How Agentforce Speeds Up Pharmacy and DME Eligibility Checks

Delays in verifying pharmacy and durable medical equipment (DME) benefits can be more than a workflow hiccup—they can directly impact patient outcomes. Whether it’s a life-sustaining medication or critical home care equipment, every moment counts when treatment hinges on eligibility confirmation.

For providers and health plans alike, benefit verification is a daily pain point. Manual workflows, faxed forms, disconnected systems, and long payer wait times add friction to a process that should be instantaneous.

Agentforce, Salesforce’s intelligent digital labor platform, helps healthcare organizations automate and accelerate these processes at scale. With real-time data integration and intelligent agents trained for healthcare-specific tasks, Agentforce reduces errors, resolves disputes, and shortens time to treatment.

The Verification Bottleneck in Healthcare

Benefit verification—particularly for pharmacy and DME—is often a manual, error-prone process:

• Front-desk staff manually log into payer portals or contact third parties
• Eligibility data is outdated or incomplete
• Coordination between the provider, payer, and pharmacy/DME vendors is fragmented
• Delays lead to medication abandonment, patient frustration, and higher resubmission rates

The result? Slower treatment, more administrative burden, and dissatisfied patients.

How Agentforce Addresses the Challenge

Agentforce introduces intelligent agents that integrate with electronic benefit verification providers (e.g., Availity) and payer systems to make real-time eligibility checks seamless.

1. Instant Pharmacy and DME Verification

Agentforce can verify a patient’s prescription drug and equipment coverage at the point of care automatically. Once a physician enters a prescription or recommends a DME item, Agentforce checks the patient’s plan details, co-pays, and formulary compliance in real time.

This eliminates guesswork, speeds up approval, and reduces the need for phone calls or faxes to confirm eligibility.

2. Proactive Eligibility Alerts

Rather than waiting for denial or delay, Agentforce agents can preemptively alert the care team if a therapy or device isn’t covered under the patient’s current plan. They can suggest covered alternatives or flag the need for prior authorization.

This foresight improves care planning and enhances provider-patient communication.

3. Faster Claims Dispute Resolution

If a claim is rejected due to eligibility or coordination-of-benefits errors, Agentforce helps customer service teams act fast. Agents retrieve payer feedback, match the denial code to the patient’s benefit profile, and suggest next-best actions, like resubmission, appeal, or plan outreach.

This allows member-facing teams to respond confidently and quickly, improving both resolution times and member satisfaction.

4. Seamless Integration With Payer Systems

Agentforce can integrate with systems like Availity or payer APIs to verify eligibility instantly and document it in Salesforce Health Cloud. It becomes part of the care journey record—centralized, trackable, and accessible across teams.

This not only improves internal coordination but also builds a longitudinal patient record across interactions.

5. Support for Home Care and Chronic Condition Programs

For chronic disease management or home-based care programs, access to DME (like glucose monitors or nebulizers) is foundational. Agentforce helps ensure that equipment eligibility is validated early, reducing lags that can derail onboarding or remote monitoring programs.

Teams can also set up rules to automatically flag patients who are eligible for subsidized or fully covered equipment.

Impact of Faster Eligibility Verification

The ripple effects of speeding up eligibility checks are tangible:

• Reduced abandonment: Patients are less likely to give up when there's no unexpected cost or delay.
• Improved adherence: Covered treatments start on time, leading to better outcomes.
• Lower admin costs: Fewer follow-ups, faxes, and resubmissions lighten the load on staff.
• Enhanced compliance: All transactions are logged, helping ensure audit readiness and transparency.

Across these areas, Agentforce improves both operational performance and patient satisfaction.

Built for Healthcare Teams

Agentforce isn't just another automation tool—it’s built for healthcare workflows:

• Patient access agents help verify eligibility during intake
• Customer service agents guide claims teams in resolving disputes
• Care coordination agents proactively flag coverage gaps that may delay discharge or remote care onboarding
• Back-office agents automate documentation and trigger updates across systems

With Salesforce Health Cloud as the foundation, all data flows seamlessly between these agents and the rest of the enterprise.

Why Digital Labor Matters Now

The pressure on health systems to do more with less has never been higher. Staff shortages, regulatory complexity, and cost-cutting initiatives demand tools that reduce manual load without sacrificing quality or compliance.

Agentforce enables organizations to extend their teams with intelligent, proactive support agents that scale effortlessly—whether you’re verifying benefits for 100 patients or 100,000.

By turning routine workflows into intelligent ones, Agentforce helps providers and payers focus on what matters most: delivering care and improving outcomes.

Ready to Eliminate Eligibility Delays?

If pharmacy or DME verification is slowing down your operations or frustrating your patients, it’s time to rethink your workflow.

Salesforce Health Cloud Services help healthcare organizations implement, customize, and scale Agentforce to meet their specific business and clinical needs.

Let’s transform eligibility checks from a bottleneck into a competitive advantage.