CDPHP
Overview
Upstate-NY regional health plan. One of the top three contributors to PM Pediatrics’s NY aged-line volume (alongside NY Medicaid and MVP).
Pain Points / Open Issues
- Terminated-provider resubmissions caused payer conflict (PMP) — Medallion resubmitted CDPHP applications for PMP providers who were already terminated. PMP’s Janette: “it created chaos for us and for the payers.” Root cause: Medallion has no quick view of line-level termination status, so recredentialing and follow-up workflows continued on termed providers. Audit trail exists; EPD request open for “provider termed on a line” visibility.
Related Customers
Source History
- 2026-04-13 — PM Peds Aged Line Review — termed-provider resubmission issue raised