Pass the Salesforce Salesforce Health Cloud Health-Cloud-Accredited-Professional Questions and answers with CertsForce

Step-by-Step Explanation:

CRM Analytics for Health Cloud:

Exact Extract:

“CRM Analytics for Health Cloud delivers prebuilt dashboards and extended analytics for monitoring care plans, outcomes, and adherence across networks and facilities.”

 Enhanced Timeline Functionality:

The Enhanced Timeline in Health Cloud displays a sequence of clinical events (e.g., health conditions and encounters) on a patient’s Person Account.

Exact Extract:

“To configure the Enhanced Timeline component to show custom event types and adjust the event display, create a Timeline View Configuration record.”

Step 1: Requirement Analysis

The provider’s office needs toverify a patient’s insurance plan information and coveragewhen a patient calls to book an appointment.

This means checking whether the patient’s insurance is active, what services are covered, and any applicable copays or eligibility details.

Step 2: Health Cloud Out-of-the-Box Capability

Benefits Eligibility and Verificationis the dedicated Health Cloud capability that allows provider offices and payers toverify a patient’s insurance coverage, eligibility, and benefit details in real time, either through integration with payers or using Health Cloud workflows.

Extract:

“Health Cloud offers Benefits Eligibility and Verification, enabling providers and payers to confirm a patient’s plan information and coverage eligibility, reducing the risk of denied claims and improving the patient experience.”

Administer Health Cloud – Benefits Eligibility and Verification

Step 3: Review of Options

A. Benefits Eligibility and Verification:Directly addresses insurance plan and coverage verification.

B. Intelligent Appointment Management:For scheduling, not insurance verification.

C. Utilization Management:For prior authorizations and care request reviews.

D. Identity Verification:For confirming patient identity, not insurance coverage.

Step 1: Understanding the Requirement

A payer organization needs torecruit, credential, and onboard providersinto its network. This requires features that manage provider information, credentialing processes, onboarding workflows, and network directory maintenance.

Step 2: Official Salesforce Health Cloud Capability

Salesforce Health Cloud offers anadd-on called Provider Network Management (PNM)that is specifically designed for payers to recruit, credential, and onboard providers.

Extract:

“Provider Network Management streamlines recruiting, credentialing, onboarding, and network directory maintenance for payers. It provides tools to manage the provider lifecycle from initial recruitment through onboarding and network management.”

Administer Health Cloud – Provider Network Management

Step 3: Review of Options

A. Contact Center for Payers: Focused on member and provider service center functionality, not recruiting or credentialing.

B. Utilization Management: Focused on authorization and medical necessity reviews, not onboarding or credentialing.

C. Provider Network Management: Specifically built for recruiting, credentialing, and onboarding providers.

D. Provider Relationship Management: Focuses on relationship management post-onboarding, but not credentialing/onboarding workflows.

Health Cloud supportsUtilization Management (UM)through the Service Request object, which tracks prior authorization requests, and through integration with electronic prior authorization systems using MuleSoft.

Customize the Service Request object:

Extract:

“The Service Request object is at the core of the Utilization Management process in Health Cloud. You can customize fields, page layouts, and automation to match your business processes for prior authorization.”

(Source: Administer Health Cloud – Utilization Management)

Integrate using MuleSoft Direct for ePA:

Extract:

“Integrate Health Cloud Utilization Management with external systems using MuleSoft Direct, enabling electronic submission and tracking of prior authorizations.”

(Source: Administer Health Cloud – Utilization Management Integration)

Why not B or D?

There isno standard custom setting called UtilizationManagementSettingsfor this process.

Support Processis more for standard Salesforce Cases and not directly linked to Utilization Management flows in Health Cloud.

Step-by-Step Explanation:

Salesforce Health Cloud Prerequisites:

Enable Person Accounts:

Required for representing patients and healthcare contacts.

“Person Accounts must be enabled before installing Health Cloud.”

—Reference: Health Cloud Installation Prerequisites

Enable Chatter:

Health Cloud uses Chatter for collaboration between care teams.

“Chatter must be enabled to use Health Cloud features like care coordination and notes.”

—Reference: Health Cloud Installation Prerequisites

Enable Contacts to Multiple Accounts:

Necessary to relate patients to multiple organizations/providers.

“Enable Contacts to Multiple Accounts to relate contacts (patients) to more than one account (e.g., provider, payer).”

—Reference: Health Cloud Installation Prerequisites

Other Options:

B. Enable Shield Event Monitoring:Not required for Health Cloud installation (but is a best practice for auditing and compliance in some orgs).

D. Enable Health Cloud Installation Monitor:Not a standard Salesforce setting or prerequisite.

Step-by-Step Explanation:

Requirement:

External provider needs access to patient allergy information.

Interoperability API:

Salesforce Health Cloud provides FHIR-based Interoperability APIs that expose clinical data, includingAllergyIntolerance resources.

“Use the Health Cloud Interoperability API (FHIR R4) to retrieve AllergyIntolerance resources and other clinical data for a patient.”—Health Cloud Interoperability API Guide

Other Options:

Clinical Summary Healthcare API:Provides a summary but not structured, granular allergy data.

AllergyMedication API:Not a standard Salesforce API.

Patient Healthcare API:Broader resource, but allergies specifically are available through the Interoperability API.