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Question: 1

By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as

  1. Network management
  2. Quality
  3. Cost-effectiveness
  4. Accessibility

Answer: D

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Question: 5

Network managers rely on a health plan’s claims administration department for much of the information needed to manage the performance of providers who are not under a capitation arrangement. Examining claims submitted to a health plan’s claims administration department enables the health plan to

  1. determine the number of healthcare services delivered to plan members
  2. monitor the types of services provided by the health plan’s entire provider network
  3. evaluate providers’ practice patterns and compliance with the health plan’s procedures for the delivery of care
  4. all of the above

Answer: D

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Question: 4

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

  1. measure the overall performance of providers who are already participants in the network
  2. assess a provider’s overall satisfaction with a plan’s service protocols and other operational areas
  3. verify a prospective provider’s professional licenses, certifications, and training
  4. familiarize a provider with a plan’s procedures for authorizations and referrals

Answer: A

Question: 1

By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as

  1. Network management
  2. Quality
  3. Cost-effectiveness
  4. Accessibility

Answer: D