Medallion

Today we’re talking about Medallion and how it’s used at your company. Could you give us a brief overview of the company and your role there?

I work for a digital health company providing telehealth to patients all over the US. We work with commercial, Medicaid, Medicare, and a few employee-sponsored plans; 99% of our patients come to us via insurance. We provide telehealth services and social services to reduce the incidence and risk of chronic disease and associated symptoms. We have the largest national network of our provider type in the country.

I am the Director of Clinical Operations and have a prior background as a clinician. I work on process improvement efforts and figuring out how to scale. I work closely with other teams on patient retention, trying to assess customer lifetime value and acquisition costs. That involves coaching providers to enable them to retain patients and get multiple follow-ups. I also work closely with our product team, in terms of choosing the types of vendors we want to use as we scale as well as building our own internal tooling.

Could you give a quick overview of how you use Medallion?

We use it both for network credentialing as well as delegated credentialing. I can speak more to the internal, delegated credentialing side. When we bring on a provider, one of the first things they do is they fill out what’s called a credentialing application with Medallion. They provide standard personal information including the credentialing number for their provider type. They also provide information about their license, education, work history, sanctions and monitoring, etc. Once completed, Medallion will go through and verify each component using primary sources. They might say they did their bachelor’s degree at a specific school, for instance, and we’d go to the school and verify that that is true. At the end of this part of the process, Medallion returns a complete file to us, verifying that it’s complete and nothing has been flagged. We then take that to our credentialing committee meeting and make a decision about their ability to practice with us based on that. After that, they are a part of our network. We have delegated credentialing agreements with several payers. This means that they delegate the credentialing for that contract to us, such that a provider that we’ve credentialed can see that plan’s members.