Transcript
Kristi Toby (00:00) good morning. Good morning, Annette. Good morning, Patty.
Patricia Kane (00:12) Oh, can you hear me now, Christine?
Kristi Toby (00:13) Yes, I can. How are you?
Patricia Kane (00:15) Good, good. Sometimes our computers work funky with zoom these days. Sorry about that.
Kristi Toby (00:20) No worries at all. No need to apologize. How is your Tuesday going ladies?
Patricia Kane (00:26) A little bit crazy, but we’ll get through it. Oh, I see.
Kristi Toby (00:30) Annette and I were chatting about that last time. I feel like busy and just crazy is the status quo. Now, I feel like those used to be outliers, but now I feel like it’s more of a phenomenon if we have a quiet day, right?
Patricia Kane (00:42) Yep. You know it.
Kristi Toby (00:44) Well, awesome. So, I appreciate you both taking the time out to connect. So, Patty just very quickly, my name is Christy Tobey. I am the senior account manager for tenor health here at medallion. And so, Patty and I will very much be partners in crime throughout this process to make sure that you’re getting value from your investment, right? And making sure you understand all of the services and commercial aspects as it relates. Did she walk you through the overall team structure here at medallion as far as the other players that you may see on calls?
Patricia Kane (01:15) No, I’m not familiar with that. But as long as Annette and Debbie from my team are, we would be good.
Kristi Toby (01:21) Okay. Awesome. And then we also have my direct manager, Jen just joined us as well. Hey, good morning, everyone. Hello.
Genevieve Seney (01:28) Good morning. How are you? Awesome. Good. Thanks for coming. Yeah.
Kristi Toby (01:33) We were just getting started doing some brief introductions. And so the reason we’re here today, Patty, is that we understand that tenor actually has some ncqa credentialing already in place.
Kristi Toby (01:45) And so we want to make sure that through the medallion partnership, we also have the services and capabilities within the platform to continue that process, but also allow for any additional payers that may need that type of structure in the future. And so, Annette was saying that you were the woman to talk to a lot about the numbers and figures like that, so we could prepare a proposal for you because currently, the ncqa credentialing, sorry, is not included within the current contract. And so, in order to scope out what it would look like and adding that to medallion, we just needed to get some numbers and understand your current process and your ideal state, if that’s okay, sure.
Patricia Kane (02:22) So, when you refer to the ncqa, would that be the delegated credentialing function?
Kristi Toby (02:28) Yes. Okay. Yeah.
Patricia Kane (02:30) So, that was something that CHS had set up on our behalf and negotiated it into two payer contracts. So there’s only two payer contracts. One being probably our second largest commercial payer being geisinger health plan.
Kristi Toby (02:49) And.
Patricia Kane (02:50) the second being a very small health plan small as far as the number of patients that we actually see with it being jefferson health plan. Okay? So those are the only two plans that we have that in our managed care contracts. And we’re potentially looking to continue with that function. So those are the only two.
Kristi Toby (03:14) Okay. And so there’s no scope or strategy at this point to expand beyond those two over the next 12, 18 months or so?
Patricia Kane (03:24) That’s correct?
Kristi Toby (03:25) Okay. And within those two sort of plans that you have to date, what is the number of providers that are incorporated within those? So?
Patricia Kane (03:35) It’s the same number as our employed physicians and providers, which I think is about 170 a.
Kristi Toby (03:42) 170. Okay. And.
To Annette Craig (03:45) That’s probably, I was quoting you 150 Christy. So I knew Patty would know, exactly. Okay. Yep.
Kristi Toby (03:52) You were definitely close. Thank you for that. And so those are the number that would need to have the credentialing through those two plans. And then does that incorporate? Is there a different subset that would need the re, credentialing through that this year?
Patricia Kane (04:08) Explain what you mean by that. So.
Kristi Toby (04:10) You know, there’s the initial setup. And then on a, I think it’s like a one to three year basis, those same providers would need to be re, credentialed with those plans. Is there within that subset, is there a specific number that would need re, credentialing over the next couple of years of the current agreement. So we could go ahead and scope that out?
To Annette Craig (04:26) It’s revals, Patty, revals, yeah.
Patricia Kane (04:30) Okay. I, now, the way that geisinger works, they rely on us, to say that someone is active with or has whatever they need. So the way I understand that it works is that there isn’t necessarily a revalidation process with geisinger health plan. They rely on us or on you in this case to make sure that we have everything that we need to and a monthly spreadsheet, excel spreadsheet is sent to the payers. Just saying these are the docs that are current with our employed physician network and meet all of the, all of the requirements that they would normally meet.
Kristi Toby (05:17) Okay. Awesome. And so I think, Jen, we refer to those as rosters here at medallion correct those monthly submissions. And so how many of those are you submitting? Just the two or?
Patricia Kane (05:29) Just the two just.
Kristi Toby (05:30) The two on a monthly basis? Okay. And do.
Genevieve Seney (05:34) you happen to have, well, once we kind of move forward or debate what the addendum is, if we can have a copy of those two as well, that would be helpful for us?
Patricia Kane (05:44) Copy of the current submissions?
Genevieve Seney (05:47) Yeah, just it’s I’m assuming it’s the same template every month, it is data they require. Okay. Yeah, we can talk about that down the line, but that would be helpful for us to just take a look at in terms of how you’re handling that. Is that just a manual process you’re doing today or are you using another vendor for, so?
Patricia Kane (06:06) CHS does it on our behalf right now? Okay. Got it. So I would have to actually ask them for their last submissions because it’s not something that we’re currently involved in the process for.
Genevieve Seney (06:20) Got it. Okay. And CHS remind me, is that what vendor is that? Does that?
Patricia Kane (06:26) Say, no, that’s actually our former owner community health systems, ah?
Genevieve Seney (06:31) Okay. Apologies. I’m not as close to the previous. Okay. That makes sense. Got it. I think maybe the only other thing and Christy, we can kind of again, if we choose to go down this path, we can also have our team take a look at the delegated contracts to see what the revalidations might look like. Because again, typically, as Christy mentioned typically every two to three years, basically, what they do is just require you to run the credentialing files again. So it’s not, it would be basically exactly what you’re saying you’re still doing and running the same checks for the providers. It’s just, they have a recredentialing date or initial credentialing date assigned to them.
Genevieve Seney (07:15) So CHS actually might have that data of what their initial date was. And then in the contracts, it likely says 24 months, 36 months, they’ll be due to be recredentialed basically.
Patricia Kane (07:25) Okay. I could also geisinger health plan did send me the criteria for delegated credentialing okay? So I could also send that on to you. Okay?
Genevieve Seney (07:36) Perfect. Yeah, not as big of a of an ask right now. I think what we could do is basically just again if we move forward with this is we would just get the data from CHS meaning the provider’s names their initial cred date, anything else that we need and we would import that to our platform and basically automatically at the 24 month or 36 month mark, they would just go back into circulation and be a part of those rosters at that date and time. But yeah, I think, Christy, I don’t think I actually have any other questions right now. I think we have like sort of what we need.
Patricia Kane (08:12) Will it take like a lot of time to put a proposal together to add this onto your, onto the current contract or just propose what it would take?
Kristi Toby (08:23) No, we should be able to get that to you today.
Genevieve Seney (08:26) Yeah. This will be straightforward. Yeah, I guess the only other question maybe is in terms of the 170, what does that number look like with attrition and growth over? Like how many new providers do you typically add in a year or month, monthly basis that you need to credential with those?
Patricia Kane (08:41) Oh, probably over the course of a year, especially the way we’re going right now. I would not anticipate that it’s more than 10. Okay, perfect.
Genevieve Seney (08:53) All right. That’s all I had, Chrissy.
Patricia Kane (08:55) Okay. Thank you.
Kristi Toby (08:57) So much Patty for the clarification point. So we should be able to get a proposal to you like I said before the end of the day certainly.
Kristi Toby (09:03) And then if it looks like something that aligns with this strategy, can you help walk us through? And that’s this will be sort of the first addendum that we partner on together? What the approval process looks like on your side? And if it is in the budget, sort of what timeline you would be looking to move forward with this? Okay?
To Annette Craig (09:21) So, obviously, as we’re going live with everything, so it would be, you know, Patty would go to our tenor leadership and tell them that we need this and then they would just need to sign it if appropriate based on price, you know, again, they would have the final say and then they could, you know, just make it live then after the appropriate signatures are on the contract, okay? Because it would be good to go, you know, to go on at the same.
Kristi Toby (09:48) Time exactly. That was going to be my platform.
To Annette Craig (09:51) Comes up. Yes. Yeah.
Kristi Toby (09:53) That was going to, I was going to say while we’re actively in implementation, I think it’d be most streamlined and not something we have to stop and start. So, I just wanted to make sure we were aligned on that.
Kristi Toby (10:01) So, yeah, I’ll let Jen and I regroup and sort of escalate this for you. And then if you have any questions as far as running it up the chain of command, Patty, aside from the proposal itself, is there any additional information that you would need to support that?
Genevieve Seney (10:15) No. Okay. All.
Kristi Toby (10:17) Right. Well, let us go with the time back then and get started on this. And then obviously, if you have any questions or concerns prior to hearing from us, don’t hesitate to reach out.
Patricia Kane (10:26) Okay. Thank you. Thank.
To Annette Craig (10:27) You take.
Genevieve Seney (10:28) Care. Bye bye.