AHM-530 Exam AI-Powered | Exam-Dumps.net (Page: 1)

QUESTION: 1

By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as

Network management
Quality
Cost-effectiveness
Accessibility

Answer(s): D

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Decide whether the following statement is true or false:

The organizational structure of a health plan's network management function often depends on the size and geographic scope of the health plan. With respect to the size of a health plan, it is correct to say that smaller health plans typically have less integration and more specialization of roles than do larger health plans.

True
False

Answer(s): B

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QUESTION: 3

The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement.

One important activity within the scope of network management is ensuring the quality of the health plan's provider networks. A primary purpose of is to review the clinical competence of a provider in order to determine whether the provider meets the health plan's preestablished criteria for participation in the network.

authorization
provider relations
credentialing
utilization management

Answer(s): C

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QUESTION: 4

One important aspect of network management is profiling, or provider profiling. Profiling is most often used to

measure the overall performance of providers who are already participants in the network
assess a provider's overall satisfaction with a plan's service protocols and other operational areas
verify a prospective provider's professional licenses, certifications, and training
familiarize a provider with a plan's procedures for authorizations and referrals

Answer(s): A

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QUESTION: 5

Network managers rely on a health plan's claims administration department for much of the information needed to manage the performance of providers who are not under a capitation arrangement. Examining claims submitted to a health plan's claims administration department enables the health plan to

determine the number of healthcare services delivered to plan members
monitor the types of services provided by the health plan's entire provider network
evaluate providers' practice patterns and compliance with the health plan's procedures for the delivery of care
all of the above

Answer(s): D

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AHIP AHM-530 (page: 1)

QUESTION: 1

QUESTION: 2

QUESTION: 3

QUESTION: 4

QUESTION: 5