QUESTION: 77

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

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

Answer(s): A

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QUESTION: 78

If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area _____________.

Has many contracting options available.
Should not contract with that entity
Most likely needs to contract with that entity
Should attempt to disband the existing affiliations

Answer(s): C

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QUESTION: 79

Immediate evaluation and treatment of illness or injury can be provided in any of the following care settings:

Hospital emergency departments
Physician's offices
Urgent care centers If these settings are ranked in order of the cost of providing c
A, B, C
A, C, B
B, C, A
C, A, B

Answer(s): B

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QUESTION: 80

In 1999, the United States Congress passed the Financial Services Modernization Act, referred to as the Gramm-Leach-Bliley (GLB) Act. The primary provisions included under the GLB Act require financial institutions, including health plans, to take several

Notify customers of any sharing of non-public personal financial information with nonaffiliated third parties.
Prohibit customers from having the opportunity to 'opt-out' of sharing non-public personal financial information.
Disclose to affiliates, but not to third parties, their privacy policies regarding the sharing of nonpublic personal financial information.
Agree not to disclose personally identifiable financial information or personally identifiable health information.

Answer(s): A

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Free AHM-250 Exam Braindumps (page: 21)

QUESTION: 77

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QUESTION: 79

QUESTION: 80

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