- (Topic 3)
Disease management is typically set up as a voluntary outreach and support program for plan members with certain diseases

1. A. Acute
2. B. Chronic
3. C. None of the above

Correct Answer: B

- (Topic 3)
The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms you have selected.
The Harbor Health Plan convened a litigation

1. A. a standing / ongoing
2. B. a standing / specific
3. C. an ad hoc / ongoing
4. D. an ad hoc / specific

Correct Answer: D

- (Topic 1)
If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

1. A. A Level One appeal, and the member has the right to a further appeal
2. B. A Level Two appeal, and the reviewer's decision is final and binding
3. C. An independent external appeal, and the member has the right to a further appeal
4. D. Arbitration, and the reviewer's decision is final and binding

Correct Answer: A

- (Topic 2)
Some providers use electronic medical records (EMRs) to document their patients' care in
an electronic form. The following statement(s) can correctly be made about EMRs:

1. A. EMRs are computerized records of a patient's clinical, demographic, and administrator
2. B. B only
3. C. Both A and B
4. D. Neither A nor B
5. E. A only

Correct Answer: D

- (Topic 2)
Parable Healthcare Providers, a health plan, recently segmented the market for a new healthcare service. Parable began the process by dividing the healthcare market into two broad categories: non-group and group. Next, Parable further segmented the non-gr

1. A. channel segmentation
2. B. geographic segmentation
3. C. demographic segmentation
4. D. product segmentation

Correct Answer: C