In Salesforce Health Cloud, managing prior authorizations involves utilizing specific objects designed to handle the complexities of authorization requests and their associated details. For an insurance provider aiming to display preauthorization outcomes from an external system that manages the end-to-end prior authorization process, the appropriate solution involves the Service Preauth and Preauth Detail objects.
Service Preauth Object:
Purpose: The Service Preauth object represents a preauthorization request within Health Cloud. It serves as a container for all relevant information pertaining to a specific authorization, including patient details, requested services, and status updates.
Integration Capability: This object is designed to integrate with external systems, allowing for the seamless import and display of preauthorization outcomes managed outside of Salesforce. By mapping external authorization data to the Service Preauth object, users can view and manage authorization statuses directly within Health Cloud.
Preauth Detail Object:
Purpose: The Preauth Detail object stores detailed information related to each preauthorization request captured in the Service Preauth object. This includes specifics about the services or procedures being authorized, such as service codes, descriptions, quantities, and any other pertinent details.
Integration Capability: By populating the Preauth Detail object with data from external systems, Health Cloud users gain comprehensive visibility into the components of each authorization request, facilitating informed decision-making and efficient care coordination.
Integration Process:
To effectively display preauthorization outcomes from an external system within Health Cloud, consider the following steps:
Data Mapping: Establish a data mapping strategy to align fields from the external system with the corresponding fields in the Service Preauth and Preauth Detail objects. This ensures that all relevant information is accurately captured and displayed within Health Cloud.
Data Import: Utilize Salesforce's data import tools or integration middleware (such as MuleSoft) to import preauthorization data into the Service Preauth and Preauth Detail objects. This process can be automated to ensure real-time or near-real-time updates, providing users with the most current information.
User Access and Permissions: Configure user permissions to ensure that appropriate personnel have access to view and manage preauthorization information. This includes setting up profiles and permission sets that grant access to the Service Preauth and Preauth Detail objects.
Reference:
Authorization Request Overview: This Salesforce Help article provides an overview of managing authorization requests within Health Cloud, detailing the objects and processes involved.
Salesforce
Built-In MuleSoft Integration to Manage Authorization Requests: This resource outlines how to integrate Health Cloud with external Electronic Health Record (EHR) and payer systems using MuleSoft, facilitating seamless data exchange for authorization requests.
Salesforce
Care Services Review and Response: This developer guide section discusses RESTful APIs that support data elements required for ANSI X12 278 format Health Care Services Review and Response, enabling electronic receipt of prior authorization requests from providers.
Salesforce Developers
By leveraging the Service Preauth and Preauth Detail objects, along with appropriate integration strategies, insurance providers can effectively display and manage preauthorization outcomes from external systems within Salesforce Health Cloud, enhancing operational efficiency and improving patient care coordination.