Transcript
Jacob Andreasson (00:00) yo.
Scott Everline (00:01) Logan.
Jacob Andreasson (00:02) You’ll get a kick out of this before they jump in here. Jordan just texted me and he goes boarded… plane because for Hawaii, boarded plane, had to deboard delayed a couple hours then delayed a couple hours again, not making it to Hawaii.
Scott Everline (00:19) Yeah. He sent me a slack message along the similar thread. I’m like that sucks man.
Jacob Andreasson (00:24) That’s so brutal.
Scott Everline (00:25) That’s what he gets for not taking me as his plus one. Yeah, there.
Jacob Andreasson (00:28) You go. Keith is in here. I’m going to let him in.
Jacob Andreasson (00:47) Hey, Keith.
Jacob Andreasson (00:57) Nope, came off mute for a second there. If you can hear us. Yeah, sorry about that. Yeah, no worries. Let.
Keith Jones (01:05) Me see if, let me get Teresa on.
Keith Jones (01:12) She, because she’s a credentialing person and Amber is not feeling well, so.
Jacob Andreasson (01:19) Okay. We can always send her a recording, follow up some material things like.
Keith Jones (01:22) That too. Cool.
Jacob Andreasson (01:27) Thank you. Teresa just jumped in here.
Keith Jones (01:30) Okay, cool. All right.
Jacob Andreasson (01:34) Hi Teresa.
Teresa Chavarria (01:36) Hello. How are you? I’m okay. Thank you. I’m a little well, not under the weather. I’m just my allergies are really bad. This go around, but I’m good. How are you?
Jacob Andreasson (01:47) I’m good. Thank you for asking it’s. Nice to meet you. Happy Monday. Both of you. Thank you for taking the time so soon after our last conversation, especially you, Keith. We’re super excited for the demo today. I know we have a couple new names on the call here. So we’d love to just start with some quick intros.
Jacob Andreasson (02:03) Teresa, my name’s Jacob. I’m on the partnerships team here at medallion. So just working with prospective customers, current customers to determine if there’s an opportunity to support them in terms of credentialing. I’ll hand it over to Scott everland on our side.
Scott Everline (02:19) So, Scott, I’m kind of Jacob’s right hand person for kind of working through the evaluation with customers. I’m here to kind of walk through the demo, answer any questions you all may have. I’ve got quite a bit of experience on the payer side. I’ve actually worked with the va in the past with caresource and I understand that’s a point of friction for you all. So I’m happy to shed any light where I can and kind of help connect some of the dots for you all.
Keith Jones (02:44) All right. Sounds great. Yeah, I’m Keith jones, I’m the CEO of skytherapist. We’ve been working with the va since 2013 14 and Teresa is over credentialing. She’s the main person for credentialing.
Jacob Andreasson (03:04) Awesome. Well, thank you guys. I’ll go ahead and share my screen here and we can jump into it as far as, you know, a goal for today’s. Call really just kind of determine, you know, can medallion fit your guys’ needs from a technical perspective? Is this something that Teresa, you could see yourself working in each day? If that, if it sounds like, yes, you know, we can continue the conversation if not totally okay, as well, we can part ways as friends, but let me go ahead and share my screen here. I did want to quickly level set on just a couple points from our last conversation, Keith. Can you guys see this? All right?
Keith Jones (03:38) Yep.
Jacob Andreasson (03:39) Perfect. Cool. So high level agenda. Just want to recap what we talked about. Like I just mentioned, I have a couple of clarification questions as well just to make sure that we’re kind of hitting on all the right notes. We’ll do a tailored, you know, short presentation of medallion led by Scott. And then Keith, I did want to introduce kind of how our pricing structure works as well. And then we can talk about next steps. Does that sound like a good plan for today?
Keith Jones (04:03) Sounds great. Beautiful. Cool.
Jacob Andreasson (04:06) So quick recap kind of what we discussed yesterday. So current state, the partnership with Andros is no longer feasible due to the scheduling restructure at the va. So essentially, you know, there are providers that were sitting in Andros, not generating revenue, but you’re paying for them to be in Andros, which obviously doesn’t make sense from an economic perspective. So, you know, tearing it down to the suds need to build the provider network back up state by state based on what the va is calling for. Where we see medallion fitting is, you know, this true automation partner that can react as fast as the va needs you to. So build your provider network back up at the appropriate pace, proactive versus reactive in terms of monitoring and maintaining compliance. Like Amber mentioned, there have been some cases where the payers are reaching out to you guys, letting you know that, you know, expirables or sanctions are, you know, ending up or are being flagged? So, you know, let’s put you guys in control there, make sure you’re the ones aware of that before they are. And then from a future state, you know, improves provider experience through faster onboarding, faster time to revenue and generating return on investment from day one. Something I’d like to understand a little bit more in terms of, you know, your guys, what success looks like for you. So take medallion completely out of the picture if you were to go with another vendor 12 months from now, how would you know that, you know this project is a success and you made the right choice?
Keith Jones (05:36) I think that’s a terrific question. I mean, for me, you know, just making sure that everything’s… monitored properly and that we can kind of, you know, grow together. I mean, that’s really, you know, my big things, Teresa. Do you have anything?
Teresa Chavarria (05:51) Well, for me personally, it’s just that all documents are available for especially during audit times and that the communication is there. So if we reach out because we need something from the auditor that, you know, we hear from you guys fairly quick and we’re not waiting for a response. Let’s say two or three weeks out.
Jacob Andreasson (06:11) Yeah, absolutely. Are there instances where that was not available in Andros?
Teresa Chavarria (06:18) Unfortunately, we did experience that from time to time.
Jacob Andreasson (06:21) OK. Got it. This is, I think you’ll be really excited with what Scott will show you in the demo then, but I mean, what situations like did like that did happen? What did that lead to? Was there any like major compliance gaps or anything like that?
Teresa Chavarria (06:34) Well, just having to go back to the auditor and just ask for extensions while we wait to get whatever documents we were waiting from Andros. And really now, just with the new updates from the, that went into place last year, it was the integrity tool where and I understand obviously we all had to make those changes as well, but that wasn’t ready or if we needed certificates like the ncqa certificates or the updated letter things of that nature, we would always have to wait about a couple of weeks before we received that from them.
Jacob Andreasson (07:09) OK. Got it. So gotcha. More speed there. That makes sense. And then I think this is a good segue. So, just a couple of clarification points I had. So, do you guys have an internal committee who approves or denies credentialing files for new providers?
Keith Jones (07:27) Yeah. But Andros was taking that on too, so that’s what we prefer.
Jacob Andreasson (07:33) OK. Got it. And so, so it sounds like you almost outsourced the committee flow to Andros. Is that what I’m hearing?
Keith Jones (07:42) Yes. Yeah.
Teresa Chavarria (07:43) So during audits, when it came time to requesting those credentialing committee meeting minutes, we would go to Andros for that as well.
Jacob Andreasson (07:51) OK. Got it.
Jacob Andreasson (07:52) Understood. And then kind of Keith just touching on the care source point that you had mentioned, you said you had uploaded 1,200 providers but only 80 made it through. Does that mean that you guys submitted credentialing files for 1,200, but only 80 are approved?
Keith Jones (08:07) No, that’s not for Andros, that’s for, tricare, we have 12 to 2000 providers that are uploaded to hold. They’re ready to go for tricare, east and west, I believe. And then for kirasource, I believe it’s like 120 or so.
Jacob Andreasson (08:22) OK. Gotcha.
Keith Jones (08:23) And then I think, and we don’t have a delegated contract with kirasource, you know, and that’s fine. They’re working on that now where it’s possible that we will have a delegated contract with them. So, the reason why I just came to you guys because I do kind of like their from the outside looking, yeah, I do kind of like their flow and just the notifications, you know, and so forth. What makes it difficult for us. An issue that is difficult for us is we can’t get a, and I just requested this morning. We’re not getting a comprehensive list of the providers that have been completely approved and others, any kind of issues or whatever whether it’s you know, caqh needs to be updated or whatever it is. You know, we’re on the outside. I’m not going to do that. I’m curious to see if that’s even possible, but I’m sure it is. But, yeah. So that’s.
Jacob Andreasson (09:18) okay. Yeah. I appreciate the clarification there. And then, you know, I know you’re kind of building this thing up back up brick by brick. You had mentioned, you know, maybe 20 providers a month or a week. What’s do you have? Any like realistic number that you see kind of added maybe in the next 12 months?
Keith Jones (09:34) You know, I.
Jacob Andreasson (09:35) Know, I know it’s obviously a ballpark obviously works. I know it’s a little bit ambiguous but just that’ll help kind of guide the conversation when it comes to pricing.
Keith Jones (09:44) So, I’ll just tell you like let’s just say for instance, like right now we have a contract where we’re adding like 50 or so a month. You know, it really just depends with carestores right now, what we’re going to do is I think there’s probably a good 60 or so providers that are completely cleared, you know? So we’re going to start with that and then the two states, Georgia and Florida, and then we’ll go state by state to build it up. But like certain states say, for instance, if it’s like, Texas might need 100, we’re always big in Texas, you know, or California or Washington or Oregon, you know, it really just depends and I hate to say, it can vary by that much, you know, but what we have proven is that we are good at like, you know, recruiting or onboarding, you know, a large amount of providers, but we have to do so, you know, now in a more measured approach and so just based upon needs, so just upload a 1,000 providers or 2000, whatever it is, which is what we did for tricare.
Scott Everline (10:45) Okay. Is caresource, sorry, Keith, is caresource, the only pair you all are not delegated with or are there other pairs? Yeah.
Keith Jones (10:53) They’re the only ones we’re not delegated with. Okay? And,
Scott Everline (10:55) is, caresource is doing va services?
Keith Jones (10:59) They’re doing this tricare, they have a tricare carve out in Tampa. Okay?
Scott Everline (11:06) And so you all, in that instance, are submitting like all the enrollment documentation directly to caresource. And then you’re waiting for them to process the credentialing, correct?
Keith Jones (11:16) Okay. But like, so they’re we’re they’re probably going to change that, you know, to the delegated you know, agreement. And of course, we want to make sure we have that in place, everything in place over, you know, prior to that or so or I mean, I’m making it, I mean, I’m making it sense. I mean, if they’re already, it’s already done, it’s already done. So it was a point, you know, so. And the, and the thing is the only reason why we started doing delegated contracting anyway is because it was taking a long time, for optum and triwest to upload or even, you know, or credential providers. It was taking up to six months, I believe, you know. So that’s the only reason why we even got into it.
Scott Everline (11:51) Okay. So, is that, is the enrollment paperwork? Is that something Andros was submitting or is that something you guys were managing on your own? We.
Keith Jones (11:59) Just submitted a roster. I mean, I’m sorry, Teresa, we just submitted for Andros, we just submitted.
Teresa Chavarria (12:06) The.
Keith Jones (12:07) link for them to, for the provider to complete. But that’s a Teresa question on.
Teresa Chavarria (12:11) The payer side, we submitted a roster to each one of the payers for tricare. I started for triwest and optum for upload. And then optum express came into play. So then we would upload the providers manually through the website. Okay?
Scott Everline (12:23) But then for caresource where you weren’t delegated you were, was that something Andros was submitting that paperwork for, or is that something? Well?
Teresa Chavarria (12:31) Same thing. We submitted a roster over to caresource. Okay?
Scott Everline (12:37) All right. That’s helpful. So, how many payers you all work with in total? We.
Keith Jones (12:44) We work with, you know, quite a few, but really, it’s the prime ones or, I mean, right right now, we kind of killed the commercial deal because it’s just too much over it’s. Just, you know, triwest, you know, for vaccn, and tricare, and then humana, tricare… and optum, ccn, and that’s pretty much it. The other ones, they don’t allow us to do any kind of like with leidos and leidos or whatever they do their own credentialing and so forth. There’s no way to have a, any kind of delegated contracting at all. Okay?
Scott Everline (13:26) And then those cases, are you also submitting just rosters and then they’re starting the process. We’re.
Keith Jones (13:32) putting together packets and then submitting to them for them to clear. And we just kind of are the middle man. Okay?
Scott Everline (13:41) Okay. Thanks. And.
Jacob Andreasson (13:44) So, Keith, with this new kind of top of funnel motion, so say, you know, your team calls the va in Georgia and they say we need 10 providers ASAP. Is it a situation where, you know, the first organization that’s able to provide them with the providers, gets the business or do you guys have a certain relationship? Can you talk to me a little bit about that?
Keith Jones (14:03) I think it’s just a relationship and we can, typically, you know, react fairly quickly. I mean, yeah, it only takes us, it only takes us one or two weeks to get, you know, providers in any location and especially any state, you know, if it was, we only have an issue with it’s in person and it’s you know, a physical location, okay?
Jacob Andreasson (14:24) Got it. So, what I’m hearing is it’s not a, you know, we’re gonna maybe lose out on this revenue. It’s more. Just let’s get this provider in front of the patient as fast as possible, maybe even accelerate the revenue, things like that, correct?
Keith Jones (14:35) So what we’ll do is, if they, if, you know, Georgia va says, hey, we need 10, we’ll say, you know, say give us two weeks over. We’ll start, you know, scheduling or whatever it is and just, you know, try to get the mode, get everything going because we know we can, you know, we certain areas, we just know we can, you know, perform quickly or just go back to the provider that we already have, you know, credentialed previously or do it just on a request or whatever it is or sometimes even like say, we like right now we’re doing a job fair, you know, we do a job. Now, we’re doing job fairs twice a month. Yeah, getting, you know, at least 20 to 40 or so per for job fair. Okay?
Jacob Andreasson (15:09) That’s incredible. And, and then, sorry, do you have something? Scott? No?
Scott Everline (15:14) No, I was saying that’s nice that’s a pretty good hit rate for a job fair… and.
Jacob Andreasson (15:20) then Keith, just thinking about, I guess potential workflow, I just want to confirm and, you know, correct me if I’m wrong, or if you have something better in mind, but, you know, like skytherapist reaches out to the va. Va, says we need 10 therapists in Georgia. Skytherapist would then upload the providers into the medallion platform to kick off credentialing? Once that provider is complete, they you hand them off to the va? Does that sound kind of in line with what you’re expecting or, is there a better process that you had in mind that’s.
Keith Jones (15:49) a Teresa question, but I would say so, but that’s Teresa’s question. Yeah.
Teresa Chavarria (15:53) That sounds about right. We’ll make contact with the provider, confirms interest. We verify that they are actually eligible. We’ll then submit them over to the credentialing platform. Wait for credentialing to be complete as far as verification and things of that nature. Once we receive the green light, we then upload them to the payer. Okay?
Jacob Andreasson (16:11) Perfect. And you said that’s usually taking about a couple weeks right now?
Teresa Chavarria (16:17) As far as verification goes, I would say about a week or so. What took a couple of weeks when it comes to andross is requesting documents from them regarding audits, and just direct requests from them directly when it comes to documents. But as far as verification, the verification process was taking about a week.
Scott Everline (16:39) Okay.
Jacob Andreasson (16:39) Got it. That’s helpful to know those timelines. Awesome. Well, I appreciate you guys letting me clarify a couple of points there. I’ll hand it over to Scott now so we can take you guys into the platform.
Scott Everline (16:48) Yeah. So one question before we jump into the platform or while I get it queued up… on the roster submission, was that something you all were managing or was that something andross was supporting as well?
Teresa Chavarria (17:02) We managed that. Okay? And you.
Scott Everline (17:05) were sending those monthly ad hoc… Teresa.
Teresa Chavarria (17:12) So, as… a provider was becoming approved or their credentialing was complete, we would upload them immediately thereafter, especially if we had a high demand. If it was like a Texas or Florida, the providers would get uploaded right away.
Scott Everline (17:28) Okay. That’s good to know. So hopefully you all are able to see my screen and I can kind of quickly run us through the platform. Yes. Okay. So I think there’s going to be some similarities between how medallion operates and how Andros operates at least based on my historical understanding. But at the same time, there’s going to be some key distinctions that I’ll call out kind of as we’re going through this journey. So within the platform, right? You’re going to manage all of the providers that you have within the system. So understanding that, you know, you’re looking to perhaps just start from fresh from scratch, we would work with you all just to make sure we’re determining the right number of providers that we want to set up seats for, and then kind of support that data acquisition process. The general journey, right? Is for net new providers, you’re going to invite them into the medallion platform. There’s a couple of different ways you can do that, right? So like if you have like a tech enabled HR system and you want to push an API call to say, hey add this provider to medallion and start credentialing. That is an option. You can manually come into the platform and add an individual provider as necessary. And what this does, well, it will kick off kind of an invitation process to the provider where they will then kind of fill in, populate that profile, have ownership. There are some ways we can kind of circumvent some of that provider interaction piece that I’ll talk about. This can also be managed in bulk, right? So if you wanted to send like a flat file to medallion to kick off and to kind of initiate these provider profiles, we can do it that way as well, right? Whether that’s delivered to an sftp or however you all want to manage it, just keep in mind there’s a lot of different ways to kind of skin the proverbial cat when it comes to kind of getting providers initiated within the platform. I’m curious. It sounds like you are doing some form of bulk with Andros today?
Scott Everline (19:29) I guess, yeah, no.
Teresa Chavarria (19:32) For tricare, it was a bulk upload, but on a day to day basis, they’re individually uploaded.
Scott Everline (19:38) Okay. No, no. There’s also a way to bulk import from caqh. So I don’t know if you all have your own caqh instance to extract the provider data from caqh. We.
Teresa Chavarria (19:52) Do have an account with caqh but we have not used that. When it comes to Andros, we would literally just upload the roster of provider name, npi title and email address and they will take it from there.
Scott Everline (20:05) Okay. So similar, we can do that as well, right? So medallion actually has essentially the same access that you would have to extract that provider data. So you can bulk import. So you’d be able to import a template directly into medallion. So that’s essentially kind of kicking off provider credentialing requests. So it’s going to be, you know, first name, last name, npi number, caqh id. And then we’ll kind of initiate that call to caqh to extract that provider data back out. So kind of similar to what it sounds like, what you all were doing, you can also kind of proactively kind of feed that data into the provider profile so that when they’re going in to kind of interact with their profile a test, et cetera. If that’s what they need to be doing, then that information’s already there within the platform… what I would think is like. So there’s kind of two different paths within medallion, right? Where we kind of have like a hands off provider experience kind of structured around kind of a purely credentialing only use case. So what we’re not doing pair enrollment, we’re not doing provider licensing et cetera. You can do it where we’re just bringing the data in from caqh populating those provider profiles, kicking off the credentialing. And we don’t need the providers to engage with medallion for any reason. Sounds like that perhaps is the closest to what you all have. We do perform payer enrollment. So like when you think about putting packets together and submitting those to the payers that you are not delegated with, where they’re asking for all this documentation that goes along with an enrollment. And then they manage your own credentialing. We do support that as well. And in that instance, the providers have a little bit more engagement with the platform. I’m kind of curious. It sounds like there are some provider payers that you all are doing that with today, but that’s not a priority, right? It’s really around this.
Keith Jones (21:57) We had a clinic in Houston, but we’re shutting that down or shut that down. So we’re having to deal with all the commercial payers, you know, blue cross and so forth. And so like now, we’re not going to be really dealing with commercial payers as of today, you know, but of course, in the future that can change.
Scott Everline (22:19) So, I’m not going to really show you the virtual provider onboarding process because what I’m hearing is their providers probably aren’t going to interact with medallion. We’ll pull all that data out of caqh. We will propagate the profile, right? So, provider, personal information, professional history, licenses, et cetera. We’ll store the documents within that provider profile, so we can bring in any of the documentation that’s on the provider caqh profile. So.
Keith Jones (22:44) I have a question because I received these notifications from medallion where providers are missing items in caqh attestations, et cetera. At what point does medallion interact with them? Or how does that work? What happens after that?
Scott Everline (23:01) Yeah. So, I’m assuming you’re getting those from caresource, yeah, correct. Yeah, because we do the credentialing, so we are the cvo for caresource. So it kind of happens in two stages. So when we do the caqh import, we’re going to check on the provider status to see if the provider profile is current. Providers have to authorize caresource or medallion to access their data. So that’s another kind of hurdle we need to overcome. Although the vast majority of providers give that global authorization that’s kind of that initial pass, right? Is the profile in good status? Meaning we can use it, it’s attested, we can extract data. And then two is the organization authorized in this case, caresource that will generate an email out to the provider, the admin to say, hey, dr smith needs to reattest to caqh once that data comes through the import, we’re then looking for any missing credentialing elements, right? So, like of a Dea or a CDS or a CSR or their face sheets out of date or any of those other components that we need to execute. The credentialing. Caresource is unique because they kind of have like a whole rubric of what’s needed based on what states you’re in and it’s kind of a, it’s a little bit more of an art than it is a science right now. But getting those additional requirements fed out to the providers, so that’s once the credentialing process starts, I don’t know if that helps Keith.
Keith Jones (24:28) Well, how does it, how does it look at our, on our end, when it comes to your outreach and us monitoring like what is missing? You know, et cetera. Because I would, you know, I’ll just say, on my end, you know, when I received it, you know, I guess I’m on the context. I received it, 100 emails or a bunch of emails from medallion, you know, are we going to be able to monitor that? So we can kind of push that provider to do whatever instead of them. Because a lot of times they ignore emails and so forth. Just like I.
Scott Everline (24:59) ignore them. Yeah. So basically, what happens is when the import takes place, you’ll have visibility and this is what’s driving a lot of those actions, on the care source side. So this is what is generating those system emails, right? So when the import comes through, we’re looking for action required. And so it’s going to that’s what’s going to kick off, that email generation. So you’ll be able to come into this action required bucket and see specifically what… providers need additional information contributed to their profile?
Keith Jones (25:34) Gotcha. Theresa, you understand what I’m saying, cause like and, you tell us like what you would need when it comes to say, for instance, we’re cause what happens is, you know, we send all that stuff to the care, the Russell caresource and all I’m getting is a bunch of emails. I don’t know if you’re getting them, but I’m getting a bunch of emails saying, you know, what’s required for those providers, and that’s you know, so the provider and I guess, you know, the provider is cced on that as well, but, you know, a lot of times they will ignore that. So in your process, you would need something to make sure that you’re you know, we would have, you know, I guess send a report or something like that to those providers to remind them or push them to go ahead and do what they had to do to, you know, move forward to the next step.
Teresa Chavarria (26:15) Correct. Yeah.
Scott Everline (26:16) So.
Teresa Chavarria (26:16) Ideally, so the way that the process works now, I’m not sure if you guys have experienced it, but with our providers, we’re working mainly with therapists counselors and nurse practitioners, right? So the nurse practitioners are pretty good with staying on top of their caqh profile. But as far as the counselors and therapists, not so much. So, what has worked with Andros is we simply, I’ll go into Andros, I’ll upload the provider’s information. They will then send the invite link to the provider’s email, and the provider will then take it. From there, they’ll click the link. They’ll open that application and they’ll fill out the application. There is some providers that work better off with just providing their caqh information and then they leave it alone, right? Andros will take it from there. But the feedback has been them uploading their own information, typing in that information in the application, and that Andros will start the verification process. I will then log into the Andros platform from my end and check the provider status, where I’m able to see the credentialing summary report and they’ll have little like green icons if this has been verified or if there’s a missing item there, there is times where they’ll send us an email and they’ll just let me know provider John is missing… Coi. And then I’ll follow up with the provider directly at that point. Like, hey, we need a copy of your malpractice information or they can’t get a hold of you. So they are very, they do stay in contact with the provider and with myself as well. And they are, we do have the option of logging in whenever, just to see the provider status with you guys working through the caqh platform. Do we have the option of logging into your platform and seeing where the provider is throughout the process?
Scott Everline (27:56) Yeah, absolutely. So I was going to, I’m going to cheat real quick. So this is actually caresource’s production account. So these are those providers within the caresource instance that have missing information. And these are the fields that are captured, right? So that’s generating back out that communication to providers that information is missing. One of the things I bypassed Teresa that you had talked about is we do invite, we can invite providers to the platform, right? And so providers will get an email that’ll be branded to the organization. It’ll say like we’re working with medallion, and then the provider is able to go through this process and kind of build out their own profile. At that point. When they’re building out that profile, they can import from caqh. They don’t have to, they can upload a resume, other documentation, and we can pull that off the document or they can just manually fill out that profile. The vast majority will use caqh. We’ll map in the chunk of that data that we have access to. They’re going to give us their caqh id, social, last name. We’re going to query the caqh API, make sure it is who they expect it to be. And then they’re able to go into their profile. And then they get access to their profile here directly in medallion. This is where they can add additional documents. So on the back end, we’re scrubbing for like missing documents within credentialing. So they’re able to see as a provider, what information is missing within their credentialing documentation?
Keith Jones (29:19) Yeah, I do like that. Theresa, do we have that right? Did we have that with Andros? I don’t remember.
Teresa Chavarria (29:25) That, the bypassing. So with Andros, if you don’t have a caqh profile, they do let you bypass it.
Scott Everline (29:35) Okay. And.
Keith Jones (29:36) The provider can go ahead and.
Teresa Chavarria (29:39) And upload it. Yes, there was one point where if the provider did not have a caqh profile, I don’t know if they were testing something or if we were trying something new on our account, but they would sort of hold the account or hold the profile until the provider was able to link their caqh profile, but we noticed really quickly that did not work. So then they did allow us to bypass it, then the provider was able to upload their own documents.
Scott Everline (30:04) Okay. Yeah. So similar journey, right? And then in that case, the providers would be filling out like all the appropriate authorizations attestations here directly in the platform. Whereas if we import from caqh, we’re pulling in those caqh attestations, but the provider does have kind of ownership of a profile, we can set it up so that they kind of go through that process.
Teresa Chavarria (30:26) Now, for audit purposes, if you are pulling from the caqh profile, say that in June, I need a packet from a provider, which would you be able to provide the attestation forms even if it came from the caqh profile? They did not directly sign your application yep.
Scott Everline (30:44) Yeah, it gets embedded in the application. So I jumped into like the credentialing module within medallion. So this is where this is kind of where the rubber meets the road, right? So you’re going to submit a credentialing request or credentialing requests to medallion. You’re going to have full visibility into the status of that, right? So at any point in time you’re able to look into the platform, you can see, right? We’re making our slas front and center. So you see where we are from a performance perspective, you can see the status. You can see if there’s anything blocking that, whether it’s a third party. And then once those files have been completed, we’ll move them into the ready phase, right? So really requests you might be going in if a provider calls or you’re curious. It feels like something’s taking longer than expected. I haven’t heard that being a problem with medallion, but there’s always a chance nobody’s 100 percent perfect. Or like 99 percent perfect. So we’ll move those files over into ready, right? And it sounds like similar to what you’re seeing, right? When the file comes through, we kind of high level flag them as a clean file, a file that has issues. And then within that, you’ll be able to see specifically just on the summary tab, what the issues are. But then I’m able to drill down into the packet itself. So I’m able to see kind of the file, what the status is of the application, what verifications took place? If I need to jump into any of the attestations, any of the documentation, I’ll see that specifically when we bring in the C. So when the provider has caqh, we actually map in the entire credentialing packet from caqh. So all 30 40 50, 6,000 pages that come out of caqh are going to be stored at the end of this file. I don’t have one on here. But, and then within the system. So this is a distinction, right? Medallion doesn’t do, we don’t manage credentialing committee. We essentially take the file, walk it all the way up to committee readiness. So this is where Teresa you potentially or some colleagues would come into the system, review the files. If there are any notes that you needed to make on that file to call out any specific instances, you could add that to the file. You could mention other users or you can mention a medallion user. If you had a question about a verification, you can add additional attachments. You can add links, right? So. You can kind of take your virtual notes here within the file itself. You can also download a PDF of the application itself. So if you need to kind of take that PDF off platform and this is accessible at any point in time. So even after years down the road after credentialing has been completed, I’ll show you kind of keep that historical running of all the verifications that have taken place packets decisions et cetera. Now.
Teresa Chavarria (33:27) As far, so here is this where I would approve the file?
Scott Everline (33:32) Yeah. So from the ready phase, right? I’m gonna move this file to a committee. So depending on again, you all will have to structure or partner with somebody to manage the committee process. You would then give them access specific to whatever committee they’re going to be participating in, but they can then, so.
Teresa Chavarria (33:52) Medallion does not provide that oversight.
Scott Everline (33:54) We don’t no. Okay. So we’re ncqa certified as a cvo, but we’re not making those final committee decisions. We’re allowing you to kind of move that file to the appropriate committee. And then the committee can log votes directly within the platform, but we’re not employing or staffing the committee piece itself.
Teresa Chavarria (34:11) That’s cool. We take care of that. That’s fine. Yeah.
Scott Everline (34:14) It’s funny because Jacob slacked me. He’s like I couldn’t believe someone’s outsourcing committee and it’s not that you all are outsourcing committee. I’m not sure I would be comfortable as a person being an outsource committee to take the risk if something were to happen. But yeah, good for Andrew, but.
Jacob Andreasson (34:30) Just to confirm Keith, that’s something that you’d be okay taking on medallion, not handling? Yeah, I.
Scott Everline (34:35) got it. So then you’d send those files. We’d set up the committees however you all need them set up. And then the file will move through. So I could send files in bulk, right? So if I grab a bunch of files, I can send these in mass, right? Probably not going to take one by one so I could send these in mass to a committee. Then the files land in the committee members again kind of role based access will see the committees that they are a part of. They’re able to look at the credentialing file itself. Any of the notes that were added to that file, right? They’ll be able to see all of that and then they can approve or reject those files and then make any additional comments on that.
Jacob Andreasson (35:15) From time file generation, we’re averaging under 24 hours with a guarantee of three days. Okay? And that’s written into our contracts as well.
Teresa Chavarria (35:27) Okay. Cool. Yeah.
Scott Everline (35:30) So, good. Call out. So a file shouldn’t be sitting in this request bucket for any longer than three days. But again, as Jacob said, typically comes out the door in a day.
Teresa Chavarria (35:42) Okay. Sounds good. And.
Scott Everline (35:45) Then once the file, once the committee file has been in logs, you’ll have all of your files here directly within medallion… any file that’s ever processed through your committee approved or rejected, you’ll be able to query, right? So if it’s a specific provider type that you’re looking for, if it’s a specific state, right? You’re able to filter down and get those results and then you can go back and get that historical credentialing packet. You then at that point, like say you need an auditor to send it, you need to send it to an auditor. You download that file. It would come with all the artifacts that were reviewed as part of the credentialing committee, as well as the committee decision. So I think like it sounds like Teresa today, this level of access to the information isn’t something you all have once the credentialing process has taken place.
Teresa Chavarria (36:32) We have. So for the meeting minutes, we do have a shared file with Andros, where we’re able to log in and get the information from there when it comes to the meeting minutes, but it’s more so of the actual certificates. So if the ncqa letter expired or the certificates were for renewal, we have to wait to get that. Also now, with the new changes, the training tool, or the integrity information tool, those things is where the delay came into play.
Scott Everline (37:02) Okay. Yeah. And like we don’t post those on our website, but you’re going to have an assigned engagement manager that’s going to be your day to day contact, and they’ll be able to get that certainly with much quicker turnaround time than two weeks. I don’t know.
Teresa Chavarria (37:16) Two weeks, okay? Perfect.
Scott Everline (37:17) Like I could probably go right now and check in our Google drive and find the ncqa cert letters for you. Okay? And then I’m assuming like policies and procedures or something you end up getting to. And then as part of the contracting process, we execute a sub delegation agreement so that’s going to call out all the specific credentialing components as well. And then for recreds, we’ll schedule recreds pretty basic, 36 months down the road. We schedule that provider start 90 days in advance. Don’t really have to think about it. We’ll pick it up, move that provider into the ready bucket when it’s time for that recredentialing cycle to start again. And then we deliver and.
Teresa Chavarria (37:57) For recreds, Scott, sorry for recreds, if the provider is non responsive, would you notify us or alert us at any point? Like, hey, this provider is getting close to recred, they have yet to respond or open the application?
Scott Everline (38:11) Yep. Yeah. So typically, I mean that’s all configurable on the back end of the platform. So like during the onboarding, different folks have different perspectives, right? Like caresource’s approach is like try three times and if they don’t respond, close the file, right? You all might say we want to give them five tries, five outreach attempts and we want to know after the third or we want to know after the first. So it’s it really, we’ll configure on the back end. So it can be ultimately, it can be like a task, right? So if a provider is non responsive, like… if a provider is non responsive within a task, we could send an admin task. So you’d be able to see that something’s outstanding for that provider. And then you could kind of lean in if necessary to get that provider engaged, you’ll be able to see the provider tasks that are coming through here within the platform as well. Okay?
Teresa Chavarria (38:59) And then, what about ongoing monitoring? Does medallion provide that as far as like licenses or malpractice policies, if something is coming up for expiration, do you send a follow up? Do you let us know?
Scott Everline (39:11) Yep. So two kind of different approaches to monitoring. One. We’re certified with ncqa to do the ongoing monitoring. So we do mpdb continuous query. We do Sam, oig, medicare and medicaid opt outs, medicare and medicaid exclusions. And then we can do in addition to those ofac office of foreign assets control, social security death master. And I don’t think it would apply to you all but the medicare preclusion list. So we can include all of those into an ongoing monitoring package. And that includes the license monitoring that came in place in July. So, Teresa, you mentioned some of the changes from last year, right? So that continuous license expirables monitoring. Okay. So that’s an ongoing monitoring package that we provide as a service. It’s ncqa compliant. We also track anything with a date within the system. So anything with an expiration date is monitored within medallion and providers get notified when those verifications or any of those components come up like even a driver’s license, right? If they have a driver’s license loaded in the system, we’re capturing that expiration date, we’re going to notify the provider and you’ll be able to track all of that here within the platform. Perfect.
Teresa Chavarria (40:31) Now, when that notification goes out to the provider, would we be able to like bcc’d on that notification? So we’re alert and made aware of it as well?
Scott Everline (40:39) Absolutely. Yeah. So we could set it up. So like it would be a provider task, but we can also include it as an admin task, so you would be able to see like, right? Like it’s like the Coi needed for cigna or whatever it might be. So it would come back as part of that. Yeah.
Jacob Andreasson (40:53) And Teresa, on the left hand side, you can see Scott read my mind there, the monitoring tab as well. You get a little bit more granular.
Scott Everline (40:59) Yep. So we offer monitoring for, so this is more around employees or talking to another va entity today, and they’re like we need to monitor providers that aren’t part of our network. And so the ability to kind of do like a monitoring light like just checking oig and Sam for providers. So you’re not purchasing a full monitoring package but making sure that you’re still maintaining kind of key monitoring components. And then within the analytics page, there’s an entire ongoing monitoring dashboard that’ll track all of your verifications. It populates in real time. So it takes a minute, but it’ll load all of the verifications in real time and give you the last verification and then any findings that might be there. And then in addition, we’ll notify you if there’s a finding, right? So you’ll get an email that says, hey, there’s a provider within your organization that has a hit on mpdb, click here and the link will take you directly to that sanction, so you can capture that as quickly as possible. Okay?
Teresa Chavarria (42:04) So now, just to clarify, so we do need state medicaid exclusions and medicare opt out monitoring, we need ongoing leveling reports. So, you’re saying that for, this is an additional package. It’s an add on to the like the base point price line that you offer, correct?
Jacob Andreasson (42:24) It doesn’t come.
Teresa Chavarria (42:25) With the package, correct?
Scott Everline (42:26) There’s a, essentially, and it might be a good time unless there’s more platform things you all want to see. It might be a good time to kind of talk a little bit about how the pricing works.
Teresa Chavarria (42:34) Yeah, we can transition over. Yeah, I.
Scott Everline (42:37) mean, it is a bit a la carte, right?
Scott Everline (42:38) So it’s essentially, you’re paying for, you know, an anticipated number of credentialing files you’re going to say here are the number of providers we need monitored, and you’re going to be able to kind of package that all up based on what your needs are. But what you just described from a monitoring perspective, fits into our kind of our standard, our ncqa compliant monitoring package. So anything you all want to talk about from a platform perspective? I know we only have about no.
Keith Jones (43:03) We got it. I think Teresa, you have anything, I think it’s pretty self explanatory.
Teresa Chavarria (43:07) No, no, we’re good on that end? Yeah, cool. Yeah. And.
Scott Everline (43:10) If we need to spend more time or you like it marinates for a little bit and you’re like wait, I wanted to see something else and I didn’t see it like we’re happy to jump on the phone and kind of dig deeper or revisit anything. Perfect. Awesome.
Jacob Andreasson (43:23) Appreciate it, Scott. Yeah, I’ll kind of pick up where he left off with how pricing works. So, you know, what we’d essentially, do we’d sit down with you. We’d map out that’s kind of why I asked earlier Keith, how many providers do you expect over the next 12 months? So we’d kind of map out what those anticipated number of providers are, or what the anticipated number of providers are from there, we would, you would get a number of core seats. So every single provider would need a core seat in the platform. And then again, how many credentialing files? Do we anticipate how many rosters do we anticipate each year? So, you know, very a la carte you can choose based on kind of what your growth projections are calling for. And then another thing that I like to call out is we do offer something called SKU flexibility as well. So you can, you know, move spend between ongoing monitoring, credentialing files, core seats kind of based on what the business is calling for. If, you know, do need some added flexibility as well.
Keith Jones (44:21) Yeah, I think so because things can just change.
Jacob Andreasson (44:24) Exactly.
Keith Jones (44:25) At any time to tell you the truth, you know. So, yeah, and well.
Jacob Andreasson (44:29) You can also, you can also pull and push spend between years as well, you know, so say, maybe growth is happening faster than you expected in year one, you can pull down some volumes from year two and things like that. So we, you know, we don’t want anything you.
Scott Everline (44:44) Know, we don’t.
Jacob Andreasson (44:46) want to lock anything too concrete. So we want to give you the added flexibility, gotcha. And then touching on the discounting options. So this definitely would come into play kind of as you guys continue to build this provider network back up, but essentially higher volumes, the higher discounts we’re able to provide because we’re doing so much of this with automation, you know, the economies of scale, so that’s kind of how we can introduce some discounts there as well. And then of course, length of contract, things like that as well. We can get a little bit flexible there in terms of unit costs.
Scott Everline (45:20) Gotcha. Any.
Jacob Andreasson (45:22) Questions on this or anything I can clarify no… well as a next step. Typically… what we would do is we’d sit down with you or we can actually just send you over a questionnaire that to get some of those, you know, initial volumes.
Jacob Andreasson (45:41) From there, we’d put together some initial pricing and walk through that with you. But just general feedback on the demo. You know, Teresa, is that something that you could see yourself living in each day? You know, you won’t hurt our feelings, I promise. But any candid feedback there would be great.
Teresa Chavarria (45:58) No, the demo appears pretty user friendly. I don’t have any negative feedback for sure. Everything was pretty good, pretty easy to explain. Sorry.
Jacob Andreasson (46:05) Awesome. Well, I’m glad to hear that. Well, yeah. Then in terms of next steps, does that sound like? Do you guys align there to start scoping out some projected volumes? And, you know, yeah.
Keith Jones (46:15) Yeah, that’s cool. Send over. We’ll get that completed and kind of go from there. And like I said, you know, unfortunately, it is like it can change dramatically, you know, but I think honestly, I think we kind of learned our lesson not to, you know, with tricare, they’re like, hey, they actually told us we want you to start with 2,500 providers and we did that and then we didn’t get the, you know, the volume or it’s like now we’re gonna take a more measured approach, you know, yep. And as they come in, you know, we’ll go in and then we’ll just build it back up. We do have the, you know, access to these providers. So that’s one good thing. But we could always like, you know, like right now, just so, you know, like I, we just emailed caresource again to see like how can we get instead of just being locked in on, you know, Atlanta and Georgia or Atlanta and Tampa, you know, let’s get the, you know, in all the states they’re in. I think they’re 16 or whatever. I forgot, you know, go national. And if we do that could, you know, that could change things, you know, so, and just like that’s how we’re kind of set up like it’s very hard for us to go do like, a state by state or like a local contract, you know, it just, it’s just hard for us to do that. So whenever I go after contracts, it’s always national, you know, the reason we did this is caresource just to get in with them, you know, and then kind of, you know, go from there. So, but yeah, let’s send over the questionnaire and, you know, my, and honestly, I’ll just tell you the biggest thing I just need. We need flexibility, you know, Andros is not giving us flexibility at all. They’re like, hey, and I think it’s just for their, you know, financial thing or books to say, hey, you know, what, you know, we’re gonna lock you in, you’re bigger, you know, you have a lot of providers, you know, but sometimes it doesn’t work that way, you know, so, yeah.
Jacob Andreasson (47:53) Yeah, 100 percent that.
Teresa Chavarria (47:55) Is extremely important only because there is months where we may only upload 10 providers, and then there is months where we can upload you know, a handful of 30 50 plus providers just depending on the need and also recruiting strategies for whatever state that currently has a high demand. So, I think the flexibility is very important there and not locking us into something where you’re expecting us to let’s say just dramatic, you’re expecting us to upload a 1,000 providers a month or, you know, have 12,000 providers submitted by month six, like we can guarantee that because it does fluctuate a lot.
Jacob Andreasson (48:31) Yeah, no, I completely hear you there. We like to describe ourselves as a utility. You know, you can scale up. We can scale down basically just whatever the business is calling for. So that’s you know, I think we’re definitely in the right place there.
Teresa Chavarria (48:45) And then, Jacob, if you can include, when you do provide us with the quote, if you can include if there’s any different pricing when it comes to maybe us submitting the provider ourselves and monitoring it and doing it ourselves manually on our end, and then having a different price point from where if we have medallion do all of the legwork on your end. Yeah.
Jacob Andreasson (49:06) So, to clarify there, we are an end to end solution. We don’t really have a self serve model. Okay? You know, because we are end to end, we’re able to guarantee certain turnaround times, things like that. So, yeah, unfortunately, it’s kind of a it’s we don’t really offer a self serve option.
Teresa Chavarria (49:23) Okay. But no, no worries. Okay. Sounds good. Awesome.
Jacob Andreasson (49:26) So as far as the next step, we will send over that scoping document once we get those together, if we can set up some time just, you know, quick 15, 20 minutes to walk through pricing. It’s a lot more helpful to be able to answer any questions you guys may have live. Does that sound like a good next step?
Keith Jones (49:41) Sounds great. We’ll give you. I’ll see what’s going on this week and we’ll kind of go from there.
Jacob Andreasson (49:44) Okay, perfect. Well, thank you guys so much really appreciate it. If you do want the recording for Amber, I’m happy to send that over as well.
Keith Jones (49:51) Yeah, send it over so she can have it too. Okay?
Jacob Andreasson (49:54) Perfect. Sounds good. All right. Well, I will, I’ll be in touch with you with that and the scoping document as well. All.
Keith Jones (49:58) Right. Cool. Thank you so much. You guys. I appreciate it. Thank you.
Teresa Chavarria (50:00) All right. Have a.
Jacob Andreasson (50:01) Good one.