Work with Benefits Verification

Learning Objectives

After completing this unit, you’ll be able to:

• List the steps to set up Benefits Verification.
  
• Explore and verify a patient’s benefits in real time.
  

Set Up Benefits Verification

For healthcare providers to access a patient’s benefits and eligibility details from the patient record, it’s essential to integrate benefits verification into the end-to-end patient access workflow. 

Here’s a list of the high-level tasks that your Salesforce admin completes to set up Benefits Verification.

• Build backend data: Build patient data such as patient records, coverage plans, and end-user permissions.
  
• Connect to an external benefit service: Configure the connection to the external service that contains patient coverage information. Benefits Verification typically integrates with external third-party solutions and obtains the data in real time.
  
• Determine the patient benefits: Configure a service request to the external benefit service to determine the benefits available to patients.
  
• Show benefits on a patient record page: Add the Benefits Verification component to the patient account page layout. With this configuration, you can view a patient’s benefit details on a separate tab of the patient record page. You can also customize the name of the tab.
  
  
• Model workflows using the data model: Use objects from the Benefits Verification data model to map and store all the data.
  

For detailed setup instructions, see Set up Data for Benefit Verification.

Verify Patient Benefits

Now that all set-up tasks are done, it’s time to see Benefits Verification in action. You must follow these instructions to verify the insurance coverage, benefits, and eligibility details of a patient.

Open the patient’s account record, and click the tab that the Salesforce admin configured with the Benefits Verification component. You see a list of the available health insurance plans for the patient.

To verify the plan benefits, click Verify Benefits.

The page then updates with real-time details of the patient’s eligibility, coverages, and benefits for the selected plan.

Under Plan Level Benefits, you can view payment-specific eligibility and benefits of the patient. For example, you can easily compare the amount the patient has to pay for covered services in a plan year with the amount covered by the insurance company. You can also see the total amount claimed so far and the amount that the patient can still claim. 

Under Coverage Benefit Details, you can access a categorized list of plan benefits. For example, you can view details of any emergency services that the healthcare provider offers for the immediate treatment of sudden medical issues.

Cool, isn’t it? Healthcare and life sciences organizations can be free of the pain and effort of liaising with every entity, patient, health provider, and insurance provider to get eligibility and benefit details for every patient. 

Salesforce offers a single platform for patient intake and management and removes the need to use another console or system to verify patient benefits. Moreover, the ability to verify coverage in real time means you’re always sure of accurate data. 

Resources

• Salesforce Health Cloud Developer Guide: Benefits Verification Data Model
  
• Salesforce Health Cloud Developer Guide: Benefit Verification