AHIP.AHM-530.v2019-03-23.q121

Exam Code:AHM-530
Exam Name:Network Management
Certification Provider:AHIP
Free Question Number:121
Version:v2019-03-23
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Exam Question List
Question 1: The following statements are about factors that health plans...
Question 2: The provider contract that Dr. Nick Mancini has with the Uto...
Question 3: In open panel contracting, there are several types of delive...
Question 4: The provider contract that Dr. Lorena Chau has with the Fies...
Question 5: One reimbursement method that health plans can use for hospi...
Question 6: Reimbursement for prescription drugs and services in a third...
Question 7: The following statement(s) can correctly be made about the B...
Question 8: For this question, if answer choices (A) through C) are all ...
Question 9: The Aztec Health Plan has a variety of organizational commit...
Question 10: The provider contract that the Danube Health Plan has with t...
Question 11: The Omni Health Plan is interested in expanding the specialt...
Question 12: Franklin Pitt selected a Medicare+Choice option under which ...
Question 13: One true statement about the Medicaid program in the United ...
Question 14: Social health maintenance organizations (SHMOs) and Programs...
Question 15: The Gladspell HMO has contracted with the Ellysium Hospital ...
Question 16: Some jurisdictions have enacted corporate practice of medici...
Question 17: The following statements are about the negotiation process o...
Question 18: Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynec...
Question 19: Although ambulatory payment classifications (APCs) bear some...
Question 20: By definition, a measure of the extent to which a health pla...
Question 21: Partial capitation is one common approach to capitation. One...
Question 22: The following statements describe two types of HMOs: The Elm...
Question 23: Since 1981, states have had the option to experiment with ne...
Question 24: The introductory paragraph of a provider contract is general...
Question 25: In 1996, the NAIC adopted a standard for health plan coverag...
Question 26: The National Association of Insurance Commissioners (NAIC) M...
Question 27: One difference between a fee-for-service (FFS) reimbursement...
Question 28: Many health plans opt to carve out behavioral healthcare (BH...
Question 29: The Justice Health Plan is eligible to submit reportable act...
Question 30: The Enterprise Health Plan has indicated an interest in dele...
Question 31: The Gardenia Health Plan has a national reputation for quali...
Question 32: Determine whether the following statement is true or false: ...
Question 33: The following statements describe two types of HMOs: The Elm...
Question 34: As an authorized Medicare+Choice plan, the Brightwell HMO mu...
Question 35: In most states, workers' compensation is first-dollar and la...
Question 36: The following statements can correctly be made about the adv...
Question 37: The method that the Autumn Health Plan uses for reimbursing ...
Question 38: The provider contract that Dr. Huang Kwan has with the Popla...
Question 39: The Walnut Health Plan provides a number of specialty servic...
Question 40: Lakesha Frazier, a member of a health plan in a rural area, ...
Question 41: One true statement about the compensation arrangement known ...
Question 42: One important aspect of network management is profiling, or ...
Question 43: Factors that are likely to indicate increased health plan ma...
Question 44: The Athena Medical Group has purchased from the Corinthian I...
Question 45: The Gardenia Health Plan has a national reputation for quali...
Question 46: The Tuba Health Plan recently underwent an accreditation pro...
Question 47: After HIPAA was enacted, Congress amended the law to include...
Question 48: The Gladspell HMO has contracted with the Ellysium Hospital ...
Question 49: From the following answer choices, choose the type of clause...
Question 50: The Avignon Company discontinued its contract with a traditi...
Question 51: The actual number of providers included in a provider networ...
Question 52: Medicaid is a joint federal and state program that provides ...
Question 53: The provider contract that the Canyon health plan has with D...
Question 54: The following statements are about the responsibilities that...
Question 55: From the following answer choices, choose the type of clause...
Question 56: Health plan contract negotiations with an integrated deliver...
Question 57: The following paragraph contains an incomplete statement. Se...
Question 58: In the paragraph below, two statements each contain a pair o...
Question 59: The Crimson Health Plan, a competitive medical plan (CMP), h...
Question 60: The Brice Health Plan submitted to Clarity Health Services a...
Question 61: The following statements are about the delegation of network...
Question 62: The Edgewood Health Plan uses a combination of structural, p...
Question 63: The method that the Autumn Health Plan uses for reimbursing ...
Question 64: Martin Breslin, age 72 and permanently disabled, is classifi...
Question 65: One characteristic of the workers' compensation program is t...
Question 66: Dr. Sarah Carmichael is one of several network providers who...
Question 67: An health plan enters into a professional services capitatio...
Question 68: In order to evaluate and manage the performance of individua...
Question 69: If the Oconee Health Plan reimburses its specialty care phys...
Question 70: The sizes of the businesses in a market affect the types of ...
Question 71: When evaluating the success of providers in meeting standard...
Question 72: The following statement(s) can correctly be made about hospi...
Question 73: Under the compensation arrangement that the Falcon Health Pl...
Question 74: Prior to the enactment of the Balanced Budget Act (BBA) of 1...
Question 75: Dr. Leona Koenig removed the appendix of a plan member of th...
Question 76: The National Committee for Quality Assurance (NCQA) has inte...
Question 77: The Gardenia Health Plan has a national reputation for quali...
Question 78: The provider contract that Dr. Ted Dionne has with the Optim...
Question 79: Member satisfaction surveys help an health plan determine wh...
Question 80: One reason that an health plan would want to use the actual ...
Question 81: Federal laws--including the Ethics in Patient Referrals Act,...
Question 82: The employees of the Trilogy Company are covered by a typica...
Question 83: For this question, if answer choices (A) through (C) are all...
Question 84: In developing a provider network in an large city with a hig...
Question 85: The NPDB specifies the entities that are eligible to request...
Question 86: Dr. Ahmad Shah and Dr. Shantelle Owen provide primary care s...
Question 87: During the credentialing process, a health plan verifies the...
Question 88: The provider contract that the Canyon health plan has with D...
Question 89: Although a health plan is allowed to delegate many activitie...
Question 90: The Foxfire Health Plan, which has 20,000 members, contracts...
Question 91: The Bruin Health Plan is a Social Health Maintenance Organiz...
Question 92: When the Rialto Health Plan determines which of the emergenc...
Question 93: In health plan pharmacy networks, service costs consist of t...
Question 94: With respect to contractual provisions related to provider-p...
Question 95: The provider contract that Dr. Bijay Patel has with the Arbo...
Question 96: The following statements are about workers' compensation pro...
Question 97: The following statements are about some of the issues surrou...
Question 98: One true statement about the Employee Retirement Income Secu...
Question 99: The Holiday Health Plan is preparing to enter a new market. ...
Question 100: Following statements are about accreditation of health plans...
Question 101: Health plans typically conduct two types of reviews of a pro...
Question 102: To protect providers against business losses, many health pl...
Question 103: An increasing number of health plans offer coverage for alte...
Question 104: The Ventnor Health Plan requires the physicians in its provi...
Question 105: Stop-loss insurance is designed to protect physicians who fa...
Question 106: With regard to the laws and regulations on access and adequa...
Question 107: The Ross Health Plan compensates Dr. Cecile Sanderson on a F...
Question 108: Jay Mercer is covered under his health plan's vision care pl...
Question 109: In the paragraph below, two statements each contain a pair o...
Question 110: The Walton Health Plan uses the fee-for-service pharmaceutic...
Question 111: Participating providers in a health plan's network must unde...
Question 112: The provider contract between the Ocelot Health Plan and Dr....
Question 113: The provider contract that Dr. Laura Cartier has with the Sa...
Question 114: The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) es...
Question 115: The Sweeney Health Plan uses the discounted fee-for-service ...
Question 116: If a third party is responsible for injuries to a plan membe...
Question 117: Four types of APCs are ancillary APCs, medical APCs, signifi...
Question 118: The Elizabethan Health Plan uses a direct referral program, ...
Question 119: State Medicaid agencies can contract with health plans throu...
Question 120: The following statement(s) can correctly be made about contr...
Question 121: The provider contracts that the Indigo Health Plan has with ...