AHM-530 Exam Dumps : Network Management

average cost of services delivered to all patients living in a specified geographic region

actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits

fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status

average fixed monthly fee paid by all Medicare enrollees in a specified geographic region

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.

workers' compensation coverage is available to all employees, regardless of their eligibility for health insurance coverage

indemnity benefits currently account for less than 10% of all workers' compensation benefits

workers' compensation programs in most states require eligible employees to obtain medical treatment only from members of a provider network

workers' compensation programs include deductibles and coinsurance requirements