Preparing for a AHIP credential calls for material that follows the official scope. Actual4dump builds its AHIP Network Management practice set around the AHM-530 objectives, with 202 questions designed to support a focused review.

AHIP AHM-530 Exam Overview:

AHIP AHM-530 Exam Syllabus Topics:

Frequently Asked Questions for the AHIP AHM-530 Exam

AHIP Network Management Sample Questions:

Question 1

The Athena Medical Group has purchased from the Corinthian Insurance Company individual stop-loss insurance coverage for primary and specialty care services with a $5,000 attachment point and 10 percent coinsurance. One of Athena's patients accrued $8,000 of medical costs for primary and specialty care treatment. In this situation, Athena will be responsible for paying an amount equal to

A. $7,700, and Corinthian is obligated to reimburse Athena in the amount of $300
B. $300, and Corinthian is obligated to reimburse Athena in the amount of $2,700
C. $5,300, and Corinthian is obligated to reimburse Athena in the amount of $2,700
D. $2,700, and Corinthian is obligated to reimburse Athena in the amount of $5,300

Question 2

One important aspect of network management is profiling, or provider profiling. Profiling is most often used to

A. verify a prospective provider's professional licenses, certifications, and training
B. assess a provider's overall satisfaction with a plan's service protocols and other operational areas
C. measure the overall performance of providers who are already participants in the network
D. familiarize a provider with a plan's procedures for authorizations and referrals

Question 3

An health plan enters into a professional services capitation arrangement whenever the health plan

A. Contracts with a medical group, clinic, or multispecialty IPA that assumes responsibility for the costs of all physician services related to a patient's care
B. Pays individual specialists to provide only radiology services to all plan members
C. Contracts with a primary care provider to cover primary care services only
D. Transfers all financial risk for healthcare services to a provider organization and the provider, in turn, covers virtually all of a patient's medical expenses

Question 4

The Omni Health Plan is interested in expanding the specialty services it offers to its plan members and is considering contracting with the following providers of specialty services:
The Apex Company, a managed vision care organization (MVCO)
The Baxter Managed Behavioral Healthcare Organization (MBHO)
The Cheshire Dental Health Maintenance Organization (DHMO)
As part of its credentialing process, Omni would like to verify that each of these providers has met NCQA's accreditation standards. However, with regard to these three specialty service providers, an NCQA accreditation program currently exists for

A. Baxter and Cheshire only
B. Apex and Baxter only
C. Apex and Cheshire only
D. Baxter only

Question 5

One characteristic of the workers' compensation program is that:

A. workers' compensation programs include deductibles and coinsurance requirements
B. workers' compensation programs in most states require eligible employees to obtain medical treatment only from members of a provider network
C. workers' compensation coverage is available to all employees, regardless of their eligibility for health insurance coverage
D. indemnity benefits currently account for less than 10% of all workers' compensation benefits

Solutions: