Unify Membership, Benefits, and Preauthorizations with the Health Insurance Data Model

Health Cloud now includes an industry-specific data model that makes systems of record—including membership, benefits, and authorizations—available in a single console. Payers and providers can work more efficiently and better understand their members’ and patients’ needs.

Where: This feature is available in Lightning Experience, Salesforce Classic, and all versions of the Salesforce app in Professional, Performance, and Unlimited editions where Health Cloud is enabled.

When: The Health Insurance data model features are made available through the new Health Cloud Platform permission set license. This permission set license is provisioned to all Health Cloud customers, based on their contracts, after the end of the Winter ’19 Production release upgrade. Once the Health Cloud Platform permission set license is provisioned to production orgs, you can replicate a new sandbox org and have access to the Health Insurance data model.

Why: You can manage patients’ financial relationships, such as who they work for, which insurance they have, and the dependents included on their health plan. You can manage details of the plan benefits to members and members’ preauthorization requests for treatment.

The health insurance data model includes these parts:

  • Membership
  • Benefits
  • Preauthorization

The health insurance data model includes standard objects and record types on standard objects.

Who: Users must have Health Cloud and the Health Cloud Platform permission set license assigned to them. Also, users need these permission sets: Health Cloud Permission Set License and Health Cloud Member Services.

How: You must have the Health Cloud managed package installed in your org to enable the Health Cloud insurance data model. In Lightning Experience, open Object Manager in Setup, and select the desired object.