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NEW QUESTION # 19
A provider's office wants to verify a patient's insurance plan information and coverage when they call into the call center to book an appointment.
Which capability should a consultant leverage to address this requirement?
Answer: C
Explanation:
Step 1: Requirement Analysis
The provider's office needs to verify a patient's insurance plan information and coverage when a patient calls to book an appointment.
This means checking whether the patient's insurance is active, what services are covered, and any applicable copays or eligibility details.
Step 2: Health Cloud Out-of-the-Box Capability
Benefits Eligibility and Verification is the dedicated Health Cloud capability that allows provider offices and payers to verify a patient's insurance coverage, eligibility, and benefit details in real time, either through integration with payers or using Health Cloud workflows.
Extract:
"Health Cloud offers Benefits Eligibility and Verification, enabling providers and payers to confirm a patient's plan information and coverage eligibility, reducing the risk of denied claims and improving the patient experience." Administer Health Cloud - Benefits Eligibility and Verification Step 3: Review of Options A . Benefits Eligibility and Verification: Directly addresses insurance plan and coverage verification.
B . Intelligent Appointment Management: For scheduling, not insurance verification.
C . Utilization Management: For prior authorizations and care request reviews.
D . Identity Verification: For confirming patient identity, not insurance coverage.
NEW QUESTION # 20
Bloomington Caregivers wants to use patient or member lists for its care coordinators in its current implementation.
What is an important consideration when implementing this in Health Cloud?
Answer: D
Explanation:
* Access to Filtered Fields:
Exact Extract:
"If a user does not have access to a field that is used in a filter on a patient or member list, the list will not be displayed to that user." Reference:
* Other Options:
Filter logic is not controlled by formula fields.
There's no official "override filter field" on the person account for lists.
Lists are not created or managed from the Campaign object in Health Cloud.
NEW QUESTION # 21
A pharmaceutical company is looking to support patients throughout their clinical journey. One of the factors the company needs to track is the socioeconomic and cultural barriers that could hinder a patient's process.
Which Health Cloud capability should a consultant implement to fulfill this requirement?
Answer: D
Explanation:
* Tracking Socioeconomic & Cultural Barriers:
Exact Extract:
"The Social Determinants of Health data model in Health Cloud enables organizations to document and track social, cultural, and economic barriers affecting patients." Reference:
* Other Options:
Clinical Barriers, Utilization Management, and Care Blockers are not documented Health Cloud features for tracking socioeconomic/cultural barriers.
NEW QUESTION # 22
Bloomington Caregivers uses Health Cloud and has an integration setup with an external payer system.
Which three business level APIs should a consultant recommend to help the payer organization electronically receive requests for care services?
Choose 3 answers
Answer: A,B,C
NEW QUESTION # 23
A payer is looking to optimize the workflow for its call center, which focuses primarily on members calling to check on the status of their prior authorization requests.
How should a consultant conduct discovery to define a workflow for these call center users?
Answer: D
Explanation:
Step 1: Requirement
Define workflow for call center users focused on prior authorization status checks.
Step 2: Best Practice for Workflow Discovery
Discovery should be user-centered, involving direct engagement with actual users (personas).
Observing and documenting their daily processes identifies real pain points and optimization opportunities.
Extract:
"Best practice for workflow discovery is to interview and observe key personas, document their processes, and map opportunities for automation and optimization." Salesforce Architect - Business Process Discovery Other options (industry research, previous projects, or proof of concept) do not provide the necessary user insight for workflow design.
NEW QUESTION # 24
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