Benefit Verification Review

Develop Health enhances the healthcare experience by providing an intuitive Benefit Verification Review process within our platform. This ensures healthcare providers can swiftly and accurately verify patient benefits, streamline their workflow, and keep all relevant parties informed.

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Benefit Verification Workflow

When a benefit verification request is initiated through our API, it will appear initially as ‘Pending’ in the task list, which means the benefit verification is currently being evaluated. Please note, since this is an AI powered system that attempts to contact the PBM, it is normal for the task to remain in the ‘Pending’ state for several minutes to a few hours. Once completed, the task’s status will update to either ‘Completed’, ‘Partially Completed’, or ‘Failed’ depending on the outcome of the AI’s process.

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Reviewing Benefit Verification Results:

Upon completion of a benefit verification, the provider is presented with a detailed breakdown of the results:

• Coverage Table: This table displays the status of each requested drug. This includes the patient’s coverage for this drug, if a prior authorization is needed, and the estimated copay amount.

• Patient Coverage Status: A simple indication of whether the patient is covered by the plan. It will report whether the patient’s coverage is active, inactive, or unknown.

• Completion Status: Each task is highlighted with a completion status indicator, which reflects the results of the verification process—‘Completed’, ‘Partially Completed’, or ‘Failed’.

• Verification Method: The method used for the verification is displayed, such as AI calls, indicating the methodology utilized in obtaining the verification results.

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Validation Tools

To ensure accuracy and transparency:

• Transcript Viewing: Providers can view a transcript of the verification call, which details the conversation conducted for verification purposes.

• Recording Access: For further validation, the actual recording of the call can be accessed, providing transparency into the verification process.

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Mark as Reviewed

After reviewing the verification results, providers can mark the task as ‘Reviewed’, which indicates that the information has been acknowledged and any necessary actions have been taken.

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Conclusion:

The Benefit Verification Review on the Develop Health platform is a crucial tool for healthcare providers. It simplifies the verification process, offers detailed insights into patient coverage, and provides robust validation options, all while streamlining administrative tasks. This comprehensive approach ensures patients receive the necessary medications without delay, and healthcare providers can maintain efficient operations.