- (Topic 1)
Identify the CORRECT statement(s):
(A) Smaller the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.
(A) (B) Gender of the group's participants has no effect on the likelihood of loss.

1. A. All of the listed options
2. B. B & C
3. C. None of the listed options
4. D. A & C

Correct Answer: C

- (Topic 2)
The Blaine Healthcare Corporation seeks to manage its quality by first identifying the best practices and best outcomes for a given procedure. Blaine can then determine areas in which it can emulate the best practices in order to equal or surpass the best

1. A. provider profiling
2. B. benchmarking
3. C. peer review
4. D. quality assessment

Correct Answer: B

- (Topic 3)
Health plans often carve out specialty services that have one or more of the following characteristics

1. A. A poorly defined patient population
2. B. High or increasing costs
3. C. Appropriate utilization
4. D. All the above

Correct Answer: B

- (Topic 1)
In addition to the credentialing activities that an health plan performs when initially accepting a provider into its network, the health plan must also perform recredentialing of the same providers on an ongoing basis. Many of the same activities are per

1. A. verification of a network provider's medical education and residency
2. B. performance of site inspections in a provider's facilities
3. C. review of information from a provider's quality improvement activities
4. D. verification of a provider's licensure and certification

Correct Answer: A

- (Topic 3)
The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

1. A. A decision as to which exclusions or limitations would apply for this product.
2. B. A decision as to how to establish the network of participating providers for this product
3. C. A determination of the level at which this product would cover out-of-network services.
4. D. All of the above.

Correct Answer: D