Introduction: The goal of the member services team is to serve members in the most efficient way possible. To do this, we must attempt to have one-touch resolutions to all inbound and outbound tickets. Utilize all systems, knowledge base resources, communicate limitations (i.e. inform members when their request is not actionable), crowdsource with member services team members, and follow protocols listed here before escalating a ticket. Agents must utilize critical thinking skills, best practices, and exhaust all other possibilities before escalating tickets. In the event that an escalation is needed, agents must communicate clearly with all necessary details in order to eliminate misrouted escalations, incomplete responses, and member issues/inquiries not being fully addressed.
Step 1: Attempt Resolution in Call or Email ticket
- Offer solutions by utilizing all member services support resources.
- If a solution is found, solve the ticket. Use “Inbound call - follow up after completion” macro when resolving tickets created from phone calls.
- Document details in an internal note.
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For highly escalated members, refer to the De-Escalation/Abusive Customer Protocol
Step 2: Inform the Member of Next Steps
If escalation is needed
- Explain to the member that you will escalate the issue for further investigation (ONLY if follow-up or action is needed).
- Assure the member that their concern is taken seriously and will be addressed promptly.
If through email
- Reply to every new email. If a solution is not found, notify the member that the ticket is still under investigation.
Step 3: Escalate to the proper team for action
The following teams may be involved in the handling of member services tickets. Tickets must meet requirements outlined in the chart following these definitions in order to be escalated.
Team Definitions:
- Member Services: The member services team composed of Tier 1 and Tier 2 agents (handling outbound enrollment calls, inbound support calls, and support@vida.com email, web, and app created tickets).
- Member Services Tier 2: Member services escalation team, processes tickets that need a higher level of access, escalation, or care.
- Member Services Leads: Member service agent’s leadership.
- Coach Support: Team that supports inquiries from Vida Medical Coaches and non-prescribing providers.
- Provider: Used to refer to all provider types including health coaches, Registered Dietitians (RDs), Vida Medical Providers (VMP or Prescriber), and Therapists.
- Device Manufacturer: Manufacturers of Vida-provided devices including Withings, Philips, and Dexcom.
- Infra (Infrastructure): Vida internal team of developers and engineers who develop and maintain the ios, android, and web applications and its features/tools.
- ProdOps (Product Operations): Oversee and process automations related to Vida systems such as device ordering, program/provider switching, form completion, member/program statuses.
- QA (Quality Assurance): Oversees clinical review process.
- QA Therapy: Oversees therapists, care navigators, and therapy leadership.
- Prescribing Support Group (PSG): Clinical team involved in processing of prescribing related functions. Includes team of Medical Assistants (MAs) and their leadership who facilitate medical front-desk related functions.
- Compliance: Legal and compliance team that act as Vida’s legal counsel.
Refer to the table below for guidance and how to escalate:
| Type of Inquiry | Escalation Instructions |
| Member Services Tier 1 – Usually ARE NOT Escalated | |
Feedback |
DO NOT Escalate! If the member gives feedback, escalate to ProdOps as [System] Service Request using JIRA integration Member Services JIRA Ticket Creation. |
Cancellation |
DO NOT Escalate! Go above and beyond to handle the escalation, be empathetic and handle the members' objection, document it, make sure to add to the DNC/cancel account if applicable.
Follow Canceling A Member Account on Admin KB steps. |
VBID requirements |
Only Escalate if there is a documentable issue w/ VBID. Review the Dell KB article and click “View Status” under “Incentive Program” on Health Guide Platform (HGP) for details of members status. If a member needs verification of when they submitted requirements, assign the ticket to the Tier-2 group on Zendesk.
Tier 2: Check looker report for submission dates. |
Provider (Prescriber VMP, Coach, RD) Availability / Scheduling |
DO NOT Escalate! Guide the member to schedule in the app or use the provider switch feature if they want a provider with sooner availability. Use tools on HGP to help the member schedule/switch.
Refer to How to Reschedule/Cancel Sessions for Members in the Health Guide Platform (HGP). |
Members reporting that they attended a webinar, but the webinar is not showing in the app. |
Please leave an internal note detailing the issue, ensure the Zendesk profile is filled out, then assign the ticket to Coach Support and mark Urgent |
Provider/Coach Switch request |
DO NOT Escalate! Walk member through how to switch in app or HGP First – Try switching the member on HGP (click switch provider under 'providers', follow prompts to switch). If the switch option does not show in the members app or HGP, escalation will depend on the provider type. See “Switch Coach or Registered Dietitian (RD),” “Provider Switch – Prescriber (VMP),” or “Add or Switch Therapist, Mental Health Coach, Suspended Program Dash Coordinator” if switch form does not work, based on the provider type. |
Member in Prescribing Program is Moving Out of State |
To prevent interruption of prescription flow since VMPs are specific to each state escalate to ProdOps as [System] Service Request using JIRA integration Member Services JIRA Ticket Creation. |
HIPAA Question/Concern |
DO NOT Escalate for general inquiries! (If there is a breach or concern of a breach, see HIPAA Breach section below) Use macro: "Complaint:: HIPAA General Inquiry". |
Public complaints |
Acknowledge complaint 3 Macros to be used for Public Complaints:
|
Request for Specific Vida Employee |
DO NOT Escalate for general inquiries! Inform caller that the employee does not have a dedicated line. If they insist on leaving a message, use the below: Take down name, number, and message from the caller. DO NOT confirm if the person they asked for is an active Vida employee. Escalate ticket to Tier 2 for review to see if the request should be escalated. |
Member Services / Switch Form / Tier 2 | |
Switch Coach or Registered Dietitian (RD) ONLY |
DO NOT escalate to ProdOps if the Suspended Program Dash Coordinator (SPD) appears in the list of providers (check Admin > Programs Section > Click Program instances). Refer to the Suspended Program Dash Coordinator section.
For Coach or Registered Dietitian ONLY: If no switch options in App/HGP: fill out Switch Form completely.
Tier 2: If the switch form does NOT result in switch after 2 days, check Switch Form Responses for errors, if none, escalate to ProdOps as [System] Service Request using JIRA integration Member Services JIRA Ticket Creation.
Refer to Program Exclusion Review Process for information about exclusion reviews. |
Member Services / Prescribing Support Group | |
Switch Prescriber (VMP) ONLY
[For Coach or RD, click here; for Therapist or Mental Health Coach, click here] |
DO NOT escalate to ProdOps if the Suspended Program Dash Coordinator (SPD) appears in the list of providers (check Admin > Programs Section > Click Program instances). Refer to the Suspended Program Dash Coordinator section.
For Prescribers (VMPs) ONLY: Use 'Prescribing Escalation Template' Macro and assign to 'Prescribing Support Group (PSG Tier 1 Group)' on Zendesk.
Refer to Program Exclusion Review Process for information about exclusion reviews. |
Member Services / QA Therapy | |
Add or Switch Therapist, Mental Health Coach, Suspended Program Dash Coordinator ONLY
[For Coach or RD, click here; for Prescriber (VMP), click here] |
DO NOT use switch form or assign to PSG Tier 1 Group if the Suspended Program Dash Coordinator (SPD) appears in the list of providers (check Admin > Programs Section > Click Program instances). Instead, use process shown below:
Switch request: For "Suspended Program Dash Coordinator", Therapist, Mental Health Coach, or any Provider in a mental health program: Escalate to #QA-CS-Therapy-support via Slack side conversation.
Add therapist request: If the member is requesting to add the therapy program, check if therapy is available for their org.
If the member is not eligible for a Therapy or Mental Health programs, we can still request a session with a Care Navigator (CN) so they can be referred to Therapy outside of Vida.
Refer to Program Exclusion Review Process for information about exclusion reviews. |
Member requests specific provider |
Escalate to ProdOps as [System] Service Request using JIRA integration Member Services JIRA Ticket Creation. |
Member Services / Infra | |
App issues / Bugs |
Refer to Handling Support Tickets Requiring Bug Reports.
If the issue is a confirmed bug after completing troubleshooting, escalate as a Bug on JIRA (use Member Services JIRA Ticket Creation KB). |
Member Services Tier 2 | |
Device Requests |
ONLY ESCALATE DEVICE ORDERS FOR MEMBERS WHO HAVE NOT ORDERED A DEVICE ALREADY, HAVE HAD THEIR 1ST SESSION IN REQUIRED PROGRAM, AND MEET ALL DEVICE REQUIREMENTS (INCLUDING CONDITIONS, METRICS, MMS/MEDICATION REQUIREMENTS). |
Device Troubleshooting Withings |
Please refer to this document for Scope of Support If a member experiences an issue that requires direct support from the Withings Program team, they can easily open a ticket online. The member should click this link to access the Withings Program Support Center. Once they are on the support page, they simply need to click on the black icon located in the bottom right-hand corner of the screen to reach a live agent and open/submit a new ticket. |
Device Troubleshooting Philips |
Tier 1 Information gathering and basic troubleshooting.
Philips Customer Support Contact:
|
Coach Support | |
Positive Provider Feedback |
Once no more correspondence is needed with the member, add an internal note stating "please pass on positive feedback to provider leads".
Change assignee to "Coach Support Group" and click "Assign to Coach Support,” submit as Open. |
QA | |
Clinical Review Request (i.e. member wants second opinion about clinical decision, such as discharge, program ineligibility, etc.) |
Use these steps if a member claims they’re eligible or disagrees with a clinical decision:
|
| Self Submission: ask members to email qavida@vida.com. Use the "QA::Member Grievance - Request Clinical Review" macro. | |
Prodops | |
Scheduling Unavailable for VMP (i.e. request to unblock scheduling) |
Check HGP to see “Requirements to Schedule” information.
Escalate ONLY IF 48 hours after all required fields were marked as TRUE on Member Status Lookup Unblocking Sheet.
IF all TRUE, escalate as [System] Service Request on JIRA (using Member Services JIRA Ticket Creation KB). |
Eligibility / Automatic Exclusions |
If “No programs available” shows in onboarding, check the OOE Onboarding Logic page to see what exclusions exist for the member’s PayOrg. Then, check the OOE Program Feature Lookup Looker to see what information the member onboarded with and verify if that should have triggered an exclusion. If “No programs available” screen is correct, notify the member. If member states this is invalid, refer to Clinical Review Request. If the member should have been eligible for any program, escalate to ProdOps as [System] Service Request using Member Services JIRA Configuration and Ticket Creation Process. |
CGM (Continuous Glucose Monitor) Ordering |
Refer to CGM Section of Device Order Support Workflows KB. |
Prescribing Support Group (PSG) | |
Complaint Regarding Provider (Coach, RD, Prescriber, VMP, Therapist, etc) |
Be empathetic, and offer a provider switch. Use Processing Member Requests to Change Coach KB.
If they want to file a complaint, escalate to the PSG Tier 1 on Zendesk with the "Provider Complaint Escalation Template" macro completely filled.
Submit the ticket as 'Open'. Prescribing Support Group (PSG) will triage the ticket to the provider’s leadership. |
Pharmacy Issue (PA, Goldcarding, Cost) |
IF member is currently at pharmacy and experiencing issues, medication is in RED (according to KB), experiencing side-effects, or was escalated by an AM, change Zendesk priority field to “Urgent.” |
Pharmacy Issue( Inquiries regarding prescription dosage or instructions) |
Gather the required Information on the call: Confirm the member info: Full name & DOB. Confirm medication Name & current dosage instructions. Clarification Need: Ask the caller what specific part of the instructions is confusing (e.g., titration, quantity). Gather pharmacy contact info: Collect pharmacy name and a direct contact number. Escalate IMMEDIATELY to PSG Tier 1 (using prescribing escalation template macro). Do not attempt to interpret or clarify the script wording. PSG has exclusive access to the script's original submission in Dosespot (as submitted by the VMP) and is required to handle all legally sensitive script interpretation and clarification requests. |
Provider / Manual Ops (ProdOps) | |
Lab Order Request |
The member should let the provider know in Chat that they want labs ordered and have completed a session more than 48 hours ago.
IF the member was already told a lab would be ordered or needs labs ingested sooner, escalate as [System] Service Request using JIRA integration MS JIRA Ticket Creation.
If a member is at the lab experiencing an issue with the order, escalate as [System] Service Request using JIRA integration MS JIRA Ticket Creation. |
|
Use the Sending members their data or clinical records KB. |
Compliance | |
HIPAA Breach |
Upon identification and/or Member reporting of a potential HIPAA breach use Macro Complaint:HIPAA Breach to advise the Member of next steps. In addition ALWAYS escalate the issue to your direct leader for review What to Look out For: (Not all Inclusive)
If you suspect a breach has occurred—even if you aren't 100% sure—do not hesitate. We operate on a "see something, say something" policy with zero penalty for reporting. Follow the HIPAA escalation flow as defined here https://support.vida.com/hc/en-us/articles/48446729460755-HIPAA-Privacy-Escalation-Workflow |
Former Provider Malpractice Coverage or COI |
Advise requester to email compliance@vida.com with this request.
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