Get All AHM Medical Management Exam Questions with Validated Answers
| Vendor: | AHIP |
|---|---|
| Exam Code: | AHM-540 |
| Exam Name: | AHM Medical Management |
| Exam Questions: | 163 |
| Last Updated: | April 21, 2026 |
| Related Certifications: | Network Management |
| Exam Tags: | AHIP Management |
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Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types of performance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
In most health plans, the formulary system is developed and managed by a P&T committee. The P&T committee is responsible for
Determine whether the following statement is true or false:
The delegation of medical management functions to providers can occur without the transfer of financial risk.
The Fairview Health Plan uses a dual database approach to integrate information needed for its disease management program. This information indicates that Fairview uses an information management system that
A health plan's coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions:
In case of conflict between the purchaser contract and a health plan's medical policy or benefits administration policy, the contract takes precedence
Purchaser contracts commonly exclude custodial care from their coverage of services and supplies
All of the criteria for coverage decisions must be included in the purchaser contract
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