QUESTION: 13

Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is that

Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision
It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute
It is considered to be an informal appeal
It will be handled by an independent review organization (IRO)

Answer(s): A

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QUESTION: 14

All CDHP products provide federal tax advantages while allowing consumers to save money for their healthcare.

True
False

Answer(s): A

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QUESTION: 15

Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood will reimburse Mercy Memorial on the basis of a negotiated ch

per diem agreement
fee-for-service agreement
withhold agreement
diagnostic related group (DRG) agreement

Answer(s): A

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QUESTION: 16

Although the process is voluntary for health plans, external accreditation is becoming more and more important as states and purchasers require health plans undergo as many states and purchasers require health plans undergo some type of external review pr

Is voluntary for health plans.
Requires all change accreditation organizations to use the same standards of accreditation.
Typically requires the accrediting organization to conduct a medical record review and a review of a health plan's credentialing processes, but not an evaluation of the health plans' member service systems processes.
Cannot assure that a health plan meets a specified level of quality.

Answer(s): A

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Free AHM-250 Exam Braindumps (page: 5)

QUESTION: 13

QUESTION: 14

QUESTION: 15

QUESTION: 16

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