Bloomington Caregivers uses Health Cloud and has an integration setup with an external payer system.

The payer-facing business APIs relevant to care-service transactions are Prior Authorization, Referral Request, and Benefit Verification. Prior Authorization supports authorization requests, Referral Request supports referral workflows, and Benefit Verification supports electronic coverage and benefit inquiries. ADT is an event-oriented clinical messaging pattern rather than one of the three requested payer business APIs in this scenario. From a solution-design perspective, the selection fits the requirement because it uses the Health Cloud capability or data model that directly represents the business need, rather than introducing a parallel custom structure or a feature intended for a different stage of the patient, member, provider, or payer lifecycle. The remaining options do not directly satisfy the stated requirement; they either address a different functional domain, provide only part of the required behavior, or introduce unnecessary customization compared with the selected Health Cloud approach. This approach also keeps the solution aligned with the standard Agentforce Health data and process model, which is important for maintainability, reporting, interoperability, and consistent user access. In practical terms, the consultant should configure and validate the selected elements (Prior Authorization; Referral Request; Benefit Verification) against the scenario ' s acceptance criteria and confirm that the intended users can access the underlying records and functionality.

Study Guide references/topics:Design - Integration; Clinical

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