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AHIP AHM-510 Exam Dumps - Actual Questions Answers


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AHM-510 Questions and Answers

Question # 1

The Hanford Health Plan has delegated the credentialing of its providers to the Sienna Group, a credential verification organization (CVO). If the contract between Hanford and Sienna complies with all of the National Committee for Quality Assurance (NCQA) guidelines for delegation of credentialing, then this contract

A.

Transfers to Sienna all rights to terminate or suspend individual practitioners or providers in Hanford's provider network

B.

Describes the process by which Hanford evaluates Sienna's performance in credentialing providers

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question # 2

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

With respect to the type of change that constitutes a material change under the HMO Model Act's disclosure requirements, the termination of one healthcare provider from Greenpath's provider network

A.

Always qualifies as a material change in the plan, and Greenpath must report the change to all plan enrollees

B.

Always qualifies as a material change in the plan, and Greenpath must report the change to only those plan enrollees who have received care from the terminated provider

C.

Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to all plan enrollees

D.

Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to only those plan enrollees who receive primary care from the terminated provider

Question # 3

The Opal Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). Samantha Hill and Debra Chao are Opal enrollees. Ms. Hill was hospitalized for a cesarean birth, and Ms. Chao was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum hospital stay for which Opal, under NMHPA, must provide benefits for Ms. Hill and Ms. Chao.

A.

Ms. Hill: 72 hours; Ms. Chao: 24 hours

B.

Ms. Hill: 72 hours; Ms. Chao: 48 hours

C.

Ms. Hill: 96 hours; Ms. Chao: 24 hours

D.

Ms. Hill: 96 hours; Ms. Chao: 48 hours

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