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Step-by-Step Explanation:

Feature Overview:TheActionable Relationship Center (ARC)in Salesforce Health Cloud is specifically designed to give healthcare organizations a graphical and interactive way to visualize, manage, and act on complex relationships among people (patients, caregivers, practitioners) and organizations.

Source:Administer Health Cloud – Actionable Relationship Center

Complex Associations:ARC supports multiple relationship types, including personal, clinical, and organizational connections, enabling users to easily view and manage these associations in a single, unified interface.

Exact Extract:

“With Actionable Relationship Center, care coordinators and other users can view, create, and manage the relationships between patients, their care teams, household members, and service providers. The ARC visualization tool shows complex relationships between people and organizations.”

 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.”

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

Step 1: Requirement Analysis

The payer wants to usepredefined rulesfor prior authorization request reviews, seekingout-of-the-box Health Cloud functionalityfor speed to value.

Step 2: Health Cloud Prior Authorization & Rules Engine

TheExpression Set Templatesin Health Cloud provide a prebuilt, configurable framework to automate and standardize prior authorization request reviews. These templates contain reusable logic and criteria that can be easily tailored and applied to common authorization scenarios.

Extract:

“Use Health Cloud’s prebuilt Expression Set Templates to accelerate prior authorization configuration. These templates enable payers to implement standardized review criteria and automate decision logic without building rules from scratch.”

Administer Health Cloud – Utilization Management and Expression Sets

Integration Procedures,FlexCards, andOmniScript Templatesare OmniStudio tools for integration, UI, and guided processes, butExpression Set Templatesare the feature specifically designed for rules automation in Utilization Management.

Step-by-Step Explanation:

Requirement Analysis:

The client wants tosend patients a personalized summary documentafter their visit, including their care plan.

The process involvesselecting from templatesand generating patient-specific content.

Tool Comparison:

Health Cloud Email Manager:

Used for composing and sending emails, not for generating documents from templates.

Salesforce PDF Generator:

While Salesforce can generate PDFs from reports, it does not offer flexible, template-based document generation suited for post-visit summaries or complex care plans, especially with dynamic fields.

OmniStudio Document Generation:

Specifically designed to enabledynamic, template-based document creationin Health Cloud and other Salesforce verticals.

Allows users toselect templates, merge patient/case data, and generate PDFs or DOCXthat can be sent to patients or caregivers.

Supports integration within Health Cloud flows, empowering users (like a patient advocate) to initiate document generation with a few clicks.

Contract Lifecycle Management:

Focused on legal contracts and workflows, not patient summaries or care plans.

Exact Extracts and References from Salesforce Docs:

Extract from OmniStudio Standard Guide:

“OmniStudio Document Generation lets you generate dynamic documents from templates, such as care plans, patient summaries, or correspondence. Templates can be pre-built and allow for the insertion of Health Cloud data fields, enabling the creation of personalized documents for patients or members.”

—OmniStudio Document Generation Overview

From Health Cloud Admin Guide, under Patient Correspondence:

“Patient advocates can use OmniStudio Document Generation to select templates and create personalized care documents for patients based on their Health Cloud data.”

—Reference: Administer Health Cloud - Document Generation

Best Practice from Salesforce:

Salesforce recommendsOmniStudio Document Generationfor any scenario requiring dynamic, patient-specific document creation and distribution.