This guide covers system-related issues requiring escalation to the Manual Ops team, primarily focusing on member scheduling blocks and lab document processing errors required for prescribing. Agents must first consult the "Member Status Lookup Unblocking" sheet or ZD tickets to diagnose the root cause (e.g., 72-hour lag, missing documents) before initiating a JIRA ticket. Proper diagnosis ensures that Manual Ops receives the necessary details to quickly unblock the member for a prescription consult.
Pre-Escalation Protocol
Agents must consult the "Member Status Lookup Unblocking - Never Consulted" sheet to diagnose the root cause before escalating.
| Check | Agent Action & Rationale |
|---|---|
| Lookup Sheet | Check the 'unable to schedule' tab on the lookup sheet. |
| Ticket Status | Search Zendesk by member's UUID. Is there an open ticket? If a new ticket is present with no work done on it, it means it hasn't been processed. Check before creating an ESCA ticket—requests often self-resolve. |
| Upload Category | Did the member upload the file to the correct category? (This impacts ticket creation.) |
| Records Rejection | Search Zendesk by UUID to see where the Records team is with tickets. Did Records reject the record and send the member a message? Check chats in admin. |
| UUID/Audit | Copy the Adv. Prescribing Team Code or member's UUID. Include UUID in the ESCA subject and an audit link where possible (Documents is our source of truth). |
Scheduling Block Scenarios
| Issue | Diagnosis & Agent Action | Talking Point & Escalation |
|---|---|---|
| Member Can't Schedule (72-Hour Rule) | Check the lookup sheet: If block_member_from_scheduling = TRUE. This is the processing delay. |
Talking Point: "I see you've met all the requirements! Processing can take up to 72 business hours after lab documents are validated. Please try scheduling again after that time passes." Escalate ONLY after 72 business hours have passed since requirements were completed, using the JIRA Support Escalation Flow under Documents and Lab Orders. |
| Member Has NOT Sent Labs | Lookup shows missing documents. | Instruct them how to share using the KB: How to Share Your Lab Results With Vida. |
Document Workflow & SLA Reference
The member's file type dictates the internal ticket flow and Service Level Agreement (SLA).
Document Verification Process
To confirm if documents have been uploaded, search the member's Vida UUID in Zendesk (ZD) and look for the following ticket titles:
Faxed Documents: Look for a ticket titled (Sfax).
App Uploads: Look for a ticket titled (Lab_Extract).
| Document File Type (Trigger) | Zendesk Ticket Created? | Directive (Ticket Subject) | SLA | Key Outcome |
|---|---|---|---|---|
| Lab Result (Member Upload) | Always | LAB_EXTRACT_MEMBER | 2 business days | Lab values extracted and saved in Admin. |
| Provider Signed Form | Always | VALIDATE_PROVIDER_ATTESTATION | 2 business days | Attestation/form validated (e.g., adds snippet to block/unblock). |
| Medical Record (Member Upload) | Yes (except Danaher/Charter) | VALIDATE_MEDICAL_RECORD | 2 business days | If passes, unblocks the member. If fails, member is messaged. |
| Fax Received (Sfax) | Yes | UPLOAD_FAX | 1 business day | Fax renamed and uploaded to Documents. |
Crucial Notes on Documents
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Progress Bar: The progress bar reflects what is saved in the backend (Admin/DocAI), not necessarily the real-time status.
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Progress bar appears in the "Required Actions" - Before your first visit section.
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Missing Info: If Manual Ops identifies labs are missing required information, agents should proactively advise members: "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?"
Missing Lab Order Escalation
When a VMP orders labs, and the member reports the order is missing from the Documents section:
System Check: Search the Adv. Prescribing Team code and UUID on Zendesk (. Look for a ticket titled [UPLOAD_LAB_ORDER].
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Escalation Path:
If the ticket was created more than 72 hours ago, escalate to Manual Ops via the JIRA Support Escalation Flow under Documents and Lab Orders to check processing or request the order again.
If the member was NOT already told a lab would be ordered, the member should contact the provider directly in Chat to request the lab order.
If the member WAS already told a lab would be ordered, escalate to Manual Ops as [System] Service Request > "Document Processing Support" using the Member Services JIRA Configuration and Ticket Creation Process.
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