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            Data Management for Pharmacy Benefits Verification

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            Data Management for Pharmacy Benefits Verification

            To help your users get the most out of the Pharmacy Benefits Verification, configure your org with the necessary data. For patients, admins must set up the data that’s automatically populated in the guided flow. For pharmacies, purchaser plans, member plans, products, care program, and related objects, admins must set up the data that’s further used in creating the verification request.

            Required Editions

            Available in: Lightning Experience
            Available in: Enterprise and Unlimited Editions with Life Sciences Cloud or Health Cloud
            • Add a Patient, Identifier, Contact Point Phone, Contact Point Email, and Contact Point Address
              In pharmacy benefits verification, patients are represented as a person account. Create a person account to represent the patient, its identifier, contact point phone, contact point email , and contact point address. Identifiers are required for each patient to get their patient ID.
            • Add a Practitioner, Identifier, and Healthcare Provider NPI
              In the Health and Life Sciences industry, practitioners play a critical role by providing essential healthcare to patients. In a pharmacy benefits verification request, patient services representatives provide the name and an ID of the practitioner who takes care of patients. Pharmacy Benefits Verification uses a numeric ID to specify a practitioner. In the US, this ID is the National Provider Identifier (NPI), but you can substitute the ID used in your country or region.
            • Add a Payor, Identifier, Contact Point Phone, Contact Point Email and Contact Point Address
              In pharmacy benefits verification, payors are represented as a business account. Create a business account to represent the payor, its identifier, contact point phone, contact point email, and contact point address. Identifiers are required for each payor to get their payor ID.
            • Add a Pharmacy, and Identifier
              Pharmacies provide patient access to essential medications and healthcare products. In the pharmacy benefits verification request, agents provide the preferred pharmacy name that the pharmacy benefits must be verified for. Pharmacy Benefits Verification uses a numeric ID to specify a pharmacy.
            • Add a Purchaser Plan
              Create a payer plan that a purchaser makes available to its members and the dependents of the members.
            • Add a Member Plan and Identifier
              Create a member plan to represent the details of the insurance coverage for a member or a subscriber.
            • Add a Product, Code Set, and Code Set Bundle
              Pharmacy Benefits Verification uses Product as a base object to represent the drug or medicine that’s prescribed to the patient. Representataives verify the pharmacy benefits for each drug prescribed to the patient.
            • Addition of Care Program and Related Records
              Pharmacy Benefits Verification uses care program as the backbone of its operation. At its core, pharmacy benefits verification uses care programs, care program enrollees, and care program products.
             
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