AHM-250 AHIP Exam Questions and Free Practice Test

Question 43

- (Topic 2)
Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

A. the National Practitioner Data Bank (NPDB)

B. the National Association of Insurance Commissioners (NAIC)

C. the Centers for Medicare and Medicaid Services (CMS)

D. independent accrediting organizations

Correct Answer:D

Question 44

- (Topic 1)
In preparation for its expansion into a new service area, the Regal MCO is meeting with Dr. Nancy Buhner, a cardiologist who practices in Regal's new service area, in order to convince her to become one of the plan's participating providers. As part of the

A. ensure that D

B. Buhner complies with all of the provisions of the Ethics in Patient Referrals Act

C. learn whether D

D. Buhner is a licensed medical practitioner

E. confirm D

F. Buhner's membership in the National Committee for Quality Assurance (NCQA)

G. learn whether D

H. Buhner has had a medical malpractice claim filed or other disciplinary actions taken against her

Correct Answer:D

Question 45

- (Topic 3)
Select the correct statement regarding TRICARE Extra plan options to military personnel’s.

A. Out of pocket expenses are generally high in tricare extra than TRICARE standard

B. Enrollment is not necessary to participate in TRICARE Extra

C. TRICARE Extra provides coordinated care managed by primary care case manager

Correct Answer:C

Question 46

- (Topic 3)
The NAIC designed a small group model law to enable small groups to obtain accessible, yet affordable, group health benefits. Specifically, the model law limits the rate spread. According to this model law, if the lowest rate that an HMO charges a small g

A. $80

B. $120

C. $160

D. $240

Correct Answer:C

Question 47

- (Topic 2)
One device that PBM plans use to manage both the cost and use of pharmaceuticals is a formulary. A formulary is defined as

A. a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications

B. a reduction in the price of a particular pharmaceutical obtained by the PBM from the pharmaceutical manufacturer

C. drugs ordered and delivered through the mail to the PBM's plan members at a reduced cost

D. an identification card issued by the PBM to its plan members

Correct Answer:A

Question 48

- (Topic 1)
In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

A. Therapeutic / always

B. Generic / always

C. Generic / never

D. Therapeutic / never

Correct Answer:A

START AHM-250 EXAM