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PM Pediatrics

7 min read

PM Pediatrics

Overview

Pediatric urgent care + behavioral health (BH) provider group. 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.

Key Contacts

PM Pediatrics side

  • 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 of RCM Operations (khanly@pmpediatrics.com). Runs quality/term-provider reconciliation on PMP side.
  • Sheena Ahlawat — sahlawat@pmpediatrics.com. Senior operational lead; maintains PMP credentialing list; drives BH workflow.
  • Janet Kahn-Scolaro — jkahnscolaro@pmpediatrics.com. Leads the BH weekly sync; focused on Optum/Medicaid NY+NJ for BH providers.
  • Janette Gargiulo — jgargiulo@pmpediatrics.com. Day-to-day credentialing + payer enrollment operations on both tracks.
  • Diana (last name not given) — sends Medallion the weekly onboarding list (new providers + termination dates).
  • Anna (last name not given) — internal PMP inbox admin; forwards payer emails.

Medallion side

  • Amy Barfield — Senior Engagement Manager (amy.barfield@medallion.co). Primary EM for both PMP and PMP-BH.
  • 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.
  • Christina — Support lead; account specialist keeping eye on PMP-specific inbox emails.
  • Jen (last name not given) — Runs Medallion’s quality team; pulling pre-April QA coverage numbers.
  • Nicole (last name not given) — Production team lead; OOO as of 2026-04-15.
  • Danielle (last name not given) — Former PMP account contact; used to handle ETIN revalidations via demographic-update workaround. No longer on account.

Active Work / Processes

  • Weekly Sync — Tuesday (main) + separate BH sync (Thursday). Amy Barfield primary. Meeting platform being migrated Zoom → Teams starting week of 2026-04-20 (Janette kept getting logged in twice on Zoom).
  • 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.
  • 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 list of new providers to Medallion → Medallion reports time-to-revenue on that cohort. Also: reports will show count of resubmissions per provider (first, second, third submission separately).
  • Term-provider cleanup (open) — PMP’s RCM team running a 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 the remaining-uncovered number; Kateland to share timeline.

Pain Points / Open Issues

Application quality + process

  • 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 the 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.
  • 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.

Payer response + timeliness

  • 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. Christina (support lead) personally watching PMP inbox until Nicole returns. Dedicated-team proposal pending.
  • Terminated providers still receiving outreach — Medallion’s workflows continue recredentialing/follow-ups on providers with termination dates. Reproduced issue: CDPHP applications were resubmitted for termed NY doctors, causing payer conflict. EPD request open for “provider termed on a line” visibility. Interim: admin team to watch for provider tasks on termed providers.

Enrollment blockers

  • 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 were submitted as “all states” rather than per-state; roster ambiguity (group enrollment vs facility).
  • NJ Medicaid: every BH provider (regardless of license type — 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.

ETIN revalidations (scope gap)

  • Medallion does not handle ETINs — Amy Barfield confirmed 2026-04-15 that ETIN revalidations are billing (not provider-enrollment) scope. Danielle had been doing them informally by “slipping” them into demographic-update requests; she’s no longer on the account and the prior ones have lapsed. PMP must build an internal process; Janette flagged it as a significant problem.

Decisions & Commitments

  • 2026-04-13 — Kateland: all pre-April applications being QA’d; Jen to pull the 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 a gap-check against PMP’s NJ medicaid roster to Sheena.

Key Facts

  • Aged enrollment lines (as of 2026-04-13, Medallion report): 780 at 150+, 75 at 120–150, 93 at 90–120 — total 947 in 90+ bucket. (Derek’s internal pull showed closer to ~612; Medallion team to reconcile and resend the accurate number.)
  • Top states by aged-line volume (2026-04-13, approximate):
    • NY: 354 (NY Medicaid, MVP, CDPHP dominating)
    • NJ: 175 (Amerihealth, Independence Blue Cross, Aetna)
    • MD: 115 (Amerihealth Caritas DC, John Hopkins, Carefirst — majority Amerihealth DC)
    • FL: 65 (Sunshine, Simply)
    • PA: 41 (Amerihealth, Independence)
    • CA: 36 (Regal Medical Group, BCBS CA)
    • DC: 36 (HSCSN, Amerihealth Caritas DC)
    • TX: 31 (BCBS TX, TX Medicaid, Carillon — behavioral groups)
    • DE: 28 (Amerihealth)
    • IL: 26 (Aetna, Tricare West)
    • CT: 11 (Connecticare)
    • MA: 8 (BCBS MA, Fallon Health)
    • VA: 8 (Carefirst, Clarity/Multiplan, Centara)
    • NC: 7 (BCBS NC)
  • 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.

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