Transcript
Jordan Tantleff (00:00) hi, Kristen. How’s it going?
Kristen Williams (00:01) Good. How are you? Happy Friday?
Jordan Tantleff (00:04) Happy Friday. It’s nice to meet you.
Kristen Williams (00:06) Nice to meet you too.
Jordan Tantleff (00:09) How’s it going Scott?
Scott Everline (00:12) Hi, Jordan.
Jordan Tantleff (00:14) Long time. No. See. I know I.
Scott Everline (00:17) Know it’s been what a couple hours maybe?
Kristen Williams (00:25) It was weird trying to sign into this one. We use teams too, and it didn’t have like the regular join link to it. It was strange yeah.
Scott Everline (00:34) I’ve run into that sometimes where it’s like the link isn’t there. And then the first link that you see is like troubleshooting, and then the next link is actually the link to log in, which always throws me off.
Kristen Williams (00:44) Yeah, insane. I feel.
Jordan Tantleff (00:47) Like there’s never a consistency with this. No, we use zoom mostly. And when I met with Ashley at the end of March, yeah, end of last month, she had issues with zoom. So I was like, all right. We’ll make sure it’s teams and it sounds like it still wasn’t super helpful. James, Brooke. Nice to meet you.
Scott Everline (01:10) Hi. How are you doing?
Kristen Williams (01:13) Hello?
Jordan Tantleff (01:18) More people in here… Brandon, how’s it going? Doing well? How are you? No complaints?
Jordan Tantleff (01:37) See Amber’s here as well? How’s it going? Amber?
Ashley Middleton Tapp (01:44) Hey, there. Good. Sorry, I’m off camera today, but I will, I’m turning my camera on and off. Can you hear me? We can we can? Okay. Sorry, it took me a second to find the right button. Hey, everyone. Yeah, I’m on, I’m sorry, I’m off camera today, but good to see everyone.
Jordan Tantleff (02:01) No worries. It’s nice to meet everyone. Are we just waiting on? Is Ashley joining today as well?
Kristen Williams (02:09) Yeah, I thought she was. Yeah.
Ashley Middleton Tapp (02:11) She is. Let me, I’ll pay her.
Jordan Tantleff (02:13) Perfect.
Kristen Williams (02:19) She may be struggling with the link a little bit like I did too, because it didn’t look like it normally does.
Jordan Tantleff (02:33) You guys are all in the Texas area. Is that correct? Yes. Is it Austin by any chance? Or?
Kristen Williams (02:43) Me and Ashley, and then Brooke and James and Amber, I think Amber’s up in DFW.
Ashley Middleton Tapp (02:50) I’m up in DFW. Yeah. And Brandon’s here. So, yep, we’re all Texas folks.
Jordan Tantleff (02:54) Got it.
Jordan Tantleff (02:55) Scott and I just got back. We sat on site in Austin, did some quarterly business reviews there. But first time I’ve been to Austin in a while, we went to like the comedy club, the mothership. So had a great time there. And like Shane Gillis popped in, I’m not sure if you guys are familiar with kind of his work, but it was a good time. Love Texas. I’m in New Jersey though. So a little bit different.
Ashley Middleton Tapp (03:25) Yeah. Well, you came to Texas during the right time of year because we are about to, we have like winter and summer and we get like a few days that are nice like this. So hopefully it was nice for y’all.
Kristen Williams (03:36) That’s the truth. It’s about.
Ashley Middleton Tapp (03:37) to be hot.
Jordan Tantleff (03:40) That’s like New Jersey. It’s just been, it’s been bipolar the last like few weeks. It’s been 40 degrees today. It’s 80 degrees. I can finally wear short sleeves, but I think we’re finally turning the corner a little bit.
Kristen Williams (03:53) Yeah. My parents live in Delaware and so, and I talk to them every day on the Facebook portal, and their weather has been absolutely crazy lately.
Jordan Tantleff (04:07) Just makes it difficult to do anything. Honestly. I’ve been like hiding away in my apartment until this week.
Ashley Middleton Tapp (04:21) Jordan, while we’re waiting for Ashley, I paint her just in the interest of time because I know we’ve got a lot to get through and I know this group is really eager to see everything. I’ll just introduce our teams on behalf of all of us real quickly. And then you guys can do quick intros. And then when Ashley jumps on, of course, she is the fearless leader, we’ll let her do intros as well. So on the call, we have our whole payr team. So James over payr contracting and Brooke over enrollment and credentialing, so licensure, everything, all things enrollment Brooke. I think this is like totally y’all’s bread and butter and Kristen as well for onboarding for new associates and new partner practices. And then from the RCM side. And, I am over like I’m in between both departments. So I support all the teams. And then on our RCM side, we have Brandon who’s over our posting, our payment posting and revenue cycle support teams. So there’s a lot of overlap in anything that comes in, you know, credentialing and contracting related to him and his teams. And then Lindsey is over our verification teams, among other things.
Ashley Middleton Tapp (05:26) But that’s really the lens she’s going to be looking through today. And so Ashley just paged me back. She has a, she has a front yard issue going on, but she’s going to be, she’s going to be on as soon as she can. So with that, I mean, Scott and Jordan, if you guys want to go ahead and do introductions, we can get Ashley up to speed real quick when she’s able to join and then we can go ahead, and get moving if that works.
Jordan Tantleff (05:49) That, that sounds perfect. I appreciate.
Ashley Middleton Tapp (05:50) It, wait. Did I get all of our team? I got everyone, right? I’m checking to make sure there isn’t another screen here that I missed.
Kristen Williams (05:57) Okay.
Ashley Middleton Tapp (05:59) Cool. Thanks.
Jordan Tantleff (06:01) Perfect. So on our side, Jordan tantleff, I’m one of the account executives on the partnerships team here at medallion.
Jordan Tantleff (06:07) I’ve been here about three years. I see Ashley coming in now. So I’ll let her in. I’ve been here around three years. So again, I met with Ashley towards the end of last month, she had mentioned the RFP that was being released in regards to the pdm evaluation you all are doing. We saw some overlap based on kind of what medallion offers as an end to end solution. So, happy to kind of dive into, you know, our presentation and demo today, but I’ll kick over to Scott for a intro here as well.
Scott Everline (06:37) Hi, all so I’m Scott Everline. I’m Jordan’s partner in crime solution consultant here at medallion, been with the company just over two years. So I’d be considered the subject matter expertise on all things payer, enrollment, credentialing platform technology. So here just to make sure we’re covering the right components and connecting all the right dots with you all to make sure you kind of have a proper understanding how medallion solves some of these pain points. So nice to meet you all.
Jordan Tantleff (07:08) Perfect. And then Ashley, I’m not sure if you want to chime in here as well. Yeah.
Ashley Middleton Tapp (07:13) Thank you guys for starting without me. I was telling Amber I looked, we have big glass front doors and there’s a giant rattlesnake right outside our front door. I do live out here in the hill country, but that’s not typically what we see. So anyway, I was like trying not to panic on your behalf. I know I was like, I, you know, I think just, for education, animal control says just don’t go mess with it. I was like, well, dad, I come on like that. I would have figured no problem. So anyway, sorry for being late but yeah, new.
Scott Everline (07:46) Boots, right? Ashley.
Ashley Middleton Tapp (07:47) I, yeah, I mean, fortunately, it’s not preventing us from getting in and out of our house so far. So we’ll so you have a six room and a dog. Do I need to come rescue you? I know you, I know you’re I know you have something that will kill it. My husband’s like don’t kill it. I’m like are you out of your mind? No, no, thank you. So sorry for being late. I did that’s a legit reason. I didn’t just make that up, but yeah, nice to reconnect with you Jordan. Let’s talk about the weather in Texas because they were just in Austin and yeah, we have pretty bad snakes here too.
Jordan Tantleff (08:20) I was going to say I might be happy I’m back in jersey because I would not be handling.
Ashley Middleton Tapp (08:24) That too. Well. Yeah, no, that’s a first. I’ve seen foxes and a lot of things out here in the whole country. This would be a first. But yeah, great to see you again.
Ashley Middleton Tapp (08:34) Jordan. I think you’ve gotten a general overview of everybody’s function and kind of where they fall and why they’re listening in but excited to get the overview going and learn more about the product. Yeah.
Jordan Tantleff (08:46) Absolutely. And before we kind of jump into the presentation and demo did want to take a quick minute just to align on how we’re thinking about this. Based on actually our last conversation, the RFP that was released, a big theme we saw is obviously the push towards a single source of truth for provider data and using that to streamline onboarding enrollment and kind of ongoing lifecycle management for providers where we tend to see organizations kind of run into challenges is when pdms approach as just a system of record, the data becomes centralized but underlying workflows, credentialing enrollment are also fragmented or manual which limits the impact on turnaround times, accuracy and operational efficiency. So just want to be upfront in how we think about partnership because medallion doesn’t typically engage as a standalone pdm vendor. Our model is built around being end to end. So the reason for that is we don’t just provide software. We actually execute on the work and contract to outcomes that we provide as long as we’re aligned in that context kind of going in got.
Ashley Middleton Tapp (09:49) It, I think that works for the purposes of today. And we talked a little bit Jordan, you and I about our current model and how this solution could fit into a long term strategy. But yeah, I think we can proceed on that basis. Thank you.
Jordan Tantleff (10:04) So we’ll level set on kind of the current state and some of the challenges relating to enrollment and credentialing and then talk through how organizations are addressing it and how medallion approaches this differently. And then we’ll spend the majority of the time in the platform. So you can see how this actually works in practice. So, Ashley, I know we had a brief call. We didn’t dive too deep into the weeds on challenges you’re facing today, but, you know, some few things did stand out. You know, first that gap between enrollment submission and infected date, which ultimately delays revenue. A key pain point being that, you know, the surgeon population and the need to onboard junior surgeons quickly. So time from submission to effective date is particularly impactful. Second, the lack of a true single source of truth for provider data or the need to evaluate solutions here. Hence the RFP that’s being released and currently being evaluated. You also mentioned there’s a heavy operational burden on a relatively lean team managing onboarding applications for providers renewals, and then potentially based on kind of the key points in the RFP, limited visibility into where things actually stand across enrollment and key operational metrics. When we zoom out, what we’re seeing across healthcare is that these challenges are getting amplified, rising labor costs, staffing constraints and increasing complexity, are forcing organizations to rethink how this work gets done. I know you guys are all using a vendor today for the enrollment piece… well versed or experienced in the dental area. Specifically, Ashley, one thing we touched on in like a long term solution would be moving towards a more delegated credentialing model. Again, those delegated agreements in place with particular payers, not short term need, but, you know, long term need as well. But I’m curious if there’s anything, you know, the broader team here might be calling out that they’re seeing in regards to credentialing enrollment and any kind of manual workloads that your teams are experiencing today that are ultimately impacting kind of revenue and driving up operational costs internally.
Ashley Middleton Tapp (12:17) I think we touched on this Jordan in our conversation but just the ability to via an API or some other format, you know, call that sort of those key KPIs into another, you know, Power BI or another source so that we can make transparent some of the information that’s in the data management system that’s probably common with other clients as well especially around enrollment. But some other areas around contracted status, fee schedules, you know, just getting that out and more digestible and usable for various departments and stakeholders is really important.
Jordan Tantleff (12:54) Absolutely. And we do have bidirectional open apis as well. I know Scott will probably dive into this a bit more when we go through the platform as well. But good call out. We definitely can cover that as well. Great. Let me start by kind of grounding us in what we’re seeing across the industry. You know, while none of these pressures are brand new, which changes mostly the intensity and urgency behind some of these issues. Nearly a third of organizations are still facing 30 to 45 day delays just to get providers live, which slows down access delays, revenue and forces, you know, internal operations teams to constantly play catch up at the same time.
Jordan Tantleff (13:34) Leaders are being asked to cut operating costs by nearly 20 percent just to stay financially stable with those healthcare costs rising. So ultimately, the ask is to do more with fewer people and still do it faster. We’re also hearing more directly from providers, you know, 74 percent are experiencing duplicated steps across the network which is not only frustrating to them but creates avoidable bottlenecks. And that friction gets compounded by rising complexity. You know, the average provider is now contracted with 19 payers each with their own timelines each with their own different portals and requirements. So that’s really 19 different workflows that the team is managing. And beneath all that is, you know, the financial impact. So every day a provider is delayed in credentialing, organizations lose about 9,000 dollars in potential revenue. When you multiply that across your provider base, it becomes a major growth on margin or major drag on growth and margin. And as a PE backed organization as yourself, you know, potentially EBITDA performance as well… to bring this just a bit closer to home. Let me share what we typically see in organizations that are still running credentialing enrollment through mostly manual and fragmented workflows. For a, you know, mid sized organization, usually a few 100 active providers. It’s common to see over a 1,000,000 dollars annually spent just to keep credentialing enrollment moving. That often translates to a seven to 12 full time team managing work across maybe five to eight different systems. And, we hear the same story over and over, you know, spreadsheets, shared drives, caqh, you know, payer portals, enrollment, tractors, the tool sprawl becomes its own source of complexity and risk as well. And then downstream, these delays create real revenue leakage. Most organizations experience anywhere from 500,000 to a 1,000,000 dollars in annual write offs due to mismatched effective dates, processing errors or providers just not getting activated on time… historically, the way that we’ve seen organizations try to solve this.
Jordan Tantleff (15:45) Is by layering in more tools, more vendors or more people, you might bring in a pdm, you know, like the goal of the RFP or cvo, a bpo, but each solves a piece of the problem. But what all these approaches have in common is that they’re layered on top of the same underlying issues, which is, you know, manual processes, siloed, workflows, limited visibility and limited automation. So instead of fixing the root problem, organizations tend to try stitching together a patchwork of people tools, vendors and workarounds. What makes medallion fundamentally different from these tools, cvos or bpo models is that we don’t organize work around tasks or workflows. We organize everything around the provider. And this is where the strategy behind medallion resonates pretty deeply with the goal of your RFP, every workflow, every automation, every compliance step starts with a unified provider profile. We have one intelligent record that powers credentialing enrollment, ongoing monitoring, any kind of other services, a part of that provider lifecycle, that means provider data is collected once and then reused across every downstream workflow. So it eliminates duplication, reduces error and creates the foundation for true automation. From there, our data collection adapts dynamically based on payor, specialty, state and workflow requirements. So teams aren’t chasing missing information or reworking applications because everything is anchored around that provider record, we’re able to orchestrate the entire process, end to end, triggering the right actions, updating systems automatically and removing a significant amount of manual work.
Jordan Tantleff (17:36) All this made possible by how we apply AI, and this is an area where we’re very intentional. There’s a lot of noise in the market right now about around fully autonomous agents, replacing entire workflows in reality, especially in healthcare, that approach introduces risk. Our philosophy is simple automate where it’s possible and apply expertise. Where it matters. We use AI to handle the repetitive operational work, things like data extraction, form, filling, payer, follow ups and status, tracking the tasks that typically consume hours of administrative time, but for the steps that require judgment or compliance oversight that’s where credentialing experts remain in the loop on the medallion side. So that combination is critical because it allows us to move much faster than traditional models while still maintaining that level of accuracy and compliance that healthcare organizations require.
Jordan Tantleff (18:33) Everything we kind of just walked through the speed, the accuracy, the consistency comes from how Medan applies AI across the unified system. So at the core is a single continuously updated provider profile. That profile acts like the foundation for every workflow like I said from credentialing enrollment licensing monitoring, and more. And then on top of that AI powered workflows, handling the operational work, we still do have that compliance oversight and internal team handling kind of any kind of interaction that needs that additional human oversight embedded in the process.
Jordan Tantleff (19:12) So when organizations modernize provider operations, the impact shows up in really three areas. There’s revenue cost and experience. So faster time to revenue is typically the biggest driver. So by automating and operating credentialing and enrollment workflows end to end, we’re able to compress the times to patient visits by about 30 to 45 percent lower opex. So most teams today are spending a significant amount of time on manual repetitive work with medallion. We removed up to 78 percent of that manual work through AI driven automation. That typically translates to around 30 percent reduction in opex. And then on the provider and admin experience from the provider side onboarding.
Jordan Tantleff (19:58) Can be a major friction, a point of friction. So we streamline that process. So providers complete their profiles in, on as little as two days. We’re seeing as average with far less kind of backing forth.
Jordan Tantleff (20:14) And then the last thing I’ll touch on here. So medallion delivers outcomes that these legacy tools, bpos and cvo models struggle to match because we’re not just providing the software, we’re actually executing the operational work. So at a high level, this shows up in three ways. First performance becomes predictable instead of chasing status updates or managing vendors, teams have clear expectations around turnaround times and accuracy because the work is being executed through a consistent automated system. Second opex comes down again, AI powered automation, removing a significant amount of that manual data entry, follow ups and coordination, which ultimately reduces the fte or full time employee burden and eliminates the need for multiple disconnected tools. And third, both providers and internal teams have a much better experience as providers aren’t stuck in repetitive paperwork loops and operations teams aren’t constantly reworking applications or chasing down missing information. So this isn’t just an incremental improvement. It’s a shift from a reactive manual operations to a system that consistently delivers results. I’ll pause here because I just want to set the stage on kind of how medallion operates and what our business model looks like. But are there any kind of questions on what we covered here first before transitioning over to the demo?
Jordan Tantleff (21:41) I don’t have any. Anybody else. Okay. Good to go. Scott. Not sure if you have any questions before taking over here as well?
Scott Everline (21:55) No, I think we can kind of pepper with some questions, hopefully not too much spice. Yeah. So I’ll go ahead and jump into the demo environment kind of walk you all through the medallion platform. Let me know if you’re able to see my screen. Sometimes teams is a little twitchy cool. So I’ll caveat going through this piece of the platform or going through the platform in general with like this is here for you all. So if you have questions, if there’s anything I’m running through too quickly because I do this day in and day out and I might breeze through things if there’s certain things you expected to see that maybe I didn’t cover there’s a potential that exists in the platform. Maybe it’s just not something I hit on. So please raise your hand, please interrupt me. Please don’t apologize for interrupting me. I would love for this to be kind of an interactive display of what medallion does. So you all are kind of familiar with what the platform’s capabilities are first and foremost. And I saw this in the RFP documentation. So this is a cloud based solution. So it is not installed. It lives up in the cloud on Aws, along with all of the data which is all supported and managed onshore. Ultimately, meaning like you can access the medallion platform through essentially any modern internet browser. Obviously, there are credentials that need to be applied. So we support single sign on. We support multi factor authentication just to make sure users are who they say they are. We have our role based access control or rbac that supports specific use cases or specific access by user. So if you have somebody say on the payr enrollment team, but doesn’t need to know what’s going on from a verifications or a PSV credentialing perspective, you can block out segments of the application from user to user. I like to start out kind of on this provider’s page, right? Very few customers are coming to us completely net new with no historical platform system spreadsheet or something else in place to store existing data. Part of the kind of the onboarding process at medallion is essentially multifactored, right? So we’re going to work with you all to get data out of incumbent systems. So we understand credentialing turnaround or credentialing deadlines. We understand existing payr enrollment contracts, revalidation dates, understanding revalidation dates sometimes is a little bit of a… challenge for people to track. We’ll be able to establish those and track those here within the platform. So bringing that information in through a variety of different options. We do have apis. As Jordan mentioned, right? We have a bi directional API. So essentially any transaction or provider data could be fed into medallion from upstream systems or core systems. That could be a credentialing request, right? That could be a payr enrollment request, that could also just be core provider data, adding practice locations, et cetera. We also do flat file imports. So we have a tooling that will kind of will work with you all during onboarding to make sure we understand kind of the structure of your data where it’s housed, how it’s managed. We can bring that into a flat CSV file and then that’ll import directly into the medallion platform. And then of course, like users, whether those are admins on your team or whether it’s the providers directly can import and manage data within the platform. Any questions on intake? I’d be curious. It sounds like you all have a pdm system in place today. Do you know if that’s like a web enabled platform that would be able to push data or you think it would be more of a, when you do a big bulk upload from a template?
Ashley Middleton Tapp (25:41) Kristen’s our onboarding guru extraordinaire. I could see a world where bulk uploading is nice. I think our biggest key is functionality through caqh. So yeah, it looks like you guys can support that here. That really mirrors the way we work today.
Scott Everline (25:58) Okay. Fun fact. I actually met the CEO and CTO of medallion while leading the solution consulting team at caqh. Real fun. Yeah. So, yeah, real fun. So I was at caqh for about seven years. I was employee number 26. So I got very early on into the weeds of the data and the structure and the architecture and the technology. I’m a recovering salesperson from those days, but I did stand up the solution consulting team. I actually worked really closely with like nadp operations workgroup, worked with Ada on that piece that got stood up for better or for worse. Yeah. So I worked with, you know, a lot of the major dental plans, united concordia, dentamax, etc. So I won’t do a bunch of name dropping, but I’m very familiar with the process because I was with medallion as they were building it out and kind of providing some of those advising surfaces. So to touch on that. I’ll show a little bit there’s kind of two ways. Three ways we’ll support the caqh integration. It sounds like maybe you all already have your own caqh instance. I think you have access to pull data from caqh today?
Ashley Middleton Tapp (27:14) We use the provider’s profile. So we don’t have an organizational view at this point, but we require caqh for our providers that we support. So if they do not have a profile, we help them build it because it is so core to what we do.
Scott Everline (27:33) Okay. Good to know. And then you’re using that. So the data that’s going into caqh is coming from a core platform or you’re working with the provider and then bringing that data back into your pdm today, our.
Ashley Middleton Tapp (27:46) Pdm, to be completely honest with you, does not support import of caqh in the way that it was originally proposed to us. I’ve seen that a few times it’s much more of a payer side. It’s much more of a payer side model. So we don’t have any import capability today, but our enrollment vendor does. And so they, between us and that team, we rely heavily on it.
Scott Everline (28:14) Okay. Cool. So you… can bulk import data, right? So if you all have the data, so medallion, we have our own participating organization access. So think of us as essentially having the same capabilities that a payer does to extract the data. So we don’t use usernames and passwords to go obtain that information from the provider profile. We’re not using clug like web crawlers that break when caqh decides to move a field around. It’s literally a direct API. We have our own account manager, actually a friend of mine that we interact with, so that’s like fully connected. Okay. It goes both ways but without getting too nerdy on the technical piece, it’s not an API going back into caqh, but we do take data from medallion and feed that into caqh. And that’s a combination of bots and some other practice manager tool that they have. Okay. So rest assured that connection is there. It’s very strong. The relationship is actually quite strong, but there’s two ways, right? So there’s a bulk import functionality. So you can just upload a file with usernames, sorry, not usernames mpis, and caqh ids, and that’ll import the provider data, so that’ll automatically kind of bring in the provider data and pre build the provider profile. Providers are also able to link. So like think about net, new providers coming into the medallion platform. You’re able to invite these providers to medallion. So think of this as kind of your new provider onboarding process, right? We’re going to get some contact information, and then we’re going to send out an email to that provider. So the provider will get a branded email saying usom qlsm is working with medallion. Here’s a little bit of the work that we’re doing. And then the provider can go ahead and get started, right? That will kick them over to a medallion dashboard. So they’re going to land here. They’re going to have their own version of themselves within medallion. So they’ll go ahead and be able to get moving through some kind of processes. So again import from caqh, they can upload like a resume. We do pull information off of like documentation. So they’re like the Coi will pull that data into the profile. So they’re not having to manually key that licenses et cetera. If they really want to, they could manually fill out the profile. But most providers are going to be able to share the caqh id. We need to social just to make sure that it is when we make the API. Call who we expect it to be. Certainly don’t want to be exposing somebody else’s information wrongfully on the platform. And then the provider will be able to make that connection directly to caqh. That process. It can take one to four hours to complete. Usually it’s within 30 minutes or so. So, what happens is then we notify the providers. Hey when your profile is ready, we’ll let you know. So the profile will get a profile. The provider will get a notification that their profile is ready. You’ll see where we’ve mapped in all that information. They’re then able to kind of interact with any of these kind of fields within here. The final step of this process well before we get there, they can also go to like a data import so they can go in and load. If caqh didn’t connect or for whatever reason they needed to rerun it. Maybe it grabbed the wrong caqh id, which is rare, but some providers have more than one, they can go in and manage that data import. And then they have agreements here within the platform that they need to sign off on, right? So limited power of attorney, that really allows us to do a lot of the work around PE again mostly system generated, but it kind of gives us those rights to interact and speak on behalf of the provider. If we’re doing any caqh management pieces, right? We need authorization with caqh with the provider to go maintain some caqh information, interact with the help desk at caqh if we need to contact them. And then we get a profile attestation from the provider.
Scott Everline (32:13) Any thoughts, comments, things you want to see within the profile? Kind of curious how that compares like your current onboarding workflow. Is it more paper based where you’re you know, asking the providers to share a lot of documentation to bring into the table and you’re capturing, you know, documents and then feeding those into the pdm, what’s that look like today? Yeah?
Kristen Williams (32:38) That’s what I’m doing is I collect the data and most of the surgeons that I work with now, they’re coming out of residency. So they’re green, they don’t even have a profile set up. Okay? So I have to actually go into caqh take all their documents and upload everything for them coming on board. But this would prevent me from having to do that twice. So I appreciate that.
Scott Everline (33:00) Yeah. Anytime savings, we can find, right? Because caqh management in and of itself is a borderline of full time job. Yeah. And what’s cool within the provider profiles, they’re able to kind of track… status of things, right? So if we have existing licenses loaded, they’re able to come in here and see the status of their license. If there’s payer, enrollments in flight, they can see what requests have been made. They’re also just able to see self service, what payers they’ve actually contracted with, right? So if the providers have questions, they can come in here and interact with the platform and check on the status of specific requests. They also have tasks that get assigned, right? So I’ll talk about that in a minute. But essentially, as we’re going through the process, if the system picks up gaps and information, if it picks up, you know, outdated documents, whatever it might be, the providers will get a task, they get an email and then they get a task so they can come into the platform, manage the tasks, or they can just manage them through the emails that are sent. And then there is a mobile friendly view for providers. So they can’t do like full management of everything, but they can come in and do their attestations and their signatures. So we will capture E signatures here on their phones. So they’re able to manage that process via a mobile device as well. The ultimate goal is to really reduce how much time providers need to be interacting with a platform. So pulling in as much as we possibly can from caqh from documents. And then even like when we submit requests for documents, we’re sending providers a QR Code. So if the provider needs to upload a driver’s license, or a TB vaccination or whatever it might be, they can just snap that image, the QR Code with their phone, and then just take a picture of that document, right? So they don’t have to go to a scanner and scan their driver’s license, they just pull it out of their purse or their wallet, snap the image, and then it gets ported over to the medallion platform.
Scott Everline (35:03) I’m going to dive into, so I went out of a provider profile and I am now back into kind of an administrative profile. So you’ll see a lot more things here affiliated with this provider, but a couple call outs. I’m not going to belabor this whole profile because a, we don’t have enough time and B it might put me to sleep and it’s Friday… major call outs, the external accounts. So, Kristen, I’d be interested to know like when you’re working with providers on onboarding, are you getting their login credentials like their Ada credentials or npez account, their caqh username and password, and those types of things and then capturing it, storing it somewhere.
Kristen Williams (35:46) That’s correct. We use keeper. Okay? Capturing all that actually. Okay?
Scott Everline (35:53) Great. Yeah. I was at a nams conference one year and somebody like whipped a list of names and passwords out of their purse and I was appalled… keeper will prevent that. This is designed to do that as well, right? So a virtual vault to kind of store those logins and linkages here directly within the platform and then documents, think of it as not just kind of the restricted repository that caqh has, but it’s kind of an open ended repository for any documentation that you want to store here within the platform when this is a fake profile obviously. But when there are expiration dates, we’ll actually track those. And then we send notifications. So there’s like an expirables tracking not just for licenses and boards and Dea, but essentially for anything in the system that has an expiration date that gets picked up. We’re able to track that and then notify providers of that expiration. And then I mentioned the QR Code. So here’s essentially the code that would go back. And then they’re able to kind of manage that document upload. Offline.
Scott Everline (37:00) Any questions on the profile? Anything you really like, you find as a like a bottleneck within your profile data collection affiliations, etc that you want me to click on?
Scott Everline (37:17) I don’t think so. This has been very, this piece has been very thorough. Thank you. Okay. Good, hopefully not too thorough that you’re all like catching up. So one… of the things that I think really helps medallion stand apart from pdms and then other kind of service partners is we have this like AI enabled intake engine, right? So on the back end and I’m happy to click on it. We keep a repository of all the payer enrollment requirements, right? So like if I jump into the platform, our team, our system is able to identify exactly what’s required links, the web forms… follow up cadences, what dependencies exist, what needs to be included in that enrollment. So all that’s mapped directly into the system. And then we’re tracking that by different types of enrollments, and even specifically around privileging requests. If we’re talking about hospitals, so able to really dive into specifically what requirements are needed by payer enrollment. These are all delegated enrollments. But the system essentially highlights what information is necessary. And then we communicate back to the provider, what information is missing. So that’s whether it’s a credentialing process, whether it’s a paranormal process like I mentioned, for privileging. So it’s making sure like we use the term and you may have seen it on the slide when Jordan’s going through it like this provider readiness layer, right? The ideal objective is let’s not kill providers with all these outreaches and requests for information. Let’s intelligently look at what enrollments they have in flight. Let’s look at what tasks are out there and let’s compare those unique needs to that provider’s profile and then fill in all those gaps in an efficient way. As I mentioned earlier, let’s come back in tasks, right? So it could be a provider task. We also have the ability to task to admins, right? So if you all say, you know, we don’t want the providers managing some of these tasks. We want to be the first point of contact with the providers. It’s our brand. It’s our relationship. Everyone works very hard to recruit a provider into an organization these days, right? You want to white glove that experience as much as possible. We can task those to admins, right? And so admins are then kind of being that concierge type experience for the providers as they’re going through this initial onboarding process and as information is being gathered. So you see admin tasks, and I mentioned expirables. So that’s all within this kind of tasking methodology. But ultimately, trying to again map to that payer specific requirement. I think I saw something in the RFP about it. So now, ultimately, this is something that’s leveraged by primarily the technology but also just like, the individual stakeholders at medallion that are managing this, right? So just an example, I jumped into our payer directory, liberty dental, as an example, right? We have the contact name there. We have the general contact information and then the system essentially is going through, you know, what request type is? It? Is it a provider enrollment, a group enrollment facility enrollment? Clearly, the service type for liberty is just going to be dental, identifying the specific state. And then it will come back with those requirements, right? So I’m able to grab Arizona line of business. Let’s just check all of them and it’s going to give me those requirements, right? So make sure caqh is up to date. I like to see that means all my hard work on the dental side at caqh pays off and then has linkages, what’s going to be required, right? Contact information, follow up cadence. If there’s anything unique, we do hear from some organizations like follow up at a different cadence. Follow up is another place that we are leveraging AI. So we use AI phone calls primarily to navigate through the payers ibr systems, but we also have direct linkages into their pair enrollment dashboard. So like we can log into like an ability system or skygen and go into the platform and actually go and check on status and then bring those statuses back into the medallion. Feels… like a good segue to talk about pair enrollment if you all want to go down that journey with me.
Scott Everline (41:42) Like silence as a as agreement, you know, a submission to my journey. So we’ll capture your pair list on onboarding track. All of that. You have kind of an easy view of, you know, what’s requested, what’s processing by payer, etc. So enrollment requests are fully mapped here within the platform. So you have full visibility. So you can submit enrollment requests again through an API. It could be triggered by an upstream system. You could do demographic updates. You could do single bulk. And then you can request revalidations within the platform. I’m going to identify specifically, you know, I have a provider, I’m going to affiliate them with a specific group. And then I’m going to be able to conduct that enrollment request, right? And I’ll pick a pick list of payers. This pick list is nauseatingly long because it’s a demo environment. So I have, you know, over a 1,000 providers payers listed here. This gets truncated with customers to their specific payer list. You can always add to that payer list, but it gets narrowed down based on that. Then I’m going to pick the lines of business for that specific payer. And then I’ll go through the process, add practice locations, any specific details, and then any notes that, you know, that the system might need to be aware of or if it goes into the hands of an enrollment specialist that they need to be tracking… here within this dashboard, right? You’re going to see all the request information that seems pertinent to the actual request itself. You’ll be able to kind of narrow down essentially filter based on status. So if you just want to focus on files that need attention, maybe there’s a dependency that’s missing. Maybe the provider doesn’t have a medicaid id. And we’re trying to manage trying to enroll with dentiquest. And we need the it’s an mco plan or MCD plan. So we need to actually get that id before we can submit that process. All that information will be tracked here. You’ll be able to see the status of all of that. You’ll be able to track, you know, notes, outcomes, follow up any emails that have gone out between the provider, with the payer themselves with you all. So all that’s going to be tracked here within the platform?
Scott Everline (44:02) So think of it. It’s the worst analogy I can have. But, I actually up is like it’s like a subway sandwich shop to an extent, right? Fewer hands on your food thankfully. But essentially, you’re putting in the request, you’re letting us know specifically what payers lines of business practice, locations, et cetera. And then, the platform’s essentially gathering all of that information, mapping it into the necessary enrollment forms. If there’s something that needs human interaction, everything does get seen by human. But ultimately, it goes through a fair amount of like aiqc before it goes out. Our, we track. One of the things that medallion holds hangs our hat on is our resubmission rate. So we see and hear the painful process of, you know, I submitted an enrollment and 14 percent of them come back with errors that we need to clean up. And that slows that whole process down, right? That, that every day is a delay kind of concept. So our resubmission rate that we track and report internally to the organization is less than one percent. So because of that intake modeling up front, because of that payr directory, where we have all those requirements, because of all the let’s say, like the redundancies within the system, to make sure that we’re adding and capturing the right information, we have a, very low resubmission rate which means we don’t have to take multiple passes at getting an enrollment through, get sent to the payr, we’re ready to get rolling. And then we start doing the status check of that. We will follow those enrollments all the way through to completion and then notify the provider and the admins that enrollment has been completed, and then all existing enrollment. So once an enrollment request is completed, move over to just the enrollments reporting that gives you all those details, revalidation, date, proof of enrollment. If it’s a document that we need to capture, storing that here in the system… there’s a lot more here kind of covering the surface layers of it. Any questions or thoughts about kind of what we just talked about? Anything that wasn’t clear?
Scott Everline (46:21) We talked about caqh management a little bit. I know this is something you all are doing Kristin it sounds like you’re deeply involved in that process. We do offer a service kind of a combination of people and technology, actually mostly technology where we can take the data out of medallion and pipe that into some in caqh’s profile. So for all of our payer enrollment requests, we do that automatically to make sure we’re aligning the group details with what’s in those payer enrollment requests. So we’re going to check caqh make sure the group practice information is present on that profile. And if it’s not, we’re going to feed that data into that provider caqh profile because, you know, payers love to say, well, there’s a discrepancy, right? You don’t have this practice on your application, but you have it on your enrollment request. So we’re making sure those two things are synced. That’s just part of our regular payer enrollment processing. Then there’s proper caqh management where we are maintaining those provider profiles, taking the whole of the provider profile, reconciling that with what’s in the caqh account, and then executing those attestations every 90 days. So that is something organizations will sign up for you essentially assign providers to it. And then we track that, right? So we’re looking at attestation dates and kind of again maintaining that information, treating medallion as a system of record system of truth and then updating caqh accordingly… and then just quickly delegated agreements. I know you all aren’t there yet. Sounds like you’re certainly large enough to start going down that path. The way we support delegation is not just the cvo work which we’ll touch on in just a second, but also those rosters which can be pretty complicated. So we’ll get the rosters directly from the payers, you will assign providers to a contract essentially to a delegated agreement. And then we will maintain that roster template on a monthly basis. So we’ll look at ads terms, demographic changes that have happened, map all of those changes directly into those payer rosters. And then we’ll deliver that back to your team so that your team can then kind of do the one final pass, fill in any gaps that might not be in the system and then deliver that back to the payers. So sounds like probably not a pain that you all go through today. But everyone we talk to says it’s a pretty significant pain where it’s taking people you know multiple days to manage this. And this is not designed to be their full time jobs. Any questions about payer enrollment before I jump through pretty quick credentialing workflow?
Scott Everline (49:02) None from me. Thank you. Scott. Yeah. All right. So credentialing medallion is a certified cvo, ncqa certified cvo. So we manage that accreditation. I think our next audit is in November of 20 26. So we manage this credentialing process. We’ll pull in the caqh application. When we do that main primary import, again, you can request through the platform. So if it’s an existing provider, already previously imported caqh, if it’s a new provider, we build out the core and details, and then pull that information in from the platform. And then all the requests that are in flight will be tracked here within the platform. I’ll say 80 percent of the psvs are automated per ncqa requirements. They do need a final human to sign off on. And we have that process in place. So, at this point in time in the stage, right? Request has been submitted, your team is able to see specifically the status of the request, we have a five day turnaround time, contractual SLA. So you’re able to track us to SLA, even within the platform, right? So you’re able to see how much time is left on that individual application before we run into trouble on the SLA… some details around kind of the status, if it’s blocked when the application has been received, etc once the psvs are completed, they go through the quality control process. The platform will deliver back a completed PSV file. This is where some organizations, our paths divide, right? Sometimes sometimes a lot of the payers that we work with will just pipe this into another system. They won’t, use medallion as a credentialing tool beyond like us performing primary source verification. This is designed however to be an end to end credentialing workflow tool. So a user can come into the platform. I’ll be able to see just kind of a high level what the status is of that PSV report, see if there’s any issues within the file, able to identify that again, tracking that SLA here in real time. And then I’m able to look at the credentialing packet itself. So I’m going to get a summary of that credentialing file. If there’s any issues… the application attestation, we actually store the full caqh file in here. I don’t have it loaded on this one because as you know, that can be a pretty lengthy application. But I’m able to jump through, look at specific licenses, right? See the source of that information. And then I’m also able to make notes on this file. So I can make it a private note. So it’s only internal, so it wouldn’t show up in an audit or I can make it a public note. I can make attachments, I can add attachments, I can add other users. So whether that’s the medallion user that manages the verification, right? So if I need to reach out to Lucille because there’s something that I have a question about, I can do that. But I can also mention users within the organization. If I want to secondize on that file. And of course, you can download these files as a PDF. And that gives you essentially a digital paper version of the application itself. So if you needed to get a PDF version of that, you can print that out… from here. I don’t have the user credentials on this particular profile, but I can send these files to a committee. It’s… a very thrilling button. I’m going to show you what it looks like. Being slightly sarcastic, literally says send to, but we’ll work with you to define what your credentialing committees are, and then you can send those files directly to that credentialing committee. So I’m able to come to the system when Chrome wants to get along with me. And then I’m able to send it to whichever credentialing committee. That file needs to go to. A… lot of orgs. Have just two, some have more. We don’t really care. We’ll set it up based on your parameters. We get out of this because the system doesn’t like me being hijacked… then quickly within the, committee members are able to then vote within this profile.
Scott Everline (53:28) Chrome’s ready for the weekend. So this file comes through as a committee member. I’m able to come into the platform if I am on that specific committee and I can vote similar look and feel, right? I’m able to see the file, able to see the actual packet itself and then make a decision. And then those votes get logged to get moved over to closed. So we’ll store historically all those credentialing decisions that have been made including all the documentation packets etc, and then the outcome. So for whatever reason, you need to filter for a specific type outcome, etc, you can do that directly here. And this will basically be your repository of all those reviewed credentialing files. And then for recreds, we schedule those 36 months out. And then we start 90 days prior with a goal of delivering 60 days prior to your recredentialing deadline. So we capture that recredentialing deadline. You can see we start that process a couple months in advance and then deliver that back. And so those files move back over to the request status and just kind of rinse and repeat, right? So you have that information available to you that way. And then last few seconds, we have an analytics dashboards, right? So able to kind of look at a variety of different performance metrics around the system we have.
Scott Everline (54:56) We have an even in enrollments by market dashboard. So you’re able to come into the system and look, it sounds like some of this is maybe some of the reporting you’re looking for, but all the data here is exportable. So you can actually download the results directly from the platform. So like actually you talked about like feeding into like a bi tool. They prefer Json files. So you could use a Json file, but there is an entire open API architecture, right? So you wouldn’t have to come in here and download this. You could literally have systems pull directly from the API, but there’s like we understand reporting is important. So there’s about a 1,000 different ways that we’ve skinned that cat to make sure people get information the way they need it. And then there’s a custom report builder. So I can come in and run, you know, credentialing requests, report builder, who’s in it by npi by name, right? And then just run a file. It’ll give me those outcomes. Now, I ran through that last bit pretty quickly. Happy to answer any questions. I know there’s only a few minutes left. So.
Ashley Middleton Tapp (56:04) For my team, anything you didn’t see that you expected or want to see. I know we don’t have much time left. We could set up separate time if.
Scott Everline (56:11) Yeah, definitely always open to spend more time if you all want to spend some.
Jordan Tantleff (56:21) If there, if there aren’t, any questions, and are you guys able to hear me? I had to turn off my camera. Yes. Perfect. The network’s being a little spotty when I’m showing my face there. But if there aren’t any other questions, and I’m worried that I just saw a five minute warning meeting that’s going to be one of those warnings that ends the call.
Ashley Middleton Tapp (56:39) Okay. Yeah.
Jordan Tantleff (56:42) Just to make sure. Okay?
Ashley Middleton Tapp (56:45) It’s not personal is what you’re saying. It’s.
Jordan Tantleff (56:48) not personal.
Ashley Middleton Tapp (56:49) But.
Jordan Tantleff (56:52) being respectful of, you know, the RFP that’s released in regards to the pdm software solution. But knowing that medallion doesn’t you know, serve as a standalone pdm vendor. I’d be curious on like what kind of guidance that you guys would expect, for next steps, for us in particular. Like we’re happy to, you know, respond to the RFP and present a proposal just with the context, knowing that we’d be aiming to take on, you know, more of the end to end work related to, you know, enrollments and, you know, credentialing for example, but also knowing that you have, that vendor relationship in place today. I just want a little guidance on maybe what would be an appropriate next step for you all.
Ashley Middleton Tapp (57:37) We had planned to have one anyway, but my sense would be have a follow up conversation with the payr team and Amber early next week. I think based on our conversation a couple weeks ago, we’re not currently, I think in a place where we would shift away from our vendor relationships in the near term, never say never, right? But I think we’d want to think about that in the broader context of the recency of those implementations, how this type of solution would factor in and it’s certainly it’s distinct right? From some others that are a standalone software or have optional. And there’s some other options out other solutions out there that make the outsourcing function an add on, right? You bolt it on as opposed to having it be an all in one solution. So, yeah, let us talk at the beginning of next week if you don’t mind. And then I can get back to you just in terms of whether we keep going down the path. Have you fully, you know, create a full response to that RFP schedule additional time. If the team here thinks of things that we didn’t get to touch on, does that sound fair? Yeah?
Jordan Tantleff (58:43) That, that sounds great because I, we definitely don’t want to be, you know, wasting anyone’s time if this is, yeah, ultimately. Yeah, no.
Ashley Middleton Tapp (58:49) I appreciate that us too. Yeah, be thoughtful about kind of what, you know, what type of solution we believe we’re looking for, bye Scott. Thank you. And we’ll circle back at the beginning of next week, if that works for you that.
Jordan Tantleff (59:01) That sounds great. Great. If you want to, I’ll send just a follow up, I guess recapping today’s conversation. I’ll include the slides if that’s of interest you all to have on hand? Yes. And we’ll wait, for your guidance on what might be appropriate. Okay?
Ashley Middleton Tapp (59:16) That sounds great. Thank you, Jordan. Thanks Scott for us as well.
Jordan Tantleff (59:21) Okay. Thank you guys. Thank you.
Ashley Middleton Tapp (59:22) Thank you.