A health plan provider would like to manage prior authorizations with predefined approval criteria.

Comprehensive Detailed Step by Step Explanation with exact Extracts from Salesforce Health Cloud documents that you have with References

Business Rules Engine (BRE):

Enables you to define, automate, and manage approval criteria for prior authorizations.

Extract:

“Use Business Rules Engine to automate decisions and apply approval criteria for utilization management and prior authorizations.”

— OmniStudio: Business Rules Engine

Utilization Management Data Model:

Provides standard Health Cloud objects to manage prior authorizations, including requests, approvals, and denials.

Extract:

“Health Cloud Utilization Management provides a complete data model for tracking prior authorization requests and decisions.”

— Health Cloud: Utilization Management Data Model

Out-of-the-box Process Libraries:

Prebuilt processes for common healthcare workflows, including prior authorizations.

Extract:

“Out-of-the-box process libraries provide reusable flows for utilization management, including authorizations, appeals, and notifications.”

— Administer Health Cloud: Process Libraries

Incorrect Options:

A. Claims data model: Related to claims, not prior authorizations.

B. Intelligent Appointment Management: Focused on scheduling, not utilization management or prior authorization.