The following statements are about health plans’ use of electronic data interchange (EDI). Three of the statements are true and one is false. Select the answer choice containing the FALSE ALSE statement.

1. A. One advantage of EDI over manual data management systems is improved data integrity.
2. B. EDI may use the Internet as the communication link between the participating parties.
3. C. EDI involves back-and-forth exchanges of information concerning individual transactions.
4. D. The data format for EDI is agreed upon by the sending and receiving parties.

Correct Answer: C

The following statements describe situations in which health plan members have medical problems that require care. Select the statement that describes a situation in which self- care most likely would not be appropriate.

1. A. Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has increased and that there are red streaks and swelling around the bruised area.
2. B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each day.
3. C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce pain and help her maintain mobility.
4. D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.

Correct Answer: A

For this question, if answer choices (1) through (3) are all correct, select answer choice (4). Otherwise, select the one correct answer choice.
Health plans sometimes delegate selected medical management activities to their providers or other external entities. Activities that are frequently delegated include

1. A. utilization review (UR)
2. B. quality management (QM)
3. C. preventive health services
4. D. all of the above

Correct Answer: A

The paragraph below contains two pairs of terms enclosed in parentheses. Select the term in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.
Under a delegation arrangement, the (delegate / delegator) is responsible for performing the delegated function according to established standards, and the (delegate / delegator) is ultimately accountable for any deficiencies in the performance of the function.

1. A. delegate / delegate
2. B. delegate / delegator
3. C. delegator / delegate
4. D. delegator / delegator

Correct Answer: B

Determine whether the following statement is true or false:
Independent review organizations (IROs) can mediate disputes and offer advisory opinions to health plans on UR issues, but they cannot render binding decisions on appeals.

1. A. True
2. B. False

Correct Answer: B