A payer receives faxes for clinical review as part of the determination process. The payer needs Health Cloud to automatically capture the data from…

To automate the capture of data from faxes for clinical reviews and manage the approval process in

Salesforce Health Cloud, the following capabilities are recommended:

1. Utilization Management (A):

Utilization Management in Health Cloud supports the payer's clinical review process by enabling

workflows for reviewing medical necessity and care appropriateness.

It provides structured workflows for processing clinical documents, making it ideal for end-to-end

determination and approval processes.

Features include care authorizations, review tracking, and decision management.

2. Intelligent Document Automation (C):

Intelligent Document Automation extracts data from documents (e.g., faxes, PDFs) and populates

corresponding Salesforce records.

This capability reduces manual data entry, improves accuracy, and ensures data is automatically

captured from the faxes received.

Paired with Salesforce workflows, it can trigger approvals or further reviews based on extracted data.

Why Other Options Are Incorrect:

B . Integrated Care Management: Focuses on patient care plans and coordination, not clinical review

or payer processes.

D . Care Authorizations: Handles care approvals but does not support document data extraction or

end-to-end review processes.

Reference:

Utilization Management in Health Cloud

Intelligent Document Automation Overview