Transcript
Noah Laack-Veeder (00:00) hey, Kyle.
Noah Laack-Veeder (00:04) Morning.
Kyle Bettencourt (00:05) How’s it going good?
Noah Laack-Veeder (00:07) Morning.
Kyle Bettencourt (00:21) You know, the cold yesterday. So, I’m spending a little bit here this morning.
Noah Laack-Veeder (00:26) Oh, good.
Kyle Bettencourt (01:02) Hey, good morning Jonathan?
Jonathan Irizarry (01:10) Sorry. Good morning, guys.
Noah Laack-Veeder (01:12) No worries. How was your weekend?
Jonathan Irizarry (01:15) Short as always. So back on the grind.
Noah Laack-Veeder (01:19) Yeah. Was there a highlight for the short weekend?
Jonathan Irizarry (01:24) No… but, you know what? No news is kind of good news. So, yeah, just had a pretty chill weekend and that’s it, the temperature dropped about 40 degrees since Friday. So bit of a shock to the system. Yeah, it’s been tough.
Noah Laack-Veeder (01:41) Yeah, we.
Kyle Bettencourt (01:42) Had some nice rain here to kick off our Monday morning in Austin. So.
Jonathan Irizarry (01:46) You guys, are you both in Texas or?
Kyle Bettencourt (01:49) No, I’m in Austin… Noah’s in Wisconsin?
Noah Laack-Veeder (01:54) From Wisconsin. Yep. Oh, that’s crazy.
Jonathan Irizarry (01:57) I.
Noah Laack-Veeder (01:57) got my first sunburn of the year if you believe it on my nose. Yeah. So I was, that’s my exciting news.
Kyle Bettencourt (02:08) Awesome. Yeah, I came down with a bit of a cold, so, I’m just going to leave the camera off this morning if that’s all right. No.
Jonathan Irizarry (02:17) Nicole, I think she has Nicole had a meeting this morning, so she might be a few minutes late.
Kyle Bettencourt (02:24) Okay. That sounds good. And yeah, thanks for getting those inputs over to us late Friday.
Jonathan Irizarry (02:30) Yeah. So I couldn’t get them all. I was like, I’ll give you whatever I can easily pull.
Kyle Bettencourt (02:36) Yeah, that’s a good starting point. Did you, did you get any additional feedback from the RCM team on the claim denials or the payr matrix by chance or still waiting on that?
Jonathan Irizarry (02:48) I’m still waiting on that. I apologize.
Kyle Bettencourt (02:51) Okay. No problem at all.
Kyle Bettencourt (02:57) Well, do we want to wait for Nicole to hop on or we?
Jonathan Irizarry (03:00) Can get started. She can hop on whenever she gets free.
Kyle Bettencourt (03:04) Okay, cool. Perfect. Well, I can go ahead and share for just like kind of a quick recap from our… call Friday as far as kind of what we took and what we heard… and then, no, did you want to kind of kick off on your side with doing a sort of like a walkthrough on their process or? Yeah, no.
Noah Laack-Veeder (03:27) For sure. I can do that. Yeah.
Kyle Bettencourt (03:29) Yeah, that sounds good.
Kyle Bettencourt (03:30) So, yeah… I think, you know, ultimately, right? We’re looking to help you guys become more efficient with your credentialing in payr enrollment. Org. So I think, you know, the way that we kind of think about adding value, right? Is sort of three main buckets. Like we kind of hit on the initial call, right? And so one of the things I was kind of curious about from your perspective is just sort of how you’re thinking about it, right? You know, with accelerating revenue by ultimately getting your providers onboarded in a role quicker, right? Or like overall just reducing operational costs and then also just kind of increasing the overall provider onboarding experience. Those are kind of the three main areas on how we are sort of thinking about the value that medallion can provide. I guess of these three areas, what kind of stands out to you as far as what will be your highest priority with?
Jonathan Irizarry (04:31) I mean, to me the highest priorities is honestly, well, honestly all three. But if I had to like pick one accelerate revenue. I like, I know a lot of what we’ve seen historically is that, you know, when some providers are credentialed with some plans and not the others, but then they’re scheduled, then scheduling has to reshuffle the deck a little bit and just kind of reallocate resources. So it becomes really tedious and really time consuming especially when, if they’re performing services and they’re not. And we find out after the fact, they’re not credentialed yet. So probably accelerating revenue is probably number one. And then a close number two is the operational end of it.
Kyle Bettencourt (05:10) Got it. Okay. That’s definitely helpful. Yeah. And so what we can kind of do here once we get those final inputs confirmed after this call and start building out sort of what that would actually look like for you. And sort of what we can, you know, accelerate from a dollar perspective by automating a lot of these workflows here for you guys. And.
Noah Laack-Veeder (05:31) John just really quick there when you’re thinking about putting together a model to articulate acceleration of revenue. Like typically, what we do is we say look and Kyle has it on the previous slide, the revenue per day with 100 percent utilization would be X. And then if we can get effective dates, you know, 30 days faster, let’s just say then we just multiply that. For that. Is that similar to the model that you would be putting together to articulate the acceleration of revenue or like how would you think about it?
Jonathan Irizarry (06:01) No, probably along those lines. Yeah, definitely. Okay. Yeah, it’s.
Noah Laack-Veeder (06:05) one of the easier Roi models or more revenue quicker. So, okay, that makes sense. So, yeah, we’ll be able to put that, but ultimately, what we need to do first is prove that, you know, the technology and kind of the difference in the current and future state matches, kind of what you think in there. So I can jump into there, Kyle, unless there’s anything else that you wanted to highlight.
Kyle Bettencourt (06:27) No, I’ll let you, I’ll let you jump in and start with the product.
Noah Laack-Veeder (06:32) So, I am hoping to do a demo today, but I do want to spend probably around 10, 15 minutes just going through your current state a bit. Now, the good news is I’ve had probably like a 1,000 of these conversations at this point. So I have a pretty good understanding of what the current process looks like. I just kind of want to see a little bit more about how, you know, if there’s any nuances in your process. And then after that, what that’ll do is help me frame the demonstration or really articulate where we add the most value to the steps that are taking the most time. So, does that sound like a decent plan?
Jonathan Irizarry (07:08) Yeah. No problem at all. Cool.
Noah Laack-Veeder (07:11) All right. Can you see a document where you can’t really read it really well yet? Yeah, there you go.
Jonathan Irizarry (07:17) Have.
Noah Laack-Veeder (07:19) You, have you all seen like a process map with some lanes before? Like something like this?
Jonathan Irizarry (07:24) I have not, but Nicole.
Noah Laack-Veeder (07:27) Have you seen something like this?
Nicol Hartnett (07:30) Sorry, who’s on mute? Yes, I have.
Noah Laack-Veeder (07:32) Perfect. Yeah. So Jonathan, really quick, the swim Lane is kind of the person doing this. And then what’s in the swim Lane is what they do. Okay. So, like how it can read is like admin HR sends onboarding email for example. So really, I just want to think about your current state and mostly, just so we can figure out the bit like the best, like the best areas where medallion can help is when a provider’s hired. The first question is how are you collecting provider data? Typically, what happens in organizations that you send some sort of onboarding email and they complete a form or it could be an email that kind of has, how is, how are you all getting information from providers initially today?
Jonathan Irizarry (08:24) Nicole? I’ll defer that to you?
Nicol Hartnett (08:26) Yeah, for the, when we submit, like if a provider comes on board, we submit everything over to our credentialing team and HR. And then obviously, our credentialing team submits all of the applications and we wait for the letters to come back with the termination from the payers got?
Noah Laack-Veeder (08:43) It, does that answer your question? Yeah. So like the credentialing team, are they just because I think we talked last time everything is more or less manual, so, is, are they just like sending emails back and forth to these providers to get their information or, how do you know, how they’re collecting their information?
Nicol Hartnett (09:00) Typically, yes, it’s through email and it is at onboarding. So, once a offer is made to a provider, obviously, we request, you know, a copy of their license and Dea, and, you know, all the documents that we would need and that is stored with HR, who then shares it with our credentialing company. Jen, who is our, excuse me, credentialing manager will pull some information off of websites as needed if she needs. Like, I know she uses that pes website a lot, but typically, it’s all shared via email.
Noah Laack-Veeder (09:31) Okay. Makes sense. So, it sounds like there really isn’t like any automation there of like pulling from like caqh or from other sources today. Okay? Not.
Nicol Hartnett (09:42) Typically, I know, like I said, sometimes Jen will use caqh, but we usually wait for the providers to send us a lot of the information which, you know, when we have providers who have worked for larger hospital systems, they’re very much used to. There’s a department that does this, and I don’t ever have to log into my caqh or make any testations or changes. It’s it’s all done. So that’s kind of one of the challenges as well.
Noah Laack-Veeder (10:04) Yeah, because they’re expecting more or less this like white glove service. And we’re like, hey, kind of just need to get this via email. And just so you know, that’s pretty typical kind of with organizations of like your size where we don’t have automation really that’s the only path is just getting it via email, but it’s highlighting here. So let’s say, you know, you get the information, the credentialing team then probably has to review the information manually. And then if there are gaps, like they have to know that, right? They have to kind of be the experts to figure out if something’s missing. And if there are gaps, then they’d be reaching out to the provider to get that information. And then when it’s time to actually start preparing and submitting these applications, I think last time we talked about the data that they’re using is housed in a couple of spreadsheets, documents might be in like a shared drive or a sharepoint. And then if caqh is going to be dependent, then that individual is also going to have to go into caqh, update it. And the like, I know that, you know, that the credentialing person isn’t here. But I’m assuming that this work is happening as part of this process. And the big thing I just want to highlight is in terms of making this process more efficient, I’ll show you kind of how medallion does it. But as you’re seeing here, there’s a lot of manual entry double checking. And then if there’s not any automation kicking off, there’s really no like accountability system or governance saying you did this correctly. So in terms of efficiency in just kind of thinking about the current state, would you say that your process is pretty similar to this?
Jonathan Irizarry (11:41) Yeah. Well, at least from what I’ve seen, I would say yes, but Nicole, I don’t know if you have any different.
Nicol Hartnett (11:47) Thoughts, no, it seems like the… process that Jen follows based on my, you know, when she asks me for questions or asks me for documents.
Noah Laack-Veeder (11:58) Yeah, that makes sense. So then you’re probably wondering, okay, what does medallion’s future state look like? So how we do this is ultimately we’re trying to reduce the number of manual touch points. So as you saw before John, like there’s a critical dependency of caqh for a lot of these payers. So what we do and Nicole, this is similar to what probably other hospital systems are doing is they’re ultimately just pulling as much information as possible before we have to reach out to a provider. So what medallion does is we pull all information from caqh if they have a caqh profile as a starting point. And then when a provider actually does need to interface with the system, their first interaction is with a pre populated profile. So there’s no needing to send information back and forth. We’ll pre populate it with as much information as we’ve gotten from these other systems. And if there are gaps, medallion will automatically surface those for your organization. So we know exactly what’s outstanding. Really what the impact there is that… if you’re not tracking these tasks, these are all reasons why a payer would reject an application. And so this whole process with this auto import and everything takes us around two days to get a fully completed profile, thinking about the current state today. Typically when we think about getting the onboarding complete with a provider, it takes around like two weeks. Ish, is that similar to what your organization is seeing in terms of how long it takes to get the data before we get to the application?
Nicol Hartnett (13:36) Yeah. Typically, our onboarding timeline in general, well prior to credentialing, obviously, we know that could take weeks, but just to get obviously like the background and all that and all the documents that we need, we’re looking at like a three to four week kind of time period. And of course, like you said, providers are much more used to white glove they’re not, they probably don’t have half these documents handy depending on when they graduated. So it does definitely cause a delay waiting for them to send us over documentation. Yeah.
Noah Laack-Veeder (14:11) And then I think one of the goals like the ultimate goal here John, as you said was let’s accelerate revenue. So this is an area I think already that we could speed up around two weeks and that’s not even dealing with the payers downstream. And I’ll show you this in the platform. But ultimately the whole, the way this works in medallion is let’s pre populate it, provide that white glove service. And then if there are things that need attention, Nicole, that’s where we would route to a credentialing person. And I’ll show you that in the platform. But how does this compare just the initial provider data collection? How does this compare to the kind of the ideal state that you both have been thinking about, right? Obviously, the timeline with two days is advantageous. But in terms of the mechanisms of how this works, how does this compare with what the ideal solution looks like for you both?
Jonathan Irizarry (15:04) I mean, to me it looks like it’s much better than the current process. I would need general credentialing just to get an idea of like, all right, like how much of an improvement is, but when we go from like almost no automation to at least this automation, it seems like a pretty big improvement.
Noah Laack-Veeder (15:20) Yeah, that makes sense. Yeah… the big value here also comes from payer enrollment. So this one already looks a lot more messy and it should, because this is the one that takes a lot of time. So, I just want to kind of highlight because I think last time I heard John, you say like, look, I’m not an expert in credentialing. I know enough to be dangerous, but I just also want to just kind of help you understand a little bit more about what this process looks like typically and where things take the most time. So, right away, so we collect the data. But then if you’re thinking about enrolling with the payer, the first question is, you know, you need to determine whether you want to link this to a group contract or you want to submit these individually. And Nicole, last time we talked about this, where you’re saying, I think we’re doing it individually. We are supposed to be doing it via group. Like we don’t know what we’re necessarily supposed to do. So with that, I just wanted to ask like if you both don’t know that’s fine. But the question is, are you supposed to be billing at the group tin or group mpi level? Or are you actually your strategy as a business is to enroll these physicians individually with these payers? Like do you know, like, do you know what I’m asking? Yeah.
Nicol Hartnett (16:38) Yep, Jen, and obviously, Allison would have a lot more information but like I said, I know we previously billed as a group. So our practice is a little bit complex. I will say we have like psychiatric nurse practitioners we have developmental pediatricians, we have pediatricians who specialize in developmental peds, we have neurologists who specialize in development. So, there’s kind of a neuropsychology right? The previous credentialing company that we had years ago and billing team. I believe they credentialed under the group contract because though some of these services can be billed both medically or behavioral health, they bill medically as a group. So my understanding was we credentialed everyone under a group tin, everyone, we build all claims medically. I think our current team had reservations about that and said, you know, technically this is a psychiatric nurse practitioner and we should be billing to behavioral health again, although we have medical codes that are being submitted for the claims. I believe that’s why they started credentialing individually. But then we run into issues with, you know, we are a specialty group and we bill specialty, but we have providers who they’re you know, with certain plans, we have to collect a specialist or a primary care copay and they pay us primary care rates instead of specialist rates. And I can’t help but wonder if a lot of that change is because we’re not credentialing as a group or billing as a group. I also know that our claims do go out from what Allison was saying, I believe are the individual npi and the group tin is on there as well on each claim as they go out. Yeah. Again, a lot of information. I’m not completely savvy in this, it’s.
Noah Laack-Veeder (18:22) just no, I mean, you say that, but it’s that was a pretty savvy response. Yeah, yeah, it sounds to me that because why the group contract or group level is typically done is because of the specialty and you’ll get more or less special rates based on the different services or codes that you’re billing. So how you explain that to me makes me think that you’re supposed to be doing it under a group. But then if you didn’t know that, then you might just skip this step right here which is going to change. Ultimately, what it’s going to affect is the reimbursement rates that you’re going to get from a payer as well as if they’re even going to be putting you in network. So I think it’s really important that if we only are doing this, we are doing it to the group level. I’ll show you it’s a click of a button with medallion. It’s not like this huge exercise there. But if what is really important is just to make sure we’re aligned and what that strategy is like, if it is the group and you get that confirmation absolutely that’s how we should be doing it. And that sounds like that’s the case. But as a follow up, let’s just make sure we get that like lie in the sand. We are going to do that going forward because we just want to make sure we’re not going against what we already have with those payers. But as you’re thinking about this, right? If you don’t know the pay requirements and someone has to research them. And if they’re not an expert, it’s kind of relying on their research to make sure that we’re doing this correctly. And then there’ll be starting applications. There’s gaps. They’ll reach out to the provider. And there’s this kind of circular back and forth happening. And if they miss something, this’ll come downstream, right? It’s reliant on the individual qaing their application, knowing the rules and regulations. And if they miss something then it’s going to get rejected from a payer, so ultimately, how I think about this pre submission process is we’re trying to take care of everything that a payer might reject this for. And if there are any rejections that’s going to lead to a delay downstream. So it’s really important that we get this process done and automated. If I zoom out, typically organizations, this request and submission can take like up to 35 days. But a lot of organizations who are a little bit more efficient.
Noah Laack-Veeder (20:31) They get these things done within 10, 15 days. Do you all have an idea of how long it takes once you get the provider data to get these applications out the door to the different payers?
Nicol Hartnett (20:47) I’m not sure. I don’t know if you have any idea. I don’t think there’s a rhyme or reason.
Jonathan Irizarry (20:53) Yeah. I don’t think there’s like a set like frequency. I think it’s just kind of as she gets them, she processes them and sends them out. I don’t think there’s like a defined. I mean, Noah, if you want to this among other questions, like any open items as we go through, I’m happy to go reach back out to the team and just be like, hey, I’m just looking for some information here if you could just like provide it just to get more.
Noah Laack-Veeder (21:14) Yeah, for sure. We could send those. And ultimately, it’s like what I’m hearing is like the predictability and visibility has been kind of a general theme like with medallion just to highlight as we get these applications out the door and like with 100 percent accuracy in less than three days. So what we’re trying to do is just like, okay, that takes three weeks to get provider data. It takes two weeks to get them out the door already. If I kind of add up the timelines of medallion, we’re comparing five days versus kind of, it seems like 30 to 40 days. So right there, if we just streamline that process, it’s about 30 days of savings, which with the math, we talked about Jonathan 30 times whatever that’s already kind of revenue without even talking about the payers. But I just want to finish here. Like another key component of this as you were both probably aware is the payer follow up.
Noah Laack-Veeder (22:05) So if there’s things that come in, someone has to track these, they have to manage those. And if you’re doing dozens of applications for folks, like things can get lost. And if things get lost, that leads to more delays, could lead to rejections. So ultimately like last time when you said the process I think takes around like 120 to 180 days generally sometimes for some of these payers, like that’s really why with a manual process that takes that much time is because if you’re not getting ahead of all these things up front, you’re going to have downstream rejections or downstream issues and it’s just kind of a stacking problem where there’s more and more work to do? I wasn’t able to do that. So any questions on kind of the current state of payer enrollment? Does this seem pretty similar to what is going on today?
Jonathan Irizarry (22:58) Yeah. I mean everything I’ve seen seems to, you know, indicate we have a manual workflow issue and this seems to address a lot of it. Okay?
Noah Laack-Veeder (23:07) So futurestate and I’m going to show you this in the demo. The big thing here is that medallion is going to be taking care of 90 plus percent of the work. So you still need to tell us like which groups to link to, which is a you’re like, hey, we have this one group contract, just make sure they’re submitting a part of that, that’s the easy part of this process. And then you submit the request, what medallion will do is auto complete the applications. We’ll QA them. If there are gaps, we’ll automatically generate tasks to your team or medallion can even take care of those. And we’ll submit the applications. And the other piece too is that we’ll actually use AI to complete the payer follow up. So if you have an individual who has to call these payers, we’ll actually follow up automatically. We’ll also handle emails back and forth. If there are things that need your group’s attention, then we’ll send them over to you. But the big thing here is that we execute this follow up immediately. We’re not kind of waiting for someone to be like, okay, I have time to do this. We’re just taking care of it. And then when you do get those par, effective dates, we’ll track them as well as the revalidations. I know last time we talked about the visibility of par effective date being a challenge with Medan as I’ll show you we’ll track those automatically. So with Nicole, you have to figure out, hey, is this person in network with this payer? We’ll be able to tell you that within a couple of clicks within the platform?
Nicol Hartnett (24:34) That would be incredible.
Noah Laack-Veeder (24:36) Excellent. Well, so again, just to summarize, can the current state manual process lots of work for one person to handle, which regardless of ability can make things challenging with medallion. We just try to automate it. So if there aren’t any more questions here, I just want to show you the platform to really just start the dialogue about how this fits with the ideal workflow. Does that sound good? Sure sounds?
Nicol Hartnett (24:58) Great. No, I just have one follow up question on the payer. So, is there, I know we’ve asked our team and I know there’s hundreds of plans out there. But when medallion credentials a provider, will there be some type of place that we can look or documents sent to us that gives all the plans under that payer that provider is participating with? Or is it just kind of like the umbrella that they fall under? So like I said, we find often that there’s you know, we might have a provider who is credentialed with blue cross blue shield, but there’s these one off plans that they’re not credentialed under. Yeah.
Noah Laack-Veeder (25:34) So usually that information is in the contract that you have with a payer. Do you know where the contracts at? Like which department would have those at your organization?
Jonathan Irizarry (25:48) That’d be under the billing team, which is also where the credentialing person falls under. So they’re all housed like within that one area.
Noah Laack-Veeder (25:57) Yeah, because usually in that contract, it’ll say like when we talk about like Aetna it’ll be like Aetna gold, Aetna silver, whatever. And then usually, if you’re doing it from like a commercial line of business, that typically includes all those kind of subplans from that broader umbrella?
Nicol Hartnett (26:14) How.
Noah Laack-Veeder (26:15) medallion does, it is like we will, if we take as an input, your contract. So if you say like, hey, the contract we have with them handles these six different subplans. Then when I show you the enrollment, we auto enroll them with all those subplans. But if the question is like, hey, do we, are we going to be in network with these subplans? Ultimately, that is actually related to the group contract that you have. And so we’d have to like as an action, just take a look at that. But the piece where that can show up is if a patient comes to you and says, look, I’ve got, you know, blue cross blue shield or like primera or whatever it is that’s typically a subplan the group contract if you have it with the kind of national or broader payer should include that, but it would be, again, it would be on your contract.
Nicol Hartnett (27:08) Okay. Like I said, we’ve had we’ve seen some providers are credentialed with like I said, like an epo or ppo plans. And then we have some that come back that they’re not participating with that plan. So I didn’t know if that was like a wrong click of the application or if it was an issue with again credentialing providers individually and not under group npi. So.
Noah Laack-Veeder (27:29) And I think based on what I’ve heard so far, it sounds like it’s actually just based on the individual versus the group because the group would have that the group would have the subplans. If you’re doing an individual, it’s kind of like do I remember which plans they’re supposed to be in? And they might forget to indicate that or they might. So it’s the process for group versus an individual is much different. And so as an individual, you kind of have to think about you’re getting an individual contract with the payer which is already done. If you’ve done the group contract. Does that make sense?
Nicol Hartnett (28:05) Yeah. Yep. So.
Noah Laack-Veeder (28:07) I have a sneaking suspicion that if we do it via the group enrollment, that issue shouldn’t happen again. So with that being said, let’s actually, can you all see tasks on my screen? Yes. Yep, I actually want to start with the group piece because with medallion, like we’ll have your group information and kind of what part of implementation is that we’ll get your group information in our system. So if it’s in a spreadsheet or somewhere, we’ll load it in. But what that’ll do is it’ll make sure that we have all the information that we need for your group, as well as which payers that they’re going to be associated with, as well as the different practices that are associated with it, ultimately, why I’m showing you this is because when you do enrollments, you need to make sure that all of these things are… kind of checked. But with medallion, because these things are all linked, you won’t have to check them manually. It’s going to auto kind of pull the information that we need. So thinking about where, so it sounds like this data sits with the billing company today. How difficult do you think it would be to get this information?
Nicol Hartnett (29:25) You know, John, I think we worked on starting to pull some of the contracts… a lot of the there’s history there. We had an outsourced billing company brought billing internally and then we’ve had a change in, you know, just that structure and that team probably two times in the past couple of years. So finding who had the contracts or where they were saved was difficult an upheld battle. I know John and the billing team themselves have reached out to the payers to try to get a copy of our current contracts, which has been pretty unsuccessful for most of the payers. But I do think that we made a little bit of progress… right? John. I think there was a few contracts that we got our hands on.
Jonathan Irizarry (30:09) Yeah, there was a few. Sorry, my internet cut out for a second there. Yes, we were still working on like getting some of those contracts. I think we got a few of them housed within the billing team, but still work to be done, yeah.
Noah Laack-Veeder (30:23) We do offer a service to kind of like again, if you’re like, hey, we need to kind of start from scratch and see which groups are enrolled. We have like a service called paranalysis that can help you get that information. However, I would say that like the number one priority whether you work with medallion or any other vendor is to try to get those group contracts in order. Because ultimately, I mean if a group tells you they’re able to submit your enrollments without that information, I’d be pretty skeptical because it’s like how do you know? Right? So kind of in parallel whether it’s medallion as your partner or else I would just say that’s probably a really important piece. However once you get it, what I want to say is you’re not going to have to worry about finding this anymore. It’s in the system and why that’s important is because when you all need to do new enrollments, let’s say you just onboard a new provider, you need to get them with all the payers as part of this group. You don’t this is the work that someone has to do. They just say, look for my provider. Naomi I need them as part of this group, npi group, tin in the state of Arizona to be in network with all of the payers in my group contract. You can just click this checkbox and effectively what it does is it makes sure that this person is now going to be in network with all of the payers that you have contracts with. And if you want to add all the lines of business as well. So sometimes you’ll have like medicare line of business, managed medicaid line of business, et cetera. You can just select all the ones that are in the group contract here. And you’ll see that they just keep kind of pulling it automatically. And so you don’t have to worry about, am I getting everything correctly? You just if the strategy is let’s get everything here, you just keep selecting all. And then when it comes to the practice locations, why I had it earlier is because you were like, hey, let’s say like I just wanna make sure they’re enrolled with all the locations, great, click this button. And then all the locations that this provider’s associated with are gonna be captured. Why this is so impactful is when you actually click next and submit what medallion’s gonna do? Is it’s actually gonna start populating these applications automatically for you. So if you’re seeing here actually this is the wrong one. Let’s do medallion. So this is blue cross blue shield. Arizona, for example, this is a slowed down version of our RPA tool which effectively just goes in and submits the application on your behalf automatically. It’ll take all the information that you gave us and then populate that for you. So you’re not gonna have to worry about, hey, did someone miss this? This automation will make sure that everything flows through. So there isn’t an opportunity of an error happening because it’s not a person error manually typing this information in.
Nicol Hartnett (33:19) So,
Noah Laack-Veeder (33:20) why I wanna show that is because if you get the contract information in order, we take care of everything else. There’s no need to prepare the application. There’s no need to track the status. There’s no need to do the initial follow up with payers, which medallion does upfront. And ultimately, the end of it is when you’re enrolled with a particular payer that visibility that you’re looking for. We have all the line of businesses and the payers and their effective dates in the platform. So we’re not if you’re like, hey, I wanna make sure I don’t have this patient see this provider until this effective date. We’ll alert you when the par effective date is determined. But you’ll also have visibility here and full transparency as to who’s in network with who?
Jonathan Irizarry (34:05) Cool. That’s that was a slow down version of the application.
Noah Laack-Veeder (34:09) Yeah, exactly. I mean, yeah, cause it’s I don’t wanna make you busy but it’s I mean, but the thing is like in that example, there was, I think 10 applications that I needed to submit. We’re gonna submit those in parallel. So it’s not waiting for someone to go. One done, two, done, three done. They’re all done immediately, which again, obviously, that’s just the power of automation versus people there. But already kind of thinking about that process before we’re talking about like a manual kind of no checks being in place. How does what I showed you compare with that ideal solution for submitting? Those enrollments?
Jonathan Irizarry (34:44) I mean, for me, it seems pretty, it seems pretty good Nicole, I don’t know if you find that useful to either you guys or the billing team, but you tell me definitely.
Nicol Hartnett (34:55) I think it would help a lot. Like I said, it’s just getting our hands on well a, the contracts, but B, just what payers and we often don’t find it on my end until there’s rejections or denials or we go to verify benefits and give an individual npi and they say that they don’t participate with that plan. So, yeah.
Jonathan Irizarry (35:17) Nicole, the one thing I know Drew’s asked for this before. He’s always won our CEO. He’s always won at like a database that shows, all right, like every provider we have every, their status on their credentialing and like when their expiration date is for credentialing, right? Nicole, or like recredentialing date, does that, it looks like it has this here, am I mistaken? No.
Noah Laack-Veeder (35:42) Yeah. And that recredentialing date is what we call a revalidation and why that’s really important is let’s say this expires and you didn’t know that. And then you still have Alex Morgan looking at Aetna. Well, then every time they see a patient, then it’s gonna be a write off or denial because you’re not actually in network anymore. So sounds like that’s from what you’ve all said the revalidation dates aren’t being tracked reliably or are they? Yeah?
Jonathan Irizarry (36:12) We’ve it’s been questioned before like in the very recent past. And some of the feedback we got from our head of our team was that it’s like the payers will automatically like re, credential some employees. I don’t know how accurate that is… but it’s become an issue in the past where our CEO and just even myself would just like to have visibility to it. And we just, we don’t like we’ve asked or the CEO’S like, hey, can we have a list of every provider when they’re due to I guess revalidate? And we just get some kind of long winded answer that it’s too much to put together and it’s too much manual work to kind of make a list like this and so on. So this seems like it addresses that. Yeah.
Noah Laack-Veeder (36:58) And you said the lots of work. So when we get these effective like Nicole, what you said earlier is like we work with every payer, so we know their revalidation windows. So when we get effective dates like it’s three months or not three years or five years, we’ll auto do that.
Noah Laack-Veeder (37:16) And then effectively, if revalidation dates are coming in, we alert you 120 days in advance. But most of our customers just say, yeah, you can alert me, but can you just process them immediately when they’re due? So what that ends up happening is you have full predictability and reliance that these revalids are going to be processed before they’re expired. So our customers who have denials due to revalidation errors, they see those drop to zero because we take care of them well above well ahead of time. There’s no rule that you need to like do a revalidation date like a revalidation, like 10 days before. It’s like whenever you, it’s coming up, just get it done.
Noah Laack-Veeder (37:57) So similar to the other piece. We’ll just do the revalidations for you. And then you can track the status just like everything else here. Like I’ll show you here like we have, you know, these different services happening here. But if you’re like, hey, what’s the status of these revalidations? You’ll see all those here as well. So you have full visibility into everything that’s going on with your operation with credentialing.
Jonathan Irizarry (38:22) I think that’s a big win in my opinion, the.
Noah Laack-Veeder (38:26) Big win because of the in.
Jonathan Irizarry (38:29) Terms of like, we’ve never had real visibility into it before and this just provides so much insight that we just haven’t had. Yeah. And I.
Noah Laack-Veeder (38:37) think so. The first piece, the revenue acceleration like just automating this, it’ll go faster if you’re rejections. But that second piece that we’re kind of, I mean, if you get the claims and hours numbers that’s great, it just helps our business case. But where the visibility usually shows up is we don’t have these denials or we really just improve patient access because we know who’s counseled with. Who is that alongside how you’re thinking about this?
Jonathan Irizarry (39:05) Yeah, 100 percent. Yeah. Okay.
Noah Laack-Veeder (39:09) So that’s the enrollment process. The big thing here that you’ll notice is that it didn’t really require you having knowledge about these payers. You just need to kind of know like the group contracts that you have, which again, that is going to be a requirement. But again, if you have that, then we’ll submit the request on your behalf and take care of everything else. But I also want to show you kind of how we get provider data into our system. And so if it’s kind of via email every day. And Nicole kind of thinking about what this white glove service is that you kind of want to see how we do it is we ask for some very basic information about a provider and we’ll auto send them an email. And so what this looks like, I’ll actually pull up with the email, it’ll be white labeled. The organization is not going to say medallion, right? It’ll say like neurabilities, but they click get started and what it’ll do is it’ll walk them through a quick flow to connect their caqh profile. And so if they give us their id identifying information, we click verify what ends up happening is all their information from caqh is going to come directly into medallion. So what they’ll see when they log in is a fully completed profile with all their information from caqh including their documents, that might be in caqh. So if like their malpractice or something is on caqh, you’re going to reach out to them again. That’s an area where we’ll get it. But the second piece here is, hey, can medallion update caqh? If anything in medallion changes and that’s a big level of effort for a lot of organizations. So what medallion will do as well is if anything changes during this intake process, we’ll actually go into caqh and update that information as part of the enrollment process to prevent those rejections. I’m not sure if you knew this, but if caqh doesn’t match the information that’s on the application, then the payer will reject it. So having this updated is really important. And then also if you’re having to do those quarterly attestations, medallion will do those as well. So we make sure that caqh is up to date. And so the impact there is that if there are any of these changes or errors happening or timeline constraints because caqh has been updated, medallion just takes care of that. So you don’t have to have a resource manually going in here or a provider going in here, which can expand that turnaround time from like two days to 30 days because a provider has to go through all these steps.
Nicol Hartnett (41:51) Very cool. So, yeah.
Noah Laack-Veeder (41:52) Think about the provider experience that white glove service. How does this compare to what you all are looking for?
Nicol Hartnett (41:59) Yeah, it’s great. And like I said, it’s a little PC right now. I think when we onboard a new provider, there’s just, you know, there’s like the hiring manager, you know, or CMO, dr chattahambe, and then there’s someone from credentialing reaching out. And then there’s someone from HR reaching out. So, it seems if I’m understanding this correctly, that really all for the credentialing piece we would need is that provider’s email, and then they would get this welcome process. And would this save all their documents? Like are they uploading or they’re sending in their information? And then we’re pulling from caqh and other places their documents. Does it save their documents in their profile?
Noah Laack-Veeder (42:41) Yes. Yeah. So I’ll show you this like think of this provider profile. I’m showing you as more or less the combination of the spreadsheet and that shared drive. It’s all in one place. And so what I will say is most of the time the, with us freeing up so much time from the pair, follow up the application submission. What teams end up doing as the fte is like helping with this still, which is in a full time position, they can actually do things on behalf of providers. So let’s say that they found their information or they have a document somewhere like they can upload the document for a provider if the provider wants to log in and do what they can. But it’s kind of like both parties are able to do it. What the provider does have to do is, you know, obviously sign the attestations, and they can do that, in the platform. So if I go here, let’s say they’re they have to sign their agreements, they just go into their phone, they go and they add their signature, they sign. And that theoretically could be the entire experience for a provider. If you’re getting all their information from caqh, supplementing it from other sources of the HR system. Really, your provider just needs a sign and that’s the whole experience for them, which can be, really nice for a provider.
Nicol Hartnett (44:04) Okay. Yeah. I would definitely want to just make sure we’re I don’t want to duplicate efforts obviously. So like if our HR team is reaching out for, you know, their license and Dea, I don’t want then the system, if the system’s actually pulling that automatically somewhere from some place, can I then tell the HR team? Hey, when onboarding a new provider, you don’t really have to get these documents. We’re gonna pull them from the credentialing software just because again, I don’t want duplication of efforts and work and I don’t want to confuse especially a medical provider coming on board with us. Yeah.
Noah Laack-Veeder (44:40) I think you’re thinking about it the right way. It’s like we, so with this kind of, the order of operations is let’s get as much from caqh as possible. If anything’s missing. We’ll summarize that for you. And then it’s like the current process would be piecemeal, send emails to this provider to get all those things. The new process would be here’s. Everything that we need for this provider. Let’s work with them to get this all at one time versus sending them like 10 20 emails. And so that, and so that’s how we get those turnaround times of like the provider complete the provider data being complete in around two days versus it taking, you know, 30 to 45 days. Got it. So, I know we went through a lot today, kind of gave you the crash course Jonathan and be, so you learned that saw kind of medallion’s perspective and how we tackle it. Would just love to see, you know, where your mind’s at? How does this compare with what you’ve seen so far? Or kind of what you’re looking for? Yeah, no.
Jonathan Irizarry (45:47) I really kind of like what we’ve seen. I thought that demo was incredible. It seems like 100 percent improvement over the current process. So my thinking now is one I would like a list of like any open items that we discussed that like Nicole and I didn’t have an answer for if you could send that to us, I want to send it to like our credentialing person. And I heard at RCM just so we can kind of fill those gaps. And what I’m thinking is I would like to get if we can schedule a call, let me like us plus credentialing just so as we go through the process, she can kind of give her inputs like, all right, this is kind of what I’m currently doing and this is where you can point out like here are the improvements that we can make.
Jonathan Irizarry (46:30) And then from there, I think if you know, if she gives us the answers we’re looking for and that, this program can streamline this like X amount, then I’m very much happy to move forward with it. Okay? So if you think that’s if you think that’s you know, a possibility that we can get on a call like loop them in and kind of get like a final, you know, visual on this, then I’m happy to keep moving forward. Yeah, I.
Noah Laack-Veeder (46:56) Think so how we typically do it is like we get this like final technical validation step plus like implementation call, but in parallel. One, one thing that I’m not sure kind of what your next steps are going to have to be internally, but kind of that Roi and just presenting that kind of revenue acceleration piece to others like that’s something that we could theoretically do in parallel if that works for you. So like what we could do is, if ultimately the revenue acceleration if you feel confident defending like look what’s 1,500 dollars a day or holding out providers until their par medallion saves X days from our current process. This is the total opportunity if that kind.
Jonathan Irizarry (47:41) Of if that.
Noah Laack-Veeder (47:42) Financial model makes sense. We could work with you to present something before we go to your, but who, who’s ultimately, I know you, you’re the one kind of giving the decision but like who’s who else needs to be involved on the decision making body on?
Jonathan Irizarry (47:56) This on the decision side probably myself… the CEO Drew and probably at least to have visibility to the head of RCM, okay… because the credentialing falls under her and I already know her and the person in charge of credentialing are very close. So I think they’re going to be very cautious about what’s going on. Are they looking to replace us? Blah blah blah. So I want to present to them. This is an alternative to you guys that will not only free you up but make everyone’s life easier. So that’s kind of it’ll probably come down to the three of us. Nicole of course has some input as well. But the ultimate last step would be to present this to our CEO. So as long as I could get Jen, who is our person doing credentialing now, get her to fill in some of the gaps of the questions we haven’t been able to answer. Maybe give her a little print like a walkthrough like a quick walkthrough like you did. And if she says, hey, like, you know, this would be great, then we just kind of move forward with presenting it to the CEO and say, like here’s kind of laid out. And then I’m happy to move forward if he gives the sign off.
Noah Laack-Veeder (49:03) Yeah, that makes sense. I think the only maybe risk is too aggressive a word, I think to make sure that. And her name is Jen the credentialing person. Yeah, to make sure sometimes… what ends up happening is they’re like my gosh, this is automating a lot like and they’re usually just saying this won’t help, this won’t help just because they, I think there’s a balance there. And I think what we could pitch it is like, look, we’re trying to automate a lot of the work that you probably don’t like doing today, that’s like. And so, I think just having your championship there would be helpful because sometimes it can get a little bit more sensitive. Yeah. But from what you’ve described, I do feel confident. I think it’s a really good idea to get her on board because she’s going to have to manage a little bit of the process still with this tool.
Jonathan Irizarry (49:54) And.
Noah Laack-Veeder (49:54) so, kind of in terms of the next steps, then there’s kind of the two paths, technical validation and then kind of the CEO, I’m sure that you’re probably trying to look at the proposal kind of what the Roi model looks like as long, as well as the price. So, Kyle, what do you think makes the most sense in terms of scheduling these next steps? Yeah.
Kyle Bettencourt (50:16) I was going to say, Jonathan, if you’d like I can put together like an initial Roi and pricing, and then we can schedule some time to look through that and make sure everything looks good. And then in parallel, we can also schedule that in depth scoping call with your credentialing team if that works.
Jonathan Irizarry (50:32) Yeah, no, that’d be great. Cool.
Kyle Bettencourt (50:34) And then, yeah, I think really the main input that we’ll want to nail down is just the growth numbers that you guys are expecting. Yep. Yeah, I know you mentioned, I think three or four potential locations that you’re looking to open. Do you have a sense for like how many of the Aba providers you… would hire?
Jonathan Irizarry (50:54) Probably between the four, I’d,… say, let’s.
Jonathan Irizarry (51:10) say, now they’re kind of looking at next steps. All right now. They’re kind of looking to, do we get approval on expansion? What would expansion look like? What areas would we look to do? So we’re in that phase of it now, but I think the goal, is to kind of open up some new clinics and get, some new sites rolling.
Kyle Bettencourt (51:27) Got it. Okay. Well, that sounds good. Yeah, I can, and then we can follow up with the rest of the items that we kind of mentioned through the call here today, to confirm, but.
Jonathan Irizarry (51:37) That’d be great. Yeah, there’s yeah, there’s definitely some outstanding questions that they’d have some better insight on. So I want to get them to at least fill those gaps for us.
Kyle Bettencourt (51:44) Okay, perfect. That sounds good. Well, do we want to try and schedule now while we’re on sure. Cool. So… I think, yeah, Wednesday is pretty wide open for me. I think I can actually really do kind of any time Wednesday, if that.
Jonathan Irizarry (52:05) Works for you. How, how’s your Thursday by chance Thursday?
Kyle Bettencourt (52:09) Is good, any time outside of nine to 10 a, M central? I’m open on Thursday that.
Jonathan Irizarry (52:15) That’s fine with me that, that’s a good time for me,
Kyle Bettencourt (52:18) Okay. I’ll do 10 a. M central?
Jonathan Irizarry (52:22) Nicole, like I don’t know if we’re doing a meeting with Jen. I don’t know if you want to be on, if you want to be optional.
Nicol Hartnett (52:27) I am good to be, I think I saw everything I needed to say, so I am good to be optional for that one unless there’s questions, you know, specific that I can assist with.
Jonathan Irizarry (52:41) But be on standby, but you don’t need to be on that one. Yeah.
Nicol Hartnett (52:44) We’ll do, okay.
Kyle Bettencourt (52:46) Great. And so, the 10 a M, Thursday that’ll be just you and I, Jonathan, we’ll kind of run through pricing and numbers and then, okay. Maybe… let’s… see Noah. Would you prefer to do Friday… for the in depth walkthrough? Yeah.
Noah Laack-Veeder (53:08) Sure. That sounds good. Yeah. Okay. And we’ll make sure again, Jonathan has sent you those kind of outstanding items.
Noah Laack-Veeder (53:17) But just also, one thing is kind of the group contracts and things. Those are also things that we do during implementation. So, getting a head start on these, all that’s going to do is help us kind of move faster. So, again, kind of working backwards, what’s the like let’s say we have this conversation that we obviously need to get the CEO and the head of RCM on board. What’s the timeline for a decision look like?
Jonathan Irizarry (53:46) Probably, I would say just rough ballpark within the next week or two, just kind of, I, you know, I want to present, we have a board meeting next week, but I don’t think anything will be right by then, but I at least want to broach the subject next week that, hey, like we’re talking to this company, and, you know, these are the kind of solutions that they offer.
Jonathan Irizarry (54:05) So, I at least want to make it known that, hey, you know, we’re working through something trying to make everyone’s life a little easier. So even so within the next week or two, I want to be at a point where, you know, we’re kind of closer to making a decision because I don’t want to drag this out any more than it has been for the last couple of years.
Noah Laack-Veeder (54:20) Yeah, no, I mean, I think, it’s a big win given what’s going on here. So, so.
Jonathan Irizarry (54:26) Yeah, I’d say in the next week or two, I want to put a bow on this thing. Yeah.
Noah Laack-Veeder (54:31) And you said, I think last time we were talking about like the cast collections piece slash revenue acceleration being like your top priority like this quarter. So, yeah, it definitely feels like an opportunity where we can make some sizable improvements for that, especially with the, is that kind of how you’re seeing it too with the new?
Jonathan Irizarry (54:50) Oh, yeah. Well, that’s you know, that’s always going to be a point of emphasis for the board and the CEO. So I’m definitely happy to address it that way. Okay… cool. Well.
Kyle Bettencourt (55:03) I’ll follow up here, with the rest of the questions that we, that we’re looking to get, some clarity on. And then I’ll send the invite out… for us to connect and.
Noah Laack-Veeder (55:16) Then the Friday time for the walkthrough, right? Kyle?
Kyle Bettencourt (55:20) Yeah. You want to do nine am on Friday?
Jonathan Irizarry (55:25) Sure. Nine am your time or,
Kyle Bettencourt (55:29) Nine am? Yeah, nine am central. Yeah, it’s fine. Okay, perfect. Alrighty. Well, I’ll follow up with that information and we’ll plan to connect in a few days here.
Jonathan Irizarry (55:41) Thanks, guys. Excellent.
Noah Laack-Veeder (55:42) Happy Monday. See you later all.
Kyle Bettencourt (55:46) All right. Thanks everyone.