Bloomington Caregivers has reviewed the functionality of Integrated Care Management and decided to upgrade from the legacy Care Plans.Which two statements are true with respect to Integrated Care Management?Choose 2 answers
Answer(s): B,D
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?Choose 2 answers
Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with ReferenceRequest Review Types:Utilization Management processes center around reviewing requests for appropriateness of care, with the three main types being Prior Authorization Review, Concurrent Review, and Retrospective Review.Extract:"Utilization Management supports prior authorization, concurrent, and retrospective reviews to evaluate care appropriateness case by case."-- Utilization Management in Health CloudCare Requests:Care Requests are the mechanism for providers to seek authorization from payers for drugs, services, or admissions.Extract:"Design care request processes to support providers seeking health plan authorization for services, medications, or admissions."-- Health Cloud Utilization Management Data ModelWhy not the other options?A: Next Best Action is more for care management recommendations, not utilization review.C: Intake agent count is an operational consideration, not a UM process.
Utilization Management OverviewUtilization Management Data Model
A clinic is looking to manage its associated physicians within Health Cloud.Which two objects support Salesforce's recommended approach to model the doctors in the clinic's Health Cloud org?Choose 2 answers
Answer(s): C,D
Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with ReferenceHealthcare Practitioner and Healthcare Provider Objects:Salesforce recommends using the Healthcare Practitioner object for modeling individual doctors and the Healthcare Provider object for organizations/facilities.Extract:"Model physicians using the Healthcare Practitioner object and relate them to organizations or facilities using the Healthcare Provider object."-- Provider Network Management Data ModelOther Options:A . Contact and B. Person Account are not the recommended approach for modeling licensed clinical professionals in the Health Cloud provider data model.
Provider Network Management Data Model
When implementing Provider Search functionality, which two changes allow an external user to access search results?Choose 2 answers
Answer(s): A,C
Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with ReferenceExperience Builder and Component Access:Add the Provider Search component to the Experience Cloud site page for external user access.Extract:"Use Experience Builder to add Provider Search components to your site to enable external users to search for providers."-- Provider Search in Experience CloudRead Access:Granting Read access to the Care Provider Searchable Field object is required for site users to access search results.Extract:"Grant the site user profile Read access to the Care Provider Searchable Field object to allow them to view provider search results."-- Provider Search SecurityOther Options:B: Sharing rules not typically required; object-level access is key.D: Data Pipeline object access is not relevant for provider search results.
Provider Search in Experience Cloud
Bloomington Caregivers needs to migrate Health Condition records from its previous org with International Classification of Diseases (ICD) information.Which two objects should an administrator load with data prior to migrating this information, to ensure a successful data load?Choose 2 answers
Answer(s): A,B
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