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AHIP AHM-530 Actual Questions

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Total 202 questions

Network Management Questions and Answers

Question 29

During the credentialing process, a health plan verifies the accuracy of information on a prospective network provider’s application. One true statement regarding this process is that the health plan

Options:

A.

has a legal right to access a prospective provider’s confidential medical records at any time

B.

must limit any evaluations of a prospective provider’s office to an assessment of quantitative factors, such as the number of double-booked appointments a physicianaccepts at the end of each day

C.

is prohibited by law from conducting primary verification of such data as a prospective provider’s scope of medical malpractice insurance coverage and federal tax identification number

D.

must complete the credentialing process before a provider signs the network contract or must include in the signed document a provision that the final contract is contingent upon the completion of the credentialing process

Question 30

The actual number of providers included in a provider network may be based on staffing ratios. Staffing ratios relate the number of

Options:

A.

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

B.

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

C.

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

D.

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

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Total 202 questions