Transcript
Kyle Bettencourt (00:02) there you go.
Kyle Bettencourt (00:09) What up, dude? What’s up? Let’s go get that water. Okay? Looks like they’re in the waiting room.
Kyle Bettencourt (00:22) Thanks a lot, man. Hi, Rhonda. Hey, Jolene, good morning. How are you guys doing today?
Rhonda Koehn (00:35) Good. I’m having some slow internet though, so I’m going to stay off camera. Okay? Hopefully that will help.
Kyle Bettencourt (00:42) Okay. Yeah.
Jolene Nelson (00:44) Mine is struggling as well. So I don’t know what’s happening today.
Kyle Bettencourt (00:49) Okay. I don’t know if it would help to shut ours off. I don’t know if that affects your guys’ stream or not, but.
Rhonda Koehn (00:55) I don’t think it affects it. It’s usually just our local side. So, okay, mine’s been good if I’ve stayed off camera, so.
Kyle Bettencourt (01:03) Okay, excellent.
Kyle Bettencourt (01:12) Hey, Eric.
Kyle Bettencourt (01:19) Hey, there. How’s everyone doing good? How are you guys doing… pretty good. Thank you. Excellent. Anybody else from your guys’ side that were waiting for?
Rhonda Koehn (01:31) Nope. This is it. We’re ready when you guys are.
Kyle Bettencourt (01:35) Well, that sounds good. I’ll just kick it off with a quick agenda slide.
Kyle Bettencourt (01:39) Garrison should be joining on here shortly as well. So you’ll probably see him pop in. But yeah… I figured it might be helpful just to do a quick recap of sort of what we understand as the current state. Noah and I kind of got together after last week’s call. And the way that we’re kind of thinking about this is sort of like a two phase approach right there’s. Sort of like the phase one of the immediate needs here and then sort of like the bigger picture with growth goals at metro. So we’ll talk through what that looks like. And then we’ll jump into the demo and kind of walk through the actual technology with you guys, validate this solution that you guys see as working for what you need. And then from there, we can pivot into pricing and talk through some different options that we put together and we’ll have to get your guys’ input there and make sure that we’re thinking about things accurately. And then, yeah, if all looks good, we can discuss next steps but does that sound good from a high level demo and call? Overview?
Rhonda Koehn (02:39) I think so one sort of just intro question also addition might be, you know, do you guys view yourself as a service company or a tech company? And just like maybe a little bit more background on medallion and how you work to fit in with groups rather than just our side? Yeah.
Kyle Bettencourt (03:00) Absolutely. We can kind of talk through that as well, but I think at a high level, you know, we’re a technology company. We operate as a service and extension of metro. So you guys will have kind of full ownership of, you know, the data, the process. But we also have a team here to support you guys when it comes to workflows around, you know, around the payroll enrollments as well. So we could certainly talk through sort of what our business model looks like at a high level as we get into the demo.
Kyle Bettencourt (03:34) So, yeah, that sounds good. Just to kind of quickly recap, you know, sort of what we understand about metro anesthesia today, right? So you guys are operating at 417 providers, 10 practices and 20 payers in the state of Texas, long term goal, right? Is ultimately to scale into, you know, 2000 plus providers in term, you know, expand to a multi state organization. And as a result, also take on, you know, likely 50 plus payers long term. And the ultimate challenge right today is that you guys are moving from a third party vendor for payrollments due to various issues and you need to be live by July one and ultimately be ready to take over payrollment by that date. So, as far as what we heard from the initial call, right? I think like a bulk of that work is going to be getting caqh profiles built from the ground up. For we understood mostly the entire forum, 17 current provider network. And then, you know, ultimately we want to make sure that you guys are, you know, ready to go live, you know, before that July one handover date, have a process in place for managing pay and enrollment. And then, you know, for future growth… of the company, be able to ultimately scale without having to continually add staff as you look to add on additional providers and get them enrolled efficiently. And you’re obviously looking for a cost competitive solution. So we’ll talk through costs. But Rhonda does this accurately summarize sort of what you’re looking to achieve here and sort of how you’re thinking about it. Yep. Okay. Excellent. And so just to kind of quickly touch on sort of like the phase one, phase two before we jump to the demo, phase one is entirely what we’re focused on today, right? And so, Noah will kind of walk through that agenda that I sent over to the group yesterday in depth and you should have a pretty good sense for how this solution will work. But, you know, really the way that we’re thinking about the… project here as a whole is that there’s a ton of value to be had for that ultimate growth goal, right? You know, I think like, you know, cost wise, you know, we’ll be, you know, maybe on par with, you know, just adding an employee for phase one, but, you know, as you look to scale to, you know, thousands of providers that’s going to require, you know, a lot of additional ftes to help manage those additional providers, you know, coming on with metro anesthesia, we can also help you achieve delegated credentialing, we can help prepare you for multi state expansion. We can help manage your ncqa certification. And ultimately, future proof metro to handle the growth that you guys are looking to take on. So that’s kind of the high level of sort of the way that we’re thinking about that Rhonda, does that kind of align with how you view this as well?
Rhonda Koehn (06:34) Yeah. I think that’s what we need to have happen.
Kyle Bettencourt (06:38) Okay. And then just to give you a sense for kind of like timelines that we operate on here… Noah will kind of maybe let you jump in and sort of talk through like what’s sort of generally involved as we pivot to the demo here, but, you know, ultimately that July one execution and go live date is entirely possible. You know, we think we can, you know, realistically help get prepared and ready to go by, you know, within four weeks, we always budget about four to eight weeks to just leave room for any unknowns that come up during the process. But yeah, I think ultimately the timelines that we’re working on here, we can certainly, we can certainly achieve with you guys. Yeah.
Noah Laack-Veeder (07:20) And Rana and team I’ll talk through, you know, if the demo goes well and we want to talk about next steps, we’d love to talk through what that implementation looks like. But ultimately, it’s just a matter of getting your existing data into our system so we can manage the things like… revalidations, upcoming things as well as just have all your provider data in one place so we can walk through what that looks like. But ultimately, that’s the biggest piece of work part of implementation that’s something that we could even get started earlier before like a contract signature, but really looking at your seven one date something that we feel really confident in being able to do… so with that, let’s get into the demo.
Noah Laack-Veeder (08:03) You all saw the demo agenda. Anything else you wanted to add to that? Or is the outline that we sent over going to work for y’all?
Rhonda Koehn (08:13) I think that outline is fine.
Noah Laack-Veeder (08:15) Okay. Excellent. Amen.
Kyle Bettencourt (08:22) Yeah. And I would say, I don’t know if we included on the agenda, but Eric and I, you mentioned interest in reporting and analytics and just kind of general visibility. So we’ll be sure to touch on that towards the end of the demo as well yep.
Noah Laack-Veeder (08:35) Are you all able to see metro anesthesia providers on your screen? Yes. Excellent. So let me just introduce you to medallion first. So what medallion is first and foremost is a provider data management tool. So think of it as a place where we can store all of your provider data so that we can do things including payer enrollment, which is the immediate need for July first. But if you think about delegated credentialing, internal credentialing, et cetera. We can use all of the provider data within our system to accomplish the variety of those use cases. How we’re able to get provider data into our system, is we have a bidirectional sync with caqh which ultimately allows us to ingest information from caqh but also push data back to caqh accommodating a lot of that maintenance and attestation process. What it looks like is you can invite a provider to medallion pretty quickly giving us a couple pieces of information. And then what’s going to happen is it’s going to kick off an email process that walks the provider through how to link their caqh profile. So it looks like this. It could be white label. The organization doesn’t have to have the medallion logo on it. But ultimately, your provider’s click gets started and that walks them through an onboarding workflow. So it’ll say welcome to medallion language that represents a partnership with metro. What’s going to be necessary to get them all started here? So with a couple of clicks and giving us some information around their caqh id and SSN. What we’re able to do is get all of their information from caqh directly into medallion. So the impact there, is when a provider gets that information into the system, we’ll actually have pre populated their entire profile for them. There might be a couple of gaps obviously because it’s around 70 to 80 percent of their profile can get populated from caqh. But as they log in and see and you’re looking at provider data, all of the pieces that are here match caqh. Now, if there are updates that need to happen into caqh, we can update medallion, there’s no requirement for providers to log into caqh to do this. And what’s going to happen behind the scenes is that we will update caqh so you’re seeing an actual robocrawler, slow down. I know this is really fast but this is even slower. What it does, what it’ll do is it’ll take any updated information from medallion and auto update caqh. And perform those attestations for you automatically. So the impact here is that providers get their information preloaded in the system. We see that profile completion can take on average less than two to four business days. But then the caqh attestation piece which can be a heavy lift for a lot of organization is automated through medallion through all of this auto population from our system. So I want to pause there that’s what the onboarding experience looks like as well as that caqh management attestation. I’d love to invite any questions or thoughts that you were thinking of as I went through that piece.
Jolene Nelson (11:42) So I have a question, are the documents uploaded as well? Like just say that the license updates, do you all go in and update caqh with that as well? Yeah.
Noah Laack-Veeder (11:55) So, yeah, that’s a, good question. Let me show you this. So there’s a documents component of medallion. So we can, we’ll store all those documents as part of this. But when it comes to the import or the, this is a test environment. So you’re not seeing this here, we will throw any of those documents into caqh as applicable for credentialing use cases. So the answer is yes. Okay. Thank you. And I’m guessing Jolene, since you’re asking that, are you the person that has to do that today?
Jolene Nelson (12:26) So that’s not actually being done today, but I’m very familiar with doing that. So that’s why, I was curious because I do know, that will hold up, you know, enrollments on providers.
Noah Laack-Veeder (12:38) Yes. And that’s a key thing. So there’s the ingestion from caqh, is the updates. If caqh is the place in which you’re going to be submitting enrollment applications as I get into the actual enrollment workflow, we will update caqh as part of that process. So there’s kind of like three areas where caqh comes in, ingesting it part of the payer enrollment, but then also the quarterly attestations will handle all of those. And typically, those are the areas that are most time intensive just mostly because where they’re relying on providers to go in there and log in, it’s a really antiquated system in that way or it’s something that’s kind of a we’ve got so many providers to do a lot of copy and pasting. So that’s where medallion really expedites the time that’s necessary to do that stuff. So.
Jolene Nelson (13:23) Like on the practice locations, for instance, in caqh, you have to go in and verify that you’re still affiliated and whatnot, and I don’t know how often they require that, but it’s at least a couple of times a year, so that whole process is automated.
Noah Laack-Veeder (13:39) Yeah. Now, the piece there is that providers will be storing their practice associations in the platform. And so, if anything changes here, we would update that in caqh as well. Okay… Rhonda, I see you’re off mute. Did you have any thoughts or questions on this?
Rhonda Koehn (13:59) No, no. It makes sense how?
Noah Laack-Veeder (14:02) Does this kind of compare to the ideal onboarding experience that you’re thinking of when it comes to credentialing? Is this pretty close?
Rhonda Koehn (14:10) Well, yeah… except for it would double the work for our physicians if we don’t do it together with credentialing, but that’s just something we’ll have to deal with. So, oh.
Noah Laack-Veeder (14:23) You’re saying like because credentialing has to use this data to?
Rhonda Koehn (14:29) Yeah. So credentialing is using their processes to use healthstream which can also import from caqh although I don’t believe it can import documents. I can’t remember. Isn’t that what we discovered, Jolene. So. Oh.
Jolene Nelson (14:43) Yeah, I’m not really sure.
Rhonda Koehn (14:45) Yeah. I mean, the bottom line is they still have to have caqh get caqh set up. And so, for the 120 or so metro doctors that don’t have a caqh profile that is still, you know, going to be a challenge that we have. So they either have to put it in caqh or they would have to put it in here or they would have to put it in a Healthstream like there’s but yeah, just, it’s nothing new or unexpected, I guess. So you can just keep going forward with the demo. Yeah.
Noah Laack-Veeder (15:14) One thought I have there is typically where we help organizations with newer caqh profiles. I just love to hear if this is similar to how you’re thinking about it. Rhonda, is because we can automatically update caqh and let’s say it’s a brand new one. Providers will typically use medallion as their like first entry of data. So they’ll enter all their data and their documents into medallion. And then what we’ll do is we’ll use our caqh integration to more or less pre populate their new caqh profile, which can expedite that because… but how does that, do you think that’s going to be feasible kind of given the situation that you’re encountering with the credentialing team? Probably not. But.
Rhonda Koehn (16:03) Let’s keep going so we can see the whole thing. I think there may be some overall philosophical approaches that we have to address in our org because I don’t believe they can be separate. But I think, you know, we just have to understand your whole process and sort of how you mean it to work in an ideal world. And then, you know, I think Jolene and I are very experienced here, so we can work with our team to try to figure out what works for us internally.
Noah Laack-Veeder (16:31) Yeah, for sure. And let’s get into the PE workflow now because I think that’ll also kind of help you to see how this all ties together and just to kind of thinking about that future state as well. Kind of the phase two we talked about delegated credentialing like if the internal credentialing is also needing to be done in a single system. We do have that as part of this. So a lot of organizations down the road will choose to kind of just use medallion for all of those definitely don’t need to talk about that today. Just wanted to just highlight that. But when it comes to payer enrollment, the first piece is collecting that provider data. So with medallion with the caqh integration and updating downstream, we can get this done in less than two business days. Typically when it comes to the actual payer enrollment request. What you need to do is just tell us what you need and what we’re going to do is have your group information as well as your practice information in the system. So we talked about implementation that’s a big part of it just getting your current relationships into our system. So that when let’s say Naomi here needs to be enrolled with a particular payer, we can auto populate which groups she’s a part of. So let’s say she’s part of community health center. With this mpi in 10, we’ll see which state she’s actually licensed in. So this is a one quick check to say, look, I’m not going to submit something where she’s not licensed yet. Let’s just do Arizona. And what it’ll do is say, look, she’s part of community health center, but there are several payers that are part of this group contract that we want to enroll. If you just click this button, it’ll automatically enroll her with all of those. So how do organizations typically use this? They say, look, I just want you to enroll my providers with all payers in my group contract. So they just check that button to do that. And then if there are lines of businesses that you want to be carefully selecting here, you can go through that as well. But the big piece here is that this is the bulk of the work when it comes to requesting enrollments with medallion, all of the other stuff that’s necessary like preparing the application copy and pasting information over going to caqh and do all that work that’s going to be automated. The last piece is you can just use this all practice locations. If that’s what you typically do. Some organizations are just doing all practice locations for their providers. But if not, you can select which ones. But again, all of this is going to be pre populated based on those group and location relationships that you currently have you submit the request. And then what’s going to happen in the background is that we’re actually going to be automatically… submitting your enrollment. So if you’re seeing here, this is a robocrawler for blue cross blue shield. So what it’s doing is it’s taking all the information I just populated in medallion and it’s auto populating it onto the blue cross blue shield portal. So we’ll be doing this across all the payers that you work with. Some organizations will do the portal, some organizations and payers, we have such high volumes that we use rosters to do this. But ultimately, the impact here is that we submit these without errors. And the total turnaround time for this is drastically reduced now, given your turnaround times, I think at least we’re going to be at par but it’s going to be in a fraction of the effort because we’re not going to have to do all this foundational work to get these applications out the door. So I want to pause there. That was the preparation and submitting those applications. We automate that process which is typically a big bulk of the work before I jump into like status tracking and payer, follow up. What questions or thoughts do folks have as I went through that?
Rhonda Koehn (20:13) So, can an individual practitioner be under more than one mpi X, or do they have to be input more than once? If that’s the case, they?
Noah Laack-Veeder (20:23) Can be part of multiple? Yeah. Okay.
Rhonda Koehn (20:25) And then how does your implementation work? Like, you know, we’re going to come in with 400 providers, most of which are already enrolled with most of the plans, but we need to affiliate them with the plan so that if that plan has a revalidation requirement?
Noah Laack-Veeder (20:43) It’s ready.
Rhonda Koehn (20:44) To go. So, how does that piece work for implementing a new group?
Noah Laack-Veeder (20:49) Yeah. Do you, where is all that enrollment or existing enrollment data stored today?
Rhonda Koehn (20:54) With our billing company the.
Noah Laack-Veeder (20:57) Billing company, are they able to, do you guys have like a relationship with them where they will send you that information?
Rhonda Koehn (21:05) Well, I mean all we have is basically to know that, you know, this provider is enrolled with these plans. So basically we have today, yeah.
Noah Laack-Veeder (21:13) And then do they have like the effective dates as well as the revalidation dates tracked?
Rhonda Koehn (21:18) They.
Jolene Nelson (21:18) have the effective dates, but, I do not see the revalidation date for all of the payers right now, got.
Noah Laack-Veeder (21:26) It, so, yeah. So revalidation dates like, we know the different timelines for the different payers. So like if you have the effective date, that’s the most important one because we can just use the typical schedule for revalidations for those. So the process would be, we have a data import template that I can show you at the end of this. It just goes through the different piece of data. But ultimately, we just need to know which group, which provider, which payer, what the effective date was, and then we’ll be able to preload all of that in what we call our enrollments tab. So at the end of implementation, what you want to think of Rhonda, is that all of your current enrollments will be here. So you’ll have full visibility as to who’s effective with who. But obviously, we need that data from the billing company. But if you’re like, hey, we don’t trust that data. We do have a service where we can effectively audit your effective dates across all your payers, we call that like par analysis. But if you feel like they’ve got that data, we just pop in our import template and then it’ll automatically just get into medallion day one when you’re using it, does that answer your question? Rhonda? Yeah. Thanks. How do you feel about that process? Do you feel like you’re going to be able to get the effective dates and everything from the billing partner?
Rhonda Koehn (22:46) I think we’ll have the majority of them. I don’t know that we’ll have them all.
Noah Laack-Veeder (22:51) Jolene, I saw you come off mute. Did you have any thoughts there? No, I agree. I’m pretty sure that we have the effective dates. Sure. And again, through the implementation process, some organizations are like, hey, we didn’t know. We didn’t have those ones. We can always do some of that par analysis afterwards. It’s kind of like a stopgap. So just ultimately, like when you’re live with the medallion, you will have those effective dates and the status in the platform and, we can get you the revalidation dates because we have the like the revalidation timeframes that these pairs typically work towards… status tracking. So the billing company I think is the one telling you status of everything. But with medallion, I just want to kind of show you a couple of things with status, you all will have access to this. We have unlimited seats for admins. It’s not a cost. So it’s like, hey, anybody can view this, who needs to have access to this? And what you’re going to see is a real time status and it’s not just like a, hey, you know, this is a medallion person who just updated the status for you. Actually, we are launching… oops, opened up a new note on my mac. One second here… we’re like this is Pecos, for example, we’ve got integrations with Pecos, you know, medicaid, state portals, commercial portals to auto scrape status. So ultimately, what this does for your organization is gives you that visibility to say who’s affected with who, or what’s the status without having to spend time looking it up. And then the second piece of this is if there are any follow ups that need to get done, let’s say we’re waiting on an update from a payer. We use a Janak AI to call payers. So we can do that in parallel as well as we will look at emails and then see if there’s anything that needs to be done by a medallion specialist. So earlier Rhonda, you asked about like what’s our model, we’re a tech company with a service component where we have specialists working on these in partnership. But if there are things that we think are best suited for your organization to do those would be routed as tasks. So let’s say we contact a payer automatically, we get some follow ups. We don’t have the information in our system to address that. That would be something that would be routed to your team and illustrated in a task here. So ultimately, the impact there is that we’re taking on the majority of the work. That is being done to check status, to reach out to payers for follow up, to track the outstanding items so that the work that is necessary for your organization to manage this can be done at a fraction of a resource. That would have to be doing this manually. So, yeah.
Erik Hemingway (25:41) No. If it is a provider task, I saw you had provider task in there, can you tell us how that works? I mean, are you interfacing with the providers or are you wanting our team to do that? How would that function? Yeah.
Noah Laack-Veeder (25:54) So that’s a good question. I mean, some organizations say, look, hey, medallion, can you work directly with our providers? The answer is yes, some organizations are just like look like we want to be interfacing them directly, Eric round to others. Like what’s your preference here in terms of provider outreach?
Rhonda Koehn (26:12) I think if it was, you know, we need a license copy, we wouldn’t have a concern about the communication maybe coming from medallion, but we would want to be looped into the communication. And if it required more than just that initial email, then I think we would want our team to handle that. But I mean a lot of that would, I mean maybe very honest come down to the accuracy of the inquiries because we handle 100 percent of our communications right now because our billing service makes so many mistakes in asking for information that they actually already have in the file and they’ve mislabeled or misfiled. So, you know, that would probably just be something that we would have to experience to make a decision about what our process would be.
Noah Laack-Veeder (27:00) Yeah, that makes sense. And just kind of maybe to give you a little bit of like data that’s helpful. Our resubmission rate is low less than one percent. So like we aren’t seeing a lot of those things happening. The other thing I’d say is we do analysis with teams before and after using a medallion and around 80 to 90 percent of the follow ups that were happening before are going to be automated and we haven’t seen accuracy issues there. So I agree with you like I think it might be a case by case basis, but typically the organization is like look, we now have so much time freed up because of the status being tracked, the payer follow up being automated, the preparation being there. So they’re like, well, we actually are freed up to support our providers more. So Eric to your point, it just, it can be a case by case basis on what task medallion can reach out to or if it’s a hybrid model. We reach out a couple of times. We don’t hear from them. We route it back to your team.
Jolene Nelson (28:02) So, I do have another question. Do y’all, do group enrollments as well or is it strictly provider focused? Yeah?
Noah Laack-Veeder (28:11) So, I think that’s a really important question for like the phase two rollout where you’re trying to get new group contracts. So we’ll do the group enrollment. We’ll do the request for bid. We’ll and I’ll kind of show you this like we’ve got a whole groups module here that can help walk through all the things that would be necessary for a group enrollment. The only piece that we don’t do as an organization is the negotiation of rates. So that’s typically done by a payer specialist on your team or like a payer relations individual. But we will do all the paperwork track and do all the follow ups that we showed with the provider enrollment as part of the group enrollment process as well?
Jolene Nelson (28:49) What about like medicaid revalidations for the group and things of that nature?
Noah Laack-Veeder (28:55) Yeah. So most organizations, Jolene, they typically just have medallion auto process revalidations. And so with the medicaid commercial, whatever it might be, we just process those revalidations automatically as in, if we get, so if you give us your data and we have 100 revalidations coming in the next like 90 days, we would say look 90 days coming in, we typically submit these and get these resolved. Would you like us to do that? And then we would just submit all the revalidations for you. And it’s a similar idea where you’ll get the full visibility into the group enrollments, provider enrollments, revalidations, all in that single place. And you can also like, you can choose which request you want to see. Like if you just want to see revalidations, you have the visibility, you have the ability to sort and filter by which request that you’re interested in.
Jolene Nelson (29:58) Okay. Thank you. And so.
Noah Laack-Veeder (30:00) And I think today, as you mentioned, like the billing company is not sharing or tracking those revalidation dates. So, how is that done today? Are they processing those revalidations automatically for you? Is that something that you all have to do to supplement the billing company’s workflow?
Rhonda Koehn (30:19) They process them?
Erik Hemingway (30:22) Sometimes after two months of not getting paid because they didn’t process it?
Noah Laack-Veeder (30:28) Oh, okay. Yeah.
Erik Hemingway (30:32) It’s yeah, superstars. So that’s been a big problem for us. We had a huge issue with that in the last two months. What?
Noah Laack-Veeder (30:42) Was the, I mean you don’t have to share like the exact number but like we work with organizations a lot. And I mean, revalidation dates seem like a small thing. But if you’re missing them, you’re only knowing that with write offs or denials, like how was that? How was that showing up for you? All? Well?
Rhonda Koehn (31:01) It showed up as a lot of denials, but that were actually found by a facility, which was super embarrassing. So, anyway, but.
Noah Laack-Veeder (31:11) By a facility, Rhonda, like a.
Rhonda Koehn (31:14) Hospital excluded a group and said they couldn’t work there because their medicaid validation had expired. So, but that regardless of medallion or anyone else that won’t happen again because now our team is managing it because we recognize that the insurance, not our billing company wasn’t managing it. So… but yeah, I mean, we had medicaid revalidations that were nine months past due when discovered. So. Wow.
Noah Laack-Veeder (31:43) Okay. Yeah. Well, with our auto notifications and everything and auto submission of those… we should take care of those and then you have the full visibility into it as well. So, I think, I’m in agreement there. I don’t typically organizations who work with us, a key Roi thing that they’re thinking about Eric and Rana is, are we going to be addressing some of these claims and aisles from the revalidation errors? And we typically take those and drop them down to zero because these things aren’t being missed and not being rejected?
Rhonda Koehn (32:18) Yeah, that would be, our expectation after July one is that we have no provider enrollment denials ever, so, regardless of who ends up doing our payr enrollment, that is, our CM team target. So.
Noah Laack-Veeder (32:32) Yeah. It’s I mean, so far from what you’ve seen Ronda. Like, do you feel like the solution that I’ve shared with you is aligning to that goal? Like just, I’d love to hear kind of what your gut check is so far given what you’ve seen.
Rhonda Koehn (32:50) Yeah. I mean, I think so. But I mean, it’s just very similar to every, all the other processes that we’ve looked at, right? It just depends on the level of automation and the cost I think for us, so.
Noah Laack-Veeder (33:03) Sure. That makes sense.
Garrison Goodman (33:05) Yeah. And Rhonda, you had asked earlier, like, hey, how does medallion kind of sit within, you know, kind of the market of other solutions? Do you kind of have a better understanding, of how we more, so take a hybrid approach to this? And, and did that add clarity to kind of how we’re differentiated? Yeah, I think so.
Noah Laack-Veeder (33:24) Okay. I think what we can talk about this too, but like just to double click into what garrison just said because we have that hybrid model. One unique differentiator of medallion is that we can contractually obligate to performance because we’re owning a lot of this work. So when evaluating this, a lot of organizations are looking for something predictable and reliable. And so our slas and service level agreements really work there. But also Eric to your reporting piece, just want to highlight that performance of medallion is going to be visible to you. So if you’re like, hey, how are pair enrollments going? We’ve got dashboards out of the box here. So we think about it as turnaround times and volumes. So here you’re just seeing like, hey, what’s the health of my operation, the volume over time, where we had these different statuses, show me who was enrolled, the, who was recently enrolled? And then what are the turnaround times for each of those and our organizations that we work with? Are, I mean, I guess with the billing company, like you said, visibility being a challenge, this data can be difficult to find with the medallion. We’ve got this out of the box. But since we are your partners here and trying to work with these work to these different outcomes, we’re talking to these numbers are going to be in constant communication with your team. So we are the kind of the difference with medallion is we’re your partners in crime here? We’re trying to get these turnaround times low because if we don’t that’s kind of going to that’s going to be problematic for our business. So that’s I’d say the biggest differentiator from the performance piece, but also from the visibility perspective, a lot of organizations that are using like a modio or a healthstream like this can be more difficult to see. So medallion’s made reporting more of a focal point of the tool. So based on what you’re seeing here, Eric and Rhonda, like anything else that from a reporting standpoint, you were hoping or dashboarding perspective, you were hoping to see that I didn’t share?
Rhonda Koehn (35:28) Is there a projection of future work? Is there a projection of future work? What’s coming due or, you know, like from a revalidation perspective, is there a dashboard to show us numbers that are coming due? Sure.
Noah Laack-Veeder (35:44) That’s actually that’s a really good idea. We can do some custom reporting like that. A lot of organizations, what they’ll do is like they’ll use this as kind of a starting point. But if you want like any… slices and dices of this data, you can, I mean a lot of organizations will either say, look medallion, can you make this on our platform? And we can, we have a custom reporting team that can do it, but you can also download all this information and kind of do what you will with it or we can connect it to bi tools. So the answer is, yes, we can do that. In terms of how we would do it. It’s just more of a matter of what’s going to make the most sense. A lot of organizations just choose to view this data here to see what’s coming up and others they’ll do custom reporting. The one thing about custom reporting I’ll just say is obviously, if it’s a custom report, there’s going to be like a cost associated with it. But if that’s something that can just be done with the download feature that I showed you there, yeah, but,
Garrison Goodman (36:46) in general, Noah, like you’re going to be able to have a dashboard that tells you like look in 30 60, 90 days or even further out, these are the revalidations that are due and when to kick off the process. And unless I’m mistaken.
Noah Laack-Veeder (36:59) No, yeah, absolutely. And I would say from the revalidation standpoint, Rhonda, we are usually monitoring those about 90 to 120 days before they’re due. And most organizations are just saying just submit them, just submit them when they’re coming. Yeah. Okay.
Garrison Goodman (37:15) Yeah. So, Rhonda, you, and,
Erik Hemingway (37:16) that was the question. So is that not? Is that built? Or would that need to be built? Yeah.
Noah Laack-Veeder (37:22) It’s built. It’s more of like if you wanted a visualization of it that’s just not in our current dashboard but like that, most organizations are just, they’re using that enrollments page. I showed you just to see that coming up. But they’re the problem that they’re trying to solve is like, hey, I’ve got these revalidations coming up. Are they going to get done? And we’re just getting those done around 90 to 120 days before they’re even need before they’re due? Yeah.
Garrison Goodman (37:49) Yeah. I mean, if it’s not in one of our standard dashboards, Eric, as part of implementation, we just set it up for you. It’s drag and drop reporting capabilities. It’s all the data is in there.
Noah Laack-Veeder (38:01) Gotcha. Yeah. Okay.
Erik Hemingway (38:06) And then, obviously, you know, you guys have invested the money in the tools and technology to keep us from, you know, hopefully having any of the slip ups and losses in the future. So, from a contracting perspective, I mean, I know you probably have slas around a lot of those metrics, but, are there any kind of financial penalties or financial offsets for you guys? If you’re not performing, is that a standard in your agreements or what would that look like? Yeah.
Garrison Goodman (38:37) Absolutely. So, I mean, we have slas to performance across the board for how long it’s going to take us to credential, how long it’s going to take us to submit a file. And then also from an accuracy perspective. So, if any one of those aren’t met, you know, consistently, there are financial obligations where you’d be credited for those particular instances as well as if it continues to happen frequently within, you know, a period of a quarter or so, there’s termination clauses in there. If you’re saying like, hey, we don’t hit our numbers and we’re consistently doing that, you have the right to term. But yes, so there is financial backing by that, and also giving you the right to out, we’re extremely confident and not only do the slas that we share, we hit, but we’re actually like on average performing much better and we give ourself a buffer as well in case something pairs change or, you know, something in that regard, and.
Rhonda Koehn (39:33) What’s the data transmission? You know, if… there was a termination, is there, you know, the ability to have the data in some file format or if there’s a termination, is it just lost? I mean, obviously, the caqh stays with us but just from the medallion application, yeah. So.
Noah Laack-Veeder (39:57) Rhonda, your question’s like what’s the kind of like you terminate the agreement with us? What’s the availability of data look like for you all?
Rhonda Koehn (40:03) Yeah, yes. Yeah.
Noah Laack-Veeder (40:04) We’ll send it over in like whatever format typically organizations would be doing a CSV but those kind of questions are a lot of times part of like a it review process. We’ve got a trust site that outlines all of our policies, if that would be interest like data retention policy, our soc two, compliance and things like that. So as a next step, I can definitely send you that, but important question, we’ll send that over to you in a format that suits you.
Rhonda Koehn (40:31) That would be great if we could get access to that trust site, thanks.
Noah Laack-Veeder (40:35) Yeah, for sure.
Garrison Goodman (40:36) Yeah. Okay. And if.
Erik Hemingway (40:38) the team is interested, Mike, does the ability to get access to data or lack thereof from ventra, have any implication on the initial cost structure? I mean, if so, I think we need to kind of know what that is because I mean we might have issues getting information from them if we don’t already have, it.
Rhonda Koehn (40:59) Sounded like it would be more of a timing thing, Eric, when you talked on our last call of like how quickly we could go live, but I’ll let you guys speak to if it also impacts cost. So.
Noah Laack-Veeder (41:12) Eric, just so I’m understanding the question. So you’re saying like, look, you talked about the implementation process. We have to send you data. Is our availability of the data going to impact the implementation cost? Yeah. So I think the question typically, what will influence the cost the most is if your organization doesn’t have the capabilities to actually put the data into our data import template, if you need our assistance to like normalize it and things like, that could have an impact. But if it’s a matter of timing, we just need to get the data. It’s not necessarily like a, we just need to get the data into our template to load in the system. We’ve got pre validation checks to tell you like, hey, what’s outstanding here? But I guess from your standpoint, Rhonda, it sounded like it’s a timing thing. Do you feel like, yeah.
Rhonda Koehn (42:04) I don’t think we would be looking to venture for any of the data. I think we would be creating that download from Healthstream from what our credentials team has done. The one plus I see that is potentially if you can go both ways with the caqhs that might automate the caqh creation for those practitioners that don’t have a profile. But I frankly, Eric, don’t think we’ll look to venture for anything on this. Well, it’s in Healthstream, what we might be missing would be effective dates and whether their auto scrubber can obtain those or whether we have to obtain those. I don’t think we’ll look to venture for them. I mean, we have already asked them to put all of the… any effective date communications in a shared folder so that we could see them because we were having access with that on appeal. I don’t know Jolene, if they’ve still been doing that or working on that at all, but, yeah.
Jolene Nelson (43:04) I have some documents, but we definitely don’t have all of them. Yeah.
Noah Laack-Veeder (43:11) And yeah. So I think implementation is like a really good thing to talk about. I know we definitely wanted to get into the pricing aspect as well. Was there, but from like a technology perspective, from what you’ve seen today, how does that line up in terms of your PE solution? Like are we hitting the mark? Is there anything that you didn’t see that you’re hoping to see?
Rhonda Koehn (43:35) No, I don’t think so. Jolene or Nicole, did you guys have questions based on the other things we’ve seen? I?
Jolene Nelson (43:43) Do have one quick question? Do you have like a payer list that’s available for us to say we want all of these payers for this particular tax id?
Garrison Goodman (43:55) Yeah, we’ve got a payer list for sure. Yep. Okay. Yeah. So, and Eric’s kind of backing up to implementation as well. We kind of look at it in two phases. There’s standing up for new, you know, credentialing or new enrollment. And then there’s also data transfer. So those are like the two different pieces. So we can be up and running for anything new very quickly. And then data transfer unless there’s like a hard cut over time for you, all we can go at your, you know, whatever pace that you need to do, but that’s typically another, you know, two to four weeks as well on top of that, no.
Rhonda Koehn (44:30) We will have a hard cut over time. Garrison at the latest will be July first, but our expectation would be probably June first because we need to know that we have it established and working before it would be fully our responsibility. So we will definitely have a hard cut over time that will have to be addressed in the implementation plan and.
Garrison Goodman (44:51) we can, if we can start on some of that data work like in parallel to just standard implementation, then we can cut that time down as well. And we can do another call that helps us understand that. Okay? So we’ve got about like 15 minutes left or so. Would you, do you want to cover pricing on this call or set up another conversation? Yes?
Rhonda Koehn (45:12) No, I need it. Okay?
Garrison Goodman (45:13) So, yeah, Rhonda, I heard you say before, hey, the automation’s there and the cost is right? You know, we might like you guys. It sounds like the automation and the platform is there. We feel pretty good about the business case especially from a phase two perspective. And so we’ll walk you through that here pretty quickly and how we got to, you know, some of the assumptions that we made that probably need to be refined and also just a high level cost structure. So you can think about this over time.
Kyle Bettencourt (45:44) Cool. So, yeah, I’ll go ahead and pivot here. So I guess just one of the key assumptions that we made and I know I sent a note over quickly yesterday Rhonda, is that we’re assuming that any new provider that is joining metro needs to be enrolled at all 20 existing payers. Is that just want to confirm if that is accurate based on? Yes. Okay. Excellent. So… just to kind of quickly summarize sort of how we view sort of where we can provide value right? There’s sort of two key buckets. And I think the main focus for you guys is really around operational costs, right? And one avoiding additional labor hours, but two ultimately avoiding ftes. And so this slide here is really just kind of based on what we’ve seen with the customers that we work with and sort of what’s involved with individual payroll enrollments. We can send this to you guys after. And this is something that we would obviously want to validate with you guys. But ultimately, if you’re onboarding 100 providers across 20 payers, we’re looking at 2000 enrollment instances, which based on the actual labor hours required there, we’re estimating about four to five ftes that would be required to actually manage that process there, right? And so as you scale right, they’ll really that number is obviously going to go up with additional enrollment instances. And so as far as like the actual hard labor costs that we’re sort of projecting for just this phase one, you know, if we were to add just 50 new providers, we’re estimating that would require an additional two to three ftes to manage that process efficiently. In addition to that one PE specialist that you’re looking to hire here on shore, not to mention the additional cost of, I think you mentioned a caqh automation vendor that you’ve gotten a quote for additional labor for sending up the caqh profiles… as you scale though that cost can grow pretty significantly, right? And, you know, again, these are all basically just projections that we’ve come up with based on the work that we do with across our customer base. But, you know, this could easily become, you know, upwards of 30 to 50 employees which, you know, annually would be a very significant cost dedicated to a parent enrollment team for managing, you know, 2000 provider plus network. Yeah, we.
Garrison Goodman (48:11) Had talked before, we had talked like, hey, we’re probably 2000 providers long term, but like somewhere in between there is where we’ll end up here in the near future. Eric tell us if we’re right or wrong there, but we just kind of wanted to model out the near end and the far end. But does that kind of make sense? Yeah.
Kyle Bettencourt (48:30) That’s what we’re all hoping for at some point. Okay… cool. And now the other aspects, right? Is reducing turnaround times. So we feel pretty confident based on what we know so far that we can help you get those turnaround times down even prior to delegated agreements… Eric, I know you mentioned this is not as important right now, but if we can actually just reduce enrollment and turnaround times by 15 days, just across 50 providers, you know, we’re projecting that out to one point 8,000,000 in accelerated revenue with providers generating 2,500 dollars a day. So, you… know, we feel pretty confident in those numbers but, you… know, wanted to just kind of share that other aspect as well as sort of where we provide value, for our customers. And so then just to recap, right? Is sort of how we’re looking at things year one, you know, we believe there’s three ftes, that would likely be required for the volumes that you guys are projecting in the future, right? Potential to avoid 50 ftes to an entire parent enrollment. Org. But then also, we can help you accelerate, that revenue and help you seek delegated status at your existing payers that you’re working with today? And so, I guess before jumping Rhonda, any questions or how does that I guess resonate in your perspective?
Rhonda Koehn (50:07) Oh, well, I think it feels really high on the number of estimated ftes like some of ours even though we’re not delegated are still a roster.
Kyle Bettencourt (50:15) But I don’t know. Okay. Yeah, yeah.
Rhonda Koehn (50:20) There’s no way we would plan to add three people to do payer enrollment based… on our experience.
Kyle Bettencourt (50:28) Yeah. And, like I mentioned, right, these are just sort of our projections based on sort of what we see with customers. But this is a number that we would obviously want to validate with you and really kind of understand that it makes sense on both sides here before sure.
Rhonda Koehn (50:41) Sure.
Garrison Goodman (50:41) Rhonda, we typically see, you know, it’s somewhere between, you know, eight to 10 hours in regards to an enrollment doing payer follow up, you know, making sure that it actually gets done like, you know, what would your estimate be on a per enrollment base?
Rhonda Koehn (50:57) Well, you’re talking about eight to 10 per provider or what I saw was eight?
Kyle Bettencourt (51:03) To 10?
Rhonda Koehn (51:04) Per provider per payer, and I think that’s high. I think eight to 10 per practitioner for all of our plans would probably be adequate. Okay?
Kyle Bettencourt (51:14) Yeah.
Garrison Goodman (51:14) I think we can look across that and just see what it would actually take. Like we said, we kind of see out there on a per enrollment basis that’s the number of hours that it takes. So we’d love to understand based upon your payers, your networks, how you’re seeing it. It sounds like you have some roster capabilities. We just factored this all into direct enrollment so we can correct some of that. But, you know, as long as we’re like directionally accurate, then this will make sense. Okay? But I think we should refine that, yeah.
Kyle Bettencourt (51:49) Cool. And then just to kind of jump into the pricing, right? So I kind of have the pricing broken out into two areas. And then this is not the full cost number here. This does not include the pair enrollments, but what this does include is sort of the core platform with medallion along with caqh profile creation across your entire existing network… now because we’re still kind of refining that pair enrollment number and trying to get that forecasted. I decided to just go ahead and break out a few different scenarios here. And so ultimately, what we’re calculating right? Would be a 1,000 enrollments. If you were to hire a 50 new providers, 2000 enrollments across 104,000 at 200 new providers, we have a per enrollment cost. This is really just a one time cost that you would ultimately pay as you’re onboarding that wave of providers, and that would be in addition to the medallion core platform cost as well. And so we kind of modeled out a few different scenarios as far as, you know, what it would look like, right? For… both the fte spend that we’re projecting based on the volume that you guys are looking to bring on board versus what that ultimate medallion cost would be here in that second column and then for that ultimate actual return on your investment here in the final column… so I’ll quickly pause. Does that make sense at a high level or… anything you’d like me to kind of run back through here? And also just so.
Rhonda Koehn (53:19) If you go back to the screen before this, Kyle, are you saying it’s 177 per provider, right? In that calculation? Not per payer per provider?
Garrison Goodman (53:28) It’s per enrollment? Yep?
Rhonda Koehn (53:32) So, per payer, oh, a 1,000? OK, I got you now. I’m catching up. Sorry, thanks. Yeah, yeah. When you go.
Erik Hemingway (53:38) Back one more slide to just talk to the 160?
Kyle Bettencourt (53:43) Yeah, absolutely. So this is, this would be your platform cost including implementation and onboarding. So ultimately, this is sort of what would be required to be enrollment ready by July one. And this would be sort of your recurring annual cost just across all 417 existing providers. And it’s one.
Noah Laack-Veeder (54:04) Thing to add here that caqh management is the whole process of managing the caqh attestations on a quarterly basis, too.
Erik Hemingway (54:14) Oh, OK. And so really the recurring is one 35, right? Because the 25 is just the one time, yep, right?
Rhonda Koehn (54:22) But the recurring grows as you grow providers because the.
Kyle Bettencourt (54:27) sure, you know.
Rhonda Koehn (54:29) If we had 100 in the first year, then this number becomes 517. So you pay the enrollments on the other screen plus, then you have 100 added here on the annual cost, yep.
Garrison Goodman (54:40) And we modeled that out. And like the whole premise there is like, hey, this can be cheaper than you adding people as you scale. And so taking a look at 200 again, sounds like we’ll have to work through like how many direct enrollments we actually have to do. And, you know, kind of refine that. But so first year relatively net even. But as you really start to achieve scale, Eric is where, this makes a lot of sense.
Erik Hemingway (55:08) And can you, I mean tell this rondon team high level, I mean if they were to pursue delegated credentialing, I mean, you guys just charge a consulting fee to help with that or like what’s the range of costs it would take to support us in that?
Garrison Goodman (55:26) It’s I think it’s like five.
Noah Laack-Veeder (55:28) 1,000?
Garrison Goodman (55:28) Per roster? Let.
Noah Laack-Veeder (55:30) Me. Yeah. So let me, but yeah, there’s multiple components like there’s the consulting like getting you all ncqa ready and I think that is like, I think it’s only like around a 5,000 dollar cost. And then if you’re going to do a delegated operation effectively, let’s say you have these delegated agreements with payers like you’re no longer having to do payer enrollments with them, you just have to do rosters.
Noah Laack-Veeder (55:57) And so effectively, if you do delegation, your costs go down even further down the line and your turnaround times are drastically improved. So like delegation is a really good thing for an organization. The thing I’ll say though is it’s a lot of work to stand it up. You have to run an ncqa process for about a year to be eligible for a payer to give you a delegated agreement. So organizations that have that long term play in mind will use medallia to do the payer enrollments up front, and then meanwhile stand up their ncqa operation. So by the time they get those delegated agreements, they can start reducing those payer enrollments as well. But we’ll stand up your operation to be able to do ncqa delegated credentialing.
Garrison Goodman (56:47) So, yeah, we’ll drastically help you achieve that faster. I mean we work with customers, your size, growing to your scale that have done, I think close to 10 plus delegations in a year with us and your costs will go down with medallia as you achieve delegation.
Rhonda Koehn (57:04) But our costs would go up because we would have to do the credentialing the facility credentialing basically would have to get rolled in here. Eric, I mean, the pieces of ncqa certification that we would be missing if we try to just do it on the enrollment side are already being addressed on the credentialing side. So I think we would have to look at like an overall proposal for both sides of our house in terms of provider relations. Well.
Erik Hemingway (57:34) We need to unpack your comment earlier around, like is this even if we’re doing this and it’s easier for RCM, you know, produces opportunity to reduce loss, but it causes more work on the credentialing side of the fence that doesn’t work, right? So we need to unpack that more. And like I don’t know if medallion, if you guys can speak to that like if you can help us understand from your perspective, what problem we might be causing just so we understand where your head is at?
Noah Laack-Veeder (58:04) Yeah. So I will say there, one of our biggest customer profiles are those that do internal credentialing with healthstream. And then they’re kind of at a situation you’re at where they’re like it’s not working for payer enrollment. So, what do we do? We have a lot of customers where we only do payer enrollment and they still do the internal credentialing with credstream but what’s happening more and more often is organizations are very pleased with the payer enrollment service and the platform and the caqh piece that they’re rolling in the internal credentialing onto medallion as well because we can do the whole system in one. So, I mean it’s each organization has different, you know, politics, they’re navigating things like that where maybe it might make more sense. But from my perspective, with even the healthstream piece, like you’ve talked about Rhonda, we have the caqh integration happening. So we’re already getting that caqh piece taken care of. The most organizations are using the internal credentialing piece separately and it’s not creating additional work mostly because they’re used to working in that system. Anyways, it’s usually the payor enrollment teams that have to work with two systems as it is. So you’re getting down to one system?
Rhonda Koehn (59:21) Yeah. So I think so if you go back one screen to the per provider per enrollment. So if you were to do the full piece, then you also have something like this for facility credentialing, correct? Like a per provider, per facility… credentialing. Yeah.
Noah Laack-Veeder (59:39) It’s like a utility. It’s like what services do you want us to do? Right? But ultimately, I think the biggest thing that we wanted to talk about with the phase two is the ability to use medallion to get to your delegated agreements in parallel because that’s a really strong value driver for cost and revenue acceleration. Sure. And that’s pretty agnostic to the internal credentialing process that’s happening in healthstream today.
Rhonda Koehn (60:03) Yeah. The problem. Let me just lay it out there for you. The problem is right now the credentialing team has access to practitioners first. And so to implement this workflow, the practitioner would be asked by our credentialing team to either put their information in Healthstream or share their caqh profile if they have one. And then, you know, in Healthstream, you can import to Healthstream from your caqh profile. If we were to try to flip that, that’s some internal conversation we have to have. Because what would make sense and what my team has been sort of preaching if you will is we need to do caqh first and then let it, you know, import to whatever else it could do, right? But, or we do medallion first create caqh and then they can import that into Healthstream. But right now, in our organization because the focus is always on the timeliness of getting facility credentials so that people can go to work that’s just not the order of operations in who connects with practitioners first. And so it’s a, you know, philosophical and somewhat political conversation and approach. I mean, I understand what you’re saying but it’s just not right now what our structure is. And before I feel like we could make a commitment, we would have to go back and resolve that because otherwise it is more work, we would be asking a doctor to fill it out in two places. Yeah.
Noah Laack-Veeder (61:33) And I think that’s a really important piece and I know we’re at time but just to kind of articulate the broader piece, like the data collection is a huge part of this process. But with payr enrollment there’s also the application preparation, caqh management, payr, follow up, the reporting. That value will still be there even with that piece. So I think it’s when I talk to organizations, it’s like you’re totally right about that data collection piece, but we’d still be able to automate those other pieces of the process that take a lot of resources.
Rhonda Koehn (62:03) Sure. Yeah. Okay.
Erik Hemingway (62:05) Real quick. Sorry, I got to hop onto the call but I know Kyle, I had asked you, I mean, assuming Rhonda and team are interested, I know y’all are working on references and can you make sure that, you know, when you do give some references for us to call that it includes people that are on healthstream and even preferably would be including one that has actually then taken credentialing internal to you. Maybe one that has, and one that hasn’t as part of that list. And we can confirm that the team’s interested before you go down that path. But I just wanted to say that again out loud to make sure we need to talk to people in our similar scenario if we’re going to do that. And then.
Rhonda Koehn (62:48) y’all are going to provide us with this deck, right? With this pricing. So we have that to go back in.
Garrison Goodman (62:54) Yeah, yeah. You can take from it. Again, we’re working on again information we had that there’s things that we need to change. We’ll do so in terms of the next steps, we know you’re working on a tight timeline… it sounds like there’s a few more things to work out operationally. It sounds like Rhonda, I heard you say, hey, we’re even pushing internally already for a caqh first. What is our best way to stay in your pocket to work through that process?
Rhonda Koehn (63:22) I think send us this, send me this.
Rhonda Koehn (63:28) I mean, I guess the question, the only question I have about the pricing is, you know, if I know five of that 20 is rosters, is that still some fee? It just lowers the overall per payer fee, you know, how does that impact the fee? So when you send it, if you could sort of address that even if you don’t modify this because I don’t know off the top of my head how many are rosters? I just know some are rosters, and so obviously, they’re not worth that much per provider to type someone’s name on a roster. And when.
Garrison Goodman (63:57) you say roster meaning you’ve already got delegated agreements or you just?
Rhonda Koehn (64:00) We don’t have delegated agreements but because we’re in, you have to remember that we’re a facility based specialty. And so, because we have to have facility credentialing in order to work, some payers will look at that and say, well, then we just need a roster. We don’t you know, it’s not about being delegated or not delegated. It’s just, we’re not going to go through the whole process for these anesthesiologists because we know that they’ve already gone through the process basically in becoming facility credentialed, not every payer does that but like united for example, does that. So I… think if you know really what, I just need you to send me the info and then we need to have some internal conversations about it and then we can get back to you if you have the references and you want to go ahead and include them, then if we decide we want to go next steps, then we’re just already one step ahead and being able to set up those calls. But it’s up to you guys if you would rather wait to hear back from us before you provide the references.
Garrison Goodman (65:02) I think I just want to make.
Rhonda Koehn (65:03) sure, I can tell you like right now, my initial gut is this is a lot more money than we than in my main.
Rhonda Koehn (65:10) It’s going to cost us. If this was everything that we was also going to accommodate all these offshore people that our credentialing team is talking about replacing onshore then… that cost makes more sense to me. But obviously, there would be increased costs if we were to do the facility side also with you all.
Garrison Goodman (65:32) It could it’s kind of if you guys want to look at that, right? Like absolutely, it is like Noah said kind of a common route. So your initial reaction is, hey, this cost seems higher, but is it on mars, right? Is it just, you know, from our perspective?
Rhonda Koehn (65:49) I don’t know. Yeah, I don’t know to be honest because I don’t have the final quotes back on some of the automation, you know, just looking at doing our own automation because we’ve worked with a couple of companies doing a lot of things and I don’t have their quotes back yet. So I can’t tell you if it’s in the ballpark or not. Yeah.
Garrison Goodman (66:06) Okay. And then you’re saying it feels high based upon what exactly just cost dollar amount or?
Rhonda Koehn (66:13) Yeah. Like I would never hire that many people to handle pay enrollment for our 417 people.
Garrison Goodman (66:18) Okay. As a follow up, could you work on getting an estimate of like how many hours you would anticipate that it would take on a per enrollment basis?
Rhonda Koehn (66:27) Yeah, Jolene and I could talk about that after we get you guys’ deck to look at. I think that would be helpful. Okay?
Garrison Goodman (66:34) And in terms of timing, you guys are going to sync internally, when will we expect to hear back from you? Yeah.
Rhonda Koehn (66:40) Probably not till around the first of may just because we have several other projects that have a deadline next week. So, I don’t think we’ll get to it next week.
Garrison Goodman (66:50) How does that work? Timing wise? Because you all need to be up and running June first?
Rhonda Koehn (66:56) Yeah, I think we’ll I mean, we’ll be on a very short timeline, but I just, I, it won’t happen. I can tell you, it won’t happen before that. We just have a lot of other contracting things that are in the works right now. I don’t expect us to have time to,
Garrison Goodman (67:13) both group.
Rhonda Koehn (67:14) Internally, possibly have that political conversation internally and get back to you in the next five days. So, yeah.
Garrison Goodman (67:21) Yeah. Okay. And then if we’re working backwards from June one and it takes us about four weeks really. I mean, we could condense it down when do we need to start implementing by? Well?
Rhonda Koehn (67:33) I mean, I would say at the latest, if we’re implementing by the.
Rhonda Koehn (67:41) end of June, we just can’t be making decisions much later than that unless our decision, is we’re going to start internally and then, you know, still continue to look at potential automation forward. Yep. And.
Garrison Goodman (67:53) just reminding me again. Sorry for making you repeat the June timeline is driven by what exactly again we.
Rhonda Koehn (68:04) Potentially have a contract termination on July first, that will put this on our lap. So.
Garrison Goodman (68:09) And you need to get like a 30 day notice to them or?
Rhonda Koehn (68:12) No, I just need to know that we’re ready to do it. Okay? Not on July first, right?
Garrison Goodman (68:18) And then, is that like a 12 month or month to month renewal? Like, what?
Rhonda Koehn (68:23) Would, no, it’s a termination that would then bring the entire process in house? Okay? So, permanently? Okay.
Garrison Goodman (68:30) Yeah, I just didn’t know if you’re I think you’re working with a building or did they do month to month or is it no?
Rhonda Koehn (68:37) It’s it’s a contract. It’s a three year contract that will potentially terminate on July first.
Garrison Goodman (68:42) Okay. And then in terms of bringing it in house, are you guys currently in the process of hiring?
Rhonda Koehn (68:52) Sort of, I mean, credentialing is actively in the process of hiring. We’ve still been discussing payer enrollment. If we hire, we’re only going to hire one person. And we just kind of put that on hold for a couple of weeks to explore this with you all and explore the other two automation proposals that we’re working on getting. So.
Garrison Goodman (69:11) Yeah, yep. Okay. All righty. Well, we’ll send some time for the first week of may and then we’ll follow up via email and I’m sure there’ll be, some back and forth. Yeah.
Rhonda Koehn (69:22) That sounds great. I, sorry, I need to jump, I’m a little bit late for my next call, but if you guys can send me that in writing, we’ll get back to you as soon as we can. It might be before the first, but I just, I don’t want you to count on it.
Garrison Goodman (69:34) Okay. All right.
Rhonda Koehn (69:36) Thanks, you guys. Yeah, thank you so.
Garrison Goodman (69:38) Much.