Discuss AHIP AHM-250 Exam Topic 6 Question 68

The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

AUnder 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

BThe 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

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

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

Suggested Answer: A

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13 comments · newest first

Meghan 12 months ago

A is a must-have, no one should be left hanging during insolvency!

Thad 1 year ago

C is spot on, credentialing is super important for quality care.

Edna 1 year ago

Wait, does B really not require a second-level review? That seems odd.

Helga 1 year ago

I disagree with D, closed plans should still have quality measures.

Gianna 1 year ago

A sounds fair, protecting patients is key!

Jenifer 1 year ago

I’m a bit confused about statement D. I thought closed plans might still need to implement some quality improvement measures, so I’m not sure if that exemption is accurate.

Leigha 1 year ago

Statement C seems correct to me; I believe health plans must select providers that meet their credentialing criteria, but I could be mixing it up with another model.

Miss 1 year ago

I remember practicing a question about grievance procedures, and I thought that the first-level review was mandatory, but I can't recall if a second-level review is required or not.

Theola 1 year ago

I think statement A sounds familiar, but I'm not entirely sure if all health plans are really required to hold covered persons harmless.

Rolland 1 year ago

This looks like a tricky question. I'll need to think carefully about the differences between dictionary and locally managed tablespaces.

Fernanda 1 year ago

I'm leaning towards the Predictive method. It seems like it would be able to predict the load on each pool member and route traffic accordingly.

Freeman 1 year ago

Okay, let me think this through step-by-step. The key is understanding how the re-learn rate works and how it impacts the different SDP connections.

Casey 1 year ago

Hmm, this looks like a tricky one. I think the key here is understanding how linear least squares regression works and what can happen when the features are linearly dependent.

AHIP AHM-250 Exam - Topic 6 Question 68 Discussion