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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Define Custom Rules to Automate Authorization Request Workflows

Achieve full potential of authorization request workflow by customizing the rules to address your business’ unique needs. Define decision matrices and expression sets to streamline, optimize, and standardize processes for your organization.

Available in: Lightning Experience

Available in: Enterprise and Unlimited Editions with Health Cloud

User Permissions Needed
To create decision matrices and expression sets: RuleEngine Designer permission set

Before you begin, analyze each stage of your organization’s review process and identify areas with tedious manual work and opportunity for errors. Fine-tune the rules to address these unique challenges.

  1. From the App Launcher, find and select Lookup Tables.
  2. Click New, and select Decision Matrix.
  3. Define and set up the required number of decision matrices for your business:
    1. Provide a name for the decision matrix and set the Type as Standard.
    2. On the Related tab of your Decision Matrix record page, click version 1 of the matrix.
    3. Add columns to define your input and output data.
    4. Add rows and values for the decision matrix, and save your changes.
    5. Edit the decision matrix version, set it to Enabled, and save your changes.
  4. Next, from the App Launcher, find, and select Expression Sets.
  5. Click New.
  6. Define and set up the required expression sets for your business:
    1. Provide a name for the expression set.
    2. On the Related tab of your Expression Set record page, in the row for version 1, click Actions icon, then select Open in Expression Set Builder.
    3. In the Expression Set Builder, define the properties of the expression set version.
    4. Define a series of steps connected in a logical flow by using variables, constants, conditions, calculations, and decision matrices that you set up earlier.
    5. Save your changes.
    6. On the Details tab of the Expression Set Version record page, select Active.
    7. Set the rank as 1.
    8. Save your changes.
      You’ve now customized the rules but we aren’t quite finished. Next, update the OmniScripts and related components to ensure they refer to these customized rules for validating request details.