Transcript
Bradley Eral (00:00) hey, Michelle, you got Brad here?
Bradley Eral (00:11) Hey, Tina. You got Brad here and Michelle’s on as well.
Bradley Eral (00:35) Hey, you got Brad here?
16025987476 (00:38) Hi, good morning. This is Michelle Bassett and Kathy hunt.
Bradley Eral (00:42) Oh, nice. Good morning. How are y’all doing good? How about yourself? Doing well, doing well. Appreciate you guys jumping on.
16025987476 (00:51) Yeah, absolutely.
Bradley Eral (00:57) How’s the day been so far?
16025987476 (01:00) Oh, good. So far? Yeah, I.
Bradley Eral (01:02) suppose, just getting started.
Bradley Eral (02:15) Team a few more minutes here’s. Josh. Hey, josh.
Joshua Levitan (02:19) Hey, everyone.
Bradley Eral (02:21) How’s it going?
Joshua Levitan (02:22) Doing well. Good morning.
Bradley Eral (02:31) You guys have any fun plans for the upcoming weekend?
16025084994 (02:35) My daughter’s getting married. Does that count that’s you?
Bradley Eral (02:40) Tell me, no, that’s amazing. Congratulations. Thank.
16025084994 (02:46) you. No, we really like her fiance. Like I’m excited to have him as a son in law.
Bradley Eral (02:51) Oh, that’s the best. Where’s the wedding going to be?
16025084994 (02:56) Up north. So, I don’t know if you are familiar with Arizona. Are you in Arizona?
Bradley Eral (03:02) A little bit?
16025084994 (03:04) Yeah. So, it’s called lake gosh, forest lakes and it’s up north of the rim.
Bradley Eral (03:13) Nice. That’s going to be beautiful.
16025084994 (03:15) Yeah, it’s going to be really pretty. She’s like mom make sure you bring warm clothes. She’s like it’s a little chilly. I’m like, okay, she’s like bring a heater because we’re doing it outdoors. So it’s like in a like out in the woods outdoors, it’s a small ceremony. Yeah, it’s going to be pretty cool. She’s like it’s cold, mom. So make sure you bring warm clothes and a heater?
Bradley Eral (03:40) Oh, bring some tissues as well. It’ll be an emotional day.
16025084994 (03:44) Right, right. I’m going to like get kleenex company out of business with all the tissues.
Bradley Eral (03:51) Oh, no kidding. Well, congrats again, it looks like Amy’s on. And then another Dallin number’s on.
Bradley Eral (04:02) How are you guys doing?
16025084994 (04:11) Is that, oh,
Bradley Eral (04:13) and Tina’s on as well. So, I’ll take the team’s lead when we have quorum see a few names, and of course, a few numbers that can’t… tell who necessarily it is outside of Kathy and Michelle, but Tina, I’ll take your lead when we have quorum and we can jump right in.
Christina Wyke (04:30) Are you able to hear me yep.
Bradley Eral (04:32) Absolutely. Okay.
Christina Wyke (04:34) I was trying to talk to you guys. Sorry, we are good on our side. So avp is on. I know we only have a short window of time. So, thanks for hopping back on with us, Brad. You and josh. Are you the two who are joining us from the? Yeah.
Bradley Eral (04:49) Absolutely. We’re a whole from the medallion side. Okay?
Christina Wyke (04:53) Awesome. Well, thanks for hopping back on the phone with us today. I know you met with the four of us previously, yep and as we walked away, right? We started coming up with different types of scenarios that we were wondering, you know, how would medallion handle this type of a scenario? Is there added cost, you know, for this type of a scenario? So, thanks for hopping back on the phone with us for this 30 minutes. Of course, I’m going to let Michelle and Kathy kind of take it from there because they are the ones who have those situational questions. And I believe Michelle, Kathy’s with you right in your office.
16025084994 (05:28) Yes, she is here. Good morning, everyone. This.
Christina Wyke (05:30) Is Kathy? Good morning. Okay. Michelle, if the two of you want to rock and roll, let’s talk through some of those scenarios and find out how medallion would handle it. And if there’s.
16025084994 (05:40) additional costs for it?
Christina Wyke (05:42) Sure.
16025084994 (05:44) The first one we’re looking at is a location add to an existing brand or group. And we’re hoping you could walk me through a real scenario where we had to add a new location under an existing group and brand with multiple payers. What steps would.
Christina Wyke (06:01) we take from?
16025084994 (06:02) Intake to the payer approval? And how would you track and communicate the status throughout that process?
Joshua Levitan (06:10) Yeah, awesome question. So we would consider that a demographic update, we process demographic updates in the exact same way that we would process a new provider enrollment or a new group enrollment. So there is a cost associated with it. It’s a per line cost just like everything else. And basically, you go into the tool the same way that you did to request a payer enrollment, you hit demographic update instead of payer enrollment. You put in the information that needs to be the location that needs to be added. And then we go through the same process as we would for like a net new enrollment to process that. So you have the same visibility window. We’re going to use our automation to go ahead and get that complete. The same SLA is applied and then we notify you when it’s done.
Christina Wyke (07:05) Okay. Can someone circulate to me the pricing proposal that we received?
Bradley Eral (07:15) Yeah, bear with me. I will pull that up here. And then while I’m pulling that up, I’ll take a quick second. What other questions does your team have? Want to make sure we’re making the most of your time here?
16025084994 (07:29) Sure. So I will go next. So we have like additional brands for existing providers. So we want to for like a patient or I mean a provider is with Barnett and Lane Perkins. And now we want to also add him to southwest icenter, two different tax id numbers. So, can you tell me about a time you enrolled an existing provider under a new brand or tin within the same organization and how did you prevent delays or denials due to conflicting or duplicate records across payers?
Joshua Levitan (08:04) Yeah. So we would process that. Most likely, I believe as just a net new enrollment. We see this all the time. We have a lot of groups and I think you guys are sort of in this category, right? Like if you’re going through acquisition, you acquire a company, everyone’s on one tin. You have better rates on a different tin that you already own. You got to move everyone over. So that would be just a new enrollment.
16025987476 (08:26) Yeah. A little different scenario. And I do think the difference matters. So we don’t consolidate tins. We run under 14 tax id numbers and we often cross enroll our providers under multiple tax ids. So Michelle’s question specifically is have you encountered that? And how do you prevent a payer or what do you do when the payer says this record already exists? It’s a duplicate.
Joshua Levitan (08:56) The first half of the question, I can certainly take the second half of mine to follow up on. We handle this all the time. Like most of our companies are, most of our customers are using multiple tins. I have never been asked about the second half of that before because if you’re enrolling them under a different tin, you’re enrolling them under a separate group contract. So I mean like we also have again a slightly different scenario, but we also have providers that are in medallion that work part time for multiple different entities. And I… can certainly ask operations if there’s ever been any issues with that. I’ve never heard of any. We’re going to just treat it as a net new enrollment and the enrollment every enrollment we submit. We’re enrolling the provider under a group contract. Is that something you see right now where even though it’s a new provider to group relationship, the payer flags it?
16025084994 (10:02) Yes, I.
16025987476 (10:06) say Michelle, not consistently, but it definitely happens.
Joshua Levitan (10:10) Yes. Okay. Yeah, I’ll ask the operations team. Yeah, I don’t know. I mean different than your business. But if you think about like the therapy space for example, where like everyone kind of moonlights and works… three or four different like major online health, telecom companies. Like we have a lot of crossover that we see with providers. And again, we’re not even talking about within one of our customers. We’re talking about across three of our customers. So we regularly like are handling that type of thing. And then for many other sort of like mso, multi state operators, more in line with yourself. We cross enroll across tins all the time regularly. We would you just create the relationship in the in medallion between the provider and the tins that they’re associated with. And when you go to request the new payer enrollment, you just specify which group that is. And then since we’ve also uploaded the group contracting information, we know like this tin has contracts with these providers, with these payers, this tin has contracts with these payers, and then map the associations. But I’ll ask if we’ve ever noticed issues, there, is it one specific payer that you notice issues with?
16025084994 (11:27) Yeah. I think we have multiple payers that will submit applications for the same provider under two different tins and they’ll either drop one and not process it or they’ll kind of merge those applications. And then we’re not sure which way they go. Sometimes they go one way or the other, but yeah, they’ll mix them up on their end. Sometimes. So I’m just curious, how you handle that internally for two different tas ids for the same provider?
Joshua Levitan (12:03) Yeah, yeah. Like I said, I’ve never heard of this being an issue with any of our existing customers. So from the way the process works to suggest like to submit it, we’re always submitting an enrollment tied to a specific tin. But I will ask our teams if we, if we’ve seen this happen and if we have seen it happen before… where like what they do about it, okay, the remedy to the issue. But I think the larger point though, I think like the vast majority of our customers are managing multiple different tins and have cross provider population across those different tins. So that the technical structure and the expertise on how to do that is like oftentimes customers are coming to look to us because their current solution has had issues with managing across multiple tins and that’s a strength of ours. So I’m not worried about that causing any issues, but I’ll do the due diligence and ask for you.
16025084994 (13:11) Okay. Thank you. The next item that I have is if you would give us an example of when a payer requests additional documentation, mid enrollment, how do you manage that turnaround time, ensure that the provider responsiveness, and keep that enrollment from stalling. Yep?
Joshua Levitan (13:32) So we’re going to first triage, however that request comes in… whether it’s like presumably it’s usually by email, but it could come in a couple of different ways. Our automation is constantly triaging things like emails so that the second they come in, it’s identified like what the next course of action is. That next course of action is always going to be a task to the provider. And if you recall the tasks populate in the provider’s profile as well as in your administrator profile. So, you know, that there’s something being asked of the provider and then tasks follow up or I should say trigger a medallion to reach out to customers or to providers. I should say, so the provider would basically that task would be generated based on the email triage, a request for xyz. They’ll be emailed. When the task is immediately created, it will show up in a weekly digest, email to them of all the tasks that are being created. And then we’ll follow up every three days with that provider as well. And then the whole time your team has visibility into the tasks that the providers are being asked to complete. So I think in the demo, we primarily talked about these tasks as happening during onboarding… but it’s the same infrastructure. It’s the same method of communication with the same follow up protocols as all of those tasks about when they’re missing data upfront that happen, they just happen down the line. The second that information is updated, our automation basically picks that up flags that understands that, and then routes that back to the payer in whatever way the payer specified. They need that information, whether it’s uploading it back to the portal or sending it in any other way?
16025084994 (15:18) Do you have any kind of like escalation process? So if you are not receiving the feedback from the provider, they’re not responding in a timely manner. Do you have like an escalation process? Yeah?
Joshua Levitan (15:30) So, it’s visible how like long that task has been out there to you and your team. So right when you log in your home screen, you’ll see the most tardy tasks. I think this is an important area where like it is still like while we’re owning a lot of this, like a lot of times those escalation paths are best from you. We’re gonna follow up every three days via email on any task and in the weekly reports, but we’re not gonna start ramping that up to like every day, you know, if it’s been two weeks or something basically because we don’t want the providers to start ignoring our emails completely. So we’re always gonna stay consistent with the every three day follow up on any task. But we’re gonna make sure that that’s available for you and your team to see like it’ll be the first thing you see when you log in that there’s a task that’s been open for, you know, 15 days or something like that. And you can sort and filter and have logic on all of that. And your team is also gonna get like whoever and, you can designate multiple people or one person however you want to do it. You can designate like for cohorts, like a specific state or a specific practice like this is the manager or the sort of like higher level contact. But we would set it up too so that like you would get an email every day, every week, whatever you want of all of the tasks that are open for all of your providers and it will stay on your like task report of what we’re like we want you to know what we’re asking of your people. And so it will be on that report until it’s completed as well. And then in the sense like I guess you are the escalation path, but the escalation path that we provide is steady reminders and like detailed visibility into what’s being asked.
16025084994 (17:16) Okay, great. Thank you. Is that the same for a payr? So there’s an escalation process for the individual provider, if you’re reaching out, but what about the escalation process? When for the payr themselves, after you’ve met their timeline?
Joshua Levitan (17:33) Yeah. And you’re talking about like in terms of follow up?
16025084994 (17:37) Yeah, yes.
Joshua Levitan (17:38) Absolutely. Yeah. So, yeah, great question. Absolutely. Most of our follow up is driven by automation. If the, if we know what to expect from payr’s on like the certain timelines, like we have data on like let’s say it, this payr average is 58 days. So if we get beyond that 58 days, we’re going to actually start using our humans, we’re going to consider that like an escalation. And we’re going to start using our humans to follow up instead of like our automated emails and portal scraping and AI phone calls. And if things really go awry, like so maybe that, you know, we give it a week past what we expect. And then we move into this escalation path. We get our humans on the case to track that down and supplement the automated outreach. Let’s say a week or two go past that. And we’re still not getting anything. Then that’s going to go not from just like one of our regular staff but that’s going to go to like your named engagement manager, who is like your expert, who you meet with every week or every two weeks or every three weeks, whatever you want about the status of like all of your enrollments, they’re then going to personally step in as like, I guess that’d be the second or third level of escalation, and like personally start working with the payer on your behalf and coordinating with you. And I’m sure that like that’s usually like sometimes it happens payers let things into their clacks. There’s someone that’s taking way longer than expected with a specific payer that’s the type of thing that you would talk about in those regularly scheduled meetings with your engagement manager?
16025084994 (19:14) Thank you. So the next question we have is in regards to caqh maintenance. So, can you describe the process for managing ongoing caqh maintenance across a large provider group? And then how do you, so?
Joshua Levitan (19:28) You’re cutting out a little bit? Did you say caqh management?
16025084994 (19:32) Yes, caqh maintenance. So, can you describe your process for managing ongoing caqh maintenance across a large provider group like ours? And then how do you proactively track the expirables like the licenses and Das, and what happens if something lapses? Yep?
Joshua Levitan (19:50) So we’ll take caqh first. We call this caqh management, which is why I had said that term. So basically, the way this works is we’re assuming medallion is the source of truth once you start using it, right? Like we’re going to pull that caqh import into medallion to build the profile. But then we’re going to ask for attestation in medallion. The provider is going to attest that it’s up to date. And then we’re assuming that all future changes happen directly in medallion, what happens next? Is there’s two points of caqh maintenance? Number one is the quarterly attestation. So we will do those attestations on behalf of you and the provider that’s a technology. It’s like a bot based automation that we’ve built that handles those before it does the attestation, it scans the entire profile assumes medallion is the source of truth and changes or adds anything in caqh to match what is in medallion. And so that happens on every regularly scheduled attestation date, on top of that, we do an additional caqh maintenance check at the time of any payer enrollment. So let’s say you’re like between the quarterly attestations, something in the provider’s profile changed in medallion, and then you go and try and enroll them with a new payer. Well, we’re assuming that payer is going to pull caqh. So we need to run essentially like an off cycle caqh update. And so that’s the first action that’s triggered by you requesting a payer enrollment is to go and run like that off cycle. It’s still automated, but it runs off that attestation cycle and we update caqh before we submit the payer and the provider enrollment to the payer. Great. Okay. Second half of the question was expiration tracking. Yep. Yeah. So remind me, are we going to be doing credentialing for you as well like in credentialing packets?
16025084994 (22:00) No, we’re just looking at provider enrollment?
Joshua Levitan (22:02) Okay. Are you going to have a need to like, what are you going to want to monitor? Are you going to want to monitor like sanctions… obviously licenses you mentioned how?
16025084994 (22:15) Do you handle the expirables within caqh? So, are you uploading and making sure that all of those items within caqh are, oh.
Joshua Levitan (22:24) Yes, current.
16025084994 (22:25) License Dea, and that there are copies or any documents that are required within.
Joshua Levitan (22:34) Caqh. Yes. Okay. Yep. Thanks for the redirect there. I thought you were talking more about like expirables and sanction monitoring and platform. Yep.
16025084994 (22:48) So next question we’ve got for you is revalidation. So can you walk through how you manage revalidations? How do you track the due dates, prioritize the workloads and ensure nothing expires?
Joshua Levitan (23:01) Yep. So there’s two different paths here. The first path we’ll talk about is if we did the initial enrollment, then we know exactly the date that it’s going to need to be revalidated because we received that back and we were the start of it. So we log that date, we track that. And when that happens, like when it’s ready for reval, assuming the provider is still active in medallion, meaning they haven’t left the company and you haven’t turned off their profile. We can just auto schedule that revalidation to process as, you know, certain payers have wildly different revalidation processes. Some of them literally just check caqh, some of them require a lot more information, but whatever their revalidation process, is logged in. Our payer guides payer by payer. So we know what their process is, where there is a little bit more nuance is with providers who currently work for you, where you’ve done their initial enrollment, and then you import them to medallion.
Joshua Levitan (24:08) And we are responsible just for their re enrollment. And for that, if you are confident in your data and the re enrollment dates that you have, we will upload that as is if you are not confident we offer a service where we can basically verify it’s called par analysis in terms of verifying that they are par with the payers. But the other function that serves is validating the exact revalidation… date I used, validate, twice, verifying the exact revalidation date. So if you don’t have confidence in any subset of your network and you want to like check whether it’s with a specific payer or a specific provider group or a specific tin, whatever it is. We can certainly talk about adding that service in. And basically what we do is we just call email like we reach out to every single payer about every single provider who you think is a network. And then we confirm that they are a network and the exact revalidation date?
16025084994 (25:13) Would.
Christina Wyke (25:14) that be like a per item cost for doing that too?
16025084994 (25:18) Yes, yeah.
Joshua Levitan (25:20) It is, but it’s nowhere near as expensive as like an initial. I don’t think it’s well, this is more Brad’s realm than mine. I don’t think it’s as expensive as like a full enrollment.
Bradley Eral (25:28) Yeah. Okay. Yeah, it’s not as expensive as a full enrollment. And then worth mentioning for every enrollment. We also do this process. If you were to do an enrollment, we’ll always back channel and make sure that provider is either in or out of network before submitting an application. Okay? And then as long as go ahead.
Christina Wyke (25:49) Oh, no, go ahead, Brad.
Bradley Eral (25:51) Perfect. I was just going to say as long as I’m on mute, I want to make sure you get your initial question answered around the proposal. We still need like a few final inputs just to verify it’s. Going to be accurate and also like mirror like, hey, what does the revenue acceleration look like? But from what I’m seeing it will be, I’d say the low 2000 or 200,000. I should say, you know, anywhere from let’s say 200 to 240 on an annual basis. Yeah, that’s.
16025987476 (26:17) helpful, Brad, what I’m actually looking for is I’d like to see and maybe you can just send over a standard template contract. I’d like to see the actual contract. So I thoroughly understand how pricing works.
Bradley Eral (26:28) Yeah, of course. I’ll send over once we get the inputs that will inform that, and I’ll send over what we’ll need. We’ll put together a thorough proposal, send that over and you can see exactly like, hey, how do we arrive at these figures? But at a high level, essentially, it’s consumption based model. So each unit of work, whether that be an enrollment or revalidation, par analysis, we’ll have, you know, dollar amounts associated with it. So the more you consume, the more the cost and then ultimate flexibility across year over year because at the end of the day, we’re never going to get closest to the pin on exact volumes. Yep.
16025987476 (27:03) And all I need to see is that I need to see the table of the cost at the line item level.
Bradley Eral (27:07) Perfect.
16025987476 (27:09) Yep, totally understand the consumption model. Then I just had one quick question. Michelle you said you’re all set with your questions?
Christina Wyke (27:16) We have one last one, go ahead.
16025084994 (27:21) Okay. I’m curious about the roster approvals and partial denials. If you could tell me about a situation where a payer only approved part of a roster submission and how do you identify perhaps the root cause and resolve the discrepancies and prevent the same issue in future submissions?
Joshua Levitan (27:41) Yep, that would be when we receive the response roster. We would validate that. And then we would. And then we would basically treat that as an escalation, the same way I was talking about an escalation before, where like that gets kicked over to one of our experts who reaches out to the payer directly to try and figure out what went wrong, figure out if it could be resubmitted, like do all the research. There might be some level of coordination with your team on that. Like again, it would be the engagement manager like running that process who would then in your weekly or biweekly meetings like bring that up and give you all the updates if we find something systematic like if it wasn’t a fluke, but there was actually like a root cause that is addressable. We would update our payer guides, that like repository of the payer’s process to make sure like if the payer changed whatever the situation is to make sure that we account for that in the payer guides, which that could be a global level change. Or we essentially sometimes create like a version of the payer guide as it relates to your organization. And like sometimes some of our customers have like different agreements or arrangements with payers or because of the provider type or the nature of your providers or something like that you’re enrolling there’s like a deviation from the process. So we can think of that as like a child guide. If you will. There’s the parent guide that we have that is based on our research that governs like generally how the enrollments work with that payer and then specific to you, there is a deviation or an update to that process tracked in the payer guides, which then informs the automated process as well as any humans in the loop on our side supporting that automated process going forward?
Christina Wyke (29:34) Thank you so much. Thank you. Great. We’re done, Amy. Okay?
16025987476 (29:42) Is vision partners still a client of yours?
Bradley Eral (29:47) Let me confirm, I’ll get back to you. Okay?
Bradley Eral (29:56) Well, any other questions at this time?
Christina Wyke (30:02) I think Kathy and Eric are good with our questions. Okay? Unless Tina or Amy have any, nope, I’m good on my side.
16025987476 (30:09) I’m good.
Christina Wyke (30:11) Okay. We’ll get right at the 30 minute mark.
16025987476 (30:16) So.
Christina Wyke (30:16) Brad, we’ll keep an eye out then for the pricing because I’m pretty sure the proposal didn’t get sent originally after our last call. So we’ll keep an eye out for that along with the per item pricing. And then I’m sure we will probably have more questions, yeah.
Bradley Eral (30:30) Absolutely. So I’ll send over that. And then Tina, I’ll shoot you a quick note, just want to make sure the proposal is going to be accurate. So I’ll send you a quick note on some of those inputs we’ll need for that. Okay. Perfect. Well, we appreciate you guys. If any other questions come up by all means, don’t hesitate to reach out.
16025987476 (30:50) Okay. Thanks, josh. Appreciate your time. Thanks, josh. Bye bye.