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Set Up Data for Benefits Verification

To help your users get the most out of Benefits Verification, configure your org with the necessary data for patients, payers, purchaser plans, and member plans.

Required Editions

Available in: Lightning Experience

Available in: Enterprise and Unlimited Editions with Health Cloud or Life Sciences Cloud
User Permissions Needed
To create payer, member plan, and purchaser plan records:

Health Cloud Starter (for Life Sciences Cloud) permission set

OR

Health Cloud Foundation (for Health Cloud) permission set
  1. Verify that each patient has a person account record.
  2. Add Payer accounts with identifiers.
    1. From Setup, go to the Account object in Object Manager, and then add Identifiers as a related list to the Business Account page layout.
      In benefits verification, identifiers are required for each payer record to populate the payer ID in the verification request.
    2. From the App Launcher, find and select Accounts.
    3. Click New.
    4. Select Business Account as the record type and click Next.
    5. Enter the payer name and other relevant information.
    6. Save your changes.
    7. In the Identifiers related list, click New.
    8. In ID Value, enter the value specific to your country or region.
    9. Save your changes.
  3. If the payer belongs to an insurance group, create a healthcare payer network record.
    1. From the App Launcher, find and select Healthcare Payer Networks.
    2. Click New.
    3. Enter the payer network name.
    4. In Payer, select the business account of the payer.
    5. Select a network type.
    6. Set the network status to Active.
    7. Enter the date that the payer network is effective from. If necessary, enter the date that the network is effective until.
    8. Save your changes.
  4. Create a payer plan that a purchaser makes available to its members and their dependents.
    1. From the App Launcher, find and select Purchaser Plans.
    2. Click New.
    3. Enter the plan name.
    4. In Payer, select the business account of the payer.
    5. Select a plan type.
    6. Set the plan status to Active and make sure the Verifiable option is selected.
    7. Save your changes.
    8. In the Plan Benefits related list, add the benefits offered by this purchaser plan.
  5. Create a member plan to represent the details of the insurance coverage for a member or a subscriber. The member plan record shows the information that's visible to users in the Benefits Verification component. To show all data in the component, populate as many fields as possible.
    1. From the App Launcher, find and select Member Plans.
    2. Click New.
    3. Enter a name for the member plan.
    4. In Member, select a patient.
    5. Enter the member number.
    6. Enter the group number.
    7. In Plan, select the purchaser plan that the patient purchased.
    8. In Payer, select the account for the payer organization.
    9. Enter the date that the member plan is effective from. If necessary, enter the date that the plan is effective until.
    10. Select Active as the status.
    11. In Primary/Secondary/Tertiary, select a value to indicate whether this plan is the primary, secondary, or tertiary plan.
    12. In Relationship to Subscriber, select a value such as Self or Spouse.
    13. In Payer Network, select a healthcare payer network.
    14. Save your changes.
    15. In the Coverage Benefits related list, add the benefits covered by this member plan.