MedallionAI Wiki

Confluent Health

· 2 Gong sources · 1 SF source

Confluent Health

Snapshot

Multi-brand physical/occupational therapy group operating a corporate + franchisee model. Grew via acquisition of smaller PT brands (e.g. Commonwealth Hand Therapy, Advanced), so historical owners of acquired brands still appear on some Medallion records. One of Medallion’s largest customers; COO sits on Medallion’s customer advisory panel.

Commercial

  • Customer · Tier 1 · ARR $1.95M · renewal 2027-02 (Pending Renewal) — per SF diff, 2026-04-19.
  • Y1 of 3: Closed Won $1,250,000 — closed 2023-12-31 (0065Y00001hdkEbQAI)
  • Y2 of 3: Closed Won $1,250,000 — closed 2025-02-01 (006PO000005qMBHYA2)
  • Current: Y3 of 3 — Closed Won $1,250,000 — closed 2026-02-01 (006PO000005qMODYA2)
  • Add-on: Confluent Health CAQH + Roster Management (Year 3 of 3) — Closed Won $255,300 — closed 2026-02-01 (006PO000008du2XYAQ)
  • Add-on: Confluent Health - Increased PE MSA Volume & Medicare SLA Adjustment Year 3 — Closed Won $416,000 — closed 2026-02-01 (006PO00000G3lpCYAR)
  • Renewal: Confluent Health - Renewal - 2027 — Pending Renewal $1,562,500 — closes 2027-02-01 (006PO000005sV5ZYAU)

Profile

  • Annual revenue: $1,027,614,000 (SF 2026-04-19).
  • Employees: 900 (SF 2026-04-19).
  • Industry: Holding Companies & Conglomerates (SF 2026-04-19).
  • Scale: ~7,000 providers across Confluent brands (Medallion internal estimate; approximate).
  • Structure: corporate company-clinics + franchisees. Franchisees often are not PTs themselves and need heavier hand-holding on credentialing.
  • Authorized Officer: Cynthia “Cindy” McCauley — all payers, delegated and authorized.
  • Delegation: Confluent has delegated credentialing with Optum covering (at least) Commonwealth Hand Therapy and Advanced brands; full delegated-payer list being reconciled against project plan.
  • Integrations: Confluent is on the prompt EMR (Medallion has had partnership conversations with prompt that were paused).
  • Executive relationship: COO on Medallion customer advisory panel.

Operations

  • April 2026 completed enrollments: 584.
  • Outstanding enrollments (week ending 2026-04-15): 120+ (150-plus bucket), down from baseline ~1,470 (~60% decrease). Week-over-week decrease of 109 from prior week’s 150+120.
  • Client tasks outstanding: 478 (−5 WoW).
  • Apps submitted this week: 487 (incoming new requests: 553; 153 passed intake).
  • Apps completed this week: 48 (recreds + follow-ups).
  • Follow-ups: 2,700 current, 126 overdue. Unusual: 43 roster-expired follow-ups with 6 in 50+ day overdue bucket.

Key Contacts

Confluent — Melody Wilson, primary ops lead (melwilson@goconfluent.com) — runs weekly ops sync, owns escalations, manages service-request visibility; Cynthia “Cindy” McCauley, Authorized Officer across all payers (supersedes prior officers on acquired-brand files); Carla, payer-roster / brand contact (BCBS NM expansion, COI follow-ups); Julie, Pecos / client-owned line admin; Kelly, contract/policy counterpart for signature + email-setting decisions; Bianca, payer-inbox monitor (daily Medicare welcome-letter check for Andy Kyle); Angela, Montana Medicaid group-reval escalations; Derek, written CAP / escalation context.

Active Work

Recurring cadences

  • EBR: bi-monthly since 2025-02; next 2026-07 (7 logged) (SF 2026-04-19)
  • Weekly ops sync — Melody ↔ Medallion (Kateland, Leigh, Lee, others); op-sync deck walkthrough and service-request review.
  • Product research — Melody participates in Medallion’s service-request dashboard widgets + per-line activity timeline research (PMs Addie Oh + Annette Hong, designer). Ranked preference: (1) open-requests-by-group view, (2) portfolio snapshot, (3) cause-of-issues breakdown, (4) requests-by-state-by-payer, (5) stalled-time view (least useful — too generic without drill-down). Key ask: separate “stalled, not started” from “stalled on follow-up” — different escalation paths. Wants group / brand surfaced on per-line views (not just provider name). Strong positive reaction to per-line timeline with human-vs-Medallion-action color coding — would replace current free-text notes. (Gong 2026-04-15)

Open programs

  • QC backlog burndown — Root cause: staffing shift moved tenured Confluent-experienced PE specialists off account. Tenured staff returned and stay; backlog at ~65% on 4/15, target 100% clear by EOD 4/15 (Kateland confirmed ~32 QC lines remaining that morning, plus night shift). QC shifted away from low-risk payers to cut bottlenecks. Historical context: the staffing shift was the March 2026 handoff from the Ultimate agent team to the Medallion India team (still in ramp-up + QC-verification posture on 3/30; critical bucket had grown to 430 + nearing 230 vs. <100 each before handoff). Alex Smith pushed to pull alternate agents in temporarily while Medallion India ramped; Josh Frankel confirmed QC held ~177 Confluent lines because the usual medicaid specialist was OOO and coverage was redeployed to Forefront Dermatology. Source: 2026-03-30 Weekly PE Operating Review.
  • Montana Medicaid group revalidation — application resubmitted 2026-04-10 after close SME review; in-process with payer (15 weekly).
  • Andy Kyle — Georgia Medicaid — resubmitted; awaiting Medicare welcome letter (7–10 day payer TAT). Bianca checks emails daily.
  • Email-triage automation rollout — Full go-live planned EOD 2026-04-16. Replaces prior triage team: emails auto-triaged on intake, auto-categorized (e.g. “still processing” emails no longer require human response), urgent/24–48h-turnaround emails bubbled to top of queue. Next phase will auto-post notes to line. Trialed on another customer first; confirmed working. (Gong 2026-04-15)
  • EPT → Confluent practice-location migration — All clients running through closed / archived / open review of practice locations. Confluent receives list (migration_review_status column) and confirms status; EPD team (Addie / Lynn) archives or updates in Medallion. (Gong 2026-04-15)

Open Issues & Requests

Operational pain

  • BCBS Kansas conditional-approval closure (most severe) — Medallion historically closed enrollment lines at the credentialing-approval letter. For BCBS Kansas (and similar), cred-approval letter is only committee approval — actual par requires follow-up enrollment/loading letter that can arrive later with an effective date. Because lines were closed, follow-up emails from BCBS KS (requesting things like office-hours clarification) went unread; BCBS KS never loaded providers and refused retro beyond first-inquiry date. Result: claim write-offs across multiple providers; one brand leader very unhappy. Audit after the Kansas incident found 5–6 more providers affected the same way across accounts. Root cause on Medallion’s side: conflation with “provisional approval” scenario. Process change: never close enrollment at cred-approval letter; wait for actual enrollment letter. Also affects BCBS Texas and others; covered by same process now. Lee reiterating that BCBS KS/TX/OK/Montana emails are time-sensitive (24–48h).
  • Authorized-/Delegated-Officials drift from acquisitions — Prior owners of acquired brands (e.g. Patrick) still listed as delegated/authorized official on some Medallion files. Source of truth: Cindy (Cynthia McCauley) is the AO for everything. Medallion to task Confluent back when a form needs the update; Confluent updating internally.
  • Horizon NJ delegation blocks credentialing-email global-off — Credentialing-approval emails can be turned off globally, but Horizon NJ delegation requires providers to receive a credentialing email — global toggle likely stays on. Melody confirming with Kelly before any change. Open: whether emails can be customized (e.g. branded “Montefiore”) per delegation.
  • Delegated-payer enrollment requests shouldn’t exist — QC surfaced several brands with active enrollment requests in-process for payers already marked delegated in project plan: Optum, Commonwealth Hand Therapy, Advanced. Correct flow after credentialing approval: providers move into “existing payers” roster, no enrollment request needed. Leigh to send report; Melody’s team will remove or migrate.
  • Tricare West contact instability — Rules and routing change roughly every 6 weeks. Confluent has one good direct contact currently. Confluent not holding Medallion to SLA on Tricare West specifically. Oklahoma Tricare routing most recently flipped — BCBS reps note Tricare department at BCBS is still being built out.
  • Healthspring national contract not yet in place — When Cigna Healthspring rebranded to Healthspring, enrollment changed. Another Medallion client has a national contract with a single roster to NP Ops. Melody reaching out to Confluent contracting to explore similar — higher volume = more leverage.
  • BCBS New Mexico + Texas border expansion — request to add TX locations; payer-directory team needs confirmation Confluent actually has TX/NM border practice locations. Carla to confirm.
  • Therapy Network of Georgia (TNG) roster — payer address discrepancy; all providers moving from address 5A → 5B. Team instruction given to update letter date and move everyone.
  • Krista Rapp / Fitness Quest Venice — Florida Blue — stuck because line still owned by ex-Medallion staff “Edwina”; admin-assistant admin access updated 4/8; Confluent to re-check access and move forward. Urgent.
  • Pecos access — Sports Medicine Associates + Strive — Strive: February paper app still pending, revalidation will be due before it approves, Medallion submitting paper app instead; line client-owned. Sports Medicine Associates: Julie to confirm brand/group mapping.
  • Blue Cross group-profile COIs — Confluent staff (via Carla) getting repeated Medallion tasks to add providers to COIs, but providers are already on group-level COI. Rarely uploaded at provider level. Leigh to investigate task origin.
  • Payer-name-mapping exercise — completed; expected to significantly increase downstream automation accuracy (fewer resubmissions caused by name mismatches).

Feature requests

  • Per-line activity timeline with human-vs-Medallion-action color coding — Melody’s product research preference; would replace current free-text notes (Gong 2026-04-15).
  • Split “stalled, not started” from “stalled on follow-up” in service-request dashboards — different escalation paths (Gong 2026-04-15).
  • Surface group / brand on per-line views (not just provider name) (Gong 2026-04-15).
  • Customize credentialing email per delegation (branded “Montefiore” or similar) — tied to Horizon NJ workaround.
  • Auto-add initially-credentialed providers to existing enrollments for delegated payers — today Confluent must manually add PAR-by-delegation providers to existing enrollments one-by-one after initial cred; product opportunity to automate (SF case 500PO00000T2A13YAF, SF 2026-04-19).
  • CAQH management table: 85%+ profile-completion filter + auto-status transition — explicit ≥85% filter option in provider profile completion filter (currently only 70–90%); auto-transition status from Queued → Assigned when completion hits 85% (currently manual); manual override of last-attestation date regardless of auto-sync (SF case 500PO00000RDwHyYAL, SF 2026-04-19).
  • “On Hold – MSA Limit” status — when MSA cap is reached, current “Backlog” status implies work queue, confusing clients; dedicated “On Hold–MSA limit” status requested (SF case 500PO00000O2eQBYAZ, SF 2026-04-19).
  • Bulk secure SSN export — no scalable mechanism to get SSNs to customers in bulk; current path is manual Django export (SF case 500PO00000NBGiXYAX, closed; SF 2026-04-19).
  • Audit/change history on Practice/Group profiles — large enterprise admins need to see who changed group profiles, similar to existing provider-profile audit log (SF case 500PO00000NBAGcYAP, committed future quarter; SF 2026-04-19).
  • Concurrent credentialing/re-credentialing dates across groups — providers working at multiple groups need parallel cred dates and an audit log of cross-group credentialing history (SF case 500PO00000NBG93YAH, SF 2026-04-19).

Decisions & Commitments

  • 2026-04-15 — Cindy (Cynthia McCauley) is the single AO across all payers; when a Medallion task references Bridget or Patrick as delegated official, use Cindy and Medallion can task back for re-sign. Source: Melody in 15 weekly.
  • 2026-04-15 — BCBS enrollments no longer close at credentialing-approval letter; Medallion waits for actual enrollment confirmation before closing. Process applies to all BCBS states with this quirk. Source: Kateland + Melody (Gong 2026-04-15).
  • 2026-04-15 — Strive Pecos line made client-owned while paper app processes. Julie to update in Pecos.
  • 2026-04-15 — SOP updates committed for Healthspring and Tricare West by 2026-04-20, then team retrain. Tricare West SLA informally relaxed given payer instability.
  • 2026-04-15 — Closed-practices list (column F: migration_review_status) to be returned by Confluent; EPD to archive / update in Medallion per response.
  • 2026-04-15 — For conditional/provisional approvals, Medallion sends an email that Confluent can bill, but keeps the line open rather than closing (so failed cred downstream is still caught). Melody actively deterring brands from seeing patients on provisional approval (“costs them a few weeks, saves thousands in write-offs”) — especially on commercial plans that don’t retro.
  • 2026-04-15 — Juan Rodriguez American Red Cross cert incorrectly listed in licensing section (should be certification). Fixed.
  • Historical — Edwina (ex-Medallion) previously owned some Confluent lines; admin handoffs still surfacing (Florida Blue / Fitness Quest Venice).
  • 2026-04-15 — Delegated credentialing addendum can be sent to Melody for signature.

Source History

  • 2026-03-30 — Weekly PE Operating Review (internal) — Confluent critical+nearing backlog growth during Ultimate → Medallion India handoff; QC bottleneck from medicaid-specialist OOO + coverage diverted to Forefront Dermatology; Sigma unassigned-lines issue tied to legacy custom payer names.
  • 2026-04-15 — Medallion weekly ops sync + product research — CAP update, op-sync deck walkthrough, BCBS KS post-mortem, widget/timeline research with Addie + Annette
  • 2026-04-19 — SF bootstrap diff — initial SF state: ARR $1.95M Tier 1, 3-year cred contract (Y3 2026-02-01), 2027 renewal pending, CAQH+Roster + PE MSA add-ons, 7 open SF cases ingested as feature requests

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