QUESTION: 49

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. A credentials verification organization (CVO) can be certified to verify certain pertinent credentialing information, including

Liability claims histories of prospective providers
Hospital privileges of prospective providers
Malpractice insurance on prospective providers
All of the above

Answer(s): D

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QUESTION: 50

The introductory paragraph of a provider contract is generally followed by a section called the recitals. The recitals section of the contract typically specifies the

Purpose of the agreement
Manner in which the provider is to bill for services 22
Definitions of key terms to be used in the contract
Rate at which the provider will be compensated

Answer(s): A

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QUESTION: 51

Most health plan contracts provide an outline of the criteria that a healthcare service must meet in order to be considered "medically necessary." Typically, in order for a healthcare service to be considered medically necessary, the service provided by a physician or other healthcare provider to identify and treat a member's illness or injury must be

Consistent with the symptoms of diagnosis
Furnished in the least intensive type of medical care setting required by the member's condition
In compliance with the standards of good medical practice
All of the above

Answer(s): D

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QUESTION: 52

When the Rialto Health Plan determines which of the emergency services received by its plan members should be covered by the health plan, it is guided by a standard which describes emergencies as medical conditions manifesting themselves by acute symptoms of sufficient severity (including severe pain) such that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy. This standard, which was adopted by the NAIC in 1996, is referred to as the

medical necessity standard
prudent layperson standard
"all-or-none" standard
reasonable and customary standard

Answer(s): B

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Free AHM-530 Exam Braindumps (page: 14)

QUESTION: 49

QUESTION: 50

QUESTION: 51

QUESTION: 52

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