QUESTION: 53

The provider contract between the Ocelot Health Plan and Dr. Enos Zorn, one of the health plan's participating providers, is a brief contract which includes, by reference, an Ocelot provider manual. This manual contains much of the information found in Ocelot's comprehensive provider contracts. The following statements are about Dr. Zorn's provider contract. Select the answer choice containing the correct statement.

All statements in the provider contract shall be deemed to be warranties, because all statements of facts contained in the contract must be true only in those respects material to the contract.
Because the provider manual is part of the contract, Ocelot must make sure that its provider manual is comprehensive and up-to-date.
Because the provider contract is a brief contract, Ocelot most likely is prohibited from amending the contract unilaterally, even if it gives Dr. Zorn advance notice of its intent to amend the contract.
Areas that should be covered in the provider manual, and not in the body of the contract, include any specific legal issues relevant to the contract.

Answer(s): B

Reveal Solution Next Question

QUESTION: 54

A provider contract describes the responsibilities of each party to the contract. These responsibilities can be divided into provider responsibilities, health plan responsibilities, and mutual obligations. Mutual obligations typically include

provisions for marketing the plan's product
payment arrangements between the plan and the provider
verification of the plan's eligibility to do business
management of the contents of members' medical records

Answer(s): B

Reveal Solution Next Question

QUESTION: 55

The Medea Clinic is a network provider for Delphic Healthcare. Delphic transferred the contract it held with Medea to the Elixir HMO, an entity that was not party to the original contract. The process by which Delphic transferred the contract it held with Medea to Elixir is known as

Most-favored- nation arrangement
Alimit on action
Aconsideration
An assignment

Answer(s): D

Reveal Solution Next Question

QUESTION: 56

Dr. Eve Barlow is a specialist in the Amity Health Plan's provider network. Dr. Barlow's provider contract with Amity contains a typical most-favored-nation arrangement. The purpose of this arrangement is to

Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract
Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters
Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract
State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity

Answer(s): C

Reveal Solution Next Question

Free AHM-530 Exam Braindumps (page: 15)

QUESTION: 53

QUESTION: 54

QUESTION: 55

QUESTION: 56

AHM-530 Discussions & Posts