In Salesforce Health Cloud, when dealing with prior authorizations, the correct data model objects are:
Service Preauth → Represents the overall prior authorization request (at the header level).
Preauth Detail → Captures the individual service line items or outcomes associated with the prior authorization.
This structure allows Health Cloud to integrate with an external utilization management system that handles the full prior authorization process. The Service Preauth object acts as the container for the request, while Preauth Detail records capture outcomes, decisions, and details returned from the external system.
This is exactly suited to the requirement:
“The provider requires a display of preauthorization outcomes from its external system which manages the end-to-end prior authorization process.”
Why not the others?
A. Plan Benefit and Plan Benefit Item – These are used to model insurance plan coverage and benefits, not authorization workflows.
B. Care Preauth and Care Preauth Item – These are older, deprecated objects in favor of the Service Preauth data model.
D. Care Request and Care Request Item – These are used to track referrals and service requests (e.g., a doctor requesting lab work), but not prior authorization outcomes.
Salesforce Health Cloud Reference:
???? Salesforce Health Cloud Developer Guide – Utilization Management Data Model:
“The Service Preauth object represents the prior authorization request and its details. The Preauth Detail object contains service line items and outcomes for the prior authorization request.”
Salesforce Help: Utilization Management Data Model
Salesforce Health Cloud Implementation Guide – Prior Authorizations
