AHM-530 Exam Dumps : Network Management

Potential providers in a plan’s network to the number of individuals in the area to be served by the plan

Providers in a plan’s network to the number of enrollees in the plan

Providers outside a plan’s network to the number of providers in the plan’s network

Support staff in a plan’s network to the number of medical practitioners in the plan’s network

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

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

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

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

To keep Medicaid enrollment costs as low as possible, states typically prohibit the use of third-party entities known as enrollment brokers to handle the recruitment and enrollment of Medicaid recipients in health plan plans

Primary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.

Typically, Medicaid beneficiaries must be given a choice between at least two health plan entities.

Medicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.