Pharmacy Benefits Verification Request

Manual Verification Request

With manual verification request, you can connect directly with payors to get the patient's benefits details and manually record the coverage details in the benefits summary section.

Electronic Verification Request

With electronic verification request, the data exchange is automated with third-party clearing houses which then further connect with payors to find out the patient's pharmacy benefit details. The coverage response received in an electronic verification request gets updated in the benefits summary section. You can edit the responses, if necessary. You can also initiate an electronic verification of an existing manual request.

To validate the insurance coverage and determine the coverage summary for each drug that’s prescribed to the patient under a care program, go to any care program enrollee record page and click Pharmacy Benefits Verification. The page contains a panel that lists the member plans associated with the patient. If the patient is associated with more than one member plan, you can connect with the patient to get details about the member plan that's considered for benefits verification. Depending on the type of verification you want to carry out for the patient, you can verify the coverage benefits against any member plan by clicking the New Electronic Request or New Manual Request buttons.