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NEW QUESTION # 37
A health plan provider would like to manage prior authorizations with predefined approval criteria.
Which three features in Health Cloud should a consultant recommend in this case?
Choose 3 answers
Answer: A,C,D
Explanation:
Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with Reference Business Rules Engine (BRE):
Enables you to define, automate, and manage approval criteria for prior authorizations.
Extract:
"Use Business Rules Engine to automate decisions and apply approval criteria for utilization management and prior authorizations."
- OmniStudio: Business Rules Engine
Utilization Management Data Model:
Provides standard Health Cloud objects to manage prior authorizations, including requests, approvals, and denials.
Extract:
"Health Cloud Utilization Management provides a complete data model for tracking prior authorization requests and decisions."
- Health Cloud: Utilization Management Data Model
Out-of-the-box Process Libraries:
Prebuilt processes for common healthcare workflows, including prior authorizations.
Extract:
"Out-of-the-box process libraries provide reusable flows for utilization management, including authorizations, appeals, and notifications."
- Administer Health Cloud: Process Libraries
Incorrect Options:
A . Claims data model: Related to claims, not prior authorizations.
B . Intelligent Appointment Management: Focused on scheduling, not utilization management or prior authorization.
Reference:
OmniStudio: Business Rules Engine
Health Cloud: Utilization Management Data Model
Administer Health Cloud: Process Libraries
NEW QUESTION # 38
A customer wants to view medication data from Health Cloud leveraging FHIR standards.
Which Health Cloud data model should a consultant use?
Answer: B
NEW QUESTION # 39
Care managers at Bloomington Caregivers call patients after they are discharged from a hospital to ask a series of questions, which the care manager enters into Health Cloud. The patient is then automatically assigned a personalized care plan based on the answers they provided.
Which two capabilities should a consultant leverage together to fulfill this requirement?
Choose 2 answers
Answer: C,D
Explanation:
The scenario involves collecting structured information (series of questions) from patients and automatically assigning a personalized care plan based on their answers.
Step-by-Step Reference:
Salesforce Surveys can be used to gather responses from patients post-discharge.
Extract:
"With Salesforce Surveys, care managers can send and record responses directly within Health Cloud, allowing structured data capture from patients." (Source: Administer Health Cloud - Surveys) Discovery Framework processes responses and triggers automated care plan assignments based on responses.
Extract:
"The Discovery Framework in Health Cloud enables dynamic question flows and recommendations, such as assigning care plans based on patient answers." (Source: Administer Health Cloud - Discovery Framework) Combining these, care managers can capture structured data (Surveys) and drive workflow automation and personalization (Discovery Framework).
NEW QUESTION # 40
A payer needs to connect an electronic health record (EHR) to Health Cloud to display key clinical data to Health Cloud users. The data in the source system is aligned to PHIR R4 standards, but some transformation is anticipated.
Which approach should a consultant use to set up this integration?
Answer: B
Explanation:
* FHIR-Based Interoperability with Transformation:
Exact Extract:
"Middleware solutions enable integration with EHRs using HL7 or FHIR standards and can perform necessary data transformation for compatibility with Health Cloud." Reference:
* Other Options:
Batch jobs/SFTP and point-to-point APIs are not scalable or flexible for ongoing data transformation.
"Swivel-chair" procedures are not a technical integration.
NEW QUESTION # 41
Bloomington Caregivers is implementing Health Cloud to streamline the process to register patients to care programs while capturing their consent. The company plans to leverage out-of-the-box Health Cloud features.
Which Health Cloud feature should a consultant recommend the company use in this scenario?
Answer: A
NEW QUESTION # 42
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