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A payer is implementing Health Cloud and wants to leverage predefined rules for its prior authorization request review process. The payer would like to leverage out-of-the-box Health Cloud functionality to drive speed to value. Which prebuilt feature should a consultant recommend the payer leverage?
A. Integration Procedures
B. OmniScript Templates
C. FlexCards
D. Expression Set Templates
Explanation:
Expression Set Templates are the prebuilt feature that the payer should leverage to implement predefined rules for its prior authorization request review process. Expression Set Templates are reusable sets of expressions that can be used to evaluate business logic and trigger actions based on the results.
A Payer Service Cloud org uses Accounts and contacts to model Health Insurance Members. While all teams within the organization Work with all members, only some teams require HC capabilities. What is the recommended best practice for modeling members in HC for this organization?
A. Only groups needing HC capabilities need to use Person Accounts.
B. Model as Person Accounts, whether they are using HC capabilities or not.
C. Account Record Types for existing members can remain as-is. Future members should be created as Person Accounts.
D. Use the individual model with HC
Explanation:
According to the Health Cloud Implementation Guide, the recommended best practice for modeling members in Health Cloud for a payer service cloud org that uses accounts and contacts to model health insurance members is to model them as person accounts, whether they are using Health Cloud capabilities or not. Person accounts are a type of account that combines account and contact information in a single record. They are suitable for representing individual consumers in healthcare and life sciences. Using person accounts for all members can simplify data management and avoid data duplication. Only groups needing Health Cloud capabilities need to use person accounts is not a recommended best practice, as it can create inconsistency and complexity in data modeling. Account record types for existing members can remain as-is is not a recommended best practice, as it can limit the functionality and integration of Health Cloud features. Using the individual model with Health Cloud is not a valid option, as the individual model is not supported by Health Cloud.
Which three types of Electronic Health Record data transmitted via HL7 can be stored in Salesforce objects? (Choose Three.
A. Continuation of Care document (CCD.
B. Observation Results (ORU)
C. Personal Health Record (PHR)
D. Admission, Discharge, Transfer Data (ADT)
E. Clinical Document Architecture (CDA.
Explanation:
According to the Salesforce documentation1, the following types of electronic health record data transmitted via HL7 can be stored in Salesforce objects:
Observation Results (ORU): ORU messages contain clinical observations and results, such as lab tests, vital signs, or imaging reports. ORU messages can be stored in the DiagnosticReport object in Health Cloud1.
Admission, Discharge, Transfer Data (ADT): ADT messages contain information about patient admissions, discharges, transfers, or updates, such as demographics, insurance, or diagnosis. ADT messages can be stored in the EhrPatient object in Health Cloud1.
Clinical Document Architecture (CDA): CDA is a standard for exchanging clinical documents, such as discharge summaries, progress notes, or referrals. CDA documents can be stored in the Document object in Health Cloud1.
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?
A. Designing Next Best Action and Recommendations for the care management team
B. Designing Care Requests to seek authorization from a health plan for drugs, services, and admissions
C. Considering the number of intake agents who will be using Health Cloud
D. Considering the Request Review Types; Prior Authorization Review, Concurrent Review, and Retrospective Review
Which industry data standard should a with Health Cloud?
A. Personal Health Record (PHR)
B. Clinical Data Acquisition
C. HL7 v1 Messaging
D. FHIRR4
Explanation:
FHIRR4 is the industry data standard that a consultant should use with Health Cloud. FHIRR4 stands for Fast Healthcare Interoperability Resources Release 4, and it is a standard for exchanging healthcare information electronically. FHIRR4 enables interoperability between different systems and applications, and supports a variety of use cases, such as clinical, administrative, and financial.
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