Benefits! Benefits! Benefits!
This CRM section guides agents through the step‑by‑step Benefit Verification process.
What is the BV Wizard?
If YES is selected for certain questions (like deductible or OOP questions), this happens on the right side of the form.
What is more boxes/questions auto-populate?
After completing the medical payer call, the next BV step is calling this organization if applicable.
What is the PBM?
When a payer refuses to share benefit information, this outcome occurs.
What is being Third Partied?
This acronym provides a snapshot of the patient’s insurance coverage to the HCP.
What is VOB?
The first step in assigning a case for BV is navigating to this section from the home page.
What are My Cases?
The CRM asks whether the provider can obtain medication via this reimbursement method for medical insurance only.
What is PBB/Buy & Bill?
To begin PBM verification, users check the box next to this case element.
What is the Pharmacy type for the case?
When Third Partied or finding coverage has been terminated, the user must collect this unique number and proceed to the end of the call.
What is the Call Reference Number?
Before generating the PDF, you must add program‑specific coverage language from this section.
What is the VOB Blurbs section?
If a case isn't automatically placed in BI status, users must manually set Sub‑Status to this.
What is BI-In Progress?
If the payer confirms that prior authorization is required, these fields immediately appear.
What are PA requirement fields?
PBM verification requires similar data to medical BV, but for this type of coverage.
What are pharmacy benefits?
A Third Partied case must be assigned this Coverage Outcome.
What is Undisclosed?
After adding the VOB text to the case, the system prompts you to verify this contact detail before generating the PDF.
What is the HCP Fax Number?
When verifying plan effective dates, users can manually enter dates or use this feature.
What is the calendar selector or button?
These program‑specific files are stored on SharePoint and used for explanations on Prior Authorizations. Often they are found in a large excel spreadsheet.
What are PA Blurbs?
PBM names auto-populate in the system unless missing, requiring users to do this.
What is create a new PBM entry?
Third Partied and Terminated situations appear under this section of the BV Wizard.
What are BV Special Situations?
Once the VOB is accepted and sent, you return to the VOB and select this option to store it in the case files.
What is “Archive”?
At the end of the medical payer call, coverage is labeled using one of these five outcomes.
What are Covered, Covered with Restrictions, Not Covered, Undisclosed, and Plan Terminated?
A payer URL displayed during PA initiation must be left blank if this is not available.
What is if the payer has no PA website to obtain the PA form?
If pharmacy benefits are part of the patient's coverage, this related step follows to ensure the patient can use their medical benefits to obtain their prescription from the Specialty Pharmacy.
What is the Medical AOB?
In both special situations, this radio button must be updated before proceeding to finish the BV.
What is the Coverage Outcome?
After archiving, the VOB PDF is saved in this case area for future reference.
What are the Files & Outbound Fax quick links?