AHIP Exam AHM-250 Topic 3 Question 109 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 109
Topic #: 3

Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example

AEncounter reports

BDiagnostic codes

CDurational ratings

DEdits

Show Suggested Answer

Suggested Answer: D

by Verlene at Mar 20, 2025, 11:15 AM

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Kiley

6 days ago

B. Diagnostic codes makes the most sense to me. Those are the key factors health plans look at to trigger additional scrutiny.

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Dominque

13 days ago

Hmm, I'm pretty sure it's D. Edits. That's the classic way health plans flag claims for further review.

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Reed

19 days ago

I believe it could also be D) Edits, as they can trigger a review process.

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Stefanie

21 days ago

I agree with Shay, diagnostic codes are crucial for further investigation.

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Shay

25 days ago

I think the answer is B) Diagnostic codes.

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