Transcript
Nneka-Shay Grant (00:00) hi, Carla. Good morning. How are you?
Carla (00:02) Hi. Good morning. How are you?
Nneka-Shay Grant (00:04) I’m doing pretty well myself… raining on. I know Erica just hopped on. I know we are waiting on two more people from sobe, is that correct?
Carla (00:13) I believe, so, let me just send them a message and make sure that they’re going to actually jump on.
Nneka-Shay Grant (00:18) Okay. Sounds good.
Carla (00:24) Hi, good to meet you, Carla. Nice to meet you.
Erica Lloyd (00:32) Are you in Florida? Yes. I was just down there on spring break with my kids down near.
Carla (00:39) Tampa. It was busy, huh? So.
Erica Lloyd (00:43) It wasn’t too bad because we stayed out of the normal touristy spots. We didn’t go to clearwater this year, so it wasn’t too bad, but the flights were pretty crowded.
Carla (00:53) Yeah, I can imagine… it gets busy down in Florida, especially spring break, yes.
Erica Lloyd (01:03) It was, but I’m so I’m in New Jersey. So it was nice to get out of the cold for a few days.
Carla (01:08) Well, that’s where my husband was raised.
Erica Lloyd (01:11) Oh, what part?
Carla (01:13) Bergenlein? Bergenlein?
Erica Lloyd (01:18) Is that in like Bergen county?
Carla (01:22) Not sure because I am not from there, but he always mentions bergenlein, like the, I guess the city?
Erica Lloyd (01:31) Oh, okay. I noticed that. Nice. I hope you make it back sometimes during the summer.
Nneka-Shay Grant (01:50) Okay. We can give them a few more minutes, Erica, or do you want me to go ahead and just hop into intros?
Carla (01:57) We can, we can start if you guys want, because I’m not sure. I’m the credentialing specialist. So I’m the one that handles this department. So, I’m not sure if they’re going to be jumping on. I just messaged them but I’m not sure. It doesn’t look, I think one is in a meeting and I’m not sure if the other person is going to jump on. So, okay.
Nneka-Shay Grant (02:15) No worries at all. Thank you, for you for making the time. We’re definitely excited for this conversation.
Nneka-Shay Grant (02:22) I was the one who reached out to sobe to set this up. So, I work on the partnership side here at medallion and I’ll pass over to Erica who works closely with Rehab and specialty groups on credentialing and enrollment and she’ll be able to walk you through what we’re seeing and we’d just love to hear more about where sobe’s at. So Erica, you can take away, yeah.
Erica Lloyd (02:43) Why don’t we start with the intro. So my name is Erica Lloyd. I’m enterprise account executive here at medallion. I’m based in New Jersey. So I actually just looked it up. So, I’m not far from Bergen line or Bergen line. I’m, in Caldwell New Jersey. So I’m a little bit west of there, and I’ve been here for a little over a year. Carla. Do you mind doing a quick intro? You said you’re a credentialing specialist?
Carla (03:07) Yes. Here at sobe Rehab, I’ve been with them full time since October of last year. Basically, they didn’t have any of the contracts, hmo, medicare advantage plans. So I’ve been able to get them a few contracts. And I’m in the process of getting like, you know, most of the therapist credentials under the group. It’s been a little by little process as I also do a little bit of the HR portion and compliance portion of things here. So, I’ve had, a big group. The thing is that most of them don’t have caqhs or don’t or, you know, have to explain to them what it is they have to create their account. So I can be able to proceed with their credentials, with the plans as, you know, most of the plans basically look at that, you know, they’re required that to be able, to proceed with the credentials right now, it’s more manual than anything. I… go by an excel sheet. I run reports quarterly just to see like who’s still with us? Who’s still not with us? We’re about 300 therapists between ptot and speech therapists. So it’s a lot of work. It’s busy.
Erica Lloyd (04:27) Thank thanks for sharing that. I think. Yeah, and really, Carla, just to back up, I think goal is really just to see if it makes sense to move forward with an evaluation of medallion. And so I can give you a high level overview and I can had a couple questions hopefully hoping you can fill in the gaps and decide if it makes sense to loop in some of the stakeholders from both of our sides, and proceed forward. Does that work for you Carla?
Carla (04:54) Yeah, that’s fine.
Erica Lloyd (04:56) Okay. So you said it’s a manual process. Are you, I list, are you utilizing any type of software today to help with credentialing? Not?
Carla (05:05) For credentialing, we have workbrite which is for the HR portion, which is where our therapists also upload all their documentations that, you know, I would, you know, obtain from their driver’s license, professional license everything there. So it’s an HR… approved platform. Just wondering how that can make sense with the credentialing platform where they could integrate or I’m… sure that workbrite is not going to be taken off right now unless we find a platform that is approved for both HR and credentialing.
Erica Lloyd (05:46) Yeah, I think it would just depend on what you’re you, what exactly you would need in it. So, medallion is credentialing software and services. So just kind of giving you overview. So we partner, with other, you know, PT, OT provider groups… provider data management platform. And so taking this kind of antiquated process with credentialing and getting providers billable faster is really the value proposition. And we’re using technology to automate around 90 percent of the manual work. And then we have hands on experts to oversee some of the quality aspects as well. There’s parts obviously that can’t be automated. And so we also do contractually commit to outcomes. So getting providers and network faster and kind of the value drivers that you would see is, you know, not having to expand your team. Karla, I don’t know. Do you, do you have a, is there a team doing credentialing right now? Do you fully own that just?
Carla (06:50) Myself? Okay. Wow.
Erica Lloyd (06:52) For 300 and I saw it looks like you’re hiring a lot from the website of PT and OT. Is that accurate?
Carla (06:59) Yes. Okay. Do.
Erica Lloyd (07:02) You have to individually credential each provider, each like PT and OT or do you credential at a facility level? No?
Carla (07:12) We credential individually because each of them need a ptan, a medicaid number, then they link to the group. And then I add them in the credentialing, like, you know, standard excels to add them to the group because our groups are already in network with several plans. So, but then that’s like 120 days before they complete. And I have to just be making sure that you know, everything is up to date. Their caqh is a test, their liability insurance is updated. All the information for sobe is in their caqh. So it’s like basically manual work individually.
Erica Lloyd (07:51) Yeah, that is a lot of manual work 120 days. Is, is a longer turnaround time? Is that, where are you seeing the biggest bottlenecks there? Is it like the provider onboarding piece or getting them through, the provider network? Is there a part that’s kind of that?
Carla (08:08) Is the protocol for all insurances? Most insurances are 120 business days to get them and network under the group? I don’t know if you guys have another way.
Erica Lloyd (08:21) Yeah. I mean, we don’t have the cheat code, but I will say we do have, we do have a significant amount of automation to remove a lot of the form filling. So kind of a lot of times just tracking down the information from the providers. Can we can see that take several weeks? So we’re able to automate quite a bit of that pair process guides. We do follow up with the payers when you’re calling the payers and following up on each application. We have a programmatic way to do that with agentic, AI, direct integrations with caqh which is not necessarily going to help on the providers that are on, the payer side, but I’ll help, with the provider onboarding, and then submission via rosters and with economies of scale. So there, are some ways to be able, to get that. Typically, we can get them in network… an average of 52 days across government and commercial payers. How.
Carla (09:17) many, how many days? I’m sorry, typically.
Erica Lloyd (09:19) An average around 52 days across government and commercial.
Carla (09:24) Okay. If… everything is clean and nothing has changed throughout that process, right? Well.
Erica Lloyd (09:33) Sorry, what do you mean by clean?
Carla (09:36) Like for example, I can go into the caqh today for the therapist, update everything. Sometimes they go in themselves because they work for other practices as well. And the other practices goes in changes something, then the credentialing department from that insurance company will tell you, hey, we don’t have, this then you have to go back in. So then they could proceed with the credentials. I mean, is that something that you guys are constantly like following up on or?
Erica Lloyd (10:09) The short answer would be yes… I wasn’t full. I would need to talk to one of my solutions consultants, but… there are some things we can follow up there’s. Some things that obviously have to be manual, and then some things that we can follow up on. Got it. Okay. Do you think there is Carla an appetite to you to use any type of software? You said you’re using work, right? Which is for HR? Is there, do you think there’s an appetite to use a credentialing software? It?
Carla (10:45) Would be ideal if it’s gonna help me in the ways that it needs to help me. And also… something that already like can be integrated with our HR platform. Like we can’t have our like, I mean, would the credentialing software be something that I would have to upload documents to there from the therapist? Or it’s something that they’re going to link it to the therapist, so the therapist can upload their stuff. Okay? So that’s the problem because we already have them doing that for work, right? We can’t have them do it for two platforms. They’ll quit on us. Definitely don’t quit on us. They’ll be like, this is too much, not worth it. You know, they’re independent contractors. So they’re not employees.
Erica Lloyd (11:31) Okay. They’re independent. Okay. So they would not need to upload into two platforms. So that’s one of the main value drivers is we do have a direct integration with different platforms and we could go down, you know, we can look more into the weeds there, but we have an open API. So we do directly integrate with different softwares. I can look and see if workbrite is one of those, but yeah, that’s so tracking down all of the information. Do your providers use caqh?
Carla (12:08) Not most of them, I’m going to be honest with you. There’s a lot of therapists that don’t even know what caqh is. So it’s like I have to give them the explanation. I have to give them the link. I have to tell them hey, you know, this is what this is for. You know, we’re getting new credentials with hmos and ppos and medicare advantage plans. So, you know, we would need this, so the plan can look at this to credential you. And then some of them answer, some of them do the portal and they do their credentials and they, you know, they fill out all their information in there and some don’t I have a lot of them pending and I just continue to send them like, you know, notifications of it that this is missing. And this is something that we just, we need to proceed with their credentials.
Erica Lloyd (12:56) Okay. Do they, sometimes you hear that results in like churn, like they, the providers just don’t… end up starting.
Carla (13:07) Starting to work with us?
Erica Lloyd (13:08) Yeah. We hear sometimes like the process can be so arduous that sometimes they just don’t end.
Carla (13:13) up receiving that’s. Why I’m saying that’s why it’s so important that we’re not bombarding them with so much with two different platforms because they’ll definitely if they complain now about, you know, their onboarding paperwork, imagine, you know, with two platforms, they’ll just be like this is not worth it.
Erica Lloyd (13:31) Yeah. So I hope that’s clear. So, that is, it would not be a situation where you would need to do two platforms. They kind of like want to let me just give you, let me show a slide here. Okay. Am I showing the right side? And again, also if it’s not, you know, if it’s not a fit or I think it’d probably be helpful also to.
Erica Lloyd (13:58) Understand like where you think there could be the largest areas of optimization in the process. So typically, what we see is again, you know, provider data management. So it could, we do integrate with different platforms really disrupting this process to leveraging automation and the outcome is going to, it’s going to accelerate growth and revenue, reduce operational costs. So not having to hire, you know, build out more credentialing staff and a big value driver is improving the provider productivity and satisfaction. So it’s single, you know, single source of truth, improving provider and patient satisfaction and really enabling them to spend more time with patients, less time filling out paperwork, following up with paperwork, having, you know, yourself having to do that. So these are some of the key value drivers. Curious if any of these are like the rally cry we’re talking to like Nadia… or dr sobe, like are any of these something that’s kind of top of mind that they’re talking about all the time? Yeah, definitely. Okay. What are the, which of these kind of, are most resonate most?
Carla (15:12) Well, to prevent write offs, for example, for the secondaries, and medicaid?
Erica Lloyd (15:17) Okay. Is that something that’s happening quite a bit? Yes?
Carla (15:23) Because not all of them are credentials with medicaid?
Erica Lloyd (15:28) Okay. I think I saw a note. Is Melissa in your HR department? Still there?
Carla (15:36) Yes. Okay. I think.
Erica Lloyd (15:39) She took a look at medine, like over a year ago, and it was an exploratory phase and I think at that point, there was a lot of medicaid and self pay and there was looking to expand the network. Is that still the case?
Carla (15:52) No. And at this point, it’s medicaid. Okay. We still have to credential them with medicare medicaid and other… plans like humana, blue… cross and blue shield aidna.
Carla (16:14) One dollar is still enough. Aren’t you?
Carla (16:32) Florida completed Florida community.
Carla (16:40) And that’s about it. Okay?
Erica Lloyd (16:48) And then, do you have to, when it’s taking 120 days since they’re independent contractors, if you hire them, do you have, do you wait to schedule them to see patients until they’re fully credentialed or are they starting to see patients? And then when they’re not fully credentialed and not able to backdate, and that’s.
Carla (17:07) that’s they’re starting to see patients and what we’re doing and what I changed in the workflow was for example, the medicare Melissa sends out like already to start every Friday with the therapists that are ready that they’re being scheduled already. Like, you know, they finished their onboarding, they finished their training, and they’re starting, they’re going to start seeing patients. And I just do their medicare applications like right away. Like I don’t wait on the medicare for too long because now medicare is like 30 days back. Only… then I’ll start the process of if they have all their paperwork like the caqh completed, then I can go ahead and start adding them to the groups to the group under the payers that I mentioned. And then that’s a standard excel that is sent to the plan and they take up to 120 business days to get them credentialed.
Erica Lloyd (18:05) Gotcha. Okay. So you’re getting them, you’re as soon as they got you immediately start medicaid. Okay? That makes sense?
Carla (18:14) Medicare and medicaid? Gotcha. Okay.
Erica Lloyd (18:18) And then I guess so kind of moving along. These are the to just to give you a little bit more insight. So, we’re… like I said, we’re fully managed. We’re a managed service. It’s and it sounds like you’re you have 300 providers, and do you know what the forecasted hiring like, how many providers you’re going to be hiring in the next year or so?
Carla (18:43) We’re always hiring that doesn’t stop… that’s. Like there’s no number there. There’s honestly that’s just not going to stop, okay?
Erica Lloyd (18:54) Is it, is it because of there, is it attrition or are you just like going to new markets? I saw like you’re in Florida, Georgia.
Carla (19:00) We’re in the whole state of Florida, Georgia and Alabama. So we’re constantly in different new areas. It’s that either that or the therapist doesn’t last long, and then they go. And then we have to obtain more therapists for that area, a little bit of both. Yeah.
Erica Lloyd (19:18) The, the therapy space is really high turnover. We sometimes hear it as high as like 30 to 35 percent in the therapy space.
Carla (19:25) Yeah, it’s frustrating because it’s a lot of work for them to just go, you know, especially if they’re 10 90 nines and they have no benefit. Like to them, it’s nothing to them. It’s like, okay, well, now, I’m good. But we did all that work already. Yeah.
Erica Lloyd (19:44) So, I’m curious, are you, like, are they, if they’re 10 90 nines? Are they with multiple yes practices? Gotcha. Okay. So that is like a large cycle. So, are you also doing their? So I guess just giving you insight into the different products too. So essentially, we’re doing everything for the provider from the time that they are hired. As Melissa is sending out their offer letter, yes. Okay. To the time they’re ready to see patients and then ongoing monitoring. So license expiration, monitoring, correct sanctions, things like that. Those are, those are things that we’re doing. So we’re getting them in network. We, and, do you have any delegated agreements… with payers today? Or are they all direct enrollments?
Carla (20:35) Delegated like a third party? You mean?
Erica Lloyd (20:39) Delegated where they, you, you’re doing, the credentialing as opposed to set, having to submit the applications to the payers?
Carla (20:48) No, it’s direct. It’s direct contracts.
Erica Lloyd (20:51) Okay. So if that was some avenue you wanted to pursue that’s where you can really see the timelines compress. Okay, for delegated agreements, we can typically get providers. If that’s something a longer term strategy that’s something we can support with family care center and other, they do therapy. They’re based out of Tennessee within six months of getting them. We got seven delegated agreements set up compressing their timelines from 90 to 120 days down to three days.
Erica Lloyd (21:19) For the delegated agreements. Obviously, that only works with commercial payers, but for the commercial payers, able to materially compress that, which can really help the growth rate and be able to get providers seeing patients faster. Do you think that’s a messaging that would kind of like land at the elt level?
Carla (21:41) I, I’ve never heard of delegate agreements. Tell me a little bit more about that? Like I’m not understanding so.
Erica Lloyd (21:49) With, the delegated and again, it’s not super important to… get into today. It’s it would like I said, it would be a much longer term strategy, but, with the payers. So, and I’m honestly not even sure if it works with tiny eyes. I’m pretty sure it would work with 10 90 nines. But essentially, you are not waiting, on the insurance providers. It typically would take at least a six month look back and making sure everything’s correct from the payers to your business and be able. And instead of having to submit the applications and they do the verification, you’re able to do that and then add them, to your roster directly. So it compresses that timeline to get them in network.
Carla (22:38) So for example, I know that’s a commercial. How would you guys go about it?
Erica Lloyd (22:42) For a commercial payer? Yeah. So we can only do it. It’s something only can do with commercial payers, you have to have typically a minimum of 100 providers, which you do. They’re basically giving you the authority. So there’s like a whole process of what, how we do to help you stand it up, cause they’re going to do a look back and make sure you’re audit ready. But essentially, we would be doing, they would be, we would be your sub delegate and doing, the credentialing on your behalf. And I would have to tag in my solutions consultant to get deeper onto that. But if it’s not something that’s like a strategy right now, we don’t have to get too deep into it.
Carla (23:25) I mean, you can send like a proposal on how much that would be. I mean, I’m not sure. Again, it’s not something I’m familiar with. So I wouldn’t even know how that part works. I mean, I’m used to just doing credentialing directly with, the payer?
Erica Lloyd (23:42) Cool. Yeah. So it’s it would essentially be, instead of the payer doing all the work they essentially are trusting you to do.
Carla (23:56) It, yeah, yeah.
Erica Lloyd (24:01) And so typically, you have to be ntqa certified, which medallion is show that you have auto ready files consistently compliant with the quality controls. So we have like basically the standards… to set that up for you, help set that up.
Carla (24:17) I see. Okay. And can you send us like a proposal on how much that would be to do that?
Erica Lloyd (24:24) So it would, we have a consumption based model. So it would depend on how many providers you’d want us to do that for?
Carla (24:35) Okay. All right. Let’s say we can do 100.
Erica Lloyd (24:45) Yeah. I would have to. Yeah, I can, it would depend on which… product SKUs would be in scope for you. But yeah, we can talk about, what pricing would look like. Okay? And then I’m curious with, for licensing. Are you doing licensing or do your providers take care, pay and take care of their own licensing or is that something you do on their behalf?
Carla (25:10) They take care of that? Okay?
Erica Lloyd (25:12) A lot of time for time. Okay. So, I guess from, I know we’re coming up on time here from like a next step perspective. Do you think this is something worth looping in… like Nadia, or I think it was a Marina who’s on the clinical operation side? I think Nadia, okay. Yeah.
Erica Lloyd (25:48) So, is that some, I guess, how would you kind of recommend scheduling that?
Carla (25:54) To have Nadia have a meeting with you guys? Yes. Okay. I can send her out, an email or a message to see what they should be available.
Erica Lloyd (26:09) Okay. That sounds good. So.
Carla (26:11) This was more of like information about the company just to see, you know, we’re interested or whatnot to this wasn’t kind of like, a demo, right?
Erica Lloyd (26:22) Yeah. This was just to see like, is there kind of like what is the goal to, you know, is there any type of need, you know, is there a need with, from your company? Is there with what we provide, you know, is there any type of alignment there? Okay. All right.
Carla (26:44) Let me send out a message to Nadia then. And then I’ll loop you guys in to see if, she has some time to jump on with you guys. Is there like a draft that you can send me about this meeting? Just so, you know, like of everything that you guys offer, just so I can provide her with that info?
Erica Lloyd (27:03) Yeah, absolutely. Okay. Yeah, I can, I’m happy to do that. And I think really where it is one, as you were talking about one, the write offs like we can help prevent some of that too. Not, if the goal is to keep growing, they probably would need to add more folks, to your team and take a little bit of the burden off of you obviously compressing, those timelines with automation, getting someone to come fully in network. And then as you’re saying, just like an extremely manual process with the providers that can cause friction with the providers is really to help resolve some of that. Perfect. Okay. So I can put that in the email as well. All right.
Carla (27:45) I’ll wait on that email, and then I’ll send her the message so she can give me some available dates. Okay. Sounds.
Erica Lloyd (27:52) Good. All right. It was good to meet. you. Thank you.
Carla (27:54) Erica. Thank you. Bye. Thank you. Have a good day.