Transcript
Molly Dwyer (00:00) hey, matt.
Matthew Ortiz (00:05) Hey, Molly. Sorry, it took me a second to get all the clicks in.
Molly Dwyer (00:08) All good. Happy Friday.
Matthew Ortiz (00:10) Happy Friday. How are you?
Molly Dwyer (00:12) I’m awesome. It’s Friday. That’s right. How about you?
Matthew Ortiz (00:17) Can’t complain? It’s nice weather down here. We had some kind of nasty storms last night where it was super windy but nothing.
Molly Dwyer (00:24) Like what the,
Matthew Ortiz (00:25) midwest had over the last couple of days?
Molly Dwyer (00:27) Oh, my God. I heard tornadoes in Ann arbor and.
Matthew Ortiz (00:30) I know which is crazy. My dad lives in Allen park, which is like 45 minutes south of there. So, thankfully, he didn’t get any tornado weather, but he said it was pretty gross where he was so knocked down some of his fence and, you know.
Molly Dwyer (00:45) Just chaos. Hi, Christian. Happy Friday.
Molly Dwyer (00:55) I can’t tell which one you’re going to call in from, I.
Matthew Ortiz (00:57) Know she was having some technical difficulties.
Christian Ellis (00:59) Sorry, I was on mute.
Molly Dwyer (01:02) Hi. How you doing?
Christian Ellis (01:04) Good. How about you? I’m.
Molly Dwyer (01:06) doing well. Thank you. And are we expecting Vanessa to join too?
Matthew Ortiz (01:13) I am not sure if she will be on or not. And we don’t have to, I know we’re a couple of minutes behind so we can go ahead and get started. Christian. Do you know how you joined twice?
Christian Ellis (01:25) I have no clue because I didn’t I have no clue.
Matthew Ortiz (01:31) Yeah, that was, it must be a zoom. Your zoom must not like to cooperate no?
Christian Ellis (01:38) It doesn’t… oh,
Molly Dwyer (01:42) zoom. Well, glad we’re all here. Awesome before we hop into agenda. Oh, here’s, Vanessa, before we hop into agenda, I want to just start with like recapping the two items that kind of came in this past week for one like the licensing.
Molly Dwyer (01:59) So merit who, you know, very well, she is implementing new internal reporting for licensing specifically so that we are like catching those before the team is using incorrect licenses. So we should not continue to see that. I will let you know once that report is in place. It’s a report that we will see you will not see, but it should be catching that further downstream so that it’s not or further upstream. So it’s not impacting you downstream. The second piece is regarding the Arizona application. So Amy did escalate this. I know she met with you on Wednesday. Was it this week? Yeah, root cause of this. Looks like our source of our sop was incorrect. So the agents were actually using like incorrect instructions. So that’s actually a really good problem because it’s a really easy problem to fix. So that has been updated. We will continue to monitor that moving forward. But if you see anything which you should not please let us know but just wanted to bring that awareness on those two fixes.
Matthew Ortiz (03:06) Okay. Yeah. So on the first one, this is a question for you, Christian, is it just happening on the nurse practitioner provider type, or are you seeing it with other provider types as well? I couldn’t remember if it was kind of the pmhmp thing that was throwing it off or if it was something different.
Molly Dwyer (03:21) No, it’s.
Christian Ellis (03:23) not just, it’s what it is and it hits mainly in Colorado because the PHDS and the psyds, they have the exact same prefix on their licenses. It’s psy. So they’re updating that. And then the MPS, they’re doing that. And then my lmfts because the license start with mft and not lmft that’s what that’s where they’re trying to update it. So they’re… just looking at that letter prefix and not and assuming that we’ve chosen incorrectly. Okay?
Matthew Ortiz (04:02) So essentially, I guess Molly it sounds like it’s not necessarily that medallion is doing the wrong thing. They just need to know that whatever license I guess we put in, they cannot override. I don’t know if that’s like an outside process that you guys have to build in for us specifically or I’m sure that this happens with other providers too. We’re not the only behavioral health provider I’m sure that you guys serve. Yeah, but yeah, that’s if you can just keep us updated on that. And then, of course, Christian obviously does a great job of catching those, but I know that just kind of adds a little bit of.
Molly Dwyer (04:31) we don’t want you catching those, Christian. We know it’s annoying. So like we want to avoid the heartburn, the new guardrails is like that reporting should be catching those. So I will keep you posted once that’s in place and then that should be mitigating any risk. But I guess please be vocal if you continue to see it as well.
Matthew Ortiz (04:53) Okay, good deal. And Arizona sounds, you know, hopefully to your point that whatever gap was closed on that process, but I think, you know, obviously there were some outreach to the wrong email address and of course, you know, they were asking for things that were medicaid related. So hopefully that can get cleared up for us just so that you’re aware of that… the I’m going to go off camera too. So that way I’m not disturbing myself. The… there’s a new state law in Arizona that we’re going to place this month in April where they know given like it’s basically state regulation that health plans have a six day period of time to credential a provider and then 30 days to load from the date that a clean application is submitted. So that’s why like this is such a big deal for us is that clean application is obviously very important because if we submit anything that they deem as not clean, then that means that they are out of, you know, the requirement of having to credential back to that date. And so what we’re doing, we are now allowing our provider once we confirm that date, which we’re still working on with blue cross blue shield of Arizona to determine how we can even confirm that we’re going to be holding claims, but letting providers start providing care that we will then bill them for. So, you know, obviously any even a missed week, you know, a week delay is a week of care that we can’t bill for which obviously is a huge deal to our, you know, leadership team and CFO. So that’s kind of one of the main reasons just so that you have kind of that background information… huge payer to fix because a lot of payers do not backdate the fact that they do obviously is a huge opportunity for us now with this new process. So we just want to make sure that we’re you know, really hitting the mark on that, no.
Molly Dwyer (06:47) I appreciate you providing the context. And Amy did also flag that as part of the escalation like this new Arizona law impact means we need to just make sure we’re following this even more closely. So completely understand the implications. And you know, I will, I know I kind of spoke at a very high level, but like I will have Amy just kind of send a recap of the, it sounds like it’s a two step process that our team is putting in place that I can have her set for us for email. So you’ve got that, sorry, I can hear some dogs barking, no worries. All.
Matthew Ortiz (07:23) Right. Well, that sounds good on those two items. I think we’ve hit on those enough.
Molly Dwyer (07:29) Perfect. Well, thank you for making some space for that for today’s. Agenda. I did want to talk through just some Q2 roadmap updates. We have the scorecard review, template, consumption reporting and go forward plan or any questions or whatnot sound good for an agenda?
Matthew Ortiz (07:47) Yeah, sounds great.
Molly Dwyer (07:48) All right. Okay. So Q2 roadmap really focused on three major things. This should not be a surprise. I feel like this group is really close to our product innovation and how we’re thinking about using AI to really help, you know, help a lot of the execution and overall operations of medallion, but you’re going to be seeing AI integrated a lot more into the product roadmap. And I’ll bring a little bit more of that to light today. But the first pillar here is faster time to revenue, which of course this team cares about. The second pillar here is really the burden free provider and admin experience and some interesting updates here as well today. And then enterprise ready to scale and control. So just thinking about more of how we can support, we call it enterprise ready, but different use cases for our clients that we’re supporting and their different needs specifically as they’re more complex and may require non standard workflows. So looking at core platform, the first bucket here and this is looking at how we can create a more frictionless provider and admin experience by reducing manual data entry. So we are currently exploring how to essentially create or make the provider profiles using new data sources and integrations outside of caqh and this is predominantly going to be impacting PE customers. So yourselves, so definitely, this is part of the we’re in research mode right now, but we’ll be using additional integrations to help just pull this and make it more seamless for providers when they’re onboarding. The second piece here is enabling real time integration. So again, we are, you know, expanding integrations or webhooks to provide instant updates across our integrations, and then also managing providers and assets. So organizing by groups while maintaining data access and streamlining workflows. I think that’s just giving organizations more capabilities in terms of how they’re managing their providers within the medallion platform.
Matthew Ortiz (09:55) That’s great. The.
Molly Dwyer (09:58) Next bucket here. So payer enrollment, faster time to revenue. Under this, we’re looking at continuing to expand our automation, pre submission checks. So just using AI to ensure application completeness before they go out the door. We are also expanding coverage of the number of payer forms that we handle via automation. So currently today we’re at, I did just ask the product team for the list of payer forms and waiting on that because I’m sure you’re interested to see like what the crossover is. So once we have that, we’ll share that over to you in email, but we’re going to continue to expand that number.
Molly Dwyer (10:34) So 35 is baseline today. It was 15 last quarter. When we met, we’ll continue to see that increase quarter after quarter. Additionally we are creating centralized timeline views. So making it more, I think what’s the word I’m trying to use? I think more easy to understand like each enrollment request, what are the updates, actions and outstanding? Intuitive? That was the word I’m trying to think of more intuitive, sorry, Friday brain more intuitive for use. Like when you’re looking at a pay enrollment request, you can just very clearly see okay, what’s outstanding? What are the outstanding tasks et cetera. And then also looking at preventing workflow disruptions by better helping you support managing terminated practice locations with clear statuses. So we’ll be implementing active inactive and archived practice locations. And then last, but not least for credentialing, we are expanding verifications that we are doing automated. So for credentialing, some of the verifications are manual. Some of them are automated. We’re continuing to expand the automated psvs. We are also doing a facelift on our sanctions alerts and sort of that ongoing monitoring reporting. So we’ll be taking a look at how can we make this more intuitive and more action or, you know, yeah actionable for our admins when it comes to sanction alerts. And then this may not be as relevant. But as it relates to facility, we are continuing to expand our facility credentialing capabilities and then strengthening our npdb verification workflows?
Matthew Ortiz (12:17) You guys have a lot going on in QT? We.
Molly Dwyer (12:19) do any questions?
Matthew Ortiz (12:24) So as far as like are these things that are rolling out during QT or towards the end of QT? Or are any of these already, I guess available? I guess that would be my only question.
Molly Dwyer (12:33) These are going to be an ongoing role. So you will see a combination of, I think like the more meaningful updates we will bring forward to you on that monthly meeting or you may receive an automated medallion alert. And then like all of this work, the goal is for it to be completed by the end of QT.
Matthew Ortiz (12:54) Gotcha. Okay. That’s great.
Molly Dwyer (12:57) Yes. Exciting. All right. So looking at scorecard, you will notice the credentialing reporting did get a facelift as well. It looks a little bit updated. So we basically made it more simplified for our admins and just our users to understand the three major phases of credentialing. So from requested to, application completed, to getting sent to committee, and then in committee to the actual outcome. And so that is why I’m just looking beginning with the month of March, we have two days is the average from requested to application completed, five days for application completed, to then be sent to committee. So that’s running the psvs and your team assigning to committee and getting it sent. And then three days for being in committee, getting that vote and outcome total time is 11 days. This is reduced from the previous month. I believe it was around 14 days. So trending, positively, currently processing with medallion, we have 47, 21 initial cred files have been delivered in March, 10 re creds, and then 100 percent of the providers re credentialed on time.
Matthew Ortiz (14:09) Great. So this is only talking about like our delegated side, right? This is not like pay per enrollment submissions or anything like that, correct?
Molly Dwyer (14:16) This is just looking at your ncqa credentialing. Gotcha. Yep. Okay. Good question. And then for pay per enrollment for the month of March, we completed 97. Currently, we see 250 requested. There’s 209 that are currently processing over 60 business days. This has been reduced to 70 which is great. I think there’s kind of two things here that I want to call out. One positive that we continue to see this decrease month over month. But this volume I think has not decreased further because it’s also what’s… the best way to describe this like it’s a moving target essentially like we are pulling 60 days plus. And so there’s additional age lines that are now moving into this bucket or potentially soon to be aging lines moving into this bucket. So want to continue to measure the cohort of like the volume of age lines which I think is the most important. So when I was looking at that, comparing to the last time we met, tricare east is something that I’ve asked Amy to escalate further because we’ve not seen this reduced since the last time this volume or yeah, this volume number reduced which is surprising.
Molly Dwyer (15:32) And so we want to dig in further and see what’s going on there. Blue cross blue shield, Arizona has been reduced by four continuing to escalate there. And then Aetna medicare from 11 to four which is really positive.
Matthew Ortiz (15:46) Okay. And just information for you on the tricare east. So like with blue cross blue shield of Arizona with Aetna. Like those are normally like your standard enrollment applications. Tricare east, technically, we are delegated with them, but they have an additional credentialing requirement where providers have to be certified before they can be credentialed. So it’s this ridiculous. Yeah, it’s really silly because it’s an additional step. So even though we’re delegated, we still have to submit this additional application in a sense to humana military. It’s done online. And so I did just want to make you aware that that’s what that submission is. It’s not a normal enrollment submission. It’s a certification application in a sense. So this does not get the provider credentialed. It just gets them certified because technically with humana military, and this is probably way too much information that you don’t really need to care about, but you do not have to be in network with them to provide care. You do have to be certified. So whether you’re in network or out of network, both have to be certified, but only in network providers have to be credentialed if that makes sense. So it’s just kind of this weird additional process. So yeah, anyway, they’ve been really quirky to work with. So any kind of headway that your reps can make with humana military would be much appreciated. On our end. They’re just a really pesky payer and they require that all communication goes through their online self service portal. So they’re kind of one of those like wizard of oz payers, where they kind of hide behind the curtain.
Molly Dwyer (17:17) But that is fascinating. Yeah.
Matthew Ortiz (17:20) And then the only other question I had on these metrics are these only for medallion owned? Because I want to make sure that because we do set a lot of things to client owned and I wanted to make sure that that’s not included in this data because I feel like that could skew the numbers we do client owned for like our delegated payers just to help us track and trend. So I just want to make sure that this is truly only like medallion owned enrollment accounts.
Molly Dwyer (17:43) Yeah. So any turnaround time metrics are only going to be measuring the medallion owned? Okay. Good deal. We do not measure the turnaround times for client owned.
Matthew Ortiz (17:55) I assumed, I just wanted to be sure there weren’t like, you know, anything old or, you know, because I’m sure we might have some cleanup that we have to do for like old lines that maybe never got flipped or whatever that are client. Obviously, we pay more attention to the medallion owned stuff than client I feel like. But yeah, I just wanted to confirm that, yes.
Molly Dwyer (18:12) No good question. I think for like for example, like number of enrollments currently requested. This may be a combination and I can follow up afterwards. I think that was last time too. It’s pulling a combination of all the current requests whether they’re client or medallion. But I can distinguish that when I send these slides and follow up.
Matthew Ortiz (18:32) Okay. Yeah, that’ll work. I think for your benefit and ours, we probably only really need to worry about medallion owned anything client owned. I feel like we kind of own that and we should be tracking. So I wouldn’t even include those numbers anywhere on here. I just feel like it just skews the numbers unnecessarily so, yeah, totally.
Molly Dwyer (18:48) Hear you. But all of the actual processing or, excuse me, all of the turnaround times will be only medallion owned.
Molly Dwyer (18:56) So I think, okay, I changed this measurement period. It was previously a six day or a 30 day look back. I wanted to pull it from a 90 day look back because I think that’s just a more accurate depiction of an average turnaround time, but you’re seeing which is really positive. Like on average, these turnaround times are decreasing month over month. So continuing to monitor that trend and looks like my last data point didn’t get in here, but I will add that to your slide when I send this as well. Sorry about that. No worries. And just to round this out the tricare east, I will connect with Amy on that.
Molly Dwyer (19:35) I’m curious though. I know that sounds like it’s unique in terms of how they’re set up and how they consider providers to be in network. But does that impact your claims? Like are you seeing this the 28? Yeah, it.
Matthew Ortiz (19:48) Definitely, can. Yeah, it can negatively impact our claims because we can’t even though we submit our delegation rosters on a monthly basis. Like I know Christian is going in and submitting the request for the application like the certification ASAP, like as soon as she can, they make those requests, her or Sam. I’m not sure who does that, but the… when we submit our delegation rosters, like the provider has to be certified first. So, you know, if they’re not certified, then we’re not able to bill, you know, claims, to the payers. So it can definitely negatively have an impact. Okay?
Molly Dwyer (20:23) Thank you for validating that and I will, I already flagged Amy, but I will get with her and kind of, see what the next steps are in terms of escalation so that we can get bring you up to speed on how we’re managing that.
Matthew Ortiz (20:35) Okay, great. Thank you.
Molly Dwyer (20:38) Awesome. And then just rounding out today’s, conversation with consumption. So of course, we just completed the most recent growth addendum. So these are the updated purchase quantities and consumption quantities overall. I think, you know, we’re trending… positive in terms of usage, like right where you, I think anticipated for medallion core and compliant monitoring. We did also, I saw your note regarding, the new pre audit for roster or excuse me for delegation. Excuse me coming up. So we’ll just keep track of that. And then payer enrollments, credentialing, you know, these are all within the purchase quantities that are forecast as well.
Matthew Ortiz (21:27) Good deal. Okay, all.
Molly Dwyer (21:29) Right. Anything else that we did not discuss today?
Matthew Ortiz (21:34) I didn’t have anything from my end. I’ll see if the team has anything, but I’m good.
Matthew Ortiz (21:45) I think we can take that. Silence is nothing, yeah.
Molly Dwyer (21:48) Right. Well, thank you all so much. I hope you have a great weekend. I will update these slides and share them over probably later today. And if anything else comes up, please don’t hesitate to reach out.
Matthew Ortiz (21:58) Sounds great. Thanks, Molly. We appreciate all the help. Thank.
Molly Dwyer (22:01) You. Bye, have a great weekend.