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Free AHM-530 Exam Braindumps (page: 12)

Page 11 of 51
PDF with 202 Questions

Health plans use a variety of sources to find candidates to recruit for their provider networks. In general, two of the most effective methods of finding candidates are through

  1. Word of mouth and on-site training programs
  2. Word of mouth and direct mail
  3. Advertisements in local newspapers and on-site training programs
  4. Advertisements in local newspapers and direct mail

Answer(s): B



During the credentialing process, a health plan verifies the accuracy of information on a prospective network provider's application. One true statement regarding this process is that the health plan

  1. has a legal right to access a prospective provider's confidential medical records at any time
  2. must limit any evaluations of a prospective provider's office to an assessment of quantitative factors, such as the number of double-booked appointments a physicianaccepts at the end of each day
  3. is prohibited by law from conducting primary verification of such data as a prospective provider's scope of medical malpractice insurance coverage and federal tax identification number
  4. must complete the credentialing process before a provider signs the network contract or must include in the signed document a provision that the final contract is contingent upon the completion of the credentialing process

Answer(s): D



The Festival Health Plan is in the process of recruiting physicians for its provider network. Festival requires its network physicians to be board certified. The following individuals are provider applicants whose qualifications are being considered:

Applicant 1 has completed his surgical residency, and he recently passed a qualifying examination in his field.

Applicant 2 has completed her residency in dermatology, and she is scheduled to take qualifying examinations in the next Six months.

Applicant 3 completed his residency in pediatric medicine six years ago, but he has not yet passed a qualifying examination in his field.

With regard to these applicants, it can correctly be stated that only

  1. Applicants 1 and 2 are board certified
  2. Applicants 2 and 3 are board certified
  3. Applicant 1 is board certified
  4. Applicant 3 is board certified

Answer(s): C



The Justice Health Plan is eligible to submit reportable actions against medical practitioners to the National Practitioner Data Bank (NPDB). Justice is considering whether it should report the following actions to the NPDB:

Action 1--A medical malpractice insurer made a malpractice payment on behalf of a dentist in Justice's network for a complaint that was settled out of court.

Action 2--Justice reprimanded a PCP in its network for failing to follow the health plan's referral procedures.

Action 3--Justice suspended a physician's clinical privileges throughout the Justice network because the physician's conduct adversely affected the welfare of a patient.

Action 4--Justice censured a physician for advertising practices that were not aligned with Justice's marketing philosophy.

Of these actions, the ones that Justice most likely must report to the NPDB include Actions

  1. 1, 2, and 3 only
  2. 1 and 3 only
  3. 2 and 4 only
  4. 3 and 4 only

Answer(s): B






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