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Confluent Health

9 min read

Confluent Health

Overview

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.

Key Contacts

  • 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 — handles Pecos / client-owned line admin
  • Kelly — contract/policy counterpart for signature + email-setting decisions
  • Bianca — monitors payer inboxes (e.g. daily Medicare welcome-letter check for Andy Kyle)
  • Angela — receives Montana Medicaid group-reval escalations
  • Derek — sends written CAP / escalation context

Active Work / Processes

CAP and escalation (open as of 2026-04-15)

  • QC backlog burndown — root cause was a staffing shift that moved tenured Confluent-experienced PE specialists off the account. Tenured staff have been returned to Confluent 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 also 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 (another escalated account that same week). Source: 2026-03-30 Weekly PE Operating Review.
  • Montana Medicaid group revalidation — application resubmitted 2026-04-10 after close SME review to ensure nothing missing; in-process with payer. See Montana Medicaid enrollment on Andy Kyle.
  • Andy Kyle — Georgia Medicaid — resubmitted; awaiting Medicare welcome letter (7–10 day payer TAT). Bianca checks emails daily.

Email-triage automation (rolled out week of 2026-04-15)

Full go-live planned by end-of-day 2026-04-16. Replaces the prior triage team: emails now auto-triaged on intake, auto-categorized (e.g. “still processing” emails no longer require a human response), and urgent/24–48h-turnaround emails bubbled to top of queue. Next phase will auto-post notes to the line. Trialed on another customer first; confirmed working.

Payer-name-mapping exercise

Completed. Expected to significantly increase downstream automation accuracy (fewer resubmissions caused by name mismatches).

EPT → Confluent practice-location migration

All clients running through a closed / archived / open review of practice locations. Confluent receives a list (migration_review_status column) and confirms status; EPD team (Addie / Lynn) then archives or updates in Medallion. Driving real action — reduces stale location records.

Product research (ongoing)

Melody is a research participant for Medallion’s service-request dashboard widgets and per-line activity timeline (PMs Addie Oh + Annette Hong, designer). Melody’s 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. Also wants group / brand surfaced on per-line views (not just provider name). Strong positive reaction to per-line activity timeline with human-vs-Medallion-action color coding — would replace current free-text notes.

Ops volume (week ending 2026-04-15)

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

Pain Points / Open Issues

BCBS Kansas conditional-approval closure (most severe)

Medallion historically closed enrollment lines at the credentialing-approval letter. For BCBS Kansas (and similar), the cred-approval letter is only the committee approval — actual par requires a 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 the providers and refused retro beyond the 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 (a separate thing where the committee conditionally approves pending full cred). 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 to team that emails for BCBS KS/TX/OK/Montana are time-sensitive (24–48h).

Authorized-/Delegated-Officials drift from acquisitions

Prior owners of acquired brands (e.g. Patrick) are still listed as the delegated/authorized official on some Medallion files because Confluent absorbed those brands. Source of truth: Cindy (Cynthia McCauley) is the AO for everything — use her on any AO/delegated-official field going forward. 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 to providers can be turned off globally, but Horizon NJ delegation requires providers to receive a credentialing email — so the global toggle likely stays on. Melody confirming with Kelly before any change. Open: whether emails can be customized (e.g. branded “Montefiore” or similar) 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 the project plan: Optum, Commonwealth Hand Therapy, Advanced. Correct flow after credentialing approval: providers move into the “existing payers” roster, no enrollment request needed. Leigh to send a report; Melody’s team will remove or migrate.

Tricare West contact instability

Tricare West 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 a similar arrangement — higher volume = more leverage.

Other open items (2026-04-15)

  • 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 the line is still owned by ex-Medallion staff “Edwina”; admin-assistant admin access was updated 4/8; Confluent team 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; making the line client-owned. Sports Medicine Associates: Julie to confirm the brand/group mapping.
  • Juan Rodriguez American Red Cross cert was incorrectly listed in the licensing section (should be certification). Fixed.
  • Blue Cross group-profile COIs — Confluent staff (via Carla) getting repeated medallion tasks to add providers to COIs, but providers are already on the group-level COI. Rarely uploaded at provider level. Leigh to investigate task origin.
  • Delegated credentialing addendum — can be sent to Melody for signature.

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 in 15 weekly.
  • 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.

Key Facts

  • Scale: ~7,000 providers across Confluent brands (Medallion internal estimate during a separate call; not directly confirmed by Confluent in this call — treat as 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 (discussed in context of comparable PT prospects; Medallion has had partnership conversations with prompt that were paused).
  • Executive relationship: COO on Medallion customer advisory panel.
  • Historical staffing: Edwina (ex-Medallion) previously owned some Confluent lines; admin handoffs still surfacing (Florida Blue / Fitness Quest Venice).

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

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