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Pharmacy Benefits Reverification
Use Pharmacy Benefits Reverification to periodically check a patient's eligibility for pharmacy benefits under their health insurance. Reverification ensures that patients continue to get the right coverage for their prescription medications without any breaks.
Required Editions
| Available in: Lightning Experience |
| Available in: Enterprise and Unlimited Editions with the Health Cloud or Life Sciences Cloud license. It's also available with these add-on licenses: Agentforce for Life Sciences Cloud or Agentforce for Health Cloud, Flex Credits Metering, Agentforce Employee Agent, Einstein GPT Platform, Einstein GPT Copilot, Einstein GPT Trust, Genie Data Platform Starter, and Einstein GPT Prompt Builder. |
With Pharmacy Benefits Reverification, insurance providers can save considerable time and resources when reconfirming pharmacy benefits for patients in care programs, especially at year-end when insurance plans and coverage frequently undergo changes.
Reverifying pharmacy benefits helps control costs for both insurance providers and patients by making sure the coverage is necessary and used correctly. It also prevents potential fraud or misuse of these benefits. Regular reverification helps achieve the goal of providing efficient, cost-effective, and suitable drug therapy to patients.
- How Automation Streamlines Pharmacy Benefits Reverification
With the reverification automation process, your reps can reverify patient benefits as needed. The automated reverification process significantly reduces manual intervention, ensuring accurate, timely updates and comprehensive communication of patient benefits details between patient services reps and healthcare professionals. - Understand the Reverification Request Generation
Pharmacy Benefits Reverification uses two flows and one data processing engine to generate a new copy of Care Benefits Verify Request records. - Assign Permissions to View Reverification Automation Status
Provide your program leads and patient services reps the permissions to view the automation status of the reverification of the care benefit verify request and care program enrollee record pages. - Set Up an Email Address for Automated Process User
Configure process automation settings by adding an email address to send emails to payers and healthcare professionals from the orchestrator. - Set Field-Level Security for Pharmacy Benefits Reverification
To use the full functionality of the Care Benefit Verify Request Data Processing Engine (DPE), you must provide field-level access to specific fields for the Analytics Cloud Integration user profile. - Enable Data Pipelines for Pharmacy Benefits Reverification
To run the Data Processing Engine for pharmacy benefits reverification, enable Data Pipelines. With Data Pipelines you can query and compute data that's available in your Salesforce org. - Clone and Activate the Care Benefit Verify Requests Data Processing Engine Definition
Before your program leads can use the Initiate Benefit Reverification flow in your org, you must create a clone of the existing Data Processing Engine definition and activate it. The flow uses the cloned definition to copy care benefit verify request records for benefits reverification. - Activate the Payor Benefits Assessment Omniscript
Help payors fill the assessment by activating the Omniscript that includes a list of questions for the payors to get the patient's missing benefits details. - Pharmacy Benefits Reverification Flows
Pharmacy benefits reverification uses flows to initiate electronic or manual verification requests, validate the essential benefits in the payor response, and share a summary of patient's benefits details with the healthcare practitioner. - Add Real-Time Reverification Updates to Record Pages
Configure the PharmacyBenefitsVerificationCareBenefitVerifyRequestOverallStatus Flexcard on the care program enrollee and care benefit verify request record pages to provide an at-a-glance view of the entire benefits reverification process and its detailed steps. Minimize manual intervention by showing real-time updates on relevant record pages.
