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Complex Care Solutions

· 1 Gong source · 2 SF sources

Complex Care Solutions

Disambiguation: Complex Care Solutions is separate from “Complex Care Medical Group” — an internal billing entity used by Theoria Medical (referred to as “complex care” inside Theoria’s transcripts). Domain: complexcaresolutions.com.

Snapshot

Multi-entity provider organization. Originally one operating entity (CCS) but expanding via separate legal entities — SME Medical Delaware PA and a new California entity — that need their own NPDB Death Master File configuration in Medallion. Bi-weekly Medallion cadence. Tier 2 customer; ARR $223,996; 2026 renewal pending.

Commercial

  • Customer · Tier 2 · ARR $224K · renewal 2026-08 (Pending Renewal) — per SF diff, 2026-04-19.
  • Y1 of 2: Closed Won $162,110 — closed 2024-08-26 (006PO00000AefMsYAJ)
  • Current: Y2 of 2 — Closed Won $162,110 — closed 2025-08-26 (006PO00000CsN2LYAV)
  • Add-on: CCS Y2 Core, OGM, and RM Growth — Closed Won $61,886 → $61,889 — closed 2025-10-31 (006PO00000ORwuwYAD) (per SF diff, 2026-04-21)
  • Renewal: ComplexCare Solutions - Renewal - 2026 — Pending Renewal $162,110 — closes 2026-08-26 (006PO00000CsOkpYAF)
  • Pipeline: CCS Cred and Roster Growth — Qualification $9,511 — closes 2026-06-30 (006PO00000Y1cMDYAZ)

Profile

  • Annual revenue: $52.16M; 272 employees; industry: Medical Specialists (SF 2026-04-19)
  • Volume: ~800 active providers, ~121 recreds/month (Kara), ~42 new files/month.
  • Entities (in Medallion): CCS (legacy), SME Medical Delaware PA (new — Tennessee address), California (in setup).
  • No Theoria relationship: explicitly distinct customer; do not confuse with Theoria’s internal Complex Care Medical Group billing entity.

Operations

  • NPDB: attached at the group level in Medallion (provider → location → group chain) — explains why each new entity needs its own group profile.
  • Cadence: bi-weekly with Jason.
  • Delegation: PSV and ongoing provider monitoring between credentialing events delegated to Medallion under signed Delegation of Credentialing Agreement (effective MSA date 2026-08-26; per SF diff, 2026-04-19).

Key Contacts

Complex Care Solutions — Jennifer Tidwell, Senior Manager Credentialing and Delegation Oversight (jennifer.tidwell@complexcaresolutions.com) — primary Medallion counterpart; Cindy Bray (cindy.bray@complexcaresolutions.com); Kara Knowlden (kara.knowlden@complexcaresolutions.com) — handles ~121 recreds/month; Muriel Stepney (muriel.stepney1@complexcaresolutions.com); Willie Bennett Etenda (willie.bennettetenda@complexcaresolutions.com); Dawnetta Woodson Moor (dawnetta.woodsonmoor@complexcaresolutions.com).

Medallion — Jason Zednick, Engagement Manager (jason.zednick@medallion.co) — account owner; runs bi-weekly; Stephanie, capacity / scope questions (OOO week of 4/15; emailed Jennifer 4/10 with questions, response 4/10 pending follow-up).

Active Work

Recurring cadences

  • Bi-weekly Medallion sync with Jason (Gong 2026-04-15).

  • EBR: monthly since 2025-08; next none scheduled (4 logged) (SF 2026-04-19)

  • NPDB Death Master File — turn-on + keep-on — Medallion accepted the NPDB tie-in and Jennifer received confirmation email. As of 4/15: 10 files waiting on Death Master File processing. Jason still working on why it stopped running (“why would they think we all of a sudden don’t need that”). Critical it stays on going forward — Kara’s monthly recreds need it for every file. End-of-month deadline pressure (only 2 weeks remaining when discussed 4/15). Source: 15 bi-weekly.

  • SME Medical Delaware PA — separate group setup — New entity that cannot be associated with CCS in Medallion because it’s separately owned. Jason creating new group profile: Legal name SME Medical Delaware PA; Practice address 5535 Marriott Drive, Nashville, TN 37214; Tax ID 81-1871057 (confirmed during call); NPI 208 (partial captured during screen-share); State Tennessee; practice moved out of CCS group → into new SME Delaware group; NPDB configuration attached to new group. Open: tax ID confirmation — second number “83-3354972” was given for the group (vs. 81-1871057 for the practice) — verify before going live. After group creation, ~300 providers need re-credentialing under the new group/location. Jason investigating engineering-side bulk path instead of provider-by-provider. (Gong 2026-04-15)

  • California entity — NPDB pending application — Relatively new entity. Has never had an NPDB account, so Jennifer needs to apply for one before Medallion can wire it up. Jennifer reaching out internally for data; not getting responses. Will take time.

  • CCS group housekeeping (4/15) — Jason removed “CCS Medical Practice” sub-label so the only option in the dropdown is CCS (Jennifer wanted to prevent accidental selection). Anovalon group entry removed — never used; Jennifer doesn’t know why created. Jason to check if back-end deletion is possible. Jennifer flagged stray addresses showing in SME Delaware practice (including a “RCM cred at Theoria” entry) — Jason confirmed not in use; cleanup to remove.

Open Issues & Requests

Operational pain

  • NPDB Death Master File silently stopped — root cause unknown as of 4/15; Jason expects to clear up same day. Risk: Kara’s 121 monthly recreds depend on it.
  • California entity NPDB application — gating; Jennifer waiting on internal data she’s not getting responses on.
  • Bulk re-credentialing tooling unclear — Jason hadn’t checked with engineering whether the 300 SME Delaware providers can be reassigned at scale vs. one-at-a-time.
  • Stale dropdown entries — CCS Medical Practice and Anovalon groups created in Medallion but never used; cleanup in flight.

Feature requests

  • Scheduled provider report with time-of-day control (SF case 500PO00000NBGIlYAP, closed/P2) — CCS runs a daily report of Provider First/Last Name, Specialty, License type, and License expiration date. Wants to replicate in Medallion on a set cadence with a specific run time: 5:00am EST. (SF 2026-04-19)
  • Cred committee backdating — signature date flexibility (SF case 500PO00000NBG7SYAX, closed/P2) — CCS wants flexibility to backdate a cred committee deadline file when the signature date differs from the deadline date, to ensure the approved cred file date always matches the signature date for audit purposes. (SF 2026-04-19)

Decisions & Commitments

  • 2026-04-15 — Jason to create new SME Medical Delaware PA group in Medallion; move existing practice from CCS into it; configure NPDB. Source: Jason in 15 bi-weekly.
  • 2026-04-15 — California entity needs an NPDB account first (CCS to apply); Medallion configuration follows. Source: Jennifer (Gong 2026-04-15).
  • 2026-04-15 — Anovalon group entry to be removed from Medallion (Jason to check back-end). Source: Jennifer (Gong 2026-04-15).
  • 2026-04-15 — Jason to investigate engineering-side bulk re-credentialing path for ~300 SME Delaware providers. Source: (Gong 2026-04-15).
  • 2026-04-15 — Death Master File issue to be cleared same day per Jason. Source: (Gong 2026-04-15).
  • 2026-04-15 — Stephanie confirmed no capacity concern on Delaware 300 + Kara’s 121 monthly recreds + ~42 new files/month (via Jason). Source: (Gong 2026-04-15).

Source History

  • 2026-04-15 — Medallion Bi-Weekly — NPDB Death Master File issue + SME Delaware setup + California entity + Anovalon cleanup + capacity confirmation
  • 2026-04-19 — SF bootstrap — ARR $223,996; Tier 2; renewal 2026 pending; delegation agreement; 2 closed SF cases (scheduled report, cred committee backdating)
  • 2026-04-21 — SF diff — Add-on opp amount updated: $61,886 → $61,889

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