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Configure Data Streams for Claims Objects
To pull claims data from external systems via a Data 360 zero copy connection, configure claims data streams.
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. |
| User Permissions Needed | |
|---|---|
| To access Data Cloud Setup: | System admin profile OR Data Cloud Architect permission set |
| To edit a data stream: | Data Cloud Architect permission set |
For real-time claims visibility, claims data streams directly from external zero copy systems into Data 360. Agentforce then accesses this data by using data model objects (DMOs). The Find Claim action fetches data via the Get Claims flow, which uses a set of fields to gather claim record details. If the set of fields is incomplete or inaccurate, the flow and action error out. To make sure that the flow and action run correctly, map claims fields for claim DMOs in data streams. You can add or remove mapped fields in the Get Claims flow by updating the Get Records elements.
- Turn on Data 360.
- If claims data is stored in an external zero copy system, set up a Data 360 zero copy connection.
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Configure data streams for the DMOs that support claims.
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Configure the data stream for the Claim object.
NoteIf the Individual DMO Birth Date field, and the Claims DMO Billing Start Date, Billing End Date, and Initiation Date fields are missing from your org, you must install an additional managed package. Ask your account team for the installation link.
Field Data Type Label (if different than the DMO Label) Claim ID Text - Primary Key Claim Number Billing Start Date Date Service Start Date Billing End Date Date Service End Date Initiation Date Date Claim Creation Date Claimant Text Patient Servicing Location Text Servicing Facility Name Text Claim Name Description Text Claim Description Summary Text Claim Summary Category Text Type Text Subtype Text Status Text Reason Type Text Status Reason Reason Text Status Reason Detail Billed Amount Number Provider Full Amount Submitted Amount Number Provider Billed Total Eligible Amount Number Plan Coverage Total Payable Amount Number Plan Paid Claim Payment Text Total Copay Amount Number Copay Total Coinsurance Amount Number Coinsurance Total Deductible Amount Number Deductible -
Configure the data stream for the Claim Line Item object.
Field Data Type Label (if different than the DMO Label) Claim ID Text Claim Number Claim Item ID Text Name Text Claim Item Name Claim Participant ID Text Provider Service Start Date Datetime Service End Date Datetime Item Category Text Service Category Item Code Text Service Code Quantity Number Service Units Unit Price Amount Number Service Unit Price Total Amount Number Service Total Price Eligible Amount Number Plan Coverage Payable Amount Number Plan Paid Copay Amount Number Copay Coinsurance Amount Number Coinsurance Deductible Amount Number Deductible -
Configure the data stream for the Claim Participant object.
Field Data Type Claim Text Claim Participant ID Text - Primary Key Name Text Participant Text Claim Participant Role Text Participant Qualification Code Text Insurance Policy Participant Text -
Configure the data stream for the Individual object.
Field Data Type Individual ID Text - Primary Key First Name Text Last Name Text Birth Date Date External Record ID Text
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Configure the data stream for the Claim object.
