Selected AHM-250 AHIP Certification Questions Answers

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Question 32

Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

Options:

380

130

550

Question 33

Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

Options:

prevent Dr. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan

require Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts

prevent Dr. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency

prevent Dr. Ware from billing a Riverside member for medical services that are not included in Riverside's plan

Question 34

As part of its utilization management (UM) system, the Creole Health Plan uses a process known as case management. The following individuals are members of the Creole Health Plan:

Jill Novacek, who has a chronic respiratory condition.
Abraham Rashad.

Options:

Ms. Novacek, Mr. Rashad, and Mr. Devereaux

Ms. Novacek and Mr. Rashad only

Ms. Novacek and Mr. Devereaux only

None of these members

Question 35

Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed-panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.