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Free AHM-250 Exam Braindumps (page: 46)

Page 45 of 92
PDF with 367 Questions

The Cleopatra Group, a third-party administrator (TPA), has entered into a TPA agreement with the Alexander MCO with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. On

  1. hold all funds it receives on behalf of Alexander in trust
  2. assume full responsibility for determining the claim payment procedures for the plan
  3. assume full responsibility for ensuring that the health plan is administered properly
  4. obtain from the federal government a certificate of authority designating the Cleopatra Group as a TPA

Answer(s): A



The Clover Group is a for-profit MCO that operates in the United States. The Valentine Group owns all of Clover's stock. The Valentine Group's sole business is the ownership of controlling interests in the shares of other companies. This information indic

  1. holding company of the Valentine Group
  2. sister corporation of the Valentine Group
  3. parent company of the Valentine Group
  4. subsidiary of the Valentine Group

Answer(s): D



The Conquest Corporation contracts with the Apex health plan to provide basic medical and surgical services to Conquest employees. Conquest entered into a separate contract with the Bright Dental Group to provide and manage a dental care program for employee

  1. a negotiated rebate agreement
  2. a carve-out arrangement
  3. an indemnity plan
  4. PBM

Answer(s): B



The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004.
Which of the

  1. The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.
  2. The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.
  3. The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.
  4. The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Answer(s): C






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