AHIP Certification AHM-250 AHIP Study Notes

The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

Each insurance company selling Medigap must sell all the different Medigap policies.

Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

Medigap benefits vary by plan type (A through L), and are not uniform nationally.

Retrospective experience rating

Adjusted community rating

Community rating by class

Community rating

A Level One appeal, and the member has the right to a further appeal

A Level Two appeal, and the reviewer's decision is final and binding

An independent external appeal, and the member has the right to a further appeal

Arbitration, and the reviewer's decision is final and binding

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients