Transcript
Lewis Elder (00:00) okay.
Lewis Elder (00:11) I got a little red tandoori chicken sauce on my polo earlier. No, no, I spent like 10 minutes with not 10 minutes. I spent like two minutes with the tide pen. It’s mostly game out but yeah, it’s like the last thing you want on your clothing item.
Jake Shubert (00:29) That’s so rough. I never, I don’t own any clothes that are nice enough to really mourn if they get fucked.
Lewis Elder (00:35) But the.
Jake Shubert (00:36) amount of shit I’ve stained with trader Joe’s. Butter chickens is truly like historic. Yeah.
Lewis Elder (00:42) I can imagine. Yeah.
Samantha Bouchard (00:45) I heard trader Joe’s and butter chicken.
Lewis Elder (00:49) I was telling the.
Samantha Bouchard (00:52) Frozen thing. Yeah, I love those. They’re great with the naan, bread. I mean, it’s like got an Indian restaurant in your freezer.
Jake Shubert (01:01) There you go. Right at home.
Samantha Bouchard (01:03) Those are my, go to that. And the orange chicken. I like the,
Crc872 (01:08) orange chicken too.
Lewis Elder (01:09) Yeah. All right. Looks like they’ve entered the waiting room. So I’ll add them in also trader Joe’s freezer, rice actually pretty good for microwave rice, the white rice, all right?
Samantha Bouchard (01:20) Yep. I got that too. Louis. You’re hitting my whole trader Joe’s list.
Lewis Elder (01:25) Nice. Hey, this is Louis from medallion. Let me know if you can hear me? I.
Crc872 (01:32) Can hear you, Louis. Hi, this is Cynthia.
Lewis Elder (01:34) Oh, hey, Cynthia. How’s it going?
Crc872 (01:37) It’s going is.
Lewis Elder (01:39) It, I’m assuming it’s warm down there raining though, maybe I don’t know.
Crc872 (01:43) It’s raining but I don’t know if it’s cold for me. Anything below seven D, it’s cold.
Lewis Elder (01:50) Okay. All right. You know, no need to brag I’m in Pittsburgh, Pennsylvania, which it’s you know, like 40. And Sam is in Boston. She told me earlier, it was very.
Samantha Bouchard (02:00) cold 30 this morning, so, I’m jealous Cynthia, but we are, we’re going to Texas. We’re going to Austin next week and it’s going to be 80, so I’m looking forward to that. Well, I,
Crc872 (02:11) hope you have lots of fun. Austin is a fun city to visit.
Samantha Bouchard (02:14) Oh, yeah. Yeah. We’re excited awesome.
Lewis Elder (02:17) And I think we have, a bunch of the team members from ut. Yeah, yes, we.
Crc872 (02:22) Have Veronica and Maribel, I think are going to join us here in a little bit.
Lewis Elder (02:27) Sure. We’ll give them.
Crc872 (02:28) A couple of minutes absolutely.
Lewis Elder (02:38) Now, are the three of y’all, all located in the same place or are you guys spread out kind of throughout the region?
Crc872 (02:45) We’re spread out. Veronica and Maribel. They’re more in Edinburgh mcallen area. Okay?
Lewis Elder (02:51) Yep.
Crc872 (02:52) And I’m in harlingen,
Lewis Elder (02:54) okay. Got it.
Lewis Elder (03:27) Oop, I see Maribel entered. I will admit her. And then I think we’re just waiting on one other. Veronica. Yes. Hey, this is Luis from medallion.
Crc872 (03:46) Good afternoon. Sorry, I’m a.
Marivel Barrera (03:48) Couple minutes late here, so.
Lewis Elder (03:50) No, not a problem at all with you and Cynthia on. Obviously, I think we’re waiting for one or two other folks. So I’m checking against the calendar invite acceptances.
Marivel Barrera (04:01) I don’t know if Veronica will be joining us. She.
Crc872 (04:06) Just responded, she said, yes, she’s joining us.
Lewis Elder (04:09) Okay. We’ll give her a moment to hop on. Okay? In the meantime. So, I’ve we’ll wait until she hops on before, since I know we’re myself and my two colleagues are new to the conversation with you guys. So we’ll hold off until she joins and introduce ourselves. In the meantime, if maybe the two of you want to, I’ve listened to the first call but, you know, Jake and Sam are new to the conversation. So if you guys want to give us a quick intro of just your role and where it sits with credentialing, and, you know, pay enrollment all that good stuff. That would maybe be a good place to start.
Crc872 (04:42) Thank you. Go ahead Mari my.
Marivel Barrera (04:47) name is Mari Barrera, I am the avp for revenue cycle operations. We’re a large clinical enterprise. We, do, we just opened what we’re calling a cancer center. It has infusion therapy services, radiation oncology, we also opened up an imaging center in there as well, and we’re getting ready to open up an asc. We’ve already started our first, you know, 10 free cases. So we hope to be fully up and running by the end of the year. So we’re pretty small. I think we have, what about 23, 24 clinics, Cynthia, somewhere around there?
Crc872 (05:30) I think they’re about 26.
Marivel Barrera (05:33) There you go. 26. We’re spread like about 100 mile radius throughout the Rio grande valley. Cynthia can give you more information on how many providers I’ll hand it off to Cynthia to introduce.
Crc872 (05:46) Her, yes, good afternoon. My name is Cynthia Gonzalez. My official title right now is revenue cycle coding manager, but I now reside in the provider enrollment and credentialing. So my title will change. Eventually. I oversee the credential and enrollment department. And so we have like Marivel mentioned, we’re a huge organization and have roughly around 120 providers getting there to that number. We have a variety of specialists. And so we do, you know, fresh source verification. We’re using a system called mdstaff. Yep. And so it’s worked really well for us so far. And so our emr system is epic.
Veronica Villarreal (06:37) Yep. And so perfect.
Lewis Elder (06:41) Awesome. Well, thank you, Cynthia and Veronica. I saw you just hopped on. We’re just doing quick intros from the ut side.
Veronica Villarreal (06:49) I’m the avp of ops, David Moreno was the one that introduced us to you. Him and I used to work together at another health system. I oversee the ambulatory operations of this side of the house. So obviously, we know credentialing is a hot topic everywhere. And so we’re trying to see if you all or someone else can help us kind of shorten the timeframe.
Lewis Elder (07:26) definitely. Well, it’s always a hot topic here. And I, you know, I think we can definitely do that. And yes, I’ve listened to the first call that you all had with Bijan and team. So I have a, took a bunch of notes. Have, you know, the rundown there of what you guys are working on. So Sam and Jacob have listened as well. So we should be well versed but, you know, good to meet the team for the first time. I will introduce myself and kind of run us through a quick agenda and then we’ll get into things. But good to meet you all.
Lewis Elder (07:52) I’m Louis elder, I work on our partnerships team here at medallion. Jake. I’ll let you go. And then Sam, you could round us out.
Jake Shubert (07:58) Yeah, thanks, Louis. I’m also part of our partnerships team over here at medallion. I’m sure to be an extra resource for the team. I’ll answer any questions where I can, yeah.
Samantha Bouchard (08:07) Hi, everybody, Sam Bouchard. I am a solution consultant here at medallion and I support Louis. So I’ll be walking you through the platform today and just really answering any technical product or operational questions that you might have about medallion’s product. So it’s nice to meet everybody. Awesome.
Jake Shubert (08:25) Yeah.
Lewis Elder (08:26) Great to meet you all. And I will share my screen. I also want to say, you know, congrats on the, I think the cancer center is in mcallen, right? I remember reading a little blog post about that. So, congratulations on that. That’s no small feat. I know for a clinical care network, you know, where you guys sit, so, very cool stuff. And let me pull this up. All right. Can you all see… that?
Veronica Villarreal (08:55) Yes, perfect.
Lewis Elder (08:58) Awesome. So we will do a kind of quick overview. So here’s kind of what the agenda will be for today. And you guys tell me if you want to add on anything or adjust at all. I’d like to since it’s been about a month since we all spoke and obviously we’re new to the conversation here. Even having listened to the recording of the first call, I’d like to kind of recapture some of the details about the use case, make sure we’re all on the same page. And we’re understanding you know, every detail of what you guys are looking for. So we’ll spend about 15 minutes doing that, of course, ask any questions at any time. And then most of the agenda for today will be, Sam will be walking through, look at demo of the product. We’re kind of showing what medallion looks like. We have a few different parts of the demo that she’ll get into. And of course we’ll kind of pepper in questions and, you know, exploratory conversations throughout that, but that’s really our main goal. And then at the end, we can decide if we want to look at next steps and what that would look like or not. And that’s all I have for the agenda. Is there anything else that you guys want to make sure that we hit on or, you know, anything I’ve missed? I see some shaking heads. Feel free to shout out too if anybody thinks of anything. So this was, these are some of the notes that I took from the first call. I’m going to kind of run through a little bit of the current state. You guys, you know, confirm with me if this is still correct.
Lewis Elder (10:26) Actually, Cynthia, you just said, I think you said it was 26. You just answered this 22 to 24 clinics is under 200 providers. Mdstaff is the central credentialing tool you’re using today. Largest payers are BCBS, superior, ambetter, Veronica on the first call. You also mentioned like united Aetna being large payers for y’all, about a 90 to 120 day window to get credentialed and enrolled to get those providers, you know, enrolled with those and billable with those payers. And then I know y’all mentioned that you were not currently delegated but, you know, interested in potentially, you know, evaluating that as a future opportunity as well to get delegated credentialing through some of those payers. Does that accurately summarize the current state? Is there anything that I’m missing or anything else that would be important to call out?
Veronica Villarreal (11:19) Cynthia, I don’t know is 90 to 100, 20 days accurate? Or is it more 120 days?
Crc872 (11:28) It’s 120 days? Okay?
Lewis Elder (11:33) That’s good to know. Any other, any other tidbits there that’s helpful context for us? Okay? If not, we’ll keep going, then the way I tend to think about these calls is kind of like, you know, a group like y’all, you get to a point where you’re like, all right, well, we need to do something and it kind of comes down to two questions. It’s like why should we do something, you know, at all? Why should we do it now? And then the other question is like, okay, if you end up going with medallion, why would medallion be a good fit? So for the why now piece, I know as part of that, you know, long term arduous credentialing timeline. One of the things that I think it was Cynthia you talked about in the first call was how just data collection for onboarding new providers took forever. It basically just too slow. It was like 45 days or more is what you cited in the first call and then you would have a 15 day window for actually submitting the credentialing packet. Is that correct? So about a goal of about 60 days to get things submitted?
Crc872 (12:36) That is correct. Okay. Got it.
Lewis Elder (12:39) And obviously, we’d be looking to cut that down significantly. Another piece of why now would be the revenue impact for physicians who are basically on the bench. They’re being paid their salary, but they’re unable to treat you all mentioned. And I think it was Veronica mentioned this on the first call that you guys were having to have some conversations you would prefer not to have with the physicians on where things stood, why there were slowdowns? And it was just creating kind of an abrasive process for both the providers and for you guys individually in terms of the amount of manual labor you were having to do. And it seemed like the kind of provider abrasion of the process was a big area for improvement. Does that sound correct that?
Crc872 (13:28) Is correct. A lot of the delays occur within the onboarding process, trying to gather that information directly from the providers, the turnaround. Once we get it, I mean it goes, you know, within 24 hours, it goes overnight, a lot of it is done electronically. A lot of the first source verification go out the same day, we get everything submitted to us, got it. But we do have a short window we’re working with and usually puts us at about the 60 day mark.
Lewis Elder (13:57) Okay. That makes sense. I know another question that Bijan and the team asked was, you know, if you guys had identified like a quantifiable dollar amount of like revenue that this kind of delay in credentialing was holding up. It didn’t seem like there was one yet something to keep in mind as we continue to evaluate.
Lewis Elder (14:14) If that is there is a quantifiable amount there. It’s always helpful to kind of benchmark that because that can kind of clearly show some of the impact that a solution like medallion can have. So just something to keep in mind. And then I know another area that was lacking was kind of physician like visibility into the process. Their current status. I know Bijan and team talked about how with medallion, the physician can see exactly where they are in the credentialing process. And it seemed like their lack of visibility into that process was a bit of a pain point for them today. With your current system… anything else that I’d love to just open it up? It basically seems like the state of the state is things are too slow and too difficult and you guys are looking for someone who can make it easier and faster. Is there anything that three of you want to call out specifically as to really what you’re looking for in a solution? Is it just let’s get something that can, you know, give providers billable as fast as possible and reduce the burden on your team? We’d love any context there just, you know, qualitatively from the team. Yeah.
Veronica Villarreal (15:23) Less manual, less manual workflows, less errors for like dropping it in someone’s hands where it’s more seamless, and it could be tracked from every step of progress of where it’s at. That would be great. I.
Crc872 (15:46) Can tell you what we’re currently doing because we’ve made some modifications to our processes and we implemented some, you know, two phone numbers for providers to communicate through our system. And so we’re able to communicate to them directly through a system. If we’re missing any information. The other thing is that we are in the process of uploading the applications so that we can do them in our system and they auto populate that information. We don’t have to go in there manually and entering, you know, filling out these forms. It pulls the data from our system. And so we’re loading those on there. That’s another one. And then the third one is that now with every health plan that they are enrolled in, once they’re approved, the provider will get a notification through our system that they’ve been approved for. Let’s say blue cross and blue shield, they’ll have a congratulations and welcome to the blue cross, you know, health plan. It’ll have effective dates and that’s something that we just implemented. So they’re getting that. The other thing that we’re working on that, that’s where we need more support in is to be able to pull the reports, the quality reports from our emr system. Our system has the capability to pull the oppe, and the fppe quality reports because those are something that are required that we run those monthly. And so other than that, you know, I would like to see because I know it was mentioned that you have a five day turnaround and I wanted to get a better understanding what that meant? You know, maybe you can explain, what that, what is the definition of a five day turnaround? Yeah.
Samantha Bouchard (17:52) And I’d like to jump in here, Lewis, because I just want to make sure that when I jump into the demo here shortly, I’m really guiding you through like the flow very similar to what you have today. So Cynthia, if it’s not too much, would you just mind kind of like starting at the top like a new provider gets hired and just kind of like walk me through what that process looks like.
Crc872 (18:15) Okay. When we have a new provider that’s onboarded and has signed the mou, you know, once that they have that agreement signed, we start working with that provider, it could be that the provider is not going to start for another six months. We start working with that physician. We know that in six months, it’s going to be their start date and try to collect the data. A lot of the times our biggest delays are the ones that have an out of state license, medical license, getting that transition over and getting them in Texas, or they’re waiting for their Dea license that holds up a lot or they’re on HB visas… those get delayed and holds us back. And so, once we have all of their documents, their claim history, you know, liability insurance education, all of that. Once we collect that, then we can go ahead and start with the onboarding process. But their caqh information, once we obtain that we start the medicare application process, medicare doesn’t allow us to send it any sooner than 60 days. So we start working on getting that submitted to them as quickly as possible. Once we never miss that deadline. We, we want to make sure we send it in plenty of time. Other payers don’t allow us to send it more than 30 days. So we still are playing catch up even after the provider becomes credentialed and approved, where we’re waiting for the health plans because they’re taking anywhere from 45. We have one plan that’s taking 120 days. And that’s where the delay is because we’re doing all the verification processes immediately. As soon as we start collecting the data from the providers, those are running 24 hours within 24 hours of collecting the data. So.
Samantha Bouchard (20:13) Those are all the prime. Are you running those primary source verifications automatically in mdstaff? Yes. So.
Crc872 (20:21) As soon as we have that data, we don’t have like an inventory that’s sitting there to be worked on. They get worked on right away because it’s you know, they’re working provider by provider today. They may have five providers they’re working on? They go from one to the other. And if they have all the information they’ll send it today.
Samantha Bouchard (20:36) And are you producing like a credential packet that’s going to a committee from those verifications? Yes?
Crc872 (20:44) Okay.
Samantha Bouchard (20:44) And what standards are you all following? Is it joint commission, ncqa? We’re.
Crc872 (20:50) following ncqa standards? Okay?
Samantha Bouchard (20:55) And are you running those to support delegated agreements? Or do.
Crc872 (21:03) you have delegated agreements today? No, we don’t have delegated. No, we don’t have delegated. Okay?
Lewis Elder (21:10) Yeah, that was something I think the three of you guys mentioned first call being potentially interested.
Crc872 (21:16) Yeah, being.
Samantha Bouchard (21:16) Interested in, sorry, no, that’s helpful. Okay. So, and then the out of state license, are you helping them apply for a Texas license or is that completely on the provider?
Crc872 (21:27) That is completely on the provider. They handle all of that. When it comes to us, we’re missing anything from them.
Samantha Bouchard (21:35) Okay, great. So you collect all the information, you’re running that packet to get an ncqa file. You’re passing the clean files along, anything that gets flagged. I’m sure is just going to a certain committee member for review. Yes. How often is your committee meeting today?
Crc872 (21:55) Well, we review those internally. Actually, it’s not a committee that reviews those documents once they’re reviewed and submitted and we approve them. They go to our medical executive committee for approval of appointment. So we’re doing all of that verification.
Crc872 (22:17) Okay.
Samantha Bouchard (22:17) Great. And so that’s kind of happening. And then you’re also starting these medicare enrollments, you’re then starting the commercial enrollments, are those getting automatically generated in MD-Staff for you? Or is there some manual intervention from your team?
Crc872 (22:31) We have some that are automatically generated, okay?
Samantha Bouchard (22:37) And then some that just require some like the portals you guys are filling out?
Crc872 (22:42) Exactly. Okay.
Samantha Bouchard (22:47) And just… so I understand, and I’m sorry if this is repetitive Cynthia, thank you for appearing with me… like the appointment piece. So, are you all like granting privileges internally to your own facilities? Is there any type of like hospital applications where you’re trying to get privileges at other partner entities?
Crc872 (23:15) Yes, we do have nine hospitals currently in the area. And so we do also assist with getting the privileges for those hospitals as well. So simultaneously, we’re working if the provider is going to be a provider providing services at a hospital or ambulatory surgical center, we will work with that or company or that hospital to ensure that they’re credentialed as well with them. So it’s all part of the packet one. Are they going to be, you know, needing hospital privileges? Yes? Or no? And then we collect the data.
Samantha Bouchard (23:50) Okay. That’s… super helpful. Louis. I think I just have a better clear understanding of the flow. So I can really align the demo in a way that I think will resonate with the team. Did you have any other questions?
Lewis Elder (24:07) I think that’s mostly it, I don’t think the privileging hospital applications came up in the first call unless I’m forgetting that’s something we can help with as well, so we can talk more about that. But I don’t think I have any questions. Yeah, Sam. I think I’m good to hand it off to you.
Crc872 (24:26) A lot of our hospital privilege applications go electronically. I think we have one hospital that’s still on paper, but most of them go electronically… and.
Samantha Bouchard (24:39) Do you have any like technology Cynthia, that’s like populating those? Or is it just kind of manually being added there? No?
Crc872 (24:46) It’s technology through mdstaff. It’s auto populated. We just have to set it up for the very first time and then we can pull the type of, you know, which hospital we are providing that access to. Okay. Awesome. Great. All.
Samantha Bouchard (25:03) Right. Well, we’ll get into the demo now. I really want this to be conversational. So Cynthia, you know, it sounds like you’re kind of in the weeds with a lot of this. So we’d love to hear kind of how things really compare to like your current workflow. And then Veronica and Marivel, if you have any questions at all, kind of how we’re doing things, how we’re using AI or if there’s anything in particular that you’re hoping to see, please chime in. So in the time that we have, I really want to just kind of highlight our core provider offering, which is just really our data management solution. It’s the data architecture that allows us to do all of these downstream functions as you all know, like data collection is the first thing sometimes the hardest thing to do. And so we have really built our data architecture in a way that is really streamlined, really easy for you all to access data, see analytics, pull data from the system as needed. And then also supports credentialing payer enrollment, hospital applications downstream as well. So I want to focus on that. I’ll also show you how we reduce data collection from that initial provider onboarding piece from what takes some organizations 30 plus days to on average two days. So we’ll look at how we’ve really used our technology to decrease that. And then really how we speed up the provider enrollment process, getting those applications out the door quickly with less errors, ultimately accelerating that revenue for your team.
Samantha Bouchard (26:43) We also have a hospital application piece. I don’t think that we’ll have enough time to get to that today, but we can certainly schedule additional time to look at that piece, if that sounds good? Anything else that you were hoping to see today that I didn’t mention? Does that sound like a good plan for you all? Yeah.
Veronica Villarreal (27:05) Okay. Awesome. Cynthia. Was there anything else? I mean, it probably won’t be able to be on this call? You had mentioned you’re getting extra modules from mdstaff. Do you want to let Samantha know? Yeah?
Crc872 (27:23) It’s that oppe and the fppe that we’re getting those are the modules for the reporting, the quality reporting?
Samantha Bouchard (27:32) The, yeah, the fppe, whatever, how do people say those? Okay, yeah, we can definitely, we can definitely touch on that. That has actually, I’m sure Jake and Louis, you’ve been hearing this too has been coming up more and more in conversation. So we will, we would love to hear more about that, Cynthia.
Samantha Bouchard (27:52) All right. And so what you’re seeing here is where is our core platform? So this is where all of the data lives. This is going to be a single source of truth for you all. So this really becomes your centralized system for credentialing enrollment, licensing, tracking, expirables, tracking and monitoring for all of your provider information as well as your payer contracts, group contracts, et cetera. We are going to, I’ll start here with the analytics piece. So I like to start here because it kind of shows all the data that we’re collecting behind the scenes really surfaces it for you in an actionable way. And then as we get into the demo, we’ll look at like the granular data that you have visibility into and how this is all populated. So specifically for payer enrollment, we’re going to give you that 30,000 foot view. This is all like live data that comes through instantaneously. It’s going to show you your enrollments month over month. It’s going to show you how those enrollments are flooding through the process. We track your enrollment from the time of submission all the way through to follow up. So we’d be doing that follow up on your team’s behalf. So that as soon as that par status is received, your team knows about it and can either release those claims or start scheduling patients for those payers. And so we’ll surface that here in a passive notification, we’ll actively notify you via email as well. And then overall just kind of looking at those different transition times as the applications are kind of flowing through the process overall. So just that high level visibility into any bottlenecks into any areas that you need to focus on. And one of the things I’ll say about working with medallion is sometimes some of these vendors that can be a little bit of a black box. And you kind of send something over when, you know, work with an end to end solution and you don’t really have that visibility. Whereas with medallion, we’re going to give you that visibility every step of the way. So I’ll pause here, Cynthia, compared to like mdstaff, and like the reporting you have available, is this comparable to what you have today? Anything jump out at you?
Crc872 (30:29) Yes, it’s comparable. I can break it down by specialty and department and user. And so it gives me a report of, you know, if I’m looking at specific department, I can break it down by the like I said, the department or the provider… got.
Samantha Bouchard (30:53) It. And Veronica, Marivel, is there any type of reporting that you don’t have today that the business is like really looking for or would be like a really nice value add?
Marivel Barrera (31:09) I think since… the last time that we spoke, I know that Cynthia and team have really made an effort consistently to automate more. So I’m even getting those emails, I can see it’s a welcome email. It’s from the team. It’s notifying the physician. Your enrollment with xyzpayer has come through like Cynthia said, you know, here is your effective date. I think that’s really that to me is one of the keys is making sure that through this process, we’re as transparent as we can be to the app. We’re onboarding, the physician, we’re onboarding and the chair, right? So this is a big piece for us because we’re not delegated yet. We’re working towards that. So when you’re not delegated, unfortunately, the time that you’re sitting waiting is much longer, right? So I think really transparency. But also too, I think an important piece is, and I don’t know any software that can help with this. But just, I think the physician that’s onboarding or the app doesn’t understand the part that they play to get this done, right? It’s not them and credentialing and enrollment. It’s me being able to work with them closely to get everything timed right? And so, I think that’s a gap that we’ve been working on. And so our new apps and physicians can understand the role that they play in this process.
Samantha Bouchard (32:50) Yeah… yes, yeah. It’s huge. It’s a huge, it’s a huge role. And, you know, we come across like white glove service teams like yours all the time where they’re really kind of doing a lot of this hand holding to get a lot of the provider data. And so when we get into the onboarding process, we’ll show how we’ve tried to access data sources that exist today, that providers are likely updating to kind of streamline this process for them and also then reduce some of that load on your administrative team as well. So thanks for sharing. We are 100 percent with you there so quickly, you know, we have a full report builder assistant here Cynthia. So with a couple of clicks, you can kind of pull any reports that you’re looking for in real time. You’ll kind of see all that data populate, you can export, save it. Of course, if it’s a report that you’re kind of like building consistently, we’d actually want to build that into our analytics tab for a dashboard. So you just have that at the tip of your fingers. But everything in our platform too, like all of these different tables, all of this can be downloaded and exported into a preferred format. So we do make it as simple as possible to really access all the data that we are storing on your behalf. Great. So excuse me, now that we’ve looked at this, let’s quickly transition into adding a new provider to the platform. So by entering a couple pieces of information from your team, we would send out an invitation to your provider. They are going to receive a welcome email which we can customize with your logo as well as your onboarding text. So Marivel, I actually came over from our implementation team. And one of the areas that I really work with my customers on is like really crafting this language to really align that messaging to the providers of like what their role is, how important this is, any kind of key dates that are like upcoming, just kind of one of the ways to really morph like your onboarding process with this tool. So it really streamlines that flow for providers. So we have the ability to do that. And then we are able to really walk them through a customized onboarding flow where we can help really kickstart their profile through a couple of different ways. We have OCR technology that can pull information off their resume and put it into the appropriate areas of the platform. That’s one option. If you’ve ever used turbotax and your W ii kind of everything kind of goes in the right place that’s the same technology that we’re utilizing here. But our most recommended and highly utilized offering to really kickstart the profile would be our integration with caqh. So we have a proprietary bi directional integration with caqh which is different. We’re actually the only ones in the space that have this and a couple areas where it’s different is we only need their caqh id. So sometimes tracking down their username, their password can be really challenging. So their caqh id is usually readily available. Something that is in their emails and easy to obtain in addition to their social security number and their last name. So with these three pieces of information, we’re able to pull in up to 80 percent of the provider’s profile. So documents, locations, all of that information. We’re able to kind of pull in today, which drastically reduces the level of effort from the provider. This is a maintained data source… attested to quarterly. So it’s usually maintained if not by administrators like Cynthia and teams, but likely by the providers themselves. So we have a lot of success pulling this information. And then what you’re seeing here is the provider’s profile. So once that information is in administrators do have access to kind of fill in any gaps on behalf of the provider. The provider’s main task would be to review the information that’s accurate, and then attest to the information that’s being stored. We have a couple of cool things that I’ll kind of show you. So that OCR technology that I mentioned, we have that available for documents as well. So rather than documents being sent via email, they can take a picture, say of their diploma that’s up on their wall, take a picture of this QR Code. It’s going to automatically get loaded in. And then we layer on that OCR technology to kind of pull that information into the right place in the profile. So really eliminating the back and forth emails, things get lost challenges. We also are going to clearly outline if anything’s missing in the profile as well, which should help the administrative process. And then they have access to any outstanding tasks that are available. With this technology. We are finding that we’re able to capture the entire profile data in on average two days. So really drastically reducing that initial onboarding time, Cynthia, you mentioned?
Lewis Elder (38:39) Getting data from caqh for MD-Staff. Is the data collection piece? Is that automated in the same way that Sam just talked about?
Crc872 (38:47) It’s automated, but we, one of our things that we do is we go in there, we log into caqh before we pull the data over. And so, yes, the data can be pulled from there and then vice versa. The data that’s in MD-Staff can also be transferred back to caqh.
Lewis Elder (39:08) Got it. That’s helpful. Do the providers have visibility into the MD-Staff like portal themselves? Or is.
Crc872 (39:15) it your responsibility? Yes, they get an invitation, they log in to complete their application, and they do get triggers if there’s something missing. And the nice thing is that we can chat with them through MD-Staff. We can communicate through text message, through messaging system. We just added that to be able to say, hey reminder because sometimes they won’t read their email if it goes into their email, but we can communicate with them. Got.
Lewis Elder (39:42) It, that’s very helpful. Okay. That makes sense. Yeah. Just trying to understand what the current process is. And it seems like because based on the conversation last time, I know y’all mentioned kind of at the top of the call that like you weren’t using the MD-Staff to its full capability. So, it seems like in the last month, you guys have met with them and I don’t know, purchased additional modules or they’ve just like helped you enable them for your current workflows.
Crc872 (40:03) I think a lot of it we already had, we just didn’t utilize it. The two marginals, you know, that I mentioned that we’re working on is a new project because it is important. It’s part of our, you know, credentialing and recredentialing and appointments and reappointments process. So we need those processes in place. Yeah.
Lewis Elder (40:25) Makes sense. I think we can then focus on Sam, maybe some of, the pay or enrollment piece because that obviously still is, you know, taking you guys a ton of time and causing a lot of headaches. So I think that would make sense as like, the next thing to show but, you know, anybody to shout, yeah.
Samantha Bouchard (40:42) Absolutely. I completely agree. So what you’re seeing here is our pay or enrollment request tab as an administrator where medallion is different is today with mdstaff. It’s more of a self serve tool. You’re kind of doing the configurations for the paperwork ahead of time with medallion. We are going to take everything on from end to end. So the way that we think about this is you as an administrator are the owner of the strategy. So, you know, who needs to be enrolled, where they need to be enrolled. We’d be looking for you to provide that information to us. So who’s the provider? What group do they need to be enrolled in? What payer? What state? Do they have a license, what payer? And then we’re going to store all of your group contracts kind of under that group. So with a click of a button, you can go ahead and auto select all of the payers in that particular group. If that’s what you’re looking to do for enrollment, you can type ahead. You can pick and choose the payer list if for some reason, it’s different. And then from here, you would associate any of the practice locations that you’re looking for. And there’s a couple other questions around application details and additional notes. If those exist from here, you hit submit and that’s really where your work ends and medallion takes over. So what we have and the way that we accomplish this is we have individual payer process guides for every single payer, you know, over 900 across the United States. We maintain these. We keep these up to date. This is going to include all of the prerequisites if there’s any dependencies. What that application method is, what those application steps are, what required documents are in order for this to successfully go through any follow up instructions, et cetera. So we have these guides. But where these guides kind of go a step further in our AI and automation really comes into play is we layer all of these requests in. So like the challenge of knowing you’re going to enroll a provider for X payer? And you’re like this is a blue ink signature or I need this additional documentation to support that. And you’re kind of going back and forth to the provider with the additional tasks. When we get those requests, we’re going to automatically generate those tasks because we already know what those requirements are. So right out of the gate, all of that information is being generated instantaneously. And then you have visibility into what those open tasks are and the provider does as well. Ideally, we have everything we need from the provider. Profile. We’re able to kind of move forward with the submission. So I’ll show you another place that our technology kind of jumps in here. So we have the form filling. So every single payer that has a form, we’re auto populating the form that seems to be on par with what Cynthia’s team’s doing today. Except you guys are kind of like manually maintaining that. But then we also have RPA technology with our portals. So here’s kind of a quick example where you can see this is like blue cross of Arizona’s portal. We’re able to log in. We’re able to fill out this portal with the information that’s required in the matter of, you know, under a minute or so and get that submission out the door. This is obviously ensuring accuracy because we’re pulling directly from the data. So there’s going to be no like errors as far as kind of copying and pasting information. We’re getting that out the door. And we’re letting you know each step of the way, like where exactly that is. We’re going to have notes associated with each line, kind of letting you know when those applications were submitted. And then once it’s submitted, we’re going to do that follow up on agreed upon cadence through AI phone calls, auto generated emails, manual, emails as needed based on the payer requirements. So that as soon as that par status is available, we are servicing that to your team. And we do that in a couple of different ways as it relates to the RCM area, right? So what’s important to RCM is, when is this provider active? What locations are they active with? And what’s that payer? And so a lot of our clients will integrate with this page specifically kind of pulling that billing status instantaneously into their RCM tool for those different practice locations, so that they are able to release those claims or begin billing as soon as possible. So I kind of just talked for a while. I want to pause Marivel. I see you’re off mute. Just curious if you had any questions or if anything stood out to you with the kind of process flow that I just walked through?
Marivel Barrera (45:47) So does this having this capability to do this? For example, blue cross blue shield is a great example. Have there been any studies or have you found from your clients that since they have adopted… medallion that enrollment window has shortened? Are they, like they said, it used to take us, you know, 60 business days to hear from blue cross blue shield. Now it’s down to 45 days.
Jake Shubert (46:20) Yeah, that’s a great question. Marivel. I can chime in here because I work a lot on that side. So, you mentioned frequent turnaround times of 120 plus days. Our average turnaround times across all payers, not just government but commercial included is 52 days. So it’s a pretty common thing for us to see that organizations similar to yourselves are having between 90 to 180 day turnaround times and see those get reduced far lower with medallion, which is obviously a lot of where our value comes in.
Samantha Bouchard (46:50) Something we.
Jake Shubert (46:52) can do Marivel, is if you share some of the priority payers, you guys have, you guys have mentioned a few on this call, we could actually run a turnaround time analysis on our side to do a direct comparison of what our turnaround times are with your exact payers today. So we can sort of share what we would forecast that turnaround time improvement to look like. Is that kind of in line Marivel with what you’re asking for?
Marivel Barrera (47:19) Yes, yes. I would say like blue cross, blue shield, Aetna. United.
Jake Shubert (47:29) It’s taking.
Marivel Barrera (47:30) a while, but, sorry?
Jake Shubert (47:34) Marivel, I missed the last pair you mentioned Aetna?
Marivel Barrera (47:37) United, cigna, blue cross, blue shield. Would there be anyone else, Cynthia, you think?
Crc872 (47:46) No, Aetna. I mean, it’s one of them?
Lewis Elder (47:50) Superior and better, I know that superior.
Crc872 (47:52) Yeah, superior.
Lewis Elder (47:54) And.
Jake Shubert (47:54) Cynthia, it might be a question for you. Are all those pairs around 120 days? Should that be what we’re looking at here?
Crc872 (48:01) No, right now, it’s blue cross and superior is taking probably about 60 plus days.
Marivel Barrera (48:10) Okay. I.
Jake Shubert (48:11) guess Cynthia, we could share this with you if we build out a little like spreadsheet just with those payer names. Would you be able to just maybe share what the turnaround times are for those pairs today? So we can make that direct apples to apples comparison. Okay. That’s super helpful and Jake.
Lewis Elder (48:26) Not to interrupt, but, yeah, Marivel, to your question that’s I mean, you’re asking basically like a big, maybe 50 percent or more of like why medallion exists as a company? Like are our, we are a good fit for groups who want to do like one of three things like accelerate revenue or like stop revenue leakage, reduce or keep flat opex expenses.
Lewis Elder (48:46) So you don’t have to like hire a bunch more credentialing managers and then reduce provider abrasion, and those three pillars. What we do like at the end of the day, one of the biggest things our platform does is shorten payer enrollment turnaround time. So, yeah, if we couldn’t do it faster than you guys could do it in house, we wouldn’t exist as a company. But it’s a great question. It’s it’s exactly like, you know, it’s the core to what we do, and we can, yeah, we can do a turnaround time analysis if we can get, those numbers, and kind of put together, you know, what that might mean, for your business? Yeah.
Jake Shubert (49:21) Maybe there’s one more question. I guess Maribel, if we are able to improve turnaround times by, it sounds like, you know, like what would the impact be to the organization?
Marivel Barrera (49:31) Well, that would be a significant impact, right? You know, as you said, I mean, I’m sure you can imagine some of these salaries that surgeons are paying or oncologists, you know, and so getting them to see the patients as soon as possible is really the goal, right? So… some of the payers like medicare of course, and medicaid, they’ll retro, yeah.
Lewis Elder (49:58) You can backdate yep, usually.
Marivel Barrera (50:00) Commercial don’t, what we’re finding is blue cross blue shield does not, yep. So we may have had a provider on board in November of 25, but they’re getting enrolled in March of 20 26. And so.
Crc872 (50:14) And.
Marivel Barrera (50:14) blue cross blue shield is, you know, it’s our largest payer and I would say in Texas, that’s what you’re going to see across the board, right? Blue cross blue shield, so.
Lewis Elder (50:23) Yep. That makes sense. I put some just, a case study link, in the chat. You’ll see that like, you know, across the case studies we’ve done, the theme is like we are getting the payer enrollment time significantly decreased for our customers. And like you just said, especially with you guys opening the oncology practice, like those are big salaries, right? And so our, what Jake and I can put together when we get those numbers like he just mentioned is basically like, hey, if we can cut down the payer enrollment time by 50 percent here is the, not only are you accelerating revenue that you would be waiting on otherwise, but like you just said, you’re not able to backdate for a lot of those commercial payers for blue cross blue shield specifically. So you will be earning additional revenue year over year, that you wouldn’t otherwise be able to access. And that’s like that’s core to, you know, basically, what medallion sells, what we offer as a company, is the ability for you guys to capture that revenue that you’re losing right now? Oh, go ahead, Jake. Sorry.
Jake Shubert (51:20) Oh, I just have one more quick question, sorry, Cynthia, because it sounds like you’re doing so much of this enrollment work yourself or overseeing so much of this work yourself today. We’re just curious for your feedback on when Sam went through the demo and showed just sort of the, you know, five or 10 clicks that it takes to submit an enrollment. And then it triages the workflow where the rest is done inside of medallion. We’re sort of curious for your feedback and how that compares to kind of, your day to day. Well, I.
Crc872 (51:44) Couldn’t tell you with all the payers. But I really was impressed with the one you just worked on, which was blue cross because I was pretty quick to pull it, you know, pull the data and send it off. Our problem here with blue cross in Texas is that the it’s not when they’re getting the information or how long it takes for them to receive the application. It’s how long it’s taking them to process the application. So we can get it out the door right away. It’s how long the payor is taking to process this, and we don’t have any information that’s missing the information. We know exactly what they require for all of our provider types and specialties. And so it’s just a matter of processing time.
Lewis Elder (52:31) Yeah. And I can.
Jake Shubert (52:33) Go ahead.
Lewis Elder (52:36) The one thing I was going to mention there is there’s like a couple ways as to how we speed up the payer enrollment process. So one would be like the actual collection of the data, but it sounds like that may be somewhat similar now that you’re using the mdstaff automation. The other two are that because of the scale of medallion, we do like over 100,000 payer enrollment apps per year. We have direct relationships with many of the largest payers in all 50 states and they allow us to submit via roster which is something they don’t let smaller groups do alone. So you can submit via the medallion roster, which often speeds it up. There’s a good number of payers like optum and some others that are our direct customers. And then the other thing is that in our platform, we’ve actually built our own payer repository where we’ve mapped out specific payer requirements of over the 900 plus payers across the country that we support. So what that means is that, and we also have a team of like nine people that, that’s their entire job is to basically just like keep up with any of the changes like blue cross makes like if they make some small change, like we pay people up salary to basically note that change and build it into our platform. And so what that means is that we can be confident that when we submit those applications, there will be no bounce backs. And the payer repository includes all the information on like what follow ups are most effective to get responses from payers. So if we know that like blue cross, blue shield responds best to like a phone call on day five and an email on day six or something like that. Like we literally have like a guidebook, you know, for our internal employees and all that institutional knowledge to push those things along. And so those are just to give you an idea of like because, you know, we’re saying like, hey, well, we can shorten your timelines but just to give you an idea of like how we do it. So it’s all of that work goes into cutting, that payroll timeline down.
Crc872 (54:21) You mentioned the ralster. How does that work? I mean, how do you process the application using a ralster?
Lewis Elder (54:31) Sam or Jake, you guys are more experts in that than I am. Yeah.
Samantha Bouchard (54:36) So, in those cases where we have a roster, it’s really through the same flow Cynthia except that, you know, rather than us saying fill out the portal, fill out the paper form, we’re just kind of dumping onto a huge roster and then ingesting that status back from the payer. So, just a unique setup that we have that allows us to streamline and reduce some of this processing time.
Marivel Barrera (55:04) Christine had mentioned that your average is a 52 day turnaround. So that’s an average. So it could be better, it could be worse. What’s the worst case scenario that y’all had? And then the best case with blue cross blue shield or other commercial payers?
Lewis Elder (55:22) I don’t know, Jake, do you? Yeah, I?
Jake Shubert (55:25) Can I can try to pull that up for you? Marivel, since we do so many enrollments that average is… like if, there’s a pretty large sample size there. So we’re typically pretty close to the pin. I was pulling some research as we were talking just for the blue cross blue shield example. And over the last 12 months, our turnaround time for blue cross blue shield and techless is 62 days. So, we would be looking around cutting your timelines by about half.
Lewis Elder (55:52) And, and I can look, we can do some digging on like, you know, if there is a, you know, outliers to a certain degree or something, and have that like, you know, honest discussion with you guys, but it should be, you know, with like Jake said, it’s a considerable amount of applications that are going into that median time. So, but we can, of course, look at that as well… if.
Veronica Villarreal (56:11) you, are able to do it faster? David told me because you all are certified in something.
Lewis Elder (56:18) I’m not sure we’re CV. Well, I’ll let.
Samantha Bouchard (56:22) You, we are an ncqa accredited cvo, Veronica, which means that if you were to pursue delegated agreements, we can get those enrollment turnaround times down to on average one day. So that’s really where the speed comes in as well. Oh.
Veronica Villarreal (56:41) It is, yeah.
Samantha Bouchard (56:42) Because we would be your subdelegate and so what a lot of groups do is they start with us for payer enrollment. We offer support to get you those delegated agreements. And so typically getting delegated on your own requires getting an ncqa accreditation. It requires setting up policies, procedures, committees. There’s like a lot to it. With medallion, we actually have all those policies and procedures. So you really leverage us as your subdelegate to help you get those delegated agreements. And then we would be producing those ncqa accredited files for you. And on average, one day which allows you all to kind of submit those rosters to the payer and then take what, you know, your 120 which you could get down to an average of 54 with medallion to start. Then you’ll start to pull some payers down to that one day turnaround time, which obviously is.
Veronica Villarreal (57:33) huge. Okay. That’s probably what he was referring to. We just, we have our new CFO. So when we were having these meetings, I don’t believe she had started with us. I would think she would be the one that asks more questions.
Lewis Elder (57:56) But.
Veronica Villarreal (57:58) I don’t know Mari if that’s… I think that would probably be the next stage is getting her on. She’s really wanting to push delegated. Cynthia is like our expert guru, but she’s also, we only have one Cynthia. Yeah. So we’re going to need the help. Yeah, but she’s the money person. So she would be the one that says, I think yes or no for this.
Lewis Elder (58:32) Yeah, we can medallion’s goal would be to basically make it seem like you have 50 Cynthia’s and then we can, yeah, I think that would be the right next step. So what we can do is, if you can connect me via email or we can set up time directly with your CFO. We can prep internally before that and basically look at your current turnaround times and build out kind of a cost analysis of, you know, here’s the impact that medallion could have and we can talk credentialed delegation with them as well. And what that would look like from both an operational standpoint, and like a partnership agreement go from there.
Veronica Villarreal (59:06) Okay. And that would be, I think Mari would take the lead. I’m just the introductory person because I, so Mari works with the CFO, but I would assume Mari, right? That would be the next step. Yes, I would.
Marivel Barrera (59:26) Need to talk to her. I’m sure she would want to see a demo and I think if we, I think what is the most appealing thing to me is this, I think we have to partner on that delegation because… I agree that’s going to be because I think what we’re doing is so comparable. Yeah.
Veronica Villarreal (59:53) And we want it sooner than later. So sooner than later takes a team, yeah, that we don’t have.
Jake Shubert (60:02) Yeah, if they’re looking for sooner than later, it’d be really important for us to chat about this with them because without leveraging us, you guys would need to go through ncqa accreditation process yourself, which could take between like one to two years. So leveraging medallion to have that ncqa accreditation instantaneously would be a pretty big value driver for them?
Veronica Villarreal (60:23) I think she knows that because she told me she’s like if we even get to delegate it. So I’m thinking she knows how long it takes. So, I mean, I think she would be interested in hearing at least hearing this.
Jake Shubert (60:40) Yeah, absolutely. I think we would think about this as like a crawl walk run approach, right? Where it’s like as we’re working on delegation, we’re getting your non delegated pay enrollment, turnaround times down from that 120 to 50 60 in that range. And then once delegation comes in since we’re already working on that in the back burner, then those go down to the one day timeline Sam was talking about. So I think we’re speaking about this the same way, but that’s kind of like the life cycle of how this would go.
Veronica Villarreal (61:06) Yeah, because the details, obviously, she wouldn’t that’s Cynthia and Mari, but like key points of what she is going to, probably, I don’t know her priorities right now. So I think it would be the best to like have a conversation with her, see if this is one of the biggest ones. And like what quarter she’s going to want to like roll this out or not? Or I don’t know, get two other vendors to see what they do? Yeah, makes sense.
Lewis Elder (61:42) Yeah, really helpful. And yeah, we’re happy to chat with her. Mari, would I just work with you to schedule something I can send over our availability? And we can pick a slot to meet with her, at least like start the conversation, talk about it down and talk about delegated credentialing? Yeah. Okay.
Veronica Villarreal (62:01) She has an assistant so Mari can include her. I think that would be the fastest way. Okay? Any other questions? This is great. I mean, I… don’t know how much it is. I don’t know, I hope that wouldn’t be like the breaking?
Marivel Barrera (62:22) Point there. Yeah.
Veronica Villarreal (62:24) Sure. So. But that would be her. Okay?
Lewis Elder (62:28) Perfect. Yeah, we will definitely, you know, we’ll work on, you know, pricing with her and, you know, we’ll find something that’s agreeable for both sides if we get to that point.
Veronica Villarreal (62:36) Is there any?
Lewis Elder (62:37) Other questions that y’all have, I know we’re a little over time. We’re happy to answer any. Okay, what we’ll do then next step. So, Mari, I’ll just shoot you a quick email you have, you can either, you know, connect me with their executive assistant or whatever’s best to get something scheduled. I’ll get started on that. And Cynthia, I will send you just like a it’ll literally just be like a few rows on an excel sheet. If you can plug in your turnaround times for those payers. We can get started on our, we call it like a business value assessment because that’ll be important for the CFO to see too. That’s like common for us, we’re always presenting that to a CFO to basically say, hey here’s. The impact on the business. We can have now. And then as we work toward credential, getting you guys delegated here’s, the impact that we would have once you’re delegated as well, so they can have, you know, full context to make a decision on whether they want to go with medallion or not.
Crc872 (63:27) Okay. I think I can run an aging report on mdstaff. I haven’t run one lately, but if I can, I’ll send that to you, but go ahead and send me the spreadsheet.
Veronica Villarreal (63:37) Okay. That’s great.
Lewis Elder (63:39) Sam, Jake, anything else from you guys?
Crc872 (63:42) Oh, nothing. Thank you all for the time. It was so nice to meet you and appreciate the conversation.
Veronica Villarreal (63:48) Likewise. Thank you so much.
Lewis Elder (63:49) Yep. Thank you. All all right. Take care, folks. Bye bye. Everybody.