Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Establish written procedures for adverse determinations and appeals

Obtain a certificate of authority from the state insurance department

Designating the organization as a TPA

All of the above

anti selection

cost shifting

receivership

underwriting

Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency

The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review

According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria

The Quality Assessment and Improvement Model Act exempts closed plans from implementing a quality improvement program.

discounted fee-for-service system

global capitation arrangement

withhold arrangement

relative value scale (RVS)

Lack of Freedom of choice

Absence of Primary care physician

Cost-cutting efforts and the structure of coverage

All of the above

Omnibus Budget Reconciliation Act (OBRA) of 1990

Tax Equity & Fiscal Responsibility Act (TEFRA) of 1982

Medicare Modernization Act (MMA) of 2003

Balanced Budget Act (BBA) of 1997

Cost per procedure

Concurrent review

Cost of review

Access requirements

278

397

403

920

Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision

It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute

It is considered to be an informal appeal

It will be handled by an independent review organization (IRO)

Provides Ms. Giambi with healthcare coverage for any illness or injury, but only if the cause of the illness or injury is work-related.

Combines the group health plan and disability plan offered by Ms. Giambi's employer with workers' compensation coverage.

Requires Ms. Giambi and her employer to each pay half of the cost of this coverage.

Requires Ms. Giambi to pay specified deductibles and copayments before receiving benefits under this program for any illness or injury.