Salesforce Health Cloud Health-Cloud-Accredited-Professional Reddit Questions

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.

When complying with HIPAA using Salesforce Shield, Bloomington Caregivers must:

Encrypt sensitive data in transit and at rest:

Shield Platform Encryption ensures encryption at rest; Salesforce uses TLS for encryption in transit.

Extract:

“Salesforce Shield encrypts sensitive data at rest. Salesforce also encrypts data in transit using TLS.”

(Source: Salesforce Security Guide, Shield Platform Encryption Guide)

Implement and regularly review audit trails:

Shield Event Monitoring and Field Audit Trail help monitor data access and modifications.

Extract:

“Implement audit trails and monitor them to detect unauthorized or suspicious activities.”

([Source: Salesforce Security Guide, Shield Platform Encryption Guide])

Configure data retention policies:

Retain records for legally required periods to comply with HIPAA.

Extract:

“Data retention policies must comply with legal and regulatory requirements, including HIPAA.”

([Source: Salesforce Security Guide])

Why not B or C?

Providing access to third-party auditors is not a Salesforce Shield requirement; such reviews are typically handled internally.

Using third-party backup solutions is not a core Shield/HIPAA control within Salesforce, and data residency must be managed with care.

Step-by-Step Explanation:

Supported Data Exchange Standards:Health Cloud natively supports modern clinical data standards such as FHIR R4 and traditional messaging formats like HL7 v2 for interoperability and data exchange.

Exact Extract:

“Health Cloud supports industry standards for data exchange, including FHIR R4 and HL7 v2, to enable clinical interoperability with EHR systems and other healthcare platforms.”