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AHIP AHM-530 Exam Questions
Network Management (Page 17 )

Updated On: 12-Apr-2026
Page 8 of 42
PDF with 202 Questions

Before incurring the expense of assembling a new PPO network, the Protect Health Plan conducted a cost analysis in order to determine the cost-effectiveness of renting an existing PPO network instead. In calculating the overall cost of renting the network, Protect assumed a premium of $2.52 per member per month (PMPM) and estimated the total number of members to be 9,000. This information indicates that Protect would calculate its annual network rental cost to be

  1. $42,857
  2. $56,700
  3. $272,160
  4. $680,400

Answer(s): C



The Aegean Health Plan delegated its utilization management (UM) program to the Silhouette IPA. Silhouette, in turn, transferred authority for case management to Brandon Health Services. In this situation, Brandon is best described as the

  1. delegator, and Aegean is ultimately responsible for Brandon's performance
  2. delegator, and Silhouette is ultimately responsible for Brandon's performance
  3. subdelegate, and Aegean is ultimately responsible for Brandon's performance
  4. subdelegate, and Silhouette is ultimately responsible for Brandon's performance

Answer(s): C



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

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

Answer(s): D



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

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

Answer(s): B



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

  1. Ideally, a health plan should have every specialist category represented on its provider panel with appropriate geographic distribution.
  2. Most specialist contracts do not ensure the provider's adherence to UM policies set up by the health plan.
  3. No-balance-billing clauses are not desirable in health plan contracts with specialists.
  4. 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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Viewing questions 81 - 85 out of 202 questions



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