Transcript
Samantha Bouchard (00:00) what do you say?
Samantha Bouchard (01:09) Yay. This day feels long?
Jake Shubert (01:15) Yeah, I agree. Agreed. Yeah.
Samantha Bouchard (01:21) How’d your cookies come out? Nicole? Great.
Nicole Campbell (01:23) I am after this call, gonna make some frosting. We’re trying to like get our shit together to drive up to Seattle this afternoon. So.
Jake Shubert (01:32) What are the cookies for?
Nicole Campbell (01:33) Well, I mean, it’s just like, so we’re going to stay at Seth’s sister’s place. We’re running a race tomorrow, and then like I forgot, it was also Easter and then I was like, well, I guess I should bring some I’m making, I made carrot cake cookies. So it’s like a carrot, really good carrot cake cookie. And then I’m gonna like pipe on some cream cheese frosting on top and it’s like as big as like crumble cookies, very crumble cookie Esque. Actually, I’ll have to take a picture.
Samantha Bouchard (01:58) Sounds so good.
Jake Shubert (01:59) Have you made these before?
Nicole Campbell (02:01) It’s a newer recipe. I’ve made like versions of a carrot cake cupcake carrot cake cookie before, but this one like just a new one that I found.
Jake Shubert (02:10) Nice. Are you a baker I?
Nicole Campbell (02:12) Bake and cook very frequently? Oh.
Jake Shubert (02:15) Hell, yeah, I know that.
Nicole Campbell (02:16) I bake all the time. Yeah. If we had like an office, I would bring stuff in, yeah.
Samantha Bouchard (02:21) Are you doing a five K? Tomorrow? A 10 K? What are you?
Nicole Campbell (02:24) Doing? I was supposed to do, I think we’re doing a 10 miler 10.
Samantha Bouchard (02:28) Miler, it.
Nicole Campbell (02:31) Depends on what the vibe is. Like. We’re like to be fair. I like three weeks ago, like right around no, a month ago, three weeks. I don’t know what time is anymore. I didn’t even, I don’t think I told the team this, but Jake, there was like a moment where I stopped being able to like use my hip like I was in so much pain, like I was like sitting on heating pads like.
Jake Shubert (02:50) I couldn’t get out.
Nicole Campbell (02:51) Of bed, it felt like my back was about to like crack in half. It was like I felt so unstable. So I couldn’t run for a couple weeks. So, I’m hoping we maybe as a group decide to just do a 10 K because I’m like I’ve only been re, running again for the last two weeks. So.
Samantha Bouchard (03:05) Yeah, a 10 miler and a 10 K are two different races.
Jake Shubert (03:09) Yeah.
Nicole Campbell (03:09) Well, yeah, it’s just four more Miles. It’s not like, it’s not huge.
Samantha Bouchard (03:13) I mean, I don’t know.
Nicole Campbell (03:16) I mean, I can do it if we’re like all like we’re doing the 10 miler, like I will do it, but I’m sure I won’t be as like I won’t enjoy it as much as I’d like.
Jake Shubert (03:26) No. Did you figure out what was wrong with your hip though?
Nicole Campbell (03:29) No, like it’s so weird. I didn’t know if it was like what is it called? Like sciatica or like something with a pinched nerve? I was like doing all these like it would look so inappropriate to show you like weird exercises, trying to like release my back. Yeah, like that’s what I think it is like I must have like it literally was like I picked up buddy, my other dog and then it was like three weeks of not being able to like use or be in so much pain. Like there were weeks I was rolling my office chair into the living room because like sitting on the couch is too uncomfortable.
Nicole Campbell (03:59) Like I was in so much pain that’s awful. It was so weird. And now it’s like fine. So it must have just been like a pinched nerve.
Jake Shubert (04:09) Also, I’m just emailing them.
Nicole Campbell (04:10) Real quick. Yeah, fun things when you like literally turn 35 in February and then immediately broken.
Samantha Bouchard (04:19) I hear you on that stuff. Yeah, mine all started with my second pregnancy, but I.
Nicole Campbell (04:25) was going to say I can’t.
Jake Shubert (04:26) imagine they just emailed that they’re joining in one minute. So, okay, I will not send this email. Great.
Samantha Bouchard (04:34) Yeah, I feel like, you know, what I do Nicole though you should look it up.
Samantha Bouchard (04:36) You cut a yoga block in half and make like little like ramps almost, oh, yeah. And you shove it under your right hip and it just kind of re centers you do it like for like five minutes in the morning and at night you should try that. It really helps. It’s weird.
Nicole Campbell (04:53) That sounds so nice. Yeah, I’ve seen some of my friends just being like by like third trimester the pain in the hips and like the compressed nerves are just like out of control. Yeah, I remember not. She was also 44 and pregnant, so like different time, but like, yeah, her last pregnancy, she went to her, like she gave birth two years ago, but the last appointment she had the doctor was like what’s your pain? And she was explaining all this and he just said to her verbatim well, you know, what will fix this giving birth? Yeah.
Samantha Bouchard (05:27) Oh, yeah. They don’t care at.
Nicole Campbell (05:29) That point, and to be fair, she was very like, she was literally like a week away from the C section, but it was like, I was just like, my God, I might have punched him if I.
Jake Shubert (05:36) Yeah, that’s been.
Nicole Campbell (05:37) Like, so, just a week of pain or like get this out of me?
Jake Shubert (05:41) Yeah, they.
Samantha Bouchard (05:43) don’t care. Yeah, no, they send that to you. They’re like how do you feel? And you complain? And they’re just like… yep, all normal. All normal. It’s the worst. You think they’re gonna be like you’re.
Nicole Campbell (05:55) like, so then, why did you ask like,
Jake Shubert (05:56) yeah, you?
Samantha Bouchard (05:58) Think that they’re gonna be like we can fix you or we can fix this and you’re like there’s nothing you can do?
Nicole Campbell (06:04) Yeah, like why give me hope by asking that question? That you’re gonna help me? Like, I’m… hoping we like this restaurant, I booked Jake.
Jake Shubert (06:14) Oh, in Seattle. Yeah.
Nicole Campbell (06:16) No, in for our team in Austin.
Jake Shubert (06:19) Oh, the one in Austin is laundrette is where we chose laundrette. Yeah, I’ve been there. You have. Yeah, I lived in Austin for like five years.
Nicole Campbell (06:28) I feel like I knew this. I’ve just fallen out of my brain. Sorry.
Jake Shubert (06:33) Laundrette is super good. Austin. I think outside of barbecue is a pretty overrated food city. Yeah. And laundrette’s one of the good spots. Also, matt’s coming in right now. So, I was excited for that to like be on the list. I also love trying new places, but I already knew that place was good.
Nicole Campbell (06:48) Okay. Cool. Well, at least we have that.
Jake Shubert (06:50) Yeah. Hey, matt, how’s it going? Hey?
Matthew D (06:52) Y’all, thanks for hanging. I just back to back Friday.
Nicole Campbell (06:57) It’s Friday. We’re all there with you?
Matthew D (07:00) Yeah, you too.
Jake Shubert (07:03) Were you on spring break? I forget.
Matthew D (07:05) We took my kids to northern California for like three days because their daycare follows the school system. And so they were on spring break, which is dumb, but we.
Samantha Bouchard (07:17) well, matt, my friends live in California and same thing like her daycare was closed the week before her big kids were then on spring break. So, her and her husband had to take off alternating weeks. I’m like people have no idea what this does to working parents, I,
Matthew D (07:36) know.
Samantha Bouchard (07:36) It’s awful. My daycare was just closed for two weeks because my provider went to Italy. So that was.
Matthew D (07:42) Fun. I,
Jake Shubert (07:43) mean, good for them, I guess. But, yeah.
Matthew D (07:46) Yeah. Money. Well spent on your side.
Jake Shubert (07:49) Yeah, yeah. Cool. That’s funny. Cool. Should we wait for Brent, should we jump into things? He’s gonna.
Matthew D (07:55) You and I were talking, we’re doing, I’m gonna audit with one of our financiers so he and I, that’s what we were kind of. I ran a bit over it before he’s chugging along with that. Still our finance team. So it’s just me.
Jake Shubert (08:05) Sweet. Well, we can go ahead. Excuse me. We go ahead and get started. Does our time to the hour mark work for you still?
Matthew D (08:11) Yeah, yeah, yeah. Okay.
Jake Shubert (08:12) Sweet. Well, let me share my screen then and we can jump into things. Okay. So agenda wise here’s what we were thinking. So last time when we chatted, I think it was about two weeks ago, we got to do some of the demo of our platform primarily focused just on the delegated credentialing piece and what that looks like. So we didn’t have time to show you the rest of what is relevant for soar. So that’s what we want to spend our time on today. We’ll just jump straight into that. So what we’re going to do is review provider onboarding, non delegated payment enrollments, reporting analytics, all that kind of stuff.
Jake Shubert (08:51) If there’s anything that we don’t cover or you want to cover that you feel is really relevant, definitely let us know. We want to make sure that we touch on that as well. And then we want to use the back half of the call to review some high level pricing estimates and then talk about what next steps might look like on your end for an evaluation? How we can best partner together? Hopefully moving forward so that’s our plan for the call. Does that sound good to you?
Matthew D (09:13) Yeah, cool. And I appreciate the time you guys have put into this. I know we’ve had a few discussions but I’m excited to get down to next steps on this too. Yeah.
Jake Shubert (09:21) 100 percent and just demo wise. Was there anything additional besides the non delegated enrollments reporting analytics provider, onboarding, anything else that would be relevant to cover today demo wise?
Matthew D (09:31) No, that sounds great. And.
Jake Shubert (09:33) On the delegation piece you guys already saw, did you feel like you had a good grasp on that or was there anything else on the delegated side we should review as well?
Matthew D (09:40) Just one question is, I know it’s like getting kind of like getting ourselves set up for success moving forward and by like kind of having like, you know, setting up our committee setting, like getting kind of ourselves like ready to kind of prove we have what the internal controls in place. You guys have a consult like my understanding is like that’s typically done like with a consultant. And then we got into the actual work of saying like cool, this has been set up. Now, we like let’s actually work with you guys to like set up. How do we kind of like execute on this for delegated credentialing? Do you guys have an internal consultant who does that sort of work or another branch or is that typically like we still work with an outside person to kind of get ourselves to that threshold point? And then we work with you from there on.
Jake Shubert (10:24) Yeah, Sam, you want to touch on that one first and I can add some context.
Samantha Bouchard (10:28) Yeah. So we would… be providing… everything that you need to get started on delegation. So you wouldn’t need to work with an outside consultant. In that case, I mean, as far as setting up the committee, we have some resources we can share. That just kind of help you kind of like set that up. And if you have specific questions, we can take those back to some of our in house experts. But essentially, you know, I think we reviewed on the last dac, and Jay can resend that is you all want to reach out to your payers, see if they’re ready for a delegation, get that information, and then we’ll work with you as like your sub delegate, and then you’ll actually be using like the policies and procedures that we would then kind of provide to you from our documentation to support that.
Jake Shubert (11:30) Okay. Cool. Yeah, that’s what I was going to say is that a lot of this is like part art, part science and we try to do both ends of it, right? Which is the actual work that’s on the platform to execute on delegation, but also providing policies and procedure templates, feedback on committee management structures, the ncqa accreditation by being a sub delegate, all that stuff we’re trying to take off of your plate as well. If you guys did make a decision as a business to use an outside consultant, we would work with them as well. Like you guys are definitely empowered to make that choice, but we try to make it that way you don’t have to do that if you don’t want to. And I would say the majority of our customers who do delegation do not also use an outside consultant. They just use mcdonald’s.
Matthew D (12:07) yeah, totally. I wasn’t sure if we had talked about that last time just from what I was reading online. I wasn’t sure the best way to go if that makes sense. Cool.
Jake Shubert (12:13) Yeah, that’s helpful. Last question here. Before we jump to the demo, you mentioned. And my guess is with spring break, it might’ve been difficult but you mentioned having some conversations internally and with your CEO about delegation and just also everything we’ve been discussing so far. We’re just curious. Were you able to have any of those chats internally or with the CEO themselves?
Matthew D (12:30) Yeah. He, I mean, we’re a bit like we’re sold on delegation. So that’s like that’s a good to go. And so now it’s more of like scope of work and like cost and everything is kind of where my mind goes to next.
Jake Shubert (12:41) Cool. And did you share any feedback with them like regarding medallion specifically?
Matthew D (12:45) Not yet. We’re going to he’s now out on spring break with his kids for this week. And so we’re going to connect when he’s back next week.
Jake Shubert (12:52) Cool. They’re going to Italy for two weeks, that kind of that kind of thing. Cool. Perfect. All right. So let’s jump into the demo. Then I think my goal will be like let’s say the last 20 25 minutes just to chat through pricing and next steps. I think that’ll give us enough time for the demo. But if we need to push a little bit over that, that’s cool too to spend more time there. But yeah, Sam, I’ll pass it over to you.
Samantha Bouchard (13:14) Yeah, yeah, matt. So you know, everything that you’ve shared with us. Like we understand you all are like a very like tech forward company. You’ve built out a lot of this automation for your payer enrollments today. I’ve done a lot of this in house. And so, you know, some of this might be completely on par with what you’re doing. So please, we’d love to hear like your feedback throughout. If anything stands out that may be, we’re doing differently than what you’re doing like we’re all ears, you know, we know you’re sold on the delegation piece and this, you know, the payer enrollment may or may not fit into your overall strategy but just kind of want to make sure you have a clear understanding of the platform overall and all of its capabilities.
Matthew D (13:59) Okay. And just real quick, just like just nomenclature wise when I think payer enrollment, I think payer contracting like we’re.
Jake Shubert (14:06) literally enrolling?
Matthew D (14:07) With a payer, right? That is not the case. This is, this is more just like saying like we are going to credential our providers as payer, not in a delegated fashion, more just like what we do, yes.
Jake Shubert (14:19) Exactly, right. So, maybe the better term just to use the same nomenclature might just be credentialing then, but yes, it’s the.
Matthew D (14:24) It’s fine. Yeah, I got you. Yeah.
Samantha Bouchard (14:26) Like a non delegated payer enrollment.
Matthew D (14:28) Yeah. So.
Samantha Bouchard (14:29) Last time we focused on this tab right here, matt, which is running the ncqa credential file and our automated kind of like committee flows to like support that and like the audit tracking and things like that. Yeah. So today we’re going to look at the provider on like our core platform as a whole, we’re going to look at payer enrollment. So attaching your providers to your contracts that already exist. And then we’ll look at analytics and report builder. Okay? So at its core, medallion is a provider data management platform. We’re going to store all of your group information, your practice information. And then we’ve set up like our data architecture so that all providers kind of roll up to those different practices or facilities in your case. And then those providers can roll up to different tins based on how that they’re enrolled. So really the thought behind this is, you know, we want to give you clear visibility into all of your provider data. And then we layer in the visibility of the delegated agreements as well as the non delegated payer enrollments and kind of surface that all nicely together in our analytics. So one component to this is obviously provider onboarding, right? We need to get clean complete data from a provider for all of these downstream functions to work effectively. And we have developed some integrations to make that happen really quickly and provide the provider with a really good overall experience. So we’ll kind of walk through just soar, is adding a new provider and what that looks like. So new provider comes on board. Your team would enter in a few key pieces of information, invite the provider to the platform. And from there, they would receive a customized welcome email. We can customize this with your current onboarding language. Make sure it really aligns with your overall messaging as a company. And they are able to click get started and come through our customized onboarding flow. So from here, we allow them to kickstart their profile through our proprietary bi directional integration with caqh. So I think we talked a little bit about this and obviously caqh is a well maintained data source. And what this allows us to do is really access that data source that’s attested to quarterly kind of pull in information that’s already been set up from the provider directly into the profile, taking a lot of that effort off their plate. So we’ll kind of look at what this looks like typically when you integrate with this. Yeah.
Matthew D (17:16) Go ahead. Can I ask you two questions on this?
Samantha Bouchard (17:18) Yeah.
Matthew D (17:20) So the first question I have is I brought this up the other day and I feel like I don’t mean to get stuck on it but… backing up a step as we’re thinking like a payer specific. So like we’ve had it in the past where like the rule frankly, the rules around like center level credentialing weren’t known and like, and when we took over RCM, I was like, I was like, I got it like I was like we need to understand this because if it’s truly center level required, we need to track this and the issue that like all the credentialing applications have room for multiple centers. And the team when they were before they joined us were confused. They’re like, well, you can only credential four centers for this one payer because we only have four locations. I’m like that is wrong. That is like when you think about going onto a like a portal and from your insurer, it’ll show you the locations where you have different like practices available. And typically we are not like you don’t choose your provider, you choose soar, and the location and your providers are assigned and we do that. And so it’s a bit different than like other people who are like signing up with your PCP for like a specific person. And so our model has kind of resulted in some confusion there. But then there are people like there are… like a few payers who say no, we require you to credential every payer with us at every center. And one of them was able to provide us this documentation in writing. One of them was just like, it’s not, but it’s a medicaid thing and it’s like it’s just like kind of known. And we’ve seen denials as a result of not doing that. And another one has said it’s needed it’s required. But like I was like, let’s just test it out and see if it is. And like we bill and we don’t get denials and for not doing it. And the rep was not able to actually point to a specific spot. And I feel like there’s a learned incompetence that payers do to make things more challenging. And so, when we talk to you guys about center level credentialing, how do you like validate if that’s needed to credential at every center? Or do you just say like how would you guys manage that for us through this delegated credentialing process? Does that make sense that question?
Samantha Bouchard (19:14) Yes. So typically, so we do have the ability, so like we would load all of your locations into the system. And we do have the ability for your team when they’re making a payor enrollment request to link all of the locations that you’re looking to have that provider credentialed at. If you’re saying you have specific pay provider payers that do not have that requirement, we would note that on your specific account. And so that would be something that we would take note of. But what we do find is that, you know, typically… payers do want those individual locations. And then we surface that directly in our enrollment tab. So you’ll see from a billing perspective, the payer as well as all of the locations that are then active under that enrollment. And that’s what a lot of our clients will integrate directly with their RCM so that they’re able to kind of like do the like release the claims like by a location basis. But again, all of that really is structured on like how your group contract is structured. So it sounds like you have some group contracts that wouldn’t necessarily be at the location level, yeah.
Matthew D (20:27) We have in writing 90 percent are not at the location level. And there’s like the few that they say they are, but only like of the three one we’re just saying we can’t risk not doing it. So we’ll do it. One gave us a clear document to like look into like the provider handbook. This is where it’s like noted on page 347 like section C. The other one said yes. And then we’re like cool where’s the documentation on this, they could not point us to a single place where that was. And so they’re like there’s almost this like discovery process and it sounds like you guys don’t do that. But like fully understanding like the payr specific dynamics that frankly like we, I’m still struggling to like, I think it’s a learning confidence where people are not being clear. We’re the opposite where it’s like we’re potentially using a group mpi, you can see kids at every center like that. And that’s what we’ve been told by payr explicitly is the case.
Jake Shubert (21:11) Yeah, there’s a couple additional pieces there. I’ll just add matt to your point because I think it is a learned incompetence. Just two pieces, one for the payers you guys already have that you’re working with upon onboarding with medallion, we take in all of the existing processes you guys have, and we flag that for our workflow. So if you guys say, hey, now, I’m sending these payers, you don’t need to do X y and Z, we’re going to follow the process.
Matthew D (21:36) Okay. So we still set the standard and you guys execute? Okay, cool. Okay, that was like the crux of my question. I’m just kind of, I was hoping you guys would figure that out for us but it’s fine. We’ll keep doing what we’re doing, but.
Jake Shubert (21:48) I was going to say there is a second piece there that I wanted to call out, which is that and Samuel chose a bit later in the demo. I’m sure. But we have a proprietary pay repository built out inside the platform that maps over 900 payers across the country in all 50 states. So, what we have is that we know the pre built rules and regulations and requirements across payers. So as you come to us and say, hey, we’re moving into Pennsylvania and we have these five payers working on contracts. With, what does this look like? We already have that pre baked in the platform. So we’ll be able to tell you and show you what we’re typically seeing. And then obviously, if you guys have a difference in what your contract looks like or what you’re hearing from the payer, we can note that for you, but we’re not just coming in blindly saying, hey, matt, just tell us what you do. We’re also going to say we’ve already worked with this payer before here’s, what we’re seeing this is what you’re seeing as well, right? So we do have a lot of that built in knowledge already in place because we’re doing this across so many enrollments. Okay?
Matthew D (22:43) Yeah, that makes sense. And yeah, that’s super helpful to hear that even that pressure testing just because we hear weird there’s this one payer in Pennsylvania that they don’t cover slpot. So we’re not credentialing with them, but they’ll pay for it and it’s going to be this uniform out of network benefit, but you still need to have in the actual claim you submit the billing process provider who’s credentialed. And so we’re using the bcba, they said like use your bcba. Whereas for blue cross blue shield, we don’t credential any providers, you credential the center. And so you use the center generic contact in our emr, sorry if I’m getting too in the weeds, you use that instead. And so we’re not credentialing any individuals. And so like I think just even pressure testing stuff like that with you guys, I’m like is this normal, like is this reference long like that’ll? Be helpful?
Jake Shubert (23:29) Yeah, 100 percent. Okay.
Samantha Bouchard (23:31) It’s so funny because I laugh not because I just laugh at like if we were to like design this system to be the most complicated thing known to man, like we still probably couldn’t design it to the level that it is today. It’s just so crazy. Matt, and all of this in your head. I’m like matt is, so.
Matthew D (23:46) You’ve.
Samantha Bouchard (23:47) I’m sure, just like your eyes have been open and over the years, right? To just like, I mean.
Matthew D (23:52) Over the it’s been about it’s. Been about seven months. So seven.
Samantha Bouchard (23:55) Months? Wow. You’re like an expert. I.
Matthew D (23:58) know. So anyway, yeah, this is great. Sorry to interject.
Samantha Bouchard (24:02) No, please interrupt at any time. Matt. It’s a great conversation. So, one thing that’s different about medallion with the caqh integration, other vendors in the space might have this, but typically they need username and password. We really streamline it by only needing the caqh id, which is much easier for providers to find. It doesn’t go down the whole like rabbit hole of like resetting passwords, things like that. And, and we have the ability to also push data into caqh with this integration, which we’re the only ones in this space that are able to do that. So.
Matthew D (24:35) We, you guys will allow like you guys can do the reattestation that’s typically needed when like when we do payr, okay, cool. Yep.
Jake Shubert (24:42) Yeah, we manage that completely.
Samantha Bouchard (24:44) Exactly. And so we can do the quarterly attestations, and then ideally, we want medallion’s profile to be your source of truth. So if you are changing an address for a provider, we’re then going to kind of push that information into caqh so that you are kind of just constantly maintaining the two systems. And a reason which I’m sure, matt, you’ve learned over your career over the course of seven months. If caqh doesn’t match the information on the application for certain payers, it will be like an instant denial if those two systems aren’t in parity and so that’s really the big play here for the caqh management is just making sure that anytime we’re submitting a payer application, all that information aligns so that we don’t get that instantaneous rejection.
Matthew D (25:29) And so in the instance where we have clinicians who are directors, and we have our psychologists who are even a step further or we have remote bcbas. So remote bcbas, we have very few of them, we believe in person is important. But when we have someone who’s been practicing for a while and bcbas are just like 950 in all of Arizona, it’s wild. And so we do have several remote ones and the remote ones then basically will jump around to the different centers where they need to take on a caseload so that we’re not spreading our bcbas at that center too thin if we’re backfilling someone who had to leave suddenly or something. And so basically, like when we think about for like the health first, Colorado was the one in Colorado where we have to like credential them at every kind of the address level mpi, using the address level mpi, we need to basically have the ability to have them like their address is all of them, like they might have an address where like we just tie them to our corporate address. But like ultimately, we credential them at every address. Directors might be a subset of centers. We have these like kind of like oversight over like one step below like clinical market president. They’re like partner clinicians, and they kind of oversee like a smaller subset of centers that are really deep in the sporting like bcba is there. And so we credential them at three centers. You have people who versus psychologists. We have a small psych team and they, we have our head psychologist who’s like licensed in like every state basically. And so we credential her in every state, at every, and like wherever needed at the center and the group level. So, like, how would we think about like managing that level of complexity of like addresses in this information?
Samantha Bouchard (27:14) Yeah, that’s a great question. So I’ll actually switch back to the provider data management platform to kind of show you how we store that. And then we’ll look at the payer enrollment piece and kind of how this all comes together. Just kind of wrapping up here. This is the provider profile. So providers actually do have access if any tasks or information are needed. We’re going to automatically surface that to them to kind of close out any enrollment. So they have their own visibility. And then you as an administrator have visibility to any tasks that are assigned to them. And ultimately, with this integration, we have the ability to like, we make it super simple to upload a photo with a QR Code. So if we need their diploma, for example, they can take a picture of this, take a picture of their diploma on the back of the wall it’s going to attach. And we can kind of pull that data through OCR technology into the profile. So with the caqh integration, other ways you know, through like this QR Code with we’ve made it super simple for providers to get us the data that we need. And ultimately we see this provider profile getting complete and on average two days. So sometimes we hear two weeks plus to kind of collect all this and we’ve really streamlined that and provided an overall improved experience for providers. So thinking about matt, just the provider onboarding experience. I know you all have built out a lot of this yourself, but just curious how this kind of maps to your experience today?
Matthew D (28:45) Yeah, no, I mean we’re basically like we’ve replicated this system in more of a form based approach, but we have this and it like ties to our people teams processes for onboarding your clinicians, which is great or like promotions for people who are becoming a bcba after they complete their licensure or whatnot, and graduate school requirements. The question I do have in here for you then is related to two things. One, you guys don’t have a partnership with central reach, the emr for Aba like it’s preeminent, it’s like the og, but like a lot of people use it, including us emr for Aba therapy.
Jake Shubert (29:20) And by partnership I’m ensuring basically.
Matthew D (29:23) We can create, we can figure this out but like on our own but it’d be like those tasks you’re talking about. We do a lot of for like authorization management and re, auth et cetera. We have like a task based system that we kind of have built this like we have the transparency for where different kids, like different things are held up for different kids who are on more than one task et cetera. And so clinicians kind of like the way we communicate is via central reach tasks so that we’re not like just losing things in email and tasks related to this would be an interesting thing to integrate. This is like a minor point but like integrate into reach directly. We could always build that ourselves. But if you guys have it like that partnership, that would be kick ass.
Jake Shubert (30:01) Yeah. So what I would say is we do not have like a pre built partnership with them, but we do have a fully open API. So integration functionality wise. I think you guys should have a lot to play with there. So we have a lot of our customers for obvious reasons, integrate less with their ehr. So this isn’t anything new, but I would say there’s nothing pre built there, but I think a lot of tools for you to play with to make that work. Okay?
Matthew D (30:23) Very cool. And then the second question is on the onboarding… side of things. So like… let’s just say there’s something changes for like a clinician or we need like a new data point to be collected. I think what you guys have is pretty comprehensive but like it seems like every time we’re onboarding with payr, there’s like some new nuance, and in an existing region, it’s like tracking out 120 clinicians to get this stuff. How does this system kind of work with like existing clinicians? Not just the onboarding process to get a lot of this stuff done. Does that make sense? Yeah.
Samantha Bouchard (31:02) So as far as like licenses expiring, we’re going to store all of that information or like their, you know, if they have, you know, any of their certifications. So one thing in the profile is we have a document section. Anything with a document that has a date attached to it is going to land here. And this is like an administrator view for you, matt and your team. So anything that has an expiration is going to be flagged here. Administrators are going to get a review of that as well as the providers will have a task and email reminder as well. And so that can all be kind of viewed and managed here. And then additionally, if there are like tasks that you would like to send out to providers specifically for even things maybe outside of credentialing, you all have the ability to create tasks and assign those to your providers as well. And.
Matthew D (31:57) How do you basically, like, is the way that you’d validate a task is complete? Is that like that info would be added to this system? And so that would be, like I guess it’s because what we have to do now is like, you know, Denver health medicaid, choice, and Denver health medicaid, which is like the only mco that I’m aware of in Colorado… basically allows like they required like this weird like this profile update for that’s what it was, our liability insurance was expired. We have to do it every year and we’ve never had to do anything with that in the past. But for some reason this year, they said every provider needs to provide their new one through and like update their profile with it. And so we had to basically like make, we had to send everyone that document with like the updated version, and then have everyone up like update their profile. And the way we track that it just like in a Google form saying like have you done this? Yes or no? And like that’s the only way and like with this system like kind of engage with that again, it’s like existing providers, existing insurers, but new requirements. Is that something that we managed through here? Or should we still have our own separate systems to do those sorts of one off needs?
Samantha Bouchard (33:01) No, you can definitely manage it directly through medallion. Like if you’re getting direct communication of like that Coi request, we can upload the cois like in bulk across the system. And then also like there could be like we could create a bulk task for all the providers. So then once that they do actually complete it, you’d be able to just kind of do a quick report from the system on that specific task and see, you know, like how many providers have completed it and then we do have.
Matthew D (33:29) And how would you see if they completed it? I guess that’s like my question.
Samantha Bouchard (33:32) Yeah. So in the tasks you’re going to have provider tasks, this is for anything that would be like open anything like an upcoming task if you want to pre schedule those. And then as they are completed, they would go into this particular bucket so that’s going to be like your whole provider network view. And then you could filter, you know, by provider by the task type specifically.
Matthew D (33:53) But I, is the provider literally engaging with this platform as like a new app they interface with or is it like there’s some way for you guys to like have integration with a payr? Or like how does this get triggered? That? Like it’s actually been completed? Is my question?
Samantha Bouchard (34:08) The provider, yeah, I’m sorry. Yeah, the provider would engage like directly with that provider portal view that we were using previously, right?
Matthew D (34:16) Right. Gotcha.
Jake Shubert (34:17) And I will say like the task can be delineated to whoever you want them to be sent to. So if that was work you wanted your admin team to handle on behalf of your providers, that could be done as well. But it would be folks doing the task inside of medallion where there are tasks that we’re doing for you guys through parts of a parent enrollment or whatever it might be. You would obviously be able to track along with that. But when we’re talking about tasking, we’re talking about setting tasks that are outside the bandwidth of what medallion would be covering for you, right? Yeah. And would,
Matthew D (34:45) that be a question that like when these kind of things do come up, I think that one is a pretty like clear like that would be something we manage but we could use the system to manage it. But if there’s other things that come up, would we like ask like if let’s just say for example, I can’t even think of a good example, but like would we work with you all to say, hey, what would be clearly managed as part of like something we use like an additional requirement in this system versus like a one off kind of like get this out to the task? Like how would we figure that out with you guys over time? Because I like this stuff keeps popping up and we’re doubling the size, doubling payers. Like I can imagine this will be a high work area. Yeah.
Jake Shubert (35:19) I mean for an organization like yourself, like you said, you’re moving into new geographies, working with new payers. Like there’s stuff that’s going to be that’s going to come up. You would have a dedicated engagement manager and account manager staff to your team. So they would be the point person running the day to day for soar. So as things are coming up as they’re moving to new places, it’d be those strategic conversations with that person who would be delineating what this would look like, how to best move forward, like how we can best assist you with those processes like that. You would have a point person you’re working with.
Matthew D (35:46) Gotcha. Okay. Yeah. And.
Samantha Bouchard (35:50) Then, and matt, their expertise too, just the engagement managers, like they come from payer, enrollment licensing, credentialing, like they’ve done it for 10 plus years. So they’re really that like operational expert that can support you with those, you know, they can meet with you weekly if something kind of comes up once a month, really whatever cadence makes the most sense. Cool.
Matthew D (36:13) I think my other question was answered within all that, too. So cool. That sounds good. Well.
Jake Shubert (36:17) Sam, I want to kind of catch the time here if we’re going to talk about pricing and next steps? So maybe we can skip to enrollment requests, and then maybe just briefly do a little bit of analytics and report building for matt.
Samantha Bouchard (36:28) Yeah, that sounds great. So once we collect all of the data have that validated profile, we’re off to the races where medallion really can start the execution. So we’re going to have multiple submission pathways matt, so direct portal submissions, payer specific portals, roster based API submissions where available. And we’re really going to use our automation across all of them. So we have, we store. So all of these different payer requirements that you’re talking about. This is a little bit of like a look behind the hood. But essentially for every single payer all 900 across the United States, we have individual payer process guides that really tell you like what the application method is, what the steps are, if there’s dependencies, exactly what required documents need to have, what those follow up instructions need to be. When can we follow up, right? So we have that documented. But where we take it a step further is through the whole overall orchestration behind the scenes. And so essentially, we look to soar to really own the strategy, right? You know, your providers where they need to be enrolled, medallion’s going to own that execution. And so your team would come in here, select the provider, select the group that you’re looking to enroll them with, select the state we’re going to pre populate where we have licenses available. Just so you don’t submit in a state that doesn’t exist. And then we’re going to populate your payer lists here under your specific tins. So it can be as simple as you want to enroll this provider in community health center tin. And you click this box and it’s going to highlight all of your providers that are all of your payers that are associated with oneclick. From here, there’s some lines of business that you can select practice locations if applicable, and a couple other selections. But essentially, once you hit submit, that’s really where soar’s work ends. And medallion is really going to take over. And so that payor requirement document that we looked at that’s really a combined requirement set. So as you know, we just talked about it, you submit for 15 payors, one payer might need an additional document. Another payer might need three additional things, right? All of those things, when you’re kind of doing it one by one, they really add up for a specific provider. We’re going to look across all of those payer guides and really surface any additional information that’s needed instantly after that request is placed. And then we’re going to follow their payer requirements to a T. So we’re going. To have our RPA technology for the portals. So I think you all have done some of this. I’ll just kind of show you a quick video where you are ahead of the game and have built some of this yourself. You’re probably familiar. But essentially, you know, we are pre populating these portal applications really quickly opposed to kind of manually entering the information. And then we’re going to give you visibility each step of the way. So when you partner with medallion, it’s not a black box. And then you’re like, okay, when are we going to get this back? Where is it? You’re going to have individual line status all the way through to completion. So once we submit to the payer, if we have the ability to do a portal scrape, we’re going to do that daily. So the second that par status is achieved, you all are being notified of it and you don’t have to wait or hold claims. We’ll also follow up via email, AI phone calling really doing everything we can to get that par status as soon as possible.
Matthew D (40:23) And so within that two questions, one is going to be, I’m just going to say it out loud. So I remember to come back to it is like medicaid kind of like state medicaid id stuff. And then it’s all come back to that. But the other, like the question on this, is like we have, and I’ve asked the team to do this, I haven’t pushed them hard enough. But as we’re kind of continuously building this stuff out where we’ve been better documenting it, which is like I need to know where you actually credential. So it’s just like it’s like payers like have it feels like there’s no, like it’s kind of whoever you get on a given day like one payer’s like, yeah, just send us like your roster and that’s all we need another pay. And then, and then other payers like, hey, just like we need these 10 page forms filled out for every person you’re like you’re starting with us for like a new payer, and you need to fill out a roster and you need to fill out these documents saying how you’ve completed this information for them by like checking boxes and stuff, and so, and some, and sometimes it’s just on the portal that we need to fill it out. So like when it comes down to the payer rules, it feels very like there is no rule, and it’s frankly just by who you get, like how do you guys manage that complexity or with every payer? Do you just have the agreement? Like we’re a medallion? We’re going to do this? We’re going to do it all through this online portal or is there’s also this PDF? Like you mentioned rosters and PDFS too. Like how do you know which one to use? Or is that on us to tell you?
Samantha Bouchard (41:39) Nope. So every single one of those guides is going to have the exact requirement of the payer. So we have a whole payer research team here that uses technology. We kind of like scrape out to all of these sites, see if there’s any changes on their process, making sure that we’re keeping these up to date. And then with the volume of submissions that we’re sending matt, if something changes, we’re going to be notified of that like instantaneously. So, yeah. So that is one big piece. I think that you all are updating and managing today. Like if that portal changes for something you’ve done RPA on, right? You guys are then now having to kind of do that reprogramming whereas with medallion that’s all going to be owned by us. So ultimately like reducing any, we’re going to reduce any manual data entry. If you have any of that. We’re going to eliminate any duplicate work. We’re going to automate those submission workflows, and really like accelerate the overall payer processing time through how quickly we collect the provider data, how quickly we’re able to then get through the requirements and to do the submission overall.
Matthew D (42:45) Okay. And then, on the access side, so like we have to, you know, for Arizona medicaid, we have to go through this. We get like an access id and pa, it’s the promise id. And so it’s basically like the way to, you know, medicaid, I’m preaching a choir, but it’s like medicaid down on basically like fraud. So you have to the state basically said this is actually, this is actually a provider that is okay to work with us. Then the mco is going to work. We can then like credential with the individual mcos. Do you guys do that with like, yeah, that process? We kind of have a, it was a beast but we kind of have like a, we have a very streamlined approach but that still takes like 60 to 90 days where it’s reliant that we have to do a lot of access follow up access. We have like people who kind of can that the state government level or whatever it is like push people along a bit more that we’d use sparingly but like that, like how do you guys engage with that kind of like that? Like it’s like not payor but it’s like state level requirements too. Yeah.
Samantha Bouchard (43:39) And like the dependency piece, yeah. So you’d be able to submit at that same time for that medicaid enrollment and the mcos. But what we’re going to do is the system’s really smart enough to know, that like promise id and that, you know, that medicaid enrollment needs to come first. So it’s going to actually the additional mco rows are going to be flagged as dependencies on that main row. So our team will go forward with processing, get that information for you. And then the second that we have that information, we’ll just instantaneously go into those next lines. Okay?
Matthew D (44:13) And there’s this thing with like access, just the Arizona examples continue with that where they, you either need to create new profiles or easy to create. But then you have to do mod requests where if like a different, so like a lot of time, what happens employers set up the access id for, individuals don’t even know their info. So they need to go back to their old employer, get that information. Do they get like, and then, and where they’re not. Yeah, old employers are not incentivized to give that information. And if, after a certain point, you need to escalate it, access will be like, okay, like have you communicated with your old employer? They’re not doing this. If, so submit this request, it’s an escalation. You can basically take ownership of your account that way. But like you need that people don’t have their passwords. And so the mod requests are a pain in the ass and like do that level of nuance. Is that also managed through here? Just I don’t get deep into the weeds, but like we’re gonna double our size in Arizona. Like this is a big area where that’s gonna take a lot of team time. Yeah.
Samantha Bouchard (45:04) So, in that case, we would likely do like a task out for like the password request. And so I think in that instance, we would still need on the soar team to kind of just like coordinate like that particular piece, until we are like unlocked with the password. So, you know, very like similar to, the same blockage that you all are having today. Okay?
Matthew D (45:27) Cool. Awesome.
Samantha Bouchard (45:29) Well, great questions, matt really appreciate, you know, just, the dialogue. It’s always much nicer to have more of a conversation when you’re doing a demo, but we’ll just kind of wrap up here with analytics. So this is real time data. It you can download. If you have a bi tool, you can download any of this information. These dashboards are customizable. But what we really like to focus on are two main areas which is volume and turnaround time, really allowing your business to see kind of what the volume looks like, where and requests are in the process when those enrollments are being completed so that you can instantaneously release those claims and make sure that patients are able to be seen and then address any bottlenecks overall as they’re kind of coming up and just better plan for provider placement patients being seen and that overall provider revenue. So we have these dashboards built. If there’s something that you’re looking for that’s like very specific. It’s something that, you know, you or your revenue cycle team would like. We can definitely build in a customized model here for you. And then we have report builder as well, which is really going to allow you to kind of come in, build custom reports instantly on an ad hoc basis and you can download and like send those on a reoccurring basis. So we really try to make it as simple as possible for you to have access to your data, but then also glean any insights from the data that are relevant to you. A.
Matthew D (47:03) Dumb question. But you guys are like open API. We, I can just pull this data out myself directly through, yeah, that’s correct? Yeah. And you guys have like you guys have like documentation on that. Yeah, I can share our API docs and it’s helpful. Cool. Yeah.
Samantha Bouchard (47:17) And then, I know we talked a little bit about the enrollments tab. So I’ll just kind of wrap up here. But this is that like tab that I mentioned that frequently are you’ll pull from an RCM perspective? So the second that par status comes in, you’ll kind of get that active status by practice location for all of your payers. And then this is also just, you know, a great source of truth from the billing perspective as well. So we just didn’t look here but just wanted to point that out and.
Matthew D (47:45) That line of business for you just to confirm like those are all like different tax ids or something or, like, what do you like? We have like SLP, OT, Aba psych, but we don’t like once you do the center of the payer on a contract, if those are covered like it’s done. So, like I just like would that be relevant for us?
Samantha Bouchard (48:05) Yeah, you would likely be just like under like the commercial like line it’s really just kind of covering like all of those particular like individual plans that are associated.
Matthew D (48:14) Okay, cool.
Samantha Bouchard (48:16) Awesome. Well, Jake, I know we only have 10 minutes left and the pricing conversation is also top of mind. So I’ll pass it over to you. Yeah.
Matthew D (48:26) I guess matt first before we come into that just sort of curious how you’ve seen delegation and also the demo today, cheers for like your big picture feedback on our platform. Yeah, I mean overall, I think it’s I’m thinking through like workflow changes and like the split of like what team still does versus what you do, how we kind of like manage the change as we grow quickly. So I want to like I need to, this is where I need to talk like work with our CEO more like the strategy on this. He is like, you know, small part of his time but he’s focused on this. And so I, this is where I’ll probably need like a bit of time over the next few weeks to engage with him on this before I come back with stuff. But this is exactly what I needed to like have that conversation and we can kind of map stuff out together on this because there’s a lot of different things in the business that like come up, oh, last question for you guys actually licensing. So the, what I’ve I built like a crappy, but like it works Ish version of this where because I needed this for the other night and cursor is great. I basically was able to pull some licenses from like the Arizona licensing board. There’s different websites for SLP, OT, Aba, and I was able to pull some licenses from that. And then from those licenses scrape the initial license like application date. And so what I’m wondering is do you guys for some of those other things like licenses, do you guys have the ability to pull from those sources for different states as well? Or would that be like a sort of thing where we need to like? Because a lot of the humans apparently like Arizona doesn’t send you like you don’t have it, they literally send you like a printout of your license. So people like typically don’t even know where their license is. And so that’s where like is like, do we have that ability in their platform to integrate with those sorts of like repositories?
Jake Shubert (50:06) Yeah, I can touch on that first and Sam will know if I missed anything. But, yeah, so that is part of our platform. We have real time checks to all the necessary data sources for state license boards, you know?
Matthew D (50:16) Npdb?
Jake Shubert (50:18) Oig, Sam, et cetera. But yeah, the license boards are certainly part of it. And if you guys did ever want to manage licensing on behalf of your providers, you don’t have to, but if you did, it’d be the same process inside of medallion where it’s like four clicks to request a new license for each state and then you’re good to go. We manage the rest of the work. Oh.
Matthew D (50:35) Great. Okay. Yeah, we have, our compliance team more takes licensing stuff. But like that’s where I’m going to give different connection points to the business and that’s great. Okay. Cool.
Jake Shubert (50:43) Yeah, sure thing. Okay. Well, we have about eight minutes left here and I’m not sure if that’s enough time to do like a comprehensive pricing conversation and chat about stuff I guess like, would you be open to meeting again for 30 minutes on Monday or Tuesday next week? And just going through the pricing stuff that we wanted to walk through today?
Matthew D (51:00) Mondays and toodles. Tuesdays toodles. Mondays and Tuesdays are brutal for me just to be totally honest and honestly, Wednesday and Thursday as well. I’m like back to back all day. Yeah. Could we do Friday again?
Jake Shubert (51:12) Yeah. Let’s do Friday again. I feel like we’ve got a sweet spot on Fridays now. Yeah. Okay. Let’s see Friday. Could we do don’t?
Matthew D (51:21) Even… I can flex most of the day. Okay?
Jake Shubert (51:26) Could we do maybe nine a M Pacific Time on Friday? So.
Matthew D (51:30) 10 a M mountain? Yes. Yeah. Let’s do it. Okay, cool.
Jake Shubert (51:34) I will send over the invite for that. That sounds great. Obviously, any other questions you have like tech platform wise? We can still cover on that call. But the goal for that call will be to share pricing for what it would look like an estimate for if we only did delegation with medallion and if we did delegation and non delegated enrollments and everything else with medallion to sort of show you what both ranges would look like and then again chat through next steps, evaluating criteria, stuff like that and do.
Matthew D (52:00) You guys have, I feel like this would be more like in the sow that we would obviously have to negotiate on. But like, do you guys have like kind of a starting point set of slas as well? Yeah.
Jake Shubert (52:11) I mean, that’s all in our like msa?
Matthew D (52:14) Oh, it’s in the msa. Okay. Does that help?
Jake Shubert (52:16) For me to share?
Matthew D (52:17) Yeah. I mean, frankly, if you could, that would like again, I just want to get like I want to, you guys spent a lot of time on this as have. I like, I want to get to the point where we have everything and then I can have like pause for a second, have these conversations because this is like a very strategic shift and it’s not going to be like we’re going to do this. It’s not, but it’s more like figuring out like how we make this work. And then totally before we get the process going and then we want to move quickly. So I think having that up front will be fantastic and really helpful. So.
Jake Shubert (52:44) I’ll share that. I’ll share the API docs and I also just want to say matt, like we understand that considering this is a big shift, there’s a lot of disruption. There’s a lot of like nuance to this. So as much as we can help whether you end up using medallion or not using medallion, like as much as we can help with those questions, the sort of you, do we do of what we take on of what you take on a crawl walk, run?
Jake Shubert (53:04) Whatever is most helpful for you guys to figure out? Like we want to make sure like we are consultative like pre sales here. So as much as we can help there that you’re willing to have us help with like we’re more than happy to meet you halfway.
Matthew D (53:15) Yeah, that’s fantastic. And I appreciate that. So, yeah, if you can send that over and then I will, you want to just like pause today and we’ll just cover pricing holistically next week.
Jake Shubert (53:22) Yeah, 100 percent. Let’s do that.
Matthew D (53:23) Okay, cool. That sounds great. I appreciate the walk through the time from everyone.
Jake Shubert (53:27) Yeah. 100 percent. Matt, this was awesome. Awesome invite for next week and then we’ll all meet up in Italy sometime next month.
Matthew D (53:35) There we go. We have a teammate named Italy too, and like I beat him and I just like, I just, oh my God, my mind is like mush. I was like, wait what?
Jake Shubert (53:45) We’ll talk with Italy on toodles.
Matthew D (53:47) Yeah, exactly. I guess a joke. All right.
Jake Shubert (53:50) All right. Thanks, matt.
Matthew D (53:52) Have a great weekend. Thank you, matt. You too. Thanks. Bye bye.