Transcript
Fatima Nunes (00:00) bye. Let’s see who is in the waiting room. I.
Mallory Smith (00:07) love this game.
Fatima Nunes (00:11) Okay. So we have Joshua, Dana, and then Jay Doherty that.
Mallory Smith (00:18) Josh.
Fatima Nunes (00:21) No, not levitan. No.
Mallory Smith (00:23) Like josh, that was on the.
Jdaugherty (00:25) Document. Yeah.
Fatima Nunes (00:27) I’m assuming, okay, but I’m not seeing the other girl who Karis, who was the one that was?
Mallory Smith (00:36) Running it, wait a couple minutes, no?
Fatima Nunes (00:40) No, as in, like I’m not even seeing on the invite. So, I wonder… juicy.
Joshua (00:47) Okay. All.
Fatima Nunes (00:50) Right. So, I will let them in. I guess Nicole is not joining. So I will let them in. Okay? And then let’s get started.
Fatima Nunes (01:12) Hi, Joshua, hi, Dana.
Joshua (01:15) Hello?
Joshua (01:21) How are you… doing?
Fatima Nunes (01:24) Well, how are you? How’s your day going there? You are, Karis, I was wondering, I didn’t see you on the invite. I was wondering if you were going to join.
Mallory Smith (01:31) Yeah… I thought that was Dana. I’m sorry, I’ve never met you guys.
Joshua (01:39) It’s okay. No.
Fatima Nunes (01:41) Worries at all. It’s great to meet you. And then I do see Jay Doherty. I’m sorry, your name didn’t come through.
Jdaugherty (01:47) It’s Jenny or Jennifer on the invite. Jenny.
Fatima Nunes (01:51) Okay. Great to meet you, Jenny. Nice to meet you all, of course. And I’m just looking to see who else accepted? I know there’s M miller. And then we have J edmondson. Are we still waiting for those folks to join? I’m.
Joshua (02:06) J edmondson. So, okay.
Fatima Nunes (02:09) So, I guess we, for whatever reason you were on here twice. So that’s perfect. Should, no, that’s okay. We have M miller, should we give that person a few seconds?
Joshua (02:20) Should we wait on them, or can we go ahead and start?
Fatima Nunes (02:23) We.
Jdaugherty (02:24) can go ahead and start. Okay, she’s probably in there with Dinah or Dinah can let her know the details absolutely.
Fatima Nunes (02:33) Happy to get started. Well, first and foremost, appreciate all of you taking the next 30 minutes to meet with us. I know how busy you are. I did read through the notes with Nicole. So I know it’s probably very difficult to find 30 minutes that works for everybody. So we appreciate that, you know, by way of introduction, I’m Fatima based out of south Florida here. And I’m part of the partnerships team here at medallion. And really what that means is I work with fast growing healthcare organizations like Ohio county to help determine whether medallion can bring greater speed and efficiency to their credentialing enrollment, licensing processes. Pretty much everything from the moment you hire a provider to when that provider is billable across your payers?
Joshua (03:17) You.
Fatima Nunes (03:17) know, Nicole met with some of, the team last maybe a few weeks ago. So she did share all of her notes. We’re up to speed on that. And so really the goal for the call today is to continue building on those notes, get a better understanding of your current state, what you’re looking to accomplish with a credentialing partner, and just share a bit more about medallion to help you determine, you know, whether it makes sense or not to continue the conversation and explore a partnership with us after today. If everything that we say is in line with what you’re looking for in a credentialing partner, then the next step would typically be a one hour demo of the medallion platform. So I’ll pause there. Does that align with your expectations for the call today? Yeah.
Joshua (04:04) Absolutely. So when we met with Nicole, it was two or three weeks ago. It was just me and Karis. So we got a good kind of baseline of what you all are doing. We did bring in the payer credentialing people. So that’s Dana, Jenny, and Melissa. So we want you to touch, we didn’t really talk anything about that. So we want to see… how you all can help our credentialing team specifically for those credentialing insurances.
Joshua (04:37) And I know last time we never got a, if we could talk about approximate cost to, or how you all determine how much it’s going to be. That would be beneficial too. So.
Fatima Nunes (04:55) Yeah, absolutely. And so what I will say on the cost I’ll address that, first… we, there’s a couple of different ways we do that. There’s really not like a one cost fits all. Typically. The way that we go about that is we would go through a scoping session with you all to understand the services that you’re looking for volumes, how many providers, how many enrollment applications, how many credentialing files you need, and really get a better understanding of your current volumes and services. And then from there, we’d be able to share, you know, the pricing across there’s a lot of like volume based discounting involved in that as well. So don’t want to just throw a random number out there that could be super out of line with what the reality is. But… I would say typically just to give you kind of a lay of the land, we would do demo afterwards, there are lists of scoping questions that we would email over to you all. And then as soon as we have those answers, then we can get you a more indicative pricing. Awesome. Is that fair? Okay? Perfect. So I do want to introduce, I introduced myself. We have Mallory smith on the call and she’s one of our lead solutions consultant. So she’s the technical expert. Once we get to the demo portion of the evaluation, she’s going to be running point on that. I’ll let Mallory better introduce herself and then would love it if I know at a high level, right? It sounds like Jenny Dana, you’re part of the peer enrollment team. And then Joshua, I mean, Candice, you’re part of the credentialing team, but we’d love to open it up to you and maybe you could share a little bit more light around your roles. Yeah. Mallory, I’ll let you kick it off.
Mallory Smith (06:32) Thanks, Fatima. It’s a pleasure to meet everyone today. I am based in Nashville, Tennessee. I’ve been with medallion for about two years and I’ve been in the provider data space for roughly 10 or so. So. I’m here to support the conversation from a technical perspective today and ensure that if we do move forward to a demo that we’re showing you everything that’s relevant to your team.
Fatima Nunes (06:57) And then I don’t know if Joshua you want to go first or Jenny’s team wants to go first. Yeah, I see Jenny coming off mute.
Jdaugherty (07:04) Hi, I’m Jenny, I’m PFS director here at Ohio county. And Dinah is actually our credentialing specialist, so she would have the details of her processes. I just, I know that we’re looking for a solution that kind of ties everything hospital credentialing in with payer enrollment and it’s just an easy flow of information and data and tracking and things like that.
Fatima Nunes (07:31) Perfect. That’s helpful. Thank you. And then Joshua, Candice, is there anything else that you all want to add or Dana? And I’m sorry, am I pronouncing that correctly? Is it, Dana, it’s.
Dana Landrum (07:44) Dana, yeah, that’s correct?
Fatima Nunes (07:46) Okay, perfect. It’s great to meet you, Dana, you.
Dana Landrum (07:49) Too. We’re basically on the provider side of the payer, we’re trying to find a system that helps us make the flow easier, be able to track certain… revalidations, caqh, different things that we have to do every 90 to 120 days every year. We, we’ve grown so much in the last year actually as far as facilities and providers. So it’s really hit us hard on this side, trying to keep the flow going and make sure we’re not forgetting stuff.
Fatima Nunes (08:39) And, and,
Dana Landrum (08:41) handling what we need to handle on the provider side of it. So that’s basically what we’re wanting. We have a lot of manual stuff on both sides. I believe that it’s that we are looking for a solution to help with.
Fatima Nunes (09:04) Absolutely. Well, I’m happy that we’re having this conversation. We can certainly address. I believe everything you just mentioned Dana, everything from just making it, you know, one stop shop, all of the information helping you track, you know, you mentioned revalidations track everything on an ongoing basis so that nothing falls through the cracks. And then also congratulations, to you all, on, the incredible growth across the facilities and providers. I do hear you. I think we have these conversations a lot and they’re like, hey, it’s great for the business. However we’re drowning on the pair enrollment and credentialing front. So I totally hear you there. And just a question off that, I guess what’s really has this been natural growth where you’ve been onboarding kind of a unique number of like higher provider volumes or really what’s driving that growth across the business right now?
Dana Landrum (09:56) Basically, I think as far as getting the different type of specialties in our community where we were limited to just a few when we were smaller and we expanded that along with expanding our facilities to neighboring county as well. So, we’re just pretty much trying to make sure we hit base on everything that we can to serve, you know, our patients in our community.
Fatima Nunes (10:33) Absolutely. And I do want to highlight a note from our notes. And actually I’ll go ahead and share my screen. I had put together just one slide around our understanding so far just so I don’t have you guys repeating yourselves and I want to confirm everything that we understand. And then maybe you can fill in some of the gaps here. And then that’ll help Mallory and I kind of jump in and tell you a little bit more about medallion and how we can support. But really, you know, from what we heard from the last conversation Nicole had with you. All right, you’re currently managing credentialing through a mix of it’s mainly spreadsheets, shared folders. Doesn’t sound like there’s one tool that you’re really leveraging. And then you have an in house team really that’s leading… the process. Of course, as you mentioned Dana, it’s been especially challenging as your provider volume and facility continues to grow, keeping up with that growth, right? You’re onboarding new providers pretty consistently. If I recall, you’re at 130 providers that you’re doing medstaff credentialing for. And then there’s 160 that are by proxy and please jump in. If anything is inaccurate, please correct me if we’re wrong. And then… everything’s being managed in house, no current software being used. It sounds like there’s been some turnover on the teams which has made it very difficult to maintain consistency, keep everything organized and retain a lot of that valuable data. And then of course, you mentioned there’s been some downstream effects like delays in getting providers fully credentialed and active. And then the biggest thing I wanted to highlight that I know you mentioned, I believe it was you Joshua is that you have strong support from your CMO?
Joshua (12:26) Jaina?
Fatima Nunes (12:28) Yeah.
Joshua (12:28) Dr. Skiba. Yeah.
Fatima Nunes (12:31) Dr. Skiba. Okay, perfect. And then that’s really what’s driving this, you have? Yeah.
Joshua (12:36) He was the one that suggested he actually suggested us to look into it. Little did we know the payer credentialing was already looking into it too. So we’ve are combining forces now and hope we get a platform that helps us both out.
Fatima Nunes (12:54) Okay, perfect. And then can you share a little bit more about like timeline? I know your fiscal year starts October first. Do you have, I guess to work backwards from a timeline? When would you want to kick off implementation? Have the vendor of choice selected?
Joshua (13:11) I’m going to turn that over to Jenny. We’re pretty much. I mean, we’ve been doing it for so long, the old way, like as long as we get it eventually that’s kind of my viewpoint. I don’t really have a timeline, Jenny, do you have something on your side that you’d like to not?
Jdaugherty (13:33) Necessarily any target date… we just, we want to be more organized sooner rather than later.
Fatima Nunes (13:44) Because.
Jdaugherty (13:44) it doesn’t look like our volume growth is going to slow down anytime soon, so.
Fatima Nunes (13:51) Yeah, absolutely. Understand that. And then, I know, I guess the reason why I asked that is in working with your CMO. Is there a reason why he’s involved and really pushing for this? Is there something happening like where, hey, we’re missing? He just,
Joshua (14:07) reviewed on the hospital credentialing side specifically. He just, they go to the mec and then the board to be approved month on a month to month basis. And he’s just personally seen the growth. The emails are getting bigger. The binders we give them are bigger. There’s just a lot more that he has to sign. He just sees and we just had re credentialing a reappointment too in January. So, seeing the frustration on our team and the delays and the amount of growth, he, we always talk. He really wants this… us to get a platform. He thinks it’ll really help the… whole organization. Okay?
Mallory Smith (15:03) Thank you for that, josh. Do you mind if I ask a quick question?
Joshua (15:07) Yeah, absolutely.
Mallory Smith (15:09) Two questions, really sorry. I always sneak in a second one. So my first question, are you credentialing to joint commission standards? I hear medstaff, credentialing, medexec board, or is it ncqa?
Joshua (15:24) I’m not sure. Do you mind repeating the question? You kind of broke up a little bit sorry about that. I’m not sure. I know the answer though. Oh.
Mallory Smith (15:33) You’re fine. So, when you say appointments medexec committee and things, I think of joint commission level credentialing privileging, is that the okay?
Joshua (15:41) Yeah, we’re joint commission accredited. Okay. Thank you.
Mallory Smith (15:46) And you mentioned you just did reappointments in January. Do you do all of your reappointments at once or is it just for a subset of providers?
Joshua (15:54) It’s for all the providers that have been here longer than a year. Okay? All right. Thank you. And it’s for every two years every two years, and we’ll do it again in the start of 20 28.
Mallory Smith (16:08) Whew, at least you have some breathing room before that happens.
Joshua (16:11) Yeah, absolutely. And it came when Karis has only been here for a couple months. So it came when our old hospital initial credentialer left. So it came at a bad time, but our team Karis is… has a marketing background and our I’m actually community relations marketing. So like we have, I… specifically have a whole other job while she’s we wanted to get this down to like maybe three days a week for her right now. She’s full time, hoping she can help us out with some community relations marketing stuff like that. This used to be just a half a week job that’s now a full time job.
Mallory Smith (17:05) Hear you. Loud and clear. Thank you for the additional insight there. Yep. Yeah.
Fatima Nunes (17:10) The one question I’ll ask and Jenny, I didn’t mean to assume, I know the conversation was before with Karis and Joshua and they mentioned that they have no system in place or no software that they’re working off of. Is that the same for payer enrollment on the payer enrollment side? Is it everything manual spreadsheets? Spreadsheets, shared folders? Yeah. Okay, great. So I don’t want to keep peppering you with questions. I think this is super helpful context, right? The last thing we want to do medallion does a breadth of things. Last thing I want to do is just start, you know, telling you how great we are without really understanding what’s important to you. So I think with that being said, I’ll just move along here. There’s actually a slide. I don’t hear you. Are you able to see this? All right. I love this graphic because it really gives you high level overview of where all the areas where medallion can plug in. Essentially medallion is a one stop shop for all of your provider data. Your credentialing enrollment needs, everything will live in the same platform. So, in terms of being able to track things seamlessly, having all of the data at your fingertips, full visibility into not only provider but also your facilities, your payer enrollment applications, statuses of those applications. Dana, you mentioned the importance of being able to track everything, ongoing monitoring to make sure nothing’s falling through the gaps in the medallion platform that’s going to be all tracked automatically without any type of like human intervention, your team having to go in and tell the platform. Hey, can you please check in on this provider? Do this? Do that? Everything’s very intuitive in the system. The one thing I would add with medallion, it’s and maybe we’ll skip back here a little bit, give you a better context at our core. We are a healthcare technology company, right? So you can see we’re backed by top tech investors. You’ll see some of those on the screens and we’re using a combination of AI and purpose built automation to really, I would say streamline about 100 percent of this process, but remove about 90 percent of the manual work involved in this process, day to day, right? So there’s a lot of things like Dana, you also mentioned caqh management that’s something that is automatically built into our platform. We’re the only participating organization with caqh. We have a bi directional integration with them which allows us to push and pull information to and from. And I see Melissa is in the waiting. Room. So I’ll let her in here. Hi, Melissa.
Fatima Nunes (19:54) Not sure. There we go. Not at all.
Fatima Nunes (19:59) Thank you for joining us. So we’ll bring you up to speed, Melissa, but… there we go. I see her coming on camera. Okay? Is Melissa part of the payr enrollment team or the mdstaff? Okay. Great. Hi, Melissa. Nice to meet you. Great. She may be having microphone problems. Yeah, it happens with zoom. Oh, yeah. Okay. So Melissa to bring you up to speed, we were just giving high level review of medallion, but essentially, what I want you to take away from this is a lot of the challenges that you’re experiencing today are going to be solved automatically with a lot of the automation and the AI that we have built into the medallion platform. And of course, in a future demo, we can give you more color to that. And so you could see on the screen, right? We are working with about 400 customers nationwide today across credentialing, delegated credentialing, mdstaff, credentialing, hospital applications, getting privileges for providers, cross state licensing, and then as well. Of course, direct enrollments. I’ll pause there. I know that was a lot to throw at you at once. Anything we can help clarify on some of the points that I just mentioned?
Melissa Miller (21:28) No, I’m good. Is it not letting me talk?
Fatima Nunes (21:34) Melissa, I can hear you but it’s a little bit distant.
Melissa Miller (21:38) Okay. I don’t know what to do. I don’t have to have them work on that. I actually had to work on that earlier.
Fatima Nunes (21:44) This morning, everything. I don’t know. Okay. Is it just me? No, it’s okay. Yeah, I.
Melissa Miller (21:58) had to work on it earlier. So I’m not sure what?
Joshua (22:01) I hear you better now.
Fatima Nunes (22:02) Yeah, it’s clearer. Well, is there another typically? Is there another meeting software that works better for you? All we can use that for our next conversation. We.
Joshua (22:18) Do use, what do we use? Microsoft teams? We use teams, but I don’t know if that would be better. Melissa’s probably, Melissa, it might be internet connection.
Fatima Nunes (22:31) It might be, it might be.
Melissa Miller (22:33) Like I said earlier, I had to have, I think it’s I had no sound for like two weeks. Well, that’s.
Fatima Nunes (22:46) unfortunate see, Mallory and I would be out of a job if we didn’t have any sound for two weeks that’s what you do. Okay? So let’s just carry on here. So we mentioned no questions so far. I think a question that I have for you all is it sounds like you want to go down the path or you already decided to go down the path of finding a software, a tool that’s going to be able to offload some of the manual work that you’re doing today. In the event that you, is it still on the table that if for whatever reason, you don’t move forward with software, you would just continue building your in house team to keep up with the growth? Is that still something that you’re considering or is it 100 percent? No, we want software because of the speed at which you’re scaling. You know, you don’t want to keep throwing bodies at the problem type thing.
Jdaugherty (23:39) We prefer a software platform.
Mallory Smith (23:44) For sure. Okay.
Jdaugherty (23:47) Okay.
Fatima Nunes (23:47) Perfect. And is this the extent of the team? So, Joshua Karras, mdstaff credentialing, and then three folks on the pair enrollment team. Essentially. Okay. So I would say that’s probably the big driver as well, right? I know it’s we have me and Mallory have so many of these conversations and they say it’s such a pain to go out, hire train, bring on somebody new. Then there’s turnover that happens like crazy, you know, six months a year. And then we have to do it all over again. And there’s so much knowledge lost there. So I hear you there, Jenny. Okay. So I will move ahead here. I do want to share. I think three big things a little bit about differentiators. I know you’re looking at some of the other vendors. So I do want to call out something that’s unique to medallion as you’re evaluating different vendors, right? And that’s really around the slas that we contractually commit to. So I believe you’re seeing on the side right now, but this is really ultimately what gives our customers predictability and confidence in the work that we’re doing. We can promise you everything the stars. But if we’re not performing to your expectations and doing things fast and accurate, then it doesn’t matter, right? And so the slas that we have in place today are we have an average four day turnaround from when we receive a complete provider information to submitting applications to payers. And 96 percent of those submissions are expected on the first attempt, which means of course, fewer delays, resubmissions, surprises down the line where claims are getting denied as a result of, hey, this provider is actually not in network. We were missing information from them. All of that. And then on the credentialing front, so this would be more on like the mdstaff credentialing side, we have a one day average for a, to have a credentialing application ready for your review. And we have a three day guarantee around that. So those are the two big ones that would impact both of your teams. And so that way when you go up to leadership, I’m assuming later on in the conversation, you have to make a recommendation around a vendor. A lot of these vendors might start saying the same things. But I think one of the big differentiators is medallion puts contracted… slas behind the work that we’re doing. And so if we miss these slas, there’s financial implications on us, right? I’ll pause here. Usually there’s some questions around this.
Jdaugherty (26:25) Yeah, I have a question. So whenever the applications are submitted, I’m assuming that there’s like a status system where they sit as pending or approved or completed. And then the information from the payer feeds back into the software as far as effective dates and enrollment letters and all of that.
Fatima Nunes (26:47) Yeah. Mallory, I’ll let you take this one. It.
Mallory Smith (26:49) Does, yes. So, Jenny knows exactly what it looks like. You’ll see full visibility in the platform for every single email from the payers, every submitted application, welcome letters and so forth. So, yeah, everything’s attached directly to the payer line.
Jdaugherty (27:04) Gotcha. So, you know, because we have several times what’s the status on, you know, dr. So, and so with humana, and we’re like nope still pending for years, of course.
Mallory Smith (27:17) Can I ask who is usually asking you for those updates the?
Jdaugherty (27:20) Clinic, the clinic, yeah, the clinics that they’re supposed to be seeing patients in. Yeah. And sometimes they’re seeing patients and we’re still pending enrollment and we get denials. So the billing team comes back. I’m like, you know, they’re not in that work, what’s going on?
Mallory Smith (27:41) Exactly. And I think sometimes they do their best to deny just for any reason, right? They do, they do, if you were to break down, how many denials you think you get based on credentialing, on average, do you track that metric?
Jdaugherty (27:54) I will be tracking that metric that’s part of my KPI.
Fatima Nunes (27:57) Dashboard that.
Jdaugherty (27:58) I’m creating right now, but I would say, I mean, it was probably five percent maybe of our denials.
Mallory Smith (28:07) Okay. Thanks. Yeah. I think that’s well, well handled for now. We’ve talked to some groups that have 35 40 percent. So, but the good news is that if you were to partner with medallion, we could even reduce that five percent. So, yeah, thank you. Okay. Thank you. Good.
Jdaugherty (28:22) To know. Thank you. Yeah.
Fatima Nunes (28:24) Absolutely. And I see we’re kind of running low on time here. I didn’t keep an eye on the clock… but any other questions on the SLA front that we can answer? And of course, we can share these slides with you after the call.
Jdaugherty (28:39) I don’t have any more. I’m interested in seeing a demo though I’d really like to see how that information flows.
Fatima Nunes (28:47) Yeah, absolutely. And so, let me go ahead here.
Fatima Nunes (28:53) Let me stop sharing my screen here. I guess in terms of a next step, right? I want to debrief with Mallory before I think the demo would probably be the best option just so that you’re able to see everything in real time. Let me see. Is there a time that usually works best for you?
Jdaugherty (29:17) Is it, would it be like an hour slot time slot?
Fatima Nunes (29:20) It would be an hour slot? Yeah. And Mallory, can you actually jump in here? I have, for some reason, somebody’s banging on my door? I don’t know what’s going on. I got.
Mallory Smith (29:28) You? Okay. So the earliest we have available, I’m just checking the calendar here. We could do anything as early as Friday the.
Mallory Smith (29:45) Or we can also do several slots on Monday itself as well. So, is that too soon? Would that be?
Jdaugherty (29:52) Monday works better for me? I don’t know, but I have a conflict at two on Friday. Okay? Perfect.
Mallory Smith (29:59) Then, how about a two eastern, one PM on Monday?
Jdaugherty (30:02) Does that work for everybody?
Fatima Nunes (30:04) Yeah, Dana.
Jdaugherty (30:06) Will you be available on Monday at two o’clock.
Fatima Nunes (30:09) yes, ma’am.
Jdaugherty (30:11) Okie. Dokie. I.
Mallory Smith (30:13) will put a placeholder on Fatima. Just double. Confirm with her that slot is okay. We look forward to seeing you then.
Jdaugherty (30:19) Perfect. Thank.
Fatima Nunes (30:20) You for the email.
Mallory Smith (30:21) Of course. Thanks again, everyone for the time.
Jdaugherty (30:24) Thank you. Bye.
Mallory Smith (30:25) Bye. Thanks bye.