Video: Medallion Demo Day for Payers | Duration: 2048s | Summary: Medallion Demo Day for Payers

Transcript for "Medallion Demo Day for Payers": Hello. Hello, everyone. And welcome to Medallion's payer demo day. We are very excited to have you all here today and appreciate you guys tuning in with us. I'm gonna wait a second for our presentation to get up on the screen, and then we will dive right into introductions. Awesome. Alright. I am Sarah. I'm our product marketing manager here at Medallion, and I work very closely with Ermul to help bring our new products and features to market. And with that, I'll turn it over to Ermul for a quick intro. Sorry about that. Hey, everyone. My name is Ermel. I am a product manager at Medallion. I work on our credential products, so helping streamline and automate the credential process, for payers. Really excited to show a little bit about what we've been doing to, address some of the common challenges in the, in the in the space. And, yeah, we'll we'll dive right in, after intros. And with that, I will pass it to Scott. Thanks, Errol. Good afternoon, everybody. Scott Everline. I am a principal solution consultant here at Medallion. I work closely with customers and prospects just to make sure that their needs align with the Medallion tools and functionalities. I also engage in a lot of the technical and tactical conversations around the provider data management workflow. I've been in healthcare for roughly 20 years. The first 8 were spent on the health care operation side working for payers. The last 12 or so I've been in the technology vendor space, partner space, working with customers like yourselves. Super excited to have you all here and looking forward to spending some time together this afternoon. Awesome. Alright. So we have a few things we're gonna cover with you all today. The first thing we're gonna cover is we're gonna learn about today's credentialing landscape and talk through some common challenges that we hear a lot of payers are facing. The next thing we're gonna do is we're actually gonna give you guys an inside look at Medallion's platform. We're gonna look at some new features we have for instant credentialing. We're gonna look at primary source automation, and we're gonna look at roster management as well. And then last but not least, we're gonna end with a q and a. So please feel free to submit any questions you have, in that q and a panel. You can also just enter them into the chat too, and we'll pull them over and make sure to cover them at the end of the session. Awesome. And with that, I will pass it to Scott to get us started. Great. So let's start off by just kind of recognizing credentialing teams are the seldom sung heroes in health care, but they play a key role in running an efficient and effective industry. As both facilitators of care and consumers of care, we wanna make sure that putting the best possible providers in front of patients. And we have to do all of this while ensuring various regulatory and timely and time regulations, I'm sorry, and timelines are met. It's no secret that payer credentialing is complex, costly, and can be cumbersome to manage. As technology continues to advance, there are new ways that we can address those complexities. Let's dig in a little deeper into the challenges and implications. Ermul is going to start us off with talking about just how complex this all really is. Yeah. Thank you, Scott. Yeah. I I think the first thing we wanted to start off with, just to set the stage is, you know, I don't think this is a secret at all. Healthcare is super complex. Credentialing is super complex. You know, whether it's regulations, crediting bodies, different provider types. It's it's really difficult to keep track of all of these requirements initially in your credential providers, but then also keeping track of how they're they're changing. Right? So you might have Medicare and Medicaid, and they have specific credential requirements that might differ from one state to the other. And as a payer, you really have to be pretty vigilant about these state specific regulations, because you wanna stay compliant. Right? Like, we wanna maintain compliance and and not take any risks. What we've spent a lot of time working on at Medallion is translating these regulations and and complexities into product that is easy to use. Right? So that's that's what I spend my my days, like, living and breathing is how do we how do we take the guesswork out of this, and how do we make this really easy to navigate? Right? We we wanna sort of boil down all of these state by state regulations and and specific rules, into this this product that is easy to use. And and we do so through a combination of, you know, technology, automation, and our subject matter experts at Medallion. Obviously, we are NCQA accredited, so you can be sure that we are sort of adhering to those standards. But we've really gone to some lengths to to make sure that those, those standards are sort of baked into the platform, itself. And it back over to Scott to talk about manual processes. Thanks, Raul. So a lot of the payer credentialing process today really, is it comes down to manual work. And so at Medallion, we've worked hard to try to eliminate or reduce as much of that manual work as possible. A lot of this leads to processing applications manually. Organizations make phone calls out to providers, web searches, emails, and we are still still using faxes to communicate. This manual work can be incredibly time consuming, prone to errors, abrasive to the provider communities and the administrators that are having to respond to these requests. What we've seen in technology in the last 5 to 10 years has been pretty incredible. And even in the last 12 to 18 months, we've seen pretty significant advances on how data can be exchanged between multiple parties. In health care in particular, more and more organizations are opening up APIs, whether due to regulations or because there's operational efficiencies to be had by leveraging technology. When we talk to customers, which is every day health plans like yourselves, they're asked to do more with less. Right? The the pots of money are shrinking. The needs to to manage large volume is increasing. Leveraging new technology and the automation can help the industry get to that doing more with less. It can improve efficiency, it gains accuracy, and it reduces costs at the same time. At Medallion, we've actually been able to automate almost a 100% of the credentialing process, and that starts with the application collection, moves into the provider outreach, communicating to providers in an efficient way to get the best response rates, Carry that through to primary source verification, leveraging a lot of those industry APIs to connect to those sources. So zero touch communication with primary sources, ensuring that there's reduced error rates as well as efficient processing timelines. And then we carry that all the way into the credentialing committee. And all of this is done using an NCQA compliant platform that provides full visibility and control over this process. So it's not giving up the reins of the credentialing process with Medallion. You are a partner in this process, and we're giving you access to kind of follow us and join us in that journey. The technology first approach gives Medallion the ability to streamline applications, manage large volumes of files, and create a smooth, low touch experience for providers. But on the payer side, we're seeing increasing turnaround times, and we're enabling internal teams to do more with less. Next up, Arnold's gonna talk about the challenges around data management. Cool. Thanks, Scott. Yeah. I I think this one ties, you know, really well into what Scott was talking about, with manual processes. I think one of the most difficult manual processes is just managing data. Right? The credentialing process, if you zoom zoom out far enough, I think can seem fairly straightforward. But, like, you guys are all probably familiar enough with it to know that, you know, as you start to get into the weeds of it, there's there's a lot of data wrangling. Right? You know, you're collecting data from all sorts of different sources. You know, we think about the credential process and the different steps. We've got the sort of application phase from the provider where we are collecting data from the provider. We've got all of our verifications across numerous different sources that we're trying to do. We are then sort of collating all that information into a a file for a committee to review, and then managing what happens after that. Right? You know, how do we notify providers that they've been approved? How do we keep track of recredentialing? How do we handle monitoring? And so there's all of these different, you know, challenges with data where we're getting pulled in different directions. And when one of the things that we found is it's it's difficult to find something that can do it all in one place. Right? And so that's that's something we've really focused on is making Medallion a truce a source source of truth. Right? We want you to be able to access all of this and and manage it all in a way that makes sense and ties together. We don't want you to be in one system for applications, another for committees, another for verifications. You know, I think you you you see a lot of the benefits of a platform when it's truly a platform. Right? When it's when it's not just, you know, a bunch of different things hobbled together. When it's a true platform with the foundation of different modules that are, sort of thoughtfully connected. And that's what we've spent a lot of time, ensuring and and what I'm really excited to to dig into once we get to the the demo portion. But before that, I'd like to pass it back over to Scott to talk a little bit about regulatory compliance. Thanks, Hernan. Feels like a bit of game of ping pong. So we talk about a lot of these data needs. Right? A lot of complexity that feeds into credentialing and provider data management. The topic of regulatory compliance can't be avoided. A lot of these challenges really come from the various regulatory requirements related to credentialing. Some of those come from credentialing or accreditation bodies. Right? Like NCQA, we see commonly within the credentialing space and payers. You have state regulations that may vary between specific state insurance commissioners as well as Medicaid organizations. You also see federal agencies, such as CMS, making applications or applying impacts into how credentialing is done and what information is actually being credentialed. Keeping with those current timelines and requirements really adds another complexity to the entire process, and it gives teams one more thing to try to keep track of. Meeting those standards set by the accreditation crediting bodies is pretty important. Right? Without them, it's difficult for us to do our jobs. It's difficult for us to ensure that we're providing the best possible networks to our members. In the dallian, you can get peace of mind that our organization is staying compliant with our NCQA accreditation. Our most recent audit, we scored a 100% on all of the 14 CBO accreditation standards. And part of that process is being able to track, all of this work that Medallion's doing within the platform. So you can run all standard NCQA primary source verifications at the push of a button. You can leverage those integrations for faster, near real time verification results for any provider type. You can auto generate NCQA compliant credentialing files that are accessible directly in the platform or can also be easily downloaded. And then we also have a developer friendly API that can support a near infinite number of system integrations. All this supports organizations in making sure that they're not only compliant with regulators, but they're prepared to meet the regulators' questions when they come. I'm gonna pass it back over to Armel. Yeah. Thanks, Scott. Yeah. I'll I'll take over here. The last thing I wanted to talk about before going to the demo is really just, you know, control and transparency. What what does that mean? One of the things I think we've strived to avoid is becoming a black box. Right? I think this is, like, all too common with, vendors where you provide an input and you get something out eventually, maybe. But you have no idea what's going on in between. Right? You know, is your provider's application complete? Has there been any outreach done to the provider? Where in the credentialing process are are they? And and that control and transparency is so important if you're gonna feel comfortable with, you know, outsourcing this to a to a vendor. And and that's something we spent a lot of time thinking about, and and striking the right balance between, you know, transparency and control, but also not having, a need for folks to be in the platform nonstop. Right? We don't we don't want you to to to live in the Medallion platform. We want it to be accessible so that you can get the data that you need when you need it. So if you need a report, you just need to check the status of the provider. You can you can do that very easily, but you don't need to be, in the platform if you don't want to be. And and that's, again, you know, something we spent a lot of time working on. And, hopefully, that'll become evident as we go through the demo. But it's something that's really sort of core to the Medallion platform. Not only for Conventional but for all of our our different products. But really excited to dig into the specifics for for cred. Alright. And with that, I think we are going to jump into the demo. So let me go ahead and share, my screen. Alright. Okay. Let me go ahead and zoom in just a little bit because I know sometimes it can be a little hard to see. But what you're seeing here is the the medallion, platform. So what I wanna spend some time doing in this demo is really covering the key parts of the credential platform, particularly for payers. Right? So I wanna cover, you know, how do we onboard provider data? How do we make that really easy to do? How do we then credential providers? And then lastly, you know, what happens after credential? How do we handle committees? How do we handle re credentialing, ongoing monitoring, all that good stuff? As you're going through, definitely feel free to take note of things, ask any questions if you have them. Again, some of the things that we talked about earlier that are really important is, you know, we built this as a true platform. All of this data is really cohesive and works across the different products. It's all super transparent. You have the same access effectively as all of our staff does. You can you can access this data really easily whenever you need it. So with that, I wanna start by just talking a little bit about the structure of provider data in the Medallion platform because it's so fundamental to everything else that happens in Medallion. Right? It's all built on top of provider data. I click into a provider. What I'm gonna see is the provider's profile. So for anyone that may have filled out some sort of profile like this might be familiar in terms terms of the the type of data that we're collecting, sort of how it's structured. The really important part is that it is structured, and it's really easy to handle. So we're collecting, you know, information on basic personal and professional, characteristics, professional history, any licenses that you might have, certifications that providers may have, etcetera. And so all of this is really nicely stored in the Medallion platform, and easy to access either through the platform or through API or or whatever they might be. Now the the sort of natural next question is, how do I actually get this data into the platform? Right? We don't need or we don't want, you know, providers to be filling this out. God knows. Provider's last thing they wanted to do is fill out more forms. And and we we we wanna make sure that this is as fast as possible. Right? And so there are a couple of options for getting data into the platform. The most common one that we see with payers in particular is integrating through CAQH and pulling the applications from CAQH itself. And so we we we have an integration with CAQH. We integrate via API, and we actually have a dedicated sort of, module to import that data. And so for payers, the way that this works is really, all you're doing is you're providing us 3 pieces of information. We collect the name, of the provider, the CAQH ID, and the NPI of the provider. With those three pieces of information, a couple of things happen when you provide that in the platform. And you can provide that in bulk, in a certain so upload. And a couple of things will happen when when you do that. We will kick off a credential request for the provider, and we'll we'll go and see what that looks like in just a bit. And we'll also start to try to import that data from the provider. So we will, roster the provider to your organization's CAQH account, if they aren't already. And we'll start pulling in that data from CAQH. And the whole time, you have full transparency into what's going on. This is a a demo organization. And so, you know, for for larger payers, you'd see much more, data in here. But we can see exactly, you know, who's, being imported, the status of their import. If there is any outreach to the provider, we can see it here. The system will actually automatically send the outreach to providers, and and ask them to update it directly in CHQH. So, for example, if they are, you know, missing some piece of information in their application that is required, if their roster settings in CQHR are are incorrect, we will automatically reach out to them. And we found this automated outreach is hyper effective in getting providers to be responsive. And we've had a tremendous amount of success in actually getting completed applications in through, through this process. Now once we get that data into the platform again, there are other options for getting data in. Right? If you've got data on hand, you can certainly push that in through a bulk upload or, through API. But for payers, typically, we found the CAQH application process, is is really, straightforward just because it pulls in all of the, like, state applications and and all of that, sort of nitty gritty information. So, for example, if I go, here, I can see all the disclosure questions for this provider. If they had state disclosure questions, we'd pull those in as well. We're pulling in the attestation, documents, and everything we might need. Once we've got that data, and we have a completed application, we will credential the provider. And so this is the credentialing module. And I wanna cover a few, important things about this, this this sort of module. We'll walk through sort of the different steps and stages of credentialing. You can see up here we have these different credentialing stages. They're sort of lined up to be, somewhat linear. Right? There are there are very distinct steps in the credentialing process, and we've made it very easy to sort of, pick and choose which one you're focused on. So we're gonna start with this in progress stage, which is where really the bulk of the actual credentialing process happens. And when I when I say that, I mean, you know, once we have a completed application, the PSVs and the file review that we are doing. So as you can see, we've got a bunch of information here that you can filter and sort to your heart heart's content. We've got obviously the provider, or or facility name because we can also credential facilities, so it's not limited to just providers. We have the type of provider or facility, the states that they're licensed in, and then some important details around their actual credential request. We, of course, have when the request was made, and when the application was completed. If this were a recredentialing file, we'd also have a deadline. But probably most importantly, we have the status here. Now if I hover over the status, you'll see a little popover that tells us, you know, what are we actually verifying about this production file? So, of course, we have the application, and we want that to be complete and verified and and sort of adhering to the NCQA standards or other standards that we are we are trying to refer to. And then we have all of our verifications. And so we've got, you know, things like port search and licenses and sanction lists and and so on. And the really cool thing is you can just click into this verifications page and actually see the, sort of in-depth detailed view of these verifications on the provider level. So this is really what I mean about, like, you know, having full control and transparency over what's happening. I can dig in here, you know, if I'm going through an audit where I just need to pull up some information for some reason, I can find all of this information directly in the Medallion platform. And the the really cool thing is that in most cases, most, if not all of these PSVs, are completely automated. So for this provider, we got fully automated PSVs. Every what that means is every single piece of, primary primary sources every primary source verification is done by the Medallion platform. There is no, human that needs to go out to a state board and and do any of that work. We are going out and doing that ourselves. So, for example, if I open up the state license verification, then we can see that this was automatically verified. We have a date time. I can go to a previous state. I can access all that information. I can even see the screenshot of this provider's, license verification. The same is true for sort of any other verification that we wanna look at, and it's all going to be in this, this dashboard. I can even run all these verifications again whenever I want. So I'll I'll run these verifications. And if I came back in a couple minutes because sometimes these take a little while while the scrapers are doing their thing. But if I came back, I'd see a new date where these had just been run. Maybe we'll take a look a little little later to see if they've they've run. So to jump back to the credentialing module, Again, this sort of status is is highly important here, right, to to help us identify what are we eventually gonna do with this, this file. But in the meantime, once these files are completed, meaning that the application has been complete and we've run all of our verifications, our team and and software will prepare this file for committee review. So we've developed a lot of software to do, actually, QA on files. So we are, running computer vision on screenshots of evidence to make sure that they actually line up with the provider that we are credentialing. We have credentialing subject matter experts that are reviewing files and making sure that they are good to go. And that combination of of sort of human and technology really gives us a lot of confidence in files. Our automation makes it so that our turnaround times are super fast. They're currently under a day on average to credential provider. But also at the same time, the accuracy is really important. Right? We want it to be accurate. We want it to be compliant. You just kind of useless if you're if you're not highly accurate. And and the good thing is that all of this technology that we built out also makes the platform highly accurate. I think the latest number where it is where it, like, 99.6% accuracy, which is fantastic and which we're really proud of. But we're also working on improving even more. And so, eventually, this file, once it's gone through all of those processes and and automation, we'll be ready to to move on to the next stage. So we'll move it over to the ready phase. This is sort of a holding place, where we can move files to the right committee. So committee, the committee process is something that we can actually manage directly on the Medallion platform. You can invite your committee members, and they can review, credential requests directly from the platform. So you don't have to manage this, somewhere else or with, sort of paper applications or anything like that. It's all digital. It's all on the platform. As a committee member, I can log in to the platform. I can review a credential file. So I get this nicely structured digital credential file that I can review. I can take a look at the license verifications. I can check if there are any sanctions, all that good stuff. I can even leave notes. So if I have a a note to write or something came up in my committee discussion, I can certainly leave that here, for for someone to read. I can download this as a PDF. So if I do need to share it outside of the Udemy platform, that's obviously always an option. So you do have that control. But once the committee is ready to vote, they can actually just log their vote directly on the platform. And the platform is is tracking all this. Right? Again, you don't have to track this somewhere else in a spreadsheet or anything like that. The platform takes care of that. It tracks exactly who is voting and when, and that will be, recorded. Once the voting's sort of completed, we move the file to what we call the closed stage. The way to think about this is sort of this is the record of all the credentialing you've done. And so any file or request on any sort of outcome is gonna end up here. So any approved files, rejected files, expired recredentials, all gonna end end here. And you can always access these files and download them or read any notes that may have been left. Again, I can see exactly who voted and when. And as files progress through these stages, the system again is gonna be doing some of these things that you might do manually, but it's gonna do them automatically. So one really cool example, here is for any approved files. So so this outcome is approved for the file. The one thing that we're gonna do is create a recredentialing request. So we'll create a recredential that tracks the next credentialing event for this provider. But when we do that, we also will send an email to the provider automatically. So we'll send an approval notice, that lets them know that they've been approved. We'll let them know when their next re credentialing deadline is. And that's all happening from their own background. Right? So you don't need to, go off and and do these things. The platform is just gonna do it, for you. Now in the midst of this this recredentialing, some of those verifications that we were looking at before, are going to run on an ongoing basis. So we can monitor these providers, of course, automatically. You'll get notifications whenever we do find any hits. That's sort of all standard procedure. Yeah. I think that's that's really everything that I wanted to cover. I think, hopefully, that gives you a quick, initial sort of view into how we think about credentialing, at Medallion as a as an end to end experience. Right? We want this to be something that you are, where where you are managing every element of your credentialing process from onboarding and application processing through to PSPs and all the way to committee and and approval notices directly on one platform. We want you to be able to manage it here. We want you to be able to leverage, all the automation that we've built out to make this super fast and accurate, and ultimately, hopefully, streamline the credentialing process. So it's, you know, something that is is maybe even fun sometimes when you're going through it. So yeah. Thanks for for allowing me the the chance to to show you guys what we've been working on, at Medallion. Super excited about some of the things that we are, working on, in terms of our road map. Happy to to to share more there. But, yeah, I think that's all we have in terms of a, demo. Awesome. Thank you so much, Ermel, and thank you, Scott. That was a great presentation. We have a little bit of time left for some Q and A. Looks like we had a few pre submitted questions. So I'll start with those. But if you guys do have any questions, you know, while we're going through Q and A, feel free to throw them in the chat. We still have some time. But I will kick it off with our first one. Okay. What part of the process is automated versus what part is done by humans? Yeah. I I can take this one. The answer is almost all of it is automated. So we have gone to to great lengths to automate everything we can, and we we have not stopped. We are continuing to automate and and refine the the processes. So if we think about, like, the the main parts of payer credentialing, what's automated, again, is is mostly. Right? So, you are telling us who you want your credential. And then from there, it's it's largely an automated process. So we are automatically rostering and importing data from CAQH or or other sources. We're automatically creating credential requests. We're automatically, completing most PSVs. Humans will will sort of fill in the gaps, if, if if if it's necessary. You're running the committee process. Unfortunately, sort of for compliance reasons, we can't automate that just yet, but maybe one day. And then once the committee is done, the the sort of active recredentialing or tracking recredentialing, approval notices, ongoing monitoring is all automated. So that's nothing that, you know, a human is is doing. It's all being done by the system. Awesome. Okay. Let me see. Looks like we have one from Mark. Okay. Mark says, what does the onboarding process look like for new businesses who would like to utilize your APIs? Yeah. Also, a great question. I'm happy to take this one as well. We are, definitely sort of an API first company. Our public API is effectively a mirror of what we use to actually run the platform. So our platform is running on the same APIs that we expose to our users. And so what that means for from your perspective is, you know, the API is very robust. You can basically programmatically do anything you can do on the platform via API, collect any data you need via API. We have a very robust set of API documents to sort of help you and your team understand, what what you can do and and how to do that. So happy to to jump in into more detail, maybe in another session. But it's it's definitely something that we are, you know, pretty pretty proud of in terms of how robust the API is. But if there are any other specific questions about, specific elements of the API, happy to happy to answer those. Awesome. Cool. The last one was a preceded question. It was just on our average turnaround times. Yeah. I can also take this one. So turnaround times for credentialing, I believe our latest metric is 0.8 days. So not even a full day, which means on average, you know, you might expect a provider to be credentialed the same day you request them. Obviously, it's going to depend when you get into individual providers. You know, if, occasionally, there are some edge cases where their their verifications might take very long if they have some weird, like, education thing. But by and large, again, on average, it's gonna be under a day, which is pretty fast. Awesome. Great. Well, thank you both, and thank you all for joining us today. If you do have any follow-up questions or anything, feel free to reach out to us. We're always happy to answer questions after the webinar, and we also love hearing your feedback. So, definitely reach out with that too, and we will be sending the recording out to you all too after the session, and we hope you guys enjoyed it. We look forward to seeing you on the next one. Alright. Take care, everybody.