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            Verify Eligibility and Benefits

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            Verify Eligibility and Benefits

            Verify a patient's eligibility and benefit details for healthcare providers. Use the agent to search for records across integrated systems and clearinghouses to confirm member eligibility. Streamline the verification process by automatically gathering required patient details and service information to confirm benefits before care is provided.

            Required Editions

            Available in: Lightning Experience
            Available in: Enterprise and Unlimited Editions with Agentforce for Health Cloud, Universal Credit Metering, and Agentforce Employee Agent add-on licenses.
            User Permissions Needed
            To manage patient registration and data retrieval:

            Manage Contact Center for Health Cloud

            AND

            Use Contact Center AI Assistive Agent

            AND

            Data Cloud User

            AND

            Health Cloud Foundation

            AND

            Prompt Template User
            Note
            Note The user interface of this product is available in English only and may not be fully supported in other languages.
            Note
            Note The agent uses public FHIR APIs to retrieve patient data in real time, including demographic data, clinical records such as prescriptions, lab results, health conditions, procedures, referrals, and care plans, and administrative data such as visit encounters, coverage, and eligibility and benefit details from any certified EMR such as Epic, Oracle Cerner, and AthenaHealth. Data retrieval has been tested in the publicly available sandbox environments of these EMRs.

            The agent leverages a pre-packaged MuleSoft API to interact with these FHIR endpoints. To enable the integration, provide the EMR-specific FHIR base URLs and credentials outlined on the MuleSoft setup page.

            1. From the App Launcher, find and select Contact Center.
            2. Open the Agentforce panel and select the agent for Contact Center if it isn't selected by default.
            3. To verify a patient's eligibility or benefits, type a message in the chat asking the agent to retrieve the patient's member plan or coverage and include the patient's first name, last name, and date of birth in your request.
             
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            Salesforce Help | Article