Most Recent AHIP AHM-530 Exam Questions & Answers

Prepare for the AHIP Network Management exam with our extensive collection of questions and answers. These practice Q&A are updated according to the latest syllabus, providing you with the tools needed to review and test your knowledge.

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The questions for AHM-530 were last updated on Jan 17, 2025.

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Question No. 1

As part of the credentialing process, many health plans use the National Practitioner Data Bank (NPDB) to learn information about prospective members of a provider network. One true statement about the NPDB is that:

AIt is maintained by the individual states

BIt primarily includes information about any censures, reprimands, or admonishments against any physicians who are licensed to practice medicine in the United States

CThe information in the NPDB is available to the general public

DIt was established to identify and discipline medical practitioners who act unprofessionally

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Correct Answer: D

Question No. 2

The Walnut Health Plan provides a number of specialty services for its members. Walnut offers coverage of alternative healthcare, including coverage of treatment methods such as homeopathy and naturopathy. Walnut also offers home healthcare services, and it contracts with home healthcare providers on a non-risk basis to the health plan. The following statements are about the specialty services offered by Walnut. Select the answer choice containing the correct statement:

AHomeopathy treats diseases by using small doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated.

BNaturopathy is an approach to healthcare that uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate.

CUnder a non-risk contract, Walnut most likely transfers the responsibility for arranging home healthcare to the home healthcare provider organizations.

DFederal law allows Walnut to contract with a home healthcare provider organization only if the provider organization has received accreditation by the Utilization Review Accreditation Commission (URAC).

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Correct Answer: A

Question No. 3

The Aegean Health Plan delegated its utilization management (UM) program to the Silhouette IP

ASilhouette, in turn, transferred authority for case management to Brandon Health Services. In this situation, Brandon is best described as the

Adelegator, and Aegean is ultimately responsible for Brandon's performance

Bdelegator, and Silhouette is ultimately responsible for Brandon's performance

Csubdelegate, and Aegean is ultimately responsible for Brandon's performance

Dsubdelegate, and Silhouette is ultimately responsible for Brandon's performance

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Correct Answer: C

Question No. 4

The following situations illustrate violations of federal antitrust laws:

Situation A Two HMOs split a large employer group by agreeing to let one HMO market to some company employees and to let the second HMO market to different company employees.

Situation B Members of a physician-hospital organization (PHO) that has significant market share jointly agreed to exclude a physician from joining the PHO solely because that physician has admitting privileges at a competing hospital.

From the following answer choices, select the response that best identifies the types of violations illustrated by these situations:

ASituation A: horizontal division of territories; Situation B: group boycott

BSituation A: horizontal division of territories; Situation B: exclusive arrangement

CSituation A: exclusive arrangement; Situation B: group boycott

DSituation A: exclusive arrangement; Situation B: tying arrangement

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Correct Answer: A

Question No. 5

The provider contracts that the Indigo Health Plan has with its providers include a clause which states that Indigo's denial of payment for a certain medical procedure does not constitute a medical opinion and is not intended to interfere with the provider-patient relationship. This information indicates that Indigo's provider contracts include:

AA business confidentiality clause.

BA scope of services clause.

CAn informed refusal clause.

DAn exculpation clause.

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Correct Answer: D

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