Transcript
Jeremy Walker (00:00) awesome. Oh, there we go. I don’t know who kickstarted that, but thank you. Let me share my screen. I’ve got two slides before we toss it over to Mallory. One is really just right. The common themes that you’ll hear about throughout this presentation, we are a company that was founded in 20 20 to solve the antiquated problem within credentialing and payer enrollments of manual workflows, manual processes. And even with a lot of the software tools that are out there today, there is still a lot of manual work. And for a team Holly like yours that is as lean in comparison to the amount of providers that you support. Manual work does not mesh well, right? And that’s some of what we talked about again last time. And so again, common themes that you hear about is AI automation and workflows. We have the privilege of being financially backed by some of the organizations that you see here as well as partners with over 400 customers who have all bought into this vision that there’s there has to be a more efficient way to get our providers in network faster for one thing and more accurately with less errors. And so that’s the solution that medallion offers and what we’re going to demo to you on this call and then jumping into kind of what we heard from you last time, right? So we understand that you’re using qgenda big issues there. It’s a great tool. We know you have like a special relationship with them, but reporting issues are still a main problem that you’re seeing come up. You have a very lean team considering the size of the network. And today, you have about 27 to 29 delegated contracts with four that are non delegated when you look at some of like the pain that you’re experiencing because of these, you know, some of these things are good things, right? But of course, with every good thing there’s some bad, right? So several 1,000,000 dollars a year in write offs, which is definitely something that we want to see if we can chip away at and just in general manual work, which is bogging down the team from either higher value work or just having more time, to do other things. And then really the outcomes are that you’re desiring right? When we asked you, like what is this? What does this actually mean? Like what would better reporting lead to, and what’s the cost of all this? It’s really reducing claims denials, right? Better reporting, freeing up manual work. And, you know, maintaining current delegation contracts and trying to see if there’s an opportunity with the four that you’re non delegated to continue to get additional delegation in place. Does this, do you feel like this summarizes our last conversation well, or, what edits would you make if anything? I think that is a good summary Holly.
Holly Turner (02:43) I would agree. Yeah, yeah, I was just taking another glance but yeah, I think it looks awesome. Say it’s accurate. Yeah, yeah.
Jeremy Walker (02:52) And I think two, two questions that we had, right? As we were thinking about these claims that are being denied, right? I think it really comes down to the first one being how many of those if you had to guess and maybe have reporting and we can follow up with this question. But if you had to guess for the claims that are denied due to enrollment related errors, what are some of like the top reasons for those claims being denied? Is it just simply missed deadlines? Is it, you know, providers seeing patients before they were enrolled? Like, what are some of those denials that you’re seeing related to enrollments were the common themes?
Holly Turner (03:32) Craig and I might have different perspectives on that, but from my perspective, I would say the majority of those issues are coming from our government payers and it would be unresponsive practitioners… you know, definitely, we see provider patients, providers, seeing patients where we don’t have them set up like we haven’t been told they were going to be practicing from a location or under a certain tax id. You know, I do have, you know, there are some issues as, you know, with revalidations, we don’t always get notified or the notification ends up at a totally different institution and they don’t include us in their revalidation. You know, obviously, I have some staffing issues obviously volume alone, but I would say the first three really are probably the biggest where we just, you know, the provider side of that is delayed or it’s a planning thing and the provider is starting before they’re ready, but people know that’s a risk they’re taking New York medicaid being huge, it’s six months to enroll. And we’re certainly not waiting until they’re enrolled before they start seeing New York medicaid patients? Yeah.
Jeremy Walker (04:56) Craig, would you that’s very helpful. Holly appreciate that. Craig, would you add anything to that or does that pretty much sum it up from your perspective as well?
Craig Chase UVM Health (05:05) Yeah. I think, you know, sometimes there’s a critical need and we have to start providers before they’re actually credentialed. So, we know that although no one remembers that when the write offs come, I will say that like they know that, that’s the risk but they never remember it when the write off actually comes. So there’s that I do think some of it too is just… I don’t know how else to say it, but just bad payer behavior like we’ll send a credentialing file or a roster and, you know, 12 of the 20 will get added, but the other eight won’t and it’s always a mystery as to if you added the 12, then we know you got the other eight and, you know, why didn’t you add those kind of things but in general, it’s what Holly said, okay?
Jeremy Walker (05:47) Awesome. And then again, very helpful follow up to that is what would you say percentage wise of all the claims that were denied were just simply missed a missed revalidation date, for example?
Craig Chase UVM Health (06:04) That’s interesting. Yeah, I don’t know if I have statistics for that. Yeah, I would say that it’s a bit… inflated because particularly for New York medicaid because not only do you have to revalidate their enrollment, but you also have to revalidate their etin. And we are having quite a few challenges with our New York hospitals getting those etins revalidated and that’s not even something that Holly’s team currently has any thing to do with. So some of it is not necessarily strict enrollment. It’s also this etin issue that New York medicaid imposes on providers. Yeah. So, okay, it comes over as an enrollment denial, but it’s really not an enrollment. Well, I mean it is, but it’s more in their electronic billing id that needs to be revalidated.
Mallory Smith (06:58) Okay. Are they able to resubmit at that time?
Craig Chase UVM Health (07:01) No, you can’t resubmit if you’re late and you miss it, they will let you go forward to once you do get revalidated, but anything that happens, they will not backdate.
Mallory Smith (07:13) Okay. Absolutely. We’ve been trying to deal with the tin problem on our side as well. Of course. So, it’s us against the problem that is New York medicaid.
Craig Chase UVM Health (07:23) Right, exactly.
Mallory Smith (07:25) Yeah. And I think as part of the demos we get into today, I have a process map on how we’re currently handling the New York medicaid portal. So I just want to validate a few of those points with you and see, but hear you loud and clear. The tin is definitely an issue we’ve been working on or the etin, however you choose to phrase it.
Jeremy Walker (07:41) Yeah. Okay. And then, you know, in an effort of being transparent and not wanting to take time right? In an evaluation unless there’s a real partnership to think about, right? I think some of these issues there’s not a whole lot that we can do, right? With regards to, you know, unresponsive providers, of course, we have workflows that we follow in order to follow up with providers. Some of our customers don’t want us directly reaching out to providers. So that one’s you know, kind of a hit or miss some of the stuff related to tin. I think there’s something that we can do there, but I think as we again spend more time together, we’ll always be very honest with you about what we feel confident actually being able to do, whether that’s accelerating your process or reducing claims denials, right? Especially if that’s going to be the main source of value. And the main source of our partnership is reduction of claims denials. We don’t want to say we’re going to reduce claims denials by, you know, 80 percent when in reality it’s not that. And so I think really what we’ll do coming out of this call is if there’s somehow some way that you guys can pull a report on your top, you know, 10 15 reasons for why claims are denied. Then we can actually go in piece by piece and say this could have been avoided with medallion. This could not have been so on and so forth. Again, that’s just in an effort to really earn your trust and not take credit for work that we’re not going to do and ensure that there’s potentially a feasibility to a partnership. So that’s just our commitment to you guys. I hope that makes sense.
Craig Chase UVM Health (09:24) Yeah, absolutely. Thank you. Of course. Well.
Jeremy Walker (09:27) With that said Mallory, we’d love for you to jump us into a demo and we’ll go from there.
Mallory Smith (09:32) Absolutely. Thanks, Jeremy. Also your dog is cracking me up. He’s like pacing back and forth in front of the door. Okay? So Holly Craig, appreciate the overview this morning, when we get into the visual demo of today’s, call, the order that I’d like to take is through first analytics and reporting. I know that’s a really big pain point for you. Currently. I just want to show you how you can create your own reports, your own rosters in the platform using the data fields that you currently have biggest value point there that you’ll see is that these reports can be automatically scheduled and sent to anyone on your distribution list as often as you need. So I will build a report given that we absolutely have the time for it today as well. The other areas want to talk about provider onboarding. So making sure that’s a smoother process. We do have a two day average when it comes to provider onboarding. So that’s from the time that they’ve been invited to the platform to their complete, we can now submit ncqa cred as well as pay our enrollment for the delegated versus non delegated. What we’ll do next is it’s kind of up to you two actually? So I can show ncqa cred for the delegation or I can just show the non delegated standard enrollment. What would you rather see first?
Holly Turner (10:46) I would say non delegated because we have a pretty solid process on our delegated work other than the reporting.
Mallory Smith (10:55) Okay, perfect. And that’s what we’ll focus on in.
Holly Turner (10:57) Our process there.
Mallory Smith (10:59) That’s great. Yes, if you’ve got to figure it out, don’t try to fix it, right? If it’s not broken, don’t fix it. So that’s what we’ll focus the demo on today. Are there any other questions or other areas of the platform you’d like for me to cover? No, because.
Holly Turner (11:18) I don’t know what to expect. So maybe that will change as we go through this, I think.
Mallory Smith (11:24) That’s very fair. Holly. Let’s go ahead and get into it. And then I’ll just share my whole screen. If you need me to click around or anything. Just let me know. Okay? So I’ll give that just a minute to load. Please let me know when you are able to see it. Okay. Thank you. So what I’ll say first, this is a browser agnostic cloud based platform. You do have the ability to white label. So you’ll see your logo up at the top left. Any of the email communication that goes out to your providers will have your logo on it. You do get to control the communication that’s on the first welcome emails that go to them as well. So we want this to be your platform. We’re behind the scenes. We’re performing the services, but this is coming directly from you is the approach we want to have with it to navigate throughout the system. Your team would use the taskbar that you see here to the left. So today, we’ll be focusing on the provider directory and onboarding, task management, and expirables management for providers, payer enrollment. If we have time, I can show you the credentialing and delegation, analytics and reporting. So we’ll start here with analytics. And I’ll go into the payer enrollment tab. The first thing I’ll call out here is that you do have the ability to export any of these. They are standard within the platform. We also have an analytics team that can build these for you as well. So there are specific metric points that you’re looking to track for your providers. You can do, so, you just let our team know what you would like to see. And then we can show you the visual representation of that. So you can export these. These are going to be real time data updates on how everything is currently forecasted for your group. So how many new enrollments have been issued this month? How many have been completed? What is the status transition time? I do want to spend a little minute here. So every single data point that you have in the system, they are able to be reported from, as well as tracked from an analytics perspective. So a great example of this is if you’re looking to streamline the provider onboarding experience, for instance, you can see when the request was first sent to the provider, when the provider first accessed the platform, and when the provider completed their onboarding, so you can track each of those metrics. And if you need to take that back to your leadership and say, this is where we’re seeing the biggest lag time. How can we work with? This, you’ll have an account manager at medallion here that basically will do quarterly business reviews with you. We will show you how those trends are progressing over time, if they’re shortening, if they’re lengthening, if there’s areas that we can improve on. So you will have full access to those metrics as well. So when we think of analytics, the flip side of this of course is reporting. But the big takeaway for you here is just real time data updates, the visual representation with charts and graphs. And these always look great in leadership presentations… with your current system. Do you have a visual analytics dashboard like this currently?
Holly Turner (14:22) We do. Yes, it’s not fully implemented. We are still working with qgenda on that, but we do have the ability to do it okay.
Mallory Smith (14:34) Perfect. Thank you. Not a roadmap for this year, of course, no, of course, understand then that would at least be parity. So you would see similar functionality within medallion then. Okay. So then when we come to report building, like I mentioned earlier, you do have the ability to have your own team create the reporting in whatever format that you need it to be whether it’s excel CSV, and these reports can be automatically sent by the workflow engine that’s embedded in the platform. So the big picture there is if you have people on your team currently having to export their reports, download them, email them to different people on the team. I used to work for a cvo that I had to send a 1,000 reports every two weeks. Could not tell you how many seven hours a week that I had to dedicate just to sending these reports. So that’s an immediate time savings that you’ll see when it comes to making sure everyone is up to date to create these reports. I would come here to report builder. There are standard reports that come with the platform. There’s 10 to 15 of them kind of covering all the different branches or segments you’d be looking for. But if I wanted to focus on… let’s take the first one here for pay, your enrollment request, all of the data points that we have in the system now become an option that you can add to the report. And in the order that I select, these will be the order that it builds the report. So if I were to say the states and I know you have some Vermont, New York as well, maybe outlying states there. I just love the new england area. Everything’s so small and cute but you’d have the state, the payer, the lines of business, we would say provider and npi number, maybe the last note date that it was put into the system. Let’s see, let’s do business dates and submission. And then the current status, what this will do? I’ll translate it to the right. I now have a report with that request and the information in the order that I requested it. There are several different functions I can do at this point, I can export this as a one time ad hoc. I won’t need this information in this format again or I could also save it. So if you’re considering about, you know, rosters that you have to send to payers, directory accuracy reports. This is where we see a lot of our customers get the most benefit out of this. So if I were to save it, I could call it uvm par status. As a user in the platform, I could keep it. Private just to myself. So maybe you’re looking to track productivity within the team. Maybe you’re looking to track how long it takes a provider on average to complete a task or anything of that nature. So you can share it with all of your admins or just keep it private, schedule it to run as often as needed. And then when do you want the first report to be sent? Once I save this report, I can now find it here. And then at this point, I can edit the metadata, I can switch around the columns if needed to, or I can also delete this. So if it’s no longer relevant. So I’ll pause there and just see, I know Holly you mentioned you’re currently working through the reporting with qgenda. Is this what you’re trying to achieve with qgenda? Or is this pretty parity with what you currently have?
Holly Turner (17:44) So I would be curious on the report builder piece because they have a robust report building product. The issue is how our data itself is structured rather complex because we have, you know, we cross state lines. We have multiple tax ids, you know, those little nuances actually when it comes to reporting become really difficult for a system to build reports and have it be accurate. So that when you’re pulling this location, it attaches the right provider license to it and the right tax id. And so I guess maybe I would be curious in the report builder like what kind of dynamic features allow that to… meet those needs?
Mallory Smith (18:41) Absolutely. I think that’s a great call out. You are absolutely correct with the nuanced needs. Especially as you cross state lines, the good news is that medallion tracks each of those data points as a separate line item. So for instance, if I were going to my licenses here, existing licensure, you’re going to see a separate line item for each of those providers licenses. So for this provider with the nurse practitioner type in this state, that is how it would be broken down. So when you pull a report, it’s not going to be three states in one line. And you’re not sure if it’s pulling for the correct state or what this license represents. So we do keep those fields delineated for that purpose. That way when you’re pulling it, you may see multiple lines of the provider’s licensure, you can also go through and group those together, but it would be a separate line so that you can see if it’s New York or Vermont, or Massachusetts or whatever it might be.
Holly Turner (19:34) But how does it know which? So if you’re talking about filling out a, and this is where I would really want Jodi to get involved a little bit more closely. She is my reporting person. But, you know, if you’re sending a report off to a payer and they want the provider on a line of their report, how does the system know that if the provider is at five locations for this location, it needs to pull this license to this line. When the provider has, you know, we’re a really heavy locum tenens, organization, right? Like the provider might have 40 licenses. How does it know to make sure that right license is pulled to the line of data that includes that location for that tax id? Does that make sense? What I’m asking? And I’m sorry if I’m missing that you answered the question. You know, I understand the different lines of data, but how does it know what to link to? What?
Mallory Smith (20:37) Absolutely. So I hear you loud and clear, to be fair, I haven’t completely answered your question. So no worries there. What I’ll say is that we use multi path configuration behind the scenes. So we have a workflow engine that’s embedded in the platform. And we also have an internal payers directory. So I think for your specific case with the internal payers directory, we have over 1,200 payers across the nation that we have prescriptive steps and supporting documents and the prereqs that are required for each payer built out how that works is we use an orchestrator tool. And essentially, that tool is able to see that if this is a New York state medicaid application, if we need to include the New York application or the license, it’s going to automatically pull that. If I were to go into providers profile here and let’s say I needed to request a New York state medicaid application for this provider, it would be able to see that, okay, either the provider does not have a New York listed or it has a California listed, it’s not going to pull the California. So all of that is just engineering work in the background. And we call it multi path configuration. When I show you how to request a payr moment application here, in just a minute, I’m actually going to show you how detailed it can be to make sure we’re requesting the appropriate information. Okay. Alright. Good, great question though. So what I can do next as we transition from analytics and reporting, is we can talk about the provider onboarding experience. And then hopefully I’m able to further just answer your question as we go through. So you can see how the information is divided. But if you ever want me to have a conversation separately with your report builder and the one managing, that would make my day. I love having those technical conversations and we can have someone from the team join as well.
Craig Chase UVM Health (22:23) Okay. Can I ask one question? Of course… is the report builder where we would go say to create a roster or upload? Okay. So how in your platform? Are you able to get around that for say blue cross or Vermont? They want they call their specialty… im, right? And then MVP calls it internal medicine and some other payor calls it some other configuration or some other abbreviation. How do you get around that? Or is that also done in the background?
Mallory Smith (23:02) That is a great question. So I’ll answer that in two different parts. If we’re speaking about delegation rosters, roster management, that is completely automated by our team. So if your team’s currently having to spend five to 10 hours a month gathering those documents and reports and sending them out the door, that could be a service that we offer for you. The other aspect, if you’re looking at the roster management for non delegated payers, that they, everyone still wants a roster. She’s like, well just delegate us if you want a roster like we’ll be more than happy to do that. But to answer your question, we use payor id specific fields. So there’s a whole payor key and how each payor represents it. And when I show you the internal directory here in just a minute, you’ll see commonly known as, or other payor identifiers so it’s all kind of just built into the directory itself on how to identify that.
Craig Chase UVM Health (23:52) Thank you. Yeah.
Mallory Smith (23:53) Of course. Great question though. Okay. So when we think of provider onboarding, of course, you have a large volume providers yourself there at uvm. So the biggest benefit here is we have the ability to either invite individually or bulk if you’re doing the bulk import. We do have a participating organization with caqh. So what that basically means is we have a bidirectional, we’re the only vendor in the space that is a true bidirectional. And what that looks like is we can import using just the providers last name, npi caqh id. It brings over 70 percent of the information needed for the provider onboarding flow. And then to push the information back, it’s completely automated. So we use RPA technology and AI technology to automatically log in the provider caqh, make the updates from the medallion system and reattest on behalf of the provider. Now, of course, for legal reasons, the provider still has to log in to caqh at least once a year, so that they’re able to say, like, yes, this information is still accurate. There’s no way around that we wouldn’t want a way around that necessarily because it is their profile at the end of the day. But if you just think of how long it takes your providers now or your team to reattest for, that would be eradicated with the medallion platform and automation. So of course, there’s the bulk import. The other great aspect if you just have one or two providers, sorry?
Holly Turner (25:16) The credentialing person in me just really keyed in on you saying that you reattest on behalf of the provider, when you’re reattesting the application on behalf of the provider, how do you know that nothing else other than the information you’ve imported has changed?
Mallory Smith (25:31) So.
Holly Turner (25:32) Again, credentialing person in me just went wait you what, because, you know, you’re reattesting to the entire contents of the application, which includes their disclosure questions, and their personal information. And so.
Mallory Smith (25:49) I’m really curious about that. Yes, I think it’s a great call. So the great thing is that rather than the provider having to log into the caqh to make those updates, they’re actually able to see that information in the medallion platform. So there’s tasks that are automatically sent to the provider to let them know. Okay, we’re about to retest your profile. Has any information changed? Do you need to log into medallion to review that? They can also log into caqh? That’s completely fine because the sync works both ways. So there are auto notifications that go out directly to them. And we do have an internal caqh management team that while this is automated, we do have people on the backend that are reviewing those files as well. So it’s just an effort to make sure it’s all completely accurate. I’m going to show you the electronic disclosure questions. We have them matching caqh 100 percent. So the providers would be able to log into medallion platform. If any of that information were to change, make the change there, rather than having to log into caqh. Okay. So you’re saying you wouldn’t read a test without the provider’s confirmation, they would be, yes, they would be made aware of that. Where we see a lot of this is that when the provider’s onboarding and connecting to medallion platform, when we go to submit the enrollments, we will send a task to the provider and say we’re about to submit the enrollments. They are going to pull your caqh, please confirm that either the medallion profile is complete or your caqh. So they have the option of seeing which one. Okay. So when it comes to inviting a provider to that platform, they’ll have role based access control. So of course, if it’s just a provider, they need to see their information alone. Perfect. They’ll just see that an admin next. So this would be someone on your team, full view of everything. We also have team manager and team viewers. So if you have different team members on your staff that manage certain provider types, certain states, certain payers, then you have the ability to go through and delineate that in the system. So they’re only seeing the information that’s relevant to them as a team member on that specific area. The big picture here though is an email name, start date and provider type. That’s really all we need from the provider. If we’re looking to do just an individual invite. And what I’ll show you next is the provider experience within the platform… all. Right. Just a minute to pull that up. Okay? So once we’ve invited the provider, they’re now going to receive an email that looks something similar to this. So you’ll see your logo right up here at the top. You do get to control what the messaging of this body itself is going to be for your providers. So oftentimes, it’ll say uvm, we are now partnering with medallion. They’re going to handle the credentialing, the enrollments, whatever it might be. Please make sure that you click get started. There’s two different ways that our customers currently use this. Some customers don’t want the providers to have to lift a hand on anything they want to complete as much of the profile as possible to make it a smoother experience for them. In that case, the provider will be able to click get started, go directly into the profile, review everything your team has done for them. The other option is that you just give us the basic information and then we are able to have the provider complete their caqh import. They can use a resume scanner. I’ll take you through each of those steps next. But we do want to make sure that your team has the autonomy to step in as much as you feel comfortable stepping in. So when they receive that email and click get started, they’ll then be taken through the onboarding flow. There’s multiple ways to do the data ingestion here. So the most common of course, caqh because we are a part org with them. The other way is the resume scanner. So if they have a copy or PDF of the resume, this can also populate the provider’s profile. We see this a lot with graduates fresh out of school. We see it a lot more with tenured providers who have been in this space for 30 35 years. They’re not very familiar with caqh. They’ve had an admin updating it for the last 15 years for them just as an example. So we see different demographics when it comes to using this feature. And then finally API integration, a health system of your size. We commonly see apis in various different formats, whether it’s to your HRIS platform to automatically create a profile, gather the information, making it easier for your providers. We also see downstream effects where we can then send it to scheduling systems, billing systems. Your billing team could receive a report if you didn’t want to do API. So lots of different aspects to consider there. Since most providers will go through and link their caqh profile, caqh id, if the provider’s linking it social, if you’re linking it just the npi… they’ll verify it, confirm and link, and then from here, they’ll be able to see that they can go directly to their profile. The other great aspect is this is mobile friendly. So they are able to do this from their phone or their tablet. I’m going to show you a few of those features. I try not to keep my demos to feature function heavy, but I do think that the next two that I call out are very important to the provider experience overall. So for the provider to now go to their profile, it’s going to look something similar to this. So you’ll have your basic information. They’ll be able to see what fields are still missing. And Holly to your point with the disclosure, we copied these 100 percent from caqh. So as long as they’re reviewing these, they’re receiving the task from medallion to make sure that nothing else has changed that’s how it updates caqh accordingly. So everything is electronic… they’re able to check, yes or no for the document section itself. I always like to say if there’s a date, we can track it. So the documents you’re able to upload by photo. So this is the other feature I want to show QR Code scanner. So they can take a picture from their phone. Very typical instance of this. The provider has their diploma up on the wall. It’s in their medical office. Rather than taking that down untacted print or find a printer scanner, send it to the admin. Have the admin send to your team, whatever that may be. Currently, they can just take a picture with their phones with AI and OCR technology. It’s now going to scan a copy of that save as a PDF and even help the provider name the document. So whether it’s their driver’s license, copy, their diploma, their Coi, face sheet, whatever it may be. The QR Code scanner is by far the biggest feedback that we get from providers. We’ll have the voice of the customer every quarter and this is the one that always gets mentioned. And then that last piece as far as features go, sorry. Was there a question? No, it said that’s a great feature. Oh, I appreciate that. Yeah, I completely agree. Look. I’m taking credits if I did anything with it. No. I just presented, but we do get a lot of really positive feedback with that. So the last feature when it comes to onboarding electronic signature integration. So again, because they’re able to view this from their phone or tablet because they can view it from their laptop there’s a few different forms we can sign and Holly where your mind is going with the legal authorization and how can we update these? This is where the forms are currently located. So, of course, if we can submit applications on their behalf, have they recently attested to their caqh profile? They can sign using their finger or their stylus… I agree that the electronic signature, legally binding profile, data attestation, they do have to log in at least once a year. So really, when we think of the provider input in this process, they are logging in the first time to sign off and say, yes, you can use my caqh, you can reattest all the information is accurate. And then at least once a year, they’ll need to log back in the profile and review that information. Our providers transparently have a lot more communication back and forth in the system because it’s task tracking. It’s expirables management if they have questions, if they want to talk to our support center. But as far as requirements, it’s at least twice a year.
Craig Chase UVM Health (34:11) From there, what do you do for like… New York medicaid, that still requires a wet signature? Is that just like a mail workflow?
Mallory Smith (34:23) Great call. Let me go ahead and pull that up since we’re talking about it. All right. Let me make this a little bit bigger. Are you able to see this? It might be a little small. I can zoom in if needed.
Craig Chase UVM Health (34:35) Okay.
Mallory Smith (34:36) So, this is essentially what we’re looking at. So with the New York medicaid using the new portal and the wet signature and all those different E tens. So the New York medicaid, when you request an enrollment in the system, then from there, it follows the decision tree. So you’ll see, has the provider enrolled previously, if, yes, is it active? If not, then they’ll register using the provider services. There is a note down here basically saying that due to state restrictions, we cannot create an account for the provider. There’s legal tape there. We don’t want to mess with that, but once the account has been created, we will send a task to the provider to let them know that they need to generate this if the provider has been enrolled and the enrollment is active, we would update it using the maintenance portal. If it has not been, it is not active, then they would populate the reinstatement or reactivation, and then depending on those different flows, they would go through the additional steps. So to your point, Craig, there is the mailing aspect. So we have prepaid envelopes, we send directly to the provider to their home, if preferred, they would sign it with the wet ink, pop it back in the mail. So we try to make it as easy as possible for them when it comes to the lift that they have to do.
Craig Chase UVM Health (35:52) Thank you. Yeah. I know also that New York medicaid went to this electronic enrollment too. So hopefully for the renewals or the reinstatements, they will move that along and get rid of that wet signature altogether. Oh.
Mallory Smith (36:06) I mean, double fingers crossed, right? I don’t know why we still have that like medi, cal was another one took forever for some reason to do.
Craig Chase UVM Health (36:14) That.
Mallory Smith (36:15) Yes, absolutely. So, yes. And I can always send this to you as a leave behind just so I’ll put it as a PDF export for you just so you can compare it to your current process. If you have any. Hey, have you guys thought about this? We’re always open to feedback as well because of course, you guys are the closest in the field to it. Great. Take care. Yeah, of course. Okay. So, I’ll transition back over? Yes?
Holly Turner (36:40) I had a question about this. Do you ever run into or how do you handle it? If a practitioner doesn’t sign one part of this? Like agreeing to allow you to reattest on their behalf or, and I say that from experience, we have some folks who won’t even interact electronically with our qgenda system.
Mallory Smith (37:01) They insist.
Holly Turner (37:03) On everything being done in paper. So I’m just curious kind of what your experience is with that and do you have, yeah, do you have any experience with that? How do you handle it?
Mallory Smith (37:16) Absolutely. We do have providers that refuse to do anything electronic. I think that really comes down to the baser concept of change management and how far they can push you internally as a team and you don’t want to lose them as a provider obviously. But it’s also a 20 26. So we do run into this from time to time especially with our more tenured providers. They just, they don’t trust anything that’s electronic. So in those cases, if they don’t want to sign certain aspects, I think the unfortunate reality is that we’re not able to work on their behalf because we don’t have the signature authorizing us to do that. So it’s not very frequently that we can’t convince the provider that this is safe. It’s talk to type two compliant. We’re following all the legal repercussions, we will have conversations with those providers if needed. So it’s not very often that we have a provider that just decides nope we are not going to be a part of this. If that were the case, your team would unfortunately still need to work with that provider. It’s obviously not ideal and we don’t see it for 99 percent of our provider population. But Holly, I think it’s a great call that there are providers like that.
Holly Turner (38:23) We have a few. And, and when you say how far can they push? I push back, but unfortunately, our legal department overrules me.
Mallory Smith (38:34) Yes, they.
Holly Turner (38:35) Tend to within the last year that I’ve been overruled on. So… no, I’m just curious. It was more the caqh attestation piece that I was curious about like if they say that they can’t they’re not allowing you to reattest on their behalf. I just wondered how you manage that other than through, the easy, like, yes, we remind them they need to do it themselves kind of thing.
Mallory Smith (38:58) That’s completely, that’s a great point. So we can just turn off the caqh maintenance for them. And rather, we can just send them a task or we can send your team a task and say, can you manually update caqh? So we do, it doesn’t have to be an all or nothing for caqh profile attestations. If you have some providers that I don’t want you to have access to it, that’s completely fine. We’ll just have to rely on them to make sure it’s updated. So when we do submit the application, that when the payer logs in, it’s not for nothing that they don’t have to send us something and say a caqh hasn’t been updated. So there are steps there. Okay. Perfect. So I know we’ve got about seven minutes left and I’m sorry, I can be a little bit of a talker. So I’m going to wrap up with the mobile experience here with providers just to give you a snapshot of what that experience would look like. And then we’ll transition to payer enrollment. So that mobile view, this could be from their phone or tablet. They can see with their profile. If they have any tasks that need to be completed, their profile looks like the agreements have not yet been signed. So again, they can view these all from their phone. If they’re on their go, they can sign, add the signature just like they would within the main laptop and portal. And I think the other benefit of the provider portal is this is a bidirectional communication tool. They can store their passwords in here. They can store any information that they need to be able to keep in a safe and secure location as well as track the communications that they’ve had with your team.
Mallory Smith (40:31) So what I’ll do now is I’ll just transition back to the environment itself. So we’re back in more of like the admin view what the two of you would be seeing and we’ll go directly into the payr section really quick. Holly just because this is on my mind when it comes to how do you identify the groups versus licensure versus what to submit behind the scenes? And so forth your groups will be broken down, I do want to give you just a visual of this. So per group, you’ll see the type two npi as well as the tax id number. You’ll also be able to see that there’s three practice locations associated with this tax id or with this group. So if I were to go into, I think this is a good one into summit outpatient. I’d be able to see profile information. So you do have the ability to track group. You can also see the roster of providers that are available at this location. If they’re a part of one practice or multiple practices, the… practice locations associated, and even the payr contracts and executed agreements can be stored at this level as well. So when we’re thinking of the payr’s list, existing enrollments for this group billing status, we have one active one. Inactive. If I wanted to see that it’s actually broken down by line of business. So we can track the granularity down to what is the effective date for this line of business for this practice location. When you’re thinking of the payr’s this is perfect for your billing and scheduling teams. Especially there’s a report that we created just a few weeks ago for a customer that all they needed was from a geographic sense, the provider was at this zip code, what providers are available and participating with this plan? And this line of business in this zip code area. So we were able to build a scheduling report of types for them. So it made it easier for their scheduling teams. So when you’re thinking of either groups or facilities, it’s going to reflect the exact same in the system. And you’ll be able to see that information delineated as such. So I’ll show you another view of that. If we go into the payers, the payer list will be specific to each of your tax ids. And I’m sorry, how many do you currently manage as far as tax ids or separate type two mpis? We manage seven tax ids. You’re busy? Yes. Okay. So essentially, we would keep a separate payer list for each of those tax ids, all. Right. So then enrollment request. So here is the other aspect of it, we do have a guaranteed SLA that will get the applications out the door in X number of days for each of our customers. And when we think of enrollment request, you’ll have full visibility. So where our team they are going through, we are auto populating the application. When we think of portal, we have portal auto population submission as well as portal scrapers. So for every portal enrollment, we’re able to check the status every single night at midnight using those scrapers. So rather than receiving an effective date on that Monday, but we’re not checking until that Friday that’s five days that you could have been billing for patients. So ultimately you’ll have the latest status the very next morning if it is a portal application and you’ll just get full transparency through the process. I’m going to take you through how to request an application. And then I’ll show you just the level of complexity that you can track. So someone from your team, let’s say that you’re inviting a new provider to the platform. Someone from your team would say what’s the new payor moment? Who do you want to work on this request? Is this for a group provider or facility? We are comprehensive and do all three… which provider or providers. So if you do have a bulk import and you want to request five providers at once, the system allows you to do that… the group itself. So it’s intuitive. So we know that Naomi’s a part of three different or, sorry, I can’t read two different groups in the platform. And then if we wanted to add her to other groups, we could do so from this screen as well. The payor states, we know that Naomi has licenses in at least five different states. So they’ll be available there. If she did not have a license, you would see missing. You would see red. We would not be able to submit the application because she does not have the appropriate state license for the application you requested. So there are safeguards all throughout the platform to avoid instances like that. And then finally selecting a payor with one click, everything that’s already enrolled with your tax id or with your practice location, can select all those payors. You also have the option of seeing all the payors broken down. Maybe you have a nurse practitioner that doesn’t need all 15 payors, but they only need 13 of the payors that an MD would typically need. So you do have the option of selecting or deselecting as you go through… you, let us know if we’re using the same lines of business for all payors or if it is going to be different, if it is different because you don’t want your nurse practitioner to accept medicaid for instance, then it’s going to open it up and let you know, okay, what’s available, what’s a part of our group agreement? Oh, I also want to include medicare advantage here. And then we would go through the next step. Auto enroll each provider at all of the locations that are part of this tax id. So, Holly you had mentioned earlier, sometimes we don’t know if they’re working at different practice locations. We didn’t receive notification of that just to be sure because we can always submit additional rosters with each application. You can also do auto enroll just to be safe just because they can’t give you the decency of letting you know that’s all I’ll say and then you can come through and do you want to use the same practice locations for all payers? Yes or no? So you have the ability to go through and delineate from there. And then finally let’s say yes for now and we’ll choose this. First one here is fine. And then from here, application details, do you want all of these to show in the payor directory?
Mallory Smith (46:30) What is the desired effective date? Is it when the applications are submitted? Is it when the provider’s start date happened? Whichever one happens first, of course, and then finally additional notes. So anything else you would want our team to know? So because of how intricate we keep this request process, we have a 96 percent accuracy rate that any application that gets submitted the first time out the door from medallion 96 percent of them go through without any pushback without any additional requests for information from the payers themselves. The other aspect that we’ll do there is if they… because payers have to do this. If payers decide that this next month, after you submit an application in July, we’re going to have a new updated application version that the providers have to submit rather than us wait for them to send back and be like, we know you submitted this last month, but we switched it.
Mallory Smith (47:22) Can you update it now? We will proactively just send the newest application and say you have one in process already. But just to avoid any further issues, in the future, here is the latest application if you prefer that as well. So we try to be as safe as possible when it comes to payers, because we know how difficult it is to work with them. I’m just being honest. And then you go through and make that. Request. Now, this is where our team would take over. Now that your team has made the request, you will be able to review all of the different data points that are relevant to any of these, if it’s a provider enrollment or a group enrollment. When’s the follow up date, we do have a gentik AI to assist with follow up. So, rather than our team making a 1,000 phone calls a day to Aetna to follow up on all of our different customer bases, we have a gentik AI with the payers request status. This is going to give you a visual tracker to know exactly where it’s currently processing, if it’s with our team, if it’s with the payer itself, if we’re waiting on a provider signature, such as the paper application with Newark medicaid, if there are any dependencies, the notes section, this is definitely where your team can be involved. So you’re able to see any and all notes that our team. Does you’re able to see payer communication, all payer emails that we have back and forth, you can also keep your own internal notes as well as see our notes. So everything is available here as far as transparency?
Craig Chase UVM Health (48:51) Valerie. Yes. Is there a version of this that you can or that you hosts for like… the end users or the practice managers who are awaiting this enrollment information for them to go in and take a look? Yes?
Mallory Smith (49:08) Absolutely. That’s definitely what I would recommend for probably the team management function. So you would grant the practice administrator at that specific tax id or location access to see their providers. And then they would be seeing something very similar to this, just not the other providers that aren’t under their purview.
Craig Chase UVM Health (49:27) Okay. All right. Thank you. Of course.
Mallory Smith (49:31) So the other great question Craig.
Craig Chase UVM Health (49:34) It.
Mallory Smith (49:35) absolutely. Is it’s also like you don’t need to see things that’s not relevant to you at all. So again, just to show you the level of detail that we can really track when it comes to it. And then your team does have the ability to track the fields that are most relevant to you. So if Craig you’re looking for just are they par or not? Then you can hide everything else. Holly, if you’re wanting to know when the application was submitted, when it’s expected to be approved, when was the last follow up? Then these are fields that you can configure per user… once we’ve gone through, submitted the application, performing that automated follow up. I did say I was going to show you what that payer directory looks like. If I were to view the processing guide, we have this built out for over 1,200 payers. Craig, you had asked a question earlier commonly known as fepe, elevents, those different payer id fields that’s all a part of the directory that you would see here. So the processing guide, how our team on the back end submits these is I would be able to say, let’s say medical here’s, all the different lines of business that are available. But because your group is medical and behavioral health and we have those selected. And then we would view, we have prerequisites and dependencies. It is an online application through availity. It is a two step process here’s. The steps we would follow. No documents are required because it’s a portal. So it’ll just be uploaded there. How often we should outreach to the payr, what additional follow ups is there an escalation pathway?
Mallory Smith (51:10) So we have this built out for every payr across the nation. Well, maybe not every payr but at least 1,200 of them. So I’m hoping that’s every payr but who knows in the US right now? Okay. So then finally, we have the existing enrollments. So once the line, you do receive a par, effective date when we receive a notification from the payr saying this is effective. We’re now good to go. We will actually have someone from our side call and double check that. The reason we do that. Of course, agentic AI is incredible. We always want to make sure that we know for sure though. So we’ll take any welcome letters. We’ll take the effective dates. We’ll attach it directly to the payr line. Your team will be notified immediately that you’re now able to bill and see the patients. We can notify your providers immediately as well. So depending on their level of involvement and how much they want to be notified that’s an option. And then you have your existing enrollments, it can be divided or broken down by group by provider, by facility. You’re able to see the billing statuses, if they’re active versus inactive, their revalidation dates can be tracked here. If it expires, if it’s set to expire soon. So a good level of detail can be tracked. And.
Craig Chase UVM Health (52:24) I know we’re running out of time here, but where do you add the like, for example, the E tin information as a tracker?
Mallory Smith (52:31) Yes, great question. Let’s see if it’s in here. I’ll just pull up another one and show you. So if I go into this one here, there’s the pay your id optional field that’s where we track a lot of the E tin information and then enrollment details down here, par, status document, upload. So it can be tracked here. I can go back and find a screenshot in the system specific to New York medicaid and E tin and send that as well.
Craig Chase UVM Health (53:01) And that gets into the workflow and the warnings that say it’s coming due or it’s up for renewal or whatever. So that.
Mallory Smith (53:09) is a great question. Let me take that one back specifically because I know we have the process flow map but I’m going to have to find out about the warning. So just to make sure I’m understanding correctly the warning, do you receive that before or after you submit the claim?
Craig Chase UVM Health (53:24) We get a independent mailing in a letter, yeah, a letter to some address, right? Who knows what it is to some address, either to the provider directly or the facility or the compliance team or whoever, and then telling us that it’s time to renew. But if we don’t get it, then we need to have a process that says, hey, you should be getting it because it renews every five years or whatever.
Mallory Smith (53:57) Okay. Thank you. Let me take that back internally and just see how our team currently handles that. Okay?
Holly Turner (54:03) I would really love to piggyback on that. To say like the same like revalidation is they’re windows of time. They don’t say, they don’t tell you like when you enroll that they’re going to be three years from this date. They say it will be three to five years. And the only way you know for sure what that date is once they load it to their site or when you receive that letter. So unless you’re going in and tracking those on a regular basis, from what I understand, unless there’s been some recent updates, they don’t even put that date up there on the website right away.
Holly Turner (54:41) It comes up later as it gets closer to when they’ve decided you’re going to revalidate. So I really would love to know how medallion figures… that out to make sure those revalidations don’t fall out, especially if you’re not getting the letters, right? They would be coming exactly.
Mallory Smith (55:00) To.
Holly Turner (55:00) us or to Craig’s point, like a lot of our providers work at northwestern hospital, which is not in our system and it depends where the payer decides to send that letter. It may not come to us. It may go there. And so we don’t know, and only out of courtesy for smaller facilities thankfully in Vermont and upstate New York.
Holly Turner (55:22) Do they like? Okay. Well, I’m just going to include the other facility in this revalidation to make sure that they don’t fall out, right?
Mallory Smith (55:28) Yeah, no, you’re loud and clear. So I think that is a great call out. So there’s what we call a, you do versus what we do. Dynamic, the reason we’re not able to reduce your staff to zero people is because of specific nuances like that. So typically, as you go through and you’re considering an evaluation with us, we would have a separate scoping call and we would show you the flows, what’s expected from our team versus your team. Is there something we can take off your plate versus the other way to answer your question quickly? Because I know we’re right up on time if your team needs to request a revalidation, and you’re not really sure who’s going to get the document or not, understandably, we wouldn’t know either, right? So that’s where we would rely on your team that once you did get notified, you could then come to the system, request a new revalidation and then say, if it’s for a provider, it’s going to give you the option to submit a document with that request. So you would upload, you know, use a QR Code scanner, if you want to a copy of that letter for revalidation. And then your team also has the ability to update the revalidation dates. So if you upload a copy of it, our team will update it if you just want to let us know to revalidate, and your team wants to update the revalidation notice, we can do that too. Okay? I’ll stop sharing. I think as far as the first demo, I really appreciate both of your input and feedback as we go through this. I’d be more than happy to have a secondary demo to talk about additional. But I want to be respectful of your time too.
Craig Chase UVM Health (56:58) Thank you. Do.
Jeremy Walker (57:00) You guys, just as we close out here, do you have maybe one or two more minutes just to close things out and make sure we’re aligning correctly from?
Craig Chase UVM Health (57:09) Here, yeah.
Holly Turner (57:11) I think.
Jeremy Walker (57:14) I think, what really is going to potentially, you know, answer a lot of the questions of, you know, is there something to explore here apart from technical questions which we can continue to elaborate on as further demos transpire if necessary is to, again, I’ll plan was to review it on this call. But what I think I’ll do is just send over the questionnaire to you guys. It’s like 10 questions some we already have filled in. Shouldn’t take you more than like 10 minutes, to fill out. And then I think that the biggest one is understanding again, is there a real impact that we could have with these write? Offs? Do we feel confident we could make a difference? Because if not, I think we, you know, potentially, we part ways as friends, and Holly, you continue, to do what you’ve been doing, right? But if there is a, you know, pretty large number of write offs that we feel we can impact… at least from our perspective, it probably warrants further discussion. But until we know that would love, to know, do you guys see it differently? Are we, you know, is there an area, of what you saw today within the medallion platform that’s even if the write offs aren’t there, that’s still worth pursuing from your perspective? Like help me understand we’d love to hear.
Craig Chase UVM Health (58:30) Yeah, I think from my perspective. Yeah, I say, I think from my perspective that, you know, it’s certainly impressive. It does seem like you’ve spent a lot of time really thinking through the process, and have a lot of nice bells and whistles, if you will that we don’t have now. We have some limitations around what we can do with vendors in this space. So, Holly and I need to kind of circle back and see, you know, where that stands. But certainly the technology seems to be there what?
Jeremy Walker (59:03) What like limitations wise? What are some of the things that normally limit you from partnering with vendors just out of curiosity?
Craig Chase UVM Health (59:11) What our existing agreements are with the vendors that we have, and how quickly we can exit, right? You know, is it an annual renewal? Is it one of those things where you have to give 90 days before the next auto renewal? Yeah, we have to just kind of look through that, those kind of contractual things to see if we’re even able at this point to do something like that?
Jeremy Walker (59:31) For sure. Okay, makes sense. And Holly, from your perspective, I think.
Holly Turner (59:38) Craig hit exactly where I was going. Yeah.
Jeremy Walker (59:43) Is there an appetite? A lot great. Yeah, go ahead. No. I was interrupting you, y’all, you finished.
Holly Turner (59:55) I was just saying that, I think that there are a lot of great components of the medallion product that I could see as being beneficial to our system, not even related to the write off piece of it but just more the visibility into where providers are in the enrollment process.
Jeremy Walker (60:19) So.
Holly Turner (60:19) I, yeah, that was probably one of the things, you know, obviously Craig’s my revenue cycle guru. He’s the one who’s you know, really going to focus on that. I certainly am focused on it as well. But I think about operations in my role the most and the information and questions and different things that come to us. And the idea that we would have a lot of visibility to that. I mean we would have to teach people how to use it because we do have some of that now and people still defer to sending an email… but, you know, I think the user friendly nature of it seemed to be there. I mean, obviously, we didn’t get to see a lot of that, but I definitely think I could visualize enough as Mallory was talking about user roles and things and, you know, I’ve unfortunately been through a number of software transitions. So a lot of what she was speaking to, I understand is from being in the implementation set up an implementation space way more often than I would like to admit. But yeah.
Jeremy Walker (61:27) Well, if things go well, hopefully this will be the last one for a while. But, yeah. And to your first point, we actually appreciate having both of your perspectives, right? From a revenue cycle and more from an operations perspective. So that’s been good to have last question before we drop? I know we’re way over time now at this point, is there like when we think about the next step of kind of looking into the feasibility? Is there other stakeholders within uvm that are usually included or not? Craig? Is this ultimately roll up to you? Holly? Like is there other leaders that you have that you think might need to see medallion? Or is it a good idea to loop them in? I’m just curious.
Craig Chase UVM Health (62:06) Yeah. I mean, I think that twofold. So I have the pay enrollment piece, but Holly’s other boss has the credentialing piece and so we definitely would need to bring in that individual if we move forward. And then obviously her, Holly’s team, right? Like her people who do it every day. So we definitely want to bring them in.
Holly Turner (62:32) Okay, cool. Yeah, I have a management team that I would definitely want at a minimum, the management team to be included in other conversations specifically most importantly to me, is the enrollment?
Craig Chase UVM Health (62:45) Leaders? Okay, cool.
Jeremy Walker (62:48) Well, I’ll tell you what. We’ll definitely get to some of those next steps following up with this conversation.
Jeremy Walker (62:54) I’ll send that scoping document and I’ll actually send a recording of this demo too, so that you can send if you need to Holly to some of those folks. Of course, we’ll revisit and do a live demonstration with them as well at some point, but just to like socialize it at a glance, right? So those will be two pieces of content to look out for me. But I appreciate letting us stay over a couple minutes and have a great weekend. We’ll talk soon.
Craig Chase UVM Health (63:18) Thank you so much. Thanks for your time.
Holly Turner (63:20) Have a good day.
Craig Chase UVM Health (63:21) Bye bye.