Free AHM-530 Mock Exam – Practice Online Confidently

In health plan pharmacy networks, service costs consist of two components: costs for services associated with dispensing prescription drugs and costs for cognitive services. Cognitive services typically include:

The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements: 

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:

Promise, Inc., a corporation that specializes in cancer services, employs its physicians and support staff and provides facilities and ancillary services for cancer patients. Promise has contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan members who are undergoing cancer treatment. In return, Promise receives a capitated amount from Cordelia. Promise is an example of a type of specialty services organization known as a 

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill compensate her under a typical discounted fee-for-service (DFFS) payment system.During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as: