Transcript
Ellington Loy (00:00) hi Ashley.
Danielle Hamilton (00:03) Good morning. How are you?
Ellington Loy (00:05) I’m good. How are you?
Danielle Hamilton (00:07) Good. Thank you.
Ellington Loy (00:23) Hi, Danielle.
Danielle Hamilton (00:24) Hi, good morning. How are you?
Ellington Loy (00:27) I’m good. How are you? Good. Hey, Rosanne. Hi. How are you this morning pretty?
Rosanne Nikolaidis (00:37) Good. Thank you.
Ellington Loy (00:39) Awesome. So, I think we have everyone from your side. Is that correct?
Rosanne Nikolaidis (00:45) Yes.
Ellington Loy (00:48) Awesome. Well, nice to meet you all. I’m Ellington, I’m on our business development team here at medallion. A big part of my role is really getting to meet people who are interested in medallion and our services, and really just wanting to hear from you all and why you’re what, how you came across medallion and what prompted you to look into credentialing and any, you know, inefficiencies on your side as far as credentialing enrollment, licensing, and anything like that. So, I’ll let you take it.
Danielle Hamilton (01:24) I can.
Rosanne Nikolaidis (01:26) Sorry. Oh, just a brief introduction. I just heard about your product while at aad, just from a physician friend of ours. Awesome. He was just familiar with it. I had asked if he knew of any systems to help us with physician credentialing just because that has been a pain point of ours for a while now, and I’ll let Danielle elaborate further on that because it’s especially painful for her, I think so.
Danielle Hamilton (01:52) Thank you. Yes… we have used the same local credentialing group since the inception of the practice and we’ve grown over the years. And so our existing group… essentially is still using what I perceive to be kind of antiquated means of communication. It’s essentially emails and excel spreadsheets. There isn’t a proactive means or way in which that we can log in to see the status of newly onboarded providers. So definitely looking to have more real time communication and updates. And then with respect to directory updates, I feel like those are always kind of slow and inevitably inaccurate. And it usually is a result of Ashley and I, Ashley and I work very closely. She’s more hands on day to day with respect to the in house billing, we use a third party, but obviously, you know, there’s going to be local practice questions that require escalation. And so she sees a lot of the frontline issues as a result of credentialing errors or payor errors, right? That are related to credentialing and just having a means to update those more efficiently and accurately. And then our HR team who isn’t on the call, they do interface with our group, obviously at the onset of a contract execution to secure documents and license your renewals and things of that nature. So, I’m sure that having some degree of automation or reminders to that end would be helpful.
Ellington Loy (03:45) Right. Gotcha. And one thing that really stuck out to me that you spoke on was just kind of the lack of visibility that you have into the process. And that’s something that we really address here at medallion. We have our platform that you’re able to go in and you can have as many seats in the… every single process of where these providers are in their process of being enrolled with payers, credentialing. So that’s something that I think that you spoke directly to that would be definitely really interesting for y’all to see the product, just kind of see what, how it works and the automation that we deliver. I have a couple of questions for you. My first is how many providers do you all currently have?
Danielle Hamilton (04:39) I.
Rosanne Nikolaidis (04:40) counted, I think we have a total of 76 including mid levels. However not all of our providers are credentialed on medicare and insurance some.
Ellington Loy (04:55) Just.
Rosanne Nikolaidis (04:56) have hospital privileges, some of our mid levels bill incident to the physician. So approximately, I would maybe 70 would be fully insurance credentialed if I’m I.
Danielle Hamilton (05:14) think we have, I’m looking at our sheet right here, we have 55 physicians of which I would estimate about five of those aren’t loaded on the plans intentionally. And then on the mid levels, we have a total of 22 five are direct billing right now. We’re kind of mid project with that other group working on direct credentialing, roughly speaking, another, I don’t know Rosanne. What do you think? 10 to 15?
Danielle Hamilton (05:54) Yeah, I think that’s fair.
Rosanne Nikolaidis (05:57) 10 to 15 of the 22 mid levels still in the works. Yes. And a couple we won’t be doing to my, I believe, right? Yeah, I think roughly 70 to 75. And of course, we can get more granular on that as needed. You know, once we have an understanding of your pricing, and what services you offer because even those providers that don’t get insurance credentialed, of course, we do still have, you know, hospital privileges, and all their, you know, licensure that needs to not expire all those things. And so if your service also helps with that, then they, maybe they’re included in your total for certain services but not others.
Ellington Loy (06:52) Right, right. No, totally understandable. Makes sense. How do y’all, have an estimate as to how many providers you’re adding annually just as far as growth is concerned? Yeah, I would.
Rosanne Nikolaidis (07:07) Say that’s a great question. Maybe… four, three or four annually just kind of thinking historically and turn, you know, occasionally there’s a turnover of replacement and then addition or, you know… increasing status of one of our nurses to a provider, things like that.
Ellington Loy (07:41) Gotcha. And how many payers do you do direct enrollments with?
Danielle Hamilton (07:49) That’s another good one. So all the majors, obviously, we access a few through… different kind of ipas. Let me pull up.
Danielle Hamilton (08:07) One of those fun status sheets.
Danielle Hamilton (08:14) I mean, roughly speaking, I would say about 40 just off the top of my head.
Ellington Loy (08:22) Okay. And are y’all, delegated or have any delegated contracts or no?
Danielle Hamilton (08:30) We do have here locally through seton physician health alliance spin. And then, so we have kind of three major markets. Well, San Antonio to a certain. So we have primary, most of our offices are here in the Austin area, then we have Dallas Houston and San Antonio. So some of the outliers outside of the Austin area, do have different ipas that, they access.
Ellington Loy (09:01) Right?
Danielle Hamilton (09:02) Payers through, let me look at one of these status sheets.
Danielle Hamilton (09:15) So, on his status sheet, we have roughly… 60 carriers that they are loading per provider. Okay? But like you said, some of them are group directs, a handful are through spin. So that gives us access to say, like 15 at once right?
Ellington Loy (09:41) Right, right. Gotcha. Curious, what are your current enrollment turnaround times? Are you guys seeing delays there? What’s the, what’s.
Rosanne Nikolaidis (09:56) going on? Yeah, that’s yeah.
Danielle Hamilton (09:58) So, for example, the majors, they’re pretty quick. I mean, medicare, we can get within 60 days, right? Okay. But for example, I actually just received an email this morning from one of our newer locations in Lockhart. We are still waiting on tricare. Last update I have on that sheet is January fifth and she’s been seeing patients since the fall, right? Rosanne. I mean, I’m trying to remember September. So essentially, in those situations, we’re just deferring scheduling when credentialing is pending.
Rosanne Nikolaidis (10:39) Not September, November. I apologize. November. Okay. But still, we’ve been working on her credentialing since last summer, like she was hired a long time ago. You know, yeah. She finished, you know, it’s our understanding, that you have to wait for the new graduates, new resi, you know, residents graduating, they finish in June and it’s my understanding we, you know, you have to wait for that completion before you can start… but it’s definitely always our goal to have everything as fully credentialed as possible before they start, right? And so in her case, she wasn’t starting until November which gave a lot of lead time. But… yeah, for whatever reason. But, but tricare specifically has been kind of slow across the board for us. I don’t know if that’s normal or not, but it’s definitely a laggard one, but some of them turn around quickly. It just depends on the payr.
Danielle Hamilton (11:43) Okay.
Ellington Loy (11:45) And how many people manage this process? Like how many people are on the team? I.
Danielle Hamilton (11:53) Directly interface with one gentleman? I don’t know how many he has behind the scenes. I think he might have one or two that help him? I honestly don’t know on their end. But as far as me with the third party, I just speak directly to him occasionally. What is she the co owner of the group? I guess? Yeah, yeah.
Rosanne Nikolaidis (12:19) I believe it’s just a husband wife. Kim is more on the contracting side of things like when there’s a renewal of a payr contract that’s when we are speaking with her. So, I don’t know if your company also helps with that, but I get the feeling the Guy is on his own in terms of enrollment and that’s the problem. We’re a large group and he keeps, we’ve sent him a lot of work in the last year because we’ve kind of changed our model and we decided suddenly to direct credential, all of our mid levels. Well, we’ve sent them to him in, you know, batches of five or six or whatever. And he is just overwhelmed. We get like a nasty gram every time we send him more people rather than thank you for the business. And this is exciting. It’s… and then when we ask for updates, it’s well, I’m busy, you know, you guys have swamped me with all these new it’s like complaining. So, you know, that’s kind of where we’re at. We’re a larger organization. And we need more help with this than, right? That’s kind of what the main situation is right now.
Ellington Loy (13:47) Right, right. And because we’re able to automate this and really own this end to end our typical. So we usually have one person from our customer’s team that really manages this. Our typical usually because you still have to see have someone that’s overseeing this. It can’t be fully automated. All of it. It has to have some human intervention as I’m sure y’all know. So our typical, I believe it’s one person managing per 500 providers.
Rosanne Nikolaidis (14:22) So, oh, wow. Yeah. And I agree that it should be possible with just him. If he were, if he knew how to work more efficiently. The problem is he doesn’t seem to know how to do that. Even though we’ve asked, we’ve right? Daniel has asked for a shared, you know, a better way of communicating and having visibility, but he kind of doesn’t want to work that way. So, yeah, yeah, well.
Ellington Loy (14:50) I have one more question for you all and sorry for all the questions, but I’m curious if you guys have a timeline in mind for when you’re you would want to have a solution in place or anything as far as timeline is concerned. Yeah, it’s.
Danielle Hamilton (15:08) a great question internally. We’ve talked a bit about that. Obviously this is, would be a big move for us. We’ve never switched credentialing partners. But… as Rosanne mentioned, we’re in the midst of this big project. And so we not saying we can’t change in the middle of the project, we would need more information from you guys as to how is that possible? Will it delay… our existing, we’ll further delay where we’re at our existing batches that we’re pending. And just seeing what that looks like also systematically, what does it look like even in general? How do we switch over the caqh profiles in terms of access and things like that, right?
Ellington Loy (16:02) Okay. Gotcha. Awesome. So based on what I’ve heard from you all today, I think that medallion could be a great partner for you all. And so I’d love to get y’all on a call with one of our executives that can really give you the nitty gritty show you the platform, give you a demo, go through pricing like y’all mentioned if y’all were to have any availability, I’d love to not sure if you have your calendars up or anything like that.
Ellington Loy (16:35) But we’re pretty open. I know it’s approaching the end of the week. So probably looking into next week… maybe on Friday of next week, but no, a lot of these calls really just trying to assess what the need would be, what services y’all would be interested in. And, you know, what your turnaround times are, how many providers you have, we work best with organizations that are scaling and have a larger provider base. So, I mean, y’all, meet all of our general basic qualifications and considering what all y’all have mentioned as far as what y’all are really looking for in this process, I think that we could deliver on those results. So, curious if y’all have your calendars up and have any availability for next week?
Rosanne Nikolaidis (17:34) Yeah… but that works for me in general… either this time on or Thursday morning? Yeah.
Danielle Hamilton (17:46) This or?
Rosanne Nikolaidis (17:46) Friday Thursday mornings are usually pretty good for, I think all three of us the.
Danielle Hamilton (17:54) Same time works well. Looking at my calendar, okay?
Ellington Loy (17:57) Yeah, that should.
Rosanne Nikolaidis (17:58) Work.
Ashley Peterson (17:59) Brooks has a doctor appointment at 10. So I might have to cut out a little bit early, but it should be fine for the first half. Okay?
Rosanne Nikolaidis (18:07) Okay. Let.
Ellington Loy (18:08) Me, look at our, we.
Rosanne Nikolaidis (18:10) could shift it not to eight 30 if it’s helpful for Ashley, or even to 11, whatever I’m open other than the HR meeting at one. I.
Ashley Peterson (18:25) think eight 30 should be fine. That should give us plenty of time.
Ellington Loy (18:29) Okay. Let’s see. So we will be out for… a company kickoff Monday through Wednesday or Thursday of next week. Do y’all, have Friday of next week? The seventeenth?
Danielle Hamilton (18:48) Let’s see. Yes, I could do same time 39. Yeah.
Ellington Loy (18:55) Friday?
Ashley Peterson (18:55) Any time for me? Would?
Ellington Loy (18:58) Y’all, have any time around any time between 12 and two 30?
Danielle Hamilton (19:08) I could do noon central. Yeah.
Rosanne Nikolaidis (19:11) Noon works.
Danielle Hamilton (19:13) Gotcha.
Ellington Loy (19:15) All righty. So, 12 to 12 30, Friday, the seventeenth, that will be with josh. He’s, one of our executives really be, will be able to give you the whole rundown based on the notes that I will give him from our call today.
Ellington Loy (19:35) Curious. Is there anyone else y’all, would like me to add to that call? Or is this or the three of y’all, who you would like for me to put on the call?
Rosanne Nikolaidis (19:45) We may need to include Dylan and Ivy, Daniel, just because they also interface with the current organization. It’s it’s really Danielle and Ashley working on the insurance credentialing side of things. And then it’s HR… namely Danielle and Ivy… who coordinate with them on… a regarding… just,
Danielle Hamilton (20:20) hospital.
Rosanne Nikolaidis (20:22) privileges, right? And those renewals and their licensure and renewals, malpractice, all the things that are required to get the insurance, right? Credentialing. Gotcha. Yeah. Okay.
Ellington Loy (20:39) Well, I’ll send you.
Rosanne Nikolaidis (20:41) Their, I’ll email you with their emails and loop them in and let them know, okay?
Ellington Loy (20:48) Awesome. Yeah. And I’m gonna send you a calendar, invite Rosanne. And then after we get off this call, I’ll add in Ashley and Danielle to the call. And then we’ll be looking forward to that email to add anyone else from your side that.
Rosanne Nikolaidis (21:03) Okay.
Ellington Loy (21:04) Included in the call, but, yeah.
Rosanne Nikolaidis (21:07) Good. I’ll talk to them this afternoon on our call. And so, I’ll they won’t know what it is if I, if you add them in right now. So, I’ll check in with them and get back to you to confirm.
Ellington Loy (21:22) Okay. Awesome. Well, it was lovely meeting you ladies. I hope you’ll have a great rest of your Thursday and excited to connect and explore further on next Friday. Just email me if there’s anything that comes up. I’m happy to help shift around if needed. Okay?
Danielle Hamilton (21:41) Ellington, before we hop off, just one quick question, I know I’ve visited your website.
Danielle Hamilton (21:46) It looks like you… have a lot of experience or solutions for data management and credentialing. I’m just curious, do you guys dabble in the contracting side at all for contract analysis on the payers or is that completely outside of your scope?
Ellington Loy (22:05) It’s it’s kind of outside of our scope at the moment.
Ellington Loy (22:08) We do offer… I believe it’s advisement for negotiations for contract negotiations that’s not exactly our scope yet, but really our scope is really… managing the onboarding process and credentialing licensing enrollment. We also offer ongoing monitoring. So we go in and update caqh ourselves on your behalf. We monitor to make sure everything’s good up to date. Our platform is very automated to keep you all in the loop at all times. So, but as far as contracting is concerned, not necessarily in our scope today, okay? And.
Danielle Hamilton (23:02) Then one last question before we go, what’s your, you mentioned there’s kind of a benchmark of minimum number of providers, if I understood you correctly, what is your average group size that you handle?
Ellington Loy (23:14) So we are honestly kind of all over the place. We work with teams that are really large like optum, his and hers. So we have really large health system provider groups that we manage. But then we also have a lot of groups that are your size as well. So we kind of are all over the place. We really work with a lot of different organizations of your size. Got it. Okay. Perfect.
Rosanne Nikolaidis (23:39) Do you have any large, really large dermatology groups?
Ellington Loy (23:45) I believe we actually do. I’m not sure. I’d have to look up their name, but I actually believe so that we do service a large dermatology group.
Ellington Loy (23:59) So, yeah, but not sure the name off the top of my head, but can definitely pass that on to josh who you’ll be meeting with, and maybe he could go over that a little bit with y’all on the call that’s scheduled.
Ashley Peterson (24:14) For Friday? Yeah.
Danielle Hamilton (24:17) Awesome. Well, we appreciate your time. Yeah.
Ellington Loy (24:19) Of course, it was nice to meet you all. And I’ll send over that invite shortly.
Ashley Peterson (24:24) Thank you so much. We’ll look for it. Thank you. Bye.