Working on an enrollment case in Workspace
Summarize
Summary of Working on an Enrollment Case in Workspace
The Patient Support Services application includes a playbook designed to assist care coordinators in managing enrollment cases effectively. This feature provides visibility into workflows and actionable steps necessary for completing patient support service requests. Note that Patient Support Services will be deprecated in future releases but will still be supported in existing instances.
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Key Features
- Playbook Activation: Access the Playbook tab when an enrollment case is assigned to you, showing stages for managing the request.
- Stages Available: The playbook consists of stages like Intake, Benefit Investigation, Prescription Details, Program Services, and Resolve and Close.
- Intake Activities: Review enrollment and insurance details, check patient consent, and assess enrollment eligibility.
- Benefit Investigation Activities: Review patient preferences, specialty pharmacy details, and pre-authorization requirements.
- Prescription Order: Place orders by verifying dosages and delivery details with the pharmacy.
- Program Services Fulfillment: Fulfill and track program services, marking activities as complete as they are done.
- Closing Requests: After completing all stages, a resolution code and notes can be added to close the enrollment case, prompting a patient survey.
Key Outcomes
Utilizing the playbook streamlines the enrollment process, ensuring that all necessary steps are followed for efficient patient support. By completing each stage, you contribute to a better patient experience and maintain compliance with support service protocols. The automated notifications and tracking enhance communication and accountability throughout the process.
Use the playbook available with the Patient Support Services application to manage enrollment cases and complete requests for patient support services.
Starting with the Yokohama release, Patient Support Services is being prepared for future deprecation. It will be hidden and no longer activated on new instances but will continue to be supported.
For details, see the Deprecation Process [KB0867184] article in the Now Support knowledge base.
The playbook experience provides fulfillers with visibility into cross-business workflows and the actionable activities used to complete these workflows. When the playbook experience is activated with Workspace in Patient Support Services, the Playbook tab appears for an enrollment case. For more information on how to interact with a playbook, see Interact with Playbook.
As a care coordinator with the sn_patientservice.agent role, you can use the Patient Support Services playbook to complete all enrollment request activities for a patient. You can access the Playbook tab on your Workspace when an enrollment case is assigned to you. The Patient Support Services workflow populates the case data for all launched activities on the Playbook tab. You can select a stage in the playbook to complete the activities associated with the stage.
By default, the following stages are available to you as a care coordinator with the sn_patientservice.agent role on the Playbook tab of the Enrollment request workspace.
Stage |
Description |
|---|---|
Complete the initial enrollment application review activities. |
|
Capture or review the benefits investigation preference opted by the patient and
manage the pre-authorization activities. Note: By default, the Benefit
Investigation characteristic is available for a program within the Patient Support Services application. Your administrator can add more
characteristics and associate them with one or more programs. Depending on the
configuration, the activities associated with a characteristic might appear in the
playbook. |
|
Place a prescription order. |
|
Review and fulfill the program services that the patient has been enrolled into. |
|
Close the enrollment request. |
Completing the initial review activities
- Review enrollment details: Review the patient, prescriber, program, and program services details entered for a patient included within an enrollment request. When the Review enrollment details activity is set to complete, the Patient Support Services workflow automatically sends a consent form to the patient.
- Review insurance details: Capture or review the insurance
information of the patient.
As a care coordinator, you can contact the patient directly to verify the insurance information. You can enter or review the insurance information from the Review Insurance activity of the playbook for Patient Support Services in your Workspace and mark the activity as complete when done.
- Review prescription: Capture or review the prescription ordered
for a patient. You can add a new prescription record to include the prescription
details. If there is no prescription available to you, contact the prescriber to enter
the prescription details.
To add a new prescription, click Add new, fill in the details of the prescription in the Medication Prescription form, and click Save. For more information, see Medication Prescription form.
Note:If there is no medication product associated with the program, the Review prescription activity doesn't appear in the playbook. - Review patient consent: Check the status of completion of the patient consent form assigned to the patient. After the patient completes the to-do item for the consent form, the consent is listed in the activity. As a care coordinator, you can then review the consent and mark the Review patient consent activity to complete in the playbook.
- Review enrollment eligibility: Accept or reject the enrollment request based on the eligibility checklist.
Completing the benefit investigation activities
In the Benefit investigation stage of the playbook, complete the following activities:
- Review patient preference: Review the benefits investigation preference opted by the patient.
- Review specialty pharmacy details: Review the specialty pharmacy details as provided by the patient. The Review specialty pharmacy details activity appears only when the patient has selected specialty pharmacy in the enrollment request form.
- Review pre-authorization: Review and verify if pre-authorization
is required for the program. If pre-authorization is required, click Add
new, fill in the details of pre-authorization details provided by a payer
organization in the Pre-authorization request form, and click Save.
For more information, see Pre-authorization request form.Note:If pre-authorization is not required for the medication prescription, you can skip this activity.
Placing a prescription order
In the Prescription details stage of the playbook, complete the Submit prescription order activity by contacting the pharmacy to place the prescription order. In addition, verify the medicine dosage and delivery location with the pharmacy and capture the expected delivery date.
Fulfilling the program services
In the Program services stage of the playbook, complete the Fulfill services activity by reviewing and fulfilling the program services that the patient has been enrolled into. The Fulfill services activity provides the complete visibility into the services fulfillment status.
In the Number column of the Fulfill services activity, click a program number and when a program service is completed, mark the activity as complete. If required, you can capture the shipping details in the Fulfill services activity along with other details including the tracking number.
When all the program services are fulfilled, the status of the associated enrolled program service record changes to Fulfilled and the date fulfilled is automatically set to the current date.
Closing the enrollment request
In the Resolve and close stage of the playbook, complete the Close enrollment request activity by waiting until all other activities are completed, and then selecting a resolution code and adding any resolution notes. For the case marked as closed complete, a survey is sent out to the patient to fill in.