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Explore Various Scenarios in Reverification Automation
Discover the various scenarios that can occur within each step of the orchestrator, along with next step.
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. |
| Stage Name | Step Name | Scenario | Next Step |
|---|---|---|---|
| Update Patient Personal and Healthcare Details | Send Email | If you don't send an email by using Agentforce within the time frame set by your Salesforce admin, the send email action is timed out. | Reach out to the patient to get their latest personal and healthcare details, and manually reverify their benefits. |
| Wait for Patient Response | If the patient doesn’t respond to the assessment within the time frame set by your admin, the wait for patient response action is timed out. | Reach out to the patient to get their latest personal and healthcare details, and manually reverify their benefits. | |
| Update Patient Details | If you don't update the patient details by using Agentforce within the time frame set by your admin, the update patient details action is timed out. | Update the patient's latest personal and healthcare details based on the responses received. | |
| When there’s no change in patient details and the Update Details button isn’t available in Agentforce. | Depending on your business use case, either update the care benefit verify request status to Completed, or manually reverify benefits. | ||
| When the patient’s insurance details are changed and the Update Details button isn’t available in Agentforce. | Create a new verification request based on the latest details received in the patient's responses. | ||
| Process Electronic Verification Request | Initiate Electronic Benefits Verification Request | If the automation fails while connecting with the clearing house. | The care benefit verify request status is updated to Error, and the automation proceeds with the manual verification process. |
| When the clearing house doesn't respond within the time frame set by your admin, the initiate electronic benefits verification request action is timed out. | The care benefit verify request status is updated to Timed Out, and the automation proceeds with the manual verification process. | ||
| When the clearing house can't process the request and rejects it. | The care benefit verify request status is updated to Rejected, and the automation proceeds with the manual verification process. | ||
| When MuleSoft can't process the response from the clearing house. | The care benefit verify request status is updated to Error, and the automation proceeds with the manual verification process. | ||
| When MuleSoft can't send the request to the clearing house because of the invalid credentials or request. | The care benefit verify request status is updated to Error. Fix the errors and retry the electronic verification. | ||
| When MuleSoft can't send the request to the clearing house within the time frame set by your admin. This can happen due to invalid credentials or requests. | The care benefit verify request status is updated to Error. Create a new verification request based on the latest details received in the patient's response. | ||
| Validate Essential Benefits | If the essential benefits are missing from the payor's response. | The care benefit verify request status is updated to Partial, and the automation proceeds with the manual verification process. | |
| When there’s an error while validating essential benefits. | The care benefit verify request status is updated to Verified. Validate essential benefits in the payor response, and share the patient’s benefits summary with the Healthcare Professional (HCP). | ||
| Send Email to Healthcare Professional | When there’s an error in sending the benefits summary email to HCP. | Share the patient’s benefits summary with the HCP. | |
| Process Manual Verification Request | Send Email to Payor | When there’s an error in sending an email with a secure assessment URL to the payor to confirm the patient’s latest benefits details. | Connect with the payor to get the latest benefits details, and share the patient’s benefits summary with the HCP. |
| Validate Essential Benefits | If the essential benefits are missing from the payor's response. | The care benefit verify request status is updated to Partial. Connect with the payor to get the latest benefits details, and share the patient’s benefits summary with the HCP. | |
| When there’s an error while validating essential benefits. | Validate essential benefits in the payor response, and share the patient’s benefits summary with the HCP. | ||
| Send Email to Healthcare Professional | When there’s an error in sending the benefits summary email to HCP. | Share the patient’s benefits summary with the HCP. |
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