Health-Cloud-Accredited-Professional Exam Dumps - Salesforce Health Cloud Accredited Professional AP-211 Exam

The scenario is about sending patients’ visit information from Health Cloud to an ERP system on a weekly billing cycle.

This is a scheduled, bulk-data transfer requirement (not real-time, not request/response).

The correct integration pattern here is a batch extract using an ETL tool.

ETL tools (like Informatica, Mulesoft, Talend) are best for handling scheduled bulk data movement between Salesforce and external systems, especially for billing cycles.

The process can be scheduled nightly/weekly to pull visit data and send it to the ERP system.

Why not the others?

A. Fire and Forget with ESB – Used for real-time event-driven messaging (e.g., when an event happens, send a message immediately). Not needed here since the requirement is weekly batch.

C. ERP system to call the FHIR Billing API in Health Cloud – This would make sense if the ERP were pulling billing records via FHIR APIs, but here the need is sending visit data from Salesforce → ERP in bulk.

D. Request and Reply with ESB – Used when an external system calls Salesforce and expects an immediate response. Not applicable for scheduled, large-scale billing exports.

Salesforce Health Cloud Reference:

🔍 Salesforce Health Cloud Integration Guide:

“For billing, claims, or other periodic back-office processes, use a batch integration pattern with an ETL tool to extract large volumes of patient and encounter data from Salesforce on a scheduled basis.”

Salesforce Integration Patterns and Practices

Salesforce Health Cloud Data Exchange

ï‚· 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.”

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.

In Salesforce Health Cloud, when dealing with prior authorizations, the correct data model objects are:

Service Preauth → Represents the overall prior authorization request (at the header level).

Preauth Detail → Captures the individual service line items or outcomes associated with the prior authorization.

This structure allows Health Cloud to integrate with an external utilization management system that handles the full prior authorization process. The Service Preauth object acts as the container for the request, while Preauth Detail records capture outcomes, decisions, and details returned from the external system.

This is exactly suited to the requirement:

“The provider requires a display of preauthorization outcomes from its external system which manages the end-to-end prior authorization process.”

Why not the others?

A. Plan Benefit and Plan Benefit Item – These are used to model insurance plan coverage and benefits, not authorization workflows.

B. Care Preauth and Care Preauth Item – These are older, deprecated objects in favor of the Service Preauth data model.

D. Care Request and Care Request Item – These are used to track referrals and service requests (e.g., a doctor requesting lab work), but not prior authorization outcomes.

Salesforce Health Cloud Reference:

🔍 Salesforce Health Cloud Developer Guide – Utilization Management Data Model:

“The Service Preauth object represents the prior authorization request and its details. The Preauth Detail object contains service line items and outcomes for the prior authorization request.”

Salesforce Help: Utilization Management Data Model

Salesforce Health Cloud Implementation Guide – Prior Authorizations

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.

ï‚· Access to Filtered Fields:

Exact Extract:

“If a user does not have access to a field that is used in a filter on a patient or member list, the list will not be displayed to that user.”