Health Cloud Administration

Administer Health Cloud
Where Do I Start with Health Cloud?
Health Cloud Data Models
Health Cloud Provider Network and Relationship Management
Health Cloud Sales and Commercial Excellence
Health Cloud Utilization Management
Health Cloud for Life Sciences
Health Cloud for Insurance
Types of People in Health Cloud
Quick Start List for a Successful Health Cloud Implementation
Set Up Health Cloud
Use the Health Cloud - Admin App
Customize the Health Cloud Console
Customize the Health Cloud Apps
Contact Center for Health Cloud
Code Sets and Code Set Bundles
Reporting in Health Cloud
Flow for Health Cloud
OmniStudio for Health Cloud
Help Patients Connect with Providers
Protect Personal Health Information
Experience Cloud Sites
Intelligent Appointment Management
Virtual Care
Medication Management and Medication Review
Advanced Therapy Management
Intelligent Document Automation
Intelligent Document Reader
Intelligent Form Reader
Document Generation in Health Cloud
Manage Patient or Member Care to Improve Outcomes
Integrated Care Management
Care Coordination for Slack
Unified Health Scoring
Home Health
Provide Easy Access to Protocols and Articles in Health Cloud
Provide Assessments and Surveys for Gathering Information and Feedback
Crisis Support Center Management
Manage Your Network of Providers
Behavioral Health App
Help High-Risk Patients and Members
Manage Care Requests
Authorization Requests
Utilization Management Setup Checklist
Authorization Request Process Setup for Payers
Set Up Care Request Configurations
Customize Case and Care Request Pages for Utilization Management
Enable the Utilization Management for Payers App
OmniStudio Components for the Payer Authorization Request Process
Configure Statuses for Authorization Requests
Configure Action Buttons for Processing Authorization Request Reviews
Manage Rules for Automating Authorization Request Workflows
Customize the Predefined Authorization Process
Define Custom Rules to Automate Authorization Request Workflows
Design Custom OmniStudio Components for Authorizations
Set Up Peer-to-Peer Scheduling for Authorization Request Reviews
Create Custom Report Types and Custom Reports for Utilization Management
Experience Cloud Site for Utilization Management
Set Up Timeline Parameters for Tracking Authorization Reviews
Automate Case Routing with Omni-Channel
Authorization Request Process Setup for Providers
CRM Analytics for Utilization Management
Artificial Intelligence for Utilization Management
Verify Patient Benefits
Support Emergency Response Management and Contact Tracing
Use Care Programs to Track and Manage Cohorts of Patients and Members
Remote Monitoring Patients
Process Insurance Claims from External Sources
Automate Key User Tasks with Flows
Set up Action Plans
Manage Campaigns
Support and Manage Provider Referrals
CRM Analytics and Artificial Intelligence
Manage Commercial Excellence
Manage Inventories, Surgical Cases, and Cycle Counts with Intelligent Sales
Support Health Cloud for Mobile Users
Enhanced Timeline
Actionable Relationship Center in Health Cloud
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Design Custom OmniStudio Components for Authorizations

Use the OmniStudio Designer to customize the default OmniScripts and components so that they match your internal process and fulfill operational requirements for authorizations.

Available in: Lightning Experience

Available in: Enterprise and Unlimited Editions with Health Cloud

User Permissions Needed
To customize OmniStudio components:
  • OmniStudio Admin permission set
  • Health Cloud Utilization Management permission set

We have already defined custom rules for automating authorization workflows. Now, let’s customize the OmniStudio components to refer to those custom rules.

The OmniScript Designer enables you to preview dynamic web forms as you build them using a drag-and-drop interface. You can update all of the OmniStudio components: OmniScripts, DataRaptors, Integration Procedures, and FlexCards. By customizing and fine-tuning these components, you can offer your users a guided interaction that helps to optimize various procedures.

  1. From the App Launcher, find and select OmniScripts.
  2. Select the OmniScript to update, and click New Version.
    • HealthCloudUM/AuthorizationRequest
    • HealthCloudUM/AdminReview
    • HealthCloudUM/UMNurse
    • HealthCloudUM/MedicalDirectorReview
    • HealthCloudUM/P2PScheduling
    • HealthCloudUM/P2PReview
  3. Use a different name for the OmniScript and update it to suit your business needs:
    1. Make changes to the logical flow, actions, steps, and elements, and more.
    2. Use the custom expression sets that you created earlier for applying the rules.
    3. (Optional) If you want to make changes to the Integration Procedures or Data Raptors, clone the corresponding record, update it to suit your needs, activate, and use it in the cloned OmniScript.
  4. After you’ve updated the OmniScript, activate the settings and save your changes.
  5. Now, from the App Launcher, find, and select OmniStudio FlexCards.
  6. Select the FlexCard to update:
    1. Click New Version.
    2. Use a different name for the FlexCard.
    3. In the Properties pane, select the corresponding cloned OmniScript as shown:
    Clone of FlexCard Clone of OmniScript
    HealthCloudUMPriorAuthIntakeLaunch HealthCloudUM/AuthorizationRequest
    HealthCloudUMAdminFlowLaunch HealthCloudUM/AdminReview
    HealthCloudUMNurseFlowLaunch HealthCloudUM/UMNurse
    HealthCloudUMAuthReviewsLaunch HealthCloudUM/MedicalDirectorReview
    HealthCloudUMAuthReviewsLaunch HealthCloudUM/P2PScheduling
    HealthCloudUMAuthReviewsLaunch HealthCloudUM/P2PReview
    HealthCloudUMConcurrentReviewLaunch HealthCloudUM/AuthorizationRequest
  7. After you’ve updated the FlexCard, activate the settings and save your changes.
  8. Go to the Case Lightning record page.

    Go to the home page of the Utilization Management for Payers app for adding the cloned HealthCloudUMPriorAuthIntakeLaunch FlexCard.

    Note

  9. Select Gear icon, and then select Edit Page.
  10. In the Lightning App Builder, add action buttons for each case status using the cloned FlexCard components and set visibility rules.
    1. Place FlexCard components on the page layout.
    2. In the Properties pane for each FlexCard, select the FlexCard name and configure visibility rules, as shown.
    Clone of FlexCard Visibility Rule
    HealthCloudUMPriorAuthIntakeLaunch No action is required to set the visibility rules.
    HealthCloudUMAdminFlowLaunch Record Field > Status Equal Admin Review
    HealthCloudUMNurseFlowLaunch Record Field > Status Equal Nurse Review
    HealthCloudUMAuthReviewsLaunch No action is required to set the visibility rules as they’re predefined based on Case Status equals MD Review and Substatus doesn’t equal Peer to Peer Review Scheduled.
    HealthCloudUMAuthReviewsLaunch No action is required to set the visibility rules as they’re predefined based on Case Status equals Nurse Review and Substatus equals Schedule Peer to Peer Review.
    HealthCloudUMAuthReviewsLaunch No action is required to set the visibility rules as they’re predefined based on Case Status equals MD Review and Substatus equals Peer to Peer Review Scheduled.
    HealthCloudUMConcurrentReviewLaunch No action is required to set the visibility rules as they’re predefined based on Request Type equals Inpatient - Physical Health Review or Outpatient - Physical Health Review.
  11. Activate the settings and save your changes.
    That’s it! Now, when your users access the Case record page, the action button that matches with the current status and substatus of the case is shown. Also, when your users create and review authorization requests, the customized OmniStudio components and rules are used.