Get All Network Management Exam Questions with Validated Answers
| Vendor: | AHIP |
|---|---|
| Exam Code: | AHM-530 |
| Exam Name: | Network Management |
| Exam Questions: | 202 |
| Last Updated: | April 19, 2026 |
| Related Certifications: | Network Management |
| Exam Tags: | AHIP Management |
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A population's demographic factors---such as income levels, age, gender, race, and ethnicity---can influence the design of provider networks serving that population. With respect to these demographic factors, it is correct to say that
The following statements are about the organization of network management functions of health plans. Select the answer choice containing the correct response:
The sizes of the businesses in a market affect the types of health programs that are likely to be purchased. Compared to smaller employers (those with fewer than 100 employees), larger employers (those with more than 1,000 employees) are
Grant Pelham is covered by both a workers' compensation program and a group health plan provided by his employer. The Shipwright Health Plan administers both programs. Mr. Grant was injured while on the job and applied for benefits.
The provider network that Shipwright uses to furnish services for its workers' compensation program will most likely
The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10% coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM).
If Ionic's actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of
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