Tech company announces funding toward AI-powered credentialing process for payers, providers

© LALAKA - stock.adobe.com

A technology company hopes artificial intelligence (AI) can streamline the health care credentialing process for insurers, physicians and other clinicians.

Medallion announced it raised $43 million in new funding toward CredAlliance, its AI-powered platform that manages credentialing, enrollment, onboarding and compliance. The company said it “serves as a unified system of for provider data, enabling customers to verify credentials, stay in-network, and connect patients with providers more efficiently.”

“In a system where inefficiency and clinician burnout are systemic, our mission is to eliminate the operational waste that stands in the way of care,” Medallion Founder and CEO Derek Lo said in a news release. “This funding allows us to double down on our AI automation platform and launch CredAlliance, our credentialing clearinghouse that makes verification truly scalable.”

How it works

Medallion touted the system as the industry’s first shared credentialing infrastructure for payers.

The company estimated there are approximately 4 million credentialed physicians and other health care providers in the United States. Each of them contracts with an average of 19 insurers or other payers; together those generate an estimated 25 million repeated credentialing events at the cost of $1.25 billion a year.

CredAlliance verifies physicians and other clinicians once and syndicates the results across participating insurers. The company uses a cost-sharing model in which participating organizations split the costs of shared provider credentialing files to minimize redundancy, lower administrative overhead, and improve financial efficiency. The process allows providers to become billable across networks more quickly, which improves access and continuity of care, according to the company.

A positive investment

The added investment was led by Acrew Capital, with participation from Washington Harbour Partners and insiders, including Sequoia Capital, GV, Spark Capital, NFDG, and others, according to Medallion. The company said its total funding on the system has reached $130 million.

“Medallion is delivering what the health care industry has needed for years: a scalable, intelligent infrastructure layer that automates the administrative burden behind care delivery,” Acrew Capital Vishal Lugani said in the news release.

“We’ve been impressed by the team’s speed of execution and the depth of customer demand across the ecosystem, from provider groups to national payers,” Lugani said. “We’re proud to back Medallion’s next phase of growth.”

Medallion announced the new capital will be used to:

• Expand CredAlliance to automate thousands of state-, provider-, and payer-specific workflows.
• Invest in go-to-market teams and partnerships to accelerate growth across health systems, provider groups and plans.
• Scale the CredAlliance clearinghouse and onboard additional payer participants.