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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:
Jan 2, 2026
Exam Status:
Stable
AHIP AHM-530

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

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Related AHIP Exams

Network Management Questions and Answers

Question 1

When the Rialto Health Plan determines which of the emergency services received by its plan members should be covered by the health plan, it is guided by a standard which describes emergencies as medical conditions manifesting themselves by acute symptoms of sufficient severity (including severe pain) such that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy. This standard, which was adopted by the NAIC in 1996, is referred to as the

Options:

A.

medical necessity standard

B.

prudent layperson standard

C.

“all-or-none” standard

D.

reasonable and customary standard

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Question 2

The Portway Hospital is qualified to receive Medicaid subsidy payments as a disproportionate share hospital (DHS). The DHS payments that Portway receives are

Options:

A.

Made for services rendered to specific patients

B.

Made with matching state and federal funds

C.

Included in the Medicaid capitation payment made to patients’ health plans

D.

Defined as cost-based reimbursement (CBR) equal to 100% of Portway’s reasonable costs of providing services to Medicaid recipients

Question 3

Health plans are required to follow several regulations and guidelines regarding the access and adequacy of their provider networks. The Federal Employee Health Benefits Program (FEHBP) regulations, for example, require that health plans

Options:

A.

Allow members direct access to OB/GYN services

B.

Allow members direct access to prescription drug services

C.

Provide access to Title X family-planning clinics

D.

Provide average office waiting times of no more than 30 minutes for appointments with plan providers