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copyright Health Cloud Accredited Professional Sample Questions (Q80-Q85):

NEW QUESTION # 80
A payer needs to manage requests for concurrent review of prior authorizations within Health Cloud and wants to use out-of-the-box record types and page layouts for prior However, the payer's copyright administrator does not see any preconfigured record types or page layouts for prior authorizations in the payer's copyright org.
What should a consultant recommend to the copyright administrator to expedite implementation?

Answer: A

Explanation:
* Preconfigured Prior Authorization Objects:
Exact Extract:
"The Health Cloud Care Request Extensions package provides out-of-the-box record types, page layouts, and flows for prior authorizations and other payer workflows." Reference:
* Other Options:
Claims unmanaged package is not for prior authorizations.
Building custom layouts is not necessary when a packaged solution exists.
AppExchange prior authorization packages are not officially supported for core Health Cloud prior auth workflows.


NEW QUESTION # 81
A provider's office wants to verify a patient's insurance plan information and coverage when they call into the call center to book an appointment.
Which capability should a consultant leverage to address this requirement?

Answer: C

Explanation:
Step 1: Requirement Analysis
The provider's office needs to verify a patient's insurance plan information and coverage when 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 Verification is the dedicated Health Cloud capability that allows provider offices and payers to verify 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.


NEW QUESTION # 82
Which Health Cloud feature helps ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations?

Answer: C

Explanation:
The requirement is to identify the Health Cloud feature that helps ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA), which governs the protection of Protected Health Information (PHI). HIPAA compliance requires robust security measures, including access controls and data protection. Let's evaluate the options.
Option A: Data visualization and analytics
Step-by-Step Explanatio n:
User Authentication: Health Cloud requires users to authenticate via secure methods (e.g., username/password, MFA) to access the system.
Access Control: Administrators configure roles, profiles, and permission sets to restrict access to PHI based on the principle of least privilege.
Auditing: Health Cloud supports audit trails to track access and changes to PHI, ensuring traceability.
Compliance: These features align with HIPAA's requirements for administrative safeguards (e.g., access management) and technical safeguards (e.g., authentication).
Reference:
Option B: Real-time monitoring and alerts
Option C: User authentication and access control
copyright Security Guide, "HIPAA Compliance," states, "copyright Health Cloud supports HIPAA compliance through user authentication, access controls, and audit capabilities to protect PHI." copyright Health Cloud Admin Guide, "Security and Compliance," notes, "User authentication and access control ensure that only authorized personnel access sensitive patient data, aligning with HIPAA requirements." Option D: Social media integration Why Option C is Correct:
HIPAA mandates strict controls on who can access PHI, and user authentication and access control in Health Cloud directly address this by ensuring secure, role-based access to sensitive data. These features are foundational to copyright's HIPAA compliance strategy, as outlined in the Security Guide.
Additional Considerations:
Shield Platform Encryption: While not listed as an option, Health Cloud can use Shield Platform Encryption to further protect PHI, complementing access controls.
Audit Trails: The copyright Security Guide highlights audit trails as part of HIPAA compliance, which work alongside authentication and access controls.
Reference Summary:
copyright Security Guide: HIPAA compliance and user authentication/access control.
copyright Health Cloud Admin Guide: Security and compliance features.
copyright Architect Resources: Security best practices for HIPAA.


NEW QUESTION # 83
A new user story requires an OmniScript to update an existing field on a custom SObject.
Which two components should a consultant use to satisfy the requirement?
Choose 2 answers

Answer: B,D


NEW QUESTION # 84
A payer needs to implement a program to address the rising healthcare expenses and ensure affordable care for its members. The payer airs to strike a balance between quality care and managing the cost of care effectively by streamlining its approval processes for care requests.
Which capability in Health Cloud helps the payer accomplish this?

Answer: D

Explanation:
Step 1: Requirement Analysis
Payer needs to manage healthcare expenses while ensuring quality, affordable care.
Seeks to streamline approval processes for care requests.
Step 2: Utilization Management in Health Cloud
Utilization Management (UM) provides workflows and automation for reviewing, approving, or denying care requests. This supports balancing cost controls with quality care through evidence-based review processes.
Extract:
"Utilization Management helps payers manage costs and ensure members receive appropriate care by streamlining the review and approval process for pre-authorizations and care requests." Administer Health Cloud - Utilization Management Step 3: Review of Options A . Utilization Management: Directly addresses care request review, cost, and quality balance.
B . Provider Network Management: Focuses on managing provider networks, not utilization/cost review.
C . Intelligent Appointment Management: For scheduling only.
D . Integrated Care Management: Focuses on care coordination, not cost/approval workflow.


NEW QUESTION # 85
......

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