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AHIP AHM-530 Exam With Confidence Using Practice Dumps

Exam Code:
AHM-530
Exam Name:
Network Management
Certification:
Vendor:
Questions:
202
Last Updated:
Mar 1, 2026
Exam Status:
Stable
AHIP AHM-530

AHM-530: AHIP Certification Exam 2025 Study Guide Pdf and Test Engine

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Network Management Questions and Answers

Question 1

The Pine Health Plan has incorporated pharmacy benefits management into its operations to form a unified benefit. Potential advantages that Pine can receive from this action include:

Options:

A.

the fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members

B.

the fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies

C.

the fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package

D.

all of the above

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Question 2

Before or during the orientation process, health plans generally provide new network providers with a provider manual. One of the primary purposes of the provider manual is to

Options:

A.

Provide a directory of contracted providers

B.

Help providers and their staffs develop methods of improving the operation of their practices

C.

Provide feedback to providers regarding their performance

D.

Reinforce and document contractual provisions

Question 3

Prior to the enactment of the Balanced Budget Act (BBA) of 1997, payment for Medicare-covered primary and acute care services was based on the adjusted average per capita cost (AAPCC). The AAPCC is defined as the

Options:

A.

average cost of services delivered to all patients living in a specified geographic region

B.

actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits

C.

fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status

D.

average fixed monthly fee paid by all Medicare enrollees in a specified geographic region