Free AHIP AHM-540 Exam Questions

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

The following statement(s) can correctly be made about the scope of case management:1. Case management incorporates activities that may fall outside a health plan’s typicalresponsibilities, such as assessing a member’s financial situation2. Case management generally requires a less comprehensive and complex approach to a courseof care than does utilization review3. Case management is currently applicable only to medical conditions that require inpatienthospital care and are categorized as catastrophic in terms of health and/or costs 

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

Health plans that choose to contract with external organizations for pharmacy services typicallycontract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for ahealth plan include1. Managing the costs of prescription drugs2. Promoting efficient and safe drug use3. Determining the health plan’s internal management responsibilities for pharmacy services

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence 2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3. All of the criteria for coverage decisions must be included in the purchaser contract