Step 1: Requirement Analysis

The insurance provider needs to displaypreauthorization outcomesin Health Cloud.

The preauthorization (prior authorization) process and its outcome are managed by anexternal system, but outcomes need to be displayed in Salesforce Health Cloud.

Step 2: Salesforce Health Cloud Data Model for Prior Authorization

Health Cloud provides specific objects for handling prior authorization processes:

Care Preauth:Represents the prior authorization request.

Care Preauth Item:Represents individual services or procedures within that authorization request.

Extract:

“Care Preauth and Care Preauth Item objects capture information about prior authorization requests and their associated services or procedures, enabling payers to track and display preauthorization statuses and outcomes, including those coming from external systems.”

Administer Health Cloud – Utilization Management Data Model

Step 3: Review of Options

A. Plan Benefit and Plan Benefit Item:Used to model insurance plans and coverage, not prior authorization outcomes.

B. Care Preauth and Care Preauth Item:Correct– These objects are designed for managing and displaying prior authorization requests and outcomes.

C. Service Preauth and Preauth Detail:These are not standard Health Cloud objects for prior authorizations.

D. Care Request and Care Request Item:Used for more general care coordination, not specifically for tracking preauthorization outcomes.

Verified Answer:

B. Care Preauth and Care Preauth Item