Health Cloud Administration
jSet Up Permissions and Data for Utilization Management
To use Utilization Management, complete these prerequisites.
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Available in: Lightning Experience Available in: Enterprise and Unlimited Editions with Health Cloud |
- Install and configure Health Cloud
- Enable person accounts
- Install OmniStudio package version 240.3 or above
- Ensure system admins have these permission sets and permission set licenses:
- Health Cloud permission set license
- Health Cloud Platform permission set license
- OmniStudio Admin permission set
- OmniStudio User permission set
- RuleEngine Designer permission set
- RuleEngine Runtime permission set
- Assign these permission sets to your users:
- Health Cloud Foundation
- Health Cloud Utilization Management
- OmniStudio User permission set
- RuleEngine Runtime permission set
- For payers, ensure you have the MuleSoft - Salesforce Healthcare APIs SKU to use the payer inbound API: Prior Authorization API
- For providers:
- Enable the Health Cloud: Utilization Management for providers org permission.
- Enable the IndustriesServiceExcellence add on license or the IndustriesServiceExcellence platform license.
- Enable Clinical Data Model.
- Ensure you have the MulesSoft add-on product called MuleSoft Direct for Health cloud to use the provider APIs: Prior Authorization EMR Retrieval API and Prior Authorization Claim Submission API
- Ensure your org data is set up using these objects:
Salesforce Object Type of Data Account (business accounts and person accounts) Member and provider details Purchaser Plan and Member Plan Member’s insurance plan details Healthcare Payer Network (business account) Payer details Healthcare Provider (business accounts and person accounts), Healthcare Provider NPI, Board Certification, Healthcare Provider Taxonomy, Contact Requesting and servicing provider details Healthcare Facility (for business accounts) and Healthcare Practitioner Facility (for person account’s contact) Payer and provider facility details Code sets Service code, diagnosis code, and care processing error code details - Add care request type values to the Type field picklist on the Case object. For example, Initial Request, Extension or Amendment.