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.
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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