Free Salesforce Health-Cloud-Accredited-Professional Practice Exam with Questions & Answers | Set: 3

Health Cloud supports Utilization 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 is no standard custom setting called UtilizationManagementSettings for this process.

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

Step 1: Requirement Analysis

The payer wants to use predefined rules for prior authorization request reviews, seeking out-of-the-box Health Cloud functionality for speed to value.

Step 2: Health Cloud Prior Authorization & Rules Engine

The Expression Set Templates in 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, and OmniScript Templates are OmniStudio tools for integration, UI, and guided processes, but Expression Set Templates are the feature specifically designed for rules automation in Utilization Management.

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, including AllergyIntolerance 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.

Step-by-Step Explanation:

Salesforce Health Cloud Best Practice for Person Accounts Access:

Person Accounts in Salesforce are a combination of an Account and a Contact.

To ensure that access to the person account (patient record) gives access to all data on the record, Salesforce recommends setting the Contact sharing setting to "Controlled by Parent".

This means the sharing and visibility of the Contact (patient details) will follow the sharing settings of the parent Account (the Person Account).

Salesforce Documentation Reference:

“For Person Account sharing and access, set the Contact object sharing setting to Controlled by Parent. This ensures that users with access to the Account (Person Account) also have access to the associated Contact data.”— Reference: Health Cloud Implementation Guide, Sharing and Access

Why Not the Other Options?

A. Set Modify All on the Account object at the Profile level: Too broad; not recommended due to least privilege principle.

C. Set Private for the Contact object: Would prevent access to the Contact, even if user has access to the Account.

D. Set the organization-wide default to Public Read Write for the Account object: Not best practice for healthcare, as it risks overexposing sensitive data.

Step 1: Requirement Analysis

Admin needs to leverage Advanced Therapy Management for complex gene therapy scheduling.

Step 2: Key Capabilities of Advanced Therapy Management

Book multi-step appointments: Supports sequencing and booking complex, interdependent appointments and procedures (e.g., cell collection, manufacturing, infusion).

Reschedule part of the appointment chain: Enables rescheduling one step in a multi-step process without rebooking the entire chain.

Extract:

“Advanced Therapy Management allows for the orchestration of complex, multi-step appointment chains and the flexibility to reschedule individual steps in the chain.”

Administer Health Cloud – Advanced Therapy Management

Other options:

A: Telehealth scheduling is not a specific feature of Advanced Therapy Management.

D: Einstein is not natively used for chain optimization in Advanced Therapy Management as per current documentation.

Verified Answers:

B. Book multi-step appointments.

C. Reschedule part of the appointment chain.

Step-by-Step Explanation:

Health Cloud Intelligent Document Automation (IDA) Capabilities:

IDA automates processing of incoming documents (like insurance cards or clinical records).

Out-of-the-box features allow:

Document Rotation: For correcting the orientation of scanned/received documents.

Record Type Association: For matching documents to appropriate Salesforce record types (such as associating a document with a Patient or Encounter).

Automated Document Checklist Item Creation: Automatically creating checklist items for actions (e.g., missing forms or needed verifications).

Supported and Unsupported Features:

Barcode Scanning: Not an out-of-the-box feature of Health Cloud IDA (may require third-party solutions).

eFax Connection: While Health Cloud supports document management, direct eFax integration is not out-of-the-box.

Official Document Extracts:

From Salesforce Help:

“You can rotate, associate, and automate checklist items for documents received in Health Cloud using Intelligent Document Automation.”

— Administer Health Cloud – Document Automation

To improve appointment scheduling and provide patient self-service, these three Health Cloud features should be configured:

Experience Cloud for Health Cloud:

Allows creation of patient-facing portals for self-service appointment booking and information access.

Extract:

“Experience Cloud enables self-service portals for patients, supporting appointment scheduling and other interactions.”

(Source: Administer Health Cloud – Experience Cloud)

Intelligent Appointment Management:

Offers advanced scheduling features and automation to reduce wait times and manual booking.

Extract:

“Intelligent Appointment Management in Health Cloud supports both self-service and agent-assisted scheduling workflows.”

(Source: Administer Health Cloud – Intelligent Appointment Management)

Provider Search:

Lets patients find the right clinic or provider based on specialty, availability, and other criteria.

Extract:

“Provider Search empowers patients to search for providers and book appointments online through self-service portals.”

(Source: Administer Health Cloud – Provider Search)

Why not A or D?

Intelligent Form Reader is used for document capture, not for scheduling or self-service.

Assessments and Recommendations are used for care management, not scheduling.