Verifiable

So today, we’re chatting about Verifiable and how it’s being used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

Sure. We offer treatment for behavioral health issues, both in person and through virtual means. Our main form of reimbursement comes from value-based contracts. We provide a comprehensive range of clinical services and I work in revenue operations.

How long have you been using Verifiable?

We’ve been fully using it for about six months.

Can you talk a little bit about the context that caused you to look into purchasing this type of solution?

We had a platform that was implemented early on in the company’s life, but it wasn’t implemented very well, so we didn’t fully utilize it. We had functionality that we weren’t using, and although we could have resolved that issue, the platform wasn’t API driven, which was really important for us. On top of that, we had turnover in the credentialing and enrollment team, which made it difficult to establish the right structure and find the right people. So what I really wanted was an API-friendly platform and the option to outsource some of the work if it made sense strategically. And finally, I just needed more automation to lighten the workload for the team.

What problems were you looking for it to solve?

As we continue to grow, we are bringing in new providers each week. These providers come from different states and have various licensures and certifications, making our process more complex than a simple primary care practice. We have a wide range of provider types across different states, each with different requirements based on their location and the payors we’re working with.

To handle this complexity, we needed to streamline our credentialing and provider onboarding process and operate as our own centralized CVO. Our first priority was to fully automate this process. We didn’t want people keeping track of things on spreadsheets; instead, we wanted everything to be handled through a single system. We also wanted the ability to generate reports and have complete visibility and transparency.

Once we had the provider onboarding piece automated, we wanted to seamlessly integrate it into the enrollment workflow so we would immediately know which providers were ready to be submitted for enrollment, whether it was through a roster or a traditional application, to the payors. Our main focus during this stage was efficiency and fast turnaround times so that we could get these providers up and running on member schedules as quickly as possible.

And on the licensing front, as we strategically progress with provider licensing, we may end up requesting their support. It’s just something we haven’t done with them thus far.

What were the key requirements that you had as you were evaluating new vendors?

One of the first criteria we considered was whether we could outsource if needed. Many new vendors require outsourcing, at least for credentialing work. However, we weren’t ready for that yet. I proposed a hybrid approach where we would test out some markets with the vendor, maintain minimal staff to handle the rest internally, and see how it goes. Then, over time, we could potentially scale by outsourcing credentialing. Verifiable offered that option, which I liked.

I also appreciated their API library. We knew we would have a single source of truth for provider data, including background checks, licensure, and payor affiliations. We can infuse this knowledge into our front-end workflows, like scheduling. For example, my schedulers need to know which of our providers are fully enrolled with a particular payor, so that’s the information I want to surface during scheduling. We wanted the flexibility to use our internal engineering team to integrate this data from Verifiable into other purposes, some of which we haven’t even defined yet. Verifiable delivered the API structure we needed.

Moreover, Verifiable has excellent automation capabilities. They handle primary source verification, automatically check for license renewals and enrollment dates, and alert my team when re-enrollment is due. I needed the automation and greater efficiency in the process.

Did you look at any of Verifiable’s competitors?

We looked at Medallion and CertifyOS.

How did they stack up against one another?

I felt that CertifyOS had the right platform, but I felt they lacked depth in terms of experience. They kept saying, “Trust us, we know what we’re doing,” but I’ve learned to always verify. Moreover, they didn’t offer the flexibility I needed. They wanted to take over my full credentialing workload, but I wasn’t convinced they were ready for that level of responsibility. I believe they will eventually be successful, they just weren’t there yet.

As for Medallion, they weren’t willing to work with us on the enrollment workflows we required. They kept saying, “Enrollment is too complicated, we’re only focusing on credentialing.” This meant we had to continue doing enrollment manually. At the time, I needed a comprehensive solution, not just a focus on credentialing. They weren’t ready in that regard (though I believe this may have changed since we spoke with them). We also spoke to a customer who gave them a so-so review in terms of responsiveness and knowledge base. However, I believe they are also making good progress. Overall, they are all good companies, just moving at different speeds.

As far as enrollment, what was it that you needed them to support?

Basically, what I was looking for was a way to streamline the payor enrollment process. Once we have someone’s credentials and data in the platform, we want to be able to easily populate the necessary information for the payors. Ideally, we would have a library of applications where we could click a button and everything would be filled in automatically. The only thing we would need is any additional information that the provider needs to provide. Then the team would do a final review before submission. I didn’t want to have to switch between different screens or platforms to do this.

Verifiable isn’t perfect either, but they have more capabilities, and the newest version of Verifiable is on Salesforce, which is known for its ability to integrate with different systems and be customized. With Verifiable, it would be easier for us to build out that library compared to other solutions.

How did the different pricing models compare?

They were all pretty similar in terms of the one-time fees for implementation, recurring fees, and pass-through costs when accessing the National Provider Databank and other similar services. Honestly, none of them stood out as super creative with their pricing model. I would have preferred an all-inclusive subscription model, but they all offered pretty much the same options. Pricing wasn’t a major factor in our decision.

From the sales process perspective, how did you find the experience with Verifiable?

The sales process went pretty smoothly, in my opinion. What I found interesting was that all the vendors wanted to do a 30-minute demo and have us agree to buy the product. But I wanted to talk to their product owners and the team who would be responsible for the enrollment work if we decided to outsource. I made it clear that it was going to be a three-month process.

Out of the three vendors, Medallion was actually the best in terms of respecting our preferred approach. They were patient, and I really appreciated their handling of the sales process. Verifiable was okay, but I had to manage it to some extent. After the implementation, I was pretty disappointed with how our sales rep responded to some escalated issues. So I wasn’t too impressed with the way they handled the handoff and just said, “We’re done.” I believe that you still need to engage even after the sale. Customer success is a team effort. So I’m not thrilled about that. However, the sales process itself was pretty straightforward, and because I have experience in sales, I knew how to navigate it. But the key thing for anyone reading this is to remember to direct the sales process, don’t let it direct you.

How did you find the implementation process?

The main issue we faced was having a weaker initial implementation team. It caused some bumps during the implementation, which is normal. However, after we moved past that stage, our issues were not being resolved as quickly as we wanted. That’s when I had to step in and escalate the situation. Eventually, they brought in a new VP of customer success who has made significant changes to the processes in a short time. This has given me a lot of encouragement. I believe the problem was in the lack of proper processes and customer support models, which have now been rectified. Overall, we’re in a good place, but it did take some time to get here.

We also encountered some issues with the product, as we were one of the first to use the new Salesforce platform. Specifically, we faced some challenges in credentialing that needed urgent attention. The person who guided us during implementation was not equipped to handle these urgent issues. However, after transitioning to a new team who actively engaged with their internal product team, we were able to swiftly address the problems. Being one of the early adopters, we did receive dedicated support from the product team and we are quite satisfied with that. Resolving issues in the beginning took longer than expected, but we’re in a much better position now.

Now that you’ve been using Verifiable for six months, what do you find works well with it?

I have to say, using this platform has been really easy and straightforward. We’ve even granted access to people outside of credentialing and enrollment, like our quality team and legal team. It’s so user-friendly, especially if you’re familiar with Salesforce or similar platforms. You just get it, you know? It automatically sends emails and forms to the providers, which they can easily complete or sign off on. And that minimizes the need for any manual intervention. Overall, the ease of use and level of automation have met our expectations.

Another aspect I should mention is how smoothly the credentialing applications are packaged for review by the credentialing committee. We’re really pleased with how the packets are put together. There were some initial issues with routing and sign-off, but we were able to resolve them with the help of the product team. The single source of truth aspect of the platform is exactly what we needed. It’s so easy to find any information we’re looking for about a specific provider and know their current status. All in all, things are working really well.

What would you say could be improved with the platform?

So, after our go-live, we encountered some issues. They weren’t supporting our need to have more scalable workflows - for example, our need to seamlessly route the completed credentialing packet to our physician lead and quality lead. Verifiable often proposed solutions that were more complicated than they needed to be. Eventually, however, they understood and agreed to figure out how to simplify these processes. Since these workflows were new on the Salesforce platform, it required people actively testing and providing feedback to improve efficiency and ensure processes aligned with our needs. Once we established a direct line of communication with the product team, things started running more smoothly. The main issues we encountered involved routing as well as the placement of different fields in the applications and packets. But our issues have mostly been addressed at this point.

Has the platform been reliable and relatively stable?

Yes, no issues there.

How has the experience been working with their APIs?

We haven’t started our first project there yet. We’re currently in the design phase. The first thing we want to address is the issue of provider enrollment and the needs for the upstream teams responsible for scheduling our members. We need to be able to inform them at any given moment which providers are participating in our plans. Right now, we are using Monday.com as an intermediary. Once someone becomes a participating provider, we see that in Verifiable, and we did create an integration to notify users to go into Monday and change the status from pending to par. Additionally, we want to enable member self-scheduling.

The first way we want to utilize this API is to make a call, hopefully in real-time, for the member scheduling team to quickly determine if a patient can be scheduled for an appointment with a given provider based on whether the provider is participating in their insurance plan. And we also want this functionality within our own member application for self-scheduling use cases. We’d like to be able to notify the member which doctors they can schedule that take their insurance right at that point of scheduling.

How would you characterize support over the period you’ve worked with them so far?

It has improved significantly. At first, things were a bit shaky, but they were receptive to our concerns. It sometimes took multiple phone calls and escalations, but they quickly acknowledged the problem. It seemed like they were already aware that their customer support team needed more experienced resources and leadership. Just when we were getting frustrated with the situation, they introduced a new team and leader. This change made a world of difference, honestly. We are now very pleased with their support and how they have resolved issues. They truly understand our issues and the relative urgency and have even involved us directly with the product team when necessary. Cutting out the middleman has helped, and we’ve been able to collaborate and design solutions with the product team, which has been fantastic. Overall, the experience has been going really well.

As we address the remaining issues, I believe we will gradually shift toward using a ticket-based system for issue submission and resolution. However, we have been dealing with post go-live issues for some time now, so we are used to having regular meetings where we review the list of issues and make sure we are on the same page. Eventually, I think we will reach a point where the support team handles issue resolution through a more traditional issue tracking system, and we will have regular discussions with our account manager to work through any problems.

Do you feel like you made the right call going with Verifiable?

I do. I know that taking on enrollment work can be really complicated, and no one out there is fully prepared for it. With CertifyOS, they’re ready if you’re fully delegated, which is great for larger entities that just need to push a button and send out a roster securely. But for organizations like ours that still rely on the full application process, no one has built a complete library. And if they claim they have, you really need to see it to believe it. It’s incredibly complicated to keep up with each payor and provider type, as the application requirements change frequently. So it’s a significant investment to stay updated.

Initially, I was hoping to find a solution where they would say, “Sure, we have a library that’s accessible to you and ready to go.” But I quickly realized that wouldn’t happen right away. At this point, the only thing that would make me reconsider my decision is if we face significant challenges on the enrollment side, which we haven’t encountered so far. However, we still have some work to do in that area, but that will be the final piece, since everyone is currently focused on licensing and credentialing.

I haven’t seen any other good options out there for enrollment yet, but what would be interesting is if someone developed a database specifically focused on enrollment requirements. I haven’t come across such a resource yet, but there seems to be a lot of interest in this area. The process of licensing through enrollment is a pain point for everyone, and nobody seems to be covering the whole process comprehensively and effectively. So it’s not surprising that people keep trying to tackle this problem and be the ones to solve it. It’ll be interesting to see what happens. If there was a template database available, it could potentially be used through an API to streamline the enrollment process, which would be great.

Any other advice for buyers who are going through the decision-making process?

All these vendors are progressing rapidly. Their roadmap and product are constantly evolving. So it’s important to understand that what you’re getting today may not look the same in six months. Knowing what you absolutely need and what you’re willing to collaborate on to develop together is crucial. It also comes down to your company being at a stage where you’re a significant enough customer that they’re willing to work with you to meet your requirements. With Verifiable, I’ve found that they are responsive to my needs. It’s important to recognize that these companies are still in their early stages, so asking the right questions and driving the sales process to ensure trust and clarity is necessary.

You also want to make sure you understand how you measure work in this specific area. It can be a complicated process, depending on the size of your organization, number of providers, payors, etc. You’ll want to go into the process knowing what can be outsourced and what should remain in-house, where scalability is possible, and the true cost of running the function. Having this understanding enables you to better assess the return on investment. It’s also crucial to consider how you will communicate the value of this decision internally and the long-term benefits it will bring. You don’t want to invest in a product that you think will solve particular problems and find out later that there’s still manual work that needs to be done.