Agent General Best Practices: Navigating Resources & Investigating Inquiries

This article defines the standard practices for utilizing Vida’s internal ecosystem (VP Card, Admin, Health Guide, and KBs) to resolve member inquiries. It covers how to cross-reference data across these platforms to accurately confirm program status and clinical requirements. To provide the most accurate support especially when members ask about medication, eligibility, or program requirements it is critical to consult the right resources. While the Knowledge Base (KB) is excellent for general process flows, questions, and org-specific details, the VP Card is your source of truth for org-specific clinical and program details.

1. The "Investigate Before You Answer" Workflow

Before providing an answer or escalating a ticket, follow this checklist:

1. Check the VP Card: Confirm the specific program rules and requirements.

2. Check the Health Guide Platform: Is the member enrolled? Are they in the correct program? Have they met the requirements for meeting with a VMP, getting devices, or whatever they are inquiring about?

3. Check Admin Data: Look at the member's profile in Admin.

   • Chat Program Status: Is the member currently active or pending?

   • Engagement Metrics: Review their recent activity. Does their engagement match what they are telling you?

4. Listen to the Member: Compare the member's statement with the data you see in Admin.

5. Determine the Next Step:

   • Is it a program specific question? Refer to the VP Card.

   • Is it an enrollment/eligibility inquiry? Refer to the Org-Specific KB article.

   • Is it a complex clinical escalation or situation? Refer to the Prescribing Overview and the Prescribing KB articles.

   • Is it a complex escalation? Refer to the Escalation Matrix.

   • Is it a general "how-to"? Refer to the Knowledge Base (KB).

2.  Check the VP Card 

When a member asks about Program Options, Eligibility, or Prescribing Information, your first step should always be to review the VP Card (Vidapedia Card).

How to Access: You can access this by going into the org-specific KB article and clicking the link for the VP Card, or clicking the Vidapedia tile from Okta and searching for the org name.

Why the VP Card? General KB articles cannot account for every client-specific nuance, especially as it relates to prescribing. The VP Card houses the specific configuration for that member’s organization, including:

• Eligibility Info: Exactly who qualifies for what.

• Program Offering Details: Specific information about programs offered for that org.

• Requirement Details: Specific labs, forms, or steps the member must complete.

• Prescribing Information: Clarification on what medications or clinical paths are available to them.

• Need more detail? You can go into the Prescribing Overview for the org, which can be accessed by clicking the "Prescribing Overview" link from the org-specific KB article or searching the org from the Vidapedia Okta tile.

Best Practice: If a member asks, "Can I get weight loss medication?" do not rely on general FAQs. Open the VP Card and the Prescribing Overview to see the exact coverage and requirements for their specific organization.

3. Use Process-Specific KBs and the Escalation Matrix

You should be using the Process-Specific KBs and the Escalation Matrix to identify and navigate processes regularly, as things change frequently.

4. Search Like a Pro

To find the right information quickly, use these key search terms in your internal tools:

• For Program Details: Search the org name in the Knowledge Base or in Vidapedia.

• For Process Steps: Search Prior Authorization, Labs, Prescribing, Devices, Suspended Dash, Clinical Review, Eligibility, or Exclusions. (Also use the key terms that come up in the call with the member based on the situation).

• For Handling Issues: Search Escalation Matrix first; usually, that will link you to more specific info where needed.

  • For prescribing issues: Search Prescribing.

  • For eligibility issues: Search OOE.

  • For device issues: Search Device.

  • For Dell VBID: Search Dell.

  • For lab issues: Search  lab.