Device replacement is a Tier 2 process authorized only after all troubleshooting is complete and only for device malfunction or delivery issues. This guide details the Tier 2 agent process, including advanced eligibility checks like the Max Med Score (MMS) lookup, strict criteria for ordering a Continuous Glucose Monitor (CGM), and the reconnection workflow for Withings devices.
Table of Contents
Tier 1 to Tier 2 Escalation Scenarios
Tier 2 Replacement Policy by Client Type
Advanced Eligibility and Ordering
Device Connection and Disconnection Workflows
Device Replacement Policy & Escalation
The decision to replace a device is a Tier 2 process. Replacements are only considered for Device Malfunction or Delivery/Address Issues. Replacements are not offered for lost or stolen devices after the member has received them.
Tier 1 to Tier 2 Escalation Scenarios
| Scenario | Policy and Action |
|---|---|
| Device Malfunction | Action: Requires all troubleshooting to be exhausted (including manufacturer escalation, if necessary). Gather member data and escalate to Tier 2 to process. |
| Address/Delivery Issue | Address Error or Return to Sender: Escalate to the Internal Team to correct the address and re-ship. |
| Lost/Stolen Shipping | We'll send a one-time replacement, but advise the member to arrange an alternative delivery address and contact their carrier for delivery assurance. |
| Member Lost the Device | We don't offer replacements for lost devices. |
| Device Broken by Member | We don't replace devices broken by the member. |
Tier 2 Replacement Policy by Client Type
Agents must ensure the member has completed a consult in the applicable program within the last 30 days before processing any replacement.
| Client Type | Replacement Qualifications | Does NOT Qualify |
|---|---|---|
| Clients with Bundled Devices | Device breaks within 1-2 years (after troubleshooting). If breaks within 1 year, warranty should cover. | Lost, stolen, or broken by member (unless warranty applies). Device breaks 3+ years after original order. |
| Clients with Invoiced Devices | Device breaks at any time after 1 year (after troubleshooting), provided no previous replacement was sent. | Lost, stolen, or broken by member (unless warranty applies). |
| Note (e.g., Boeing) | Can get more than 1 replacement as long as it's been more than 1 year since the last replacement. | Only one non-warranty replacement is sent per year. |
2. Advanced Eligibility and Ordering (CGM / MMS)
Continuous Glucose Monitor (CGM) Ordering
Ordering a CGM (Excluding Walgreens + CapRx) requires a strict review of multiple clinical criteria.
- 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 |
|---|---|
| Member received and filled Form: CGM Questions | Ask the member to check To-Do list |
| MMS score matches current medications | 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 |
Cap RX Continuos Glucose Monitor Order Process
For members enrolled in CapRx plans where the [Vida Prescription required] flag is present in the Vida Platform (VP) Card, please note that Vida's role is strictly limited to prescribing authority only.
This arrangement means that Vida does not provision, ship, or manage the dispensing of any medical devices (such as Continuous Glucose Monitors or CGMs) for your members. Instead, the member is responsible for coordinating the device dispensing through their local pharmacy.
The Simplified Member Journey
Vida's process is designed to ensure clinical appropriateness and provide the necessary prescription to the member's pharmacy. The steps are as follows:
Data Intake: The member inputs their current medical and health data into the Vida platform (app or desktop).
Screening: Based on the member's reported health conditions and clinical data, they are sent a specific device questionnaire (e.g., a CGM screener) within the Vida app.
Clinical Approval: If the member meets the necessary clinical eligibility criteria, they are enrolled in a specific Core Prescribing program under the care of a Vida Medical Provider (VMP).
Prescription Issued: The VMP reviews the case and writes the necessary prescription. The prescription information is then electronically sent to the member's designated local pharmacy.
Device Fulfillment (Member/Pharmacy Action): The member contacts their local pharmacy to coordinate the dispensing of the device. The brand and type of device used are not determined by Vida but are decided between the member and their local pharmacy, in accordance with the member's insurance plan and pharmacy stock.
In summary: Vida ensures the member meets clinical criteria and provides the necessary authorization (the prescription). The fulfillment and product choice are handled externally by the member's pharmacy.
Checking Max Med Score (MMS)
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
Exceptions for Device Orders (Tier 2 Approval Required)
| Device Type | Exception Made If... |
|---|---|
| Meters | Member has MMS2 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. |
3. Device Connection and Disconnection Workflows
Withings Device Reconnection Steps (Tier 1)
If a member reports a Withings device (supplied by Vida) is not connected to the app:
- Ask the member to check for a green checkmark in 'Settings' > 'Connect Devices and Apps' > 'Connect with Fitbit, Garmin, Withings or others'.
- If NO checkmark: Escalate to Tier 2 immediately.
-
If YES checkmark (but no data):
- Ask the member to log 2-4 measurements in a row.
- Verify syncs in Admin (Metric Points, Filter by Weight/BP).
- If no metrics show after confirming a new reading, ask the member to wait up to 24 hours. If data is still missing after 24 hours, escalate to Tier 2.
IMPORTANT: Withings devices are pre-connected and cannot be reconnected by the member via the devices page.
Withings Device Reconnection Steps (Tier 2)
-
Verify Connection Status: Check the Withings Fleet Dash (Link:
https://developer.us.withingsmed.com/dashboard/welcome). -
Submit Reconnection: If no connection is shown, add the Date, member_uuid, and device support comments to the (Link: Withings Device reconnection requests) sheet.
- (Note: This sheet auto-processes the reconnection; add a new line for each attempt.)
- Notify Member: Use Macro: "Withings Devices::Reconnection Request Submitted".
-
Follow-up (If still fails):
- Step 1: Verify in Device Fleet that the device has successfully reconnected.
- Step 2: Instruct the member to take a new reading.
- Step 3: If all steps are complete and no data is visible in Admin, escalate the issue by creating a bug ticket for Anshuman.
Device Disconnection Process
Vida Devices are shipped for use only in Vida programs and cannot be used with other apps or services.
- Tier 1: Use Macro "Device Support::Device Disconnection Verification (1/2)".
- Tier 2: If the member still wants to disconnect, request a disconnection in a [System] Service Request JIRA and send the macro "Device Support::Device Disconnection Request (2/2)".
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