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            Omnistudio Components for the Payer Authorization Request Process

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            Omnistudio Components for the Payer Authorization Request Process

            Utilization Management is built using a predefined suite of Omnistudio components, which combine to provide a smooth, guided user interaction that empowers users in your payer organization to easily handle the complex authorization process.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud

            The built-in Omniscripts contain the user-interaction logic that takes users through the authorization process with consistent responses. Your users can easily review the requests using these Omniscript processes.

            From the App Launcher, go to the OmniStudio app to view the built-in Omniscripts, Flexcards, Data Mappers, and Integration Procedures. From the Omniscripts page, you can enter HealthCloudUM in the Search field to show only the Omniscripts for Utilization Management.

            Omniscript Use
            HealthCloudUM/AuthorizationRequest Create and submit an authorization request
            HealthCloudUM/AdminReview Conduct an admin review of an authorization request
            HealthCloudUM/UMNurse Conduct a nurse review of an authorization request
            HealthCloudUM/MedicalDirectorReview Conduct a medical director review of an authorization request
            HealthCloudUM/P2PScheduling Schedule a peer-to-peer review meeting between the medical director and requesting provider
            HealthCloudUM/P2PReview Conduct a peer-to-peer review with the requesting provider

            Each of these Omniscripts launches from Flexcards, which display data and launch actions for reviewing the requests.

            Each Omniscript includes a number of:

            • Integration Procedures, which bundle server-side data integration operations for efficiency and reuse.
            • Omnistudio Data Mappers, which transfer and transform data between Salesforce and the OmniScripts, Flexcards, and Integration Procedures.
            Note
            Note The predefined Omnistudio components represent a default implementation and are ready to use. However, we recommend you customize these components per your organization's requirements. To do so, save a new version of each Omniscript and clone the associated Data Mappers and Integration Procedures. Retain the settings, save the new version or clone with a different name, activate the new version or the clone, and then relink the components. Similarly, clone and activate the Flexcards that launch these Omniscripts and relink them to the corresponding new versions of the Omniscripts. Cloning ensures that you don’t face any process disruptions when predefined components are updated during automatic upgrades.
            Flexcard to Clone Omniscript to version
            HealthCloudUMPriorAuthIntakeLaunch HealthCloudUM/AuthorizationRequest
            HealthCloudUMAdminFlowLaunch HealthCloudUM/AdminReview
            HealthCloudUMNurseFlowLaunch HealthCloudUM/UMNurse
            HealthCloudUMAuthReviewsLaunch HealthCloudUM/MedicalDirectorReview
            HealthCloudUMAuthReviewsLaunch HealthCloudUM/P2PScheduling
            HealthCloudUMAuthReviewsLaunch HealthCloudUM/P2PReview
            HealthCloudUMConcurrentReviewLaunch HealthCloudUM/AuthorizationRequest
             
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