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PM Pediatrics

· 4 Gong sources · 1 SF source

PM Pediatrics

Snapshot

Pediatric urgent care + behavioral health (BH) provider group; Tier 1 ($986K ARR); E2E contract Year 3 of 3 closes 2026-05-15; renewal opp pending 2027 at $1.585M. Two operational tracks run in parallel at Medallion: the main (urgent care) account and a separate BH account with its own weekly sync. Email domain: pmpediatrics.com.

Commercial

  • Customer · Tier 1 · ARR $986K · renewal 2027-05 (Pending Renewal) — per SF diff, 2026-04-19.
  • Y1 of 3: Closed Won $488,556 — closed 2024-05-15 (006PO000008DkWfYAK)
  • Y2 of 3: Closed Won $554,090 — closed 2025-05-15 (006PO00000A4WefYAF)
  • Current: Y3 of 3 — Closed Won $554,090 — closes 2026-05-15 (006PO00000A4PuxYAF)
  • Add-on: PM Pediatrics - Volume Adjustments (Year 1 Only) — Closed Won $1,041,452 — closed 2025-03-27 (006PO00000IDFLUYA5)
  • Add-on: PM Pediatrics - Volume Growth Y2 — Closed Won $312,000 — closed 2025-05-22 (006PO00000LIcqjYAD)
  • Add-on: PM Pediatrics Y2 Adjustments (PE Growth) — Closed Won $120,000 — closed 2026-03-17 (006PO00000QOrfJYAT)
  • Renewal: PM Pediatrics - Renewal - 2027 — Pending Renewal $1,585,150 — closes 2027-05-15 (006PO00000A4O4QYAV)
  • Pipeline: PM Provider Outreach Agent Pilot — Scoping $29,167 — closes 2026-05-15 (006PO00000QVHYfYAP)

Profile

  • Annual revenue: $80.5M; 901 employees; Industry: Physicians Clinics (SF 2026-04-19)

Operations

  • Aged enrollment lines (as of 2026-04-20): 314 at 150+, 92 at 121–150, 87 at 90–120 — total 593 in 90+ bucket; ~400 in 60–90 bucket; ~1,000 workable 60+ lines total. Projection as reported: ~21 completions in April, ~187 in May, remainder back-weighted to August — Vikas flagged as unacceptable. Derek Lo investigating and to provide revised projection midweek. (Gong 2026-04-20) — possibly stale per Gong 2026-04-13: prior counts were 780 at 150+, 75 at 120–150, 93 at 90–120 (947 total 90+).
  • Top states by aged-line volume (2026-04-13 baseline, top payer spikes as of 2026-04-20): NY (CDPHP, MVP, NY Medicaid); NJ (Amerihealth Caritas DC, Independence Blue Cross, Aetna); MD (majority Amerihealth DC); FL (Sunshine, Simply). Amerihealth and HCHSN cited as driving recent rise in two states (Gong 2026-04-20).
  • Provider onboarding medians (last 12 months, updated analytics): 8 days total (invite → profile complete). 2 days invite → join, 4 days join → profile complete.
  • Enrollment median (last 12 months): 46 days from first-app submission to request complete.
  • March 2026 completions: ~800.

Key Contacts

PM Pediatrics — Vikas Bhalla, Chief Commercial Officer (vbhalla@pmpediatrics.com) — joins exec-level reviews; drives reporting requirements (new-provider time-to-revenue, 60+ day aged-line projections); Kristen Hanly, Senior Manager RCM Operations (khanly@pmpediatrics.com) — quality/term-provider reconciliation; Sheena Ahlawat (sahlawat@pmpediatrics.com) — senior operational lead; maintains PMP credentialing list; drives BH workflow; Janet Kahn-Scolaro (jkahnscolaro@pmpediatrics.com) — leads BH weekly sync; Optum/Medicaid NY+NJ for BH providers; Janette Gargiulo (jgargiulo@pmpediatrics.com) — day-to-day credentialing + payer enrollment both tracks; Diana — sends Medallion the weekly onboarding list; Anna — internal PMP inbox admin; forwards payer emails.

Medallion — Amy Barfield, Senior Engagement Manager (amy.barfield@medallion.co) — primary EM both tracks; Amy Frana, Head of Engagement Management (amy.frana@medallion.co) — oversight; Kateland Sanders, Senior Director Operations (kateland@medallion.co) — owns quality/QC program; Derek Lo, CEO (derek@medallion.co) — joined 2026-04-13 aged-line exec review; Nate Rosenthal (nate@medallion.co) — joined aged-line reviews; leading operational improvement investigation across org; Christina, Support lead — account specialist keeping eye on PMP-specific inbox; Jen, runs Medallion’s quality team — pulling pre-April QA coverage numbers; Nicole, payer enrollment director — Amy Barfield + team report to her; OOO as of 2026-04-15, returns 2026-04-21.

Active Work

Recurring cadences

  • Weekly sync — Tuesday (main) + separate BH sync (Thursday). Amy Barfield primary. Meeting platform migrating Zoom → Teams starting week of 2026-04-20 (Janette kept getting logged in twice on Zoom).
  • EBR: bi-monthly since 2025-06; next none scheduled (4 logged) (SF 2026-04-19)
  • Aged-line exec review — monthly / ad-hoc cadence with Vikas Bhalla + Derek Lo. Focused on 60+ day enrollment bucket with state-by-state payer breakdowns.

Open programs

  • Provider onboarding analytics refresh — Medallion platform updated week of 2026-04-13 to show median (not average) turnaround times, filterable by 6mo / 12mo / all-time, broken down by state and payer. Fixed a prior issue where old average showed inflated numbers (~57 days).
  • New-provider cohort tracking — Vikas requested separate reporting for “new providers” vs. existing. Agreed approach (2026-04-13): PMP HR sends weekly new-provider list to Medallion → Medallion reports time-to-revenue on that cohort. Reports will also show count of resubmissions per provider (first, second, third separately). Vikas additionally requested (2026-04-20) tracking of time-to-revenue for new hires specifically — from enrollment-complete to first revenue received.
  • Term-provider cleanup (open) — PMP’s RCM team running reconciliation: cross-check termination report against claims activity + zero-balance lines; deactivate providers with no activity. Kristen’s team owns.
  • 100% QC on Medicaid applications — Medallion policy; confirmed 2026-04-13 by Kateland. QC team now proactively updates outdated forms across the system when one is flagged.
  • Pre-April QA retrospective — Medallion auditing all applications submitted before April 2026 (per Vikas’s request). Jen pulling remaining-uncovered number; Kateland to share timeline.
  • External QC reporting — Kateland, Jen, and Nate working to share weekly QC file externally. Currently internal only. Planned format: Monday report showing prior week’s lines that went through QC, with breakdown by new hire / Medicaid / other categories. (Gong 2026-04-20)

Open Issues & Requests

Operational pain

  • Mistakes on Optum amendments and DOOs (multiple) — Medallion specialists completed DOOs incorrectly (listed owners as providers, wrong NPI belonging to a different doctor). Janette: DOOs should be handled by her (owner signatures), not sent to providers. Sheena raised broader training concern on 2026-04-15 and asked whether a third-party vendor is doing the work. Specific example: Angela Heppner’s NY location page missing provider name / title / signature / org name. As of 2026-04-20: a Medallion support team member filled out an Optum form with a provider listed as owner; Optum rep now refuses to deal with Medallion. Janette and Amy agreed all DOO forms must be routed directly to Janette going forward. (Gong 2026-04-20)
  • Duplicate providers created by resubmission workarounds — attempts to get signatures via group email failed; resubmissions with different emails + two NPIs created duplicates.
  • Selden group: BH locations being added to urgent-care practices — Medallion access team keeps merging behavioral-health locations into urgent-care groups. Janette has opened multiple tickets; keeps reappearing. Wants visibility into who’s making demographic-update changes (audit trail).
  • Old-form medicaid rejections — NY in particular; submissions using outdated form versions get rejected. Now mitigated by 100% QC + automated form-update step.
  • Inbox response lag closes payer cases — payers (various) require 3–5 day or 7–10 day response windows; when Medallion misses, cases close and apps must be resubmitted. Pattern continues as of 2026-04-20: Vikas confirmed payer emails went unanswered in the past 2 weeks. Christina personally watching PMP inbox until Nicole returns (2026-04-21). Dedicated-person proposal in progress; Amy Barfield meeting Nicole on return. Janette is forwarding time-sensitive Optum contracts directly to Amy as a workaround. (Gong 2026-04-20)
  • Terminated providers still receiving outreach — Medallion’s workflows continue recredentialing/follow-ups on providers with termination dates. Reproduced issue: CDPHP applications resubmitted for termed NY doctors, causing payer conflict. Interim: admin team to watch for provider tasks on termed providers.
  • Optum BH providers held pending NY medicaid — Jamie Morzowski, Jessica Williams, Josephine Pimentel flagged. Amy Barfield committing (2026-04-16) to push Provider Enrollment team to release dependencies and proceed commercial-only.
  • Amerihealth Caritas DC required dual medicaid (DC + MD) — originally submitted with only one medicaid approval; many resubmissions required when Amerihealth updated its PDIF form. Expect spike week of 2026-04-13.
  • Anthem par analysis — CA / NJ / TX / VA pending; Connecticut confirmed. Internal confusion: anthem requests submitted as “all states” rather than per-state; roster ambiguity (group enrollment vs facility).
  • NJ Medicaid for all BH providers — every BH provider (LMHC/LCSW/psych) must be credentialed through NJ Medicaid. Janet proactively scoping new-provider pipeline.
  • Simply Healthcare (FL) — facility-based payer only; Medallion was requesting per-provider enrollment in error. Per Janette: remove from individual-enrollment queue.
  • Sunshine Health (FL) — waiting on Sunshine confirmation whether Medicaid is an in-scope line of business on the roster before closing out enrollments.
  • Client tasks moving to “Reviewed” bucket — PM is using provider-profile tasks to communicate internally, but those tasks are being moved into Medallion’s “Reviewed” bucket, potentially disrupting Medallion’s task reporting. Case status: Not Doing/P2 (per SF diff, 2026-04-19)
  • ETIN revalidations (scope gap) — Amy Barfield confirmed 2026-04-15 that ETIN revalidations are billing (not provider-enrollment) scope — Medallion does not handle them. Prior informal workaround (a departed teammate slipped them into demographic-update requests) has lapsed. PMP must build an internal process; Janette flagged as significant problem.

Feature requests

  • “Provider termed on a line” visibility — EPD request open; would prevent continued outreach on termed providers.
  • Demographic-update audit trail — Janette wants visibility into who’s making demographic-update changes (driven by Selden group location mix-up).
  • Separate resubmission counts per provider (first / second / third submission) — part of new-provider cohort tracking.

Decisions & Commitments

  • 2026-04-13 — Kateland: all pre-April applications being QA’d; Jen to pull residual count + provide timeline. Medicaid gets 100% QC on all clients going forward.
  • 2026-04-13 — Derek Lo: will report enrollment-completion by cohort (everything in the 60+ bucket as of today, tracked to closure) and provide projection for clearing the ~1,000 aged lines.
  • 2026-04-13 — Vikas: PMP HR will send Medallion a weekly new-provider list so reporting can separate new vs. existing.
  • 2026-04-15 — Amy Barfield: migrating both weekly syncs from Zoom to Teams starting 2026-04-20.
  • 2026-04-16 — Amy Barfield: will push Provider Enrollment team to release medicaid-dependency holds on Optum for Jamie Morzowski, Jessica Williams, Josephine Pimentel (commercial-only).
  • 2026-04-16 — Janette: will download Medallion’s credentialing list and send gap-check against PMP’s NJ medicaid roster to Sheena.
  • 2026-04-20 — Amy Barfield: will set up daily sync (Nate + Amy + team from Medallion; Janette + Kristen as optional from PMP) focused on issue-by-issue log; Vikas to be optional attendee. Goal is granular per-payer, per-provider issue tracking on a spreadsheet updated daily. (Gong 2026-04-20)
  • 2026-04-20 — Amy Barfield: will meet with Nicole (returns 2026-04-21) to discuss dedicated person for PMP account. (Gong 2026-04-20)
  • 2026-04-20 — Derek Lo: will investigate back-weighted projection report (70% of 90+ lines completing by August) and provide revised assessment midweek; will include 60+ bucket in analysis. (Gong 2026-04-20)
  • 2026-04-20 — Janette / Amy Barfield: agreed all DOO forms routed directly to Janette going forward to prevent Optum errors. (Gong 2026-04-20)
  • 2026-04-20 — Vikas: requested tracking of time-to-revenue for new hires specifically (enrollment-complete → first revenue), in addition to existing time-to-credential metric. (Gong 2026-04-20)

Source History

  • 2026-04-13 — PM Peds Aged Line Review — exec touch w/ Derek Lo + Vikas Bhalla; analytics update; QC coverage discussion
  • 2026-04-15 — PM Pediatrics Weekly Sync — par analysis, DOO errors, term-provider outreach, ETIN scope clarification
  • 2026-04-16 — BH PM Pediatrics Weekly Sync — Optum medicaid holds, NJ medicaid credentialing, Selden group location mix-up
  • 2026-04-19 — SF bootstrap — initial Salesforce state: ARR $986K, Tier 1, E2E contract Y3 closes 2026-05-15, renewal 2027 at $1.585M pending
  • 2026-04-20 — PM Peds: Aged Line Review — updated aged-line counts (593 at 90+), back-weighted projection escalation, inbox lag continues, daily sync commitments, Optum DOO routing fix

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