AHM-530 Exam Dumps : Network Management

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.

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

Must provide Medicare participants with standard HMO benefits, as well as with limited long-term care benefits

Does not need as great a variety of provider types or as complex a reimbursement method as does a traditional HMO

Receives a payment that is based on reasonable costs and reasonable charges

Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's goals is to minimize the use of community-based care