Medallion

So today we’re chatting about Medallion and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

We are an outpatient behavioral health group. We operate in several states and have grown extensively recently, from four clinics a year and a half ago to 26 today, with more opening this year. We provide talk therapy, medication management, and transcranial magnetic stimulation (TMS). We provide both in-clinic and telehealth services. One thing that’s different about us is that our telehealth services are performed within our clinics: we don’t hire outside providers for telehealth. We try to create kind of a synergistic approach where providers feel like they’re part of a community and they can work directly with their teams and collaborate on outpatient care. I’m our vice president of payor strategy and relations. I lead all of our payor contracting efforts, and I’m heavily involved in our traditional and delegated credentialing processes with our payors.

What was the business need that drove your search for a tool like Medallion?

We were looking to right-size our credentialing process. We were doing it in-house and it wasn’t very efficient or fast. We also had plans to set up delegated credentialing agreements with our payors, so we were looking for a platform and a partner that could help us secure those agreements and support us in our overall credentialing efforts: primary source verification, ongoing monitoring, and practice management. Our previous tool wasn’t very user friendly.

In traditional credentialing, outside providers submit credentialing applications to payors in order to work with those payors. In delegated credentialing, we do that process in-house. We’ve created a credentialing committee consisting of several clinicians, with Medallion as our sub-delegate, handling the primary source verification and ongoing monitoring checks.

What requirements were you looking for in a credentialing partner?

Customer service was a big factor for us. We were looking for a partner who could support us on the technical aspects and could also offer a high level of trust and communication. We also needed a tool that was user friendly and easy to navigate for our staff and clinicians. And finally, of course, we needed a partner who could handle the various tasks around delegated credentialing, such as ongoing monitoring, primary source verification, and roster management with our payor partners.

What tools did you consider other than Medallion? How did they compare?

We did some initial calls with a couple other organizations, including Symplr and Medversant, as well as a few others. It was very apparent early on in the process that Medallion was the best offering available. A number of things made Medallion stick out early on. They were responsive from the start and we liked what we saw in the demo. The software we were using before Medallion was stone-age technology, built in the early 2000s! Medallion was leaps and bounds beyond that.

The other factor that was huge for us is that Medallion links to providers’ CAQH profiles and pulls that information automatically, so the provider doesn’t have to build their profile from scratch, which is very time consuming. They just have to confirm the imported information as accurate.

How did the tools compare on price?

I think it was fairly similar, but we didn’t get far enough in the process with the other products for me to do a good price comparison. We were happy with the pricing structure Medallion offered, though, and have been able to drive those costs down as we have increased our volume.

How was the sales process?

We’ve had one point of contact on their sales team ever since we first submitted an inquiry on their website; he was even the same person we worked with to renew our contract. He’s been great to work with and very communicative. He was really helpful when we found we hadn’t forecasted some of our numbers appropriately and had to revise the contract to avoid overage charges. Their sales team has also helped us drive our individual unit costs down as we’ve grown our volume. It’s been a really seamless process. Their customer service level is very high and we’ve been extremely happy with it.

How was the onboarding and setup process?

We started by sending over some reports we’d pulled from our prior system, CredentialMyDoc, of all the individual clinicians we had onboard at the time, as well as our providers’ contact information. They then set up the accounts and connected the providers’ CAQH feeds into Medallion. From there, we had some more time-intensive work on our end, setting up all our providers’ profiles, adding our groups’ demographic information, tax IDs, and NPI information, and adding the payors we had contracts with. I wasn’t directly involved with it, but for our credentialing staff it went very smoothly. Our providers gave us feedback almost immediately on how much easier the platform was to use than before. I think it took less than 30 days to fully implement it.

Could you talk about the specific use cases you have for Medallion?

We utilize Medallion for a few different buckets of services. First, we are charged for each provider profile in the platform. Next, we are charged per payor, per provider, to credential or enroll providers with any payor that we don’t have a delegated agreement with. Next, we pay a one-time delegation support fee, which helps us conduct a delegation audit, which is something that each payor requires us to go through as we’re obtaining a delegated agreement. They audit us to confirm our policies and procedures and to ensure that we conduct ongoing monitoring and primary source verification (confirming providers’ licenses, education, work history, malpractice, etc.). Next, there is a credentialing fee for each provider, where Medallion does the ongoing monitoring and primary source verification for us. And finally, they take care of demographic updates, for situations where a provider has a change of name or address, or gets a new licensure or Medicare number.

They offer other services, such as licensing providers, and we’ve discussed using that in the future, but for now we typically hire providers that are already licensed.

Which of these services are purely digital solutions, versus services Medallion provides for you?

The ongoing monitoring and primary source verification is digital and largely automated: we can go into a provider’s profile and see a history of the ongoing monitoring that is continually going on in the background. Their API feed is digital: we pull that information out of the system and load it into Power BI, which allows our intake staff to see exactly who is credentialed and with what payors.

The manual services they provide include helping us with audits, as well as the ongoing contact we have with our customer success manager: we have monthly calls with them.

Out of all these services you’re using Medallion for, what is working really well for you?

Their delegation support has been outstanding, including the primary source verification and ongoing monitoring. We’ve been able to obtain seven delegation agreements since we started with them, which is pretty outstanding. They’ve allowed us to be much more successful than we would be if we were just doing traditional credentialing. That stands out the most to me.

I also can’t speak highly enough of their service. They’re always willing to support us. We have submitted some platform enhancement requests to them that they’ve taken into consideration, and the fact that they’re continually looking to improve their offering and services stands out to us.

Finally, their provider enrollment process is really seamless and allows our team to focus our activities on other areas that are more value-added.

What has the user experience been like, both for your admin team and for providers?

The user experience has been very positive. Different types of users have different access settings, whether they are administrators, auditors, or providers. Providers access the platform to build and update their profiles, while regional directors and clinic administrators don’t need to edit, so they have read-only access. And one of the great things about it is that it’s a one-stop shop for all the information you need, and it’s all HIPAA-compliant. Providers have told us the system is really easy to navigate and not confusing. There’s also a document management section which is really helpful, so we can store copies of a provider’s ID, resume, or licensures, or correspondence from payors, and have it available if we ever need it.

How are you managing payor arrangements where you don’t have a delegation agreement in place?

Those are the cases where we have to submit payor enrollment requests in the platform. So we go into the provider’s page and then click a few buttons to request the payor enrollment for a given payor. Then Medallion receives that information, pulls all the information from the provider’s profile, completes the application, and submits it to the payor. Then we can check the status of the credentialing submission and see any notes on the process. When the application is approved, Medallion then updates the provider’s profile to note that they are participating with that payor, and that goes into the API feed and shows up in our Power BI, to let our teams know of the change.

What would you say are Medallion’s biggest weaknesses?

The biggest weakness I see is that they have credentialing staff submitting those payor enrollments, and from time to time we do see typos or mistakes on the credentialing application; for example, they might put a typo in an address or something small like that. But they haven’t been overwhelming and haven’t impacted our experience with Medallion or our reimbursements or status with the payors, and they always resolve those issues quickly.

How has the platform been from a reliability and stability standpoint?

It’s been great. There have been some connectivity issues occasionally, but they put up banners on the platform so we can see they’re having a problem, and they send out notifications once it’s fixed. It doesn’t happen super often, and we haven’t had instances where we’ve been taken by surprise.

Could you describe the way Medallion integrates with your systems?

I’m not super in the weeds on the technical side, but we have the API feed that pulls out of Medallion and links to our Power BI. We try not to overwhelm our intake team with data but just ensure that they have the information they need to schedule patients with providers that are in-network with their health plans. There are switches in the system we can select to notify that a provider is participating with different payors, and the intake dashboard reflects that. I’ve heard really good feedback from the data person on our team on how easy it’s been to set up and navigate.

How has the support and account management experience been for you?

We have a customer success manager assigned to us, in addition to the sales rep who helps with our contract and renewals. The customer success manager helps us with any concerns we have and provides us updates with the platform and any new enhancements. We meet regularly with them and we feel like we’re really connected with Medallion, not just as a platform, but that there are actually people behind it.

What channels do you use to facilitate support?

We mostly use email, and then we have regular Zoom calls.

Do you think you made the right choice with Medallion?

Yes, absolutely. We would make the same decision again, and obviously we would, since we renewed the contract!

Do you see any areas for growth?

There are obviously always areas for opportunity, ways to enhance the system. For example, each payor has a commercial product as well as a Medicare Advantage product, and sometimes those aren’t separated in Medallion. It would be helpful to be able to see them separately. Other than that, I think just generally, we anticipate and hope that as we grow, they also grow and build out their staff and support capabilities.

How has Medallion impacted your business operations?

It’s had a significant impact. The delegation agreements allow us to credential providers much, much sooner, often as soon as they start with the company, which is unheard of: usually for traditional credentialing, it can take 60 to 90 days to credential a provider. So it’s increased our revenue substantially, since we’ve been able to provide reimbursable services with those providers so much faster. And our ability to work with payors has grown as well, because having those delegated agreements gives you a much closer relationship with a payor. They appreciate it because it’s less work for their teams to do internally. So it’s impacted our business both from a revenue perspective and from a relationship perspective.

I don’t want to understate the support they do on the payor enrollment side, too, because they’ve made that process much more seamless as well. When we started, we didn’t have the right people to manage that, and prior to starting with Medallion, it just wasn’t working very well for us. So delegation is the bread and butter, certainly, but their payor enrollments have also been really helpful in getting providers through traditional credentialing much more quickly.

It’s helped from a staffing perspective too. We have two people working on credentialing, and without Medallion, we’d probably need five to seven people. It’s helped us reduce unnecessary staff.

Would it have been feasible for you to stand up delegation agreements without a partner like Medallion?

I do not think so.

Any final pieces of advice for other potential buyers?

I would highly suggest Medallion, I give them a five-star rating! They’ve been a great partner. Everyone in their organization is really easy to work with and very personable, they’re great at communication and exactly what you would expect out of a partnership. We look at them not as a vendor but more as a strategic partner: they’ve really helped us grow our business. At the end of the day, we’re here to provide behavioral health services to individuals and close that gap in access to care. Getting your credentialing right-sized is one of the best ways to do that. Medallion has allowed us to home in on that, increase our service capacity, and shorten wait times for patients. They’ve been a great partner.