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Learn About the Provider Data Model

Learning Objectives

After completing this unit, you’ll be able to:
  • Describe the Health Cloud provider data model.
  • Explain the purpose of different objects used in the provider data model.

Introduction

The provider data model makes it easy for members, patients, and organizations to find the right provider, in the right network, with the right specialty, in the right location, and so much more!

This diagram illustrates the provider data model. For more details on each object in the provider data model, see the Salesforce Health Cloud Developer Guide.

Diagram that illustrates the provider data model.

Explore the Provider Data Model

Carol Petersen is a physical therapist (Contact) who is a part of the PT Health Specialists organization (Account). The provider data model stores information about her National Provider Identifier (NPI) number, awards, credentials, and licenses, including her Physical Therapy certification by the American Board of Physical Therapy Specialties (Board Certification).

An example of Carol Petersen's credentials

One of Carol’s physical therapy specialties includes pain management (Care Specialty), which makes her an excellent choice for Charles’s lower back pain condition. Thanks to the provider data model, you not only know that Carol has this speciality, but also that she offers this specialty at the downtown location (Location) for PT Health, on Mondays, Wednesdays, and Fridays, from 8 AM until 4 PM. You can also see that the downtown location is in the Bloomington Health network (Healthcare Payer Network). This is fits well with Charles’s healthcare needs.

That’s a lot of significant provider information made available to you in Health Cloud, making it a whole lot easier to find the right provider for your member, patient, and organization.

This diagram illustrates how the provider data model can help in finding the best provider for Charles’s lower back pain condition.

Diagram that illustrates how the provider data model can help in finding the best provider for Charles’s lower back pain condition.

Here’s a look at the records, objects, and relationships in the provider data model that can help in finding the best provider for Charles’s lower back pain condition.

This Record... ...Is Related To
Carol’s ABPTS Certification (Board Certification) Carol Petersen, Physical Therapist (Contact)
Carol’s NPPES NPI Details (Healthcare Provider NPI) Carol Petersen, Physical Therapist (Contact)
Carol’s license to work in CA (BusinessLicense) Carol Petersen, Physical Therapist (Contact)
Carol’s Med Degree Details (Person Education) Carol Petersen, Physical Therapist (Contact)
Carol Petersen, Physical Therapist (Contact) PT Health Specialists (Account)
Provider—Specialty Association (Healthcare Provider Specialty) Carol Petersen, Physical Therapist (Contact)
Provider—Specialty Association (Healthcare Provider Specialty) Pain Management (Care Specialty)
Provider—Location—Specialty Association (Care Provider Facility Specialty) Pain Management (Care Specialty)
Provider—Location—Specialty Association (Care Provider Facility Specialty) PT Health Downtown—Carol Petersen (Healthcare Practitioner Facility)
PT Health Downtown—Carol Petersen (Healthcare Practitioner Facility) Carol Petersen, Physical Therapist (Contact)
PT Health Downtown—Carol Petersen (Healthcare Practitioner Facility) PT Health—Downtown (Account)
PT Health Downtown—Carol Petersen (Healthcare Practitioner Facility) Carol’s Hours at PT Health Downtown (Operating Hours)
Facility—Network Association (Healthcare Facility Network) Bloomington Health PPO Network (Healthcare Payer Network)
Facility—Network Association (Healthcare Facility Network) PT Health—Downtown (Account)
PT Health—Downtown (Account) PT Health Specialists (Account)

In this unit, you learned how the provider data model helps you find the right provider for a patient. Next, see how the utilization management data model allows care providers to deliver the right services according to the medical policies of the health plan. You learn how the recommendations of Charles’s primary care physician and physical therapist are handled with the preauthorization request, review, and approval process.