Loading
Administer Health Cloud
Table of Contents
Filter by (0)Add
Select Filters

          No results
          No results
          Here are some search tips

          Check the spelling of your keywords.
          Use more general search terms.
          Select fewer filters to broaden your search.

            Search all of Salesforce Help
            Search all of Salesforce Help
            Agentforce for Payer Contact Center

            You are here:

            1. Salesforce Help
            2. Docs
            3. Administer Health Cloud

            Agentforce for Payer Contact Center

            Improve the member experience and speed up claim and member benefit queries by using Agentforce. Offer personalized support by providing payer contact center reps immediate access to submitted claims data, payment status, and real-time member coverage and benefit details, all in a single interface. Increase operational efficiency and verify data accuracy as Agentforce connects with external systems, streamlining claims and member coverage data retrieval while upholding stringent healthcare compliance.

            Required Editions

            Available in: Lightning Experience
            Available in: Enterprise, Performance, and Unlimited Editions with the Agentforce for Health Cloud and Agentforce Employee Agent add-on licenses

            Claims Data

            The Claims Service Assistance subagent reads data in real-time from external zero copy systems and makes the data available for summary and query. This subagent uses the Find Claim action to retrieve claim records based on the member number, service start date, and service end date via the Get Claims flow. The Claim Service Assistance subagent also uses the Get Claim Summary action and associated Generate Claim Summary flow to summarize a claim record and show details to payer contact center reps in an easy-to-scan bulleted list. While the summary only lists a few fields by default, data is pulled and available for query from all fields mapped in the Claims Data Model Object data streams.

            Member Coverage Details

            The Member Coverage Assistance subagent uses the Fetch Individual Record ID action to invoke the Get Individual ID flow to fetch the individual ID and pass it into the Get Member Coverage Summary action. This action then queries and summarizes the member’s plans and coverages. The Member Coverage Assistance subagent also passes the individual ID into the Find Specific Member Coverage action, which extracts specific member plan and coverage details based on user context and requests. This action queries member plan and coverage data and returns only the specific information requested by the user.

            The Member Coverage Assistance subagent also supports picking up limited member information from the background account page and passing the member context into Agentforce when the user prompt doesn’t contain member context. Out of the box, this subagent can gather the first name, last name, and date of birth from the background page. You can customize this subagent to gather data from custom fields by adding the Query Records action.

            Get Started

            Agentforce for payer contact center is an extension of Agentforce for Contact Center. Before you can set up and use Agentforce for payer contact center, make sure that you Set Up Agentforce for Contact Center, Create an Agent for Contact Center, and Create a Permission Set for Contact Center Agent Access.

             
            Loading
            Salesforce Help | Article