Transcript
Brian Ewart (00:00) hey, what’s up, man? Hello?
Scott Everline (00:06) Trying to change some settings, I keep getting some notice that it’s… taking notes or something. I hate pop ups and dings, and like, I just like there’s too much.
Brandon Chase (00:18) Yeah. There’s a lot. It’s a lot, man. That’s why I got rid of my iwatch or whatever apple watch because it was like sitting at my desk, I’m getting yelled at by my MacBook. And then my phone’s yapping at me. And why do I need a third device chiming?
Scott Everline (00:34) Yeah. And it’s chiming for the same stuff. It’s like I just got an email or slack message then I get it on my phone, then I get it on my watch like triple tendencies there.
Brandon Chase (00:45) Yeah, our.
Scott Everline (00:46) Son lost his apple watch as a punishment because… he’s an idiot and he’s been a better person without it, you know, like he was constantly checking it because he’s like in all these group chats and he’s always like smacking it to turn it off.
Scott Everline (01:03) And he’s like I’m like dude just be in the present. And so we got rid of it, took it away from him. It’s actually sitting. I think right here on my desk, maybe it was supposed to be. I think he took it back… and we were like I was talking to him like don’t, you feel better like less anxious without that thing on your wrist like don’t, you feel like because you admit that you’re not missing out on anything. Yeah, 12 year old boy group chat.
Brandon Chase (01:28) Right. Exactly. Hey, these guys are here. I’ll let them in but yeah, dude, I get it. Like our 12 year old wants to get an iPad and, you know, a watch and all this stuff. And I’m like enjoy… it while it lasts. You know what I mean? Like once you open up that box, you can never take it back.
Brandon Chase (01:49) People will be able to get a hold of you pretty much 24 seven, right? So just enjoy it now. Yeah. Hey, Brian, hey, Evan. How you guys doing?
Brian Ewart (01:59) I’m doing all right. I turned my video on, but it looked just like a green rectangle when I did just a second ago. So I’m going to go ahead and say, I’ll fix that later. Sorry about that.
Brandon Chase (02:11) No worries. Yeah, I did see that screen just for the record, you.
Brian Ewart (02:18) Saw the green rectangle, not my face, right? So, okay, it’s not just on my end. That is what you all. Yeah.
Brandon Chase (02:24) Yeah, yeah, exactly. Well, I appreciate you guys taking some time to talk with us today. I figure, you know, for today’s, call, what I’d like to cover is just some introductions. Then we can just kind of confirm what we’ve heard so far just to make sure that we’re you know, on the same page and we’ve captured all kind of the right information, Brian, from your conversation with fletcher. Then we’ll do a little bit more discovery… probably a little bit more information pointed discovery, Brian than your first call. And the purpose of that is to really direct the demo that Scott will do. So we’ll kind of use that first little bit of the call to do to just to ask some clarifying questions and stuff like that. And just to get a better idea of, you know, kind of a direction we want to head in and that’ll allow Scott to tailor the demo… and that’s really kind of the main objective of today’s. Call. So unless you all want to add anything else, I can start us off with intros. Yeah, let’s do it. All right. Well, my name is Brandon chase. I’m one of the partnerships directors here. Oh, we got someone else coming in here.
Brian Ewart (03:43) Stan.
Brandon Chase (03:44) Yeah.
Brian Ewart (03:44) Yeah. All right. Cool.
Brandon Chase (03:48) All right. Hey, Stan. You’re just in time for the intros. I was just kicking us off. So didn’t miss a thing.
Scott Everline (03:56) All right.
Brandon Chase (03:57) Stan. So as I was saying, my name is Brandon chase. I’m one of the directors of partnerships here at medallion. Essentially, my role here is to be your single point of contact here at medallion and the quarterback here, and make sure that we’re aligning from a business perspective. And I’ve also brought my colleague Scott as well. So I’ll turn it over to him for an intro there.
Scott Everline (04:22) Hi afternoon all. So I’m Brandon’s right hand person role is solution consulting. So I’m here to kind of walk through all the details, make sure we really understand your all’s needs as an organization, walk you through the platform, make sure everything’s kind of making sense and meeting your expectations. So, nice to meet you all.
Brian Ewart (04:42) Nice to meet you.
Brandon Chase (04:45) All right. We’ll turn it over to you. Yeah, so.
Brian Ewart (04:49) Brian, you were deputy general counsel for Brighton marine and leading our provider network stand up that we’re undertaking this year. I’ll hand it off to Stan, but to give him a quick introduction, he is our CIO and his team is eagerly trying to work with me to figure out all the provider data, where it goes, how it flows and what’s what in that world. And I am probably we are impressing him every day with how much of that data there is.
Brandon Chase (05:31) What he said? Yeah, there you go. Need no more. Yeah.
Brian Ewart (05:37) Welcome, Stan. And then we have Evan who’s been for longer than me been supporting the bmi team through this current transition process. And I’ll let you if you want to say anything else about yourself, Evan. No, that would have.
Scott Everline (05:56) Been my intro.
Brian Ewart (05:57) Yeah, he’s a little bit of a utility player. I think on the team is the best way to put it.
Brandon Chase (06:05) Awesome. And Evan, I know it’s a different email for you. Are you part of the Brighton team employed by the team directly or are you like a consultant or something like that? I?
Brian Ewart (06:13) Am a third?
Scott Everline (06:14) Party. Okay.
Brandon Chase (06:15) Okay, perfect. All right. So just to kind of recap very briefly, the first call Brian that you had with fletcher, I did watch that call. I watched the whole call and what I wanted to service to the group today to kind of get us all on the same page, is that you, Brian, like you mentioned you’re sort of leading this charge if you will, what we’re calling an insourcing initiative.
Brandon Chase (06:42) And what you’re really doing is insourcing that credentialing function which was previously held by point 32, and you’re aiming for sort of a mid summer launch if all goes according to plan… right now, you’re anticipating needing to credential approximately 25,000 providers, mpis… and then you’re in the process right now of securing your caqh and mpdb accounts, right? That’s all that sounds about right? That’s.
Brian Ewart (07:18) all sounds about right. Yeah.
Scott Everline (07:20) One.
Brian Ewart (07:21) Change probably since our last conversation is that we.
Evan R. Trauger (07:26) are very.
Brian Ewart (07:28) Likely, well, one, we’re going to pursue a lot of as much delegated credentialing as we can because 25,000 is a lot… and two point 32 is going to be come at some point this year, pre transition… our… delegate for credentialing on some of the providers who are currently in network, which means we’re going to just take over those providers on the re cred cycle. So hopefully we won’t be processing… the end result is we don’t I don’t expect that we’re necessarily doing 25,000 this year, but we’ll end up owning that many mpis at least at a bare minimum within our ecosystem that we’ll have to manage against.
Brandon Chase (08:22) Okay. And I know that you and fletcher kind of covered this because a typical re cred cycle is about three is three years, but in Massachusetts, it’s two. So I’m not sure if you had it. I didn’t see it. I’m not sure if you had a chance to send over your current mpi file to us. I.
Brian Ewart (08:41) Don’t know if I did. Okay.
Brandon Chase (08:43) Yeah. If you do want to send that over as a kind of a follow up to this call, we’d be able to take a look at that. And then like typically just, you know, generally speaking, the way that we break up the credentialing is we typically take like let’s just use the 25,000 as an example for initial creds in your first year. We would just take 10 percent of that, and then we would take so that’d be like 2,500 initial creds and then we would divide that entire network into thirds for the re creds. So, I mean, and that’s just like again, generally speaking, but just, I wanted to make sure you knew that we were on the same page in terms of like we’re not pushing 25,000 mpis or cred files through this year.
Brandon Chase (09:26) And we do have a method to the madness of how we would break that up. But once we get that mpi file from you, we could show you exactly, you know, what’s going to happen when, so.
Brian Ewart (09:36) Okay. Makes sense.
Brandon Chase (09:39) Yeah. You guys.
Scott Everline (09:40) Have an idea on delegation, how many like a percentage of providers that are going to go through a delegated relationship because you have some big markets, right? Like mass general is probably going to be delegated.
Brian Ewart (09:52) Right, right. So, I was personally told that pointthirtytwo had no delegation. I don’t know if I believe that is probably hearsay. And I find it very hard to believe, but yeah, my guess is it’s going to be a, pretty good percentage of maybe hopefully at least close to half is going to be delegated. Because, yeah, as you know, like mass general, you know, we’ve got Beth Israel, which is a lot of providers et cetera. Like they’re going to be hundreds or even, you know, large numbers of providers that very easily can be delegated.
Scott Everline (10:31) Who are you working with at pointthirtytwo today?
Brian Ewart (10:35) Specific on credentialing specifically or just in general?
Scott Everline (10:39) Credentialing specifically because I have a former friend or friend. I guess somebody I used to work with who is over there. So, I was going to ask about that delegated BCP Evan.
Brian Ewart (10:51) Do you, do you happen to know who even is the… so the,
Evan R. Trauger (10:59) Brighton marine team is primarily working with people who worked on the legacy tufts associated health plan?
Brian Ewart (11:06) Group. I could.
Evan R. Trauger (11:11) Not tell you who is actually in charge of the credentialing? I believe that’s a broader network function. I don’t know the,
Stanlowe (11:25) answer to that. I’m sorry, the group that we’re working with are basically the plan administration nerds, and the it groups. Okay. The credentialing Guy is a whole different. I think that credentialing group is a whole separate function within tufts that we haven’t had exposure with yet. Okay?
Scott Everline (11:40) Yeah, I’m going to reach out to Melissa who I know over there and she’s the VP of network strategy and operations.
Evan R. Trauger (11:49) So, I’ll just ask, not dickens, right?
Scott Everline (11:52) Hinckley, Melissa, Hinckley?
Evan R. Trauger (11:54) Oh, okay.
Brian Ewart (11:57) That doesn’t.
Evan R. Trauger (11:58) yeah.
Scott Everline (11:59) I’ll anyway… let’s try to track that down. I saw that you guys had caqh down as a necessary linkage. Yeah.
Brian Ewart (12:14) Yeah, it was.
Scott Everline (12:15) Brighton usfhp, us family health plan we.
Brian Ewart (12:19) are okay.
Scott Everline (12:20) I thought you all already had a caqh account. I was there for nine. So the name rings a bell when I saw like when I went.
Brian Ewart (12:27) Onto your.
Scott Everline (12:27) website?
Brian Ewart (12:27) Right. I was like, I remember us family.
Scott Everline (12:29) Health plan. I probably even sold it to you guys back in the day, but I don’t know if it was deactivated when you started delegating to pointthirtytwo or well?
Brian Ewart (12:37) It’s always been delegated. So they may have an account that’s sort of separate for us. Family health plan. I’m not really sure exactly what they’ve got going on, but we don’t as far as I know, we don’t own that, okay or pay for it. We definitely don’t pay for it, right? Evan. You would know that I don’t think so.
Evan R. Trauger (13:01) No.
Scott Everline (13:01) Yeah.
Brian Ewart (13:02) Okay.
Scott Everline (13:06) Cool. Sorry to derail things.
Brian Ewart (13:07) No worries. No.
Brandon Chase (13:09) I mean, Scott, I was actually, when you jumped in, I was just going to honestly turn things over to you to kind of ask what you needed to ask to get ready, you know, teed up for the demo. If there’s anything that you wanted to dig in terms of, you know, the notes you know, that I sent over and just kind of what we’ve discussed so far, you know, just a brief recap of Brian and fletcher’s call, but yeah, I was turning, I was in the process of turning things over to you anyway. So you weren’t really interrupting anything.
Scott Everline (13:43) Sorry, I’m just texting someone at caqh.
Brian Ewart (13:46) See what you guys have, okay?
Scott Everline (13:50) Yeah. So how, I mean, how far down this credentialing… rabbit hole, have you all gone right? Understanding that point? 32 is doing all of it? And it sounds like there’s some provider data needs as well? Like have you all started looking into the ncqa regulations? Are you building out a staff credentialing committee? Those types of components?
Brian Ewart (14:12) Yeah. So we’re pursuing urac accreditation, okay, which we’re underway… with is probably the best way to put it early in that process, but we are working against their standards. We will be having, we will be building out a credentialing committee. Got a couple folks, you know, internal, and some external resources. I think we’re able to leverage to get that up and running. And we’ve been talking, we talked a little bit with caqh. It’s hard talking with you guys. There may be another vendor that we’ve talked to as well… but yeah, we’re kind of very early in the standup here, but also we’re kind of off to the races in, you know, we’re going to build the network out. So, you know, it’s time for credentialing to like start to really, come into focus. I think.
Scott Everline (15:14) Okay. And when you say build the network out, is that, so you all, you already have an established network of providers, right? That’s the rough we.
Brian Ewart (15:20) Have, right? All contract. Well, the primary care providers are contracted directly in our paper. We have a number of, we have some specialists specialist groups on our paper and some hospitals historically, but most of the hospitals and most of the specialists were leased essentially through that point 32 relationship. So as part of the transition that we’re going through right now, we’re repapering the network on our paper. So we will, we’ll go out. We’re you know, we’re going out and engaging with a lot of them. We expect, you know, based on the, based on, the, you know, interactions we’ve already had like the hospitals are all like, yeah, absolutely. Like we’re in network, we’ll be in network. So we expect to have a lot of uptake high percentage on existing network which is good for our beneficiaries. And we’ll layer on some other new ads as well that aren’t current network as.
Scott Everline (16:18) Part of that.
Brian Ewart (16:20) Okay. Just curious.
Scott Everline (16:21) Why, why are you all changing from the point 32 process like, the lease network piece?
Brian Ewart (16:28) Yeah. There’s a lot of, there’s a lot of history there and.
Scott Everline (16:32) you can just tell them it’s none of my business too. I’m fine.
Brian Ewart (16:34) With that, yeah, it, I don’t know if it’s any. I don’t know what I’m allowed to say about it to be honest, but it’s I think it’s a little bit of a mutual parting is probably, the best way to best way to put it. Okay. And then,
Scott Everline (16:49) from the urac perspective, is that a tricare requirement that you all follow urac? Is there another decision?
Brian Ewart (16:56) Yeah. So, so dha requires us to be either urac or ncqa, okay. And in kind of assessing it, we decided that urac was the most achievable, on our timeframe okay?
Scott Everline (17:13) Awesome. And so have you guys looked at any? I don’t know how much, I unfortunately, well, fortunately, unfortunately just got back from vacation at like two am last night. So I haven’t had a chance to listen to your calls, the call with fletcher, but I’m curious like have you guys looked into tooling software to manage this? I don’t know Stan, if you guys have like in house functionality that you were planning on kind of pulling some of this in. But like how do you beyond like the work of the PSV work, right? The primary source verification and, the packets and the committee? Like how do you foresee or have you gotten that far to think about, how you’re going to we?
Stanlowe (17:51) Haven’t gotten that far. So just for general, you know, knowledge of everybody, we are building everything, there is nothing that’s good that exists today. Okay? So everything that we’re doing, is we’re buying the services from everybody. So if you say, hey, what do you? Nothing? But it’s not a zip. Cool. Yeah.
Scott Everline (18:10) And then, are you all beholden to any like you mentioned provider data, people and nerds? It’s funny because I’m on a slide called literally called credentialing or provider data nerds.
Brian Ewart (18:23) So,
Scott Everline (18:24) like you guys like you’re dealing not just with the credentialing workflow, but it sounds like there’s some contracting components that you’re trying to focus on as well as I’m guessing some directory type needs as far as being able to identify who’s where and when they’re practicing and all those fun components, all of the above.
Stanlowe (18:43) Okay.
Brian Ewart (18:43) Yeah. Okay.
Scott Everline (18:45) Cool. That’s helpful. I’ll stop asking you with so many questions but I might ask more, but I’ll share my screen so we can kind of walk through it. I think it’s a good visualization of the process to kind of start off. Medallion is an ncqa certified cvo. In terms of urac, we will support the primary source verification requirements. There’s other things in urac that we don’t do as a cvo. So we are not urac certified, but we are urac compliant as far as how we manage the primary source verification process… as a business partner. Medallion is kind of a combination of both tooling, some software you don’t have to leverage it, but it’s there. And if you start thinking about really kind of a credentialing workflow, the tool is very precisely designed around that. So managing the credentialing committee process, managing that provider application intake process. So what we’ve set up is kind of this a call to provider data management system, although it doesn’t do contracting work. So we don’t manage that contracting lifecycle. Piece of the puzzle, we can store some of the provider location data, right? So we can store practice information. We would probably wanna talk about what the appropriate source for that information would be, and how that would get into medallion. If that’s where you wanna use medallion as a tool to store some of this kind of provider directory. I’ll call it kind of use case of data. I know we use the term directory right here. So it’s a little unfair for me to even say that. So here within the platform, right? We’re gonna store those providers that you have sent to medallion for the purposes of credentialing, right? So there’s a couple of different ways that can happen. So we have just an easy caqh import. So we have a direct API with caqh. We’ll actually extract the provider applications from caqh in Massachusetts. There’s a state mandated app. So we would pull the state mandated app for mass. I think your other states that you have listed all just generally use a standard app. So that request can be as simple as uploading a template, right? Literally, like caqh id, mpi, first name, last name. We will then call caqh API and pull back that data. You can also initiate this with an API. You could do an sftp upload, you could even individually put providers in the system. There’s a couple of different ways to initiate the work. Here are the providers, here are the parameters that you need to. Pull this information back and then we will start that process. So we call caqh, we check for missing information, attested profiles, that type of thing. And then we’ll start the credentialing process from that point forward. Any questions on that piece so far? Nope the credentialing use case is super easy. So I don’t know if like credentialing itself is oddly complex. But the use case with the medallion and how we handle it is pretty straightforward and easy. So there’s probably not going to be a lot of fireworks that go off but it’s a really good clean process for managing this especially if it’s something that you all are kind of walking through and you don’t already have tooling. It gets a little more complicated if you’re like, hey, we already have a system and we’re doing all this somewhere else. I mean, we still manage a lot of that. That’s how we work with most of our payers… but the tooling is here within the platform. So if I wanted to just look at a provider profile, just to give you guys kind of a perspective of kind of the type of information we’re pulling in, this was a caqh imported profile. I have access to like the provider’s personal information, contact details, gender, race, ethnicity, right? All that’s going to come in from the caqh import. These are all fake providers. So we don’t have live data here… professional details, right? So like their specialties, down to the taxonomy. So we’re going to include that taxonomy code so that’ll probably be meaningful when you start mapping data between systems, right? Some data standards there… mpi, the caqh id, any practice information that can be brought in… there are licenses around like controlled substances licenses, board certification. So capturing that tracking, expiration dates… their credentialing contacts, the disclosure questions, like, have never, have I ever done anything? Shouldn’t be practicing medicine as a result of? And then we capture the authorization form. So the aar form from caqh or from that mandated form, perfect. So that’s all stored here, right? All of this is portable, right? So if we need to like build out a CSV file for you all to pick up. And we drop that in sftp folder. Happy to explore that option. We have an open ended a double like bi directional API. So you’re able to pull all this data back out. So, Stan, if you want to nerd out on some API endpoints, happy to share those with you super exciting stuff. But it’s there, right? That’s how a lot of our customers leverage this. They’ll pull it into a Salesforce instance, they pull it into other third party systems, whatever, wherever we don’t really care as long as it’s you know, being managed in a meaningful way that you all are needing to use that?
Brandon Chase (24:19) Stan, did you have a like a kind of a gut feeling on which direction you’d want to go? Like were you hoping API, were you trying to keep it to fstp? Yeah.
Stanlowe (24:28) I’m trying to keep it as much API as we possibly can mainly because of some security boundary requirements we have with the government. So API is the easiest. For the most part. It’s easy. Sometimes we can run into hitches, then they giddy up with, you know, how keys are rotated and tokens are stored and stuff like that. But for the most part, I’m hoping to push API first.
Scott Everline (24:55) Okay. That’s our preference too, right? Like not dropping files in sftp folders, just becomes a bit onerous building out. Apis is certainly a more dynamic option as, you know, and definitely more secure. You all know, like this is probably something we want to talk about is like we have the option of doing so. All of our data is stored onshore. So we actually store it in Oregon, and then we store it Aws in northern Virginia. We do have offshore operations that manage our credentialing process. They don’t do a lot of the work. They’re kind of doing the QA at the end of the AI based QA. And then they are also doing any manual verifications that might need to be performed as like the verification process might not be fully automated. So like if we need to contact an institution to verify a specific credential, we will use our offshore team. We do have the ability to do 100 percent onshore. So if that’s a requirement because of the dha requirements, which I would understand and probably expect we just need to like get that upfront. So we know volume wise and pricing wise, what that’s going to look like?
Stanlowe (26:11) Brian, do, you know, do you know if that’s a requirement? Yeah.
Evan R. Trauger (26:15) So,
Stanlowe (26:19) we’re operating on the assumption that it is, we’re waiting on a couple of rulings with regards to flow down requirements. Okay? Again, we don’t consider the provider’s cui, so it may not be an issue, but we’re still validating. Yeah, that’s what?
Scott Everline (26:40) I’ve come across a lot of times and like historically, you’ll have medicaid programs that will do the same thing. We’ll say it has to be onshore only, but that typically is member related. It’s not provider.
Stanlowe (26:49) Yeah. So, yeah.
Brian Ewart (26:50) There’s definitely more rules and regs around the member information, absolutely. So, yeah.
Evan R. Trauger (26:59) Okay. Yeah. So.
Scott Everline (27:01) Just let us know, but we’ll operate under that assumption for now.
Evan R. Trauger (27:04) So the credentialing?
Scott Everline (27:07) Workflow, right? So load the providers, provider data is in the platform. The credentialing workflow essentially all kind of rests in this credentialing section of medallion. I’m a super user. So I’m going to have a lot of different additional sections that you might not necessarily need. And we wouldn’t turn on for you. So think of this being perhaps quite a bit leaner. So the intake process, we’re essentially.
Evan R. Trauger (27:30) Contact in the.
Scott Everline (27:31) provider, making sure that we have all the necessary information. We perform the primary source verification. So, our contractual SLA is to have a five day turnaround time from the time that we receive a clean application to the time that we put a credentialing file in your hands.
Brian Ewart (27:46) Average, we’re.
Scott Everline (27:47) closer to about a day because a lot of this is managed through automation, then it goes through QA. And then per ncqa requirements, there is a human that actually signs off on every file. So you’ll see a human signature kind of in these files as we start looking through them… there is an API call again if you want to track this. So if you’re not wanting to interact with a medallion platform from a day to day perspective, no need to, there are status API. So you can do a status check, get that API query back and let you know where that is in case you need to put that in front of the providers or customer services, getting phone calls or provider reps are getting phone calls on status again by day turnaround time. Providers usually aren’t that impatient, but.
Evan R. Trauger (28:28) You.
Scott Everline (28:28) never really know. So once those files are finished, right? So we’ve conducted all the primary source verifications, gathered all the evidence, ran the file through the QA process. And then that final ncqa analyst is signed off on that we’re going to move the files into a ready state. So typically there’s kind of three statuses that you’ll see in ready. There’ll be a clean file, right? So we have this PSP report where no issues. Everything went fine.
Evan R. Trauger (28:57) Pretty.
Scott Everline (28:58) Conservative in what we flag as clean.
Evan R. Trauger (29:01) So,
Scott Everline (29:01) typically people aren’t coming back and being like, hey, well, there was actually an issue with this file that you came back as clean, which I’ve heard with other cbos where they say there’s no issues. But then it comes back and they do some research and they find out that there’s a fair amount of problems. We’re pretty conservative as I said, about what we qualify as a verification, a clean verification. We’ll also flag a file that has issues. So, if there’s a discrepancy on the file, like a national practitioner data bank hit, maybe there’s a medical malpractice claims history. We’ll capture that here. It’s going to reside within the packet ultimately, but you’ll be able to see through these icons kind of quickly what the status is. The third will be archived. So, if a provider is non responsive, we’ll work with you all around like what the cadence, how long we want to file to sit, right? So like some payers are pretty aggressive, some where they say, like I don’t want to file sitting more than two weeks but provide or hasn’t responded for two weeks, shut them down, close the file. I’ll tell them they can’t be in the network. It’s a different story when you’re a smaller organization and you’re trying to build a network, you might not.
Brian Ewart (30:04) Want to produce such a.
Scott Everline (30:05) Fine net. So we can kind of throttle that on or off depending on kind of how you guys anticipate or want to manage that. It’s not a set one and done, we have customers that will come back and say, hey, we’re doing a big network push. Can we open that window up a little bit longer? Because we’re new to some of these providers. So those are your three, right? The clean needs review. And then a file that will be marked as archive which I don’t have any here. Are you all going to be credentialing facilities as well as providers? Or is it just the individual practitioners?
Evan R. Trauger (30:39) And we’re.
Brian Ewart (30:40) going to need facilities?
Scott Everline (30:41) Okay. Do you have an idea on how many facilities you all will be? I know there’s still a lot of stuff to figure out as far as.
Brian Ewart (30:47) Yeah, yeah, there’s a lot there’s a lot kind of outstanding.
Evan R. Trauger (30:53) Less than.
Brian Ewart (30:54) 100 is maybe the best way to guesstimate.
Scott Everline (30:58) It more than one, less than 100? Yeah.
Brian Ewart (31:01) I mean… definitely, more than one. I think we’ve got something like close to 60 hospitals, for example, in the current network across our region, there’s more that we’d add, right? If we can. So, you know, so, yeah, they’ll be, you know, and then, you know, whatever else. So definitely, I think we’re probably coming in under 100 in total, but closer to between 60 and 100.
Stanlowe (31:35) Okay. Facilities.
Brian Ewart (31:37) I guess.
Evan R. Trauger (31:38) Perfect. Then, as far as the.
Scott Everline (31:42) Output goes, right? The delivery, the deliverable. So you’re going to get a virtual credentialing file here. So you’ll have kind of all the verifications that were conducted, the source, the verification date. And you’re going to have the individual that signed off on that file. So you’re going to have kind of that ncqa standard checklist, you’re going to have access to the application and the provider’s attestations, you’re going to have copies of like the license, the verification evidence, right? So it’s going to be a screenshot, not a picture of animal crackers, you’ll have the link to the source that we use to do the primary source verification. So that’ll all be embedded here within the packet. These packets again can be extracted via the API. So there’s basically an API… that’ll basically give you any file that’s ready. Then you can pull those files back into your downstream system. So it’ll give you the metadata. It’ll also give you the actual PDF of the packet. If I wanted to again, like doing this stuff off platform, I could manage that. And I would get a credentialing file off platform that’s a PDF. What’s cool at least is that these are searchable PDFS. So if I’m sending this to a credentialing committee for review, I don’t have to be like, hey page 37 and then you’re all sitting there scrolling during committee. It’s like an issue on the license. I can just jump straight to the license and see that. Nice. It probably seems like a minor detail. But in the world of credentialing and you have a bunch of medical directors or medical personnel, sometimes billing by the hour, you want to be in those credentialing committees… within the platform. If you’re going to leverage a platform as a credentialing workflow tool, you can make notes directly on the files, right? I can add other users. If I wanted to go back to Allison because maybe a verification, I had a question on. I can mention Allison. I could mention other team members within the platform for them to review and look at it. I can add links. Maybe there’s a DUI that I saw in the news and I want to attach that to my provider’s credentialing file or there’s additional data that you want to bring in or files, you can attach that to the packet itself. You can select whether or not you want that to be included in audits, right? So maybe if it’s just a note to a staff member, maybe not something you need as a public note. You go through a urac audit. They’re going to see all of your individual internal notes. You can make those private notes so that they’re only between you and that individual versus something that’s more kind of general packet review type content. Nice. Yeah. And then from here, I actually have to change roles. You’re able to… send these files over to a credentialing committee. So I’m able to we’ll work with you all to determine… the number of credentialing committees. You have some people do it regionally, some do it provider specific. Some just have as easy as like, hey, here’s a weekly committee that goes to the medical director and they just literally rubber stamp these files because they’re ready to go. They’re clean or there’s files that need to be reviewed. So once those files are here, you have a chance to take a look at them. I can then highlight multiple files and I can send these in bulk to like my clean committee versus sending files to the committee that needs additional review.
Scott Everline (35:00) Once a file comes into committee again, if you’re leveraging the platform, we use role based access control. So people who have been assigned to the appropriate committees would have access to approve or reject the files. So same look and feel right? I can still get into this file. I can still take a look at it. I can see any notes. And then as a committee member, I’m able to approve these files… in that off platform. We just ask that you send us your committee decisions. So we have a file to kind of intake that committee decision because we will then flag those files to a closed status and then schedule them for recredentialing. If you do them in the platform, it just automatically kind of recognizes that, right? We also see and hear from a lot of orgs. Like there’s no way I’m going to get my credentialing committee to log into a platform and do this. Typically, what we see in that case is like you have a committee chair, the committee chair will pull up the medallion platform and use it as like part of a virtual committee. They’ll make notes on the files while the committee is taking place. And then they have like essentially can sign off as the kind of sole committee vote to move the files forward. Just whatever your credentialing policies are, that should be written into them. That way. Any questions through this process so far? Pretty straightforward, almost pretty straightforward. Yeah, good. That’s our goal. Like I feel like a lot of people have taken credentialing and made it this like ridiculously complicated thing. At least from a workflow tooling perspective. It still is unnecessarily complicated as you’re learning through your rec. So then we’re going to move those files over and over into the closed status. This will essentially be like your filing cabinet, your repository of all files that have been processed. So if you ever need to go back and grab a file, pull it up for an audit review, it’s all here. You can just self service that of course, if you want to work with your account manager, your engagement manager, they can help you navigate this as well. You can also go back and call historical files through the API. If you’re working through that process. And then this is, you know, filterable searchable. So if it’s a specific provider, if I’m looking for a specific outcome, right? I can do that. So if I’m just looking for rejected files or clean files, I can manage it that way… schedule the files for recred. So it’s kind of rinse and repeat from there, right? So what? I’d envision with you all is you’re going to, it sounds like point 32. The vast majority you’re going to leverage that existing initial credentialing yeah, or even if it was a recred because it could have been a recred at this point in the journey, you’re just going to flag them for that next recred event. So we basically take all of your files in or all your providers say like we’ll identify the recred date. I think fletcher talked a little bit about cred alliance and we can go down that rabbit hole, but ultimately, there’s going to be a recred date assigned whether that’s an aligned recred date or whether that’s a static Brighton marine recred date. And then we work off of that date. So we start 120 days in advance. So we kind of have a start date that’s a deadline and then we deliver no later than 60 days prior to that recred credentialing deadline. So you still have time to like review the packet, put it through the credentialing committee and then communicate to the provider. We can send approval and denial notifications out of the platform to the providers and email. We can templatize that to an extent.
Brandon Chase (38:28) A lot of organizations will.
Scott Everline (38:29) Have us do the approvals. Some will have their own process for denials because there’s like a whole appeal process. I’d imagine you all would have to have some kind of onerous appeal process through dha. So oftentimes like that doesn’t really touch the rejected files as much as we’re sending out the approval notifications. But yeah, we’ll schedule those for rinse and repeat, you can call this. So if you ever need to look at your kind of credentialing universe, you’ll know kind of what’s coming down the pike as far as upcoming credentials and managed volumes and staffing accordingly.
Brandon Chase (39:05) But that’s like.
Scott Everline (39:06) That’s pretty much the credentialing workflow from end to end, happy to dip into the analytics or the report builder. It sounds like there’s potentially you all pulling a lot of this data out of a morpho from like from an API perspective. Yeah, just.
Brian Ewart (39:20) On the technical credentialing committee stuff. So you mentioned that talking about sending the approvals, I think that’s I mean, we obviously always hope to have a lot more approvals than denials for all sorts of reasons.
Brandon Chase (39:40) So typically… like,
Brian Ewart (39:43) we will have a large number. Like, is that something that can be done kind of in bulk, right? We finish a committee session and presumably all of the clean files, they’re going to go ahead and approve with rare exceptions, right? To be able to just go through and kind of select all and move them through and say, you know, these are all approved and have it go.
Brandon Chase (40:08) Yep. Absolutely.
Scott Everline (40:09) So, in the committee, like say this is just the clean committee, right? I would just blank out.
Brandon Chase (40:17) Ideally.
Scott Everline (40:18) Ultimately, like if a committee like.
Brandon Chase (40:20) I’ve never heard of a.
Scott Everline (40:22) CMO go in and like deny or close out a clean file if anything, just change it and send it to the committee for review versus like them. Yeah, blank it.
Brian Ewart (40:32) Yeah. In my experience, typically, and I sat in as a non voting member of a credentialing committee for years and typically like the clean files all got kind of bulk approved. Yep. With rare exceptions. If someone saw someone in there that they’re like, I don’t know, let’s take a look at. So, and so.
Scott Everline (40:52) Yeah. So.
Brian Ewart (40:53) Typically, those would get kind of bulk approved if they’re clean and it was the other ones where there was something else going on where, you know, the committee spent some time on each one of those records.
Scott Everline (41:03) Yeah, precisely. Yeah. So they could manage that. And then once say these votes were like all these were approved, they’d move over and it closed and then that would initiate the approval notification. Got.
Brian Ewart (41:16) It. Okay. That’s if you’re.
Scott Everline (41:19) leveraging the platform, right? Like if you all have you’re going to build up your own tooling stands, like I could blow this thing out of the water, much cooler, graphics and colors and party favors.
Brian Ewart (41:29) Definitely more animal crackers and stands, right?
Scott Everline (41:33) But it’s a pretty straightforward tool to manage that credentialing process, especially if you don’t have something already… we see a lot of customers like bookend around that, right? So you can have like a contract solution and that will kick off a credentialing event, right? Whether it’s like you’ve received your enrollment paperwork or the contracting paper, whatever that initiates on your end, that will generate an API call, say, hey, medallion start, this process goes through credentialing once it’s approved or rejected, it kicks the results back out and then potentially feeds out any other data components that were collected during that process, all want to consume in the downstream process downstream, right? Like if it’s the license or the education or the board certification, right? You’ll be able to map that into other platforms.
Brandon Chase (42:22) What other questions do you all have? I mean, I’ll open it up to like Stan and Evan as well. Any questions from the demo or do we feel like we’re fairly good on that? And we can kind of just open it up to more of a conversation at this point?
Brian Ewart (42:43) I’m going to talk because you’re muted.
Brandon Chase (42:46) My mouse.
Stanlowe (42:47) The battery on my mouse is going dead. So it’s not. Yeah. So I’m pretty comfortable with this from a technology perspective. It looks fairly easy to integrate. So.
Brandon Chase (42:57) Cool. Yeah. I know Brian, you talked to fletcher already about this and kind of, and I flagged this as one of the follow up calls is, you know, we’ll want to schedule kind of a data and integration call, right?
Scott Everline (43:08) Yeah, just to.
Brandon Chase (43:09) Just… you know, figure that out and we can put placeholders in there. I know you had mentioned facets and.
Brian Ewart (43:16) then.
Brandon Chase (43:17) You know, you did mention a potential directory solution, right? So, if, even if you haven’t identified those yet, we’ll just put boxes where they, you know, placeholders basically and then, but we can still map out that process and understand, you know, kind of the workflow where the data is going from where it needs to move to. And then any integrations that we need to do as well? I’m curious, I mean, without obviously without getting too far into the details about the mutual parting from point 32. I’m curious what’s the biggest pain point you’re really trying to solve for here with this solution like insourcing and I guess, and then bringing out a cvo? Yeah.
Brian Ewart (44:01) I mean, I think, you know, we’re because we’re building everything from the ground up, right? So, you know, in,
Scott Everline (44:09) our.
Brian Ewart (44:12) I mean, I think we need to get it, right? You know, we’re papering up the providers is one thing for a network and it’s its own challenge, but, you know, operationalizing that network, is really key, right? We can get all the paper we want and it’s worth zero zero in the end, right? If we can’t actually operationalize and to do that, especially with, you know, accreditation requirements, everything else, right? We’ve got to be able to, we’ve got to be able to credential the providers, we’ve got to be able to, you know, ingest the data and, manage the data. Those practice locations is really important, right?
Evan R. Trauger (44:55) So, right.
Brian Ewart (44:56) Now, we’re trying to find the best solution to get us efficiently.
Evan R. Trauger (45:01) To.
Brian Ewart (45:01) that endpoint where we’ve got an operational network and that’s across all of the different, you know, pieces and parts that we’re solving for, right?
Evan R. Trauger (45:12) Yeah, yeah.
Stanlowe (45:15) So, we’re.
Brian Ewart (45:16) trying to do the least amount of frankensteining, and I know in a lot of, yeah, there you go Stan, you know, because, you know, I come from an organization. I came here from an organization that had been, you know, doing this stuff since, you know, the nineties and so there’s a bit of frankenstein because you replace and change little pieces and parts here and there. But then you’re always stuck with some legacy systems. And so, the way that we.
Evan R. Trauger (45:42) did.
Brian Ewart (45:42) It, there was wasn’t necessarily how we have to do it here. And we’re not because we’re not tied to any legacy system in this process, right? We’re just trying to, we’re, just trying to find the most efficient way to go from where we are today to fully functioning everything right? At the end of, at the end of the process.
Evan R. Trauger (46:06) Yeah. And you know, for,
Stanlowe (46:08) you know what I call ioc initial operating capability because we have a limited amount of time we’re.
Brian Ewart (46:15) you know, I’m.
Stanlowe (46:17) looking for an MVP minimally viable product when we get, or platform when we get to the date that we need to hit, which is one 127 if we, you know, to get some other bells and whistles, that can be phase two, phase three and we can plan that out. But what I’m looking for an ease of implementation and to drive down the complexity for that integration and that build is, hey, listen, what is the minimal minimum that we need to do to be able to perform the function that we need to be able to utilize to support what we’re doing? I’m not looking for, you know, a cadillac right off the bat or the lamborghini, we’re talking Toyota corolla.
Brandon Chase (46:58) Yeah, yeah, no, that’s all language that I’m intimately familiar with. So, I came from the Salesforce ecosystem before coming to medallion. So, we talked a lot about frankensteining, yeah, yeah. And, and you know, quite frankly a lot about MVP as well, right? I mean, looking at what Salesforce can do, they can pretty much do everything but make your breakfast for you in the morning. So, right.
Brian Ewart (47:23) Salesforce is kind of like a it’s not a it’s not a corolla. It’s like a British sports car, right? Everything’s a little bit weird and you got to know, you got to really know what you’re doing if you’re going to work on it. Yeah, I think, maybe, oh, yeah, we’re going to stick with the car analogy, right?
Brandon Chase (47:37) You definitely do. And then, the further newer nuanced you get into niches of specific industries, the more that becomes that British sports car for sure. And we’re sort of at the we’re at the end of one of those cul de sacs in the credentialing world in terms of like how niche and how nuanced things are. So, yeah. So Salesforce typically isn’t the right solution for credentialing. Obviously, we, we’ve mentioned it before like, we can pump, you know, information back in there if they’re using it for other purposes, but typically not, for a cvo or for credentialing workflow. But yeah, Stan to your.
Evan R. Trauger (48:15) Point, I think, you know.
Brandon Chase (48:17) And if you’re amenable to this, I think what makes sense is that we have that data and integration call and then, you know, our team can kind of let you know, hey, here’s what MVP looks like. And then here’s what like the additional time that would be needed for these integrations. And then I think that’ll just allow you the ability to choose, right? So, if we, you know, if we say, hey, you know, MVP is like four weeks, but, you know, we’re pretty confident we can get this integration stood up and,
Evan R. Trauger (48:50) you know, and,
Brandon Chase (48:50) fully implemented in six weeks, we’ll kind of leave that to you and you could kind of, you know, sit there and kind of,
Evan R. Trauger (48:57) just evaluate that.
Brandon Chase (48:59) Decision, right? But yeah, we’ll look, to you to kind of tell us like, yeah.
Evan R. Trauger (49:06) Two weeks is too long.
Brandon Chase (49:08) Or four weeks is too long. Let’s just stand this up, get cred flowing and then, you know, we can push integrations to phase two. We’re easy.
Evan R. Trauger (49:17) To work with in.
Brandon Chase (49:18) That regard, so we could do either.
Evan R. Trauger (49:22) Cool. And then I’m curious too.
Brandon Chase (49:25) Obviously, knowing, you know, these decisions and this whole process is kind of a team sport.
Evan R. Trauger (49:33) Brian, you,
Brandon Chase (49:34) have yourself Stan, Evan, who else needs to be involved in this process to make a decision on this?
Evan R. Trauger (49:44) I mean, this is, I.
Brian Ewart (49:44) think the core group we’ll have some other folks weigh in on the.
Evan R. Trauger (49:51) Final.
Brian Ewart (49:53) Final final approval, to sign off on anything. But this is the group that’s going to kind of make the recommendation, I think.
Evan R. Trauger (50:02) Okay.
Stanlowe (50:04) Yeah. At some.
Brandon Chase (50:05) Point, it’ll be helpful to understand who those are, that are signing off and like what they’ll need to see because a lot of times, you know, I can help you build out, you know, kind of an Roi or a business value analysis or something like that. So it’ll be good to know who those folks are and then what they’ll need to see in order to kind of give the, you know, give the green light, but, I could work with you, Brian, offline on that.
Brian Ewart (50:29) Yeah.
Stanlowe (50:30) Okay. So, in terms.
Brandon Chase (50:31) Of next steps, I think immediate next steps would be if you do have that npi file, Brian, if you could send that over to us and then break it down by state as much as possible that would help us to understand how we would sort of fit these cred files into, you know, like an overarching kind of three year process and break it out between initials and re, creds. We’ll also, we could send over some dates to have our teams get together to sort of, you know, look at that, the scoping call from an integration and implementation perspective. And then I think that’s I mean, Brian, it sounds like you’re already kind of underway with caqh and PDB.
Brian Ewart (51:21) Yeah.
Brandon Chase (51:21) And then Scott, it sounds like you may have already texted folks at caqh and pointthirtytwo. And then once we get that information, I’m happy to pass that along to you.
Evan R. Trauger (51:34) All as well, Brian. Perfect. Okay.
Brandon Chase (51:40) Anything else that I missed in terms of what you’re looking to see with?
Evan R. Trauger (51:44) Nextup so.
Brandon Chase (51:45) Moving forward or anything like that?
Brian Ewart (51:50) Yeah. Okay. I think.
Brandon Chase (51:53) I think we’re tracking in terms of timeline, if we’re looking at, you know, if we are looking at launching mid summer, let’s call it July, you know, and let’s say it’s four weeks for just a standard implementation.
Evan R. Trauger (52:08) I mean, it does.
Brandon Chase (52:09) Give us a decent runway, but I just wanted to let you all know, like we’re able to work just, you know, as fast as you’re willing. Yeah. So at any point in time, if you’re like, hey, like we need to put the gas on or put the brakes on, just let us know and we can go faster or go slower, you know, whatever it is.
Brandon Chase (52:29) But we’ll be working towards that kind of that July go live and then we’ll work backwards from there from a timeline perspective.
Evan R. Trauger (52:37) All right.
Brian Ewart (52:38) That sounds great.
Brandon Chase (52:41) Awesome. All right. I’ll send a recap to the group with kind of everything we’ve discussed and with next steps and action items and all that fun stuff. But unless there’s anything else that we want to cover today, we can all say sayonara for.
Evan R. Trauger (52:54) Now, no, that sounds great.
Brian Ewart (52:57) Nothing else here.
Brandon Chase (52:58) Dan’s ready. Yeah, I’m going to go.
Stanlowe (53:00) To my next meeting. All right?
Brandon Chase (53:02) Sounds good. Well, I appreciate it, guys. Thanks a lot, and we look forward to chatting again soon here.
Stanlowe (53:06) All right, take care bye.
Brandon Chase (53:07) Bye. Take care.