Transcript
Shaun Urbanozo (00:00) good morning.
Jordan Tantleff (00:04) How we doing today?
Scott Everline (00:07) Pretty good. How about you?
Jordan Tantleff (00:09) No complaints. Got a, my brother’s birthday dinner in the city later. So nice. More family time coming off the family time weekend. So, it’s.
Scott Everline (00:21) good someplace fancy.
Jordan Tantleff (00:24) It’s this place called quality Italian. I’ve never been, but I think it’s just like family style servings and game plan is to starve myself going into it because I know it’s just going to be a heavy meal. So.
Shaun Urbanozo (00:38) Yeah.
Scott Everline (00:39) Yeah, nice. Are you, you’re going to Austin?
Jordan Tantleff (00:43) Yes.
Scott Everline (00:45) When, are you leaving on Wednesday or Thursday?
Jordan Tantleff (00:47) I moved up to Wednesday because I mean, ending that early in the afternoon, yep?
Scott Everline (00:53) Yep. I was just asking because there’s a Michelin star barbecue place and Austin and I were going to hit it up Wednesday afternoon.
Jordan Tantleff (01:01) Are you staying Wednesday?
Scott Everline (01:03) Yeah, I didn’t know. And it was like looking at flights. It was like 150 bucks and I was getting home at like one o’clock in the morning. Yeah. Forget it. I’ll just like take the easy train and relax… get some work done.
Jordan Tantleff (01:17) Makes sense.
Scott Everline (01:18) Quietly, I’m.
Jordan Tantleff (01:19) going to let Sean in here.
Shaun Urbanozo (01:21) Sounds good.
Jordan Tantleff (01:32) Morning, Sean.
Shaun Urbanozo (01:34) Hey, good morning, Jordan.
Jordan Tantleff (01:36) How you doing today?
Shaun Urbanozo (01:37) Good. How are you?
Jordan Tantleff (01:39) Doing well. I appreciate you taking the time to meet today. I imagine you guys are still digesting a lot of the information from the RFP response, but I know there’s obviously interest in a demo here. Obviously, we met, I do want to let Scott introduce himself here quickly before we kind of dive in. We can take it from there.
Scott Everline (02:01) Hey, Sean. So I’m kind of Jordan’s right hand man, I’m a solution consultant here at medallion. So kind of run through demos, technical conversations, apis, et cetera. So just here to make sure all the stars align for you all to potentially look at a partnership with medallion. And I’ve been in the healthcare space for about 25 years, spent a fair amount of time focused on dental. I worked at an organization called caqh for a while and worked with the Ada and nadp and adso to kind of like look at how do we approach the dental provider space from a more meaningful kind of consolidated efficient place and then my mom managed a dental office. So got a lot of love for you all. So happy to kind of put all these pieces together for you and get you a good taste for what medallion brings to the table.
Shaun Urbanozo (02:56) Awesome. Nice to meet you likewise.
Jordan Tantleff (03:00) And then Sean, do you want to do a quick intro on your side first? Scott, just like your kind of role and responsibilities within the organization?
Shaun Urbanozo (03:06) Yeah. My name is Sean. I’m the credentialing manager here at hero DBO. We have about 30 different locations in seven different states, probably manage close to 250 providers. Focus on dental vision and orthodontics so.
Jordan Tantleff (03:30) Yeah, perfect. And I know before we kind of jump into the demo here, wanted to make sure we tailor this to what actually matters for you and the CEO, that kind of released the RFP. So, from what we understand, this initiative came down from leadership just around kind of improving efficiency, seeing maybe how other vendors are using AI to kind of improve efficiency of teams, but we’d love to kind of better understand maybe what’s not working today that led to the RFP, like is there a specific problem? I think you guys are using medtrainer? You mentioned to Mike? Is there a specific problem or like metric that you’re measured against today? That kind of triggered this evaluation?
Shaun Urbanozo (04:16) Not really. I mean, we, I, it just came out of the blue. So, honestly, I don’t know why the CEO requested this, but he wanted it. So we’re doing the we’re doing the exercise, got it that.
Jordan Tantleff (04:32) Makes sense. I mean, I guess from the RFP, like… of everything that’s kind of been outlined in the RFP, are there any like absolute must haves that we should focus on in this demo or, you know, nice to haves that, you know, bells and whistles that you guys are looking for, just want to make sure we kind of orient this to you guys.
Shaun Urbanozo (04:55) I mean, talking to my boss about it. We just, we were just looking to see what AI can do to help… make the process faster as far as credentialing as well as payer enrollment? So.
Jordan Tantleff (05:11) Okay. Yeah. Makes sense. Do you happen to know like what turnaround times you see today on the credentialing side? And then the actual enrollment side for those payers that you’re not delegated with?
Shaun Urbanozo (05:22) The credentialing side, we see about a 14 to 21 day turnaround, okay? And then payer enrollment, it just depends on the payers, like we have some payers that take 120 to 160 days at the most. So.
Jordan Tantleff (05:42) Absolutely, is the goal to actually get delegated with those payers as well or?
Shaun Urbanozo (05:51) We have asked them a number of times, either, they don’t have a delegated credentialing program already set in place or we’re not at the, we don’t have enough providers that meet their criteria for delegated credentialing got.
Jordan Tantleff (06:09) It got it. That make sense. That is something I believe we submit that in our response as well. I mean, we can help with that delegated setup. Should that kind of relationship come up with the payers that you guys aren’t delegated with today? Scott, do you have any questions, I guess on kind of day to day workflow that would help you with the demo here?
Scott Everline (06:31) Yeah, I mean, I guess from a medtrainer perspective, Sean, is it you, is it a team of individuals that are kind of doing a lot of this work manually and tracking it in medtrainer? Does medtrainer have some tools that automate some of these functions for you all?
Shaun Urbanozo (06:48) No, not really. My team. And I, there’s six of us all together including me that go in and input the information for tracking.
Scott Everline (07:00) okay. So you’re going out and like doing your own psvs, you’re going out to stay licensing boards, capturing an image, pulling it into medtrainer. Yeah, there’s no, like npdb linkage or anything. There’s no like magic sauce between anything.
Shaun Urbanozo (07:16) No, and there was an, at one point, they had a linkage between the software and caqh… but then they updated it and that went away. So.
Scott Everline (07:33) It’s a backwards version of an update. I think. Yeah, yeah.
Shaun Urbanozo (07:37) A lot of their updates to me put us… backwards instead of forwards. So like their reporting capabilities that they had, they updated all the reports. Now, we have to build their reports manually and they don’t look as nice. It’s harder to read for our clinical staff. So, yeah, it’s been frustrating trying to work with them to, I was like, can we get back what we had? And they’re like, unfortunately, we can’t I’m like, okay, your updates, your improvements made it worse, but move?
Scott Everline (08:08) Forward and move backwards? Yeah. Interesting. I saw reporting was kind of heavily commented in the RFP. Are there specific reports that you all refer to on a regular basis? Is it like turnaround time reporting? Is it just providers are enrolled and credentialed ready to go type reporting? Like what are the key reports?
Shaun Urbanozo (08:27) I think all, I mean, we do like reporting for providing… enrollment to let our clinic staff know which payers the providers are approved with. But also, we wanted to start capturing like you said time to fill turnaround times, how long it takes for payers to process applications and all of that. So, unfortunately, we don’t have that capability right now to capture that, even like to figure out how many like how many applications my credentialing specialists submit in a month or a quarter. It’s.
Scott Everline (09:10) hard.
Shaun Urbanozo (09:11) For me to.
Scott Everline (09:12) Performance tracking on the, yeah, yeah, yeah.
Shaun Urbanozo (09:17) So, we’re trying to look at implementing some type of bonus structure for our team and it’s just like we need to be able to pull that reports and get that KPIs before we can implement anything.
Scott Everline (09:28) Yeah, I mean, it’s hard to report up, too, right? I’m sure. Leadership. Yeah. How many files per person can you process? It’s? Like, I don’t really know. Yeah.
Shaun Urbanozo (09:36) Exactly. Yeah.
Scott Everline (09:37) Maybe like throw a dart at a board and see what we get back… interesting. So, and then… provider onboarding, like what does that look like? As far as gathering the provider data and getting it into medtrainer to even start the whole processing? So, right.
Shaun Urbanozo (09:56) Now, we’re doing it manually where whenever we hire recruiting hires a provider, we send out a PDF packet of our intake packet to the provider. They fill it out. They send it back to us. We got to upload all the information into medtrainer manually.
Shaun Urbanozo (10:16) Yeah. I thought when we looked… at medtrainer, they said we could do that all through the software. But yeah, it hasn’t happened yet. So.
Scott Everline (10:29) All right. I think at a high level and even maybe at a very detailed level, we’re going to be much better, but let’s show it instead of talk about it Jordan. Anything you want to talk about, last questions before we jump into the demo?
Jordan Tantleff (10:47) No, we can wrap up with some questions. I just kind of want to understand the RFP timeline. Sean. I’m not sure if you have answers to that, but we can wrap up on level setting on that next.
Shaun Urbanozo (10:56) Time? Cool.
Scott Everline (10:59) We’re going to jump in here. So my caveat here, Sean is, I hate the sound of my own voice. And so if you have questions, if there’s things you want me to talk through, I do demos a lot. I think this is my first of like four today. So like let’s make this interesting for you and interesting for me and bear with my bad jokes.
Shaun Urbanozo (11:26) One.
Scott Everline (11:26) Of the reasons why I started the question about onboarding… because I think you guys probably know this like the rest of the processes are so dependent on the ability to get the provider data into the platform in a way that doesn’t irritate the providers because this isn’t what they do for a living, right? That’s what they assume you’d all be the owners of, right? And so, we’ve invested a lot of time and energy into finding ways to make an efficient onboarding process for the providers because we know without that data to start, the rest of the problems just compound on themselves, right? You’re submitting bad enrollments, credentialing delays take place. All these other things that happen. If we just have a really good mousetrap at the front end of this problem, we really start smoothing out the rest of the processes and make life easier for everybody. So within medallion, there are a lot of different ways to kind of initiate a provider’s access to the system. But essentially, you’re inviting the provider to medallion, right? So, whether that’s a flat file that you send to us, whether you all have an HRIS system that can feed an API, call be like, hey, we’ve hired a new provider, here are their details, kick off the medallion invitation, whether it’s literally somebody just coming into the platform and saying, hey, I want to invite a provider, right? Filling in these details. The process all remains the same, right? So what happens is the provider will receive an invite, we will send that provider a welcome email. So we’ll capture some just high level language. Hey, welcome to hero practice. This is what we’re doing. We’re partnering with medallion to take on some of these services. This is a technology that we’re leveraging to manage credentialing, manage payer enrollment, it’s secure, safe, you’re in good hands. Right there. The provider is going to basically just have this very clean easy process kind of walk through process. So getting started, they can fill out, giving them some details around this is kind of the information we want. And so a lot of orgs will say even as part of that onboarding process. So instead of you all sending like a packet to the provider, it might just be like, hey, heads up, we partner and we use this technology called medallion. You will be receiving an email to prepare yourself, pull some of these things together, right? Be ready to go. Okay? And then from there, we do have a fully functional caqh linkage that’s actually how I met, medallion was building out that linkage with caqh. I was there at the time medallion came over and was like, hey, there’s this whole idea of like pre populating provider data with caqh profiles. Brilliant. So we have that capability. In addition to that, we also can have the provider upload like a resume and they can go to fsmb and use that as a data source to populate. We also pull from documents. So like if you guys are going to load your Coi into the system, we could take all that data from the Coi and populate it into that section of the provider profile. Awesome key objective is we reduce this option as much as humanly possible, right? Again, doctors, your team don’t bring a lot of value to the world, no offense. By filling in keyboard icons, right? Like filling in boxes on a web form is not what any of us hopefully aspire to be. When we grow up, we’re looking to try to take that out of folks’ hands. So happy path. We’re grabbing the caqh id. There is a way that you all can also bulk load that. So if you have the caqh ids, you can even almost, you could bypass this process by just loading that when you’re doing the provider invite and then we’ll automatically suck in that data from caqh. I don’t know if you guys have your own caqh account to extract data. Oh we do. Okay. So we could leverage yours. Medallion also has our own. So if for whatever reason, yours is not an option, we can pull that information indirectly from medallion. So caqh id, we’re going to get the provider social and the provider’s last name. We’re really doing this to make sure we’re pulling back the right provider, right? The last thing we want to do is expose somebody else’s information because somebody fat fingered a caqh id. Provider’s going to verify that information, they’re going to confirm and link. And then basically, from that point forward, provider can just relax, right? Get a cup of coffee, whatever cliche phrase we want to use. They’re not sitting in front of a system. We are going to notify them that the profile has the caqh import has been completed. And then they’ll be able to log into their profile and do any additional steps as necessary or your team can step in. So back to kind of the administrator view, right? I mentioned that caqh bulk import. So you literally can load that. What’s cool is it tracks that progress. So I can see what’s in progress. I can see what’s failed. So, if there’s any files that have failed for whatever reason, it’s going to give me some details here. And then it’ll show me which ones have been processed as completed. We can also import all of your incumbent data, right? So if you obviously already have a lot of this information that your team has painstakingly put into medtrainer, we can get like a flat file from medtrainer, and then map that back into medallion. So all of your existing providers don’t have to go through this whole new onboarding process. We would pull from your existing data set into the medallion platform to kind of build out all of these profiles. Any questions on that onboarding step? Anything I’m moving pretty quickly because there’s a lot to cover.
Shaun Urbanozo (16:59) No, that’s good. Okay, perfect.
Jordan Tantleff (17:01) Sean, how long does this typically take now that medtrainer got rid of the caqh linkage for you all? Just like a few weeks now to onboard these providers?
Shaun Urbanozo (17:12) Yeah. I mean, the hardest part is, I mean getting them to fill out our intake packet and getting that back to us with all their documents that we request. Yeah, sometimes it can take two weeks and that’s… two weeks off of time that we could have been spent getting them enrolled with our payers.
Scott Everline (17:34) Yeah, definitely. And payers already take a slow enough time to begin with. Yeah. What type of documentation are you requesting in that packet?
Shaun Urbanozo (17:42) I mean just the basics license, Dea, CV… driver’s license. I mean, just the standard things. Okay?
Scott Everline (17:54) I’ll show you something that’s kind of cool that hopefully will help with the providers too. So when we talk about the provider profile, right? It’s I hate to say this, it’s not super sexy stuff, right? It’s data that we all need. The vast majority of this is going to be populated from caqh. So we typically say anywhere from about 75 to 80 percent of the information that we need will automatically come from caqh when it comes to documents, not all that information is necessarily going to come through caqh, right? There are documents that providers can’t store. There might be documents specific to your processes and workflows? There might be surprise documents that are very unique to specific payer enrollment processes for whatever reason. And we need to capture those. Providers can upload documents. When we need a document to be uploaded, we will send the provider a QR Code and they can snap like a driver’s license, right? They flip out their wallet. They snap a photo of the QR Code, and then they snap a picture of their photo id. And then that gets populated in the platform. So they’re not having to go find a scanner. They’re not going to have to put it down and save it as a file type, and then email. All that stuff that doesn’t have to happen. All that can go directly into the medallion platform just simply by using the QR Code.
Shaun Urbanozo (19:07) Awesome. Yeah.
Scott Everline (19:09) And then we’ll track all the expiration dates that are here within the platform. So if there’s an expiration date attributed to that document, we will track it and then notify providers. And I’ll show you there’s like a expirable section where you can track all expirables not just license and Dea and boards, but pretty much anything, right? Passport expirations to exhaustive measures, I.
Shaun Urbanozo (19:31) mean, I’m probably going to be jumping ahead of, your demo, but do.
Scott Everline (19:36) it, when we’re talking?
Shaun Urbanozo (19:36) About expirables, I mean, does medallion have the ability to send out reminders to the providers that their expirable is due and ask them and they can just upload their renewed certification or license to the platform, yep?
Scott Everline (19:55) Yeah. So two things. One is, yes, we can notify providers. Our process is notify them to the expiration date, and that will continue to nudge them along to make sure they’re aware that these things are expiring. And then we also do ongoing monitoring. So our platform will actually go out and do primary source monitoring for these things. So like if it’s a license, we’re checking prior to the expiration date, and after the expiration date, we’re checking npdb for any disciplinary actions. So all that kind of gets wrapped up into the monitoring. And then when we perform those tasks, we bring from the primary source data the update. So we’ll actually update the provider license information based on what we found via the primary source. So it’s even less dependent on the provider, right? The provider will go out and do it. They might forget to come into medallion or tell you guys that they renewed it, but the system will grab that from the primary source and then populate that within like the license section of the application. So we’ll update that automatically here. Anything particular within the profile that you want to see or that’s interesting to you. Okay? The one call out, I’ll make that, I think. Oh.
Shaun Urbanozo (21:12) I do have a question.
Scott Everline (21:12) Okay. Go for it. So.
Shaun Urbanozo (21:14) One thing we do ask the providers now is for a copy of their signature. Is that something that medallion can also request? Or? Yeah.
Scott Everline (21:25) Yep. So we can request it and then also providers, ultimately, we’ll log into medallion and they will complete an information authorization of release, right? So there’s essentially a limited poa. So that if we’re doing when we’re processing payer enrollments, you know, the medallion signature can kind of go through the process and support that provider. So they’re able to E sign here, they can also E, sign on the mobile app. So if I want to just, oh, awesome mobile app. And again, I don’t want to be whipping anything out and going into scanners and all that other fun stuff. I can literally come in here and sign the poa in platform. Oh, awesome. Yeah. So taking providers again out of systems and into the data, right? We’ll get the caqh authorization. So we have the ability to maintain caqh profiles. So we’ll take the data that’s in medallion and push it to caqh kind of automagically. It’s a little bit of like some forcing and some robots pushing data into platforms and caqh’s functionality. But we’ll get authorization to do that. And then if there’s any profile issues, we can then call caqh on behalf of the provider and talk to their customer service team. So we get those signatures here. If that’s something, we’re going to be doing agreement to update data, and then the attestation. So we get signatures from them in a couple of different places directly within the platform. The one other thing I want to call out on the profile. And then we’ll talk about kind of like payer enrollment and credentialing, but we… store user credentials, provider credentials for other systems within the platform. So I suspect providers are like, well here’s my npez login if you guys need it. And here’s our caqh username and password if you need it. And we’ve heard I’ve actually literally seen at conferences where people have like spreadsheets with all that stuff on it, right? We store that all here within kind of a soc two compliant vault if you will. So all those can be managed here within medallion platform and we leverage role based access control. So you’re only going to get access to this information if you have the privileges to do it, right? So like maybe someone from your scheduling team has access to medallion, they don’t need access to this type of information, right? Kind of block down what they need based on the platform role that they have. So that’s the profile. You can see there’s a lot of stuff here, right? Part of the profile process is this intake mechanism that we have in place from the back end of medallion. This is where kind of some of the AI comes into play on the back end. We essentially have payer enrollment requirements by line of business, by state, by market, by provider, type. All that’s baked into the platform on the back end. And we have an entire research team that’s going and updating managing, obtaining new ones. If there’s a new payer that comes into the mix, perhaps it’s a payer we don’t have in the system already. We’re going and getting all of those payer specific rules and then we map those rules directly to the profile. So when you’re submitting a payer enrollment request for zealous, for example, right? The system’s going to look at what zealous needs. We’re going to look at that provider profile. And then we’re going to map tasks back to that provider, saying, hey, there’s information that’s needed and we can task it to your team or we could task it to the provider. We’re indifferent to it, whatever works best for you all. But we’ll task those gaps back to the provider to get them to provide the additional information. Our key objective and something we track ourselves on pretty relentlessly is resubmissions on payer enrollments, right? So, like we don’t want to send an enrollment out the door with an expectation that it’s going to come back like the enrollment process shouldn’t, be a QA check. The QA check should happen before the enrollment leaves the four walls of the platform, so to speak.
Scott Everline (25:18) So our resubmission rate is less than one percent and we hold ourselves to that. We talk to organizations 1,415, 20 percent resubmission rates. What that means? You probably feel it more than I do, right? It’s like you send it out to the payer, it takes them 45 days to get back to you and they’re like by the way you forgot to fill out this one little form or you forgot a two by two photo of the provider to the back of the line you go.
Scott Everline (25:41) And then you send it, right? Our objective is to keep that from happening as much as possible. This intake module keeps that from happening as much as possible, right? Payers move the ball on us all the time, right? But we do our best to keep on track of it because of the volume of enrollments. We do thousands every month. We’re able to kind of keep on top of this type of process. Pretty easily and make updates as changes occur. So those all come back as tasks again, whether that goes back to you or whether that goes back to the provider. And what’s cool is we’re looking at all those enrollments that are in flight. So we’re not just looking at onesie twosie, enrollments. We’re basically going to look at the collective whole of data that’s needed and then test that out. So it’s not like, hey, this whack a mole game of like, you know, we have a new enrollment. You got to look at this. There’s another enrollment that we missed or we didn’t look at the same time, you need to do this, right? So just trying to pull all that together for the ease of use for the provider practice information. So you had mentioned you guys have seven 30 locations. You can store those as practices. I’m assuming those are unique individual brick and mortar locations and not groups or are those groups with more locations under them? No, they’re individual locations. Okay? So you could store all those here in the platform, you attribute providers, whether or not there’s the primary location. And then you can attribute locations to groups. So like when I think of like a type two mpi and an intent bringing those together, I can affiliate multiple practices under that one group. Okay? As well as I can jump in between all of these screens, right? Like I’ve seen a lot of systems, either I’m looking at the group or I’m looking at the provider. I’m looking at the practice, but I have to like find some maze of a navigation to get back to it here. If I’m looking at community health center, for example, I can just jump hyperlink right into that group. Same thing for the providers, right? So within the provider directory, I have the groups that the provider’s affiliated with. I’m also gonna have the hyperlink access to those locations or at least you’re just trying to keep your clicks down to a minimum and bouncing around between screens. Okay? I’m gonna stop on all that noise? Okay. So from let’s start with credentialing? I guess for your all’s perspective, do you credential the provider first? And then you submit the pair enrollment request or does that happen in parallel to each other? How does that work internally today? It’s.
Shaun Urbanozo (28:01) usually in parallel obviously for pairs that we’re delegated with, we need to finish the credentialing first. But the other ones, we kind of do it in parallel, okay?
Scott Everline (28:17) So, let’s start with the credentialing workflow… and then from a delegated perspective, is medtrainer doing anything as far as generating the delegated rosters? No. So you guys do that too, you manage like all the ad terms, changes every monthly yep. And how many rosters, how many delegated groups are you or pairs are you guys delegated with, right?
Shaun Urbanozo (28:41) Now, we’re like at 12.
Scott Everline (28:45) Okay. So that’s a lot of work. Yeah. Like would you guesstimate, how long you think it takes for you guys to get a delegated roster pulled together?
Shaun Urbanozo (28:57) Well, currently, we’re we kind of split it out amongst, I think each person is doing two or three rosters each. So it takes… like for mine, it takes me a good day like almost a whole day.
Scott Everline (29:14) Wow, like a whole day of productivity just moving data into boxes. Yep. Okay. I think we can help with that too. Cool. So credentialing, right? So the process submit requests through the platform. So whether it’s an initial, whether it’s a recredential, you can submit those in bulk, right? So if it’s a net new provider and we need to add the provider to the system, you can do that if it’s an existing provider. So we’ve already done that onboarding process. You’d grab the individual providers that you need to add to the process. And then we would go ahead and the system kicks off kind of through automation these psvs. So your team isn’t having to go out and capture this. The system automatically will go out and it’ll ping the state licensing boards, it’ll ping mpdb. It pings, oig, it pings, Sam, we can hit ofac, we can hit social security, death, master, pulling in education history from national student clearinghouse, or from licensing boards, Ada, et cetera, right? So we’re going out and capturing the vast majority of that work through automation. And if there’s any verification elements that our team can’t pull in or that the system can’t pull in, we have individuals that will go out and retrieve those manually. We build all that into a credentialing packet, right? So, will your team have visibility into the status of these files? We have a contractual SLA to turn these files around in five days. So files won’t sit in this bucket for more than five days. And then we’re going to move those, the system moves these over into a ready phase, right? So within ready, we’re going to identify a whole bunch of information to get you started. But there’s a PSV report so that highlights whether or not it’s a clean application or whether it’s an application that might require some additional review. And then I’m able to come into the platform and look at the credentialing file itself. So if I want to look at the credentialing packet, this one has a, very, lean summary, but, you know, your typical summary is going to have all of your verification pieces, the source of that, the verification date, the status of that specific element. And then at the end of the day, per ncqa requirements, somebody has to get their eyes on this file, right? So, medallion has trained staff that will put their eyes on the file. At this point, your team can look at these files and say, hey, this is what they need. This is what needs to happen, right? If there’s an issue with a component, they can go in and make notes here within this file, they can mention other users like if I wanted to go back to Sam and I had a question around a verification evidence or I needed to push maybe to you because there’s something that I, as an analyst, I’m not familiar with. I want your expertise on it. You can do all that, right? I can add attachments to this file and I can add links, right? So pretty much anything I need to do with a file and paper, I can manage all of that here within the platform. And then you can choose whether you want these notes to be public. So public would be show up on an audit or you can make them private so that they’re not going to show up on the final file. So that if it goes through like an audit or a payer goes through an audit, they’re not seeing all your internal notes on the file. They’re only seeing notes that are relevant to the actual like processing of the document itself. You can also download the packets. So you can download the actual PDF of that credentialing packet and then look through that as well. Let’s grab you a packet real quick. Any questions on the packet or the processing or how that all? No, it’s pretty straightforward. Yeah, that’s our goal. Straightforward… here. I’ll show you a picture of the packet. So the packet looks a lot like this, right? So this is a more complete one that I pulled that I had saved. So you’re gonna have your summary and then you’re gonna have your table of contents. What’s cool is the table of contents is hyperlinked. So if you do have users that are working off of this, I can jump straight to a section. I don’t have to sit here and scroll through as, you know, so sometimes 100 pages depending on how crazy it is. So being able to pull that information that way… from this point forward, right? I’ve made all my notes. I’ve done everything I need to do. I actually don’t have the privileges within this profile, but there’s essentially a send button here, right? Let’s see if I can steal it. It’s gonna let me hijack this person. There we go. Fingers crossed. Nice. I don’t know if I like the term hijacking a human. But anyway, so here, I can determine where this needs to go, right? So you all will determine what credentialing committees you have set up. Typically, you’ll see like a clean committee, you might have a review committee. I don’t know how you guys break them up. We don’t really care. We’ll build all that within the platform. And then you’re able to send these, right? If you say medallion, we trust you’re clean auto, send the cleans over to the CMO to get signed off. We don’t even wanna touch them. Totally fine. We can auto process those and move those over. So your team’s then ultimately only looking at files that need some review because there’s some kind of discrepancy those files get sent over. And then this has a full committee management workflow, right? So I’m able to come in as a committee member and vote. So whether you all wanna manage this in platform and you have your committee members join within medallion. What I’ve seen is like sometimes committee chairs because committee meetings are oftentimes zoom meetings. Now, I don’t know if you guys do them locally as well. Yeah. So you’ll have like a committee member, pull up this screen in the zoom, right? And then you’re looking at that individual platform or that individual credentialing file as you’re going through the process, all the notes are in there, right? Everything you just did in the prior phase. And then either committee chair logs the vote here and you take like a vote within the committee virtually, or you can actually have committee members with privileges that come into medallion and log their vote directly within the platform. Okay? What I consistently hear is like our committee members are never logging into a platform, right? Yeah, we’re lucky to get them on zoom let alone get them to log into a system that’s totally fine. So that’s the alternative. It’s kind of have a chair come into the platform and manage that Files get voted on. They move through the closed process. And then that’s essentially, this is going to be your audit log, right? So let me just release this admin real quick because I don’t like that little pop up. I don’t know about you, but like pop ups are the bane of my existence. Pop ups and dings. I feel like I might have a mental health issue, but like dings, just drive me crazy. Everything in my health is a noise now including my children. So closed, right? So this is going to be your audit log. So this is going to be all historically every credentialing file you’ve ever processed. It’ll give you the outcome. You’ll be able to go back and review the packet, right? So all those details are there. So if you get an audit you’re easily going to be able to come in here. I can filter all of this, right? So if it’s by outcome, if someone just wants to look at specific states, right? Illinois is a particularly difficult state to deal with, right? Because of their centralized credentialing unified credentialing deadlines, right? So I can narrow all this down any way I need to get this data back out of the platform. Okay, great. All this can come out via API too. So I’m showing you platform functionality. But like all this can be moved outward quite easily through the API functionality. Awesome. And then for recreds, we just schedule for a 36 months down the road. Unless you come in and tell us to do something else, we’ll start recreds 120 days in advance with the goal to deliver that packet back to your team in that ready bucket 60 days prior to that recredentialing date. Awesome. So then it just becomes rinse and repeat, you don’t have to worry about missing anything, right? You don’t have to worry about like restarting the process. It all kind of auto kicks off and then the cycle starts over again. And then you kind of manage that process. From there. Any questions, thoughts comments? I think it’s a process we’re user friendly right now that’s our goal, right? Like I find I’ve been in credentialing for a long time and I feel like we’ve as an industry done a really good job of overcomplicating it, overcomplicating the details that don’t need to be complicated because there’s a lot of complication in credentialing that rightfully is complicated. But like this workflow management stuff doesn’t need to be complicated at all in my opinion, right? The easier, the better, there’s plenty of stuff that we should be doing and not moving things around in a bunch of buckets manually. If we don’t have to. So that’s credentialing as a workflow… from a delegation perspective, we will manage or can manage delegated rosters. So as providers are going through this credentialing process, if you’ve assigned a provider to a delegated agreement, right? So here are all the providers, maybe I’m adding a new provider, we’ll automatically populate those providers. So if there’s like a change, if there is a provider that gets termed or a new provider that’s been added and has been credentialed, we’ll populate that directly to the payer’s roster. So we’ll get the rosters and then we’ll push all that data to the roster at the end of the day. If there’s data that you all have, that’s not on the platform, you’re going to have to add that, but you’re not copying and pasting a lot of stuff to a bunch of different rosters. I would say at least 90 95 percent of the roster is pre built if not 100 percent depending on what this data stewardship is in. Medallion we give that to you. We don’t send it directly to the payer. So we’ll send you back the delegated roster. You scan it with your beautiful eyeballs and then you can send it directly to your provider. But the heavy work of like managing the terms, changes, ads, all that stuff. We’re just pushing directly into their platform. So those 12 that you’re managing will generate those 12. If there’s 12 different rosters but your team doesn’t need to sit down there and copy and paste data. Again. Probably not the value they bring to the organization, being able to intelligently look at things and make intelligent decisions… payor enrollment, similar, kind of ease of use, I think so you’ll submit an enrollment request. So again, this can get generated out of like an HRIS system, whatever it might be, or you can come in here and just do enrollments, demographic updates. You can do bulk demographic updates. So say a practice moves across town and you need to update a payer with that change. You could just move all the providers that are with that, and then revalidation. We do auto manage revalidation. But if you needed to request a revalidation manually, you can do that. So here within the platform, right? It’s going to give me the option of whether I’m enrolling as a group, whether I’m enrolling as a provider? Are you guys enrolling mostly at the group level? Are you like all the groups? And then all the providers that roll up under that group? Are you doing more individual provider enrollments, more individual provider enrollments. Okay. Cool. So from provider enrollment, right? I’m going to get my full list of providers that are within my group. Let’s grab Naomi. It’s going to give me the groups that provider is affiliated with. There’s other groups that Naomi isn’t affiliated with, right? So if I say I want to put her in a downtown clinic, the system later on is going to say, hey, do you want to add Naomi to this group? Because she’s not affiliated right now? Okay? The system is smart enough to say like, right here, she’ll be added to this group and you’re like wait, she’s actually not part of that group, right? So let me pull that group off of this, okay? And then I’m able to select the payers. So what we’ll do is we’ll truncate this down to your markets. So you’re not going to have this massive list that I’m about to show us looking at where this provider has the licenses. So again, I don’t have a license in California, I probably can’t get enrolled with a payer in California. So we’re searching for those dependencies in the platform. And then it’s going to give the list of payers. This is going to again be based off of your payer list. We have a very long list of payers as you can see. Yeah, zing health that’s a fun one, right? So let’s just go, just grab six degrees and then it’s going to ask there’s not a group enrollment, right? So the system does some stuff here to configure… I’m, going to select the line of business for this case. It’s only commercial for six degrees. It’ll give me all those lines of business. And then I’m able to add the providers by practice location. So I can either just say every location that the provider’s affiliated with, add those, or I can come in and specifically identify practice locations. Awesome. So I’m going through this process, filling in these boxes. All right. I’m, not going to fill in all these boxes because we’ll be here all day mostly because I’m never going to give it the right answers and it’s going to keep defaulting out. Yeah. So this once that’s set, we’re going to run that intake module that I showed you earlier, right? So like what’s needed for this enrollment specifically, and then get all that information gathered. And then the system will actually generate the enrollment packet for the payor and submit it. So the system will actually run that enrollment packet, whether it needs to be a form that we fill, whether it’s a roster template, so not a delegated roster, but we do submissions via roster or whether it’s like a direct link into a portal platform, right? So if we need to go into somebody’s availability platform to pre populate an enrollment request and fill in all those blanks. We got robots and AI agents that’ll do that. So those will go into the platform. You’ll be able. To see here within the platform within medallion exactly what the statuses of all of those are, right? So you can see any specific like this one, right? The provider’s roster eligible. I can even view the roster that’s here. So when I look at the roster template, I can do that here within the platform… we’re not going to do that because it’s not super exciting.
Scott Everline (43:46) Oh… done. Broke the baby clicked too many times. Sean. Here we go. Okay. So we’re going to get all that kind of core data, the SLA. So we do have a contractual commitment similar to credentialing to get these enrollment files out the door. Once we have the data we need within a 10 day turnaround time. And that allows us to do all the appropriate QA and make sure that you know, everything’s what it needs to be and kind of manage that resubmission rate of the sub one percent. You’ll be able to see kind of the status of the application. So think of this kind of as your PE pizza tracker. We actually use AI agents to do follow up. So we do follow up via phone, which is actually kind of fun to see because the AI agents can navigate an ivr system like I’ve never seen better than iPhone actually. And then we have like screen scraping capabilities, right? So we’ll have bots go out and check like somebody’s enrollment portal. If that’s the best path. Ultimately, we’re conducting that follow up on kind of a predefined cadence. Typically, it’s 10 days with some payers, it’s adjusted because some payers will come back and be like, hey, 10 days is too much. You guys are killing us, right? So maybe we need to do every 14 days or whatever they kind of instruct us. So we’ll build that out kind of specific to that payers’ requests or even their performance right there’s. AI on the back end just looking at how long is somebody going to respond, but you’ll be able to see all those outreaches, you’ll be able to see any notes, any outstanding tasks that are in place, any dependencies. I don’t know if you guys do anything in like the medicaid managed dental space, but like if you don’t have a medicaid id in that state, we’re not going to start the processing of an mco agreement because we know what’s going to happen there, right? They’re going to come back and say where’s the medicaid id. So looking for specific dependencies. Yeah, we’re.
Shaun Urbanozo (45:33) currently, we are probably about 90 percent of our patients are medicaid.
Scott Everline (45:37) Oh, wow. Okay. Nice doing the lord’s work. Appreciate it. And then like all those details, right? And if I don’t want to look at all these details because you see, I’ve been scrolling for like the last 45 minutes, I can narrow that down. So as a user, I can come in and be like, I don’t care about the caqh sync, turn that off. I don’t care about caqh. I care about request owner, right? Created on. So I can truncate all that down. So I’m only seeing fields that I care about. Okay, we will follow that all the way through the system. You’ll be able to see what needs attention. So anything that’s been flagged for attention. These will also generate tasks either to the user or to the admin. And then we’ll follow this all the way through to enrollment complete. And so the provider as well as the admins will be notified. Hey, this enrollment’s been completed. If there’s anything that we need your team’s help on. We’ll specifically call that out. But most of this is just the bot doing what bots do, right? They’re submitting the documents, filling out the paperwork, and then you’re able to track all those enrollments. So like when you talked about, so we’ll map in your existing enrollments. So take your medtrainer enrollments that are in the system today. We can move those into medallion, map them to the revalidation date. So we can start those revalidations in a timely fashion. But then you also have full visibility into all of the existing enrollments, you get the provider ids, you get the par statuses, lines of business, proof of enrollment, if it’s something that’s been generated. So like if there’s a proof of enrollment document that comes back, we’ll store that here in the platform, give you kind of your effective date, your recred, your revalidation date. So all that information you need to track is here within the platform, you can download just this report. So thinking about getting into the hands of some of your peers, right? That might not necessarily be in here. But like the clinical team or the scheduling team needs to know who’s where and when you can download a report. We also just build custom dashboards for customers, right? If you’re like, hey, I really need like net new, I need to know who was enrolled within the last week or who was enrolled within the last 24 hours. We could build out dashboards within the analytics section, but you can also just literally download. This, or you can pipe this data out of the system via the API directly into whatever platform you want, right? I saw something about like a Power BI tool, right? We have tons of customers that do a lot of like that metrics tracking you were talking about. We’re not doing it. You can pull it out via an API and then run it through Power BI or any other tools you want, awesome.
Jordan Tantleff (48:08) Real quick, Sean. I know we’re two minutes over here. Did you have a hard stop five?
Scott Everline (48:13) Minutes? I’m sorry, I.
Shaun Urbanozo (48:15) Have another call at 10. So, my hard stop is 10.
Jordan Tantleff (48:19) Scott, you don’t have a hard stop? Do you? I know reporting and analytics is pretty big.
Scott Everline (48:25) Yeah, no, I’m… good until noon, my time. So… good… Sean. I’ll quickly give you the analytics and report building. How about that? Yeah, if we ever need to dive back into this, happy to do it, there’s a lot of weeds I didn’t get into if you can believe it. I’ll.
Jordan Tantleff (48:45) also send you the recording by the way, Sean, because I know there’s a lot that we just went through, yeah.
Scott Everline (48:51) So within the analytics section, right? We’re going to, we have these kind of pre built dashboards. As I mentioned, we have dashboard, we have customers that come back and say, hey, there’s some key dashboarding that is not in the prepackage. We can work with you all to build those out. You’re looking at enrollments issued by month, you’re able to see completed enrollments, the status of enrollments. So even like down to like how many enrollments are in a specific status at any given time, you can see how long things are sitting in individual statuses. You can see at the actual total throughput time for this process. All of these are exportable. So if I want to access that metadata like, hey, this looks like a cool report, but I want to see like the real numbers, you can put it down as a CSV in excel if you want to put it in like a bi tool, Json, if you really like a graph because people like pictures, you can save it as an image, right? And drop it into like a presentation for leadership. Same thing for credentialing, right? Looking at turnaround times, looking at how long files sit in certain parts of the status. I don’t know what’s going on with that one. And then provider onboarding, there’s dashboards that really track like that onboarding timeline, right? You mentioned it being two weeks like how are we doing with that? Right? Our typical onboarding time is like two days depending on the provider level of engagement and how much nudging they respond to. But you have reporting on all of those turnaround time, right? Pieces too. So all these are being built live which is why they have a little bit of a lag but not like an online lag, but it’s happening in real time.
Shaun Urbanozo (50:21) So,
Scott Everline (50:22) you can see like how many invites are out waiting to be sent or waiting to be completed, you can look at all those metrics around that.
Shaun Urbanozo (50:29) Awesome. And then,
Scott Everline (50:30) there is a custom report builder. So if you do want to come in and build a report, you can come in and grab whatever reporting you need, right? Just like ad hoc reports throws it up for us. I can save it or I can export it as a CSV file. So essentially any data element that’s within the platform, you’re going to be able to pull into the custom report even if you want to know what color eyes your team has literally eye color, it’s interesting height and weight anyway, probably not going to get populated there, but you can get as you can see a pretty finite level of detail within this report builder. If you save it, we’ll store it here and then you can always go back, right? And then just rerun it or pull it at that given time. Awesome. So I’ll stop talking as much as I said, I hate my own voice. I did a lot of it. Hopefully that gave you a good flavor of things. Yeah.
Shaun Urbanozo (51:26) You did?
Scott Everline (51:26) Curious how this feels compared to medtrainer?
Shaun Urbanozo (51:31) Like I said, it looks a whole lot more user friendly and looks… a lot more less hands on by myself and the team. So.
Scott Everline (51:44) I’m.
Shaun Urbanozo (51:45) sure. I’m going to have more questions as we go along. So we might have to schedule another one of these with additional questions that I have, but I will definitely let you know.
Jordan Tantleff (51:55) Awesome. Yeah.
Scott Everline (51:56) Thank you. Happy to answer any questions you have. And I’ll.
Jordan Tantleff (52:00) follow up like I said, Sean, with this recording, if you want to kind of socialize that with your team, we can also set up time and kind of run through this again. Curious if you have any idea like kind of what the next steps are within the RFP? Like are you making kind of the recommendation to the CEO on, you know, who advances pretty much to the next round?
Shaun Urbanozo (52:20) Well, our project team is meeting. I believe we’re meeting at the end of next week to go over. I sent everybody as rfps are coming in. I’m sending it to everybody in the project team.
Shaun Urbanozo (52:33) So they hopefully should be reviewing it before the meeting, but we’ll meet next week to kind of go over the rfps and see who we kind of want to move forward with in the next round. And then we would go from there. So I should have some feedback for you by the end of next week, by the end of the day next week. Friday. Okay? And then I’ll let you know what the next steps will be. That sounds?
Jordan Tantleff (53:01) Good. Yeah, we can circle back on that Friday. If any questions kind of come up in between, then don’t hesitate to shoot me an email. We can get that answered async. But yeah, I appreciate your time today again. I’ll follow up by email and don’t hesitate to reach out if anything comes up.
Shaun Urbanozo (53:17) All right. Thanks, Jordan. Thanks Scott.
Scott Everline (53:20) Bye bye, son. Bye bye.