This guide provides step-by-step instructions for agents to efficiently manage member inquiries related to lab document processing, incomplete lab results, missing lab orders, and prescriber scheduling blocks. Use the internal procedures within this article to diagnose the root cause of scheduling issues (e.g., the 72-hour rule), troubleshoot member document upload errors, and properly escalate system-related blocks to the Manual Ops team via the required JIRA process, ensuring the member is quickly unblocked for their prescription consult.
Critical Note: The member contact form will not show complete and a lab order can only be generated after a member has completed a consult and has been successfully added to the AMS system. The AMS step is critical and often the bottleneck.
Action to Prevent Delays/Escalations: To prevent unnecessary escalations to the manual operations team, please advise the member on the following best practice:
The member should schedule a consult with their Registered Dietitian (RD), or
The member should wait until they have been assigned a Vida Medical Provider (VMP).
You can check this by going into admin under programs> program instances> and checking to see if the AMS program shows in progress
Do your due diligence to follow this process to do a thorough check before escalating (JIRA Escalation for VMP Scheduling Blocks & Missing Lab Errors).
If the member is at the physically at the lab and needs assistance with a lab order please escalate using the standard JIRA escalation process for labs, then message Jennie Le on slack for urgency.
Table of Contents
Member Guidance & Processing Timeline
Medical Records Requirements (Labs & Scripts)
Escalation Path for Basic Processing Delays
System Blocks and Lab Order Issues (Escalation to Manual Ops)
Critical Note: Contact Form & AMS Status
Member Guidance & Processing Timeline
| Category | Tips for Quick Processing (Member Guidance) | Purpose & Timeline |
|---|---|---|
| Initial Guidance & Preferred Format | "To ensure your provider reviews your documents quickly and accurately, please submit them through the app. The preferred file type is a PDF." | Set expectation for submission channel and optimal format. Processing Time: 24–72 hours. |
| Why PDF is Best | "A PDF is best because it clearly shows your full name, date of birth, the lab name, collection date, and all results on one single file. Do you have an option to 'print to PDF' from the lab website?" | Explain the benefits of PDF and guide on creation. |
| Photo Submission Guidance | "If you can only take a picture, please make sure the image is clear and you take enough pictures to include your full name, date of birth, the date of the test, and all the results." | Provide clear instructions for alternative, less preferred method. |
| Quest / Labcorp Auto-Send | Advise the member that they can opt-in to have their labs sent directly to Vida. The Health Guide Portal (HGP) and App now ask members to opt-in to allow automatically sending labs to Quest or Labcorp. | Eliminates manual upload requirements for the member. |
| Fax Alternative & Intake from Labs |
"Your provider or lab facility can fax results directly to 1-877-684-4791."
Agent Note on Verifying Receipt: If a member asks to confirm a fax was received, check the member's document repository in HGP. If the document is not visible after 72 hours, escalate to ProdOps to verify the inbound fax queue. |
Offers an alternative for direct lab/provider submissions while setting agent expectations for verification. |
| Labs stuck "In Review" | Talking Point: "Your labs have been successfully received and are currently 'In Review' by our clinical team. This standard processing window takes up to 72 business hours after the labs are received." | Reassures the member when they see this specific status in the app. |
| In-App Navigation | "Once you have your document ready, you'll upload it via the 'Share Documents' section in your app's menu." | Guide the member on where to find the upload feature. |
| Member Troubleshooting | Advise the member to try the following if having upload issues: Check file size, ensure the app is updated to the latest version, and restart the app before trying the upload again. | Helps agents quickly troubleshoot common technical issues. |
Medical Records Requirements (Labs & Scripts)
When members submit labs or supporting documents for prescriptions, the documents must contain specific information to be valid. (Agent Note: Please refer to the main Medical Records Knowledge Base for deeper dives into document types).
Required information on all medical records:
Member's full name
Member's Date of Birth
Date of test or prescription
Test or prescription name
Test result, value, or dosage
Name of the prescriber
Member's BMI at the time (Specifically required for script support documents)
Escalation Path for Basic Processing Delays
Follow this path only if the 24–72 hour processing time has elapsed and the member needs a status update or action on documents uploaded outside of a scheduling block.
| Step | Action | Condition |
|---|---|---|
| 1. Initial Check | Check HGP (Health Guide Portal) to find the “Requirements to Schedule” information. | Before escalating, confirm all required information has been received. |
| 2. Time-Based Check | Escalate ONLY IF 72 hours have passed since all required fields were marked as TRUE on the Member Status Lookup Unblocking Sheet. | Do not escalate if the required waiting period has not been met. |
| 3. Final Escalation | If all TRUE after 72 hours, escalate as a [System] Service Request on JIRA. | Use the specific process outlined in the Member Services JIRA Ticket Creation KB for this service request type. |
System Blocks and Lab Order Issues (Escalation to Manual Ops)
Prior to Escalating: You must consult the "Member Status Lookup Unblocking - Never Consulted" sheet to diagnose the root cause.
A. Member Can't Schedule with Prescriber in App
| Check/Condition | Action to Take | Escalation |
|---|---|---|
Block Reason: block_member_from_scheduling = TRUE (The 72-Hour Rule)
|
Talking Point: "I see you've met all the requirements! There's a slight processing delay of up to 72 business hours after lab documents are validated. Please try scheduling again after that time passes." | Escalate ONLY IF 72 business hours have passed and the member still cannot schedule. Escalate to Manual Ops via JIRA Support Escalation Flow under Documents and Lab Orders. Include: Team Code, Date/time labs were sent, and Explanation. |
| Block Reason: Member has NOT sent labs. | Instruct them how to share using the KB: How to Share Your Lab Results With Vida. | No escalation needed. |
B. Lab Results Received are Missing Info
| Check/Condition | Action to Take | Escalation |
|---|---|---|
| Block Reason: Manual Ops identifies labs are missing required information. | Talking Point: "To ensure your provider can use the documents, your files must clearly show your full name, date of birth, and the date of the test all on the same page. Could you please resend the results?" | No escalation needed; advise the member proactively. |
C. Missing or Proactive Lab Orders
| Check/Condition | Action to Take | Escalation |
|---|---|---|
| System Check: Member states VMP ordered labs, but order is missing from the app. | Search the Adv. Prescribing Team Code on Zendesk (using Manual Ops tracking sheet). Look for a ticket titled [UPLOAD_LAB_ORDER]. | If the ticket was created >48 hours ago: Escalate to Manual Ops via JIRA under Documents and Lab Orders. |
| System Check: Member wants to proactively request a lab order. | Instruct the member to contact the provider directly in Chat to request the lab order. Do not bypass the clinical provider to request a lab order via JIRA. Clinical assessment is required first. | No escalation needed. |
| System Check: Member WAS already told a lab would be ordered, but it hasn't been. | Route to Manual Ops as [System] Service Request > "Document Processing Support" using the Member Services JIRA Configuration and Ticket Creation Process. | Escalation required. |
Critical Note: Contact Form & AMS Status
🚨 IMPORTANT: Managing Incomplete Contact Form Tickets
There is no need to submit a ticket for an incomplete Member Contact Form if the member has not yet been placed in AMS. This is standard system behavior.
The form will always show as incomplete until the member is formally assigned to AMS. The status is corrected automatically once the member is in AMS and their DoseSpot ID populates.
Actionable Guidance:
If Member is NOT in AMS: Do not ticket. The form status will correct automatically upon AMS placement.
If Member IS in AMS and the form remains incomplete: This is an actual issue. Please submit a support ticket to address the delay.
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