Vida Program Devices are essential tools for our members. This guide details device eligibility, the ordering process for all clients, and product specifications for scales, blood pressure monitors (BPM), and glucometers. When a member asks, "Am I eligible for a scale?" or "How do I order this?", never speculate. Device eligibility is complex and varies by PayOrg, Condition, and Program. You must verify eligibility using the Device Ordering Eligibility Looker before providing an answer. In the event that the looker is not working you can follow the manual workflows listed below.
Table of Contents
Handling Eligibility & Ordering Inquiries
Continuous Glucose Monitor (CGM) Ordering
Withings Blood Pressure Monitor (BPM) Eligibility Check
Exceptions for Device Orders (Tier 2 Approval Required)
Device Specifications and Troubleshooting
Quick Links for Eligibility and Ordering
| Resource | Purpose |
|---|---|
| Device VP Card | Confirm which devices an organization/program supports, and check specific requirements for eligibility. |
| Device Ordering Eligibility Looker | The primary tool to check member-specific eligibility, rules, and order status (Training Context). |
| How to order your device in the app (Public Article) | The self-service guide to share with members for ordering. |
| Clinical Device FAQs | Check specific client requirements for eligibility. |
| Check Order History | Check previous orders. |
| New CS Device Requests | Tier 2 adds new orders to this sheet. |
Handling All Device Eligibility & Ordering Inquiries
When a member asks, "Am I eligible for a scale?" or "How do I order this?", do not guess. Check their eligibility using the Device Ordering Eligibility Looker.
The Looker Investigation Workflow
To determine eligibility, agents must verify the data in the Device Ordering Eligibility Looker report:
Step 1-Filter by Organization: In the "Device Rules by Paying Organization" table, select the member's PayOrg to see the specific Program, Condition, and HTN logic required.
Step 2-Search Member: Paste the member's UUID into the search box to view "Device Ordering Eligibility by Member".
Step 3- Look at the column for the specific device (Scale, Cuff, Meter).
TRUE: The member is eligible to receive the order form.
FALSE: The member is not eligible. See "Troubleshooting" section below for deep-dive investigation.
| Eligibility Status | Agent Action | Required Macro |
|---|---|---|
| Eligible | Confirm eligibility. Direct member to in app ordering method detailed below. | Device Order Support - Eligibility Confirmed |
| Not Eligible | Inform member the device is not covered by their current program. | Device Order Support - Not eligible for Device(s) |
| Need MMS Score | Send the following macro and await response from member. |
Device Support::Eligibility::MMS - Medication Verification |
The Ordering Process
Members must complete an in-app survey (sent up to 4 times) to confirm they don't already own a qualifying device.
The order form is only sent after the survey is complete.
It takes up to 72 hours after the initial consult w/ the RD for the forms to generate.
Check Form Status: Use the "Device Order Form Details" table in the Looker to see if the form is Initialized (sent to To-Do list) or Complete (filled out).
Manual Order Assist: If the member cannot complete the survey, or has incorrectly filled it out support can manually assist with ordering the device. T1 can complete all steps to verify eligibility with the member and T2 can add the request to the device order sheet and update the ticket status once the order has been placed.
Continuous Glucose Monitor (CGM) Ordering
Check their eligibility using the Device Ordering Eligibility Looker.
Ordering a CGM (Excluding Walgreens + CapRx) requires a strict review of multiple clinical criteria.
Process
Check All Criteria: Review the table below to find the specific block.
Submit JIRA: If any item is blocked, submit a [System] Service Request to JIRA via the Zendesk app-panel.
JIRA Details: The JIRA ticket must include a list of all checked criteria and a clear explanation of the issue.
CGM Eligibility Check (Must Pass All)
| Check Location | Criteria |
|---|---|
| HG Platform | Member received and filled Form: CGM Questions |
| Ask the member to check To-Do list | MMS score is 5 or higher must be on insulin |
| Looker Report (see MMS Check below) | A1c within the last 26 weeks |
| Admin | Enrolled in an eligible program |
| VP Card | Pay org supports CGM |
| VP Card | Not terminated in B2B |
| B2B | Had a consult (past or scheduled) |
| HG Platform | Member received and filled Form: Order Your CGM |
| Ask the member to check To-Do list | Member completes the To-Do item |
Checking Max Med Score (MMS)
Tier 2 only has access to the MMS looker. If T1, escalate to tier 2 to check. MMS must be confirmed for members of clients with MMS criteria for both blood glucose (BGM) (most orgs require 3 or higher but check VP card for confirmation) and continuous glucose meters (CGM) (Most orgs require 5 or higher check VP card for confirmation).
Claims Data (Preferred): Run the member’s UUID in the Max Med Score User Lookup Looker report.
Manual Check (If no Looker result): Ask the member for their diabetes medications. Look up the medication class using the [max med score_details] Google sheet to determine the MMS.
Medication Complexity Score is calculated based on level of diabetes medications a member is on
- 1 no diabetes medication
- 2 - metformin
- 3 - other diabetes medications (SGLT-2, GLP-1, DPP-4, acarbose, TZDs)
- 4 - sulfonylureas
- 5 - long acting insulin
- 6 - multiple short acting insulin
Withings Blood Pressure Monitor (BPM) Eligibility Check
Check their eligibility using the Device Ordering Eligibility Looker.
Check Payer Requirements: Verify if the Paying Organization has a specific eligibility requirement related to Blood Pressure (BP) readings (Use "HTN Logic" column in Looker).
-
Request Latest BP: If a requirement exists, ask the member to either:
Log their latest BP reading in the app.
Provide their latest BP reading directly.
Confirm Eligibility: Use the reading provided to determine device eligibility.
Confirm Size: Confirm their arm circumference to determine what size of BMP is needed (follow the device order macro template).
Exceptions for Device Orders (Tier 2 Approval Required)
Check their eligibility using the Device Ordering Eligibility Looker.
| Device Type | Exception Made If... |
|---|---|
| Meters | Member has MMS 2 and coach indicates a strong need. Member is transitioning from another program and is running out of supplies. Walgreens Only members can request a meter. |
| Scales/Cuffs/Oximeters | NO EXCEPTIONS unless there's an incredibly strong clinical need approved by a coach and coach lead. |
Device Specifications and Troubleshooting
Check their eligibility using the Device Ordering Eligibility Looker.
Troubleshooting Eligibility via Looker
If a member's eligibility is "FALSE" in the Looker, check the specific Device Type Tab (e.g., Scale Eligibility) to find the failure point:
Program/Conditions: Is the member in the correct program with the included conditions (e.g., Diabetes, HTN).
Survey/Consult: Has the member answered the device survey and completed their RD consult.
Prior Orders: Ensure the "Does Not Have Device Prior" field is TRUE.
| Device | Key Details & Shipping | Troubleshooting/Escalation |
|---|---|---|
| Withings Scale & BPM | Shipped by Vida in ~10 days. Devices are pre-connected. The member will receive an email from Withings with tracking once the device has been shipped. Scale max 440 lbs, gives weight, BMI, and weather. |
Troubleshooting your Withings Scale
General Issues: Use relevant internal KBs. |
| Philips Glucose Meter (BGM) | Tracking/Status: The member will receive an email for Philips with tracking information once the order has been shipped. For additional questions the member must call Philips directly (888-666-4530, M-F, 9 AM-9 PM EST). Starter Kit includes meter, 100 test strips & lancets, and charger. |
Philips Glucose monitor Internal Support Guide
Test Strips/Lancets: Refer to the dedicated KB article for supply details. |
| Continuous Glucose Monitor (CGM) | The CGM continuously tracks your glucose. Your provider will prescribe the CGM and it is shipped directly from the pharmacy/manufacturer. |
Dexcom Data Check:
1. Have member log into their Dexcom portal.
2. Confirm data is being shared with Vida.
3. If confirmed but readings are still missing, Escalate to Product Ops.
CGM Troubleshooting: If a member is connected but not seeing the data in the app, they need to link their Dexcom within the Vida app. Linking through the Clarity portal does not connect to our database for credit. The Clarity portal only shows long-term trends for clinicians and does not link to our app automatically. Direct the member to link their device in the Vida app using the KB article: How to Connect a Dexcom CGM to Vida. |
| ChoiceMMed Pulse Oximeter | The pulse oximeter should get to the member within 10 business days. If they have any questions about their order, they are directed to contact the customer support team. | If they have tried the steps listed here Getting started with your ChoiceMMed Pulse Oximeter to no avail, refer the member to contact ChoiceMMed by visiting https://www.choicemmedamerica.com/contact-us and filling out the form. |
Comments
0 comments
Please sign in to leave a comment.