Transcript
Scott Everline (00:00) hey, sicko.
Cliff Marg (00:02) Hello?
Scott Everline (00:03) Man. You all right there?
Cliff Marg (00:05) I got food poisoning. Ooh, a really good one.
Scott Everline (00:11) Nice. How’d you manage that?
Cliff Marg (00:14) Honestly, I’m not 100 percent sure my sister in law made dinner for like six of us. I’m the only one that got sick. So, I assume it was something else that I ate… but yeah, I did not sleep, was up all night growing up and it was just atrocious.
Scott Everline (00:36) It’s always fun.
Cliff Marg (00:37) But I’m on the other side of it, I’m just like I just have, I haven’t eaten in 36 hours and I’m like just rotting like.
Scott Everline (00:46) The fatigue is just no joke exactly.
Cliff Marg (00:48) Yeah, I’m just, I can’t move.
Scott Everline (00:52) That’s rough. Sorry to hear that.
Cliff Marg (00:54) That’s all right. I’m going to let them in.
Cliff Marg (01:07) Hi, Neil. Hi, Stephanie.
Neil Sullivan (01:10) Good morning. Good afternoon.
Cliff Marg (01:12) How’s your day going? Good? Glad to hear it. Are you guys working from home today?
Neil Sullivan (01:19) Yes, very.
Cliff Marg (01:21) Nice. I am as well. I’m staying off camera today. I am recovering from food poisoning, so I’m a little down in the dumps, but I’m making my way back slowly.
Neil Sullivan (01:32) Yeah, that’s not fun at all.
Cliff Marg (01:33) It is not fun. It’s been probably four years for me and it’s worse than I remembered.
Neil Sullivan (01:39) Yep. You kind of want to die.
Cliff Marg (01:42) Yeah, yeah, exactly. So, I’m just like, you know, I’m on the chicken broth and oatmeal diet for another day or so and then hopefully I’ll be back.
Neil Sullivan (01:53) Goodness. All right.
Cliff Marg (01:55) But anyways, I wanted to just start by letting Scott introduce himself. He’s going to be the star of the show for today.
Scott Everline (02:01) Okay. Hi. All. So Scott, I don’t have food poisoning. Okay? Thankfully, one of us are at least at 90 percent. Yes. So, I’m cliff’s right hand person. So I’m a solution consultant here at medallion. So I work closely with prospective customers, our engineering team, our product teams just to make sure that everything is kind of aligning with people’s expectations and kind of serve as the subject matter expert as we go through these conversations. So it’s nice to meet you all.
Neil Sullivan (02:31) Nice to meet you. I’ll let Stephanie introduce herself. And then I’ll introduce myself and we can get started.
Stephanie Rodriguez (02:38) My name is Stephanie. I am the front end RCM manager. So I deal with onboarding verifications, claims and stuff like that for dentology?
Scott Everline (02:49) Perfect.
Neil Sullivan (02:51) Neil, director of revenue cycle for dentology.
Neil Sullivan (02:54) I’ve been with the organization for a shade over a couple of years now and together we handle all things RCM.
Scott Everline (03:03) Perfect.
Cliff Marg (03:05) So, for today, I think, yeah, the plan is I’m going to hand it over to Scott here in just a minute, and really we’re going to walk through the platform and I think most importantly, just like the workflows of kind of operating, you know, credentialing and specifically like the payer enrollment process just to kind of recap. Yeah, you know, our conversation from last week, it sounds like today, my understanding is you all are partnered with unitas credentialing, who is kind of a third party that’s really kind of handling more of the enrollment applications and all of the day to day work that’s required for getting new providers in network. You then kind of have an onboarding team that handles all the outreach to providers, and then finance team is actually gathering all the documents. And then all of those documents finally go to unitas credentialing. And then you describe just, you know, unitas will send you kind of a weekly color coded PDF that you sift through. And I think that the core kind of fundamental challenges that you all are looking to solve for is one kind of a lack of visibility. So being able to spend a little bit more kind of hands on time seeing, you know, where folks are at in this process would be helpful… being able to reduce the actual end to end turnaround time for credentialing. And then just all in all kind of streamlining the, I guess the entire credentialing process. But mainly like the onboarding process for your providers and helping just provide a better experience for them overall. I want to pause there, gut check that. How to do, what did I leave out?
Neil Sullivan (04:46) No, I think that’s I think that’s fairly spot on. We’re just getting looking to get the process as efficient as it possibly can be and as transparent as it possibly can be.
Cliff Marg (04:56) Perfect. And so my only other question, I guess at this point, you know, since our last conversation, have you all made progress with having some follow up conversations with some of the other partners that you all are looking into?
Neil Sullivan (05:10) No follow up conversations as of yet.
Cliff Marg (05:13) Okay. Yeah. I was just curious to potentially get your take on some of those. So, yeah, I’ll hand it to Scott. I think all in all, what you’re going to find with the medallion model is a much more streamlined approach. And really we just want to show you like how we are, you know, offering a seamless experience for your providers and then giving you all what you need from kind of an executive perspective to manage the credentialing process. Yeah.
Scott Everline (05:45) So, can I ask a question around? I saw a note about fluent and you guys are looking to work with fluent, potentially… a competitive perspective, like looking at fluent as another option as alternative to medallion or looking at fluent from like they would take on the actual cvo credentialing component and medallion would manage the payer enrollment process.
Neil Sullivan (06:10) No, it’s competitive.
Scott Everline (06:11) Okay. I have a friend who used to work at fluent if you want me to get some nasty intel for you. Okay. I’ll just sell what medallion has and let the best organization the best fit win for you guys. So when we’re talking about credentialing, I’m going to be a bit of a nerd for a second. So bear with me. I’m always a nerd, but with you all try to be less nerdy. Are we talking exclusively the enrollment of payers and getting providers enrolled with the payers? Or are we talking about and, or are we talking about credentialing? So the primary source verification aspects of validating providers’ credentials in addition to, or is… it one or the other?
Neil Sullivan (06:56) It’s going to be all inclusive. And Stephanie, I don’t know, you know, and these are, this is something that’s that I’m making a push to move over to the revenue cycle division here at dentology. We’re so some of this is learning for me. I don’t know that I don’t what I don’t know and that what we’ll need to ask unitas is whether they’re doing any primary source verification on their side or whether they’re just gathering, you know, we hire, we gather the documents we send to the payer and the payer obviously has their primary source verification process as they go through their credentialing process. I don’t know whether there are two PSV processes there that work in parallel together or what that looks like. But the long and short of it is, I’m looking to get a, an all in one solution, you know, like not an all in one solution but, you know, where primary source verification, you know, I would, you know, the way I’ve always seen a benefit to it even in the hiring process because, you know, if we can vet doctors before, you know, we hire all the better and because we don’t want to find out that they have, you know, 10 malpractice lawsuits in the last six months after we’ve hired them, but we may be doing that Stephanie. I don’t know if you know the answer to that.
Stephanie Rodriguez (08:14) I want to say, I don’t think we are because I haven’t heard anything from like what unitas was doing and us internally. So I want to say, no, okay. Yeah.
Scott Everline (08:25) And I would think you guys are getting pretty close to the cusp of being eligible for delegated contracts with some of these payers. And so credentialing from a PSB perspective is going to be a pretty critical part to getting that. If that’s a path you all want to go down it.
Neil Sullivan (08:40) Is a path we want to go down eventually particularly at scale. I, you know, the, I was a little bit surprised that at, you know, we’re at right now we, you know, filter between say 45 and 55 doctors that we would be eligible even through fluent.
Neil Sullivan (08:58) I don’t know how fluent works that process, but there’s no indication that we wouldn’t be now obviously going through the traditional route, you know, that may look different, I don’t know. But eventually we do want to get to delegated.
Scott Everline (09:10) Yeah. Okay. Yeah. I have some thoughts on the fluent piece. I think there’s like, a dental DDS arm of fluent that has pre established delegated contracts, but it’s a little bit different. It sounds like it’s a, an alternative route that they’ve been able to finagle with some of the payers. But it’s less control over the credentialing processes for you all. So it’s not less… work but like less control. So, it’s it sounds like we were just talking to a customer that was coming over from dental DDS or considering it from the fluent side to come over to medallion to have more control and ownership of that delegation agreement. Yeah, because essentially, you’re delegating your delegation to fluent?
Neil Sullivan (09:49) Right. Yeah. And that part I did understand. Yeah.
Scott Everline (09:53) Yeah, it’s kind of, it’s a strange model creative for.
Neil Sullivan (09:56) Sure. Well, in part of the benefit for that, and I may be wrong there, but part of the benefit there is that, you know, obviously, we have, you know, we have to be compliant on our side but, you know, they will make sure we are compliant versus, you know, kind of quote unquote being on the hook for it ourselves.
Scott Everline (10:20) Yeah, yeah. And I think that, the medallion and we could talk through all those details, but medallion is… supporting the compliance requirement when it comes to delegation, right? Because we are an ncqa certified cvo, the actual finite credentialing requirements there. I think the difference would be like you potentially would need to, well, you would need to build like a credentialing committee, but we can talk about that and how our tooling supports that too. So let’s jump into a demo. I do this a lot. So please interrupt me, please kind of push me back in one direction or another. Ask tons of questions because that’s what it’s here for, right? So medallion is a platform. It’s cloud based. So it doesn’t get installed in your systems. It’s on the Aws web, but you can get access to it from essentially any modern machine even America online. So, looking in the platform, right? Just to start off, you have kind of your list of your providers that are in the platform, right? So, assuming you all already have your, you know, your 50 Ish providers, you would want to import a lot of that data that you already have today. Kind of curious, where that data sits, is that something that’s in unitas? Or is that something that you all store and house internally like in spreadsheets or some other pdm platform?
Neil Sullivan (11:48) It’s in folders, spreadsheets. Okay?
Scott Everline (11:51) So, we could a couple of different ways. We could do that from an onboarding perspective, but we can kind of sift through spreadsheets, get those added to a template, and then that template could be added so that all that incumbent information that you have can be stored here within medallion. So we’re not going back to those providers to kind of capture some of that information. It can come directly from what you already know when we’re talking about onboarding for net, new providers? Sorry?
Scott Everline (12:19) You’re essentially going to be able to invite a provider. So kind of curious as new providers come to the organization, they’re running through HR, I assume? Is there like an HRIS system that’s being leveraged for those onboarded providers or just smile Neil, is it more kind of hands on paper pushing like approach to the process? I?
Neil Sullivan (12:42) Would have to ask Ross, Stephanie. But if I was to guess, we don’t have an HRIS system?
Scott Everline (12:49) Okay. Fair enough. So you could invite the providers to the platform, right? So say the provider comes in, they accept a contract, they partner with dentology. You guys then are going to push an invitation to the provider to join medallion, right? So this is where… I’d say an API call, but it sounds like probably not an option. So you’d probably come in here, enter the provider’s email, enter their first and last name, estimated start date. And then you’re going to throw in their provider type, right? Nothing overly onerous. And then you’re going to go ahead and invite that user. The provider will receive an email as a result of that. So they’re going to get a welcome email from you. All it’ll have dentology’s logo here, right? So it’ll say, you know, dentology is partnering with medallion, taking a lot of this stuff, lots of blah, blah blah. So they understand what’s going on feel secure with this information being stored in medallion. And then they’re simply going to indicate this click started, get started. And then they’re going to get into their medallion profile, right? So that provider is going to be able to come in just some preparation identification, letting them know what they probably need and want, we work with organizations, say, like as you’re kind of going through this HR onboarding process, almost notifying them ahead of time, right? Like part of your onboarding process, you’re going to get an email from medallion. Here are the things that you want when you sit down in front of your computer to start pulling some of that information together so that you’re not in and out of the system and uploading information, right? So that previous page really calls out like what type of information, right? We’re going to need your professional history licenses, specific documents related to this. And then from there, there’s a couple of different ways that they can really start pulling data into the platform, right? So we have a link with caqh. So a lot of dental providers actually worked at caqh for seven years and spent a lot of work trying to get dental providers in the system and partnered with the Ada to do that. So a lot of those providers will be able to pre populate about 70 80 percent of their profiles directly from caqh. So not needing to put their fingers on a keyboard and re, enter all this information. We can pull that directly out of caqh and store that within the platform including documents, including attestation signatures, as well as disclosure questions. They can choose to upload from their resume. We can also pull from fsmb. The federation of state medical boards and pre populate some of the data from there, or if they’re really bored, they can manually key in all this data, right? So they can literally go in and interact with every individual field within their platform and fill that out. We’re going to take the happy path today. So the provider will share their caqh id. They’ll provide their social security number. We really do that just to make sure we’re linking the provider to the right caqh account. We don’t want to accidentally pull in the wrong user’s information, and then expose personal data to somebody who shouldn’t have access to it. You’re going to verify those credentials. Caqh id is found. Then that’s going to go ahead and kick off that import depending on like where caqh’s apis are bandwidth. The like could take anywhere from 10 minutes to an hour, right? So we tell the provider like sit tight, we’re pulling your data in from caqh. We will notify the provider via email. Hey great news. Your profile has been uploaded from caqh, click in here to get into your platform into your profile to complete all those additional components. They could go in and look at their profile and start kind of navigating through that process. Any questions on that onboarding piece? Does that?
Neil Sullivan (16:29) Yes. So, a lot of younger providers obviously may not have their caqh set up. Yep. What is, I guess first question is, will medallion kind of help us help the new hire get their caqh set up? And is there any benefit to that after the fact, you know, in other words like helping them prove, you know, kind of pushing all of our providers at dentology to be on caqh. Is there any ongoing benefit to that like recredentialing, et cetera.
Scott Everline (17:02) Yep. So I will answer the first question is, yes. So we do offer a caqh management SKU which is on like full end to end support of caqh. So it’s not just getting the account set up, it’s also maintaining that. So if medallion is treated as a source of truth at dentology, we would map the data from medallion directly into caqh to make sure those two profiles align and there’s a downstream benefit to that. And then we’ll conduct the attestation on behalf of the providers. So we’ll actually go in because caqh requires 120 day attestation, we’ll actually log in and kind of make sure all the data is confirmed validated, and then click that attestation button so that profile remains like current in the eyes of caqh… to put my caqh hat on. I will say there is a pretty significant advantage to maintaining caqh. If you think about if you’re not delegated… with those payers, every single payer is going to request a credentialing application from that provider. Almost all of the dental providers I’d say, with the exception of maybe all the dental payers, with the exception of like metlife are using caqh as that application. So instead of saying I’m contracting with 20 different dental payers… you’re only going to send you’re only going to maintain one singular caqh account. And then they will pull from that versus having to go back and rinse and repeat and manage all these duplicative applications, sending them over to the payers. So that’s really the big piece is just making sure that you’re not like repeating the process of completing a credentialing application. The caqh app can serve that need across all these payers. Okay? And,
Neil Sullivan (18:51) without caqh, does medallion fill that void as well? The source of truth? So that we’re not duplicating credentialing applications or is cqh necessary in that?
Scott Everline (19:01) Yeah. So for direct enrollment medallion serves that need, the funny thing on the payer side is they don’t their enrollment teams and their credentialing teams, although kind of are driving towards the same objective. They’re they don’t work off the same paperwork. So, even though we’re literally importing data for enrollments in the provider profile from caqh, the payer is still going to go back to caqh and extract that credentialing application or send out a credentialing application for the provider fill out. So it is unfortunately a dysfunction within the payers. And I feel safe saying that because I’ve worked for payers and lived it, but it’s a dysfunction within the payer architecture around that enrollment team and the credentialing team, them kind of living in two separate silos and duplicating the process even internally got.
Neil Sullivan (19:50) It. Okay. And how does like we have a lot, not a lot, but we’ve defaulted to some of the umbrella networks, connection and zealous in particular instead of direct contracts. How does this, how does this relate to? Because I would imagine even in the umbrella networks, there’s a credentialing contracting process. In other words, they don’t just say here’s a bunch of out of network dentists, we’re going to fluff them into the, how does this play into that? Yeah.
Scott Everline (20:20) So it’d be treated like any other enrollment. So like we would enroll in zealous or connections or Carrington, or geha, I guess geha is direct, but we would enroll in any of those, the same as we would enroll in a payr directly. So whether it’s united concordia or whether it’s going through zealous, we’re going to that, supplying all of their requirements for those enrollments to be processed, right? And then zealous is going to sell their network to united concordia, but the process is the same as far as the linkage between those two different types of orgs.
Neil Sullivan (20:52) Okay. And I imagine that we would tell you like, hey, instead of direct contract with cigna, we want you to contract with connection. And then that will do we let you handle that? How does that, how does that work there? Yeah?
Scott Everline (21:07) So, we don’t do the contracting piece, but we will submit the enrollment information. So you’ll have the contract with connection. And then through the platform, you’ll essentially say… whether it’s an individual provider or whether it’s a bulk of providers. I can come in and submit an enrollment request. I’m able to come in and say this is a group. And then I’m going to affiliate providers to that group agreement. So you’re going to enroll all of your providers from dentology with connections in one fell swoop or whether you’re doing it in more segregated market type approach, got it. People then did to identify specifically the group that I want to do that enrollment for. You guys may only have one I don’t know. Like, are you guys, you have multiple tins and mpis or are you leveraging a singular tin and mpi? And you’re doing like big bulk group enrollments?
Neil Sullivan (21:56) Singular? Okay.
Scott Everline (21:57) So, that makes life a lot easier for everybody, right? So then you’re going to say here’s our group, all the providers are affiliated with the group. Here are the markets that I want to do. So I can multi select markets for that specific payer, and then I would able to come in. And, yeah. So there you go. That’s right? Geeha, is connection dental. That’s why my brain went there. It’s been a while since I’ve played in the dental space at this granularity. So, and then determining whether it’s commercial or government business, right? What line of business I want to enroll in. And then it’s asking, do I want to enroll these providers too? Yes, right? I’m just going to select all of my providers that I’m going to do that enrollment in. And then medallion is going to run with this, right? So we’re going to grab all these providers. We’ll add them to the enrollment… next. If there’s specific locations that I need to pull into the process. Oh, whoops… lines of business, right? So we’re going to say commercial government move on to the next one, right? And then they’re going to ask for practice location. So if the providers all have one practice location that’s universally applied. If you have all of your associated locations, you can do that. And then you’re going to go through the rest of this process. So you’re going to… oh, there’s a provider and no associated locations. There we go. Sorry, the system’s got like a lot of weird defaults in the back, right? So, if I’m trying to unload and they’re like, well, wait a minute. This provider doesn’t even have a license in Arizona, you can’t enroll them. So the system will actually stop and prohibit me from moving forward. If there are certain like dependencies that aren’t being hit. And then notes I want to throw in here for the processor. And then I would submit that. What happens is that enrollment lands here within these enrollment requests. So you’ll be able to see all your requests that haven’t started yet. You’ll be able to see which ones are in processing. So as enrollments are kind of running the gamut. So, from that point, we’re going to fill out the payr enrollment documentation. If there’s anything missing in those provider profiles, we’re going to task back the team so we can either task the provider directly, say, hey, provider, you’re missing a two by two photo that united concordia needs or connection needs. If we want to run that through the admins, and we notify the admins, and then the admins go back. So like Stephanie, if it goes to you and folks on your team, and then you want to kind of run the triage, like maybe you have that photo in hand, you don’t want to bother the provider with that request, you all can kind of run that front end triage and then communicate with the providers as necessary. We don’t really have an opinion, whatever works best for you. All right. Some people say just go to the provider directly. It’ll be faster. Some people say I already have that type of information come to me and I’ll ask the provider if I need it, and then we start that processing, right? So we’ll submit the enrollment to the payer. They’ll have different ways of doing it as you all probably know, right? Some make you fill out a PDF, some allow you to enroll into a portal. There’s a skygen portal that I think somebody uses, right? So logging in through that portal, so being able to leverage that, and then we will track that here in the platform, right? So there’s not work for you to do unless we task back to you all like, hey, we’re missing this information. But our objective is to get as much of this information done on the front end so that we don’t have to go and do rework once that enrollment’s been submitted. So we’ll submit that enrollment. If there’s information that say we’re doing follow up and we identify that there’s something that needs attention. Maybe there’s a dependency. Maybe there’s a new policy that got put in place and there’s a new document that needs to be included. We’ll notify you all of that. And then we’ll get that processed. And then we’ll follow that enrollment all the way through to par completion. And then we’ll notify yourselves as well as the providers that they are now in contract with that specific organization… before an org say, like, well, we need that data to feed into like our scheduling teams or other teams that can all be like reports that are generated. We can send that email out to a blast. We can create a custom dashboard to kind of support that I know it blazed through that super fast. Anything you want me to double click on. There’s? A lot of granularity here. So I try not to put people to sleep. There’s a ton of detail that’s here to the point that like, even if you don’t want to see all this stuff, you can. Hide it, right? Like, I don’t want to see the discovery outcome. So don’t show it to me so I can narrow down all this in platform, I’m kind of ad hoc configuration, but.
Neil Sullivan (26:14) Got it. And so really the… let’s say, I’ve hired a provider. I’ve got all their information. I’ve gone through this process of entering their, linking their ceqh up. And I’ve said, hey go and let’s contract with Aetna. Cigna, blue cross, blue shield, Illinois, delta dental… set that up in here, kick off the process from that point forward. From that point forward, what happens on the back end is medallion take all that information, automatically, submit the credentialing packets to the payers and that real time information comes back through this dashboard. Is that right?
Scott Everline (27:00) Yep, exactly. So we’re going to bundle it all up like this. And on the back end, we have kind of this full payer requirement list. So we have this payer directory that’s all the requirements for all of these payers by line of business, by market. So what we do is we then take all of that criteria. And then from a provider perspective, we look at the provider profile, we identify the gaps, and then we mail off that package. Once we have everything, okay, that goes to the payer, we follow up with the payer typically every 10 days, right? It’s a combination of like AI phone calls pretty cool that propagate through like ivr systems. So we can actually like press one for English and then like press two to check on the status. So the bots can do all of that. And then we also do portal scraping. So we’ll then scrape the portals of the payers to make sure that we’re capturing any like updates that are posted to like an availability or a skygen. So we’re actually going into those portals, and then we’re feeding all of that back to them. So like I use this terrible analogy of like a subway sandwich shop, right? Like you all are going to tell us what sandwich you want. We’re going to then start piecing together that sandwich. If there’s any detail or information we want to know as we’re building it, we’re going to ask you questions, right? Like do you like banana peppers on your Italian sub? Yeah, I love banana peppers. Awesome. Can you give me? Like, right? We’re taking all that in order during the intake process, submit it. And at the very end of the line, you’re going to get that finished sandwich. You’re going to get that enrollment that’s been processed. And then you have that in your hands and the providers are ready to roll. Okay? I know it’s a terrible analogy in subway. I don’t know that.
Neil Sullivan (28:34) Makes sense. And so really we’re doing, you know, as currently with unitas, we’re getting all of the necessary information, licenses, everything and to be fair, unitas reaches out and where they’re able to, they grab that information as well. So in theory, we’re only bugging the provider for documents that we need or that we don’t have. So in theory they’re doing that. Now really medallion is with minus… I guess the account manager who like at unitas, we have a point person minus that point person essentially medallion’s doing the same thing for us in the background.
Scott Everline (29:19) Yeah, but I think that probably if I understand unitas’, workflow, you have all the visibility here in medallion, correct? So like Stephanie’s able to come in here and say, okay, what provider tasks are outstanding, right? I see that this provider hasn’t responded to this task that’s holding something up and we can escalate that, right? You’ll have an account manager and an engagement manager. You’ll have like your day to day operations like engagement person that will help manage some of that. They’re not the ones doing the outreach. A lot of the outreach is system and it’s processors if there are processors involved, but you have that full visibility as to like what tasks are being submitted as well as the providers having that. So it’s not a black box. It’s not one person that’s kind of like a single point of contact to kind of single thread. This information through it’s all visible and kind of interactive from a platform perspective.
Neil Sullivan (30:14) Okay. And then we can on the left hand side, you can just kind of take us down through. I don’t want to interrupt your flow, but, oh, I.
Scott Everline (30:22) Have no flow. You might like to a.
Neil Sullivan (30:25) Little bit about like groups facilities like how does that, you know, licenses, how does that left hand pane play into kind of the overall, what are those things there? Yeah?
Scott Everline (30:36) So this is a good question. So it’s all kind of how we’re packaging up the data. So in my experience, a lot of data platforms usually look at the relationships in a monodirectional path, right? It’s like either I’m looking at the group and I’m trying to figure out what provider’s tied to the group, what practice is, or I’m looking at the provider. And then I’m trying to figure out what groups the provider links to us. The group is that single tin, type two mpi combo. So it sounds like that would be one, right? That’s dentology. So you all would have one group, right? So let’s grab community health center. So this would be like all of your core group information within the profile. So necessary information, lines of business, states of incorporation, taxonomy, codes, specialties, et cetera, right? So all that stuff that is specific to the organization, operational details, uploading your W9 liability insurance, all that fun stuff, right? Owners, and then you’re going to add practice locations because I assume all of your providers aren’t practicing out of the same brick and mortar, right? They’re all in different locations, maybe a couple per location, but maybe not all across one location. You would add that location data. So that then becomes like a brick and mortar facility where they are seeing patients, right? They have an operatory all their fun dental equipment.
Neil Sullivan (32:01) You’re.
Scott Everline (32:02) able to either add existing. So existing groups or practices or I can add a new practice location that’s going to get the name if the practice has a separate mpi. Perhaps you would include that address information, hours of operations, doing business as accepting new patients, age of patients, kind of like typical practice location, brick and mortar type data stuff that would feed into a provider directory. I would think at the end of the day.
Neil Sullivan (32:27) Okay. And real quick before while we’re on the group section and it reminded me of something that Stephanie and I talked about last week, you know, I have unwound and stood up, you know, just the operational pieces of Rc, you know, cash posting Ar, all that sort of stuff. I have never been in a situation where I have questions. I have questions on the contracting and credentialing side that don’t make sense to me currently, but things seem to be working. Okay. An example of this is Stephanie and I looked at claims that were going out under the billing entity section of the Ada claim form, one of our founders rendering npi. But I think the group tax id, Stephanie were intermingled in that billing section. What I would say in the rendering section is the rendering doctor claims seem to be getting paid. Then of course, delta dental of Washington is telling me they updated their system and said, by the way, we’re requiring different type two mpis for all rendering locations in the state of Washington, though that’s not an mppes requirement which makes me very happy with them. So, you know, it’s so some of my questions when we move forward, it’s like, okay, there’s an unwinding here of making this process, make sense to me while keeping in mind that I don’t want to affect our cash flow, you know? So the unwinding piece is I want to make sure that delta dental of Washington has the right type two mpi, is the right address attached to the W9, the tax id, I can keep track of all of that here. But if we run into questions that say, delta dental of Washington has as we let’s say we start on this process and I set up medallion as it makes sense to me. But unitas and like there’s all sorts of screwy stuff that’s happening at the payer. How forms were submitted up to this point for providers? What’s the feedback loop look like there? How does medallion alert me and say, hey, delta dental of Washington got this contract conditionally in contracting packet, but they have questions, they need to talk to somebody because these things aren’t matching. They want to know which address they’re actually using. How does medallion kind of what’s that feedback loop look like?
Scott Everline (35:00) Yeah. So if we can address it, right? If it’s an issue with the actual submission from like what data is in the system to what data has been submitted, right? We’ll address that. You all wouldn’t have to interact with that. If there’s any other questions, em, the engagement manager would come back to the team and say, whoever I would assume it might be Stephanie, right? That’s kind of the primary contact for medallion. We’d come back and work with you all to kind of address those questions. I think a lot of it’s like packaging it up in a meaningful way.
Neil Sullivan (35:29) Yeah, I’m.
Scott Everline (35:30) kind of curious like how today does unitas manage that? Or is that just like fall into a black box and you don’t find out it’s a problem until too late?
Neil Sullivan (35:38) Well, like this last round, it fell into a black box until I found out about it. And then I found out about it only to find out that like some of the things that were worrisome to me, you know, apparently dental is just a little bit more lax than the medical side about things on some things, you know, for example, the tin address our controller had told unitas, hey, use our corporate address. And the way I’ve always set things up is very simple. It’s like you get a lockbox and it’s a po box that rarely if ever changes when you set up, the entity for that market, you associate it with that po box. Done. It never changes. That’s your type two mpi, that is your tin, you know, in other words, everything’s associated, with that entity at that address. And it rarely if ever changes. Yeah… you know, in our situation, for example, with delta dental in Washington, they had, you know, we had moved to a different corporate address. So, for tax purposes, our controller wanted the tin associated with our corporate address. I’m like, hey, wait a minute, but that’s not the way things are set up. From a billing perspective. It’s always been the first practice location. It’s always been that way but we were still getting paid. I don’t know it’s just like it’s things like that. That I look at it’s just, it’s very unclean to me. It doesn’t make sense to me. And that’s that rewinding piece that, you know, Stephanie, if you want to jump in like I’m just surprised that we don’t see more of a cash impact knowing that we have all these moving pieces that know that from my perspective, it’s like, OK, well, did we think about the implication of this before we change the address on our W9, you know, in this area, you know, kind of a thing.
Scott Everline (37:31) Yeah. I mean, my two cents is dental does operate quite differently. Yeah, I think it’s the nature of how those like I wouldn’t even use the term insurance for dental. Yeah, right? Because it’s not like a percent of claim type payment kind of open ended. Typically, it’s a benefit, right? Like you’ll get, your, you know, your annual checkup or your biannual checkups covered at 100 percent, like any other service beyond that usually has a limit to it, right? So it’s more of like a benefit than it is truly an insurance. And so maybe there are those little like maybe there’s a little less scrutiny, right? Because like metlife’s like, well, it doesn’t matter what they submit for at the end of the day, they’re only going to bill us for 2000 dollars done. Yeah, there’s a cap on the benefit versus where medical, it could go on forever, 30, 40,000 dollars, you know, millions of dollars on claims. I don’t know if that changes the way they process, if it’s that intentional.
Neil Sullivan (38:25) Yeah, yeah, but.
Scott Everline (38:27) I would think like from a medallion perspective because we’re capturing the group information that’s going to be your corporate entity, right? The advantage is like theoretically you guys have a single entity, single group, single 10, type two mpi. And then when you’re submitting those groups, if you remember when we did the enrollment submission, I’m linking the provider directly to their practices and that practice, potentially this data is if maintained adequately and efficiently on your end could feed into the claim system. Say, here are the providers and here are the practices. And those are the type two rendering mpis that need to be submitted on the claim versus like the entity mpi. Okay. It does take like we’re not managing this for you, right? You all are entering this data. Yeah, you’re making updates. And so maybe having a single place like a single source of truth to manage that versus a variety of different spreadsheets that, you know, somebody could be looking at the wrong version of a spreadsheet and get off track. Whereas if this medallion, everyone’s kind of using it collectively and they have good hygiene within the platform. Like any other technology. This could be a pretty important like feed to the process that would help clean some of that up.
Neil Sullivan (39:45) Okay.
Scott Everline (39:47) I know we only have five minutes left quickly. I’m going to jump into credential. We can always set up more time, hopefully when cliff can get his beautiful face on the camera. But from a credentialing perspective, so, talking about primary source verification, we follow ncqa requirements… because we are ncqa certified. Again, when you go down that delegation path, right? We are able to kind of check that credentialing requirement component. You’re going to submit a provider for credentialing, whether that’s initial, whether that’s recredentialing or whether that’s facility, hey, puss, I don’t know how many are you all doing? Any credentialing or facility enrollments in credentialing or everything’s done at the individual provider or the group level?
Neil Sullivan (40:34) As far as I know, Steph, it’s at the rendering. It’s at the rendering level? Yeah.
Scott Everline (40:39) It’s at the provider level. Yeah, because you’re not doing like brick and mortar type facilities, right? It’s not like ambulatory center.
Neil Sullivan (40:45) No, we don’t no, there’s no facility claims in dental. So,
Scott Everline (40:49) you would submit the request to medallion. We have a contractual SLA to turn around these PSV packets within five days of the day, sorry, three days of the day that you submitted it. So you submit it, we’ll get that clean application. Again, a lot of times we’re able to pull that out of caqh or we’ll pull it out of the provider profile. And then we have a medallion application we can use. Then we deliver the credentialing package to you all. So it’s going to come back and say, hey, here’s the provider. The PSV report is everything checked out? No issues. There were issues on this file et cetera. So then you’re able to look at that information and then you can look at the credentialing packet itself. So you’re able to come in through the checklist identify which verifications have been performed. This is a pretty lean packet if I need to, I can jump through those components? Okay?
Neil Sullivan (41:41) Do most, no, no need. Do most, does most primary source verification on our side happen in parallel with the contracting credentialing piece? Or is it linear like we, do you medallion does PSV? And then we submit for contracting and credentialing. How does that, what do you usually see how?
Scott Everline (42:05) Entities that are delegated, usually their requirement is that you credential the provider prior to submitting them on the delegated roster that’s a little bit different. A lot of orgs will run these in parallel and payers actually run them in parallel, right? Like the enrollment team is doing their thing, loading providers to the system. Meanwhile they’re actually doing the primary source verification at the same time. I would think if you’re doing it from a like an HR hiring perspective, you clearly want to do that before you even submit that payer for that provider for the new enrollment, right to add them to the group contract. But then within the platform, I’m able to manage this from a committee perspective, right? Ultimately, these verifications, what we find in these reviews need to go to a credentialing committee, a decision making team typically that has to have some level of like a medical officer making those determinations with a team of peers, but they’re able to come into the platform, look at the actual packet itself. So similar look and feel and then come into the platform and approve or reject that file. So as a credentialing committee, they might meet the vast majority of them are going to come through clean, no issues. Those can go as a clean file, rubber stamp by the CMO. No problems. Anything that has issues. Your team would then review it, make a determination. Does this provider meet the expectations? Yes or no? And then that’s logged here. And then the credentialing cycle is every 36 months. So, you know, 36 months three years down the road plus.
Neil Sullivan (43:36) A.
Scott Everline (43:36) 120 days. We’ll start the process again. So we’ll look at, you have a recredentialing deadline established and then we will start 120 days prior to that recredentialing deadline. Okay. Sure. We.
Neil Sullivan (43:50) don’t miss it. And this is not just delegated, right? Like this will keep track of our of payer, recredentialing, some payers recredential automatically. Others will let us know when it’s time, will this keep track of that as well? So.
Scott Everline (44:03) That’s in the payer section. So that’s where you have your enrollments. So existing enrollments, it’ll be able to track my par status, the effective date, and then the revalidation date. Got it. We would track that for revalidations, we’ll go ahead and start processing those automatically. So you all don’t have to keep track of those, right? So we just continue that revalidation and.
Neil Sullivan (44:23) I know we’re running out of time. So I just did want to ask real quick as part of and this is separate with unitas. So it’s not a, it’s not a blocker. I’m just curious what one of the things that fluent provided that would allow us to negotiate our own contracts where it was actual adjudication data by geozip. And I don’t know what unitas uses to determine like when it’s when, you know, what, you know, how to negotiate, when to negotiate all that sort of stuff is, are there any resources that medallion provides to give us insight to the contract negotiation side of things we?
Scott Everline (44:59) Don’t no, no, not today. Okay?
Neil Sullivan (45:02) Perfect. No worries. All right, Stephanie. I’m sorry, I monopolized our time. I apologize, Stephanie. Did you have any questions? No, it’s okay.
Scott Everline (45:16) All right. I know we’re a minute over. I know cliff popped off mute, but always happy to spend more time or if you guys have like if this marinate as this marinates and you have more questions, hopefully you feel like you can throw lots of random questions at me and I’ll do my best to answer them as honestly as I possibly can. No.
Neil Sullivan (45:32) I, is there a, do you have like a simple slide deck with some of these pages where I can, you know, present this to, you know, to my boss and, you know, as we make our decision here just to kind of give some insight into like here here’s, what it looks like here’s, what it does here’s, the process, etc. Yeah.
Scott Everline (45:50) If we don’t have, I’ll see what we have in our kind of our collection of materials. But if we don’t have something, I can easily grab some screenshots and package up some content for you guys?
Neil Sullivan (45:59) Yeah, that’d be great. And then, and then, any follow up questions that way? Because I’m sure we’ll do, you know, once we get pricing and we kind of make a determination, I’m sure there will be, you know, I’m sure folks will want to, you know, have, you know, kind of another touch base, but it would help if they’ve kind of seen what, you know, what it is beforehand? Yeah, definitely.
Scott Everline (46:20) Great.
Neil Sullivan (46:21) Thank you. And so.
Cliff Marg (46:23) Neil, my only question for you. I can send you in a follow up email to like the metrics that we need to kind of go through like a scoping and pricing exercise. My only other question for you is just like how do you, how are you thinking about?
Cliff Marg (46:40) Like, I guess like evaluation criteria, like, what is kind of going to be the best fit for you? All? Because I think on the last call I mentioned like, you know, oftentimes we are helping to evaluate, you know, current state versus future state and understanding current turnaround times versus, you know, what the averages kind of look like with medallion across different payers, etc. Like, how are you thinking about it from an evaluation perspective?
Neil Sullivan (47:04) Time, you know… onboarding to contracting timeline is one. So we want to shrink that we want to make sure that we’re employing best practices and providing the best workflow to get information. You know, we don’t want the provider to be a blocker. So, you know, getting information, making it as easy as possible for the provider to get information to us. So no, you know, as little lag time as there is between like when we hire to, when they get us their state license, you know, copy their state license or whatever document we need. You know, obviously, there’s a cost component to it. And really, you know, part of it is going to be the flexibility and the optionality to, you know, at least start down the road to delegated. If that’s what we choose to do, you know, which would increase our, you know, decrease our timeline even more from hire to contracted. So really and transparency is a piece of that as well because like I said, I don’t Stephanie, I don’t know how you feel about it, but I know from my perspective, just, you know, we get information from unitas. When we ask, we don’t have a real time dashboard. You know, I’ve asked what system they use? Can we get it’s? All very nebulous at this point.
Stephanie Rodriguez (48:25) Yeah. I think that’s probably the biggest for us is the visibility to it. We’ve asked for like an ongoing list right now. We’re really only getting lists for newer doctors. We don’t really get a breakdown of when doctors are being recredentialed to like make sure that a doctor that’s been with us six years is still being credentialed. It’s just done in the background. We don’t get that kind of update.
Cliff Marg (48:51) Yeah. Got it. I think based on a lot of those things like I’m very confident in medallion’s fit for dentology, and I think the main thing that sticks out to me is like, and we do have some collateral on this. But the average time that it takes to onboard a provider with medallion is less than two days and a lot of that has to do with just like our onboarding process and kind of the flow of information our ability to pull in from caqh and other external sources.
Cliff Marg (49:19) So, I think based on those things like I’m pretty confident, I’ll like I said, send you a follow up email with some more kind of like product walkthroughs that can maybe be used to share internally the metrics that we need to follow up with some scoping. And then we don’t have to calendar anything now unless you’d like to, but we can follow up and kind of walk through what a proposal will look like and, you know, keep the conversation going. Yeah.
Neil Sullivan (49:46) And, and even if it’s just, you know, I won’t hold it, hold you to it before we scope out, you know, just to give me an idea ballpark of like cause I know where fluent landed. I know where unitas is, what our cost is. Anything would be helpful to kind of give me some indication of like, okay, this is a net neutral move. This is, you know, it’s going to actually lower our cost. You know, whatever that is. I don’t know how your pricing has been. Yeah. And again, I’m not going to hold you to it. Just give me some indication my.
Cliff Marg (50:15) Guess Neil without more information is going to be that you guys would fall into the 50 to 85,000 dollar range? Okay? That makes sense. Yeah. And how does that compare to unitas today? And?
Neil Sullivan (50:29) That’s where it makes it, it’s very consistent with what we’ve gotten from fluent, consistent with what we’re paying now with unitas, it’s in the same range. Yeah.
Cliff Marg (50:37) Yeah, makes sense. Okay. So let me follow up on those items and then do you want to schedule something for us to reconnect perhaps like early to mid or perhaps late next week.
Neil Sullivan (50:49) Let’s do this. If you guys could get me those materials and we can coordinate over email and then, you know, my just full transparency here. My goal is to make a decision soon this.
Cliff Marg (51:02) Is,
Neil Sullivan (51:02) not something that I want to linger on. I mean, I got, you know, I’ve got decisions with, credit card processors. I’ve got it like there’s a, and so this one, I just, I want to, I want to stick a fork in it pretty soon. So, I’m not pushing you off. Just want to get some, you know, we can coordinate over email. I think would be easiest once we get packet, I guess. Yeah.
Cliff Marg (51:25) No problem. All right. I’ll get something out to you by the end of the day today, and then we’ll work on scheduling some follow ups.
Neil Sullivan (51:31) All right. I appreciate it.
Cliff Marg (51:33) Alrighty. Thank you both.
Neil Sullivan (51:34) Thank you bye.