Free AHM-250 Exam Braindumps

- (Topic 1)
Federal Employee Health Benefits Program (FEHBP) requires health plans offering services to federal employees and their dependents to provide

1. A. Immediate access to emergency services
2. B. Urgent Appointments within 24 hours
3. C. Routine appointments once a m
4. D. D
5. E. A
6. F. B & C
7. G. All of the listed options

Correct Answer: F

- (Topic 3)
Utilization data can be transmitted to the health plan manually, by telephone, or electronically. Compared to other methods of data transmittal, manual transmittal is generally

1. A. less cumbersome and labor intensive
2. B. faster and more accurate
3. C. more acceptable to physicians
4. D. subject to greater scrutiny by regulatory bodies

Correct Answer: C

- (Topic 1)
A particular health plan offers a higher level of benefits for services provided in-network
than for out-of-network services. This health plan requires preauthorization for certain medical services.
With regard to the steps that the health plan's claims e

1. A. should assume that all services requiring preauthorization have been preauthorized
2. B. should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim
3. C. need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits
4. D. need not determine whether the member is covered by another health plan that allows for coordination of benefits

Correct Answer: B

- (Topic 1)
Dr. Samuel Aldridge's provider contract with the Badger Health Plan includes a typical due process clause. The primary purpose of this clause is to:

1. A. State that D
2. B. Aldridge's provider contract with Badger will automatically terminate if he loses his medical license or hospital privileges.
3. C. Specify a time period during which the party that breaches the provider contract must remedy the problem in order to avoid termination of the contract.
4. D. Give D
5. E. Aldridge the right to appeal Badger's decision if he is terminated with cause from Badger's provider network.
6. F. Specify that Badger can terminate this provider contract without providing a reason, but only if Badger gives D
7. G. Aldridge at least 90-days' notice of its intent to terminate the contract.

Correct Answer: C

- (Topic 3)
The owners of an MCO typically delegate authority for governing the operation of the MCO by electing the MCO's

1. A. quality management committee
2. B. medical director
3. C. board of directors
4. D. chief executive officer

Correct Answer: C