Reduce the time patient services reps spend on call with payors to determine the
missing fields from the benefits summary. Pharmacy Benefits Verification uses Einstein
Generative AI to help patient services reps generate a call script, which they can use to fetch
missing coverage information from payors.
Required Editions
Available in: Lightning Experience
Available in: Enterprise and Unlimited Editions with Health Cloud
or Life Sciences Cloud, and Einstein GPT Platform and Einstein GPT Prompt Builder
Add-On licenses
User Permissions Needed
To generate call script
Context Service Admin permission set
AND
Context Service Runtime permission set
AND
Prompt Template Manager permission set
AND
Prompt Template User permission set
AND
Manage Pharmacy Benefits Verification permission set
Before you generate the call script for payors, make sure the verification request is
initiated.
With Pharmacy Benefits Verification, patient services reps can generate a call script by
using an auto-launched flow. This call script includes a subset of the missing information
in the benefits summary that's required to complete the patient’s pharmacy benefits
verification request.
The call script is divided into four sections. The first section highlights the patient’s
information. The second section outlines the insurance coverage information, and the third
section highlights the information related to the drug that’s prescribed to the patient. The
fourth section includes the list of all the fields that the coverage information is missing for.
You can copy this script with a single click.
Important To customize the Generate Call Script flow according to your business
needs, implement the TransposeContext interface.
From the App Launcher, find and select Care Program Enrollee.
Select a care program enrollee.
On the Pharmacy Benefits Verification tab, in the Benefits Summary
section, click Generate Call Script.
Note The tab name can vary based on the admin setup of your Salesforce org.
The Generate Call Script flow is launched.
To accept the disclaimer for Einstein AI usage, click Got It.
The call script is generated.
Here’s a sample call script.
To copy the call script to the clipboard, click Copy.
Warning This tool uses generative AI, which can produce inaccurate or harmful
responses. Before using, review the output for accuracy and safety. You assume responsibility
for how the outcomes of Einstein are applied to your organization.
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