AHM-530 Exam Dumps : Network Management

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

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

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

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

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

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.