Most Recent AHIP AHM-530 Exam Dumps

Prepare for the AHIP Network Management exam with our extensive collection of questions and answers. These practice Q&A are updated according to the latest syllabus, providing you with the tools needed to review and test your knowledge.

QA4Exam focus on the latest syllabus and exam objectives, our practice Q&A are designed to help you identify key topics and solidify your understanding. By focusing on the core curriculum, These Questions & Answers helps you cover all the essential topics, ensuring you're well-prepared for every section of the exam. Each question comes with a detailed explanation, offering valuable insights and helping you to learn from your mistakes. Whether you're looking to assess your progress or dive deeper into complex topics, our updated Q&A will provide the support you need to confidently approach the AHIP AHM-530 exam and achieve success.

The questions for AHM-530 were last updated on Apr 22, 2026.

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Question No. 1

A health plan that delegates designated credentialing activities to an NCQA-centered or a Commission/URAC-centered credentials verification organization (CVO) is exempt from the due-diligence oversight requirements specified in the NCQA credentialing standards for all verification services for which the CVO has been certified:

ATrue

BFalse

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Correct Answer: A

Question No. 2

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

A$30,000

B$270,000

C$300,000

D$702,000

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Correct Answer: B

Question No. 3

One true statement about the compensation arrangement known as the case rate system is that, under this system,

AProviders stand to gain or lose based on the number and types of treatments used for each case

BProviders have no incentives to take an active role in managing cost and utilization

CPayors cannot adjust standard case rates to reflect the severity of the patient's condition or complications that arise from multiple medical problems

DPayors have the opportunity to benefit from the provider's cost savings

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Correct Answer: A

Question No. 4

One important aspect of network management is profiling, or provider profiling. Profiling is most often used to

Ameasure the overall performance of providers who are already participants in the network

Bassess a provider's overall satisfaction with a plan's service protocols and other operational areas

Cverify a prospective provider's professional licenses, certifications, and training

Dfamiliarize a provider with a plan's procedures for authorizations and referrals

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Correct Answer: A

Question No. 5

The Aegean Health Plan delegated its utilization management (UM) program to the Silhouette IP

ASilhouette, in turn, transferred authority for case management to Brandon Health Services. In this situation, Brandon is best described as the

Adelegator, and Aegean is ultimately responsible for Brandon's performance

Bdelegator, and Silhouette is ultimately responsible for Brandon's performance

Csubdelegate, and Aegean is ultimately responsible for Brandon's performance

Dsubdelegate, and Silhouette is ultimately responsible for Brandon's performance

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Correct Answer: C

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