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NEW QUESTION # 24
A payer needs to work with plan members and medical providers to influence decisions through a case-by- case review of the appropriateness of care. When gathering requirements for this use case, which two Utilization Management processes should a consultant discuss with the client?
Answer: A,B
Explanation:
Utilization Management requirements center on designing Care Request records for authorizations and establishing review workflows across the three standard review types: Prior Authorization, Concurrent Review, and Retrospective Review. Utilization Management structures care requests, authorization review, medical-necessity determination, concurrent review, and related payer-provider approval workflows. From a discovery perspective, the consultant should validate the current-state workflow with the people who perform it, document pain points and handoffs, and translate the findings into functional, data, security, and integration requirements before solution design begins. The remaining options do not directly satisfy the stated requirement; they either address a different functional domain, provide only part of the required behavior, or introduce unnecessary customization compared with the selected Health Cloud approach. This approach also keeps the solution aligned with the standard Agentforce Health data and process model, which is important for maintainability, reporting, interoperability, and consistent user access. In practical terms, the consultant should configure and validate the selected elements (Designing Care Requests to seek authorization from a health plan for drugs, services, and admissions; Considering the Request Review Types; Prior Authorization Review, Concurrent Review, and Retrospective Review) against the scenario ' s acceptance criteria and confirm that the intended users can access the underlying records and functionality.
Study Guide references/topics:Discovery - Utilization Management
NEW QUESTION # 25
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?
Answer: A,B,C
Explanation:
Managing prior authorizations with automated rules requires the Utilization Management data model (CareRequest, CareRequestItem), Business Rules Engine (BRE / Expression Sets) for decision logic, and prebuilt out-of-the-box Process libraries. Utilization Management structures care requests, authorization review, medical-necessity determination, concurrent review, and related payer-provider approval workflows.
Business Rules Engine uses decision matrices, expression sets, and reusable rule templates to externalize decision logic from user-interface components and workflows. From a solution-design perspective, the selection fits the requirement because it uses the Health Cloud capability or data model that directly represents the business need, rather than introducing a parallel custom structure or a feature intended for a different stage of the patient, member, provider, or payer lifecycle. The remaining options do not directly satisfy the stated requirement; they either address a different functional domain, provide only part of the required behavior, or introduce unnecessary customization compared with the selected Health Cloud approach. This approach also keeps the solution aligned with the standard Agentforce Health data and process model, which is important for maintainability, reporting, interoperability, and consistent user access. In practical terms, the consultant should configure and validate the selected elements (Out-of-the-box Process libraries; Business Rules Engine; Utilization Management data model) against the scenario ' s acceptance criteria and confirm that the intended users can access the underlying records and functionality.
Study Guide references/topics:Design - Utilization Management; Business Rules Engine
NEW QUESTION # 26
A consultant is implementing Identity Verification for their customer ' s customer service representatives and needs to add a new search parameter. Which record should the consultant configure to accomplish this?
Answer: B
Explanation:
Identity Verification Process Detail records specify the fields used for searching callers, verifying caller identities, and returning search results. From an implementation perspective, the configuration should use delivered Health Cloud and Salesforce mechanisms first, preserving standard relationships, security enforcement, and upgrade compatibility while limiting custom code to cases where declarative capabilities are insufficient. The remaining options do not directly satisfy the stated requirement; they either address a different functional domain, provide only part of the required behavior, or introduce unnecessary customization compared with the selected Health Cloud approach. This approach also keeps the solution aligned with the standard Agentforce Health data and process model, which is important for maintainability, reporting, interoperability, and consistent user access. In practical terms, the consultant should configure and validate the selected elements (Identity Verification Process Detail) against the scenario ' s acceptance criteria and confirm that the intended users can access the underlying records and functionality. The implementation should be tested with representative healthcare data and end-user workflows so that relationships, permissions, automation, and integration behavior remain consistent from the source transaction through the user experience.
Study Guide references/topics:Implement - Agentforce Health architecture and implementation
NEW QUESTION # 27
A provider wants to set up a Contact Center leveraging Health Cloud to enable its patients to set up appointments, get answers to their billing questions, and update their plan information. Which group of people should a consultant work with to identify pain points and define project requirements?
Answer: D
Explanation:
For a patient contact center handling scheduling and billing inquiries, the primary end-user persona is the Contact Center Agent, supported by the Salesforce Administrator and Integration Architect as technical stakeholders. From a discovery perspective, the consultant should validate the current-state workflow with the people who perform it, document pain points and handoffs, and translate the findings into functional, data, security, and integration requirements before solution design begins. The remaining options do not directly satisfy the stated requirement; they either address a different functional domain, provide only part of the required behavior, or introduce unnecessary customization compared with the selected Health Cloud approach. This approach also keeps the solution aligned with the standard Agentforce Health data and process model, which is important for maintainability, reporting, interoperability, and consistent user access. In practical terms, the consultant should configure and validate the selected elements (Personas: Contact Center agent | Stakeholders: Salesforce administrator, Integration architect # (Correct Answer)) against the scenario ' s acceptance criteria and confirm that the intended users can access the underlying records and functionality.
Study Guide references/topics:Discovery - Provider; Integration; Scheduling
NEW QUESTION # 28
A provider is looking to implement Utilization Management in Health Cloud and submit and track prior authorizations. Which two capabilities should a consultant customize to achieve this?
Answer: A,B
NEW QUESTION # 29
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