Health-Cloud-Accredited-Professional Salesforce Health Cloud Accredited Professional Exam (SP25) Questions and Answers

Step 1: Requirement Analysis

Payer needs tomanage healthcare expenseswhile ensuring quality, affordable care.

Seeks tostreamline approval processesfor care requests.

Step 2: Utilization Management in Health Cloud

Utilization Management (UM) provides workflows and automation forreviewing, 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.

To access a patient’s insurance coverage, co-pay, and deductible information in theBenefit Verification componentof Health Cloud, you need to integrate with external systems (e.g., payers or clearinghouses). Health Cloud provides the Benefit Verification component, which relies on secure API integrations for real-time eligibility and benefits checks.

Step-by-Step Reference:

Configure the Connection Label with the source system's API details:

Extract:

“In Benefit Verification setup, specify the Connection Label and configure the external endpoint and API details to connect to the benefit verification source system.”

(Source: Administer Health Cloud – Benefit Verification Setup)

Create a named credential to support authenticated callouts:

Extract:

“Use Named Credentials to securely store authentication settings and endpoint information for callouts to external services (such as clearinghouses or payers) required for benefit verification.”

(Source: Salesforce Security GuideandAdminister Health Cloud – Benefit Verification)

Why not A or B?

TheHCBenVerConnect custom settingis not part of the standard configuration for the out-of-the-box Benefit Verification component.

Configuring a URI path alone (without API details and credentials) does not enable secure, authenticated communication.

 TheHealth Cloud Reports for Patient Referral Managementunmanaged package provides prebuilt reports and dashboards to analyze referrals.

Extract:

“The Health Cloud Reports for Patient Referral Management unmanaged package includes reports and dashboards that help track patient referrals in Salesforce.”

(Source: Administer Health Cloud – Reports and Dashboards)

 Other options are either not standard package names or do not match referral reporting.

DataRaptorsare best for extracting, transforming, and loading Salesforce data, especially when handling data from related SObjects.

Single DataRaptor for related SObjects:

Extract:

“Use a DataRaptor Extract when you need to read Salesforce data, such as retrieving fields from multiple related SObjects in a single read.”

(Source: Omnistudio Standard Guide – DataRaptors)

Why not B, C, or D?

SendMail tasks, complex multi-step logic, or external data connectionsare handled by Integration Procedures, not DataRaptors.

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

Explanation: Data visualization and analytics in Health Cloud provide insights into patient data and care coordination but do not directly address HIPAA compliance requirements like securing PHI or controlling access. These features are more about operational efficiency than security.

To improve appointment scheduling and provide patient self-service, these three Health Cloud features should be configured:

Experience Cloud for Health Cloud:

Allows creation of patient-facing portals for self-service appointment booking and information access.

Extract:

“Experience Cloud enables self-service portals for patients, supporting appointment scheduling and other interactions.”

(Source: Administer Health Cloud – Experience Cloud)

Intelligent Appointment Management:

Offers advanced scheduling features and automation to reduce wait times and manual booking.

Extract:

“Intelligent Appointment Management in Health Cloud supports both self-service and agent-assisted scheduling workflows.”

(Source: Administer Health Cloud – Intelligent Appointment Management)

Provider Search:

Lets patients find the right clinic or provider based on specialty, availability, and other criteria.

Extract:

“Provider Search empowers patients to search for providers and book appointments online through self-service portals.”

(Source: Administer Health Cloud – Provider Search)

Why not A or D?

Intelligent Form Readeris used for document capture, not for scheduling or self-service.

Assessments and Recommendationsare used for care management, not scheduling.

Step-by-Step Explanation:

Intelligent Document Automation:

Exact Extract:

“Intelligent Document Automation in Health Cloud automatically extracts data from incoming documents, including faxes, and creates structured data for downstream 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 thataccess to the person account (patient record) gives access to all data on the record, Salesforce recommends setting theContact 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.

Video Visits for Social Determinants of Health (SDOH):

Exact Extract:

“Use Virtual Care in Health Cloud to enable video visits between care providers and patients, including for conversations about social and economic factors.”

Step 1: Requirement Analysis

The insurance provider needs to displaypreauthorization outcomesin Health Cloud.

The preauthorization (prior authorization) process and its outcome are managed by anexternal system, but outcomes need to be displayed in Salesforce Health Cloud.

Step 2: Salesforce Health Cloud Data Model for Prior Authorization

Health Cloud provides specific objects for handling prior authorization processes:

Care Preauth:Represents the prior authorization request.

Care Preauth Item:Represents individual services or procedures within that authorization request.

Extract:

“Care Preauth and Care Preauth Item objects capture information about prior authorization requests and their associated services or procedures, enabling payers to track and display preauthorization statuses and outcomes, including those coming from external systems.”

Administer Health Cloud – Utilization Management Data Model

Step 3: Review of Options

A. Plan Benefit and Plan Benefit Item:Used to model insurance plans and coverage, not prior authorization outcomes.

B. Care Preauth and Care Preauth Item:Correct– These objects are designed for managing and displaying prior authorization requests and outcomes.

C. Service Preauth and Preauth Detail:These are not standard Health Cloud objects for prior authorizations.

D. Care Request and Care Request Item:Used for more general care coordination, not specifically for tracking preauthorization outcomes.

Verified Answer:

B. Care Preauth and Care Preauth Item

Out-of-the-box caller authentication in Health Cloud is primarily supported throughIdentity Verification Flow Templates. These flow templates are designed to help organizations comply with HIPAA and other regulatory requirements by standardizing the caller verification process for contact center agents.

Step-by-Step Reference:

Health Cloud provides Identity Verification Flow Templatesthat streamline the authentication of callers, reducing manual processes and ensuring regulatory compliance.

Extract:

“Use the Health Cloud Identity Verification Flow Templates to verify a caller’s identity based on information you select, such as date of birth, phone number, or other criteria.”

(Source: Administer Health Cloud)

These templates can be deployed as standard flows and easily customized for the organization's authentication requirements.

Extract:

“Leverage out-of-the-box Identity Verification Flow Templates to quickly set up and deploy identity verification processes in your contact center.”

(Source: Administer Health Cloud - Identity Verification)

This approach is preferred over FlexCards, OmniScripts, or ad-hoc processes, as it provides a compliant and guided experience.

Step-by-Step Explanation:

Understanding the Scenario:

The provider aims to build aContact Center using Health Cloudfor patients to:

Set up appointments

Get billing answers

Update plan information

Salesforce’s Best Practices for Requirements Gathering:

Salesforce Health Cloud documentation emphasizescollaborating with end users and technical stakeholdersto uncover pain points and define requirements.

Extract from Health Cloud Admin Guide:

“Successful Health Cloud projects start with workshops that bring together key personas, such as contact center agents and care coordinators, with technical stakeholders including Salesforce admins and integration architects. These sessions surface pain points, business needs, and integration requirements.”

—Reference: Administer Health Cloud – Implementation Best Practices

Who Should Be Involved?

Contact Center agent (Persona):

Directly understands patient needs and pain points during calls and chats.

Can highlight workflow, usability, and feature needs.

Salesforce administrator (Stakeholder):

Understands platform capabilities, permissions, and how features will be implemented or configured.

Integration architect (Stakeholder):

Critical for connecting Health Cloud to other systems (e.g., EHR, billing, insurance).

Ensures technical feasibility for integrations (e.g., real-time eligibility checks, appointment scheduling with external systems).

Why Other Answers Are Not Correct:

B:General physician and Marketing Cloud admin are not core to Contact Center workflows or technical design for scheduling/billing.

C:Sales administrator and Tableau developer focus on sales or analytics, not operational or integration workflows for Contact Centers.

D:Tableau developer and MuleSoft developer are more technical roles but not typically involved in initial workflow and requirements gathering at the Contact Center user level.

Official Document Extract:

From Salesforce Implementation Guides:

“It is essential to involve actual end users (such as agents) and platform administrators in requirements workshops, and to include an integration architect for designing connected experiences.”

—Reference: Administer Health Cloud – Implementation Best Practices

Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with References

Business Rules Engine (BRE):

Enables you to define, automate, and manage approval criteria for prior authorizations.

Extract:

“Use Business Rules Engine to automate decisions and apply approval criteria for utilization management and prior authorizations.”

—OmniStudio: Business Rules Engine

Utilization Management Data Model:

Provides standard Health Cloud objects to manage prior authorizations, including requests, approvals, and denials.

Extract:

“Health Cloud Utilization Management provides a complete data model for tracking prior authorization requests and decisions.”

—Health Cloud: Utilization Management Data Model

Out-of-the-box Process Libraries:

Prebuilt processes for common healthcare workflows, including prior authorizations.

Extract:

“Out-of-the-box process libraries provide reusable flows for utilization management, including authorizations, appeals, and notifications.”

—Administer Health Cloud: Process Libraries

Incorrect Options:

A. Claims data model:Related to claims, not prior authorizations.

B. Intelligent Appointment Management:Focused on scheduling, not utilization management or prior authorization.

 FHIR-Based Interoperability with Transformation:

Exact Extract:

“Middleware solutions enable integration with EHRs using HL7 or FHIR standards and can perform necessary data transformation for compatibility with Health Cloud.”

Step-by-Step Explanation:

Requirement:

Encrypt files in a full sandbox instance.

Salesforce Shield Platform Encryption:

Provides encryption of files and attachments at rest across Salesforce environments (including sandboxes).

“Use Shield Platform Encryption to encrypt files and attachments stored in Salesforce, including those in sandbox environments.”—Salesforce Shield Platform Encryption Guide

Other Options:

Classic Encryption:Only encrypts a limited set of standard fields, not files or attachments.

Salesforce Data Mask:Masks data for sandbox use, but does not encrypt files for runtime.

Industry Data Security:Not a Salesforce product for file encryption.

 FHIR R4 Standard:

Exact Extract:

“Health Cloud supports FHIR R4 as an industry data standard for EHR interoperability.”

Step 1: Requirement Analysis

Bloomington Caregivers wants toview potential drug-to-drug interactionsfor patients' medications and makerecommendations based on that datawithin Health Cloud.

Step 2: Health Cloud Add-On for Drug Interaction

TheMedication Managementadd-on in Salesforce Health Cloud is specifically designed to handle comprehensive medication tracking, including the ability to surface potential drug-to-drug interactions and provide recommendations for care teams.

Extract:

“With Health Cloud Medication Management, you can track all of a patient’s prescribed and OTC medications, receive potential drug-drug interaction alerts, and use this data to provide recommendations and clinical guidance.”

Administer Health Cloud – Medication Management

Medication InteractionsandRxNorm DDI Connectivityare not standalone Salesforce Health Cloud add-ons; the capability is delivered as part of the broaderMedication Managementfeature set.

Allergy Intoleranceis used to track allergy data, not drug interactions.

Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with References

Record Alerts:

Notify agents of important or recent changes in patient information.

Extract:

“Use Record Alerts to keep agents informed of changes and critical updates on the patient’s record.”

—Contact Center for Health Cloud Overview

Timeline:

Provides a single, unified view of all engagement interactions, encounters, and activities with a patient.

Extract:

“Timeline shows a consolidated history of patient interactions and engagement, giving agents a complete view in one place.”

—Health Cloud: Enhanced Timeline

Member Plan FlexCard:

Displays key patient insurance information directly on the record page.

Extract:

“The Member Plan FlexCard displays essential details about the patient’s insurance coverage for agents.”

—OmniStudio: FlexCards

Other Options:

A. Identity Verification:Used for verifying caller identity, not information display.

D. Action Launcher:Launches actions/processes, not for displaying info or alerts.

Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with References

Healthcare Practitioner and Healthcare Provider Objects:

Salesforce recommends using theHealthcare Practitionerobject for modeling individual doctors and theHealthcare Providerobject for organizations/facilities.

Extract:

“Model physicians using the Healthcare Practitioner object and relate them to organizations or facilities using the Healthcare Provider object.”

—Provider Network Management Data Model

Other Options:

A. ContactandB. Person Accountare not the recommended approach for modeling licensed clinical professionals in the Health Cloud provider data model.

Step-by-Step Explanation:

COPPA Requirements in Healthcare Applications:

Disclose privacy policy and obtain parental consent:

“Organizations must provide clear privacy notices to parents and obtain their consent before collecting any personal information from children under 13.”

—Reference: Salesforce Security Guide, COPPA Compliance

Obtain verified parental consent before collection/storage:

“Verified parental consent is a core requirement for COPPA, prior to collection and storage of children’s personal data.”

Implement security measures:

“Appropriate security controls and safeguards must be in place to protect children’s data as mandated by COPPA.”

Encryption:

While encryption is a best practice (option D), COPPA explicitly requires appropriate security but does not mandate encryption at rest and in transit as a specific requirement, though it is recommended.

Partner Compliance:

Option E refers to the implementation partner, butregulatory responsibility remains with the covered entity (Bloomington Caregivers), not the partner.

Step 1: Requirement Analysis

The provider’s office needs toverify a patient’s insurance plan information and coveragewhen 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 Verificationis the dedicated Health Cloud capability that allows provider offices and payers toverify 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.

Step-by-Step Explanation:

Requirement Analysis:

The client wants tosend patients a personalized summary documentafter their visit, including their care plan.

The process involvesselecting from templatesand generating patient-specific content.

Tool Comparison:

Health Cloud Email Manager:

Used for composing and sending emails, not for generating documents from templates.

Salesforce PDF Generator:

While Salesforce can generate PDFs from reports, it does not offer flexible, template-based document generation suited for post-visit summaries or complex care plans, especially with dynamic fields.

OmniStudio Document Generation:

Specifically designed to enabledynamic, template-based document creationin Health Cloud and other Salesforce verticals.

Allows users toselect templates, merge patient/case data, and generate PDFs or DOCXthat can be sent to patients or caregivers.

Supports integration within Health Cloud flows, empowering users (like a patient advocate) to initiate document generation with a few clicks.

Contract Lifecycle Management:

Focused on legal contracts and workflows, not patient summaries or care plans.

Exact Extracts and References from Salesforce Docs:

Extract from OmniStudio Standard Guide:

“OmniStudio Document Generation lets you generate dynamic documents from templates, such as care plans, patient summaries, or correspondence. Templates can be pre-built and allow for the insertion of Health Cloud data fields, enabling the creation of personalized documents for patients or members.”

—OmniStudio Document Generation Overview

From Health Cloud Admin Guide, under Patient Correspondence:

“Patient advocates can use OmniStudio Document Generation to select templates and create personalized care documents for patients based on their Health Cloud data.”

—Reference: Administer Health Cloud - Document Generation

Best Practice from Salesforce:

Salesforce recommendsOmniStudio Document Generationfor any scenario requiring dynamic, patient-specific document creation and distribution.

Requirement Analysis: Customize the patient enrollment process for Care Programs while leveraging Health Cloud’s out-of-the-box Advanced Therapy Management (ATM) functionality.

Health Cloud’s Standard Enrollment Mechanism:

Health Cloud uses Screen Flows for Care Program enrollment. The Health Cloud Admin Guide explicitly states:

"The enrollment process is built using Lightning flows. Admins can clone and customize these flows to match organizational processes."

Why Flow (Not OmniScript or Others)?:

A (FlexCard): Used for dynamic UI components—not multi-step processes like enrollment.

C (Apex Class): Custom code is avoidable; Health Cloud provides configurable flows.

D (OmniScript): Primarily for Life Sciences Cloud (e.g., clinical trials). The Life Sciences Cloud Guide confirms OmniScripts are for "clinical trial workflows," not core Care Programs.

Customization Steps:

Clone Default Flow: Navigate to Setup > Flows, locate the "Enroll in Care Program" flow, clone it, and modify steps (e.g., add custom fields, logic).

Retain Core Functionality: Preserve standard actions (e.g., associating patients to Care Programs) while adding custom validations.

Activate: Assign the cloned flow to Care Program record types.

Documentation Reference: The Health Cloud Implementation Guide emphasizes:

"Customize enrollment by editing the embedded Lightning flow. Do not alter Apex classes to maintain upgrade safety."

Conclusion: Cloning and customizing the out-of-the-box Flow ensures seamless enrollment customization while preserving ATM functionality.

Step 1: Requirement Analysis

Admin needs to leverageAdvanced Therapy Managementfor complex gene therapy scheduling.

Step 2: Key Capabilities of Advanced Therapy Management

Book multi-step appointments:Supports sequencing and booking complex, interdependent appointments and procedures (e.g., cell collection, manufacturing, infusion).

Reschedule part of the appointment chain:Enables rescheduling one step in a multi-step process without rebooking the entire chain.

Extract:

“Advanced Therapy Management allows for the orchestration of complex, multi-step appointment chains and the flexibility to reschedule individual steps in the chain.”

Administer Health Cloud – Advanced Therapy Management

Other options:

A:Telehealth scheduling is not a specific feature of Advanced Therapy Management.

D:Einstein is not natively used for chain optimization in Advanced Therapy Management as per current documentation.

Verified Answers:

B. Book multi-step appointments.

C. Reschedule part of the appointment chain.