AHM-530 Exam Dumps : Network Management

medical necessity standard

prudent layperson standard

“all-or-none” standard

reasonable and customary standard

A discounted fee-for-service (DFFS) system is usually easier for a health plan to administer than is a fee schedule system.

A case rate payment system offers providers an incentive to take an active role in managing cost and utilization.

One reason that health plans use a relative value scale (RVS) payment system is that RVS values for cognitive services have traditionally been higher than the values for procedural services.

One reason that health plans use a resource-based relative value scale (RBRVS) is that this system includes weighted unit values for all types of procedures.

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

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

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

all of the above