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AHIP Exam AHM-250 Topic 3 Question 109 Discussion

Actual exam question for AHIP's AHM-250 exam
Question #: 109
Topic #: 3
[All AHM-250 Questions]

Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example

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Suggested Answer: D

by Verlene at Mar 20, 2025, 11:15 AM

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Filiberto
20 days ago
Haha, I bet the exam writers are having a field day tripping us up with these tricky claims processing questions.
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Carin
28 days ago
I was leaning towards C. Durational ratings, but now I'm second-guessing myself. Decisions, decisions!
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Serina
8 days ago
A) Encounter reports
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Kiley
1 months ago
B. Diagnostic codes makes the most sense to me. Those are the key factors health plans look at to trigger additional scrutiny.
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Shannon
9 days ago
B) Diagnostic codes
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Bulah
18 days ago
A) Encounter reports
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Dominque
2 months ago
Hmm, I'm pretty sure it's D. Edits. That's the classic way health plans flag claims for further review.
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Merilyn
19 days ago
Yes, edits are commonly used in automated claims processing systems to prompt further investigation.
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Berry
27 days ago
I think you're right, edits are definitely used to flag claims for further review.
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Reed
2 months ago
I believe it could also be D) Edits, as they can trigger a review process.
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Stefanie
2 months ago
I agree with Shay, diagnostic codes are crucial for further investigation.
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Shay
2 months ago
I think the answer is B) Diagnostic codes.
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