Health-Cloud-Accredited-Professional Practice Test

Salesforce Spring 25 Release
228 Questions

Which three business process are supported by Salesforce HC utilization Management? (Choose 3)

A. Ticketing

B. Physician Request

C. Drug Request

D. Admissions

E. Appeals

B.   Physician Request
C.   Drug Request
D.   Admissions

Explanation:

✅ B. Physician Request
Documentation: Health Cloud’s UM module includes CareRequest objects for provider-initiated authorizations (referrals, procedures).
Example: A cardiologist requests approval for a stress test.

✅ C. Drug Request
Documentation: Medication_Request__c object handles prior auths for medications, tied to FHIR MedicationRequest.
Example: Step-therapy requirements for specialty drugs.

✅ D. Admissions
Documentation: Admission_Review__c object manages inpatient/outpatient authorization workflows.
Example: Concurrent reviews for hospital stays.

Why Appeals (E) and Ticketing (A) Are Not UM-Specific:

❌ E. Appeals
While appeals exist in UM, they’re tracked as standard Cases (not a dedicated UM process). Health Cloud routes appeals to Case Management, not UM-specific objects.

❌ A. Ticketing
Generic Service Cloud functionality (e.g., Case objects). UM uses specialized objects like CareRequest, not tickets.

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