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

Question 125

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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