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AHIP AHM-540 Exam With Confidence Using Practice Dumps

Exam Code:
AHM-540
Exam Name:
Medical Management
Certification:
Vendor:
Questions:
163
Last Updated:
Jul 27, 2026
Exam Status:
Stable
AHIP AHM-540

AHM-540: AHIP Certification Exam 2025 Study Guide Pdf and Test Engine

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Medical Management Questions and Answers

Question 1

Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.

If Ms. Stanley agrees to the generic substitution, she will receive a drug that

Options:

A.

has not been tested for safety and efficacy in large clinical trials

B.

is available without a prescription at a reasonable cost

C.

has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

D.

contains active ingredients that are identical to those of the prescribed brand-name drug

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Question 2

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of

Options:

A.

case management

B.

geriatric evaluation and management (GEM)

C.

intervention identification

D.

interdisciplinary home care (IHC)

Question 3

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

Options:

A.

must pay the entire cost of the examination

B.

must obtain a referral to a dentist from her primary care provider (PCP)

C.

can schedule the examination without preauthorization of payment by the DHMO

D.

can schedule an unlimited number of examinations and cleanings per year