Give your payer contact center reps the tools to resolve member and provider claims queries more efficiently by using adjudicated claims data. By using Data 360 claims actions, agents can now fetch adjudicated claim records directly from external systems via zero-copy integration. Agents can use the adjudicated claim records to provide payer contact center reps quick access to high-level summaries and specific claim details, such as status, denial reasons, and patient responsibility.
Where: This change applies to Lightning Experience in Enterprise and Unlimited editions with the Health Cloud, Agentforce for Health Cloud, and Data Cloud add-on licenses. To access the agent action, users also need the Agentforce for Health Cloud add-on.
When: This feature is available starting Feb 13, 2026.
Who: This feature is available to users with the Contact Center for Health Cloud permission set, the Contact Center Agent for Health Cloud permission set, and the Use Contact Center AI Assistive Agent user permission.
How: On the Contact Center Settings page in Setup, turn on Contact Center for Health Cloud. Then, follow the guided setup in the Agentforce for Payer Contact Center section.