Transcript
Philip Stefani (00:00) hey, morning, Andrea. You’re on mute by the way, if you are talking, good morning. Here we go. How are you?
Andrea (00:10) I’m good. How are you doing?
Philip Stefani (00:12) Well, do you go by Andrea or Andrea?
Andrea (00:14) I mean, I do like to sound fancy, but it’s just Andrea.
Philip Stefani (00:17) Andrea. Okay. Sounds good. I have an aunt. She was like abroad for a little while and she came back and she was like, I’m Andrea now.
Andrea (00:27) Oh, yeah. I do get called that a lot or people even make it even fancier. But yeah, nope. I’m just straight up. Andrea. Actually, my younger years, I went by Andy because I had, oh, yeah, I had Andrea, there was four Andreas in my grade, oh, and we were a very small elementary school, so they’re like we need someone to go by something else. My mom’s.
Philip Stefani (00:46) like call her back, you volunteered?
Andrea (00:48) Yeah.
Philip Stefani (00:50) Yeah, that’s funny.
Noah Laack-Veeder (00:52) Hey, how’s it going? I walked into some elementary school talk. What did I miss?
Andrea (00:56) Yeah. I was talking about names. He asked how to pronounce my name. I said it’s just standard Andrea.
Noah Laack-Veeder (01:01) Okay. Cool. And you said there was a couple Andreas in your class?
Andrea (01:07) Yeah. And I went to a very small I’m from a very small town. So, it was like literally a one hallway elementary school and there was multiple Andreas because I guess that was 83 was a very popular year for Andrea. I guess.
Noah Laack-Veeder (01:20) So,
Andrea (01:20) my mom was like just call her Andy to make it easy. So that was what I went by for a long time in my life until I got older and I’m like my name’s really Andrea… you’re.
Noah Laack-Veeder (01:31) like, look at your birth certificate, you’re at the DMV, you’re like, what is this? Who am I? Yeah.
Philip Stefani (01:37) Oh, that’s funny. What was the small town that you grew up in?
Andrea (01:41) It’s called Marne Michigan. If you look it up, it’s literally we’re known for, we have the Berlin raceway that’s like the only thing that we’re known for, but, and then I moved to an even smaller town that was only 20 minutes north of there called conklin, Michigan. You blink and you’re already through it, but we’re known for the smallest st paddy’s day parade. It literally is two seconds and it’s out of a, you know, a Irish bar that’s.
Noah Laack-Veeder (02:09) really funny. It’s very.
Andrea (02:10) Small.
Philip Stefani (02:10) Nice.
Noah Laack-Veeder (02:11) Yeah. Is there any, is there a stoplight in town or is it like one of those?
Andrea (02:15) Not a single stoplight. Nope. I mean, we literally it’s I’m from the country as, you can’t see it, but I’m straight up country. We drive our golf cart to the bars.
Noah Laack-Veeder (02:24) Oh, that’s cool.
Andrea (02:25) I love that. That’s.
Philip Stefani (02:26) convenient.
Andrea (02:27) Yeah, yeah. Easy.
Philip Stefani (02:28) Access.
Andrea (02:29) yeah. No more stoplights. Nothing.
Philip Stefani (02:32) Very cool. Are you? So, are you still in Michigan?
Andrea (02:35) Yep. I’m still in Michigan.
Philip Stefani (02:37) Nice. Where, where in Michigan?
Andrea (02:39) Conklin?
Philip Stefani (02:41) Oh, you’re there now? Perfect?
Andrea (02:42) Yeah, I’m there now. I grew up in Marne, and then we built a house in conklin. So, one small town to another. So I’m close to grand rapids. I’m about 30 minutes Ish from grand rapids. I’m north of there. I’m closer to the lakes.
Philip Stefani (02:56) Okay, cool. I’m on the other side of the lake in Chicago right now.
Andrea (03:00) Oh, yeah. Nice.
Philip Stefani (03:02) Michigan’s beautiful, love going there in the summer.
Andrea (03:05) Yeah. As I say, in the summer… it’s really nice in the summertime.
Philip Stefani (03:11) Yeah, it’s the place to be all right. Well, it looks like we’re still waiting for Kirby. We can give him another minute and then get started, and then we’ll do some intros from all the folks on the medallion team.
Andrea (03:24) Sounds good.
Philip Stefani (03:26) And then, do you know, is there going to be anybody else joining from?
Andrea (03:29) The eyecare partners, I don’t believe. So it’s possible. I don’t know if I don’t think I saw who was on the invite. I have access to that. Okay? I don’t know, I think I saw that there’s another one maybe at two o’clock maybe that’s separate people. I’m not sure.
Philip Stefani (03:48) Yeah, it sounds like you’re on the ophthalmology credentialing team? And then I think there’s optometry as well, which we’ll do later today.
Philip Stefani (04:05) Cool. Well, maybe let’s get started and if Kirby joins, we can catch him up. But, yeah, purpose of this call really? So we’ve been chatting with Kirby a little bit, just around like potential efficiencies for credentialing provider, onboarding, just getting providers, seeing patients sooner. And he was like, yeah, you guys should talk to my credentialing team, and see how they’re doing it. So, yeah, for this call, just kind of want to understand current process. And then I think share our perspective on maybe where we might be able to help if there are any places you’re getting slowed down, but kind of, yeah, open ended agenda in that way, but curious if there’s anything in particular, that you wanted to cover.
Andrea (04:50) I mean, honestly, I think we’re just trying to see, okay, right now, we’re in, if you’ve ever heard of qgenda, that is the platform that we currently use. We went, I’ve been in a few now. To be honest, we did credential my doc, I didn’t love it, but that was many years ago before they like suited up and made it the sweat interfaces with a lot of things. But we got out of that before that happened. And then we went to symplr, and symplr, we used them for more of a enrollment management system, however that was a huge fail. We lose visibility like there was just so many pieces you’re essentially depending on somebody else to do their job for you to do your own. And it just, it caused too many barriers, too many gaps, all those things. So we pulled from there and we are now in qgenda. We’re freshly. I don’t want to say freshly, but it’ll be a year in August that we’ve been in there. It does do what we need it to do.
Andrea (05:47) However, I do think there’s a lot more capabilities. We just haven’t had the time to really dive into them. But basically, we’re just, we use it for, you know, the platform really just to keep us organized, you know, we’re running off of workflows. So like everything we do, we built out a workflow for everything we do. There are some barriers. Obviously, you know, I think that you’re going to find that with any credentialing software… and it just depends on, you know, what software is, where it’s geared towards, right? So like that one is more provider facing, but we do bigger things than providers as well. Like we do also facility enrollment and that’s not really designed for that. Everything is provider and location based. I come from where everything used to be tin based, you know, it was tin and provider. I think that’s probably one of my biggest struggles is still today that I’m like I don’t care if he goes to 17 locations. I just want to see it at the corporate level of a tin, you know, like I want to see all providers that are underneath that tax id number. I don’t care if he goes everywhere else, but that’s how qgenda is driven is location based. So that is definitely a barrier.
Philip Stefani (06:57) Okay. Yeah, that’s super helpful so we can dive into all of those pieces. And yeah, I think for today just super curious for your perspective on kind of where the opportunities are. But yeah, real quick, just by way of introduction. I’m on the sales team at medallion. I’ve been here about three and a half years at this point. So we support clients across licensing, credentialing, paying enrollment, privileging, kind of all of those pieces from point of hire through to billing for services, seeing patients. I work pretty closely with garrison and Noah on the sales team here. I’ll pass to garrison for an intro and then we’ll go to Noah.
Garrison Goodman (07:33) Yes, nice to meet you. I look after the sales team as Philip said, I’m based out of New Jersey. I’ve been with the company about six months or so but I have loads of experience joining companies at our stage and growing to later and also support some of our largest fastest growing customers. So I also have to be rude and jump off at the half hour. But I wanted to meet you as we had a great conversation with Kirby yesterday and place the name.
Andrea (07:59) Awesome. And.
Noah Laack-Veeder (08:00) then I’ll introduce myself. I’m Noah lead solution consultant, fun fact about me. I know you said you live in the country.
Noah Laack-Veeder (08:07) So, my mom lives in a town. I think it’s 100 people. It’s called dickeyville Wisconsin. So, yeah, it’s like the kind of town where like my uncle lives across the street, he’s got his big pool in the backyard and like everybody just comes to his house, which is really funny. So when you’re talking about that, you’re kind of giving me memories. But really today, you know, just like kind of what Phil said, I’m more of the technical person so I can kind of answer more of the technology questions that we do. And ultimately, what I’m trying to figure out is, you know, where are some areas that you think aren’t going? The best areas that are going well, just so I can try to help figure out if, you know, where we think medallion can help the most. So it’s great to meet you.
Andrea (08:46) Yeah. So do, you know, I guess right off the gates right now we interface with caqh and I believe this is probably how you guys do as well. We can extract data from there, but we can’t feed into there. Is that how you guys are as well? Oh, interesting.
Noah Laack-Veeder (09:01) We can actually feed back into it. Can you just tell me, is it, tell me like, so when I talk to organizations like the ingestion part is like, you know, usually what that helps with is just getting provider information upfront. So we’re just managing that gaps or having providers review the information versus from starting from scratch. But then when it comes down to applying via caqh or making sure that caqh is updated, that’s more of a manual task. Is that how that’s showing up?
Andrea (09:29) For you today? Yeah, that’s exactly it. So, yep. So we do everything on our side of things as we are the providers, we have special documentation on file that says, yes, you can act on their behalf. So basically their caqhs are created before they come to me, but then obviously, I have to go in and I have to add in all of the eyecare partner, you know, significant stuff to their accounts and whatnot. And then what happens is after that happens, then I go back into qgenda and I can run an import. Now. You just can’t do it, vice versa. Like I can’t have everything in qgenda and expect it to go to caqh. And I think that’s probably the caqh doesn’t allow that we can extract it, but we can’t like I said, add stuff, you know, imported, I guess from there, yeah.
Noah Laack-Veeder (10:11) And I mean, so when I talked to, let me actually share my screen and kind of talk about this because me.
Noah Laack-Veeder (10:21) I’m creating a lot of suspense here. Is it raining where you are? Did you, are you getting it right now? Yeah?
Andrea (10:27) Hopefully I’m leaving here. I’m actually on pto today. I’m heading out soon to catch a flight to Florida for spring break with my kids and family. So, you’re.
Noah Laack-Veeder (10:36) like I want to get out of here. Well, first of all, try to wrap up quickly then. Yeah.
Andrea (10:42) No worries. Yeah.
Noah Laack-Veeder (10:44) No, seriously. Thank you so much. Is it a vacation or is it a trip with kids?
Andrea (10:49) Well, my kids are like 15 and well, almost 15 and 16 years old. So I still put the bill. Let’s just say that, yeah.
Noah Laack-Veeder (10:58) That’s good. Yeah, I just, I have a seventh month old and we went to, we went on a vacation and I just learned that vacations are a little different now. So.
Andrea (11:07) Vacation after a vacation?
Noah Laack-Veeder (11:09) Exactly. Yeah. Haven’t didn’t do that, but I think we’re going to schedule that next time, or just ask Graham and grandpa to.
Andrea (11:17) Say, yeah, get an adult vacation after that, you deserve it. Yeah.
Noah Laack-Veeder (11:20) Yeah. Stop at the conklin bar. Yeah.
Andrea (11:24) There you.
Noah Laack-Veeder (11:24) Go. You won’t be disappointed. Do you have a stoplight? Do you have a grocery store? Do you have a bar? Sounds like, the bar, is the part of the?
Andrea (11:33) Town, the bar is, there is a tiny little grocery store, but it’s a hispanic grocery store that’s connected to it. Okay? So it’s very limited in what you can get.
Noah Laack-Veeder (11:42) Yeah. Okay. Yeah. I mean, anyways, we’ll we can talk about that all day. Yeah. So sounded like, so this is just generally, if I was going to make payer enrollment extremely simple. These are kind of the steps that customers or, of ours are typically doing. They’re hiring someone, they’re collecting data, they’re doing some provider outreach. They’re preparing applications, they’re submitting it. They’re following up payers tracking status, doing some caqh management. Like the piece, you just said whether it’s quarterly attestations or updating the information as part of the enrollment process, and then also preparing reports. So, I mean, I like to start in two ways but you already kind of said it like I just like to understand like other areas that you’re like man, this is a big effort for me today. And if I could wave my magic wand, if this could be easier, I would love that. It sounded like caqh management could be a piece where, if that was automated that could help you out. Are there?
Andrea (12:41) Yeah, if it’s possible, I swear that they had said that caqh has some sort of barrier in there that doesn’t allow you to import from other places, but I could be wrong. I don’t know if that’s because it has to be essentially, it’s supposed to be the real doctor that does it. You know, maybe that’s why I don’t know, but right now we do, like I said, we can import it from caqh into qgenda. So like that, anything I add for ecp, it’s going to be put back in there.
Noah Laack-Veeder (13:06) Yeah. So we’re uniquely, we’re and again, there’s so many credentialing vendors out there. So you’re like, okay, what do you guys do versus what qgenda does? One of our biggest differentiators if you leave this conversation is that we are what’s called a participating organization with caqh which means that we can import data without username and password.
Noah Laack-Veeder (13:27) It also means we can update caqh so we can do both. Yeah. And then, so let’s so I was actually talking to an organization the other day where like quarterly attestations are coming up. I don’t know the, how many providers you’re responsible for, but they had 700 providers where they had to do quarterly attestations for, and they’re like, yeah.
Andrea (13:51) About right. So.
Noah Laack-Veeder (13:52) It’s around that kind of volume for you as well.
Andrea (13:55) Yeah. We’ve got about 700 that we handle everything from start to finish on providers. Okay? And then we manage about 18 tax id numbers. So then we’re doing everything at a group level as well.
Andrea (14:06) Okay. Now, the majority I’d say 60 percent of that 700 are MDS or dos. So we also do all of their facility privileging.
Noah Laack-Veeder (14:16) Oh, okay. Yeah.
Andrea (14:18) And that’s a big piece of it too, which is a whole lot of work. That one gets even more dicey because a lot of places have moved to specific portals. So it’s not like it’s just an application. You have to use their significant portal. So like maybe you guys could, but qgenda couldn’t even help us because it has to be done through, you know, like paralon or Symplr or one of those things. So that’s another big piece of what we handle.
Noah Laack-Veeder (14:39) Yeah. And so, yeah, we can kind of go through that as well. Do you, so in your, in terms of the overall process that you’re following? Do you do like? So if I was going to simplify this even further, is it like someone’s hired? So the internal credentialing like the facility, no?
Andrea (15:02) So, actually, so what happens is we have our onboarding team, right? So they work with our recruiters. We hire a doctor, the doctor works with that onboarding team to collect every single document licensure, whatever we need to be able to do our job. Once that is done, they pass the doctor’s file to us. Then we immediately go out and we update things like their Ina. We go to availity and add them to the groups. We’re going to their mpps and updating their information. There… all that stuff in the caqh that’s the next step. And then from there, we would begin submitting medicare and medicaid. Then after that, we do all of the commercial payers, and then within our policy and procedures, within five days of receiving that file, all hospital applications are initiated. And then within 10 days, they’re supposed to be submitted. And then, you know, the tracking and the following up with payers continues on. And we do those bi weekly on everybody.
Noah Laack-Veeder (15:59) Got it. And… you said that you do the medicare and medicaid first in the commercial, is there, is that done in sequence more from like a just bandwidth?
Andrea (16:13) So, no, medicare is a lot of the commercial payers are dependent upon medicare. So we want to get medicare out the door as soon as possible. Yep, medicare and medicaid are the two biggest payers too that we have. So once those are out the door, then we look forward to everybody else because a lot of times, if I submit somebody, they’re like, well, we don’t have a medicare number. Well, we want to make sure that they do. So. Yep, those are the first two things we do always.
Noah Laack-Veeder (16:36) That makes sense. And so like kind of zooming out on this sounds like ceqh management is a big effort here. Typical organizations I talk to like following up with the payers is a big thing effort as well. Like, is that consistent with you all as?
Andrea (16:54) Well, I mean, if that could be automated, that would be amazing, like if it was built in like a workflow, if you could see who we initiated the request with or whatever. And then it would continually follow up. That is what we spend a lot of time, like we have follow up Fridays.
Noah Laack-Veeder (17:06) And.
Andrea (17:07) then we have every Friday where it’s like high priority providers that we spend a lot of time just going back to the workflows, picking up where you left off of. Hey, just wanted to check on the update on, you know, dr X, does he have an effective date yet? I mean, I also wanted to be clear too like you guys probably know this but credentialing and enrollment are often confused with one another. We don’t really do a ton of credentialing. We do provider enrollment. The credentialing aspect right now, what we do is automated through qgenda. So there are, they are running some primary source verifications for us and licensures, board certifications, that kind of stuff. But outside of that, we really don’t do credentialing, we’re the ones that are submitting the stuff to the mso offices for them to do the cred. Yeah.
Noah Laack-Veeder (17:52) Yes, that makes complete sense. But the payor enrollment is the piece that you’re having to do. Yeah. Okay.
Andrea (17:59) Yeah.
Philip Stefani (18:00) And so real quick just to confirm from another side, are you, you’re not delegated with any payors, then we?
Andrea (18:08) Are not delegated. No, we do have a piece of the opt side is delegated just a small piece, but no, we’re not part of delegation. Okay. And we also, I don’t know if it’s another thing to add to it is we actually manage all of the license renewals for the payors. Oh sure.
Noah Laack-Veeder (18:27) Okay. So.
Andrea (18:28) We track those when we renew and we disperse.
Noah Laack-Veeder (18:33) I don’t know why this is happening. Give me one second.
Noah Laack-Veeder (18:40) That is a really important thing to call out. So we spend.
Andrea (18:44) a lot of time doing that, but, you know, that’s getting, we have to have their individual logins. And depending on the states and depending on the specialty, they’re all different. And then, you know, you have to account for their ces, and just there’s a lot of moving pieces to that. Yeah, our opt side does not do that. Obviously, they don’t do any hospital privileging, and they don’t do any license renewals at all. They’re more roster based. So, one of the things they’re doing is they have some medical, but typically, it’s all vision and it’s here’s, a roster. Here you go. And they’re done. We’re way more convoluted. It’s just a different beast.
Noah Laack-Veeder (19:20) Yeah, no, for sure. So then kind of when I think about the, I mean the volume that you’re working with 700 providers across 18 tax ids and then how many… payers obviously medicare and medicaid, but actually.
Andrea (19:37) Sorry, I said that we’re in 18 states. We have over 30 tax ids. My bad, I’m so used to saying that spiel.
Noah Laack-Veeder (19:45) Yeah, no, it’s all good. So then I mean, like in terms of the volume you’ve got existing providers and you’ve got either like churn providers that are coming, you’re replacing or you have new providers, and those are the ones that need the new enrollments like maybe like every month, like how many enrollments are you all having to do?
Andrea (20:07) Right now is our super busy season because we’re getting ecp has a lot of fellowship programs. So we’re getting all of this year’s fellows, and we have a good residency program. So we’re also have a ton of residents coming in. So right now, I think just between the residents and the fellows, I want to say there’s like 17 of those alone and then add in all the new grads period, you know, they’re not going into those things that are graduating in may. So right now we have, I would guess over 20 new providers that were in flight. And mind you we’re also maintaining all the other ones and doing all their hospital privileging and whatnot. So definitely super busy. Yeah.
Noah Laack-Veeder (20:45) I bet, how many payers do you have to enroll each of these providers with? Yeah.
Andrea (20:54) Nope. It’s way more than that. I wish, I would guess honestly because we’re vision and we’re medical, so.
Noah Laack-Veeder (21:01) I.
Andrea (21:02) would guess on average, it’s 40 payers. At least now, Michigan is a little bit more convoluted because we use a lot of the ipas or acos. I think there’s like 48 of them available to us. We don’t use those 48, but we do use. One of the big ones is Trinity health. So everything is processed through them, but we still manage it. So it’s like, yes, you’re going to do this and you’re going to send out the rosters to these payers, we send you the application. But at the end of the day, the follow up is us still, and there’s some payers that they can’t directly do that to. So there’s like, I want to say five of them that we still have to do everything from beginning to end. And there’s some hospital organ like the acos that we use as well. Yeah.
Noah Laack-Veeder (21:46) Busy season. It sounds like it’s really busy. You’ve got let’s see 20 times 40 that’s 800 applications a month and you’ve got well.
Andrea (21:58) 20 is about like right now. So that’s this time of year. I wouldn’t say it’s per month. I mean, it could waver, sometimes you might only get five new oph providers, you know, but right now, it’s super busy.
Noah Laack-Veeder (22:10) Yeah. How’s the team handling that? I mean, like, is it like is because with the follow up, the caqh management, the renewals, like I’d just love to hear like, how is that going? Yeah?
Andrea (22:25) I mean, right now, I’m managing the team and we have it broken down by tax id and by state. So these people have built a rapport, they know their doctors, they know their staff, we’ve built out expirable reports inside of qgenda, and then those workflows. They also have a due date on them. So like we always do it ahead, you know, like 10 days before it’s due for whatever step you’re on. And then we get an email that says, hey, you have a workflow that needs your attention. So it’s keeping them organized and you can see that stuff. But no, there’s obviously, like I said, some gaps, you know, with like better reporting, you know, if we could interface one of the things we were sold on when we went with qgenda, we were actually promised a lot of things during the sales part of it and it comes out that it never really was actually available. Like one of the things they said, you can find like an application, you know, like let’s just say it’s blue cross blue shield of Michigan. We can put it in there and it’ll automate it for you. That has never happened. We brought it up and they’re like, yeah, you can’t do that. I’m like, well, that’s cool because that was one of the biggest things.
Noah Laack-Veeder (23:27) that we wanted. So then what do you have to do? Then? Like you have to, we do it all.
Andrea (23:30) Manually, every application we do is manually. So we go to whatever if it’s availity or the website. We’re the ones keying in those applications and then we add them into qgenda as like a snippet or whatever to say, okay, submitted, you know, application here’s. The person it went to, emailed. So, and so everything like that. So it’s a good organizational tool. But if you’re talking about time management, it didn’t really help us in that aspect of what we wanted it to because that’s where we spend, you know, the majority of our time is, you know, some of those applications are like 10 pages long that’s a long time. Yeah, you talk.
Noah Laack-Veeder (24:07) About blue cross, blue shield and automation there. I mean that, yeah, that with all this work on your plate, they’re kind of like, you know, usually I talk to operations like yours like things are going well. It’s really resource dependent like we’re really busy during busy season and like when it’s going well, kind of just in terms of what kind of this looks like is timeframes around like, I mean, it depends on the payer obviously for medicare and medicaid, you know, it’s 60 days Ish, for commercial or managed medicaid or medicare. It’s around like 90 to 120 days to get these things from start to finish. Is that consistent with what you all are seeing or like what’s the kind?
Andrea (24:52) Of, so we kind of… we manipulate medicare a little bit like if we have a provider that’s not going to start within 60 days from when we get that file, it’s outside of that 60 day window, we make it.
Andrea (25:05) So it’s in that 60 day window so that we can get that approved faster and move on. But typical payers vision is super fast. Like vision is literally, hey, I have a provider that wants to be added and some days it’s like two days from now like it’s been completed. It’s the medical ones that are taking forever. Like the humana of things. It’s forever. So, I would say 90 to 120 days, full life cycle.
Noah Laack-Veeder (25:27) Got it. Yeah, and full life cycle after you submit the application?
Andrea (25:31) Yep. Exactly. Yeah. But we should, I mean the application process is it’s as tedious as it is. It’s simple, you get it out the door. It’s the follow ups and ensuring that it’s done, which I get, they go through their credit process over there, but it’s just and, you know, there’s no speeding that process up that it is what it is, you know, and we’re in the mercy of the payer’s hands. So, yeah.
Noah Laack-Veeder (25:51) I mean, really, I mean, like you kind of said, it’s like the only way you can speed it up is like you just have enough capacity to continue to badger the payers like send them emails, call them and it’s like, yeah.
Andrea (26:02) When you have so much.
Noah Laack-Veeder (26:03) Work on your plate already. It’s kind of hard to get all that done. So, I kind of like let’s just imagine because I just want to just think about this, right? Because like it’s busy season. There’s so many things like the caqh management piece is a heavy effort, like the sounds like the even tracking status that’s done manually today because.
Andrea (26:28) there’s no, no. So, I mean the status is there’s reports like when we flip them, when we get like an approval, we go into that workflow and mark it complete. We put a participating date and a, you know, rider numbers or whatever, and then got it. It’s like a medicare. Okay. Well, now, in five years from now, you’re going to have to revalidate. So we mark that, you know, let’s get on that 90 days before that five year period to make sure that we’re revalidating the individual providers’ profiles as well. Same with medicaid. We don’t track the other ones because typically they’re reliant upon caqh. So our caqh should always be updated because we’re testing those, you know, every 122, if it’s Illinois, 180 days.
Noah Laack-Veeder (27:05) Instantly.
Andrea (27:06) That’s also an expirable report that shows up every week. Hey, you got people that are due. So we’re going in and we’re manually doing that just, you know, going in and testing it. So.
Noah Laack-Veeder (27:19) Well, so a couple of things, I mean, I really appreciate you telling me all about this. Like if you don’t mind, I’d love to just show you a couple of ways we automate that in the platform just to kind of see because it sounds like things in qgenda are working. But kind of some of these things that we’ve thought about that we’re going to reduce some of the time. It just didn’t seem to happen or materialize. So like if you were to kind of consider a different option, you just want them to honor those promises. Like do they actually do the application? Yeah, do they actually do that work? Are we, is that kind of how you’re thinking about it?
Andrea (27:56) Yeah. I mean, honestly, like I said, I think just, you know, I’m always open to obviously a better efficient process that anybody should be. But like I said, it does work for what we need. And I think it does have a lot more capabilities. We just honestly don’t have the time to fully dive in because, you know, we went through that implementation process and in two phases, but you can’t put things on pause, right? We have to continue with their day to day. So it was like, okay, you know, I’ve spent numerous hours but there’s still so many things. And I think like I said, with any program, there’s a wish list right there’s. Just some things that they’re like, yeah, your wish list is irrelevant. We’ll get to it when we get to it. And it’s been like a year. They don’t understand like how detrimental it is to us, you know, like to have those things. Like I said, you know, tin driven. I think that’s probably one of my biggest struggles because, you know, if I want to run a report that’s going to pick up every provider that their stuff’s going to expire. You know, I want to do it by tax id number. I don’t want to see if they had a license in Virginia seven years ago. I don’t care, you know, I want to know what’s current now and what tax id they’re attached to.
Garrison Goodman (29:04) Before I jump off, you mentioned, hey, that’s one of your wish list items if you had to say like three to five other items that were on your wish list, what might that be?
Andrea (29:15) Oh, boy, we have a whole running tally and it’s funny it’s on this box. I can’t even think of them because we’ve gone like we have these meetings with them and I’m like where are we at with this? Where are we at with this? But that would be one of them. And then obviously, like I said, interfacing, do… you guys interface with national practitioner database? Do you guys run those? Yeah. So we do that, but they’ve never gotten back to us with a price. So right now, we’re not running those which I think is wild because I came from a place that we did them every year and we were doing a continuous query but I was asc based. So that was part of our bylaws where they’re like we’re not asc based now. Well, it doesn’t matter if you have anything hit on your national practitioner database. We need to be reporting that out. Yeah.
Noah Laack-Veeder (30:01) No, 100 percent. Yeah. So have you had any instances where those things have gotten?
Andrea (30:11) Missed. We have. So yep, when that happens, it’s not ideal but I still have my login from when I did the asc. So I go in and I run my own and I’m like, yep, you’re right? And then we go back and we fix what’s in caqh, you know, like the question number nine and then we have to provide, you know, a summary of what happened and start over. So.
Noah Laack-Veeder (30:32) Yeah. Well, I mean, so there’s a lot of, I think there’s from what you said, there’s a couple of wishlist things that I like definitely just want to show you here to hopefully get you a little bit more excited to have more conversations. And, hey, Kirby, welcome to the conversation. How are you doing? Awesome, perfect timing. So I just want to show you this. So, you know, you mentioned that qgenda can’t push things back to caqh. I actually want to show you what this looks like in medallion. So if you need to update caqh, like all of these steps that you’re probably having to do manually, we use what’s called RPA technology to enter all the update information into caqh automatically. So the impact here is that let’s say you have to make like 700 updates. We can do all of them in parallel and you don’t have to worry about it. Ultimately, what you tell us is like, look, the data is accurate. Now, let’s update caqh so medallion can actually update caqh because we are that participating organization. So if that’s an area where you’re like, hey, this is taking a lot of our time to make these updates. It’s something that we can focus time on. Other things. We can take over this piece. No.
Andrea (31:45) I mean, honestly, like we’re in caqh, but we’re it’s not a huge piece of it like we literally go in right at, I told you in the front end and I’m just saying, hey, dr X is now going to be attached to my tax id. I fill out the three pages, make sure their licenses are up to date and I attest it. It’s really not terrible. But what we’re doing right now is, you know, the provider gets a login to qgenda, we’re launching it and we’re having them go in and put everything in there. Well, nine times out of 10. They are hardly ever in caqh. They’re always used to somebody else managing it. So the information they’re putting in qgenda is current today’s, stuff, but they’ve never told anybody else that it’s changed. So if you go into caqh, they might have moved 17 years ago or vice versa. So, what happens, is we go in and we’re doing our best to mirror what’s in qgenda. And then we go back and we hit import well anytime that there’s a discrepancy if something was missed or just whatever if it was added in caqh, but not in qgenda, it erases the data inside of qgenda, which is a problem. If somebody’s not paying attention, you’re supposed to say, no, I don’t want to override this. That’s more of a, you know, user error kind of thing, but I don’t want room for user error, right? Like I want it to be, this is right?
Noah Laack-Veeder (32:59) Yes. And let me show you that. So you do, I’m going to just pull up an example here so you can see this just a high level. We do have the control to not just overwrite things and your workflow around. Let’s make sure that providers don’t go to caqh because caqh is really clunky and not a provider’s best friend. So typically, how our organizations use it is they’ll update the information within medallion and then we’ll push all the information back to caqh. And then if there’s quarterly attestations that are necessary as well, then we’ll manage those on a quarterly basis. But ultimately we’re removing the need for both you and the physicians to interact with caqh. We’ll just take all of that burden on VR automations. So with that being said, I mean, like if we were able to get those things updated, like what would the impact be for your team or for those providers?
Andrea (33:56) Honestly, the providers, they wouldn’t care because they don’t see it. We’re the ones that are fixing it all. But for us, I mean it would be nice. Do I think it’s like my gosh this is night and day difference, no, but I do think, you know, if we can save time, places obviously want to do that. So we’re more efficient.
Noah Laack-Veeder (34:14) Yeah. Okay. I just want to, I want to show you something else too. And Kirby kind of what we were talking about earlier is just, I can kind of get you up to speed just so you can see… where we started here. But we were going through the typical payer enrollment process at a high level and just identifying areas where we think we can make some improvements from just big time commitments and areas where, you know, as you said, Andrea, like qgenda said, this could be automated, but it’s not. And the three pieces that I highlighted was that medallion can automate the following up with payers, we can automate the caqh management. And we can also automate the license renewals. And it sounds like Andrea, if we were able to automate, that would free up a lot of time.
Noah Laack-Veeder (35:04) And the other piece too with the follow ups if we could automate that, you know, if you’re not constantly badgering payers, like they have no kind of excuse to move quickly. We do actually see that our timelines can go faster. So, I know you said that your commercial timelines are anywhere between 90 and 120 days on average with medallion, we see that our turnaround times again across medicare medicaid and commercial is around like 55, 60 days. So, because we are having these automations happen, making sure things aren’t slipping through the cracks like, we can materially… speed up those timelines. I just.
Andrea (35:45) I’m a little curious on that though like just to be honest, yeah, I’ve never seen any commercial pair that’s really that fast. Typically, the life cycle is more than that. So, I mean, I would just love to see like examples if you have that just because that has never been my experience. And, you know, like we get it as fast as we can. But medicare, obviously, that’s usually within a couple of weeks, you know, I get that medicaid same thing. But the other ones those ones are, I’ve never seen it be that and sometimes it’s even outside of that where they’re like, no, they’re still in the credentialing process. So just like I said, I would love to see more on that because it makes me like, well, what are we missing here? If you guys can do it that fast? What’s going on? Because we’re doing everything we’re supposed to be doing. And I just, yeah, yeah.
Noah Laack-Veeder (36:29) And totally hear you like it’s not a matter of like it’s really a matter of like sequence of events, right? So if I have to follow up payers, in your case, you have like the busy season, we’ve got 800 applications that we have to follow up on. There’s just a limit to how much follow up that we can do. And so by us using I’m sure you’ve heard of like all the new AI technologies coming out, we can actually, we do virtual AI phone calls to the different payers and we can execute those all in parallel. So you don’t have to wait on hold for two hours at the payer. We just have our organization waiting on hold. And so not only are we able to do that, but if status changes, we’ll update the platform. So what that will do is it just saves a lot of that back and forth. And yeah, like that claim is bold, especially if you’re used to seeing 120 days. Like I totally understand what you’re saying. We can work with the analytics team to kind of give you more real answers in terms of your specific payers. But in general, we’ve done over 200,000 enrollment applications over the last year.
Noah Laack-Veeder (37:36) And so those averages from that volume, we kind of get those economies of scale and those commercial payers because we’re submitting so many, sometimes let us do unique submission methods like via roster or others. That just I.
Andrea (37:51) was going to say, is that why because you guys are essentially like acting as a delegated even though we’re not delegated, is that we have those agreements?
Noah Laack-Veeder (37:58) That’s a fair.
Andrea (37:58) Way to think about it. We haven’t added a stocker to this roster. Yeah, it’s fair like you behave like an ipa or aco essentially then, yeah.
Noah Laack-Veeder (38:06) And it’s like we are. And I just say though, like a lot of those ipa organizations like they’re they don’t have a technology foundation. So us having the technology that automates all of these things is where medallion is uniquely positioned to deliver those turnaround times. Yeah.
Andrea (38:25) So, I just now, how do you handle the ones that are like we have some key accounts that are very specific about, you have to submit it through their file bound system. And like I only worry about these kind of things, like it sounds great. But I do worry about because we built rapport with our direct reps and we’re in constant contact with them. I worry that would be fizzled away and we rely on those for like claim denials and things of that nature. And if they’re not hearing from us, they’re hearing from an automated person or whatever it is. I feel like you lose that relationship. Yeah.
Philip Stefani (38:58) I can jump in here totally like, yeah, the relationship part is obviously a huge element of like the process you’ve built out and we definitely would not want to touch anything to do with that more. So like the automated phone piece that Noah is talking about. That’s more just for like the initial applications that are being sent out, like anything related to your claims, or like your relationship with the payer, like we’re absolutely still leaving that for you to manage. And like just during the implementation process, like we actually would just align with you on like what your preferred process is for specific payers, because oftentimes it could be that like we talk with an organization and they say, hey, we’re seeing, you know, a ton of success with humana when we do it this way. And then it’s like, all right, cool. If you’re seeing really good timelines with that, like we obviously don’t want to touch that like it’s the problem payers like, hey, where’s the low hanging fruit in terms of like the biggest delays that we’re seeing? And like, where can we apply technology to those payer processes to improve those turnaround times that really are like the long tail of the average, if that makes sense?
Andrea (40:00) Yeah, no, it does. And that’s why I said like I just was curious how that all worked because we unfortunately also have a lot of since we are vision and medical a lot of the time, our vision carriers will administer the medical as well. So like it’s weird if you look at our stuff, it’ll say ambetter which is a centene product, but it’s done. You have to send your application to involve. So there’s a lot of if it’s this, then this happens. You know what I mean? We have a lot of through this payer. So it’s not like for imed, is another one, you know, for our Aetna enrollment for our ods and some of our MDS depending on the contract. Their Aetna enrollment is done through, imed holds that contract through Aetna. There’s no direct, but it’s all different depending on how those contracts are set up as well.
Noah Laack-Veeder (40:47) Yeah. So.
Philip Stefani (40:48) Summarizing that, it kind of sounds like there’s specific processes in place like specific to the ipas that you were working with that are like, you know, you’d have to essentially preserve those in order to continue enrolling on those plans. It sounds like.
Andrea (41:01) Yeah. And like I said, we have some key accounts. They’re very specific. We have monthly meetings with them. They’re a little bit harder to handle you’d. Think that it would be easier, but they’re not, they like it how they like it and we don’t waver from that. But I mean, it sounds great. Like I said, I’d love to see like a demo. I know, like I said, one of the things too like, do you guys have anything to do with availability at all? Do you interface with them at all? Because that’s probably one of the biggest pieces is the attestations that we have to do for them.
Noah Laack-Veeder (41:31) Yeah, we can chat through that in more detail. But I mean, we definitely work with customers with availability dependencies. And I think through the demo, we can kind of talk about the pieces that are totally within medallion’s realm. And as Phil said, what are the things that would still remain? Because look, there are so many things that need to get done. Medallion’s approach is let’s automate the pieces that are like the repeatable things that are more or less automatable, where your team can then focus on everything else that’s still on your plate. Like there’s always going to be a ton of work. But removing the follow up, the initial follow up to caqh management. Some of those license renewals usually frees up enough time where we can actually get a lot of the work that we want to get done is kind of how we think about it.
Andrea (42:14) The other piece, oh.
Noah Laack-Veeder (42:17) Go ahead Andrea.
Andrea (42:17) I was going to say, do you guys run primary source verifications behind the scenes? Like are you checking on any of those like oigs, you know, license verifications? Any hits on that stuff? Like to keep us in compliance?
Noah Laack-Veeder (42:29) Yeah, it sounded like, yeah, so we do. And it sounded like that’s not being run today.
Andrea (42:35) They are so like anytime there’s like a PSV is always on and everything that’s uploaded for a license board, certifications, that stuff. There are some states. I don’t know why, but qgenda can’t go out and verify the license. So we have to manually do those which is just going out to the site and bringing those down. But they said it’s because of the state doesn’t allow that I don’t know, but it, it’s not a big deal where I’m I came from a background that everything was manual. Is it ideal? Absolutely not, but, you know, when there’s something that doesn’t work, we just figure out a way.
Noah Laack-Veeder (43:09) Yeah. And so with the license pieces absolutely, and like a lot of organizations like this is like a risk mitigation piece, like if these things are just not consistently done or we have to worry about it, it’s like another thing we have to make sure we get done on a timely basis. We automate those and have we’re up? We’re we’re doing them up to like the ncqa standard of how often you should be reviewing these things. Ultimately, the impact there is that one your team doesn’t have to like look for these hits. We’ll just notify you as they go. But then from like an economic perspective, if any sanctions or things are going to happen because we didn’t catch that we prevent those claims and aisles upfront.
Andrea (43:47) Yep. That’s perfect. And then that’s what kind of we do right now? Like a little red flag will pop up and be like, hey, this has a hit on this, you know? But the national practitioner is the big thing. And like I said, qgenda offers, it just needs to be revisited again. And unfortunately, I think there’s more layers to that. Just we’ve had a lot of leadership changes, you know? So it was managed by one person that are working with them. Let’s get a contract and then they leave and then so on and so forth. So I just think it’s probably we need to put that back at the top. So I do think that that’s probably the most from my perspective, the most important piece of it because we want to be ahead of it not, you know, reactive of something like what do you mean? They’ve got to get on this. How did I not know?
Noah Laack-Veeder (44:25) Exactly. Yeah, I’m totally aligned with you. Yeah. So I know we only have about a minute left, you know, Kirby anything from your end questions, thoughts and where we go next, no.
Kirby Cole (44:38) This is the smart people call. So that’s why Andrea is here and I knew I could be a little late. So, I know we’re talking to Casey later today, kind of similar call. And then from there we’ll meet up the team. And then like we do, I mean we’ll do a legitimate demo with the two of them. And then also Pam who I mentioned will be kind of the downstream, one of our downstream teammates that’ll be important in this. So I really think that’s kind of it. And then I think kind of parallel… to that Noah. I know that you were probably we’re going to look at oph and opt’s workflows and then see how we can’t make it the same. I think that’ll be really valuable for the conversation too because I know that is as a new leader that knows nothing about credentialing having two processes and using multiple tools and not using the system of record is going to be tough for me to learn. And so that is a big goal for this is to kill the spreadsheets and the smart sheets and all the other things and really focus on the tool at hand. I agree.
Andrea (45:40) But I will tell you like, I know you obviously know this but opt and oph are vastly different like I told them that, you know, they don’t do any license renewals, they don’t do any hospital privileging anything of that nature. So our workflows are never going to be like 100 percent mirrored. But from a basis standpoint, absolutely, we should be having everything done the same. And right now we are not, my team is like I hammer it like we need to be utilizing qgenda to its fullest we pay for it for one. But that’s what keeps you organized and that’s what provides visibility to the leaders that need to see what the heck is going on. And Casey will be the first to admit she does not like qgenda, but Casey is very Smartsheet driven like she wants everything to be smartsheets. And she’ll tell you that she lives off of those, every new provider they get. They’re literally building out a Smartsheet and doing it in qgenda. So total duplicative efforts. My team absolutely does not do that. We don’t have the time for it for one, but I also don’t see the gain in that. I think she’s doing it because she wants to us to be like not using these software, so we will see. But I agree with Kirby that the end goal is let’s make sure we’re the best most efficient process across the board that provides the best visibility to everybody. Yeah.
Philip Stefani (46:58) 100 percent real quick just on the software piece. Andrea, I know you mentioned like doing license renewals as well doing privileging as well. Are those workflows also in qgenda?
Andrea (47:10) They are, yep. So they’re built out. We have a step by step process of, hey, number one, we’re going to initiate the pre app request. Okay, you got to mark when you did it, who you did it with, upload. The things next is you complete the application process itself. You put uploads in their notes, whatever you need to do, and then it’s follow up. And then it’s continued, you know, like reaching out to the mso office, making sure that they got their badges, all those things they’re all steps created in our workflows. And then when we get a welcome letter that’s our final step, we go in and mark it as, hey, they’re active. Now, their privileging is good through, you know, three years, and then we have it automated to ding us 90 days from that renewal date to let us know that their reappointment is approaching so we can be proactive and reach out to that mso office and say, hey, dr X is coming up for reappointment, please launch their application and we try to be ahead of it, yeah.
Philip Stefani (48:01) No, it makes perfect sense. Excellent. Well, Andrea really appreciate the time. I know we went two minutes over, don’t want to keep you from your trip to Florida. Hope you have a great time.
Andrea (48:11) Kirby.
Philip Stefani (48:11) we will see you later today for the call with the optometry team. And, yeah, well, after we do both of these, we’ll have the opportunity to kind of put together a demo and a solution and we’ll reconvene as a group and kind of go over that awesome.
Andrea (48:26) Well, thank you for your time, everybody. It was nice to meet you all I.
Kirby Cole (48:29) Am working on some of our same data. Still, I’ve got somebody looking into that, the very last part of that file. So I just had to go to a different source. So I’m hopeful I’ll have that file today.
Philip Stefani (48:40) Okay, perfect. Appreciate it. Thank you.
Kirby Cole (48:43) Thanks guys.