PSP Benefits Verification

The Patient Services Benefits App for Salesforce Life Sciences or Health Cloud enables automated benefits verification through integration with multiple third-party vendors to effectively run patient services programs. This integration app allows customers to connect with payer and pharmacy benefits manager (PBM) systems based on patient, insurance, prescribed drugs, and preferred pharmacy information.

This app also provides the capabilities to consume the responses from the third-party service into the Pharmacy Benefits Verification Data Model (CoverageBenefit, CoverageBenefitItem, CoverageBenefitItemLimit, CareBenefitVerifyRequest, MedicationRequest). These superior experiences enable admins to use the patient services app to set up and configure third-party vendor details. Patient services representatives can then request a benefit verification request, receive an async response, and provide the patient with accurate information about their benefits and eligibility for the prescribed medication.

Patient services representatives can use these benefit details for informed decision making and other downstream activities like verifying if the patient is eligible for financial assistance.

Key features include FHIR compliance, data transformation, scalability, and robust security measures.

The Rtpbc Request Bundle is used to send pharmacy benefit verification requests to the healthcare clearinghouse or payer system. The Rtpbc Claim Response is used to get the pharmacy benefit verification response from the clearinghouse or payer system.

This integration app is for any payer or clearinghouse system that exposes an FHIR implementation Rtpbc claim-compliant endpoint. This integration app is clearinghouse or payer system agnostic.