Workflow model

• Prescription issue

  The core unit. Represents one prescription that cannot move forward right now. Holds patient reference, Rx reference, blocker type, status, priority, owner, and next action.

• Claim case

  Captures one claim submission and rejection. Holds the original payer text, a manual category (Prior auth required, NDC issue, Refill too soon, Coverage limit, Drug not covered, COB, Other), and the next chosen step. Linked to a prescription issue.

• Prior auth case

  Tracks one PA from request to outcome. Status moves through Not started, Prescriber follow-up, Payer pending, Patient update due, Approved, Denied, or Cancelled. Linked to a claim case and/or a prescription issue.

• Patient update

  A short message to the patient about a delay, request, or next step. Channel is SMS, Email, or Phone script. Has a draft state and a sent/called state. Never auto-sent — pharmacy team reviews.

• Prescriber message

  An outbound communication to the prescriber office — typically a callback request, fax draft, or message text. Draft and sent states are tracked. Pharmacy team reviews before sending.

• Inventory risk

  A flagged product that is likely to block refills soon — short stock, back-order, recall, or short-dated. Holds expected demand and low-stock threshold. Linked to affected prescription issues.

• Alternative path

  A suggested alternative workflow (for example, contacting the prescriber about a different strength or pack size). Always pharmacist-reviewed. Refillops does not select therapy on its own.

• Task

  A small unit of work attached to an issue — ‘Call Dr. Patel’, ‘Fax PA form’, ‘Recheck Thursday’. Has an owner and a due date. Tasks resolve when done; the parent issue can stay open.

• Note

  Free-text annotation on an issue, claim, PA, or patient update. Notes are appended to the timeline; they are never silently rewritten.

• Audit event

  An immutable record of a meaningful change — status change, owner change, sent message, accepted suggestion. Used for review and compliance.

Prescription Issue
  ├── Claim Case ──── Prior Auth Case
  │                     └── Patient Update (status timeline)
  ├── Prescriber Message
  ├── Inventory Risk ── Alternative Path (pharmacist-reviewed)
  ├── Task(s)
  ├── Note(s)
  └── Audit Event(s)

A prescription issue is always the parent. Every other object is attached to one — including audit events — so the full timeline reads top to bottom without jumping screens.

• • Resolving an issue does not delete its children — they stay in the timeline.
• • Reopening an issue preserves its full prior history.
• • Patient updates and prescriber messages never auto-send.
• • Audit events are append-only — they are never edited or removed.