QUESTION: 125

Natalie Chan is a member of the Ultra Health Plan.
Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred h

Within Ultra's system, Ms. Chan received primary care from both Dr. Craig and Dr. Lee.
Ultra's system allows its members open access to all of Ultra's participating providers.
Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.
Ultra's network of providers includes Dr. Craig and Dr. Lee but not Arrow Hospital.

Answer(s): C

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QUESTION: 126

One characteristic of disease management programs is that they typically

focus on individual episodes of medical care rather than on the comprehensive care of the patient over time
are used to coordinate the care of members with any type of disease, either chronic or nonchronic
focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition
use clinical practice processes to standardize the implementation of best practices among providers

Answer(s): D

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QUESTION: 127

One characteristic of the accreditation process for MCOs is that

an accrediting agency typically conducts an on-site review of an MCO's operations, but it does not review an MCO's medical records or assess its member service systems
each accrediting organization has its own standards of accreditation
the accrediting process is mandatory for all MCOs
government agencies conduct all accreditation activities for MCOs

Answer(s): B

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QUESTION: 128

One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

A contract management system
A credentialing system
A legacy system
An interoperable communication system

Answer(s): A

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QUESTION: 125

QUESTION: 126

QUESTION: 127

QUESTION: 128