Healthcare Provider Portal Manuscript

Version 0.1
Last Updated: September 14, 2020
General Website Requirements
• The URL will be <TBD>
• System will automatically log user off due to inactivity after 15 minutes.
• System will give warning 30 seconds prior to logging the user off.
• Passwords will expire every 90 days.
• Users will receive a Password Expiring Email 5 days before password expiration with a link to reset their password
• If users allow their password to expire without resetting, then they will be presented with the requirement to reset their password prior
to logging into the system
• End users account will be locked if they make 3 unsuccessful log in attempts. Notification will be sent to the end user if their account
becomes locked. Notification will include a link that allows them to reset their password.
• Passwords will need to be alphanumeric-must contain 8 characters, 1 upper case letter, 1 lower case letter and 1 numeric value (will not
allow special characters)
• Header and Footer will be consistent on all pages within the portal
• Hamburger menu in portal header (for logged in user) will have links to various services being implemented for a specific client
• Resources page will include documents and/or webinars as provided by the client and will be available to a logged out user as well as a
logged in user.
• Portal will have a contact page that is available to a logged out user as well as a logged in user.
• While Upload functionality is displayed in various pages within this manuscript, it should be configurable per program as to what pages
it is available from.
0.1 Home Page Header/Footer
Header (Logged Out) The hamburger menu will have links to all of following or a
subset depending on what is configured for the client.

Submit Enrollment
Additional Support Request
Header (Logged In) Submit Order
Order History
Apply for PAP
Request Copay Card
Contact Us
Footer (same for Logged In or Logged Out) Profile
Log Out
When the end user clicks on one of these links from the menu it
will route them to the associated page in the portal.

The Header (Logged In) represents the Header that will display on every page of the portal once I am logged in.
The Header (Logged Out) represents the Header that will display on the Log In Page to a user that is not logged into the portal.

Header
• Register (link) – when clicked, directs user to “User Registration” page
• Contact Information (link) – when clicked, directs user to “Contact Us”
• Resources (link) – when clicked, directs user to “Resources”
• Home (link) – when clicked while logged out of the portal, directs user to “Home-Log In”
• Home (Link) – Once logged into the portal, any time the end user clicks the Home link they will be routed to the Dashboard/Recent Activity page.
• Logged in users will see a hamburger menu in the header.
Footer
• Privacy Policy (link) – when clicked, directs the user to <TBD> this will open in a separate tab
• Terms of Use (link) – when clicked, directs the user to <TBD> this will open in a separate tab
• Important Safety Information (link)-when clicked, directs the user to <TBD> this will open in a separate tab
• (These documents should either open a PDF document in a separate tab or route to a URL provided by client where this information resides. This should be
configurable per client.)
Secure Message Center
• Secure Message center should be configurable as to whether it is implemented for each program.
• When an end user clicks on the link from the header they will be routed to the Secure Message Center [insert slide #/name]
1.0 Home-Log In Page

Login Form
Required Fields:
• User Email – alphanumeric- email address
• Password – alphanumeric, must contain 8 characters, 1 upper case letter, 1 lower case letter and 1 numeric value, special characters are not required but system should
allow for it.
Links:
• “Forgot Password” (link) – directs user to the “Forgot Password” page (2.0_

Register Now (Button):

• “Register Now” (button) – directs user to the “User Registration” page

Login (button)
1. When the user clicks “Login” without both Username and Password complete, then an error message will display in a popup next to the field(s) that are missing
information, stating, “This is a required field”.
2. When the user clicks “Login” and both Username and Password are complete, but the credentials are not found, then an error message displays, “The credentials you have
entered are incorrect. Please verify and try again, or contact the program at 1-XXX-XXX-XXXX for assistance. “ (This will also occur if a registered user tries to log in before
their access has been validated)
3. When the user clicks “Login” and the credentials entered match a user account with an expired password, then the user is directed to the “Expired Password Form”
4. When the user enters invalid credentials 3 times, the system will lock the end user out and an error message displays, “Your account has been locked. An email will be sent
to the email address on file with a link to reset your password. If you do not receive an email within 1 hour, please contact the program at 1-XXX-XXX-XXXX to have the
account unlocked.”
5. When the user clicks “Login” and the credentials entered match a valid user account, then the user is directed to the “Dashboard/Recent Activity” page
2.0 Forgot Password Page

4.1 Forgot Password/Collect Username Form

Required Fields:
• Username – alphanumeric- email address

Button:
1. When a user clicks “Submit” without completing the Username field, then an error message displays, “This is a required field”.
2. When a user clicks “Submit” and the Username entered is not in the credentials database, then an error message displays, “The username you provided was
not found. Please verify and re-enter, or contact the Program at 1-XXX-XXX-XXXX for assistance.” (This will also happen if a registered user that has not been
validated yet accesses this page)
3. When a user clicks “Submit” and the Username entered is found in the credentials database, then the user is directed to “Password Reset Request
Confirmation” page (5.0) and the Forgot Password Email is sent to the email address associated with the username that contains a link to the “Change
Password” page (4.0)
3.0 Password Reset Request Confirmation

4.1a Password Reset Request Confirmation

“Return to Home” Button:

1. When a user clicks “Return to Home” button they are directed to Home-Log In page (1.0)
4.0 Change Password
If accessed from Change Password link on Profile Page
If accessed from link in email associated with forgot password

Required Fields:
• New Password – alphanumeric, at least 8 characters, and contain one upper case letter, one lower case letter and one numeric value, cannot match any of the
last three passwords used by the end user.
• Confirm New Password –must match value entered in the “New Password” field.
• Existing Password will only be on the screen if the user has been routed to the change password page from the link on the profile page and the password
entered must match existing.

Barometer should display next to password to show end user if password they are creating is weak/strong etc.
Submit (button)
1. When a user clicks “Submit” without completing the New Password and/or Confirm New Password fields, then an error message displays, “This is a required
field”.
2. When a user clicks “Submit” and the Enter New Password and Confirm New Password fields do not match, then an error message displays, “The passwords
you entered do not match. Please try again”.
3. When a user clicks “Submit” and the Enter New Password and Confirm New Password fields match but do not meet the minimum password criteria, then an
error message displays, “The password you entered does not meet the minimum requirements. Please try again.”
4. When a user clicks “Submit” and the password entered matches one of the last three passwords the end user has used, then an error message displays, “The
password entered must not match the last three passwords.”
5. When a user clicks “Submit” and the value entered in the Existing password field does not match what is in our records they will get an error message “The
existing password you entered does not match what we have on file, please try again.”
6. When a user clicks “Submit” and all requirements are met, then the user is directed to the “Password Change Successful” page. (5.0)
5.0 Password Change Successful page

4.5 Password Change Successful

“Return to Home” Button:

1. When a user clicks “Return to Home” button they are directed to Home-Log In page (1.0)
6.0 Expired password page-logged in user 6.1 Expired Password page- accessing from link in email

Required Fields:
• User Email-must match registered email
• Current Password –must match ‘expired’ password
• New Password-– alphanumeric, at least 8 characters, and contain one upper case letter, one lower case letter and one numeric value, cannot match any of the last three
passwords used by the end user.
• Confirm New Password –must match value entered in the “New Password” field.

Barometer should display next to password to show end user if password they are creating is weak/strong etc.
If user logs into the portal with expired password and they are rerouted to this page they will receive page view that requires they re-enter username, current password and
then set new password.
If user clicks on link from “Password Expiration Notice” email they will be routed to page that only requires user to enter new password.
Submit (button)
1. When a user clicks “Submit” without all required fields entered on the page, then an error message displays “This is a required field” next to the field(s).
2. When any user clicks “Submit” and the Enter New Password and Confirm New Password fields do not match, then an error message displays, “The passwords you entered
do not match. Please try again”.
3. When any user clicks “Submit” and the value entered in the Current Password field does not match registered password then an error message displays, “The Current
Password you entered is not correct. Please verify and try again, or contact the program at 1-XXX-XXX-XXXX for assistance.
4. When any user clicks “Submit” and the Enter New Password and Confirm New Password fields match but do not meet the minimum password criteria, then an error
message displays, “The password you entered does not meet the minimum requirements. Please try again.”
5. When any user clicks “Submit” and the password entered matches one of the last three passwords the end user has used, then an error message displays, “The password
entered must not match the last three passwords.”
6. When any user clicks “Submit” and all requirements are met, then the user is directed to the “Password Change Successful” page (5.0)
7.0 Contact Us page

Content Page
User is routed to this page if they click on the Contact Uslink from the header/ hamburger menu.
8.0 Resources page

Content Page
End user is routed to this page by clicking the Resources link from the header

Links:
• “Resource Document” (links) – opens corresponding PDF document
• “Webinar Videos” (links) – directs user to <TBD> or opens corresponding video- opens in separate tab
9.0 Dashboard/Recent Activity
Page should have search functionality that allows end user to search by patient
name or patient UID. Should be able to search by first name only, last name only,
or full name. (If by first or last name only it will return all possible matches for
user to select from). End user should also be able to search by date range.

Navigation buttons left side of page are dependent on services configured for the
client. Labels will align with links available in hamburger menu.

When end user clicks on Patient UID link to view a patient-they will be routed to a page that lists all cases for the patient. End user can click to view next
to any case and be routed to a “Case Details” page that gives them more in depth details of the case from patient connect (Claim Detail pages – X.X-X.X)

Flag represents if case has been

updated in the last 10 days. Items that
would trigger this flag should be
configurable per program but at
launch we will begin with the following
two:
Any time a document is appended to a
case in patient connect.
Any time a case has been saved with a
new status, sub-status or disposition.

Flag represents case needs

attention. Defining what triggers this
to show up on the portal should be
configurable per program but for
launch it should display when the
sub-status on the Case is equal to
Missing Information.
See Next page for additional requirements for this functionality
 9.0 Dashboard/Recent Activity (continued)
End users will be routed to this page as their landing page upon logging into the portal successfully.
Default for this display will be- DRAFT enrollments followed by all patient records from newest to oldest based on Last Modified Date.

Search functionality:
1. End user can search by Patient Name/PAT ID OR they can search by Date Range but not a combination of Patient Name/PAT ID and Date Range.
2. When searching by patient name end user should be able to search by first name, last name or full name and see results returned to select from.
3. When the user starts entering a value into the Patient Name/PAT ID search field, the Date Range filter is greyed out or not accessible.
4. When the user selects a date range value then the Patient Name/PAT ID search field is greyed out or not accessible.
5. Date Range: dropdown (allows user to choose from select values or enter range)
Sort Functionality:
6. End user should be able to sort the information displayed on the pages by the headers. (Single column sort-Ascending/Descending)

Export:
7. When end user clicks on “Export” all patient details from the page it was selected on will be exported to excel file that the end user can download. This will not include case
details information. If end user filters the data returned on the page prior to clicking export they should only get the filtered results exported to excel. If they don’t filter, they
should get all data exported.

Buttons:
1. When the end user clicks on “Submit Enrollment” they should be directed to first page of the Enrollment process
2. When the end user clicks on “Request Additional Services” they will be directed to “ Request Additional Services” page
3. When the end user clicks on “Request Copay Card” they will be directed to “Request Copay Card” page
4. When the end user clicks on “Resources” they will be directed to Resources page
5. When the end user clicks on “Apply for PAP” they will be directed to PAP Eligibility page
6. When the end user clicks on “DRAFT” they will be directed to first page of Enrollment Process –that is pre-populated with the information previously entered.
7. When the end user clicks on “Patient ID” a page will display with expanded information showing all cases associated with that patient.
 10.0 All Cases-Case View
Recently updated and Needs Attention flags will
have same functionality on this page as
documented on the Dashboard/Recent Activity
page

Case #, Case Type, and Patient Name will auto

populate

• End user will be routed to a “Case Details” page when they click on the Case ID to see more in depth details for that case.
• Page should have search functionality that allows end user to search by Case ID or Case Type.
• End user should be able to clear the filter once applied to return to default view.
• Default View for this page is newest to oldest based on Last Modified Date

Filter Functionality:
Page will have filter capabilities that allows end user to filter results using any of the column headers displayed – End user can click on
the filter icon and have the option to filter the return/view of cases by filters selected-filters will consist of all column headers. Once
Closes Case Functionality:
they filter a view they should be able to name and save the view. • This should be configurable per program as to whether we allow end users to
These views will be saved and accessible on any future logins by clicking on the caret next to the Case View header and selecting from a
close a case from the portal.
“Saved Views” section. • When a case is closed they will select the check box to the left of the case
and click “Close Case”.
If a client requests a set of pre-set reports these views will be configured for the program prior to launch and be accessible by clicking on • Upon Clicking “Close Case” this page will pop up that requires the end user to
the caret next to the Case View header and selecting from a “Default Reports” section.
enter a reason they are closing the case.
• Once a case is closed it will come over to our system and update the
Export Functionality:
status/sub-status/disposition on that case in Patient Connect (defined by
When end user clicks on “Export” all patient details from the page it was selected on will be exported to excel file that the end user can
business rules) and generate a task on that case for an associate to be
download. This will not include case details information. If end user filters the data returned on the page prior to clicking export they
notified of request so they can follow up as needed based on business rules
should only get the filtered results exported to excel. If they don’t filter, they should get all data exported.
for the program. (Task details will include reasons and comments entered in
submission)
11.0 Case Details View -Enrollment

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.

1. When the end user clicks “View” from the dashboard page next to a Enrollment ‘case’ they will be
directed to this page that displays information entered during the enrollment process as well as any
documentation any additional information we have associated to the Program case in Patient
Connect. (Mapping for Each Field from the screen to patient connect will be provided in associated
user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in the next page “Case Details-Related” (12.0)

Back (button):
• When the user clicks “Back” if will take them back to page they were on previously.
12.0 Case Details View-Related (except Order) This page represents the “Related” tab view of any “Case Details” page except ORDER- that page will mirror this one but
have one additional option to view dispense records- refer to Related tab view of an Order case on page 20.0
• Case History will allow end user to see updates made to any field on the case and the date it was updated.
• Case Comments will allow end user to see any case comments we have associated with that case in Patient Connect
• Attachments will allow end user to view any documents we have associated with the case in Patient Connect and
also upload additional documents to the case from the portal.
• When a document is uploaded from the portal it will be sent to Patient Connect and appended to that case using a
document tag that aligns with the category selected during upload. (category to document tag mapping will be
configurable per client)

When end user clicks on case

comments link they will see list
view of all comments associated
with that case in Patient Connect.
End user can click on Summary
link to see expanded comment
details.

When end user clicks on the

Attachments link they will see this
view that lists all documents
associated with that case in
Patient Connect. End user can
click on the document to view PDF
version of the document.

Once a document is appended,

end user will see name of
document and have the option to
remove it in case they appended
the wrong one.
Back (button):
• When the user clicks “Back” if will take them
back to the “Dashboard/Recent Activity ” page
(9.0)
13.0 Case Details View (BV Results)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a BV case they will be directed to
this page that displays information we have associated to the BI/BV case in Patient Connect.
(Mapping for Each Field from the screen to patient connect will be provided in associated user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)

Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously.

• Fields that display on this page will be configurable per program.

Each section can be collapsed by clicking on the caret next to the header
14.0 Case Details View (CDR Results)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a CDR case they will be directed
to this page that displays information we have associated to the CDR case in Patient Connect.
(Mapping for Each Field from the screen to patient connect will be provided in associated user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)

Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.
15.0 Case Details View (CDR Appeal Results)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a CDR Appeal case they will be
directed to this page that displays information we have associated to the CDR Appeal case in Patient
Connect. (Mapping for Each Field from the screen to patient connect will be provided in associated
user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)
Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.

Note: Auth number/start and end date fields are not on the CDR Appeal case in Patient
Connect currently- may need to add these to be able to display appropriate details on this
page. Open question internally on this item.
16.0 Case Details View (Claim)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a Claim case they will be directed
to this page that displays information we have associated to the Claim case in Patient Connect.
(Mapping for Each Field from the screen to patient connect will be provided in associated user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)

Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.

Note: need to discuss how much we will be able to document at a detailed level within the
Claim Case record. This aligns with values we need to be able to provide for Glaukos which has
been our most detailed claim screen thus far.
17.0 Case Details View (Copay)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a Copay (or Savings Offer) case
they will be directed to this page that displays information we have associated to the Savings Offer
case in Patient Connect. (Mapping for Each Field from the screen to patient connect will be provided
in associated user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)
Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.
18.0 Case Details View (PAP)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a Patient Assistance Program case
they will be directed to this page that displays information we have associated to the Patient
Assistance Program case in Patient Connect. (Mapping for Each Field from the screen to patient
connect will be provided in associated user story.
a. Default view of this tab will be the Details View
b. Every Case Details View will have a second tab “Related”, and this tab functionality is outlined
in page “Case Details-Related” (12.0)
Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.
19.0 Case Details View (Order)

End user can be routed to this page by clicking to view a case from the Dashboard/Recent Activity
pages (9.0) or from clicking to view a case from the View Cases page (10.0)

1. When the end user clicks “View” from the dashboard page next to a Order case they will be directed
to this page that displays information we have associated to the Order case in Patient Connect.
(Mapping for Each Field from the screen to patient connect will be provided in associated user story.
a. Default view of this tab will be the Details View
b. Order Case Details View will have a second tab “Related”, and this tab functionality is outlined
in the next page “Case Details-Related” (20.0)

Back (button):
• When the user clicks “Back” if will take them back to the page they were on previously

Each section can be collapsed by clicking on the caret next to the header
Fields that display on this page will be configurable per program.

20.0 Case Details View-Related Tab for Orders
Back (button):
• When the user clicks “Back” if will take them
back to the “Dashboard/Recent Activity ” page
(9.0)
This page represents the “Related” tab view of an Order Case
• Case History will allow end user to see updates made to any field on the case and the date it was updated.
• Case Comments will allow end user to see any case comments we have associated with that case in Patient Connect
• Attachments will allow end user to view any documents we have associated with the case in Patient Connect and
also upload additional documents to the case from the portal.
• When a document is uploaded from the portal it will be sent to Patient Connect and appended to that case using a
document tag that aligns with the category selected during upload. (category to document tag mapping will be
configurable per client)
• When end user clicks on case comments link they will see list view of all comments associated with that case in
Patient Connect. End user can click on Summary link to see expanded comment details.
• When end user clicks on the Attachments link they will see this view that lists all documents associated with that
case in Patient Connect. End user can click on the document to view PDF version of the document.
• When end user clicks on Dispense Records link they will see list view of dispense records associated with that order
to include dispense date, product, dispense quanity, tracking number (items for display are configurable per
program)
Patient Enrollment Requirements:
The next set of fields represent the screens and functionality to submit enrolling a patient in the program from the HCP Portal
• All fields in Patient Enrollment form need to be configurable so that we can identify which fields should display at a product and program level, and also which fields are required at a product and
program level as needed.
• Enrollment screens will only return providers and sites in dropdowns that the end user has access to.
• Enrollment process will utilize our master payer database lookup when an end user enters insurance information
• End users should have the ability to upload documents prior to submitting a patient enrollment.
• Upon Submission of a patient enrollment form the information will be entered in Patient Connect by creating and populating the following records/cases as applicable.
o Patient Account
o Address Records
o Prescription Record
o Program Case (and set appropriate status/substatus/disposition based on client configuration)
o Consents & Authorizations
o Associate HCO and HCP records to Program Case
o Related Contacts record(s)
o Create BV Case and run eBV
o Results will populate the Program Coverage Case and will appear on the BV case details page on the portal.

Duplicate Logic Detection:

Portal should have duplicate logic associated with the enrollment process that is configurable at program level as to which of the following logic we implement/turn on-
a. When a duplicate is detected after select values are entered on the first page of the enrollment process the system will display a warning message that the patient is a duplicate but allow the end user
to override it and submit the enrollment
b. When a duplicate is detected after select values are entered on the first page of the enrollment process the system will display a warning message that the patient is a duplicate and will not let the end
user submit the enrollment.

DRAFT Functionality:
Portal should allow an end user to start an enrollment, not complete it and have the record saved within the backend of the portal or a table that supports the portal, so that they can come back to that
incomplete enrollment and finish it later. When they come back to it they should be able to see information they entered previously already populated and just finish the process.
DRAFT enrollments should not show up in Patient Connect.
Each page of enrollment process should have auto save functionality that occurs when user advances to the next page.
Each page of the Enrollment process should also have a save button so that if the user needs to abandon the page prior to advancing to the next page they have the option to do so.
To save a record as a DRAFT, a minimum set of data must be entered on the first page to include patient name and date of birth.

The Patient Enrollment process consists of 4 pages- Patient, Physician, Insurance and Treatment. The top of each page should have a progress bar to show where the user is in the process.
21.0 Enrollment-Patient Information

Fields that display on the page will be configurable at a program and product level, this
view represents the basic set of fields.
Required fields will be configurable at a program and a product level (if we need to go
down to the product level for a specific client we will need to add a provider selection as
the first step to the enrollment process-

And then the fields that display on the pages will align with what has been configured for
that product.

If end user clicks on the plus

sign to add the shipping
address-the shipping address
fields will display with a trash
can above them. Once they
display they are required fields
so if end user added them in
error they will need to click the
trash can to remove them.
Like all fields this is configurable per program- this would need to be accounted for in
Patient Connect if needed on the portal

If patient checks the box then the caregiver name, relationship and at least one phone
number field will become required for submission.
Next (button)
• When the user clicks “Next” (button) without completing all the required fields, then an error
message will display, “This is a Required field.” next to the missing field(s).
• When the user clicks “Next” and all the required fields are complete, then they are directed to
“Patient Enrollment – Insurance” page (22.0)
22.0 Enrollment-Provider

Fields that display on the page will be configurable at a program and product level, this
view represents the basic set of fields.
Required fields will be configurable at a program and a product level

Back (button):
• When the user clicks “Back” if will take them back to the “Enrollment-Patient” page
(21.0) –page will still be populated with info previously entered.

Next (button)
• When the user clicks “Next” (button) without completing all the required fields,
then an error message will display, “This is a required field.” Next to the missing
field(s).
• When the user clicks “Next” and all the required fields are complete, then they are
directed to “Patient Enrollment – Insurance” page (23.0)
General:
• The Patient Enrollment process consists of 4 pages- Physician, Patient, Insurance
and Treatment. The top of each page should have a progress bar to show where
the user is in the process. (see labels in blue on screen shot- need to modify this in
some way to make it a progress bar)

Provider Dropdown
• This dropdown will only have providers the end user has access to view to select
from.
• Once a provider is selected the NPI, TIN and PTAN will auto-populate and not be
editable.

Treating Site Dropdown

• This dropdown will only have Sites associated with the provider chosen that the
end user has access to view.
• Once a site is selected the Address, phone and fax fields will auto populate but not
be editable.
 Required Fields: (all fields should be configurable based on program and product but have listed some as required for a
23.0 Enrollment-Insurance baseline)
• Does Patient have insurance?
• If “No” is selected, all other insurance fields will be greyed out and not required.
• Insurance Company-Dropdown with list of payers from our Master Payer Database
• Primacy: Dropdown with Primary,Secondary, Tertiary
• Plan Type: Commercial, Medicaid, Medicare, Medicare Supplement, Other State & Government
• Plan Sub-Type: (dependent on Plan type select, user story will include specific values available for each plan type
selected)
• Plan Name- free text field for end user to type in plan name
• Insurance Phone-numeric, 10 digits required, formatted with parenthesis and hyphen Example (800) 123-1234 (this
should not auto-populate but be open and required for end user to enter phone number)
• Policy ID Number-Alphanumeric
• Group #: Free text field, alphanumeric
• Subscriber Name-Alphanumeric
• Relationship to Patient: Dropdown: Child, Dependent, Domestic Partner, Father, Guardian, Mother, Other, Self, Spouse

Plus Sign:
When the user clicks the plus sign all fields above it will duplicate to allow end user to add Secondary Insurance. This should
only allow them add up to two additional insurances.
Once the plus sign is added and the additional fields are populated, there will be an option to remove the fields (trash can or
minus sign) so that if the end user clicked the add button in error they are not required to complete the fields since they are
required fields.

Back (button):
• When the user clicks “Back” if will take them back to the “Enrollment-Provider” page (22.0) –page will still be populated
with info previously entered.
Next (button)
• When the user clicks “Next” (button) without completing all the required fields, then an error message will display, “This
is a required field.” Next to the missing field(s).
• When the user clicks “Next” and all the required fields are complete, then they are directed to “Patient Enrollment –
Treatment” page (24.0)

General:
• The Patient Enrollment process consists of 4 pages- Physician, Patient, Insurance and Treatment. The top of each page
should have a progress bar to show where the user is in the process. (see labels in blue on screen shot- need to modify
this in some way to make it a progress bar)
24.0 Enrollment-Treatment

Required Fields:
• Place of Service-dropdown with values (Physician’s Office, Hospital Outpatient, Ambulatory
Surgical Center) This will only show sites end user has access to view and that are applicable to the
physician selected on the Enrollment-Provider page (22.0)
• Product-dropdown with values (this is only needed on this page if it is not configured on the first
page of the enrollment process)
• Treatment Codes-dropdown with values configured specifically for the program and product.
• At least one treatment code is required.
• Primary Diagnosis-At least one is required for each eye selected. Dropdown with values configured
specific to the program and product.
• When user selects ‘Other’ an additional field displays that is required for end user to enter an
additional Diagnosis code not in the list of values provided in the dropdown. (image above)
• Consent Language-consent language is a checkbox that must be checked for an enrollment to be
submitted successfully.

Plus/Minus Buttons:
• “Plus sign” button- when the user clicks the plus sign next to the treatment code field or the ICD 10
Diagnosis code field an additional field will populate with the same dropdown minus the code they
have already selected to allow the end user to remove a code added in error and/or to add
multiple codes.
• “Minus sign” button-Any additional fields will have a minus sign next to them that allows the end
user to click on them and remove the additional code that was added.
Back (button):
• When the user clicks “Back” if will take them back to the “Enrollment-Insurance” page (23.0) –page
will still be populated with info previously entered.
Next (button)
• When the user clicks “Next” (button) without completing all the required fields, then an error
message will display, “This is a required field.” Next to the missing field(s).
• When the user clicks “Next” and all the required fields are complete, then they are directed to
“Enrollment Submission Successful” page (25.0)
25.0 Enrollment Successful

End user can click the Home button from the header to return to Dashboard/Activity page or choose any other
page from the hamburger menu to be re-routed.
Additional Services/Support Request
High Level Requirements.

Process should allow a physician office to request support for additional services that are configured for the program.

Additional services can only be requested on patients already enrolled in the program.

Functionality should allow end user to search and select an ENROLLED patient.
Upon selecting an ENROLLED patient, the patient information will auto-populate but will not be editable.

End user will be able to select from a list of Request types that are configurable per program and will align with cases in patient connect.

Help functionality should include verbiage that identifies what documents are required for each request type.

End user should be able to upload documentation prior to submission.

If end user fails to submit, the end user should be presented with an error so that they know the request did not transfer.

When request is successfully transferred to EVERSANA, the system should locate the patient, create a case that aligns with the request type for the patient and create a task so
that associate knows a request was received and needs to be completed. (task details should include all information entered during the submission as well as document
names)
 Required Fields:
26.0 Additional Services • Patient Search: search functionality will search list of patients affiliated with physicians and sites the end user has
permissions for. Once returned, the Patient First Name, Patient Last Name and Patient ID fields will auto
populate.
• Physician and Treating Site fields will auto-populate with physician and treating site associated with the patient’s
enrollment.
• Request Type: dropdown will have a list of case types associated with the program.

Searching by patient name or PAT ID:

End user can search by patient first name or last name or full name

Request Type: dropdown will have a list of options configured for the program.

When the end user clicks on the information icon verbiage will display that advises them which documents are
required for submission of each request type.

Submit Button:
• 1. When the user clicks ‘Submit’ (button) without completing all the required fields, then an error message will
display “This is required field.” next to the missing field(s).
• When the user clicks ‘Submit” (button) and all required fields are complete, then they are directed to
“Additional Services Submission Successful” page (27.0)
• When submitted a case that aligns with the request type entered on the screen will be entered in Patient
Connect and any supporting documents received in the submission will be attached to the case. The system
then generates a task for follow up on the case. Task details will list the request type, documents checked on
the screen and if “other” is checked it will also list what the end user typed in the description field.
• Task Name: Additional Request Received From Portal
27.0 Additional Services Successful Submission

“Return to Home” Button:

1. When a user clicks “Return to Home” button they are directed to Dashboard page (6.1)
Secure Message Center
This section will define the requirements for the Secure Message Center for the End User Experience

This secure message center is configurable as to whether it is available on the HCP portal for a program.
When it is configured for the program it will sit in the header and include an indicator to show when new messages have been received.

The secure message center will include a notification section – that allows the end user to see any notifications sent from the program
The secure message center will include a section to show any new messages received
There will be a link to history that allows an end user to view history of all messages sent/received (this does not include notifications)

End user will be able to send a secure message from the Secure Message Center.
28.0 Message Center- End User

Message Center will be accessible from header and have a clear

indicator when there are new/unread messages. See image below
where it shows the number of new messages inside the envelope.

When end user clicks on History Tab they will be

routed to History tab view page (30.0)

When end user clicks on Notification ID the

Notification will display as shown on page (29.0)

When end user clicks on Message ID the Message

will display as shown on page 29.0)

End user will have the ability to delete notifications

that have been read. Delete button will not be
available next to notifications that have not been
opened. End user can select one or multiple
notifications to delete and then click update to
remove them.
29.0 Message Center- End User Notification and Message Views

When end user clicks on

Notification ID from page
28.0 the Notification will
display as shown here.

When end user clicks on Message ID

from page 28.0 the Message will
display as shown here.

Close Button:
Routes end user back to main page
for Secure Message Center (28.0)

Reply Button:
Opens screen that allows end user
to send response-
30.0 Message Center- End User-Send Secure Message Link
When end user clicks on Send Secure Message link from page 28.0 they will be presented
with this page.

End user name and email fields will auto populate and not be editable.

Subject is free text field that allows end user to enter brief summary

Message is text box for end user to enter their message end.

End user will have the ability to attach documents as needed.

Cancel Button:
When the end user clicks the cancel button they are routed back to the main Secure
Message Center page.

Send Button:
When submitted, the message center will assign a Unique Message ID #.
The email and any associated documents will be transferred and show up in the EVERSANA
internal Message center with the unique message id.
It will also show up immediately in the senders History (31.0) with the unique ID.
31.0 Message Center- End User-History
When end user clicks on History link from page 28.0 they will
be presented with this page.

Once a message has been sent from the portal it will show in
this history list with a date sent but not a response received
date.

Once a reply is received to that message it will display on the

main Secure message center page (28.0) in the messages
section as a new message.

Once the end user opens the message they will have the
option to reply to it oat that time or close it. Once they close it,
it will be removed from the messages section on the main
page and be listed under message history.

An end user can open any message from the History screen and see original message and any
previous responses etc. They will have the option to close it or send another response on it.
If they close the message they should be routed back to History view.

If end user chooses to reply from the message they will be

presented with the same reply page shown on page 29.0
Secure Message Center
This section will define the requirements for the Secure Message Center for the EVERSANA Associate Experience

The main page of the internal secure message center should have three views- Pending Messages, History and Send Notification
The default view of the page will be the Pending Messages

Pending Messages section should clearly indicate how many new messages are pending and allow associate to click on Message ID to view the message.
Once a pending message has been responded to it will disappear from the Pending Messages view and only be viewable from the History view.

History will have all messages received along with any responses that were sent with date and time stamps

Send Notification page will allow an associate to send notifications to one or multiple portal end users.
32.0 Internal Secure Message Center –Pending Messages
All new/pending messages will display in this view in order of oldest received to most recent

End user will click on Message ID to open message.

Back Button:
Routes Associate back to main Secure Message Center page

When an end user clicks Reply from the message they will be presented with a pop up
screen that allows them to respond to the end user. This screen functionality works the
same as the end users Reply screen shown on page 29.0

Once an end user replies to pending message it will be removed from the Pending messages
view and only be viewable from the History view.
32.0 Internal Secure Message Center –History
All messages and notifications that have been sent in order of most recent to oldest based on Message Response date or Notification Sent Date

End user can click on Message ID to view

message history of messages or notifications
that have been sent.

When end user clicks on Message ID next to a Message type of Message the message history
will display with option for associate to respond to it again

When end user clicks on Message ID next to a Message type of Notification the Notification
sent will display
33.0 Internal Secure Message Center –Send Notification
This page allows an associate to send a notification to all portal end users, some end users or one end user

Sending a Notification:
Associate can select to send notification to an individual user or multiple users associated with a site.
Once they enter a site ID and search the screen will display usernames of all portal users associated with
that site for the associate to select one or multiple.

OR

Associate can select to send a global notification to ALL Portal users across the program.

Once Associate clicks Send they will see the notification that was sent in the History view with a message
type equal to Notification and a unique message ID.
If it was only sent to one user it will show the username of that end user in the username field on the
history view.(32.0)
If it was sent to more than one it will show Multiple in the username field on the history view. (32.0)
If it was sent to ALL portal end users it will show Global in the username field of the History view page.
(32.0)
34.0 Profile page- HCP Role
• NPI: displays the end users NPI. Not editable
• First Name/Last Name fields: Displays the end users first and last name. Not editable
• Phone: Displays the phone number of the logged in user. Editable/can update
• Email Address: Displays the email address of the logged in user. Not editable

• Office/Site location: dropdown of all locations logged in user is affiliated with. When user selects a value
from the dropdown the corresponding Address, City, State, Zip, Phone and Alternate Contact Names will
populate based on information submitted during registration.
• Office Phone, Ext, and Office Fax fields are editable.

• When the end user clicks save it will save and a message will appear above the save button in red font that
says “Your updates were saved successfully”
• Any updates made to the editable fields will be sent to EVERSANA.

Click here to Change Your Password link:

• When the end user clicks the “Click Here to Change Your Password” Link they will be directed to the
“Change Password” page (4.0)
35.0 Profile page- Office Staff Role
• First Name/Last Name fields: Displays the end users first and last name. Not editable
• Phone: Displays the phone number of the logged in user. Editable/can update
• Email Address: Displays the email address of the logged in user. Not editable

• Office location: dropdown of all locations logged in user is affiliated with. When user selects a value from
the dropdown the corresponding Address, City, State, Zip, Phone and Alternate Contact Names will populate
based on information submitted during registration.
• Office Phone, Ext and Office Fax fields are editable.
• Physicians: dropdown of all physicians the logged in user is affiliated with. When user selects a value from
the dropdown the corresponding NPI, First Name and Last Name fields will populate. These fields are not
editable.

• When the end user clicks save it will save a message will appear above the save button in red font that says
“Your updates were saved successfully”
• Any updates made to the editable fields will be sent to EVERSANA.

Click here to Change Your Password link:

• When the end user clicks the “Click Here to Change Your Password” Link they will be directed to the
“Change Password” page (4.0)
36.0 Copay/Savings Offer- Main Page
This section will define the requirements for the Copay/Savings Offer Service
This service should be configurable at a program and product level as to whether it is available on the portal.

Product dropdown: Products that are applicable to the

savings offer for the program.

The eligibility statements on this page should be written as

“true” statements so that they are required to be checked.
The statements themselves are defined by each client but
these are the standard for a starting point.

End user must check all eligibility statements prior to clicking

“Request Copay ID”

Request Copay Card:

• If the end user clicks “Request Copay ID” but does not check all validations or select product (if applicable) on the screen then an error will display- “This field is require.” next to the missing field(s).
• If the end user clicks “Request Copay ID” and all required fields have been completed they will be routed to the Confirmation page 37.0

When the request is submitted it will be sent to patient connect. The system will locate the patient and create an associated Savings Offer Case. Validation will be done against business rules configured for
creating a Savings offer case for the program.
• If the request is successful the system will activate an ID number, set the status on the Savings Offer case to Active and return the Card ID, Group #, PCN and BIN to the portal.
• If the request does not pass validation in patient connect a Savings Offer case will be created and set to status, Complete/Denied/Not Eligible.
• Case will show up in the portal once it has been created in Patient Connect.

The return of the Copay information should be configurable per program as to whether it returns on the screen for the end user or returns a PDF version of the card in a client approved tactic for the end
user to download when the card is activated. (this pdf would also be available from the copay/Savings Offer case in the portal in the associated documents section)
37.0 Copay/Savings Offer- Confirmation

End user will be routed to this page from the Copay/Savings Offer Submission page (36.0) once all required fields have been
completed and the end user clicks “Request Copay Card ID”

Return to Home
This button will route user back to the Dashboard/Recent Activity page.
38.0 PAP SS Product Integration
The PAP Self Service Application that allows the end user to apply for Patient Assistance is a stand alone product that should be able to be integrated to the HCP portal and has its
own manuscript.
To date this has been patient facing so making it HCP facing may require a few adjustments.

If implemented on an HCP portal it should be available from the Hamburger menu in the header of the HCP portal.

Suggestion: This remain a separately billable and stand alone product that is patient facing and if a provider wants to be able to assist patients with it then we will put a link in the
header of the HCP portal that allows them to link to the patient facing portal
 U1 Session Expired

Content Page
 U2 Error Page

Content Pop up message.

When the end user clicks the x the pop up message will disappear and leave patient on the previous page so they can refresh and try again.

This page will appear any time the end user tries to access something within the portal and the process that supports it fails.
General Field Requirements
Username = email address and must be in standard email format
Password= alphanumeric, at least 8 characters, must contain one upper case letter, one lower case letter and one numeric value
Program Phone Number to be replaced throughout every program phone number placeholder is [unique per client]
Program Name to be replaced throughout every program name placeholder is [unique per client]
Program Hours to be replaced throughout every screen that references hours is [unique per client]

Formatting
Phone number fields should validate on 10 digits and throw an error if value entered is not correct. Upon entering a phone number the system should format it as 1-(xxx)-xxx-xxxx.
Zip Code: allow 5 or 9 digits
NPI:
Tax ID:

Dropdowns:
Product: list of products applicable to program [unique to each program]
Category: Will have a list of document types available that end user can select from [configurable per client and will need to be mapped to document tags in patient connect]
Gender: Female, Male, Other
State: Will be dropdown of state abbreviations
Preferred Language: English, French, Spanish
Preferred Method of Contact: Email, Fax, Phone, Postal Mail, SMS. (configurable per client)
Provider: Will only have providers listed that the end user has access to view
Treating Site: Will only have sites listed that end user has access to view and that are associated to the provider selected
Relationship to Subscriber: Child, Dependent, Domestic Partner, Father, Guardian, Mother, Other, Self, Spouse
Plan Type: Commercial, Medicaid, Medicare, Medicare Supplement, Other State & Government
o Plan Sub-Type values are dependent on Plan type selected as follows:
o Plan Type Commercial: EPO, HMO, Indemnity, POS, PPO
o Plan Type Medicaid: CHIP, MCO, QMB, SLMB, Traditional
o Plan Type Medicare: Part A, Part A & B, Part C, Part D
o Plan Type Medicare Supplement: Medigap A, Medigap B, Medigap C, Medigap D, Medigap F, Medigap G, Medigap K, Medigap L, Medigap M, Medigap N, Nonstandard Supplement
o Plan Type Other State & Government: IHS, State Elderly Drug Assistance, TRICARE, Tricare for Life, Veteran Affairs
Insurance Company: lookup to master payer database
Primacy: Primary, Secondary, Tertiary
Diagnosis Code(s): Unique per client and will be provided in program specific user story
Treatment Codes(s): Unique per client and will be provided in program specific user story
Request Type: configurable per program but for product-Benefit Verification, Coverage Determination, Coverage Determination Appeal, Claim, Copay, PAP