AHIP AHM-530 - Network Management Exam
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Total 202 questions
Question #6 (Topic: Topic 1)
The following statements are about the negotiation process of provider contracting. Three
of the statements are true and one of the statements is false. Select the answer choice
containing the FALSE statement.
of the statements are true and one of the statements is false. Select the answer choice
containing the FALSE statement.
A. While preparing for negotiations, the health plan usually sends the provider an application to join the provider network, a list of credentialing requirements, and a copy of the proposed provider contract, which may or may not include the proposed reimbursement schedule.
B. In general, the ideal negotiating style for provider contracting is a collaborative approach.
C. Typically, the health plan and the provider negotiate the reimbursement arrangement between the parties before they negotiate the scope of services and the contract language.
D. The actual signing of the provider contract typically takes place after negotiations are completed.
Answer: C
Question #7 (Topic: Topic 1)
Dr. Eve Barlow is a specialist in the Amity Health Plans provider network. Dr. Barlows
provider contract with Amity contains a typical most-favored-nation arrangement. The
purpose of this arrangement is to
provider contract with Amity contains a typical most-favored-nation arrangement. The
purpose of this arrangement is to
A. Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract
B. Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters
C. Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract
D. State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity
Answer: C
Question #8 (Topic: Topic 1)
For this question, if answer choices (A) through (C) are all correct, select answer choice
(D). Otherwise, select the one correct answer choice. A credentials verification organization
(CVO) can be certified to verify certain pertinent credentialing information, including
(D). Otherwise, select the one correct answer choice. A credentials verification organization
(CVO) can be certified to verify certain pertinent credentialing information, including
A. Liability claims histories of prospective providers
B. Hospital privileges of prospective providers
C. Malpractice insurance on prospective providers
D. All of the above
Answer: D
Question #9 (Topic: Topic 1)
The Avignon Company discontinued its contract with a traditional indemnity insurer and
contracted exclusively with the Minaret Health Plan to provide the sole healthcare plan to
Avignons employees. By agreeing to an exclusive contract with Minaret, Avignon has
entered into a type of healthcare contract known as
contracted exclusively with the Minaret Health Plan to provide the sole healthcare plan to
Avignons employees. By agreeing to an exclusive contract with Minaret, Avignon has
entered into a type of healthcare contract known as
A. a carrier guarantee arrangement
B. open access
C. total replacement coverage
D. selective contract coverage
Answer: C
Question #10 (Topic: Topic 1)
For this question, if answer choices (A) through C) are all correct, select answer choice (D).
Otherwise, select the one correct answer choice.
Understanding the level of health plan penetration in a particular market can help a health
plan determine which products are most appropriate for that market. Indicators of a mature
health plan market include
Otherwise, select the one correct answer choice.
Understanding the level of health plan penetration in a particular market can help a health
plan determine which products are most appropriate for that market. Indicators of a mature
health plan market include
A. Areduction in the rate of growth in health plan premium levels
B. Areduction in the level of outcomes management and improvement
C. An increase in the rate of inpatient hospital utilization
D. All of the above
Answer: A
