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NEW QUESTION: 1
The following statements describe two types of HMOs:
The Elm HMO requires its members to select a PCP but allows the members to go to any other provider on its panel without a referral from the PCP.
The Treble HMO does not require its members to select a PCP. Treble allows its members to go to any doctor, healthcare professional, or facility that is on its panel without a referral from a primary care doctor.
However, care outside of Treble's network is not reimbursed unless the provider obtains advance approval from the HMO.
Both HMOs use delegation to transfer certain functions to other organizations. Following the guidelines established by the NCQA, Elm delegated its credentialing activities to the Newnan Group, and the agreement between Elm and Newnan lists the responsibilities of both parties under the agreement. Treble delegated utilization management (UM) to an IPA. The IPA then transferred the authority for case management to the Quest Group, an organization that specializes in case management.
Both HMOs also offer pharmacy benefits. Elm calculates its drug costs according to a pricing system that requires establishing a purchasing profile for each pharmacy and basing reimbursement on the profile.
Treble and the Manor Pharmaceutical Group have an arrangement that requires the use of a typical maximum allowable cost (MAC) pricing system to calculate generic drug costs under Treble's pharmacy program. The following statements describe generic drugs prescribed for Treble plan members who are covered by Treble's pharmacy benefits:
The MAC list for Drug A specifies a cost of 12 cents per tablet, but Manor pays 14 cents per tablet for this drug.
The MAC list for Drug B specifies a cost of 7 cents per tablet, but Manor pays 5 cents per tablet for this drug.
To calculate its drug costs, Elm uses a pricing system known as:
A. Actual acquisition cost (AAC)
B. Wholesale acquisition cost (WAC)
C. Package rate cost (PRC)
D. Estimated acquisition cost (EAC)
Answer: D
NEW QUESTION: 2
One of the requirements of the Uniformed Services Employment and Reemployment Rights Act of 1994 is that employers must grant a leave of absence for military service. Typically, how long must an employer grant leave to the individual for military service?
A. Five years
B. One year
C. Seven years
D. Two weeks
Answer: A
Explanation:
Reference: Professional in Human Resources Certification Guide, Sybex, ISBN: 978-0470-43096-5. Chapter 7: Employee and Labor Relations. Official PHR and SPHR Certification Guide, HR Certification Institute, ISBN: 978-1-586-44149-4, Section III, The US Body of Knowledge.
Chapter: Employee and Labor Relations
Objective: Federal Employment Legislation
NEW QUESTION: 3
Sie haben ein Microsoft 365-Abonnement, das eine Standarddomäne namens contoso.com verwendet. Die Domäne enthält die in der folgenden Tabelle aufgeführten Benutzer.
Die Domäne enthält Richtlinien für den bedingten Zugriff, die den Zugriff auf eine Cloud-App mit dem Namen App1 steuern. Die Richtlinien werden wie in der folgenden Tabelle gezeigt konfiguriert.
Wählen Sie für jede der folgenden Anweisungen Ja aus, wenn die Anweisung wahr ist. Andernfalls wählen Sie Nein.
HINWEIS: Jede richtige Auswahl ist einen Punkt wert.
Answer:
Explanation:
Erläuterung:
Hinweis: Zugriff blockieren überschreibt Zugriff gewähren
Verweise:
https://docs.microsoft.com/en-us/azure/active-directory/conditional-access/plan-conditional-access
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