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Two Ways to Mastery: Learn with the PDF, Validate with the AHM-530 Simulator. Know You're Ready and Pass with 100% Confidence. Your Complete AHIP Certification Success Package: Study Anywhere, Test Anywhere.
Network Management
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AHIP AHM-530 Questions and Answers
From the following answer choices, choose the type of clause or provision described in this situation.
The provider contract between Dr. Olin Norquist and the Granite Health Plan specifies a time period for the party who has breached the contract to remedy the problem and avoid termination of the contract.
Salvatore Arris is a member of the Crescent Health Plan, which provides its members with a full range of medical services through its provider network. After suffering from debilitating headaches for several days, Mr. Arris made an appointment to see Neal Prater, a physician’s assistant in the Crescent network who provides primary care under the supervision of physician Dr. Anne Hunt. Mr. Prater referred Mr. Arris to Dr. Ginger Chen, an ophthalmologist, who determined that Mr. Arris’ symptoms were indicative of migraine headaches. Dr. Chen prescribed medicine for Mr. Arris, and Mr. Arris had the prescription filled at a pharmacy with which Crescent has contracted. The pharmacist, Steven Tucker, advised Mr. Arris to take the medicine with food or milk. In this situation, the person who functioned as an ancillary service provider is
Most health plan contracts provide an outline of the criteria that a healthcare service must meet in order to be considered “medically necessary.” Typically, in order for a healthcare service to be considered medically necessary, the service provided by a physician or other healthcare provider to identify and treat a member’s illness or injury must be
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It covers healthcare network structures, strategies, and performance improvement essentials.
It helps professionals understand how managed care networks function and succeed.
It includes network design, provider relations, contracting, and quality management.
Healthcare managers, insurance professionals, and network administrators benefit most.
It boosts credibility and opens advanced roles in healthcare network management.
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It focuses on real-world applications of healthcare network strategies.
It breaks down complex topics into clear, easy-to-understand lessons.
To ensure efficient provider coordination, cost control, and quality patient care.
Healthcare Management: An Introduction
Governance and Regulation
Health Plan Finance and Risk Management
Medical Management
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TESTED 01 Dec 2025
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