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Question 147 - Certified Health Cloud Accredited Professional discussion

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Bloomington Caregivers uses Health Cloud and has an integration setup with an external payer system.

Which three business level APIs should a consultant recommend to help the payer organization electronically receive requests for services?

A.
Admission, Discharge, and Transfer (ADT)
Answers
A.
Admission, Discharge, and Transfer (ADT)
B.
Prior Authorization
Answers
B.
Prior Authorization
C.
Care Services
Answers
C.
Care Services
D.
Benefit Verification
Answers
D.
Benefit Verification
E.
Referral Request
Answers
E.
Referral Request
Suggested answer: B, C, E

Explanation:

To help the payer organization electronically receive requests for services from Bloomington Caregivers, a consultant should recommend the following business level APIs:

Prior Authorization API: This API allows Bloomington Caregivers to create requests for prior authorization for services that require approval from the payer organization.The API also allows Bloomington Caregivers to update or cancel existing requests or query the status of requests9.

Care Services API: This API allows Bloomington Caregivers to create requests for care services that are covered by the payer organization's benefit plans.The API also allows Bloomington Caregivers to update or cancel existing requests or query the status of requests10.

Referral Request API: This API allows Bloomington Caregivers to create requests for referrals to other providers that are part of the payer organization's network.The API also allows Bloomington Caregivers to update or cancel existing requests or query the status of requests11. Admission, Discharge, and Transfer (ADT) API or Benefit Verification API are not business level APIs that can fulfill this requirement.

asked 23/09/2024
Ruud God
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