Health Cloud in the Payer Sector

Design member and provider claim journeys with integrated document management to automate claim intake and reduce administrative costs with digital self-service claim tools. Manage provider claim denials, appeals, and grievances in a compliant and intuitive way using a comprehensive claims data model integrated with service codes and benefits structures.

Available in: Lightning Experience

Available in: Enterprise and Unlimited Editions with Health Cloud

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Learn About Health Cloud for Payers

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Get to know Health Cloud for Payers.

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Data Models

Explore the Health Cloud data models and objects that support payers.

Install the Unmanaged Packages and Grant Permissions

Related Unmanaged Packages		Install the Care Request Extensions, Reports for Patient Referral Management, and Flow Templates for Payers packages. Install Health Cloud Packages
Related Permission Sets and Permission Set Licenses		Assign permission set licenses and permission sets. Assign Health Cloud Permission Sets and Permission Set Licenses The Health Cloud Social Determinants Permission Set The Health Cloud Utilization Management Permission Set

Optimize the Health Cloud Console to Manage Members

Health Cloud Console		Customize the console to reflect the way you manage patients. Customize the Health Cloud Console
Care Plans		Create customized care plans to help members and patients achieve better outcomes. Manage Patient or Member Care to Improve Outcomes
Patient or Member Card		Give care coordinators and managers with the basic information they need about a patient or member. Customize Patient or Member Information
Householding Map		Get a comprehensive view of the patients’ household relationships. Manage a Patient or Member’s Relationships
Timelines and Life Events		Track your patients’ health with timeline and life events. Monitor Health Events Over Time Manage Life Events
Social Determinants of Health		Capture critical social and environmental factors like homelessness and low income as barriers in the care of your patients or members. Set Up Social Determinants to Assist High-Risk Patients and Members
Surveys and Assessments		Gather information that helps you manage your patients’ or members’ health more efficiently. Provide Assessments and Surveys for Gathering Information and Feedback
Surveys and Assessments		Gather Insights With Salesforce Feedback Management
App Templates for Patients and Members		Create your own dedicated, branded app that helps people stick with goals and get faster access to treatment. Release Your Patient or Member Experience Cloud Site as an App
Care Gaps		Identify and track gaps in a person's care where the care team can make a difference. Enable Care Teams to Track Gaps

Streamline Member Processes

Benefits and Eligibility Verification		Help caregivers and patients reduce the time and effort it takes to find out what coverage is available under each patient's health benefits. Verify Patient Benefits
Medication Management		Gain a single view of a member’s medications to streamline administration. Supporting Medication Review
Intelligent Appointment Management		Simplify agent-assisted scheduling and empower patients to schedule their own appointments. Get Started with Intelligent Appointment Management
Remote Monitoring		Gather personalized care metric targets for each patient, making it easy to correlate care metrics and identify healthcare gaps. Remote Monitoring Patients
Provider Relationship Management		Let patients, members, and agents search for healthcare providers by specialty, location, and other factors. Help Patients to Connect with Providers
Referral Management		Help users monitor referrals from submission to closure. Support and Manage Provider Referrals
Utilization Management		Streamline care request reviews and evaluate reviews for medical necessity. Support and Manage Care Requests with Utilization Management
Intelligent Document Automation		Streamline intake and referral conversion on a digital, HIPAA-compliant workspace Set Up Intelligent Document Automation

Extend Health Cloud for Payers

These features require separate licenses.

Note

Analytics for Healthcare		Get a complete view of your data to help you deliver connected, one-to-one patient or member care Provide Patient and Member Insights with Analytics
Provider Network Management		Attract and retain top talent and decrease provider onboarding time. Set Up and Manage Your Network of Providers
Campaigns and Journeys		Enroll members into journeys and campaigns with Marketing Cloud Distributed Marketing integrated into Health Cloud Manage Campaigns Build Relationships and Personalized Journeys with Campaigns Campaigns in Marketing Cloud
Salesforce Scheduler		Let members self-schedule non-physician appointments and equipment reservations Appointment Booking with Salesforce Scheduler
Salesforce Scheduler		Set Up Salesforce Scheduler
Intelligent Form Reader with Amazon Textract		Help increase accuracy and efficiency by automatically extracting text from faxed documents Intelligent Form Reader
Field Service Lightning		Empower field care providers with mobile patient management Field Service Basics
Field Service Lightning		Field Service

Salesforce Experience Cloud provides the collaboration support for Health Cloud. Some of the collaborative features are available only when you enable Experience Cloud and create a site.