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Review Payer Contact Center Flows
To support payer contact center processes, review and update claims and member coverage flows.
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 open, edit, create, activate or deactivate a flow: | Manage Flow |
- From Setup, in the Quick Find box, enter Flows, and then select Flows.
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Open a flow and review the data space for the Get Records elements.
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For Claims, review these flows and elements. Make sure that the Data Space referenced in
these elements matches data space that contains your claims data.
Flow Name Get Record Element Get Claims Get Claims
Get Claim Participant Records by Name
Get Claims by Claim ID
Get Claims by Status
Get Claim Participants by Name
Get Claims by Participant and Status
Get Claim Summary Get Claim Records
Get Claim Item Records
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For Member Coverages, review these flows and elements. Make sure that the Data Space
referenced in these elements matches data space that contains your member coverage
data.
Flow Name Get Record Element Get Individual ID Get Individual Record ID
Get Member from Member Plan
Get Member Coverage Get Active Member Plans
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For Prior Authorizations, review these flows and elements. Make sure that the Data Space
referenced in these elements matches data space that contains your prior authorization
data.
Flow Name Get Record Element Identify Member From Identity Details Get Individual
Get Prior Authorization Get Individual Record ID
Get Care Requests (
GetCareRequestsByClaimId)Get Case (
GetCaseForCareRequestByClaimId)Get Cases
Get Care Requests (
GetCareRequestsByStatusAndServiceName)Get Care Requests (
GetCareRequestsByStatus)Get Case (
GetCaseByStatus)Get Care Requests (
GetCareRequestsByServiceName)Get Case (
GetCaseByServiceName)Get Healthcare Providers
Get Care Requests (
GetCareRequestsByProviderName)Get Case (
GetCaseByProviderName)Get Care Requests (
GetCareRequestsByRequestedDate)Get Case (
GetCaseByRequestedDate)Get Prior Authorization Summary Get Care Request
Get Care Request Items
Get Care Request Drugs
Get Case
Get Healthcare Providers
Get Healthcare Facilities
Get Individuals
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For Provider Network Search, review this flow and element. Make sure that the Data Space
referenced in the element matches data space that contains your provider network data.
Flow Name Get Record Element Get Provider NPI Get Provider NPI
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For Claims, review these flows and elements. Make sure that the Data Space referenced in
these elements matches data space that contains your claims data.
- Save your work.
