The Following Statements Are About Some of the Issues Surrounding

question 85

Multiple Choice

The following statements are about some of the issues surrounding the contractual responsibilities of health plans. Select the answer choice containing the correct statement.

• A) Typically, health plans are required to pay completed claims within 10 days of submission. 26
• B) Health plans typically are prohibited from examining the financial soundness of a self-funded employer plan that relies on the health plan to pay providers for services received by the plan's members.
• C) Patient delivery is one of the most significant factors that health plans consider when determining whether provider services should be reimbursed on a capitated or fee-for-service (FFS) basis.
• D) Health plans require all providers to agree to an exclusive provider contract.

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Definitions:

Waking State

A state of consciousness where an individual is fully awake and aware of their environment, as opposed to being asleep or in a dream state.

Brain Waves

Patterns of neuronal activity in the brain, detectable with EEG, associated with different states of consciousness and mental activities.

Postural Muscles

Muscles used to maintain the body's posture, providing stability and balance.

Most Relaxed

A state or condition of being free from tension, stress, or anxiety.