Free AHIP AHM-540 Exam Questions

One true statement about state regulation of case management activities is that the majority of states  

The paragraph below contains two pairs of terms in parentheses. Determine which term in eachpair correctly completes the paragraph. Then select the answer choice containing the two termsthat you have chosen.Health plans use both internal and external standards to assess the quality of the services thatthey provide. (Internal / External) standards are based on information such as published industrywideaverages or best practices of recognized industry leaders. Health plans primarily rely on(internal / external) standards to evaluate healthcare services. 

Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs  

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

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQ A. These NCQA credentialing standards apply to