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Understanding Pharmacy Benefits Reverification Flows
Automate various tasks in Pharmacy Benefits Reverification using pre-built flows. Customize these flows to run patient support programs according to your requirements.
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. |
| Flow | Description |
|---|---|
| Initiate Benefit Reverification | Initiates a benefit reverification request based on data provided by the flow user. |
| Copy Care Benefit Verify Request Fields | Copies the authorized prescription, original prescription, and coverage benefit from a source care benefit verify request to a target care benefit verify request. |
| Wait for Care Benefit Verify Request Status Change | Waits for a care benefit verify request status change from Pending Confirmation to Ready For Verification. |
| Process Electronic Benefits Verification | Sends an Electronic Benefit Verification request to a clearing house, waits for the response from MuleSoft, and updates the status of the Care Benefit Verification Request record. |
| Update Coverage Details | Update the benefits coverage details in the care benefit verify request and related records based on the payor's response. |
| Validate Essential Care Limit Types | Validates if all the essential care limit types are present in the payor response. |
| Send Email To Payor | Sends an email to the payor with an assessment URL to get patient’s latest benefits details. |
| Send Benefits Summary Email | Sends a benefits summary email to the healthcare professional with the patient's latest benefit details. |
| Get Benefits Details using Context Service | Gets the benefits verification details using context service. |
| Publish Care Benefit Verify Request Status Change Event | Publishes a care benefit verify request status change event when the status of the care benefit verify request record is updated. |
| Reverify Benefits | Reverifies patient’s personal and healthcare details, then proceeds with either an electronic or manual benefits reverification. After validating the payor response, the flow shares the patient’s benefits summary with the healthcare professional. |
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