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Some new questions:
Q
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?
A. Designing Next Best Action and Recommendations for the care management team
B. Designing Care Requests to seek authorization from a health plan for drugs, services, and admissions
C. Considering the number of intake agents who will be using Health Cloud
D. Considering the Request Review Types; Prior Authorization Review, Concurrent Review, and Retrospective Review
Q
A payer receives faxes for clinical review as part of the determination process. The payer needs Health Cloud to automatically capture the data from the documents received from patients and manage the end-to-end approval process.
Which two Health Cloud capabilities should a consultant recommend as a way to build this process?
A. Care Authorizations
B. Intelligent Document Automation
C. Utilization Management
D. Integrated Care Management
Q
Bloomington Caregivers has more than 1 million patients and each patient has an average of 10 claims a year, which are maintained in an external claims system. Management would like their agents to view all the claims of patients in Salesforce on demand when they open the patient’s record.
What should a consultant recommend as the appropriate integration pattern to achieve this?
A. Add a nightly job to fetch all the claims from the external system and store them in Salesforce.
B. Use an Enterprise Service Bus (ESB) to load all the claims data from the external system into Salesforce.
C. Make a callout on demand to the external system and store the claims data against the patient record.
D. Configure the claims system as an external data source and leverage external objects with the claims data.
…….