Free AHM-530 Exam Braindumps (page: 14)

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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

  1. Liability claims histories of prospective providers
  2. Hospital privileges of prospective providers
  3. Malpractice insurance on prospective providers
  4. All of the above

Answer(s): D



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

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

Answer(s): A



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

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

Answer(s): D



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

  1. medical necessity standard
  2. prudent layperson standard
  3. "all-or-none" standard
  4. reasonable and customary standard

Answer(s): B






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