Last Attempt AHM-250 Questions

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Question 24

From the answer choices below, select the response that correctly identifies the rating method that Mr. Sybex used and the premium rate PMPM that Mr. Sybex calculated for the Koster group.

Options:

Rating Method book rating Premium Rate PMPM $132

Rating Method book rating Premium Rate PMPM $138

Rating Method blended rating Premium Rate PMPM $132

Rating Method blended rating Premium Rate PMPM $138

Question 25

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services.

With regard to the steps that the health plan's claims e

Options:

should assume that all services requiring preauthorization have been preauthorized

should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim

need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits

need not determine whether the member is covered by another health plan that allows for coordination of benefits

Question 26

Health plans use the following to determine the number of providers to add to a network:

Options:

Staffing ratios

Drive time

Geographic availability

All of the above

Question 27

Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?