Credentialing, Licensing, and Enrollment

Credentialing, Licensing, and Enrollment are products and services for verification of providers qualifications, acquisition of necessary licenses, and enrolling in insurance networks and healthcare plans. These solutions automate and manage complex, time-consuming tasks of validating educational backgrounds, professional training, certifications, and legal authorization to practice, ensuring that providers meet all regulatory and industry standards for licensure and enrollment with payers.

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4.5/5
10 min readReviewed on: 11/19/2024
Reviewer
Title: Manager of Licensing & Credentialing
Organization Type: Virtual-First Provider
Specialty: Women's Health
Summary
  • Product Usage: Verifiable is used for compliance, gathering and verifying provider information to meet NCQA standards, and for information reporting such as tracking which providers are credentialed and maintaining accurate data.

  • Strengths: Key strengths include its role in achieving NCQA accreditation, its recognized reputation by NCQA, and its robust reporting features which are vital for the organizations operational decisions.

  • Weaknesses: The primary source verification process often encounters errors which require time-consuming re-entry of information, communication cosnfusion with onboarding forms, and difficult merging of various types of reports.

  • Overall Judgment: Despite its weaknesses, the decision to choose Verifiable was deemed correct, with its valuable contribution to compliance confidence, efficiency in managing payer enrollments, and robust tracking and reporting features for operational guidance.

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1/5
11 min readReviewed on: 12/14/2023
Reviewer
Title: VP
Organization Type: Primary Care Clinic
Specialty: Primary Care
Summary
  • Product Usage: Symplr is used for the peer review process to monitor provider quality for a behavioral health group, streamlining an originally manual operation.

  • Strengths: The platform was affordable and the company offered responsive customer support throughout implementation.

  • Weaknesses: Symplr suffered from an antiquated user interface and problematic account setup for providers which was difficult to manage on a large scale.

  • Overall Judgment: Despite the affordable cost, the user interface difficulty and provider setup issues resulted in dissatisfaction with the selection of Symplr for peer review operations.

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3/5
10 min readReviewed on: 11/27/2023
Reviewer
Title: Credentialing & Enrollment Manager
Organization Type: Virtual-First Provider
Specialty: Behavioral Health
Summary
  • Product Usage: Modio is used for credentialing tracking and verifying licenses across diverse behavioral health categories in different states.

  • Strengths: Modio is intuitive, makes data entry easy, verifies licenses effectively, and provides a helpful feature to send out forms for completion or signatures.

  • Weaknesses: Modio does not run checks automatically and fails to alert users about skipped required fields, and sometimes the verification doesnt match up to the appropriate licensing board.

  • Overall Judgment: Modio is effective and supportive for the companys needs, but as the company has grown, its proven not as efficient due to lack of automation and integration for larger-scale needs.

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3.5/5
15 min readReviewed on: 11/15/2023
Reviewer
Title: Director of Clinical Programs
Organization Type: Specialty Practice
Specialty: Orthopedics
Summary
  • Product Usage: The reviewer uses CertifyOS for handling licensing and credentialing requirements of their national telehealth company.

  • Strengths: CertifyOS has been successful in obtaining licenses for the reviewers organization, providing good customer service, and beneficial pricing.

  • Weaknesses: Communication, lack of transparency, handling multi-state telehealth credentialing, and a non-intuitive dashboard have been notable downsides.

  • Overall Judgment: The product is suitable for straightforward licensing requirements, but struggles with complexity, particularly relating to telehealth credentialing across multiple states.

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2.5/5
15 min readReviewed on: 11/09/2023
Reviewer
Title: Operations Manager
Organization Type: Virtual-First Provider, Care Navigation
Specialty: Primary Care
Summary
  • Product Usage: The user employs the CertifyOS platform for credentialing purposes only, utilizing a credentialing dashboard for tracking progress and submitting requests.

  • Strengths: CertifyOS offers a wide range of services including licensing, credentialing, payer enrollment, renewal, and primary and secondary source verification.

  • Weaknesses: The user found the organization to be somewhat disorganized and experienced substantial delays in the credentialing process due to the unavailability of immediate responses from subject-matter experts.

  • Overall Judgment: Despite some improvements since a subject matter expert began joining their calls, the user remains uncertain about trusting CertifyOS to effectively scale with them and license and credential a large number of providers due to their early experience.

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5/5
17 min readReviewed on: 10/06/2023
Reviewer
Title: VP of Payor Strategy and Relations
Organization Type: Primary Care Clinic
Specialty: Primary Care
Summary
  • Product Usage: The user utilizes Medallion for credentialing process, primary source verification, ongoing monitoring, and practice management in their outpatient behavioral health group.

  • Strengths: Medallions delegation support, continual improvements, high customer service level, and relatively seamless provider enrollment process are appreciated.

  • Weaknesses: The user occasionally noticed typos or mistakes on the credentialing application during the payor enrollments by the Medallion team.

  • Overall Judgment: The user highly recommends Medallion, citing its substantial positive impact on their business operations, successful support for payor enrollments and transformation of their credentialing process.

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4/5
25 min readReviewed on: 09/07/2023
Reviewer
Title: Director of Operations
Summary
  • Product Usage: Verifiable is used for healthcare provider credentialing, verifying that providers meet a certain quality standard, and streamlining the process of adding new providers on a daily basis.

  • Strengths: Verifiable offers a user-friendly platform, immediate results due to its integration with primary sources, and valuable automated alerts for license expirations or status changes.

  • Weaknesses: Its detection of changes in primary source data is inadequate, often raising false alarms, and the system continues to verify licenses even for archived providers.

  • Overall Judgment: Despite certain weaknesses, Verifiable is exceptionally beneficial in terms of managing the time-consuming process of credentialing, providing immediate results and significantly reducing manual work.

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4/5
21 min readReviewed on: 08/28/2023
Reviewer
Title: Revenue Operations
Organization Type: Virtual-First Provider
Specialty: Behavioral Health
Summary
  • Product Usage: Verifiable is used to automate and streamline the credentialing and provider onboarding process, offering an API-friendly platform.

  • Strengths: Strengths include high levels of automation, ease of use, and the ability of Verifiable to function as a single source of truth for provider data.

  • Weaknesses: Some weaknesses the reviewer highlighted include initial issues with support and implementation, and complications with scalable workflows for credentialing applications.

  • Overall Judgment: Overall, the company is satisfied with their choice of Verifiable, commending its ease of use and automation capabilities, while noting the time it took to address initial implementation problems.

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4/5
21 min readReviewed on: 08/09/2023
Reviewer
Title: Director, Clinical Ops
Organization Type: Virtual-First Provider
Specialty: Metabolic Health
Summary
  • Product Usage: Medallion is used for network credentialing and delegated credentialing for healthcare providers, with the platform facilitating the verification of information submitted by these providers.

  • Strengths: The platform has a user-friendly interface and significantly improved processing speed compared to previous vendors, with most applications processed within a few days.

  • Weaknesses: The platform lacks the ability for customization, doesnt notify when a secondary verification is complete, and doesnt fully support providers in understanding and completing the credentialing process.

  • Overall Judgment: While Medallions service and user interface are appreciated, areas for improvement include ability for customization and more proactive communication regarding task completion. Their utility for a specific organization may depend on the complexity of the credentialing needs such as multiple state licenses.

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3/5
10 min readReviewed on: 07/20/2023
Reviewer
Title: COO
Organization Type: Virtual-First Provider
Specialty: Men's Health
Summary
  • Product Usage: The telemedicine clinic uses Medallion to monitor the credentials of its physicians and to assist with contracting in-network with payors.

  • Strengths: Medallion excels at assessing payor contracts and determining market standards, and their team provides valuable advice during contract evaluation.

  • Weaknesses: Despite having a edge in technology, significant amounts of work still require human interaction which can cause delays, and the platforms internal communication could use improvement.

  • Overall Judgement: Despite some weaknesses, Medallion has proven to be as effective as any other platform for handling contracting, credentialing issues and has overall enhanced the companys operations.

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4.5/5
30 min readReviewed on: 07/14/2023
Reviewer
Title: Operations Manager
Organization Type: Virtual-First Provider
Specialty: Behavioral Health
Summary
  • Product Usage: andros is primarily used for primary source verification for credentialing purposes, including running education checks and reporting entities from databases, and also provides support to become delegated and manage payer audits.

  • Strengths: andros stands out for its exceptional service - effective communication, prompt issue resolution, accommodating to specific business needs and providing quick turnaround times when necessary.

  • Weaknesses: andros is not the cheapest option in the market, which could be a potential downside for companies with strict budget limitations.

  • Overall Judgment: The overall experience with andros has been very positive, with the platform demonstrating reliable functioning, robust features, and remarkable customer service, making it a valuable asset in managing the credentialing process.

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3/5
30 min readReviewed on: 07/14/2023
Reviewer
Title: Operations Manager
Organization Type: Virtual-First Provider
Specialty: Behavioral Health
Summary
  • Product Usage: Medallion is used to support the provider licensing process by managing all communication and follow up with the Department of Health, saving time and reducing confusion.

  • Strengths: Medallion is cost-effective and flexible regarding the number of licenses required and length of contract, they provide a platform for information collection and process tracking and their service level improves when issues are raised.

  • Weaknesses: The platform struggles with delivering personalized and prompt communication to clinicians, and the service level can slip causing delays in achieving the agreed-upon timelines.

  • Overall Judgment: Medallion is a satisfactory service for behavioral health licensing, however, user experience could improve, particularly in the area of timely and personalized communication.

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