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AHIP AHM-510 Exam Dumps - Actual Questions Answers


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Governance and Regulation

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  • Last Update: Oct 25, 2025
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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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AHIP AHM-510 Exam Dumps FAQs

1. What is the AHIP AHM-510 Exam?

The AHIP AHM?510 exam, officially titled Governance and Regulation, is offered by AHIP in partnership with the Blue Cross Blue Shield Association. It validates knowledge of the types and structure of health management organizations, governance frameworks, public policy, legal issues, Medicare/Medicaid, fraud and abuse, ERISA, and pharmacy benefit administration.

2. Who should take the AHM-510 Certification Exam?

The AHM-510 exam is ideal for professionals in healthcare management, including agents, brokers, case managers, financial planners, medical directors, and insurance provider staff. It’s especially valuable for those working with government-sponsored health programs or regulatory compliance.

3. What topics are covered in the AHIP AHM-510 Exam?

The AHIP AHM-510 exam covers 10 core areas:

  • Health insurance industry structure and formation
  • Strategic planning and reengineering in healthcare
  • Legal issues post-healthcare reform
  • ERISA, pharmacy benefits, and wellness regulations
  • Federal and state regulatory requirements
  • Government’s role in healthcare purchasing
  • Medicare and Medicaid service delivery
  • Fraud and abuse in healthcare
  • Organizational control systems
  • Key industry terms and case scenarios

4. How long is the AHM-510 Exam and how many questions are there?

The AHIP AHM-510 exam duration is 90 minutes, and it typically includes 60 multiple-choice questions.

5. Why is Governance and Regulation certification valuable?

Passing AHM?510 demonstrates proficiency in complex health plan governance, public policy, legal frameworks and Medicare/Medicaid programs. It builds credibility and can boost career advancement in industry roles.

6. What is the AHM-510 exam cost and how do I register?

The AHM-510 exam fee is $220 for AHIP members and $280 for non?members. You register via the AHIP Insurance Education portal, select the exam, and pay online to schedule your test appointment.

7. What is the difference between the AHIP AHM-510 and AHM-520?

Both exams are essential for professionals aiming to master different facets of managed healthcare. If you're focused on regulatory frameworks and government programs, AHM-510 is the right choice. If your role involves financial oversight and risk strategy, the AHM-520 exam is more aligned with your goals.

8. What AHM-510 study materials does DumpsMate offer?

DumpsMate offers:

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9. Is there a success guarantee with DumpsMates AHM-510 dumps?

Absolutely. DumpsMate’s success guarantee ensures that if you study with our verified AHM-510 exam dumps and real questions, you’ll be fully prepared to pass the AHM-510 exam on your first attempt.

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