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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

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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Question 2

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 3

The Holiday Health Plan is preparing to enter a new market. In order to determine the optimal size of its provider panel in the new market, Holiday is conducting a competitive analysis of provider networks of the market’s existing health plans. Consider whether, in conducting its competitive analysis, Holiday should seek answers to the following questions:

Question 1: What are the cost-containment strategies of the health plans with increasing market shares?

Question 2: What are the premium strategies of the health plans with large market shares?

Question 3: What are the characteristics of health plans that are losing market share?

In its competitive analysis, Holiday should most likely obtain answers to questions

Options:

A.

1, 2, and 3

B.

1 and 2 only

C.

1 and 3 only

D.

2 and 3 only