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Who should take the AHM-530 exam
- Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
- Case administrators and medical directors who inquire a broader administrative background
- Agents and brokers who expert in life and health insurance
- Financial executives working with clients looking to maximize their health dollars
- Teachers at the school level who teach health care administration
- Medical management employees working in hospitals, health systems, and, health insurance plans
AHM-530 Exam topics
Candidates must know the exam topics before they start of preparation. Because it will really help them in hitting the core. Our AHM-530 exam dumps will include the following topics:
- The process for network provider selection
- The primary responsibilities and obligations of health plans and providers under a provider contract
- Network strategies for access, quality, and cost-effectiveness
- Essential elements of a contractual relationship between health plans and providers
- How health plans select, contract with, and compensate specialists and healthcare facilities
- Scope and organization of the network management function in health plans
- Special requirements that affect network management for Medicare, Medicaid, and workers' compensation networks
- How health plans ensure their provider networks remain adequate to meet member needs
Reference: https://www.ahip.org/courses/network-management-ahm530
AHIP AHM-530 Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Specialist and Facility Network Management | 15% | - Hospital, ancillary, and facility network management - Specialist network design and contracting |
| Topic 2: Network Adequacy and Performance Monitoring | 8% | - Access, quality, and capacity metrics - Ongoing network evaluation and maintenance |
| Topic 3: Provider Contracts and Compensation | 25% | - Reimbursement models: FFS, capitation, bundled payments - Contract terms, obligations, and legal requirements |
| Topic 4: Scope and Organization of Network Management | 20% | - Network strategy alignment with organizational goals - Role and function within health plans |
| Topic 5: Government Program Network Requirements | 12% | - Medicaid and workers’ compensation network standards - Medicare network adequacy rules |
| Topic 6: Provider Selection and Credentialing | 20% | - Credentialing and recredentialing standards - Selection criteria and processes |
