QUESTION: 33

Although a health plan is allowed to delegate many activities to outside sources, the National Committee for Quality Assurance (NCQA) has determined that some activities are not delegable.
These activities include

evaluation of new medical technologies
overseeing delegated medical records activities
developing written statements of members' rights and responsibilities
all of the above

Answer(s): D

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QUESTION: 34

The Brice Health Plan submitted to Clarity Health Services a letter of intent indicating Brice's desire to delegate its demand management function to Clarity. One true statement about this letter of intent is that it

creates a legally binding relationship between Brice and Clarity
most likely contains a confidentiality clause committing Brice and Clarity to maintain the confidentiality of documents reviewed and exchanged in the process
prohibits Clarity from performing similar delegation activities for other health plans
most likely contains a detailed description of the functions that Brice will delegate to Clarity

Answer(s): B

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QUESTION: 35

The following statements are about the specialist component of a provider panel. Select the answer choice containing the correct statement.

Ideally, a health plan should have every specialist category represented on its provider panel with appropriate geographic distribution.
Most specialist contracts do not ensure the provider's adherence to UM policies set up by the health plan.
No-balance-billing clauses are not desirable in health plan contracts with specialists.
In geographic regions where there is a shortage of PCPs, a health plan is not permitted to contract with specialists to perform primary care services, even for patients with chronic conditions.

Answer(s): A

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QUESTION: 36

In contracting with providers, a health plan can use a closed panel or open panel approach. One statement that can correctly be made about an open panel health plan is that the participating providers

must be employees of the health plan, rather than independent contractors
are prohibited from seeing patients who are members of other health plans
typically operate out of their own offices
operate according to their own standards of care, rather than standards of care established by the health plan

Answer(s): C

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Free AHIP AHM-530 Exam Questions (page: 13)

QUESTION: 33

QUESTION: 34

QUESTION: 35

QUESTION: 36

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