Modio OneView

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

I work for a behavioral health telehealth company. We are active in all 50 states and Washington, D.C. We have both prescribers and therapists on our platform. I oversee the credentialing and enrollment department.

What was the core business problem that your company wanted to solve with a tool like Modio?

We were tracking credentialing in spreadsheets, and wanted a better tracking system, as well as being able to automatically keep track of license expirations and run reports on the data. We use the credentialing standards of NCQA to figure out what functions we need to have in a replacement system.

What influenced the decision to transition to Modio from Symplr, the tool you were using prior?

From what I understand — we were already using Modio when I started working here, and Symplr was before me — the team working with Symplr felt that it wasn’t living up to the contracted standards with regard to primary source verifications. I don’t know if that’s true or not but that was what I was told. They were looking for a tool that could do data tracking as well as CVO services.

How was the onboarding and setup experience?

I joined at the tail end of the implementation process. The onboarding part seemed to go well. I was working with an implementation manager to fine-tune the reports. We did have some turnover during that period so the process took a little longer than it would have otherwise. It was easy to work with them, but slow to see the results of our requests. We would ask for a custom report and they would build it for us and send it back for approval, and then when we tested it, we’d find out that things weren’t pulling correctly. So there was a lot of back and forth on getting those reports built. They were easy to work with, but it was just slow. There are still some problems with some of the reports, but they’re issues we can fix on our side.

What are the use cases you have for Modio?

We’ve used Modio in a couple of ways. One way is to take a provider’s CAQH application, enter the data into Modio from there, and then send it to our CVO, which is VeriFide, to perform all the primary source verifications. And then when that comes back, we check that the data we entered is still true and accurate, and send that file to our medical director for approval of their credentialing. We’ve also tried sending providers a link to Modio so they can fill out the information themselves. But we’ve found that doesn’t work as well, because providers won’t always fill out all the required information. We’ve settled on just doing the data entry ourselves, since even with the second method, we ended up doing a lot of the data entry anyway.

Modio does have features to verify their licensing information, but it doesn’t run in the background automatically, so you have to click a button to run the verification. This is a more manual, time consuming way and you may not catch an action on a license until after it is imposed. Other systems will run an automatic query in the background making it a more efficient process. .

What strengths and weaknesses do you see with Modio?

It’s intuitive and easy to enter data. The verification tool is very helpful, because then you don’t have to know which licensing website to go to across all the different types of behavioral health licenses across the different states. It’s hard to be sure you’re hitting the right one if you do that manually.

They also have a feature to send out different forms for filling out or for signature which is very helpful. Once the forms are signed or completed, the form automatically goes into their record and we don’t have to upload it ourselves.

As for weaknesses, you do have to be proactive and initiate the verification step to make sure licenses are being renewed. It doesn’t stop or alert people if they skip over a required field, so it’s easy to end up with incomplete data. Some of the verifications don’t match up to the right licensing board, and then we have to ask Modio to fix it. Some of the licensing boards require a fee, and it’s not set up to just charge us a pass-through fee, we have to go outside of the system and verify it manually.

Also, other platforms have the option of pulling in data automatically from CAQH. When we were initially talking with Modio, they said this feature was on their roadmap, and it continues to be on their roadmap. It’s something they still haven’t gotten to. So we still have to manually enter that data into Modio.

How effective has Modio been in meeting your needs overall?

Overall it’s been supportive. We’ve been able to do what we need to do. However, we’re approaching 1,000 practitioners on our platform, and I think it worked better when we had a much smaller number. At the point we’re at, we’re trying to tie so many practitioners to so many health plans, and it’s too big for Modio to be able to handle it well. I’ve heard from a lot of organizations that it works better with maybe 200 practitioners or less. Other services have more automation to map provider plans and can more easily handle providers who are licensed in multiple states, and can combine data tracking with a services CVO in one platform.

What other services have you looked at as you consider switching?

We’ve evaluated CertifyOS and Verifiable. They both seem to have very similar features, and both have a lot more automation than Modio.

Have you looked into combining platforms and using Modio as your, primary source verification tool to handle the CVO services as well?

Modio does offer a CVO services package, but it’s extremely expensive, so expensive that negotiations wouldn’t even help. And I’m not sure they would be able to do all the verifications we need, either.

How has Modio’s platform reliability and stability been?

Whenever they update, especially if it’s a large update, they’re notorious for going down, sometimes for weeks. And it seemed like we would go back into files after an update and find that data was missing. So we all get a little nervous when they update.

Is Modio integrated with any other part of your tech stack?

They are not. We have an SFTP report that gets pulled daily and loaded into our EHR, but it’s not a true integration, it’s a workaround. Modio doesn’t talk to any other systems.

Does the solution you’re looking at moving to have integrations?

We’ll be working with Verifiable, and they do have APIs that can integrate with other systems. We’re working on setting that up so we have one source of truth for our data.

How does the price compare for Verifiable?

It’s more expensive on paper, because we’ll be utilizing their services as well. But the efficiencies we’ll gain will far outweigh the overall cost compared to Modio.

How has the support and account management experience been?

Generally it’s very good. They’re responsive and helpful when they know the answer. But sometimes, we’ll ask about an issue and they won’t be able to help us. For example, one of the licenses wasn’t pulling updated data from the spreadsheet on the state’s website, and nobody knew how to get that fixed.

Do you think your team made the right choice in going with Modio back in 2020?

No, I don’t, just knowing what I do about the things we would need in the future. I knew it wasn’t going to meet our needs. I think they should have stayed with Symplr to keep all the services in one spot instead of working with multiple systems. But there may have been a cost factor involved.

Do you have any advice for folks looking for a credentialing network management tool?

Make sure you’re either okay with it being basically a data warehouse, or if you need automation to get your credentialing done. A lot of contractors enjoy using Modio because they can set it up in different ways, and they have maybe 10 people they’re keeping track of. But if you have a larger organization, I would advise looking at some other systems. If you’re small but planning to grow, you may need to reevaluate once you get to that point.