Transcript
Noah Laack-Veeder (00:00) hey, Noah. Hey, what’s up?
Philip Stefani (00:04) Hey, good afternoon, Casey.
Caseybennington (00:12) Hello?
Philip Stefani (00:13) Hey, how are you?
Caseybennington (00:15) I’m a teams girl. So it took me a minute to figure out that zoom stuff.
Philip Stefani (00:19) Yeah. There’s always something when you make the switch over.
Noah Laack-Veeder (00:22) You set a record Casey. I know other teams folks who have taken much longer to get in a zoom call. So.
Caseybennington (00:29) This isn’t.
Noah Laack-Veeder (00:30) your first rodeo?
Caseybennington (00:31) No, not my first day, not my first day.
Philip Stefani (00:35) Awesome. Well, how’s it going? Where are you calling in from?
Caseybennington (00:38) I’m actually in southern Illinois. I’m right across the river from st Louis in Alton, Illinois. Cool.
Philip Stefani (00:44) I’m in Chicago, Illinois. So, not too far. And Noah’s also midwest, Noah, where are you?
Noah Laack-Veeder (00:51) I’m in Wisconsin. Are you a bears fan?
Caseybennington (00:54) No, I am from basically st Louis. So, no football here. We just lost our rams, so.
Noah Laack-Veeder (01:06) Yes, yeah.
Caseybennington (01:07) I’m a baseball person. I’m a baseball person. I love the cardinals diehard cardinals fan.
Noah Laack-Veeder (01:13) Yeah. I remember when I was younger, Albert pujols playing.
Caseybennington (01:17) Those days. Oh, yeah. Yep. I can remember going to a game after he left and he was playing for the other team, but in st Louis and when he walked up to bat, the whole stand stood up and clapped, even though he was the other team. I was like that’s some cardinals fandom right there.
Noah Laack-Veeder (01:35) Yes. Yeah. Yep. Do you, what got you into baseball? Did you have like family playing it’s? Just like what you guys did growing up or?
Caseybennington (01:42) Not really. It’s honestly, boyfriends. Okay. Yep. You know, my twenties or whatever. That’s what they wanted to do. They’re all cardinals and you get over there and you just, you get into it with all the fans and it’s just, always fun over there.
Noah Laack-Veeder (01:57) Yeah, that’s super cool. Yeah.
Philip Stefani (02:00) That’s awesome. We’d love to go to a cardinals game one day.
Caseybennington (02:03) Yeah. Well, come on down when the cubs are coming up, yeah.
Philip Stefani (02:08) That’s a good idea. We’ll bring the whole medallion team down. We’ll go to a.
Caseybennington (02:12) Cardinals game. There you go.
Philip Stefani (02:14) Cool. Well, do you know if Kirby’s going to be joining this call? I.
Caseybennington (02:19) thought, so, let me shoot him a quick message.
Philip Stefani (02:23) Okay. I know we did another one and he kind of joined halfway through. So if that’s the case, no worries. We can catch him up when he joins. But, yeah, I mean, in terms of this call, I know we’ve got an hour on the calendar. Does that still work for you?
Caseybennington (02:37) Yeah, absolutely.
Philip Stefani (02:38) Perfect. So, yeah, in terms of the agenda, we’ll do some intros because this is the first time we’re meeting you just, you know, for background for this conversation, like we’ve been talking to Kirby a little bit. I don’t know how familiar you are with medallion but like we work with organizations specifically like multi state growing provider groups who are doing like large volumes of credentialing or licensing or privileging kind of any of those like provider data management pieces. And we just kind of work with those organizations to like help make that process as fast as possible as easy as possible. Like for the folks who have to complete those applications, that sort of thing. So, purpose of today’s, call like really just want to understand like how this process works today. We can share some background like on, you know, how we typically help organizations like where the low hanging fruit is in terms of like making this easier for you if you’re like working in a ton of different systems or whatever it might be. But yeah, we kind of just like reached out to Kirby because the organizations was growing and he was like, yeah, like maybe let’s talk to the credentialing team. So, yeah, that’s you know, super open ended agenda just kind of want to understand. Hey, how are you doing credentialing today for optometry? Like this is what we’re seeing and kind of see if there’s anything that makes sense to work together on. Is there anything in particular that you were hoping to cover?
Caseybennington (04:02) Well, I guess that’s better answered with a little bit of my background. So, I’ve worked for a few different companies now helping them grow their credentialing department. And even sometimes bringing it back in house. I’ve also worked the opposite way where, you know, we built the internal process, but we did it knowing that we were using an outsource team as an extension of the team. So I have worked both ways on that. I’ve also worked demoed. I thought until medallion came up every single credentialing software out there, medallion I will say is not one that I am familiar with. You know, I’ve demoed and I’ve worked in modio, symplr, qgenda, credentialmydoc, credentialstream, veritystream… medusa. I don’t know if anybody else calls it medusa, but I do.
Noah Laack-Veeder (04:55) I’m going to steal that Casey.
Caseybennington (04:56) Yeah, absolutely. Yeah, that is the.
Philip Stefani (04:59) First time I’ve heard that that’s really good.
Noah Laack-Veeder (05:01) Because, I mean, you’re calling it medusa for a reason?
Caseybennington (05:04) Yes, I am. Yep, because it is all over the place. Yes, that is so funny. Wow. Yep. So, yeah, I will say that, and I will say most of them do seem to be built kind of with the same ideas in mind except for, qgenda, seems it’s workable and it’s different, but it, it’s kind of built backwards, you know, it’s dependent on locations and corporate entities and not the providers. So there is, you know, some room for, you know, things that I don’t I haven’t had in other platforms like that. So, very interested to hear what medallion is like especially like I said, you guys have not, I have not used medallion before and I thought I knew every single software there was out there.
Noah Laack-Veeder (05:53) Well, after today, I think you can claim you do so.
Caseybennington (05:57) I will. Absolutely.
Philip Stefani (05:59) Yeah. Well, yeah, we’re super excited, to show you a new system Kirby welcome. Not sure if there’s anything you want to say to like tee up the combo, but yeah, happy to jump into it, yeah.
Kirby Cole (06:11) No, I told Casey what the goal was. I’m just here to learn from her. She’s walking you through her process and then kind of like the last one, just whatever questions you guys have throughout and then we’ll start working on next steps all.
Philip Stefani (06:22) Right. Cool. Sounds good. And so, yeah, Casey real quick in terms of intro. So, you know, who you were working with here. I have been with medallion for about three and a half years at this point. So supporting clients across licensing, credentialing, payer, enrollment use cases, really everything from, you know, point of hire through to billing for services, getting your providers, seeing patients. And I work pretty closely with Noah and I’ll pass it over to Noah for a quick intro.
Noah Laack-Veeder (06:49) Yeah. You just think of me as Phil’s technical tag team partner. So I’ll kind of walk you through medallion. What we do, fun fact about me is I have a seventh month year old daughter and she knew I was meeting with you all today. So she woke me up at four a M to get me ready. So I’m up and Adam and ready. I, I’m debating having a third cup of coffee which I haven’t done in years. So after the call, you might have to let me know if I should or not.
Caseybennington (07:16) Will do okay.
Philip Stefani (07:18) Awesome. So, yeah, to kick us off, I think Casey, what would be super helpful is just to kind of walk through like the process from your point of view. I mean credentialing can mean five different things to five different people. So we’d love to understand how you think about it and what it, what looks like today, from your perspective.
Caseybennington (07:36) Absolutely. So we’ve got kind of a two part team. We’ve got our onboarding team who does a lot of what I think everybody would consider the credentialing. So they do, you know, make sure that they’re licensed. If they need a Dea, they collect all of the documentation that we need to do the actual enrollments with the payers. So they.
Noah Laack-Veeder (08:00) don’t mind Casey. I might just, I might just take some notes while you’re.
Caseybennington (08:03) sure. Absolutely. So.
Noah Laack-Veeder (08:04) We got onboarding team to do the credentialing. So like someone’s hired like make sure, so like they handle the licensing.
Caseybennington (08:15) Yeah, licensing, if we need any signatures for enrollments, you know, they make sure they’re that we have the list of locations, and they’re the ones that I would call provider facing. So they work a lot with the providers like on the phone, all that stuff. So they’re that direct line to the providers once they get through their process and they have their file complete, they then pass it to one of the girls on my team who does it’s not a title, but it’s how I describe it as our quality assurance. So she takes the file from the onboarding team. She reviews all of it for accuracy, make sure nothing missing. And then she also prepares the file for the enrollment. So she will, you know, in whatever system we’re using, she’ll go in and make sure the profile is correct. Make sure everything’s hooked up correctly. And then she’ll pull what we call the standard roster. So it’s just a roster with all the basic information that most insurances are going to ask you for. So she prepares all of that. And depending on the software, she’ll add in workflows, if that’s an option within the software and set those all up. And then she will enroll our top five biggest payers so that they get the ball rolling right away. All of this happens within three business days of receiving that file from onboarding. After after that, she submits she gets those done with the three business days. She then passes the file to the dedicated provider enrollment specialist. So whomever is in charge of that state or states that we’re adding this provider to. And then from there that PE specialist goes out to all of the different insurances or our reps or however they, you know, do their enrollment and they complete all of those submissions. They are the ones that follow it all the way through to fruition and to their start date.
Caseybennington (10:16) Once we get to my goal. And what I always set the goal for all my girls is I want my doctors a minimum of 90 percent done before their start date. There’s always going to be a few payers that are taking, you know, a little bit longer or… you know, in general just have a little bit more difficult of an enrollment process or some of them are dependent on, you know, medicare getting approved or medicaid getting approved. So those may take a little bit longer. So that’s why I can’t confidently say 100 although I will say we have been hitting that consistently. But 90 percent is the goal. We did used to be outsourced. They took on average 66 business days. We’ve cut that down to 32. So by bringing it in house, and, you know, creating our own process. Then on day one, when the doctor starts, one of my other team members goes and reviews the whole file again, make sure that, you know, we didn’t get an approval that we didn’t see that, you know, our system is reflecting the correct dates or the correct status for each of the individual payers. And then she creates a day one report that she sends to all of the leadership and the provider, so that everybody knows where they stand on day one with that provider. And like I said, we’ve been consistently hitting the 100 percent, but the 90 percent’s the goal. And I… mean, that’s kind of the high level, I guess view of that. I mean, we do follow it through to fruition, you know, if they’re 90 percent on day one, I’d say on average, it doesn’t take us longer than an additional 30 days to close out those other three.
Caseybennington (11:58) So, yeah, that’s kind of I’d say our typical timeline. Now, there’s always, you know, one or two providers that might fall outside of that. But for the most part, as long as we follow our process like, that is how it works. Yeah.
Noah Laack-Veeder (12:13) That makes sense. And then, I think I was hearing you say you’re using a variety of tools. So qgenda, I know is being used, the organization, what tools are you using? And like to help you with this work? Smartsheets?
Caseybennington (12:27) Is another big one although I will say we’re getting a little bit away from smartsheets. Okay? It does help with communicating to people that don’t have access to qgenda. So that is why we keep it around. I will say that’s probably a limitation of our current qgenda is being able to communicate to people that maybe don’t have a login or have, very, limited access to what they can see one.
Noah Laack-Veeder (12:57) Fact about me is I actually worked at smartsheets for three years. So like, I don’t know if I know everything. But when you’re saying communication, I’m guessing you have some workflows created with automatic alerts sent to people like when things move status to make sure things are moving along.
Caseybennington (13:12) Yep. Yeah. Well, I created the ticketing system within qgenda, an automated ticketing system that we use for that. So, yeah, we also use if you for three years, you understand this dynamic view and data shuttle. Yes. So both of those, that dynamic view is everything when it comes to communicating to people outside and that’s probably what I use the most for smartsheets. Especially with this because I can show status right away, but I am currently working on building that dynamic view for that, but we have it for other items and it doesn’t require Smartsheet license to be able to use that dynamic view. So that is a, huge tool that we use. Yeah.
Noah Laack-Veeder (13:53) I totally see why using Smartsheet with the free collaborator function like that makes a lot of sense.
Caseybennington (13:58) Exactly what?
Noah Laack-Veeder (13:59) So just kind of thinking about some of the, so it sounds like this process is going really well, right? We’ve got this down with science. Would you say? Like there are steps in this process that are particularly like pretty resource intensive like things that require like a lot of manual work? Yes?
Caseybennington (14:19) Yes, I would say that because I’m trying to think of a really good example here. Licensing is an issue because at least in qgenda, they have an auto verify function, but they don’t have it set up for every state. So it’s really difficult to track those expiration dates when they don’t update in there. That is a very manual process. And for me, it’s kind of like an open wound is what I call it because, you know, you, somebody has to have human intervention to make sure that it doesn’t you know, drop off. And so it’s trying to remember it set reminders, you know, it has to do something like that. I can’t automate that for every state and a couple of the states that they don’t have it for are some of our biggest states, Arizona, Kentucky, North Carolina, Alabama, usually.
Noah Laack-Veeder (15:16) When I hear that, I mean, like it’s not a function of we’re like missing it, just like it’s really hard to, with everything else going on to stay on track of that. Like where that shows up sometimes is that there might be some resubmissions or rejections from payers because of how’s that showing up for you all?
Caseybennington (15:34) Yeah. I mean, luckily caqh is kind of our backup plan because they are following it and they’re going to send it to us. I also, what I do to take care of that is we created a smart sheet that has all the states and when the licenses expire, if it’s by issue date, if it’s by provider birthday, if it’s like Kentucky, everybody expires on three 126 of every year, you know. So that one’s easy. So then we just have to implement a workflow outside of the software in order to track it. And so that’s that is if I have to go outside of the software, then to me that’s an open wound.
Noah Laack-Veeder (16:13) Yeah, 100 percent. I mean that makes a lot of sense. It’s something like license expirations would be something that you probably expect. And I mean you’ve used other credentialing software, so I’ll use probably like why isn’t it in here? When the other ones that make sense exactly?
Caseybennington (16:27) With.
Noah Laack-Veeder (16:27) the, and I have, I’ve I was actually trying to count how many conversations I’ve had. I probably had like a 1,000. At this point. The other things that come up that are like time intensive is actually preparing and submitting the applications, the follow up and the status tracking like tracking revalidation dates, like following up on revalidations. Is that, are those areas like difficult? I will say I.
Caseybennington (16:53) Will say the follow up and tracking. I will say that is one thing that I actually really do like about qgenda is their workflows and, you know, for the things that they have built in there, it’s a fantastic system for tracking expirations, but, you know, if they have that limitation where they don’t have the right website link or whatever, you know, it may be that’s where it’s an issue. But, if they did have all of those, I do like their system in their workflows, you know, you can create the steps and then you can create a step automation off of that, which I really like. So, you know, if the PE specialist goes in and says this is complete, then qgenda will automatically send an email to me saying it’s done or leadership or whatever. And that’s all with just clicking one button, it goes and does that whole automation. And you can also email out of the workflow. So if someone’s out of the office for two months or something, I can go into qgenda and pick up right where they left off because the whole communication is in there and it stays out of outlook. That is a huge thing for me is staying out of outlook for our communications, yeah.
Noah Laack-Veeder (18:06) Sounds like with these workflows, if I’m tracking, like you really like the visibility, you like the audit trail, you like being able to handle things when it comes to like the things like, hey, this payer is being unresponsive we have to reach out to them. We have to kind of go to these portals to track status. Like I haven’t heard qgenda having any automations. There? Is that something where you have to kind of do that manually or, yes?
Caseybennington (18:32) Yes, they don’t have any kind of connections to any insurances. It is strictly a, you know, a warehouse data warehouse kind of, yeah. So we do have to go out to all of those. But I will say especially in the optometry space, we usually have direct reps that are very helpful. That is more of an issue when it comes to like your major medical. So blue cross blue shield, you got to go to availability cigna, they have their own website or God help us uhc, where you’re not allowed to talk to people. That one, you know, their website is luckily pretty user friendly, but, you know, if you run into an issue, it, that is, a difficult one there. And then I would say probably the other biggest thing. And I mentioned that I’ve used credential my doc before and this is one thing credential my doc had that I missed terribly is the collection of blank forms. I don’t know if you’re familiar with credential my doc, but they have, I guess we would call it signable documents where it’s a collection. It’s cloud based. So all of their clients can say, you know, here’s the updated form and then it becomes available for everyone. You click it, download, it auto, fills it out and then you download it and do what you need to do. Qgenda also has that function, but I have to map each and every individual form. And once you map it, it’s kind of stuck like that. It’s very hard to edit. And, you know, when we have, if I have a doctor going to 10 locations, I’d have to map the same form over and over.
Noah Laack-Veeder (20:13) Okay. Before.
Caseybennington (20:15) I could make it available. That becomes very difficult. And then they also have an auto fill form function where, you know, they have like a browser extension, you can go out to the website, click fill in. And once you’ve downloaded it would fill in from that doctor. But that doesn’t always work right? Either. So those are two limitations. And then the other biggest one and this might be kind of switching gears because we have what I described there is our non delegated process, but we do have a tax id in Arizona that is 85 percent delegated. And that process does look different… is.
Noah Laack-Veeder (21:02) that still under your team? Or is that a different team? Yeah. Okay. Nope.
Caseybennington (21:05) That’s still me. Yep. So.
Noah Laack-Veeder (21:07) Then, so I’m guessing you have to do because I mean, yeah, guessing you have to do primary source verifications. You have to do like oops, you have to do that’ll inform a cred file like create. And is it ncqa cred file that you guys are doing or?
Caseybennington (21:25) Yeah. For the most of, for the most part, all of them, do you follow that? Yep?
Noah Laack-Veeder (21:31) And then you have it. Do you have a, do you have your own ncqa cred committee that would review those files? Yes. Okay. Yep.
Caseybennington (21:42) That would be it’s. Made up of my provider enrollment specialist, the two area medical directors, myself and Kirby, and yeah, we meet once a month for those committee files, but I will tell you my limitation in this current software. And I’ve honestly never seen a software that really did it the way that these delegated payers want. It is the continual tracking that we have to provide at the annual audit. So, oig, you know, oig, Sam, ofac, you know, death, master file, medicare, opt out, medicaid, opt out. Cugenda, has that and it’s doing the work but I don’t have a way to print it out and provide it in an audit, right? Like, so I can tell you it’s done, but there’s not really a good report. The report says checked on, you know, one 30, nothing found that’s not good enough for a lot of these delegated. They want to know the link, the place, they want to see that there was nothing found. They want to have an initial, you know, they want us to initial and date it. So a lot of times at least before my PE specialist that does the delegated was printing out like, you know, killing 900 trees a month, printing them out, you know, sign in time stamping and then putting it back in the system. Okay? So I am still trying to navigate through the best way to prepare that for our audits every year. Right now. It’s a very manual process.
Noah Laack-Veeder (23:12) Got it. Probably your favorite part of the year. I.
Caseybennington (23:15) Love it. I love it when eight of them come at a time too. Yeah, exactly. Just what’s going on right now?
Noah Laack-Veeder (23:21) Yeah. Well, so thinking about that, right? You’ve got your team’s got a lot of work on their plate and like that systemic piece where we don’t have the verification evidence available that can make the audits hard. Like has that affected your audit results at all? Or like, has that no?
Caseybennington (23:39) Because I will say the PE specialist I have has been doing it for a long time and is very used to doing it manually. So she is very good at tracking it. I just, I wish that I could automate it for her because I feel like she spends a lot of time doing that when we could be, you know, working on other things or, you know, preparing for other audits. And sometimes it kind of puts her under the gun too because, you know, they’re going to send you files of whomever they choose and she has to go track it all down. Some of it’s paper, you know, all of that. So being able to automate that for her would be a huge win for.
Noah Laack-Veeder (24:14) the team. Yeah. So let’s say we did automate that because I mean medallion is an ncqa accredited cbo. So we can we handle audits all the time. We produce that perfect. Pretty much how it works, is you need that we give it to you, right? And let’s say we did free up that time. Like what would that individual be able to do instead? Like because it’s like with all the work that’s going down and then this audit being thrown on top, it just seems like that’s going to be a lot to manage. Like what would that free them up to be able to do?
Caseybennington (24:45) I mean, that’s a very good point and I will tell you especially for her, she spends all of her time looking forward and if she had free time, I’d want her to look back and, you know, what are we missing? Is there an effective date for a new insurance? We added, you know, make sure and have that time to go back and go through everything with a fine tooth comb. And then if she did have that free time, what I’d want to do is set up monthly quality assurance audits for us internally so that when those files came due at her audit, she’s not looking for anything. It’s you want that doctor. I’m clicking that file here you go. Because we’ve done that QA throughout the year every month on every provider.
Noah Laack-Veeder (25:29) Yeah. And I hear that. I mean, I hear that a lot. I think the one piece is if you don’t have a solution like this that’s automating it like, and I don’t know if this is the case for you all. The only way you really find out if something is missing or there’s a sanction or something was if a claim got denied, you’re like, oops.
Caseybennington (25:46) Right?
Noah Laack-Veeder (25:47) So, is that, how is that showing up for you all? Is that happening at all that you’ve seen or it?
Caseybennington (25:52) Happens, very, rarely because I will say we have an amazing onboarding team and the same onboarding team that does the non delegated also handles delegated and they are absolutely fantastic at what they do. So, it’s very few and far between. I would say that shows up more so if something, you know, the doctor’s already working for us and maybe something came up, you know, sometimes they work for other employers or maybe things that we’re not going to be told about. So it usually happens on revalidation recertification, or if we’re doing like a location ad or something and they’re running them through the system, it may come up that way. But yeah, other than that, it might just come up in the audit like you said, or denied claim or something like that. And then we’re doing damage control instead of trying to get ahead of it, which is what I would much prefer. I don’t like surprises.
Noah Laack-Veeder (26:41) Yeah. I mean, you’ve already accomplished the 90 percent done before their start date. Like if you could catch 100 percent of those claims and aisles before they’re done. I mean that’d be huge, right? And I think that’s kind of what talking to you briefly. It seems like that’s kind of where you want to go.
Caseybennington (26:56) Absolutely. So just kind of zooming.
Noah Laack-Veeder (26:57) Out there’s a couple of things that I’ve heard and I just want to make sure I’m tracking. So sounds like the license piece up front which is more handled by the onboarding team is a pretty big opportunity because license expiration dates aren’t being tracked and not being reminded. So you’re kind of going above and beyond to make sure that these things are being tracked so that things aren’t falling through the cracks. The other piece is that you’ve created a Smartsheet system to do a lot of the things that aren’t happening in other software. So you’re kind of like plugging in the gaps where, hey, we’re not getting these notifications. We’re not doing this. So you’ve gone above and beyond to make this system to do that, which is just, I think making you have to potentially do dual entry sometimes because you’re having to manage two things. So we’d want to get to one system. Ideally something that’s you’ve seen every you’ve seen every cred, software. We want to make sure that the Smartsheet, the same functionality you have there as part of that software sounds like with the applications, like you do have the ability to create and map them, but it’s all on you. And if you do make it, if anything changes, you then have to stop what you’re doing, stop doing the critical work to do it again. So it sounds like if that’s the case, I’d probably just be doing it manually every single time because it’s not worth configuring it every single time, right?
Caseybennington (28:16) It’s kind of where a lot of it has fallen to except for the ones that, you know, aren’t broken.
Noah Laack-Veeder (28:21) Yep. And then the other part is that like the follow ups and tracking status, like we’re doing, it, you know, it’s a part of our job, right? But like there’s always opportunity if we have our contacts to do certain things, I’d love to reach out to them. But if there’s things like, you know, more routine things like what’s the status? Like, can I get a quick status check if that could be automated in some way? That would be really helpful? Because then your team can focus on chasing some other things down. And just, I guess in general, you know, having the visibility you have in Smartsheet across the board, I don’t think I’ve heard that, that’s an issue, but it sounds like it is limited to, is the update from Smartsheet getting into qgenda, right? Is that?
Caseybennington (29:11) Yes. And that’s kind of where data shuttle came into play. We’re not currently using data shuttle because the reports were broken in qgenda at the time. But you’re right? I liked data shuttle because it removed that human error possibility, you know, from going from one system to another, it was just drag and drop and then it was built out that way. So, I do agree with you there that I really like smartsheets but I don’t like that. A person has to take it from one to the other because there’s always room for error there. And then, and we have.
Kirby Cole (29:46) been dinged a couple of times on those errors. Yes.
Noah Laack-Veeder (29:49) We hear that if we.
Kirby Cole (29:50) Get it, right, we don’t get a damn high five, but if we mess something up, we get the shit kicked out of us. So. Oh.
Caseybennington (29:57) Yeah.
Noah Laack-Veeder (29:57) What do you mean by that specifically? Yeah. What was credential was that from the claims in ielts or what?
Kirby Cole (30:02) I’ll give you one example that I saw and I don’t even know which team it was Casey, but we had one that came in and we said that a provider was cleared for a payer and somebody else on the cred team or RCM team got a letter of denial like the day before, but we told the practice that they were clear and it was because something didn’t translate between the both places. So we missed it. And then like this was before I was part of this team, but I heard about it because it impacted, it was a doctor who was trying to get started. Yeah, that’s definitely easy little fat finger stuff that you can mess up with whenever you’ve got to do data stuff outside of your source of truth. It absolutely opens you up for error at a different level.
Caseybennington (30:50) Absolutely. When.
Noah Laack-Veeder (30:51) you’re getting like claims now like that, like.
Philip Stefani (30:54) Are those like isolated or like, I guess how often does something like that happen?
Caseybennington (30:59) I mean, for the size that we are, it’s an ongoing thing. We are always tracking claims. And I work, very closely with the RCM. I really like to build that relationship. I mean, I describe it as they’re my right arm, you know, if my claims aren’t working, you know, if I haven’t done my credentialing, they can’t do their job. So. And then when something in error does come up, you know, I’d say 50 50, it’s credentialing or, you know, some other factor on the claim. So working with them and having honestly having better visibility for them is probably huge too. Right now. They use like a lookup tool where you type the doctor name, you know, it’s just, you’re very basic lookup tool search function within qgenda. It doesn’t give a lot of details. It doesn’t allow me to create separate.
Kirby Cole (31:51) No plain information, right? Right?
Caseybennington (31:52) I mean, yeah, I mean, it gives you the basic it’ll say, you know, I’m at effective this date, but it will not let us get.
Kirby Cole (31:58) Yeah. We want detailed plan data if we can. It.
Caseybennington (32:00) Won’t, let us get down to the plan level which if you do ever end up talking to contracting, they’re going to tell you that is their biggest issue. I think our call center would even say that is their biggest.
Kirby Cole (32:10) Wish list. Yeah. Pam said that’s her number one wish list is down to the, I know is all the way down.
Caseybennington (32:15) Exactly. And right? Is that?
Noah Laack-Veeder (32:16) Just like any example of that. Yeah, like what is that? What is that? So, yeah, how is that showing up? Yeah?
Caseybennington (32:21) So, for instance, we have let’s just use unitedhealthcare that’s a pretty easy one. We have medical only, we have medicare advantage. We have commercial routine. We have medicaid, we have medicaid, medical. All they see is uhc, oh, really? So I can’t I mean, I could split it down to the level, but that is not a sustainable thing like I, that would take forever if we got it would, and I would not trust my data at that point because we’re getting, you know, down to the nitty gritty there. So if there was some kind of functionality that, you know, here’s everything that uhc offers, click that’s what we use and that’s what you add. But right now, it’s a manual per payer per provider per location entry. That is all manual. Wow. It’s done through the workflow, but it takes complete human intervention for it. You have to guide the workflow the whole way. That must be a lot of work. It is that’s why I got 10 people?
Noah Laack-Veeder (33:24) Yeah, I mean, yeah, I mean, I’m just, I’m thinking about and like seriously hearing what you’ve put together to solve for a lot of these… things that aren’t being done through your tool is incredible. Like, I mean, you’re no, I mean, that like it’s like I’m to be fair, I talk to I’m talking to organizations that are saying like, yeah, we don’t have a solution like you are the solution and you’re doing this, but there’s a limited amount of time that this system gives you. And there’s going to be things that like if we could just do it automatically, it’s going to help you be even more effective.
Caseybennington (33:58) Yes, just.
Noah Laack-Veeder (33:59) Right away, we absolutely capture that level of detail and we also capture the location level. So it sounds like you’re doing it at the location level, which makes that very hard. And I mean, I can just, I’m just going to really, I think this is if this is like kind of zooming out if you could prioritize like all the things we talked about like the most impactful things that this technology has to do, like what would they be?
Caseybennington (34:25) Definitely down to the plan level. I think the whole company would benefit from that from top to bottom and automations for my team to free us up for that quality assurance I want to do. And then if I had to add a wild card in there, I would love to be able to give both granule for the practices visibility as well as high level visibility for like Kirby. So Kirby doesn’t have to spend hours going and poking through things. He can go show me the last 10 doctors that we onboarded and what’s their percent. And if he could do that quickly, that’s what I would like to see. So those would be my three biggest asks. Okay. Well, what if?
Noah Laack-Veeder (35:05) I just showed you those right now?
Caseybennington (35:08) Then I think you might be my best friend, Noah.
Noah Laack-Veeder (35:11) Well, my wife is my best friend.
Caseybennington (35:13) All right. Second best.
Noah Laack-Veeder (35:14) Friend. So you’ll be up there though. Okay, we can tie all.
Caseybennington (35:18) Right.
Noah Laack-Veeder (35:19) Kirby, you know, we’re setting a high bar for being my best friend here.
Kirby Cole (35:24) I’m an asshole, so I won’t be able to compete it’s fine.
Caseybennington (35:28) Don’t let him lie. Kirby’s my best friend.
Noah Laack-Veeder (35:34) Okay. Well, okay. Now, the pressure’s on now, I have to show you this because otherwise, I’m not going to be your best friend. Okay? Can you see payr’s on your screen? Yep. So I’m just going to show you just a quick flash. So if I go to the enrollments here, you know, kind of the similar idea. You’ve got different lines of businesses that are going to be broken out. Like we’re able to give you that level of detail by the practice locations. So here it is right here. Love it with the provider. I mean, with the effective dates and the revalidation dates. This is a demo, but it also is going to have the proof of enrollment right here… yep.
Caseybennington (36:15) Yep. So that gets us down to that level and it kind of combines the provider profiles and the payer enrollments that qgenda offers in two spots, puts it in one. So that’s one great and.
Noah Laack-Veeder (36:29) For Kirby, if you want to see like the last 10, we have an analytics dashboard that will give you exactly that like the top 10, like latest enrollments here. But if you do, I will say personally, I think that this is so user friendly. That like there’s executives that are looking at this level. Like you can see all of this here and you can search and filter by anything you want. So if you have Kc, they’re like I need to know who is enrolled with this payer, as of what date, whatever it might be. You can get that data within a couple seconds, right? So given that you’d have that usually that helps with like patient access issues, making sure that we’re not getting people enrolled with or like seeing the right people. Like how would this benefit you all having this or the other teams having this? And you said this was Pam’s top priority, Kirby, like how is this going to help the org?
Caseybennington (37:28) I mean, that would be tremendous. I mean to give you a real world example. Humana medical as of one 125 stopped offering commercial routine plans to ods, but apparently they still offer medicare advantage, but in our system, it says humana medical. So I can’t get that down to the… when the patients, my thing is when the patients come in and what their card says is what they should be able to see in our system, you know? So humana, medical, humana, medicare advantage, the practice is going to see humana and assume if I had both of those and I could say non participating and participating like you have right there, then that would clear up some of that confusion. And I really think it would give a lot of more… faith in us by the providers because all they see is a denied claim. And you know, I could tell them, you know, one 125 humana, stop doing it but that doesn’t get them paid. So if we could, you know, they could have that information and know ahead of time then, you know, yeah.
Noah Laack-Veeder (38:38) And I think there’s two parts to that one, the visibility. And also there is a lot of work that you have to do to get this. So this is how you do it with medallion. You just say I want all lines of business and they all get added automatically. Yes. So you’re not going to have to do like 10 different requests. And the other piece, I just want to highlight practice… locations can also add a lot of complexity here. So we’ll have these loaded in our system. You can just tell us like do all of their practice locations too. So you’re not going to have to do this like several. I can’t talk since I’ve been up since four a. M. It’s not going to make you choose every single location if you don’t want to, if you’re just like the processes, all of these, all these locations, simple as that. If you do want to pick the locations, one by one, we’re automatically pulling the ones this provider is associated with. So there’s no like look up that needs to be happening… another.
Kirby Cole (39:32) Example, and this is back to also the manual processes. We had a provider who was working for one of our practices, there’s a practice 40 Miles away, you know? And so we needed to get her busier. So we’re like, hey, do you mind driving 30, you know, 35 minutes. We’ll get you loaded up for the patients and do some surgeries, go through the credentialing process. We get her credentialed for the new locations. The team that was supposed to take the fact that she was credentialed and then add it to the freaking excel tracker that says, yes, she can see these payers in this location didn’t get updated. And so at first they were loading patients on locally. And then the call center saw it. And since it wasn’t on the thing actually pulled patients off of.
Noah Laack-Veeder (40:16) The doctor’s.
Kirby Cole (40:17) templates.
Caseybennington (40:19) Okay. And then we’re like shit is this?
Kirby Cole (40:20) Happening in one spot? How many places is this happening? Because if the team that is responsible for saying, yep, these 10 are done. Doesn’t go make that change. And the doctor starts which this one did. It was like she was pissed ops was pissed. It was not a pretty situation.
Noah Laack-Veeder (40:37) Well, I mean, yeah, the being pissed is coming through. Well, now, we just missed out on how much revenue we could have made that day from a business perspective. And then the more human piece is wow, these patients aren’t getting the care that they need. Casey. I think you said that happens a lot like.
Caseybennington (40:51) what he said there, not necessarily the excel thing because that is more I would say of the oph side, but the not being down to the granule level and call center, you know, trying to… establish where a patient should go. Sometimes they don’t schedule patients in a certain area because it’s not to the granule level. So, you know, you say humana medical, it says non participating now because I can’t get down to the medicare advantage level. And so they may not be scheduling those patients or like just to give you an example of some of the manual stuff we did in order for me to make it easier on the call center to identify where medicaid patients can go because not every location takes medicaid on the back of the name of the location I put in parentheses. M, so now they can search by M.
Noah Laack-Veeder (41:44) Oh, my goodness. I’m only saying that because that’s just like I’m so happy you’re doing this, but like I.
Caseybennington (41:50) just that.
Noah Laack-Veeder (41:51) is like that is so that,
Caseybennington (41:54) is, yes.
Noah Laack-Veeder (41:55) So, let me just ask you this. So, like from what I’ve showed you, just like it seems like the problems around tracking visibility that are leading to patient access and claims and aisles things medallion can solve. So… where do we want to go? Yeah, go ahead.
Kirby Cole (42:17) Can I give you another example that I heard today? That is, and this is one that’s interesting because it’s ophthalmology. Sorry, Casey, but you’re.
Caseybennington (42:24) fine, you know?
Kirby Cole (42:25) Apparently there are now, so we had a patient who has been seeing us for a while, he went in and he got an aca plan. It’s a blue frost blue shield, aca plan. We credentialed. It says we’re in network. He actually bought like a specialized trim down plan… that doesn’t allow for services outside of certain providers and places, and we’re not approved at that trim down version.
Caseybennington (42:54) And so he’s saying I’m covered.
Kirby Cole (42:58) We’re saying, yes, blue frost blue shield is in network, but your particular plan isn’t and the card doesn’t call it out. And so the question from the practice now is okay, we figured out what the issue is for this poor Guy. But the next person that walks into that card, how do we figure it out? Because short of this level of investigative detail, like Fred was doing stuff, payr contracting was doing stuff RCM, they’re all poking around and then finally, we get on a meeting and we’re like, well, shit, he’s not a cover yep it.
Noah Laack-Veeder (43:29) Sounds like the visibility is like the crux of a lot. I.
Caseybennington (43:35) Would say that’s the source of a lot of our tickets that we get. I told you about that ticket system and smart sheets. A lot of them are, do we take this plan? Do we take this? And for me, I know the hierarchy. I know this weird small plan you see first health, it usually means Aetna but not everybody knows that, especially not the practices. I would never expect that, but I would love for our language and credentialing to be able to identify or at least link back to what our practices are seeing on the card to Kirby’s point, because that’s where that patient’s standing in your face. I don’t want my practices to have to do any investigative work. I want them to be able to here’s, the hierarchy here’s, the tree. If you see, if a person gives you a medical blue cross blue shield card, you would be able to know that most commonly their vision is through imet or VSP. If you’re in these states, it’s VSP, if we could do that and kind of give them that trail because that’s a lot of the emails and tickets that we get. And then we’re doing that research and giving it back to them. And, you know, either they’re doing fantastic and they’re doing all this a day or two before the patient comes in or poor practices that patient’s standing in front of you? Like I have blue cross. What do you mean? You know, to Kirby’s point? You know, that plan level? Yeah, kind of.
Philip Stefani (44:57) Reading between the lines on that is the like with the story that Kirby just told is like the future state. Like if you had that plan level information and that was available at that location, like they would have just known right then, like this Guy’s not covered like let’s not move forward with this and.
Caseybennington (45:13) They all pull eligibility. So they would see, I mean once they got past the card, they’d pull eligibility, see that plan name. If they could take that plan name and just double check, they would have not, you know, seen that patient would have ended up. I don’t know if it did. I’m assuming ends up in a write off, you know, which is what we want to avoid at all costs. Yeah.
Philip Stefani (45:33) It seems like a patient experience issue. And then, yeah, to the write off point, I guess I was curious to pull in the thread of write offs a little bit because we talked about claims denials a little bit earlier. Like Noah and I, we chat with a lot of organizations where claims denials are coming up. But for many organizations like, you know, there’s an error. They’re able to rectify it like it does get kind of solved. But then it’s just in Ar, for a little while like, you know, longer than you would like, but you’re still getting paid for it. Are these ending up like as actual write offs or are you able to like rectify these down the road?
Caseybennington (46:07) I would say that’s kind of a two part answer if they make it to me as a credentialing issue. I have a fantastic relationship with our reps. I can usually go back and I can tell that story. I had one today where we’ve got a bunch of denials for a doctor that is for some reason being denied for involved medicaid in Georgia. You go to, you know, I’ve got a great relationship with that rep. I get monthly rosters from them. So I go check the roster. I see you’re missing medicaid lines. Why are we missing medicaid that’s a CCO state that is automated there? Should you need no intervention from me to add medicaid lines? So I reach out to him, send him the two approval letters for locations. I say he was effective seven 125. I want you to backdate and reprocess all of those claims. So I try to keep that burden off RCM at any opportunity that I can and get our payers to reprocess. But then, you know, then it like you said, it’s sitting in Ar until it gets reprocessed by them. And, you know, sometimes we have to go back if it, if we have to backdate it enough or we have to go get special waived for timely filing and then collect it. It just becomes a project if we let it get to that point. Yeah.
Philip Stefani (47:18) And with all these other pieces on your plate, it’s like taken away from the time that you would spend on fixing these pieces that actually impact the bottom.
Caseybennington (47:24) Line, yeah, if we could automate credentialing, that is where personally, I would put a lot of my effort is with RCM and touching everything sooner and being able to find those trends a little bit quicker and try to cut them off before we get to timely filing.
Caseybennington (47:39) Because I mean, I assume you guys are, you know, in it every day. So, you know, that some of these payers have cut down their timely filing to, I think I even heard of 60 days. The other day. I said, I’ve never heard of a 60 day timely filing but, you know, we’re talking 90 days. I mean, you got to go through a lot of teams, you know, and hitting that before 90 days to identify the problem, fix it and resubmit it usually not happening in 90 days. So we are having that conversation going back with the payers and that kind.
Philip Stefani (48:10) Of stuff.
Philip Stefani (48:10) Yeah. And now for those where it’s 60 days, you’re like even more under the gun like, yeah, I can’t even imagine, no, that’s tough. So, I know we’re coming up on time here. We got about 10 minutes left like overall like Casey, thanks for walking us through the process. It sounds like there’s definitely, you know, a couple areas where I think we could add significant value to what you’re doing. And these are areas that we would dive in more on like a future demo. But essentially like the biggest pieces I’m thinking are like tracking the plan level data, just giving you visibility into like where those are in the process. And like specifically who’s in network with which plans. So you don’t have to like go and hunt for that information manually. I guess like if we were able to like just make that really easy for you. And you didn’t even have to think about tracking that data down. Like, you know, would this become like an immediate priority to solve?
Caseybennington (49:05) I would say yes, except for I would love to hear about your reporting capabilities. Like can I, you know, build, you know, some of our payers like spectera is a great example. They have a very specific roster that has to be filled out in a very specific way. And I cannot build a template in qgenda because it doesn’t allow for blank fields. So it’s pulling a standard roster, copy paste. That’s why Terry does a lot of that prep work because I said, I don’t want my girls copying and pasting that’s a waste. I want them to get the doctor and go go go.
Noah Laack-Veeder (49:41) So, yeah, no, we can absolutely do that and like, and I think kind of to Phil’s point like happy to do more technical validation. Like we’re going to talk through implementation anyways. We can do that. But like I guess Kirby from your end, from what I’ve heard, this seems like, I mean it seems like the general visibility leading to these business problems is like a top priority for you and Pam. So like is there an opportunity for us to kind of there’s literally a report? He wants us to build that? Like it’s like I got to see this cool we’ll get there.
Caseybennington (50:19) But I mean, other than that, I love the plan level stuff. I like that you have that analytics function. I mean, I would use that, you know, a lot as well. And like I said, the delegated we have to, I mean while qgenda allows for delegated, it doesn’t you know, call it out the way that I would as a completely separate process from non delegated. So she has to follow a lot of our trends that we have in there. And some it’s still manual for her. Like I said, that was just.
Noah Laack-Veeder (50:53) to say we automate that piece as well. So I mean if it makes sense, we can walk through what the credentialing workflow looks like. It’s the similar story where there’s really important things that we need to do. Like you said, you want to spend more of your time with the RCM folks and getting that done. Like we don’t need to spend our time like manually copying and pasting data into applications like that’s not where your team is extremely valuable like it’s what you’re saying you’re chasing down dollars to make sure that patients are being seen more important stuff. So same story with credentialing. So happy to do, you know, that demo to kind of walk that through. But Kirby is, you know, it’s kind of the next step. So you do that demo, is there, what else do you think we’d need to do, to push this forward? Yeah, I.
Kirby Cole (51:41) Think, the demo is the first step. We’ll make sure that we have everybody at the table. The second step is me getting you the finalized data so that we can finish out the sort of the return tracker and see what that looks like. And then I know once we get that we can talk more about pricing like we just, we’re not really. So I just don’t know how your pricing model works. That’s really, it, the only thing is Andrea is on pto now. So, she did that call today and then was like literally in her car heading out. Yeah.
Noah Laack-Veeder (52:09) So,
Kirby Cole (52:10) we will need to look the week of the thirteenth and probably give her a day when she gets back.
Kirby Cole (52:14) So we’re not hammering on her first day back. But sometime the week of the thirteenth, I think we get Casey and myself and Andrea and probably Pam all together, on the demo, and walk through it, that screen you showed with the detailed plan information. You can just start there with Pam and she’ll say, yeah, I’m in and hang up. Yeah. Okay.
Noah Laack-Veeder (52:37) Deal. That’s true. Yeah. Any coaching you guys have for us? Because I mean, ultimately like Casey, we’re trying to help you out here. So just help us understand like what’s most valuable and we’ll do that. But if you want to have like a, again, we typically do a little more like an executive demo, we can do more of a deep dive demo this.
Kirby Cole (52:57) Should never be deep dive because this should be deep dive for Casey and Andrea because they’re going to be the ones that are going to have to help us implement. They’re going to be the ones using it. So they’re going to be the ones that are defining the additional value that helps us make this change. So I want them to feel comfortable with it. Pam will sit on it. She’s very technical. So I’m sure she’ll get most of it. I’ll sit, I’ll just watch and act like I know what you guys are talking about. And then after that, we’ll do an executive demo for my boss, probably Sunil on the credential, you know, the credentialing leaders, and anybody else that wants to be engaged just for that final decision 100?
Philip Stefani (53:32) Percent, yeah, those, I think we’re aligned on what those next steps would be. We’ve kind of talked about this previously, but I guess like in terms of like loose timeline, I guess when do you have in mind that you’d want to be like wrapped up with an evaluation like this?
Kirby Cole (53:48) I mean, I would say end… of April, probably… end of April, end of April, early mid may and looking at the countdown, I’m thinking we’re losing a week next week, but I mean, you know, we can absolutely get this demo. In the week of the thirteenth. We’ve got a couple others we’re evaluating and then like, I mean, we’re all moving about the same speed. So yeah, I would say if middle of may, we should know if we want to move forward and have a decision made. Yeah.
Philip Stefani (54:22) Absolutely. And I guess then two questions on that, like one, assuming we’re like checking all the boxes on the demo and everything. And like we’re aligned on kind of the structure of a partnership and all that, like when would you want to be live with a new system?
Kirby Cole (54:40) So our actual contract with qgenda is up at the end of the year. And so I don’t know how that works. Like if I had an ATS, I’d probably keep both live for a minute just to make sure that the new one was working. Yeah. And the recruiting space. So like just know that the last date we could be live is the, you know, December 30 first. If we could get some time, you know, some overlap time with both while we’re you know, in case there is something that we screw up, you know, on the implementation, heaven forbid, then we could still get back into qgenda and bang something out if we need to. Yeah. So, you know, live by November one would be great. You know, I don’t know what the, I don’t know what ural’s timeline is for implementation. One of the other ones I think that we talked to said 60 days. So just kind of back into also from what you guys need. Yeah.
Philip Stefani (55:30) That’s helpful. We’ll we can actually just give you some specific insight kind of as we move through this on what implementation looks like. It’s pretty quick with medallion, but we’ll give you details there. And then you mentioned other vendors, I guess based on the conversation so far, like how does medallion compare?
Kirby Cole (55:47) You guys are the furthest along and I have only seen a very tiny demo of the other one that was recommended by our… private equity sponsor. So they’ve got other groups like, yeah, I think you guys have forefront is forefront with you guys. Yeah. So there’s one other group that they suggested from one of their other PE groups. And there’s actually one that Casey worked with a while ago that we’re going to look at. But I don’t think from what I can tell so far… I think that the automation and time saving is probably bigger here, which seems like a bigger deal to the team, but is definitely something I don’t think qgenda… can do for us today. Like at all, I think visibility, it sounds like it’s going to be like it feels like you guys are doing the things that the others will do plus a bit more, which is really, you know, what we need to get to. Yeah, yeah.
Philip Stefani (56:46) Makes perfect sense and happy to kind of do specific comparisons kind of as we get deeper in this. Yeah. So I know we’re coming up on the end of time here. Yeah, week of the thirteenth. I think Noah and I are going to be traveling the beginning of that week.
Philip Stefani (57:00) It sounds like Andrea will be coming back as well, but yeah, maybe second half of that week, the group demo would make sense there. I can send some specific times and we can calendar from there.
Kirby Cole (57:10) That works. If you send me times and I will, I’ll get it. I’ll look at everybody’s calendars and we’ll get it set.
Philip Stefani (57:16) Okay, perfect. Appreciate.
Kirby Cole (57:18) You.
Philip Stefani (57:19) anything else that you guys wanted to cover? I do.
Caseybennington (57:21) Have just one more question I thought of while we’re talking about that. So speaking of Andrea, she is my counterpart for the oph side of the business while we do work together and we’re a team. We do things completely differently. She needs a lot more things. So the way we’re split up in qgenda today is we both use qgenda, but we have different organizations under that. So it’s opt and oph, is that something medallion offers as well? Yeah.
Noah Laack-Veeder (57:46) Absolutely. We’ll be able to split it up yep good.
Caseybennington (57:49) Just want to make sure you know, Andrea has room for all her oph nonsense, yes.
Noah Laack-Veeder (57:55) 100 percent that’s the thing like we’re kind of built where whatever kind of like the way that your organization works like we’ll be able to accommodate. And so, yeah, I don’t have any worries there. Yeah.
Kirby Cole (58:06) Casey, one of the things that, you know, and I asked this the first time I’ve met with these guys is that custom fields are absolutely part of what we can build in here. So, you know, if we need to do division custom field, I don’t even remember there was something we talked about that I’d asked about. So there is the ability to customize it a little bit. We talked about. It had to do with reporting stuff. So, there’s an ability to do a little more than to match us than what qgenda does. I don’t want to go crazy, and change the entire configuration because then it gets hard to continue to use it, but we can add some stuff to help us, okay, for sure. It’s.
Noah Laack-Veeder (58:42) a really important question you asked and so, yeah, like the answer is yes, okay, perfect.
Philip Stefani (58:48) We’ll really appreciate the time. Casey. Great, to meet you and Kirby. Good to see you again. I will send some email follow up with some times for the week of the, and we’ll look to connect as a group for the demo. Cool.
Kirby Cole (59:00) Thanks guys. Thank you.
Noah Laack-Veeder (59:01) Have a good day.