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  1. Home
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  3. AHM-250

AHIP AHM-250 Exam (page: 14)
AHIP Healthcare Management: An Introduction
Updated on: 15-Feb-2026

Viewing Page 14 of 74
AHM-250 PDF 367 Questions

Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example

  1. Encounter reports
  2. Diagnostic codes
  3. Durational ratings
  4. Edits

Answer(s): D



Health plans require utilization review for all services administered by its participating physicians.

  1. True
  2. False

Answer(s): B



Health plans sometimes contract with independent organizations to provide specialty services, such as vision care or rehabilitation services, to plan members. Specialty services that have certain characteristics are generally good candidates for health pl

  1. Low or stable costs.
  2. Appropriate, rather than inappropriate, utilization rates.
  3. A benefit that cannot be easily defined.
  4. Defined patient population.

Answer(s): D



Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

  1. users can access the Internet using a number of different types of computer systems
  2. access to the Internet is available only to members of the health plan's network
  3. the Internet is immune to internal security breaches by employees or trading partners within the network
  4. users can contact a single controlling organization to rectify disruptions in Internet service

Answer(s): A



Health plans use the following to determine the number of providers to add to a network:

  1. Staffing ratios
  2. Drive time
  3. Geographic availability
  4. All of the above

Answer(s): D



Viewing Page 14 of 74



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