And from there, you can go in just like we showed earlier and request that enrollment based on what your goal is for state lines of business, provider group. From there, our team does basically intake, we review the request and the profiles that are appropriate there, make sure everything looks good on our end, do that discovery process, make sure that we kind of are ahead of any strange requirements based on that payer, if there’s dependencies, like sometimes commercial like you need to have like a medicare id, whatever to be submitted first or medicare line of business needs to be done first. Stuff like that. So we’ll let you know if there’s any like dependencies there from there that intake. Is completed as much as possible. We get that application ready to go and submit it out the door to the payer based on their processes. And then we’ll do follow ups generally every 10 business days with the payer, whatever method is appropriate for them, phone call, email, if we have, if you have a contact at the payer, that we can leverage to help kind of fast track, we’ll ask for that. And then any contact we do in the follow up until we’re part in network is documented in the notes on that request. So we’ll say like here’s our reference call number here’s. The agent we spoke with here’s, what they told us if we need to. Like they’re like, hey, actually we need this document. We’ll create what’s called a task that basically says, hey, we need something from you. Okay? And I can show you what that looks like too since you’re not using us for managed, but basically, we try to do all the legwork stay on top of it, help push them until we get somewhere, and then we will update the enrollment line once we have an effective date. All that good stuff. Okay. Any questions there? Cool. Okay. So I’ll go ahead and send this. This is just kind of the big list of general things that we’ll need for medicare medicaid. We do need like surrogacy for like the picos, all that good stuff. So just a heads up that we generally will need that. But just so you have an idea of some of the stuff we need up front, we’ll share this information. Okay. Perfect. Okay. Last few things, I know it’s a lot of information. This is where the group profile sit. This is where you can create your group. We’ll ask for that basic stuff. Oops, add group profile. There. It is up front, name, state, tax id, npi, and then kind of like a provider profile. If you’ve been into the provider profiles, we’ll just ask for a ton of stuff up front. We need bank information. We recommend like group officials. So we know who to sign your contract if we’re getting those into external accounts of things like picos and then providers you want to affiliate with the group, you can add as well as practice location. So all that stuff lives here. Okay. Perfect. And then last thing I’ll go over real quick. This is how this is where the tasks live. So if we do realize like maybe the profile is 85 percent complete, that’s usually when we can start reviewing stuff, we can’t really start work on anything until we’re at least like 85, 90 percent profile complete. It’s like, hey, your Coi is expired. Can you upload a new one? Our task, our team will go ahead and create that task and assign it either to the provider or the admin, depending on what kind of task it is or if you have like a protocol on your end, you want us to follow basically just says what the action item is your team does, you know, does, whatever that is, you can always ask questions if you have them. If you need clarification, you mark it complete. And it basically triggers the next steps for our team to go ahead and move forward with the request. So lots of stuff. We’re constantly trying to use automation and efficiency, different tools to speed up the process, make it easier for you. But it’s you know, just one of those things where we do have to go back and forth with the payor. We are kind of at their mercy. Once we do submission, we generally say from submitted to actually being part and network, depending on the payor for medicare medicaid a little faster, sometimes in the range of like 60 days to see that completed.
Mira Guha (19:52) Sometimes more. And then for commercial 90 to 120, sometimes more. It really just depends on a lot of different factors. So that’s kind of just the big high level overview of how the software works and how our managed service works. But any questions for us?
Hilary Hartje (20:07) So, I think like just understanding what, like if and what slas would be built into like the agreement it’s just so we understand. And then, and any like SLA performance is helpful to understand. So, like while it’s industry standard for like cigna for example, takes a really long time, but Aetna can be like 30 days or less or whatnot, just understanding like, what different metrics and slas you guys are measuring against.
Hilary Hartje (20:49) So like time from complete application to submission to payr and things like that. So, and then any, like any additional steps like once submitted to the payr, that are ongoing? So like is there expected follow up? Is there, you know, different like types of outreach just so we can understand like, the scope and the touch?
Mira Guha (21:20) Absolutely. We can definitely send some information on our slas based on the msa, which is just going to kind of be our source of truth. Most our slas are going to be based on places where we have control of the process. So that’s going to be kind of leading up to submission. Usually it’s going to be based around once we have all the information from your team for the provider group, etc against the request and us being able to take that and put it into the application for submission. We don’t have slas about like total turnaround time because we can’t control, you know, what’s happening at the payr side, if they’re super overwhelmed. I can share some more information about that. We do have in platform analytics for any of our managed services. So that is something you can view live at any time. Is once we enable payr enrollment in your account, we track a lot of those based on our database. So just volume that we’re processing status, transition time. So like I think this is kind of our old dashboard. So yours might look a little bit different, but we can kind of track the different steps in the process. Something that your engagement manager and your account manager will kind of be able to do over time is help track where we can get more efficient with those things and get it out of blockers. So we do have in platform analytics, we’ll kind of stay on top of general performance and strategy. And then different types of outreach. That was the other question. Sometimes you reach out to the payr and you don’t get a response. They’re really slow. I believe our process and we might need to fact check. This is if we do either two or three reach outs through the same method and we don’t get a response or action. It’s our protocol that we should change our method of outreach. So we definitely do what we can to try to kind of push for any progress. Again if you have like contacts on the payr side, we can leverage never hurts for us to have, but we can probably share a little bit more. And then as you have questions on kind of process and what things would look like. We can go from there. Okay.
Mira Guha (23:20) Any other questions? Okay. Perfect. Again, a ton of information. We’ll go ahead and share just some of our documentation on things we can share like the msa and whatnot. And then I think as far as next steps, obviously, I’m not going to be your account manager going forward. So Jack will probably reach out to like see if you want to set up recurring time. You can continue working with Jason, and then if you do want to scope enrollments further, we can follow up from there to set up more calls or just provide any more information.
Mira Guha (23:53) And then if we add, it would be a contract addendum where we would add those providers we’re seeing on the high trending side as well as the enrollments.
Hilary Hartje (24:01) Okay.
Mira Guha (24:03) Perfect. Jack. Any questions or anything?
Jack Koonce (24:06) There, no, just, you know, Mira will copy me on the email that comes out of this information.
Jack Koonce (24:10) Okay. I’ll respond back. So you have my contact info, feel free to give me a ring, shoot me an email, whatever, and I’ll be in touch probably next week just to set up something recurring.
Hilary Hartje (24:20) You.
Jack Koonce (24:20) know, I’m the kind of person if you’re busy, just let me know, but I want to make sure it’s on the calendar just so you have an avenue for questions, comments, concerns, whatever it may be. Okay?
Mira Guha (24:31) All right. Perfect. Well, I’ll go ahead and before my day gets too crazy, I’ll see if I can get that email out the door and then you can work with Jack on next steps.
Hilary Hartje (24:40) Okay, awesome. Great. Thank you so much.
Mira Guha (24:42) Thanks Hilary. It was great to meet you. It’s nice to meet you too. Take care. Have a good rest of your day. Bye you too. Bye bye.