Transcript
Bradley Eral (00:00) hey, josh, can… you ask granola… who is on the first call? Yep? I know Karen was and Nicholas, but there’s one other woman.
Cindy Howell (00:28) I can’t hear you if you were speaking? Oh, there we go.
Bradley Eral (00:33) I was on mute classic. How are you doing Sydney?
Cindy Howell (00:36) Good. How are you?
Bradley Eral (00:38) Doing well, appreciate you jumping on. Yeah.
Bradley Eral (00:55) Any big plans for the upcoming weekend?
Cindy Howell (00:59) No, I have to, it’s not exciting plans. I have to help my mom clean out a storage unit. So, you know, fun stuff.
Bradley Eral (01:09) Yeah, no kidding. Did you, ever, have you seen that show? Storage wars?
Cindy Howell (01:13) Yeah.
Bradley Eral (01:14) Maybe you’ll find some hidden gems in there. You never know.
Cindy Howell (01:18) Maybe it’s going to be a lot of trash. I have a feeling.
Bradley Eral (01:21) Yeah, no kidding. Well, godspeed on that front. It looks like Lindsay’s on as well. Hey, Lindsay.
Lindsay Alfke (01:33) Hello? Good morning. Good.
Bradley Eral (01:35) Morning. How are you doing today? I.
Lindsay Alfke (01:37) Am. Well, how are you?
Bradley Eral (01:38) Doing well. And Lindsay, where are you calling out of?
Lindsay Alfke (01:43) I am in union Kentucky, actually. Oh,
Bradley Eral (01:47) that’s awesome. Yeah. Looks like Kyle’s on as well. Hey, Kyle… actually, I’ll be in Kentucky next weekend for a wedding. We’re like Cincinnati, but we’re staying on the Kentucky side with family out there. Oh, that’s.
Lindsay Alfke (02:08) super close to where I am. I’m about, I don’t know half an hour away from Cincinnati.
Bradley Eral (02:13) Okay. That’s what I was thinking but my Kentucky geography is up to date. That’s awesome.
Lindsay Alfke (02:20) Yeah, Newport, Covington’s right across the river from Cincinnati. Yeah.
Bradley Eral (02:26) That’s awesome. How’s it going, Kyle?
Kyle Mccall (02:30) Good. How about you guys? Can you hear me okay?
Bradley Eral (02:32) Yeah, we got you. Appreciate you jumping on.
Bradley Eral (02:43) And how about yourself? Kyle, where are you out of?
Kyle Mccall (02:45) I’m here in sarasota. Florida.
Bradley Eral (02:47) Oh, beautiful. I am out of Minnesota, so, not quite Florida by any stretch of the imagination, but I love getting out there when I can.
Kyle Mccall (02:59) Yeah, I’ve been up there a lot. My wife has a ton of family in Minnesota.
Bradley Eral (03:03) Oh, is that right? Whereabouts?
Kyle Mccall (03:05) I couldn’t tell you to be honest, I.
Bradley Eral (03:07) don’t remember the,
Kyle Mccall (03:08) name of any other place… but, yeah, out in the country, not a lot of people you.
Bradley Eral (03:14) Know. Yeah, too. Funny. And we’ll give Karen a few more moments here. Obviously, I’m sure. She’s on back to backs per usual, and then we can get some introductions.
Bradley Eral (03:31) But I guess you know, in the interest of time, what we can do, obviously, Karen knows you guys and she’s met us before, so I think we can jump through introductions and we can kick off the kind of demo and presentation when she jumps on. But with that said, Kyle, I will have you lead the way from an introduction standpoint, since.
Kyle Mccall (03:48) You’re off mute. Yeah, for sure. So, I’m Kyle Mccall again the director of us operations for the rcms team. Nice, primarily my role is with our relationship managers and working with customers directly.
Bradley Eral (04:03) Amazing appreciate that, Kyle. And then Lindsey.
Lindsay Alfke (04:06) My name is Lindsey alfke, and I’m our director of rcms customer operations. So I oversee our credentialing onboarding solutions consulting and focus on kind of process development and procedural type things.
Bradley Eral (04:21) Perfect. And.
Cindy Howell (04:23) I am Cindy Howell. I am the manager for customer onboarding. I work directly underneath of Lindsey to ensure that our customers get implemented within rcms, you know, effectively and efficiently for credentialing and just our rcms services in general.
Bradley Eral (04:40) Yeah, no, great to meet you, Cindy. And yeah, I think we have a good perspective because obviously, Lindsey owning the credentialing function and the output, Cindy, seeing like, hey, the impact that could have an implementation then of course, Kyle, any customer friction or excitement that may come from that, but with that said, Karen, it’s good to see you again. For those that are new, hello? Good morning. Good to see you. For those that are new to the conversation, Brad, Erol, director of strategic partnerships. What that means is I work with many of your peers to help them evaluate medallion as an option, help them determine if there’s alignment with where they’re trying to go. We also have josh levitan on. So josh I’ll have you introduce yourself?
Joshua Levitan (05:17) Yeah, thanks, Brad. Pleasure to meet all of you. I ride shotgun here along with Brad, but a little bit more of a technical context, Lindsey, you manage the solutions consulting team. So you probably know the drill here, but I’ll be leading demos, working on sort of the technical and process intricacies of the conversation.
Bradley Eral (05:37) Perfect. Well, that said I’m not going to endate you with slides, going to walk through a few, and then we’ll jump to the demo. But ultimately the goal today guys is want to provide you with enough information about medallion. So you can very easily and comfortably determine is there enough alignment for us to keep talking or not? And obviously want to get your perspective on some of the challenges the team’s facing with the new faces in the room. But with that said, can you see one screen? All right?
Lindsay Alfke (06:02) Yes, I can see.
Bradley Eral (06:03) Perfect. So for those new to medallion from a medallion perspective, essentially, we tackled the challenge of credentialing and enrollment. I’d say fundamentally different than anyone else out there where we’ve taken a hybrid approach of, you know, automation and AI in every possible facet that we can. But we also have a team of experts that sit behind the scenes where supervision is required and the output. Like what matters here is that we contractually commit to how fast this work is done for all of our customers. With financial implications. If we were to miss our slas, like there’s actually teeth behind the turnaround times that we guarantee. And ultimately, we do this better faster and at a lower cost than anyone else out in the marketplace and hit thresholds. We haven’t seen anywhere else, whether that be with third party systems or some of the largest health systems in the country, right? And what this means to our customers and to you guys is first off, we accelerate revenue, look at the end of the day. Providers are revenue producing assets for your customers. And if we can get them delivering reimbursable revenue, faster, huge impact to the RCM function. Of course. But also as I understand it huge impact to your ability to implement and get your ehr customers live. The next piece is reduction of opex. Recognize that hey, today, it’s a fairly lean team, right? But as you roll this out to as like a bundle including all your new offerings, essentially medallion will enable you to scale with technology opposed to people and have to continually add headcount as you scale. And then the last piece is just an improved provider experience for both. Obviously your customers. And then, you know, Kyle on your side like let’s make sure that credentialing doesn’t become a point of friction. And as we all know, like oftentimes current state is the customer’s fault why there’s denials. It’s they’re owning the credentialing process, but they blame you guys at the end of the day, they don’t care whose fault it is that.
Karen Baker (07:54) Happens to other people as well. I thought that only we were the ones that got blamed by our customers. I didn’t know that other people got blamed by their customers for things the customers themselves were supposed to do. I had no idea.
Bradley Eral (08:06) Exactly. The customer is always right, right? They can do no harm, but I want to pause here. Quick, would love to get any first off, answer any questions thus far and then get some of the team’s feedback on like, you know, do these align with some of the things that you’re trying to drive for? Maybe we’re missing some of the key focal points here.
Karen Baker (08:27) There are questions on my end.
Lindsay Alfke (08:31) Beautiful, no questions here.
Bradley Eral (08:35) Perfect. So I did want to take our previous conversation to still at least like, hey here’s, what I captured, right? And want to get your feedback. Does any of this look off size? Were we missing anything? But really the situation as I understand it is today, it’s a fairly manual credentialing process, right? And the challenge is because it’s so manual, it can oftentimes lead to, you know, delays. And as we discussed, this can impact the ability to collect revenue. It can impact the customer experience. They blame your team for potential denials. And then csat is implicated as well. So ultimately like our position here and our belief at medallion is through this approach of automation technology, we’ll put you in a spot where turnaround times are now a differentiator for organization. Customers are now like credentialing candidly is something you never hear about. I think if it’s out of sight out of mind that’s job well done. And then all the revenue implications that will come for that. But I’ll pause here. Quick. Anything off sides? Are we missing anything as far as current challenges you’re seeing today? I think we have obviously some unique perspective of all facets of the business on today?
Karen Baker (09:41) No, I think that’s those are good points on the left.
Lindsay Alfke (09:46) Awesome. And.
Bradley Eral (09:50) then I guess Lindsay and team especially Lindsay kind of owning this function today would love to get your perspective like look, let’s fast forward six months from now, medallion or other. But you find the right partner for the business. Like what would success look like? What would let the team know that? Hey, this was a successful project in your eyes? Yeah.
Lindsay Alfke (10:10) I think overall, we just want to drive more efficiencies with more automations. We need good dashboarding reporting and analytics capabilities. One question I do have, and I know Cindy you typically bring these up on the calls when we’re reviewing these types of things, but is there any integration with caqh?
Bradley Eral (10:31) Yeah, there absolutely. Is. Actually, it’s a fairly unique integration. Josh. I’ll have you touch on the participating org status? Yeah.
Joshua Levitan (10:40) We’ll get into this and see this a little bit more in the demo, but we have a relationship with caqh that.
Bradley Eral (10:47) allows.
Joshua Levitan (10:48) us to natively pull data from caqh’s platform using only a provider’s caqh id. So we’re not going to ask them for their username or password, just their id number, which is different than other organizations. And with that id number, we can trigger an import of literally everything in caqh. We’re going to talk a lot about this when we’re talking about how a provider gets onboarded to medallion, because obviously, there’s a huge time savings component there. And speeding up that beginning part of the process speeds up the overall process and helps us get to actually submitting applications to payers a lot quicker.
Lindsay Alfke (11:23) What about being?
Cindy Howell (11:24) Bi directional where you can, they have a, you know, a bunch of locations or things that we need to add. Is there a way for medallion to talk and input back into caqh into their profiles? Yep?
Joshua Levitan (11:37) Absolutely. Is that something you guys do for them right now or do they do on their own like a practice manager would go in or you guys do it?
Cindy Howell (11:43) We update all of that information and maintain it?
Joshua Levitan (11:47) Probably the least fun activity of everything that we’re going to talk about, right? It’s like caqh takes like eight seconds to load between pages. It looks like it was built in the nineties. Yeah. So we take that off your plate as well. We’re going to manage any medallion essentially becomes the source of truth for all credentialing related data and changes that need to be made are going to happen in medallion first. And then we will push those back to caqh that’s also an automated process. From a technical standpoint. It works a little bit differently. It’s actually a bot that logs in on behalf of the provider instead of an API push, but the outcome is the same, which is no human is involved, but caqh is updated. And in addition to that, in addition to like the actual data being updated, we handle the attestations in caqh on behalf of providers. So we do ask the providers to test once a year in medallion, right? Because we need to make sure that the data at some point in time is good. But then those quarterly attestations that you have to do right now for providers or providers are doing themselves that work goes away as well. So you’re never going to miss one of those. And there’s never going to be any implication on like… an enrollment being denied because caqh was out of date or something like that. So short answer. Yeah, bidirectional. Thank.
Lindsay Alfke (13:04) You.
Cindy Howell (13:05) Awesome.
Lindsay Alfke (13:10) I think some of the other things that just like high level what we’re looking for like automated source verification across different licensing boards, that type of stuff alerts, provider alerts, configurability for role access to the system, those types of things as well.
Joshua Levitan (13:29) Perfect. Yeah. Let’s break into that a little bit more Brad. Actually, if you don’t mind that last point, Lindsay, the role access piece there’s the normal conversation around, that conversation then becomes a little bit more layered with like your relationship with your customers. So when you raise that as something you’re thinking about, can you describe like what an ideal state would be for you there in terms of like sort of the role based access or the splitting of data?
Lindsay Alfke (13:57) Yeah, I think it’s really more aligned and I’ll let Cindy and Kyle weigh into kind of with their perspective, but I think there’s two things. One, well, I guess the question I’m going to spin off with a question here, is there portal access for providers? Yes. Okay. So portal access for providers… like read only, right? So if we’re doing like training for staff and we’re demoing the system, those types of things I think ability to, and I don’t know if this, how this works, I guess with medallion, but if we have to update certain settings or things, I don’t know if that goes directly to you, but I think like administrator rights to update or build or do things that we need to do within the system at maybe a supervisory level versus individual contributor level, just flexibility with that, Cindy.
Joshua Levitan (14:47) And Kyle, and are you thinking about that in context of like your team helping your customers or like those different permission sets within the customer’s organization themselves or both?
Lindsay Alfke (14:59) Probably both?
Kyle Mccall (15:00) Both. Yeah. What I would say on that front, Lindsay is just thinking about levels within our organization and our staff doing the work right for the customers, but then also probably levels within the customer as.
Joshua Levitan (15:12) Well, right.
Lindsay Alfke (15:13) Yeah. So.
Joshua Levitan (15:14) This is an important context that I think will help inform the demo right now. If I’m one of your customers and I hire a new provider and I want to get them enrolled with the 10 payers. I work with, what is like my next step? What do I do? Do I reach out to you? Do I put that in the system somewhere?
Kyle Mccall (15:30) Currently, we have a,
Cindy Howell (15:32) process that we have internally?
Joshua Levitan (15:37) Okay, Karen, I think that was the Salesforce?
Lindsay Alfke (15:39) Process. No, it’s an email? Yeah.
Karen Baker (15:43) So, yeah, definitely. Correct me, Cindy and Kyle, but I think, is it a Salesforce? If they’re an established customer as a support tech, it comes in through qcc that routes over to someone. But then there’s still like a human being that gets involved in there somewhere that then converts that into submitting via our current technology partner and then starting that process with whoever those providers are with whoever their therapy practices to say. All right now, let’s start getting all of your credentialing information together so we can start submitting. Okay. So it’s basically a support task for a task. Yeah. Right? Like you could not take action off of that single support task fully you would then there’s still a bunch of human stuff that needs to happen in order to be able to start the credentialing process.
Joshua Levitan (16:27) But that’s one of the reasons Karen, why in the last conversation, you had made an emphasis of Salesforce service cloud and how important that is to the overall landscape? Okay? That makes sense.
Karen Baker (16:36) Yeah. Today, that’s how we do it, right? And we’re open to whatever this technology partner would enable us to do. We obviously want the most seamless experience possible. And if it means we back end our way into a support ticket versus front end our way to a support ticket where we can be, we can be creative with how we do that. But that’s.
Sonia Lucas (16:54) how we want our existing customers to interact with us is through that support mechanism? And.
Joshua Levitan (16:58) Do you find, like if we, and I think this will make a little bit more sense when we get into that? But if we hypothetically had a way for your customers themselves to just directly put into a system, I want to get this person enrolled with these 10 payers ready set go. And both the technical plumbing and the human interaction on your side was removed. Do you see that as a value point? Or do you think that there’s value in you, your organization in some way being part of that process for like advice or guidance or consultation? Do?
Sonia Lucas (17:37) You, I have a question on that actually. So one of our, can you guys hear me?
Joshua Levitan (17:45) One.
Sonia Lucas (17:46) of our main challenges is getting the actual information back from the customer, whether we’re interacting with them, and we don’t have that mechanism where they actually, they can input information into a sheet. The other secondary to that is that they feel like sometimes they give, if it’s a let’s say a brand new customer. So they’re not already, in our ehr, they feel like they’re having to give information to two different groups, our implementation group, and then us later a little bit downstream. So, the, my question is what do you all see in terms of?
Joshua Levitan (18:25) That.
Sonia Lucas (18:26) as a blocker and how do others that are using your system kind of get around that? Do you see success if they have actual direct interaction in, into the system? And do they take ownership of that? Because whether we’re meeting with them hounding them down for the information that is a big barrier for us? Yeah.
Joshua Levitan (18:48) Yeah, great question. Appreciate you. Something. Sometimes I do on these calls is turn a question right around to the person that asks it?
Sonia Lucas (18:57) Because I think we can do it either way. Yeah, we want to move to a way that’s going to make us more successful in getting what we need. So, I think that’s where I’m coming from with the question, yeah.
Joshua Levitan (19:08) I think the best model that we see, well, let me copy out this by saying, I know that there are three different products within your org that serve different size groups. And so I don’t think this is necessarily a one size fits all approach, I think… as a general statement though, we can talk about how this might play out in the different size groups, removing like having to put a ticket and then ask your team to go and do something like giving the customer the access like the ability to make requests on their own. It just removes like if you mapped out, the process map of what you described, right? Like there’s a lot of work whether it’s technical work or human work, that every transition point has room for error. It slows down the process. So, I think it’s important with what other customers that we see that your team is involved from like an oversight standpoint and is fully in the loop from a visibility standpoint, if there is some sort of like escalation or if the customer needs help or sort of more of like a customer support motion. But at steady state, the best way is that your customers just transmit directly the payers that they want to get. And like they kick that process off directly themselves and sort of removing the middleman, but they know that when you’re doing that, you are still part of the process, right? Like it’s still at the end of the day, a reflection of you and your company and your brand, and extension, of your services. So getting a little bit long winded. But I think Brad, I’m curious if you have other thoughts too about how you think, this is, we’ve seen this best. And if no, I.
Bradley Eral (20:46) I think you’re spot on and Sonia, what you’ll see in the demo is we make it like we’re going to collect this information that’s required for enrollment and credentialing if it exists elsewhere. We’re going to collect it first before reaching out to the provider. So essentially make the collection of the information as easy as possible for the providers and only ask for the ingredients to bake the cake that we currently don’t have and automate that approach. So make it like as easy to eliminate provider non response as possible and accelerate the collection of that information and we can talk about like, hey, what are the ways that we partner with some of our ehr partners around getting that information? So there is only kind of that one time ask opposed to your point getting hit from multiple teams. And then what we’ll do is for anything that’s outstanding, automate that process to make it as easy as possible for the providers to give us the information that’s missing. And then where we see as josh mentioned, your team come in as escalation points. Of course, there’s going to be the occasional provider who’s just entirely non responsive that’s where we see a great opportunity for your team to reach out and build that relationship.
Bradley Eral (21:47) But with that said, before we jump to the demo, Sonia, sorry, I know you joined briefly after kickoff, would love to have you quickly, just introduce yourself. And then we can jump in.
Sonia Lucas (21:58) Sure. And sorry, I was late. Oh, no worries.
Bradley Eral (22:01) I know how.
Sonia Lucas (22:01) it goes. I’m Sonia, Lucas, I’m vice president of revenue cycle management services. So I lead the overall revenue cycle management department… perfect.
Bradley Eral (22:10) Great to meet you. And from our side, Brad Erol, director of strategic partnerships here, which, you know, essentially the leads go to market for the ehr and RCM space. And then we also have josh levitin on josh. I’ll have you introduce yourself and we can jump to the demo yep.
Joshua Levitan (22:22) I ride shotgun with Brad, get into the weeds on technical on process integrations, all that stuff. And I will be moving forward here with the demos and it’s great to meet you.
Sonia Lucas (22:35) Great to meet you all too. Thank you. Okay. So.
Joshua Levitan (22:38) As we dig in a couple points of context, we’re going to look at medallion today as if it was from one of your customers, right?
Joshua Levitan (22:47) So there’s a whole other view that like you could see across all of your customers like aggregated. But what we find in these conversations with the ehr partners is it’s really important for you to understand like how medallion works as if you were just like a single organization that was providing care. And then we use that knowledge to expand the conversation to what is the overall visibility for you look like of all your customers as well as sort of what are the different operational models like in terms of the conversation that we were just having… we’re going to look at the demo in three parts. It’s going to be collecting data from providers and managing that data. So this touches on like the portal question that we had before about providers having a portal touches on. The caqh piece touches on making this process easy. So providers don’t feel like they’re giving information to multiple different groups, right? And then from there, that’s sort of the foundational element of everything, right? Then from there, we’re actually going to talk about submitting enrollment requests, which is the meat of the process here, right? And I think where there’s a lot of value profit in the automation that we deliver and how easy and quick that process is third piece. If we have time, I’m going to preface this by saying I am a long winded person. So we often don’t get to the third piece in the first call. But the third piece would really be reporting analytics that’s where there’s two parts, right? Like reporting analytics for your customers, so they can understand how everything’s tracking and moving at a holistic level, as well as reporting analytics like globally for you at the sort of the parent level we’ll call it to understand how all of your customers are moving. So that’s our flow today. We’re going to start impersonating a provider. And then we’re going to switch to sort of like the practice admin view. Any questions about any of that before I jump in here?
Karen Baker (24:46) No, I mean, one thing that I think I mentioned when I met with you that we’re looking at replacing our current technology and I know that you guys are more of a hybrid approach for us where you’re going to be not so much selling us the technology, and then we’re the hands and feet so much as you are hands and feet and technology. But yet our team does have a responsibility. So I think it’d be great in your demo, josh, if you would help bridge that sort of understanding for our team. Yeah, certainly credentialing is an add on service to our revenue cycle services that we provide. And so we are not a company that just is only doing credentialing, right? That’s one of many things we do for our customers. And I don’t think any of us think that it’s the one that customers show up at our door and demand that we’re doing for them and they don’t care about everything else, right? The value we provide is all of the other revenue cycle services and we provide credentialing for good strategic reasons to do it together. So, I’m interested if you could help highlight for us where your team would be playing a part versus what our team would be doing and helping us sort of understand that.
Sonia Lucas (25:56) Kind of along that line too. I’d like to piggyback on Karen who like, how do you all scale as… the organizations you’re serving scale? We’ve had sort of a hybrid Ish,
Karen Baker (26:13) relationship previously. It didn’t go well and it failed and.
Sonia Lucas (26:16) So, I’m really interested in knowing who your competitors are, who your top competitors are, and how you’re different. And also kind of again, how do you scale and support like large volume? We have some big customers that have some big needs. And I want to understand that like eyes wide open.
Joshua Levitan (26:35) Yeah, for sure.
Bradley Eral (26:37) And I can take the scalability piece before we jump in here. Is to your point, I think there’s a lot of third party providers of credentialing services that don’t scale. Well. The reason being essentially, it’s porting over a historically manual process and they just own that manual process, right? So it’s just, you know, transferring who owns the clutter and the friction with medallion. What makes us scalable is the level of automation. You’ll see this in the demo. But because we leverage AI and automation so much, essentially, we operate as a utility model, can flex up and down as needed.
Bradley Eral (27:07) And from like a sizing perspective, of course, you have many large customers. We have customers, you know, on the smaller end, of course, but all the way up to 200,000 providers where like we got dropped the other day, it was, I think 60,000 providers. No impact, from a medallion perspective, right? Where as far as like our slas, Sonia, we commit to how fast and accurate this work’s done. Our slas don’t change regardless of volume, right? So from a scaling perspective, right? If we miss our slas, financially, medallion’s on the hook. Essentially, if you get burned, we get burned.
Bradley Eral (27:40) So we need to scale with you. From a business perspective, we don’t have a choice, but the level of automation that we have is what allows us to do that.
Joshua Levitan (27:49) Yeah, I’ll just add, I think specifically to, if you look at a lot of our larger customers, they actually happen to be in your space, right? So it’s not only large organizations of all shapes and sizes, but specifically within, the therapy space, some of our biggest and, you know, most household name customers that you can find on our website like the headways of the world are.
Bradley Eral (28:10) You know, also.
Joshua Levitan (28:12) Providing the same services that your customers do, maybe different in terms of telehealth and all that, right? But at the end of the day, same provider type, same same license types and same enrollment paths, no.
Karen Baker (28:21) I’m we’re certain that some of our customers use you to do their credentialing. So, yeah.
Karen Baker (28:31) And.
Joshua Levitan (28:31) so, I think that the last thing I’ll comment too is like we could say the people that we like compete against but I don’t think we have any direct competitors. The, the market out there is really focused on providing tools that are glorified task management tools. And then whatever the organization is, be that you or care organization do the work which is kind of what Karen was just talking about. We are the only player and this is like we believe this is the best model and it’s our differentiation. And it’s why these conversations sometimes are a little bit challenging because it’s not a model, that is always understood because it hasn’t been around for a while, but it is this end to end delivery model where we are focused on giving you outcomes. And as brat has said, like guaranteeing those outcomes via slas, and that means that our team via automation and human escalation point to supplement and train. That automation is doing a lot more work than in traditional existing models with like a cred stream or simple or some of these tools that have been around, for.
Sonia Lucas (29:28) a while? Who do you consider your closest competitor to your model as well as kind of just you run into them? And, yeah.
Bradley Eral (29:35) I would say, I would say Symplr, Symplr does have that end to end service model. And then, you know, the challenge there is, you know, it’s kind of begs the question. Do they have the automation? But Symplr is certainly, I’d say the most like for like competitor out there from, hey, we’re gonna own the process in totality gotcha. And they’ve been around for quite some time. They’re you know, very prominent and have been in business for decades now. Okay?
Joshua Levitan (30:03) I’m gonna go ahead and jump in but appreciate the question. Sonia. Okay. So we’re gonna start again impersonating a provider who just got hired by one of your customers. We’re gonna walk through the flow that they would walk through here to give us information. Now, I’ll note some of this could actually be absorbed natively into your product. So there’s a whole host of conversation sort of I was alluding to beforehand about like does this actually have to happen in this way? And the answer is not necessarily. But again showing this is important, I think to understand the groundwork so providers are going to be invited to the medallion platform so that they get access to their portal. Lindsay to your question beforehand. We’re going to send out, invite the email. One thing to know like we’re going to co, brand this, right? So we’re going to have your logo here. We’re going to work on this language with you. So there’ll be some language inserted about like the partnership and qualifacts powered by medallion, something like that. And the provider is going to create an account and then go through a really easy onboarding flow… in this onboarding flow as they’re clicking through to set up their profile. Here. One thing that you’ll note is the first thing we do is ask for their caqh id. We can bypass this step. If you have their caqh id up front. We do this with a number of our large ehrs, where we completely rework this flow because we get the caqh id from the ehr partner provision the account and it’s already set up. But I think it’s important to again show this as foundational here. So provider pops in their caqh id, not their username and password. In two other fields, they verify their profile. They link it to medallion. And at this point, that’s it, it’s like, you know, a couple seconds to get the tool set up and then they move into their profile… or their portal. I should say. So what we’re looking at right now, this would exist in perpetuity for as long as a provider is employed by your customer. And this is the primary source of importing data into medallion. We can see for Naomi here. Her caqh profile was in really good shape. So like all we got green checks here. We don’t need anything else from her. We took all of the information we needed from caqh depending on the quality of caqh profiles. There might be some of these that are yellow. She might need to come in here and put in some like professional history or supplement, you know, add a new certification, something like that. What I also want to mention is like while the caqh process is uploading a lot of this data specifically in like the demographic data might already exist within your system. So with our eha partners, in addition to grabbing data from caqh, we’re also grabbing data from you if it’s already in your system and using our API integrations to also like pre build the profile with that information as well. The goal here, whether we do that with data that you have and, or data that comes with caqh is to make this process incredibly quick and to cut down on emails paperwork, what you were describing before, like, hey, I already sent this form to one person. Why do I have to send it to another? So the provider has like a good experience but also a fast experience. And so.
Lindsay Alfke (33:31) If we were to consider like an implementation timeframe where there’s a lot of like data conversion or data submissions, is that something that would happen could happen? A mass import of all provider information that currently exists in our current system?
Joshua Levitan (33:48) Yes, definitely. Okay. And I think also what we’ve had good success with our API partners is… not necessarily starting there but building up to that. So like getting this into the marketplace pretty quickly leveraging caqh because it grabs almost all the data almost all the time as we continue to work with your development teams on like the piping to supplement that in process so that we’re not delaying getting this product to market while our development teams are collaborating on a more like integrated data or visual experience. Okay. Yeah. And yeah, the crawl walk, run airword has been, really effective. One thing I’ll just quickly note here as well if the data doesn’t exist in your system or in caqh and we want to get that into medallion really easily. We have other really helpful methods to do that as well. Providers can scan documents. This is like turbotax just in my taxes, April may timely comparison here. You scan this QR Code and then you point it at in turbotax’s case, I pointed it at my 10 99 div. In this case, we would point it at a resume. We read that document, ingest it like pull all of the words out of it and then stick those words in other sections in the profile. All right. So if they scan their resume, we would then automatically have all of the fields in professional history and we would have a copy of their resume in the document section. So just an additional type of automation there to make it really easy to grab data really helpful if caqh is out of date or if a provider doesn’t have a caqh? And josh just to poke in on that section specifically, is it mobile friendly for that step? Yes. Yep.
Lindsay Alfke (35:36) Okay. Yeah.
Joshua Levitan (35:38) And I’ll show you the mobile experience in just one sec… now as they’re building out their profile here. What medallion is constantly doing is comparing like the golden record, all of the data that we know we need to do enrollments down the line to what this provider currently has. Naomi here. She’s in green. We’re good to go. But if she wasn’t we would see tasks pop up right here. These tasks are auto generated by our system and they could be anything from, hey, we’re missing your two by two headshot passport style photo to you have a gap in employment history that we need to figure out. It could also be things like we need you to sign a document or, hey, here’s a reminder that like your license is expiring 90 days from now. So tasks are both notifications and action items. But the point is here we’re constantly evaluating as part of the onboarding flow. Do we have everything we know that we need down the line? And if we don’t we’re proactively pushing that out via tasks to providers so that they know exactly what it is that they have to do to get to 100 percent complete and green. These tasks also trigger emails and we regularly follow up with those emails. So it’s not like they have to log in here to know like we’re gonna make sure we notify them in other ways of these tasks as well.
Lindsay Alfke (37:06) You took the question signature capture. I was gonna say signature capture. Is that E signature capture? Yep like DocuSign type capability? Yeah.
Joshua Levitan (37:15) So gonna switch to a mock up of the mobile experience here. Last step in this process, for example, would be for example, like signing their attestation… so… we can go ahead right here, sign their caqh attestation. This is them giving the ability for us to do their caqh attestations on behalf. Go ahead and save that. We can add the profile data activation. Again, signing on their phone with their finger, right? And hit save, say it doesn’t work in my mock up here. And there’s full capability in here as well to view the overview sections, expand on the profile and understand what’s missing and change data in here as well.
Cindy Howell (38:05) And I assume we’re going to have full visibility to all of the tasks and everything that’s outstanding. So if we needed to do something, say they sent it to us to update on their behalf, we would be able to still perform all of those tasks and maybe update them or push out reminders and meet with the customer? Yeah.
Bradley Eral (38:27) So, we’ll have full visibility in tasks. And we can also, if you ever want these tasks to go to the provider and you directly like get email notifications. If you have like a, you know, a marquee client that’s you know, hyper focused on credentialing as a bottleneck. We can vibrate like, hey, where we send these emails to as well. But in short, Cindy, you’ll have complete visibility. Yeah.
Cindy Howell (38:46) Can that be broken down by customer be like, hey, these certain customers and providers? Like it’s tagged and so different people might get different notifications or, yeah.
Joshua Levitan (38:58) Absolutely. Yeah.
Bradley Eral (38:59) So each one of your customers essentially will have their own and you’ll see this but their own level of visibility with the medallion and their own like instance of medallion, imagine parent child relationships. So, yeah, you can dictate that at the customer level.
Joshua Levitan (39:12) Yeah, that’s a great segue. So, I switched here. As you were talking, we’re now, not in the provider profile anymore. We’re in like the administrative profile. And so this is what like a practice admin at your larger groups might have access to. This is what you would have access to. And this is where like the rest of the work happens, right? So, everything that we just saw it’s specific to a provider, it’s their information. It’s their portal. This is the organization’s environment. And as Brad was saying, right? I can come right in here. And in tasks, in the organizational environment, I can see all the tasks assigned to all my providers, and I can see how tardy they are right now. If it’s 30 days old, medallion has emailed them 10 times reminding them about this task. But this is an escalation point where it is really important to have someone on your side who can help move the needle along and are.
Karen Baker (40:01) those reminder configurations at a provider by provider level, at a task by task level, like how matrix are all of those reminder kind of things?
Joshua Levitan (40:10) There, it depends on the specific type of reminder. So we’re always going to be able to hit like a next level supervisor we can, although we don’t regularly change like send this reminder every three days in this reminder every five days. It’s technically possible. But we’ve put a lot of effort and research into like the right amount of squeaky wheel, gets the grease to where like we don’t want providers like ignoring all of our emails entirely. Yeah. So we don’t recommend changing too much of this around because we, we’ve and there are 100,000 providers that use medallion any given year, right? So we’ve put a lot of thought into the right amount of level I.
Karen Baker (40:55) Was trying to make sure they don’t get too much noise, right? How do they get the right amount of noise to get the right?
Joshua Levitan (40:59) Action.
Karen Baker (41:00) Yeah.
Joshua Levitan (41:00) And I’ll show you in a sec where you do have some provider level controls like if, you know, if an organization knows they have one specific provider who’s like not technically savvy, and they don’t want any emails going to that person, like how we would toggle that off for one provider. Yeah. But yeah, this is, your action based dashboard and these are all provider tasks. There’s also admin tasks in here. Think of this as like one of your groups that needs to upload a new like group level Coi, as an example. Like it’s not a specific provider task. It’s for the entire group. We’re also going to be tracking any expirables in here. So obviously license expiration is a huge piece of this. But also we’re talking board certs literally like a passport that’s expiring and we need, a new, a picture of the updated passport or something like that. Literally, if it does expire, it will be tracked or can expire, it will be tracked in here. And there’s notifications that get pushed out based on these expirations as well. And then we can see what, you know, what this looks like projecting into the future as well. Can we?
Cindy Howell (42:01) Action out those admin tasks to certain customer contacts on our own. So, yes, absolutely.
Joshua Levitan (42:11) If I move forward here into the provider section, this is modeled after like, a more sizable org. This would obviously everything we’re looking at would be a lot cleaner if it was a three or five or a 10 person org. This org I think is built around 70 providers or something like that just for the size and scale, of the demo here. But this is where all of our providers have the profile that we as administrators. Now, this could be you as qualifacts administrators. This could all be also be the practice admin or practice manager at your customer can view everything for all providers. I’ll take a detour there just to say as well like what you can imagine here is having an environment like this for each of your customers. So I would say that qualifax dash, you know, Brad arrow LLC, qualifax dash, the best company ever. And so each environment is segmented at the customer level. And then we would roll all of that up into one combo environment for your team to be able to view everything. So in these provider profiles, let’s click into Naomi because we were already talking about her. This is where we have like all of the information that we could possibly need. And in one place providers have access to fill all of this out in their portal. They don’t have a lot of this data and that’s by design. We don’t want to overwhelm providers and you might not even necessarily need all of this data or your customers, right? Might not. So like verifications is where we’re talking about like primary source verifications, which usually has to do with ncqa credentialing for the larger groups… we’re going to run those credentials automatically using our automation, most of your practices. My guess is don’t need this, but for those who do, we have it and it’s in one single place. We’re tracking licenses in here with expiration dates. We’re tracking if they’re tied to physical practice locations, which is important for enrollment. We’re tracking the payers that they’re enrolled with as well. And this is both payers that they’re that Naomi is requesting to be enrolled with and enrollments that are currently active. And then also just quickly highlight Karen to your point email preferences. So this is where we can toggle on and off certain email preferences just for Naomi. We’re not going to manipulate the follow up cadence, but we can toggle off like the weekly report of all outstanding items or whatever it might be. So this is your database. This is your source of truth again there’s a lot in here. Almost all of this data comes from caqh. And a lot of this data can also come from data that you already have. So there is not a lot of burden in our relationships with ehrs like yourself. For people in like doing a lot of data entry here, that burden is almost none. This is more a reference or store of information if needed. But to the point we were making before about caqh, like if a provider change, let’s say a provider gets married and changes their name, that could initiate in qualifacts that could push from qualifacts to medallion. And then medallion is going to go ahead and update caqh. So that’s sort of like some of the flows that we might see here with… respect to just like medallion as a database and a repository… going to pause for a sec. I want to make sure we have time to get to payer enrollment with about 15 minutes left on the call because I think that’s the meet and there’s going to be a lot of questions and good conversation there. But so far, how are we doing on understanding the foundational elements? Is there anything we want to poke at or dig into… good on my end? Okay? How does this compare to like the ability that you have to see and view and store this information? Currently… it’s quite a bit better. I would say.
Karen Baker (46:05) We’re trying to temper our opinion, josh. Thank you for asking though.
Joshua Levitan (46:10) My job that’s right? Do you?
Karen Baker (46:13) Have to love it. Do you think it’s beautiful and shiny? Do you think that’s exactly what you want?
Joshua Levitan (46:17) To brand sign a DocuSign. Yeah, that’s right. Okay. So let’s move forward here to the payer enrollment piece. And so now we’re moving to this process of actually requesting work, right? This is a really simple process. Again, you explained how this happens by ticket right now, the ticket comes into Salesforce. You have some humans involved, some process involved and then you have to go and do something… purely just a medallion. This could still hypothetically be started by that ticket process coming in through Salesforce. But what I was sort of implying earlier is since your customers will have a version of this, they could come in directly and hit new payer enrollment. And what we do when we request the payer enrollment, we just hit the provider. We know what group or 10 they’re affiliated with. We know what states they’re licensed in. And in this case, we know that community health center in Arizona has contracts with these specific payers. So we’re just going to hit our all button and enroll with all of these groups. Just want to quickly select our lines of business here. We want to make sure we import our practice locations properly. I’m just going to hit select all for purposes of the demo… just quick check in. Yes, we want this enrollment to show in the payer’s public facing directory. So patients can find us. We want to request a specific start date, any notes we have, and then we hit submit… that is it, that is all the work that is required from someone to initiate a request. Now, I say someone here because again, this could be your team initiating the request on behalf of your customers or this could be your customer themselves, but that is all that is required to start this process. And this is what we need you to do, direct the strategy and the vision. And from this point forward from the time we hit submit, medallion owns, submitting the application, follow up with the payers all the way through till par status. We’re going to talk about that in a little bit. But just to baseline on Karen, your point like this is what is required from someone could be, you could be the customer? Yeah.
Bradley Eral (48:38) And two comments here on the customer side for your smaller practices where they, maybe they don’t have an admin today, this will be the providers in a self serve fashion. And we’ll layer in enablement for like, hey here’s how they walk through that. And then for your larger practices, I imagine they have an existing admin helping with this today. The admin will own that process typically. But Karen, going back to your original point of like, hey medallion’s the hand and feet, right? We’re going to own all the blocking and tackling behind credentialing, but we still want your team to be, I guess the head of the operation as far as owning the relationship, again, any escalation points? Like ultimately, we want to enable your team to deliver some of those like white glove like touch points that folks associate with qualifacts, but make sure that the team’s not getting bogged down with all the manual process, the follow ups and the applications working back and forth with payers in the process.
Kyle Mccall (49:29) Yeah. And do you have analytics into turnaround times from submission?
Joshua Levitan (49:35) Yeah, absolutely. Okay.
Kyle Mccall (49:38) Is there like across all customers?
Bradley Eral (49:42) Yeah. I looked at this the other day. It was, I think 65 days last, I saw from submission and then our SLA to submit the applications. SLA is 10 days, but we’re averaging, I think three days. This last I saw of submitting the payer enrollment applications.
Joshua Levitan (49:59) Yeah. And to achieve those timelines, like we’ll talk about what happens. Now. The submit button is the magic button, right? But on the back end, medallion has spent tons of effort and time building out essentially a database of 1,100 plus payers across the country and what it takes to get enrolled with them. They use a portal, they use a roster. It’s a paper application, et cetera. And we update and maintain those regularly. And then we use that information to train our process. Now, our process ideally is as automated as possible for a major payer that’s using a portal, I’m going to show you in a sec what that looks like when we have a bot that goes into a portal and does the enrollment for us. If it’s a small regional ipa that still requires a paper form, can’t be automated 100 percent because a paper form still has to be sent. But we’re going to own that process as well. We’re going to map the data onto a paper form. We’re going to print it out and mail it to the ipa or maybe mail it to the provider for a wet signature. Like New York medicaid used to need wet signatures. So we would mail the provider the form with all the data mapped and prepaid postage and say, sign here and send it off to New York medicaid. So whatever the process is, if it’s a roster, we’ll go ahead and submit that directly 1,100 processes. So there’s a lot in there, but that is part of the value of medallion is that we know how to work with these payers already. We have team members that can step in and supplement this process. If there’s any sort of escalation point during follow up, or if there’s a change in payer policies, and we need that team to like remap the payers process, right? This just happened with New York. They changed from that paper signature process to a portal finally, and our team stepped in and broke down all the language and read all the medicaid stuff and played around with it and then retrained the process and built portal based automation as opposed to the… paper process. This is what it looks like.
Cindy Howell (52:03) Go ahead before you hit play, I guess. So, when we get the information and they say, hey, we have these providers, but we say like the customer saying they’re already enrolled in all of our, you know, insurance companies, does your system check that to validate who they’re already enrolled with right out of the gate? So we don’t recreate or duplicate any enrollments that are already done?
Joshua Levitan (52:31) Yeah, yeah. We absolutely can.
Bradley Eral (52:33) Here’s the scenarios we have a, we have a service that essentially we call par analysis but reach out to the insurance companies to verify. Are they in network as a standalone? And then also if they submit an enrollment or you submit enrollment, whoever dictates that we always before submitting enrollment confirm, do they already have an existing enrollment with that payer? And then quick audit? I did misspeak. I did confirm. We’re averaging 52 days from submission to par, not 65, but go ahead, josh. Yeah… yeah.
Joshua Levitan (53:03) In addition to checking if they already have an enrollment, as Brad said, we also update. So what you can imagine happening after we hit submit, is we first, actually the first step is we update caqh. So we’re going to make sure caqh in this exact moment is exactly the same as the data that we have. As Brad said, we’re going to confirm the current enrollment. I don’t think we’ll have time to get here, but I have another video of our bot going and confirming like a medicaid number. But real quick, I’m just going to let part of this play. This is a recording of our bot logging in and completing an application in Arizona blue in their portal and.
Bradley Eral (53:38) Sonia as this is running, going back to your original commentary around like, hey, how does this scale, right? You’ve been burned in the past? It sounds like with some third party providers, this is how it scales historically. This is done by humans with medallion. We’re going to automate everything we possibly can in the process.
Cindy Howell (53:57) Again.
Joshua Levitan (53:57) this is where the model is different, right? This hopefully adds some context to the conversation about our competitors and how we’re approaching this differently and the scalability. What we also recognize is with this model where we are owning a lot of this work like you, your customers, all of our customers need to be able to know what’s happening and need to be able to trust us. Part of that trust is our slas, and the contract. More importantly than that though I would argue is visibility. So when I’m in my enrollment request screen here, this is where I started before I had new requests, but this is all of our active enrollments for this organization. And you can come through and get tons of details about these. So like right off the bat domino’s pizza tracker, super high level. Where is this at? But as I move across my field here, you can see what are the next steps that medallion is taking? Did medallion schedule for ourselves? The next follow up point? Three days from now, you can view that. You can view notes from our team. And there’s oftentimes gonna be screenshots or attachments in here. If our portal scraper went in and verified in the availability portal that the application was received, we’re gonna document that for you right here and give that to you. You can see related enrollments. Is this an mco enrollment that first has to be tied to a medicaid enrollment? You can even get down into the level of if we are emailing as part of follow up, the payers, you can literally read the emails we are sending and receiving from payers about this specific enrollment right here in medallia. Yeah.
Bradley Eral (55:28) And the nice thing about the visibility, like again, if we’re gonna contractually commit to our turnaround times and there’s financial implications. If we miss, there needs to be some checks and balances. Your team needs to have visibility into what’s going on but also your customers, they’re gonna have visibility into every enrollment, the status of the update, what plans they are in network. So what that’s gonna do is it’s gonna reduce escalations and you’re not gonna get calls of, hey, what’s the latest with this enrollment? What’s the status? They can self serve that as can you, and essentially just reduces any escalations at any point in the organization. But let’s pause here.
Karen Baker (55:58) Can they?
Lindsay Alfke (55:58) See, sorry, can they see the back and forth between the payers? Is that what you’re talking about as well as I mean, obviously like the status of everything, but do they see that dialogue between with the payer we get payer responses as well?
Joshua Levitan (56:12) Yeah. If you choose to have them fully in medallion like this absolutely. And that goes back to the model of like there is a choice here on how much control you want to have or they want to have. But if they had full portal access and you were in there as well, then they see everything that we just showed. Some of our ehrs, do also port back a subset of this information into their native platform. So like just the high level status, but then also give the customers the option to go into medallion for more detail. So there’s a little bit of strategic choice here, right? Like if you want high levels, these are the enrollments and here’s, the very high level status, right? In qualifacts, great. But then if they want more detail, you give them the option to move over into medallion, of course, co branded with your logo and everything but medallion’s native platform to view the additional detail.
Sonia Lucas (56:57) Do you have a visual on, you know, kind of how you work ideally with customers like ours, where the responsibility kind of, you know, here’s where some handoffs are here’s. What we could be responsible for if we wanted to or could go up to here or whatever? Like do you have something that kind of shows us you?
Joshua Levitan (57:21) Know those?
Sonia Lucas (57:22) Adding a workflow or something we do?
Bradley Eral (57:25) And I think that’s a great segue as far as like what we’re I was thinking of for next steps is walking through that visual as far as, hey, what will your team own? Typically? Like it’s always flexible, right? But what do we recommend your team owns in the process? What do we recommend your customers own? And ultimately, what will medallion own to give you an idea of, hey, what are the roles and responsibilities? What does this look like? End to end? And then in that meeting, we can also talk about, hey, as we look at your customer base, do we want different approaches for your large customers versus your smaller customers, which typically we do absolutely recommend based on what we see. So we can walk through that in detail.
Lindsay Alfke (57:59) That sounds great. And that would be.
Karen Baker (58:01) A great, like next step because I think we all have a bunch of additional like we were starting to think through like how could this work? And some of our pain points of a customer just signing with us a new logo customer? And they’re a startup therapy practice versus a long established therapy practice that’s switching over from a competitor of ours to us as a new logo and my understanding. And the team should tell me, right? Like that feels like a different hurdle of getting that customer live. If they are a startup, they may be not credentialed at all anywhere, right? Versus you have some that are they’ve been credentialed, they got some new, you know, new providers, but a bunch of them are already credentialed and they’re migrating over to our ehr. So I’d love to maybe we could start to maybe come up with some of those additional bullets for ourselves and we could pre provide those. And then you already understand some of our concerns and we could do that in our next meeting because I think this is sparking some conversation of like, what would make sense? Like, what could make sense with?
Joshua Levitan (59:08) This love the way.
Bradley Eral (59:09) you’re thinking about that and that’s exactly what we’d want to discuss. And I think there was one more question before we break if I heard someone.
Lindsay Alfke (59:17) Yeah. I was just curious, high level what’s a typical implementation timeframe look like for a company our size?
Bradley Eral (59:23) Yeah. So it’s typically, I’d say eight to 12 weeks is a good benchmark. I’d if I always err on the side of caution, I’d if I’m in your shoes, I’d say 12 weeks to the business. But what I’d say is on those startup practices, like we can deliver, we can kick off enrollments in as little as like.
Karen Baker (59:39) Yeah.
Joshua Levitan (59:40) There’s.
Bradley Eral (59:42) there’s no historical data. We give them access to the platform. They point and shoot what plans they want to enroll and you’re off to the races, but in totality, I’d say like eight to 12 weeks to get this off the ground. And then the next discussion, we can be a little more tactical of what does that look like for individual organizations? Because obviously, there’s the initial implementation, but long term, there’s gonna be continuously adding different partners and your customers to the platform. Yeah, love it. Okay. Amazing. Well, we’re out of time. Karen, I’ll coordinate with you on the follow up.
Karen Baker (60:10) Yeah, sounds great. Let’s do that.
Bradley Eral (60:11) So, we can collect that information and we’ll get really tactical as far as what’s the ownership and the partnership.
Karen Baker (60:17) Sounds great. All right.
Lindsay Alfke (60:18) Thank you guys.
Karen Baker (60:19) Thank you, everyone.
Joshua Levitan (60:20) Bye.