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Complex Care Solutions

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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.

Overview

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. Cadence with Medallion is bi-weekly. Volume estimate from Jennifer: ~800 active providers + ~121 monthly recreds + ~42 new files per month.

Key Contacts

Complex Care Solutions (external)

Medallion (internal)

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

Active Work / Processes

NPDB Death Master File — turn-on + keep-on

Pain point under active resolution. Medallion accepted the NPDB tie-in and Jennifer received confirmation email. Status as of 4/15: 10 files waiting on Death Master File processing. Jason still working on figuring out why it stopped running (“why would they think we all of a sudden don’t need that”). Critical that 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 a separately owned business. Jason creating a new group profile in Medallion:

  • Legal name: SME Medical Delaware PA
  • Practice address: 5535 Marriott Drive, Nashville, TN 37214
  • Tax ID: 81-1871057 (per Jennifer; Jason confirmed during call)
  • NPI: 208 (partial number captured during screen-share)
  • State assigned: Tennessee
  • Practice moved out of CCS group → into new SME Delaware group
  • NPDB configuration attached to the 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, providers (~300 mentioned) need to be re-credentialed under the new group/location. Jason looking at whether engineering can do this in bulk instead of provider-by-provider; Jennifer confirmed Stephanie agreed scope is fine (“there’s no concern” about the 300 + 121 + 42/mo capacity).

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 it was created. Jason to check if back-end deletion is possible.
  • Jennifer flagged stray addresses showing in the SME Delaware practice (including a “RCM cred at Theoria” entry) — Jason confirmed not in use; cleanup to remove.

Recred capacity confirmation (Stephanie)

On 4/15 Jason confirmed Stephanie reviewed the Delaware 300 + Kara’s 121 monthly recreds + ~42 new files/month and saw no capacity concern. Stephanie OOO that week; will respond on Jennifer’s 4/10 email upon return.

Pain Points / Open Issues

  • 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 yet 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.

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 in 15 bi-weekly.
  • 2026-04-15 — Anovalon group entry to be removed from Medallion (Jason to check back-end). Source: Jennifer in 15 bi-weekly.
  • 2026-04-15 — Jason to investigate engineering-side bulk re-credentialing path for ~300 SME Delaware providers. Source: 15 bi-weekly.
  • 2026-04-15 — Death Master File issue to be cleared same day per Jason. Source: 15 bi-weekly.

Key Facts

  • 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)
  • 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
  • No Theoria relationship: explicitly distinct customer; do not confuse with Theoria’s internal Complex Care Medical Group billing entity

Source History

  • 2026-04-15 — Medallion Bi-Weekly — NPDB Death Master File issue + SME Delaware setup + California entity + Anovalon cleanup + capacity confirmation

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