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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements:

Options:

A.

A statement that identifies the purpose of the contract

B.

A statement that defines in legal terms the parties to the contract

C.

A statement that identifies the Sailboat products to be covered by the contract

Of these statements, the ones that are likely to be included in the recitals section of Dr. Cartier's contract are statements:

D.

A, B, and C

E.

A and B only

F.

A and C only

G.

B and C only

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Question 2

The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:

Options:

A.

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

B.

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

C.

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

D.

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

Question 3

The following statements are about Medicaid health plan entities. Select the answer choice containing the correct statement:

Options:

A.

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

B.

Primary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.

C.

Typically, Medicaid beneficiaries must be given a choice between at least two health plan entities.

D.

Medicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.