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| Section | Weight | Objectives |
|---|---|---|
| Implement | 42% | - Customize features for specific use cases - Configure applications and OmniStudio components - Set up care programs, patient management and workflows - Installation and configuration of Health Cloud |
| Design | 42% | - Define success metrics and reporting - Solution design using best practices - Healthcare data modeling - Integration and data migration strategy - Security, compliance and data access design |
| Discovery | 11% | - Define required capabilities and use cases - Identify customer personas and stakeholders - Gather functional and technical requirements |
| Deploy | 5% | - Pre-deployment validation and preparation - Post-deployment monitoring and optimization - Manage mobile and user experience |
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NEW QUESTION # 100
A provider is looking to implement Utilization Management in Health Cloud and submit and track pror authorizations. Which two capabilities should a consultant customize to achieve this?
Choose 2 answers
Answer: C,D
Explanation:
Implementing Utilization Management in Salesforce Health Cloud to handle prior authorizations involves customizing specific components to streamline the submission and tracking processes.
1. Integrate Using MuleSoft Direct for Electronic Prior Authorizations (ePA):
MuleSoft Direct for Health Cloud facilitates seamless integration between Electronic Health Record (EHR) systems and Health Cloud. This integration enables providers to electronically submit and track prior authorization requests, eliminating manual processes and reducing decision times. By leveraging electronic prior authorization (ePA), healthcare organizations can automate workflows, ensure timely approvals, and enhance patient care delivery.
Salesforce
2. Customize the Service Request Object:
The Service Request object in Health Cloud serves as a central repository for managing various patient-related requests, including prior authorizations. Customizing this object allows organizations to align the authorization process with their specific business requirements. Enhancements may include adding custom fields to capture necessary clinical information, modifying page layouts for improved user experience, and implementing validation rules to ensure data accuracy. Such customizations facilitate efficient tracking and management of authorization requests, ensuring that all relevant information is readily accessible to care teams.
Reference:
Get Started with Health Cloud Utilization Management
Manage Authorization Requests in a Provider's Office
NEW QUESTION # 101
A consultant is working with an insurance provider to set up prior authorizations in Health Cloud. The provider requires a display of preauthorization outcomes from its external system which manages the end-to- end prior authorization process.
Which solution is appropriate to meet this use case?
Answer: A
Explanation:
In Salesforce Health Cloud, when dealing with prior authorizations, the correct data model objects are:
* Service Preauth # Represents the overall prior authorization request (at the header level).
* Preauth Detail # Captures the individual service line items or outcomes associated with the prior authorization.
This structure allows Health Cloud to integrate with an external utilization management system that handles the full prior authorization process. The Service Preauth object acts as the container for the request, while Preauth Detail records capture outcomes, decisions, and details returned from the external system.
This is exactly suited to the requirement:
"The provider requires a display of preauthorization outcomes from its external system which manages the end-to-end prior authorization process." Why not the others?
* A. Plan Benefit and Plan Benefit Item - These are used to model insurance plan coverage and benefits, not authorization workflows.
* B. Care Preauth and Care Preauth Item - These are older, deprecated objects in favor of the Service Preauth data model.
* D. Care Request and Care Request Item - These are used to track referrals and service requests (e.g., a doctor requesting lab work), but not prior authorization outcomes.
Salesforce Health Cloud Reference:
# Salesforce Health Cloud Developer Guide - Utilization Management Data Model:
"The Service Preauth object represents the prior authorization request and its details. The Preauth Detail object contains service line items and outcomes for the prior authorization request."
* Salesforce Help: Utilization Management Data Model
* Salesforce Health Cloud Implementation Guide - Prior Authorizations
NEW QUESTION # 102
Which type of files can be uploaded as Consent Documents in secure folders of Health Cloud for a Care Program? (Choose two)
Answer: C,E
Explanation:
According to the Salesforce documentation1, consent documents are files that capture the enrollee's consent to participate in a care program. Consent documents can be uploaded as PDF, DOC, DOCX, or JPG files in secure folders of Health Cloud for a care program. The file size limit for consent documents is 2 MB1. Therefore, options C and D are correct. Option A is incorrect, because copy-protected PDF files cannot be uploaded as consent documents. Option B is incorrect, because opt out consent documents are not used to enroll in a care program, but to withdraw from it. Option E is incorrect, because password protected files cannot be uploaded as consent documents.
NEW QUESTION # 103
Bloomington Caregivers has replaced its legacy Contact Center application with Health Cloud. During user acceptance testing (UAT), the call center team Is reporting differences between current Identity Verification business processes and what was built in Health Cloud.
The call center manager has requested the following changes:
* Birth Date be available in results and as an optional verifier, but no longer required for verification purposes
* Add 'Bloomington ID', a custom field on Account, to search results and as a required verifier What should a consultant do to meet these requirements?
Answer: B
Explanation:
Step 1: Requirement Analysis
* Birth Dateshould be a result field and an optional verifier (not required).
* Bloomington ID(a custom field) should appear in search results and be a required verifier.
Step 2: Salesforce Health Cloud Identity Verification Process Configuration TheIdentity Verification Process Fieldobject in Health Cloud determines which fields are used for search results, required verification, or optional verification during the identity verification process.
You can add multiple records for a field with different purposes (e.g., one as Result Field and another as Required/Optional Verifier).
Extract:
"You can add or modify Identity Verification Process Field records to control which fields are shown as search results, required verifiers, or optional verifiers. For example, to make a field a required verifier, set Field Type to 'Required Verifier'. To make a field show in results, set Field Type to 'Result Field'. You can have more than one record for the same field with different Field Types." Administer Health Cloud - Identity Verification Process Step 3: Actions Needed
* For Bloomington ID:
* Add a record with Field Type = Result Field (to display in search results)
* Add another record with Field Type = Required Verifier (to make it a required field for verification)
* For Birth Date:
* Update the current record so that Field Type is changed from Required Verifier to Optional Verifier (to make it not required but still usable as a verifier)
* Ensure there is a record with Field Type = Result Field if Birth Date should show in the results Step 4: Review of Options
* A:Incorrect; it says to delete the Birth Date Required Verifier instead of changing it to optional.
* B:Not the right object/method; doesn't mention the correct object (Identity Verification Process Field).
* C:Correct; matches the best practices and object structure in Health Cloud.
* D:Incomplete; does not cover all configuration requirements.
Verified Answer:
C). Add two new Identity Verification Process Field records for 'Bloomington one with Field Type set to Result Field and one with Field Type set to Required Verifier. Change the Birth Date record with Field Type value Required Verifier to Optional Verifier.
References:
Health Cloud Identity Verification Process Setup
NEW QUESTION # 104
A payer needs to enable its agents to answer questions from members regarding their benefits coverage. The payer has already set up the required objects to be populated with the necessary information through an integration.
Which Health Cloud should a consultant recommend for the record page?
Answer: B
Explanation:
The Benefits Verification component in Salesforce Health Cloud is designed to help agents respond to member inquiries regarding benefits coverage. This feature integrates seamlessly with Health Cloud objects and data, offering agents real-time access to benefit information.
Key Features of Benefits Verification:
Real-Time Verification: Displays benefits data retrieved through integrations, allowing agents to answer member questions promptly.
Comprehensive Coverage Details: Includes plan benefits, covered services, and limits.
Customizable Layout: Can be configured on the record page to provide relevant benefit details in a user-friendly format.
Why Other Options Are Incorrect:
A . Eligibility Validation: Focuses on determining program eligibility rather than detailed benefits coverage.
B . Benefits Coverage: While related, it is not the specific tool designed for verifying benefits inquiries.
C . Coverage Confirmation: Typically used for confirming specific services under a plan, not general benefits questions.
Reference:
Benefits Verification in Health Cloud
NEW QUESTION # 105
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