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            Set Up Support Processes and Record Types for Payers

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            Set Up Support Processes and Record Types for Payers

            In order to use Omniscript processes included in Omnistudio, configure support processes and record types that support Utilization Management. Assign profiles and page layouts to record types to determine which record types apply when users create, edit, or view records.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud
            User Permissions Needed
            To set up support process and record types: Health Cloud Utilization Management permission set

            Create support processes for Utilization Management and then associate them with record types for the Case object. A support process determines the values that appear in a case record's Status field, dependng on the case record type.

            For example, a PreAuthorization support process includes these case status values: Intake, Admin Review, Nurse Review, MD Review, P2P Review, Determination, and Closed. A Concurrent Review support process includes these case status values: New, Admin Review, Nurse Review, MD Review, P2P Review, and Closed.

            1. Create support processes for Utilization Management:
              1. From Setup, enter Support Processes in the Quick Find box and select Support Processes.
              2. Click New and select Master from Existing Support Process.
              3. Enter a name and description for the support process.
              4. Save your changes.
              5. Specify the Case Status values for this support process and save your changes.
            2. From Setup, open the Object Manager, and go to the Case object.
            3. Under Record Types, click New.
            4. Select Master from Existing Record Type.
            5. Provide a label, name, and description for the record type.
            6. Select the relevant support process. For example, for the PreAuthorization case record type, select the PreAuthorization support process.
            7. Select Active to activate the record type.
            8. Select Make Available next to a profile to make the record type available to users with that profile.
            9. For selected profiles, select Make Default next to a profile to make it the default record type for users of that profile.
            10. Click Next.
            11. Choose a page layout option to determine what page layout displays for records with this record type:
              1. To apply a single page layout for all profiles, select Apply one layout to all profiles and choose the page layout from the dropdown list.
              2. To apply different page layouts based on user profiles, select Apply a different layout for each profile and choose a page layout for each profile.
            12. Save your changes.
            13. Repeat the steps to create record types and assign profiles and page layouts in these objects: Care Request, Care Request Extension, Care Request Item, Care Diagnosis, and Care Request Drug.
              Important
              Important Create a record type named PreAuthorization in each of these objects to enable your users to manage authorization requests.

            See Also

             
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