Which three standard objects are used in the workflow to manage utilization data? (Choose 3)
A. Care Request Plan
B. Care Diagnosis
C. Care Authorization
D. Care Request
E. Care Request Drug
Explanation:
According to the Salesforce documentation2, the following standard objects are used in the workflow to manage utilization data:
Care Request Plan: A care request plan is an object that stores information about the plan of care for a member. It includes details such as the diagnosis, the service type, the start and end dates, and the status of the plan2.
Care Authorization: A care authorization is an object that stores information about the approval or denial of a service or payment by a payer. It includes details such as the authorization number, the decision date, the decision reason, and the status of the authorization2.
Care Request: A care request is an object that stores information about the request for a service or payment by a provider or a member. It includes details such as the request type, the request date, the priority, and the status of the request2.
A Health Cloud administrator has to provide the DevOps team access to production copy sandboxes for investigation and fixes. How can be administrator ensure that all privacy, compliance and regulatory requirement are met.
A. Install Mask and anonymize sensitive data on production copy sandboxes.
B. Only allow offshore team access to production copy sandboxes if they have taken compliance training and are certified to have access.
C. Only allow onshore team access to Health cloud objects on production copy sandboxes.
D. Install Shield only in production copy sandboxes.
E. Install shield and encrypted all PII data on production sandboxes.
Explanation:
Mask is a Salesforce product that helps you anonymize sensitive data in production copy sandboxes to ensure privacy, compliance, and regulatory requirements are met3. Mask replaces sensitive data with fictitious yet realistic data that preserves the characteristics of the original data. It also prevents unauthorized access to sensitive data by masking it before it is copied to a sandbox3.
A payer is looking to track relevant information for its provider network. Which three objects are supported with Health Cloud out-of-the-box to track information related to a provider?
A. Healthcare Provider Specialty
B. Provider Education
C. Practitioner Tier
D. Healthcare Practitioner Facility
E. Board Certification
An Health Cloud administrator has setup risk recalculation by setting the recalculate flag to true, but is not seeing the recalculation score for the patient. Which of the following is mostly likely the reason why the recalculation score for the patient is not displaying?
A. CMS risk scores cannot be recalculated in Health Cloud.
B. CMS risk scores should be recalculated using only third party APIs.
C. Risk scores are recalculated only for patients that are affiliated with a Care Program.
D. Risk scores can only be calculated using the CMS recalculation API.
Explanation:
Risk scores are recalculated only for patients that are affiliated with a Care Program © is the most likely reason why the recalculation score for the patient is not displaying. CMS risk scores can be recalculated in Health Cloud (A), so this is not a reason for the score not displaying. CMS risk scores can be recalculated using both third party APIs and Salesforce APIs (B), so this is not a reason for the score not displaying. Risk scores can be calculated using both the CMS recalculation API and other methods (D), so this is not a reason for the score not displaying.
Care Requests seek authorization from a health plan for drugs, services, and admissions. They can also contain request for review, appeals, complaints and grievances. Which Care Request review ensure that a member is getting the right care in timely and cost-effective way?
A. Disposition Review
B. Concurrent Review
C. Care Review
D. Preauthorization Review
E. Retrospective Review
Explanation:
Concurrent review is a type of care request review that ensures that a member is getting the right care in a timely and cost-effective way. It involves reviewing the medical necessity and appropriateness of an ongoing service or admission3. Disposition review, care review, preauthorization review, and retrospective review are not the correct terms for this type of review.
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