Free AHM-250 Exam Braindumps

- (Topic 2)
Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

1. A. fixed amount in advance for each medical service the member receives
2. B. a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider
3. C. a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services
4. D. specified amount of the member's medical expenses before any benefits are paid by the HMO

Correct Answer: C

- (Topic 2)
Phillip Tsai is insured by both a indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of benefits p

1. A. $0
2. B. $300
3. C. $400
4. D. $900

Correct Answer: C

- (Topic 2)
One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

1. A. A contract management system
2. B. A credentialing system
3. C. A legacy system
4. D. An interoperable communication system

Correct Answer: A

- (Topic 3)
In Order to act as a TPA an organization must

1. A. Establish written procedures for adverse determinations and appeals
2. B. Obtain a certificate of authority from the state insurance department
3. C. Designating the organization as a TPA
4. D. All of the above

Correct Answer: B

- (Topic 1)
Health plans use the following to determine the number of providers to add to a network:

1. A. Staffing ratios
2. B. Drive time
3. C. Geographic availability
4. D. All of the above

Correct Answer: D