Network Managers Rely on a Health Plan's Claims Administration Department

question 154

Multiple Choice

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

• A) determine the number of healthcare services delivered to plan members
• B) monitor the types of services provided by the health plan's entire provider network
• C) evaluate providers' practice patterns and compliance with the health plan's procedures for the delivery of care
• D) all of the above

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Definitions:

Voltage Drops

The reduction in electrical potential measured across a component or conductor when current is flowing, indicative of resistance or impedance.

Source Voltage

The voltage provided by a power source such as a battery or power supply, which drives electrical current through a circuit.

Visible Light

The portion of the electromagnetic spectrum that is visible to the human eye, ranging approximately from 380 to 750 nanometers in wavelength.

Photons

Elementary particles of light and all other forms of electromagnetic radiation, with both particle and wave-like properties.