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AHIP Exam AHM-250 Topic 3 Question 109 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 109
Topic #: 3

[All AHM-250 Questions]

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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Filiberto

1 months ago

Haha, I bet the exam writers are having a field day tripping us up with these tricky claims processing questions.

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Nakisha

5 days ago

B) Diagnostic codes

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Justine

9 days ago

A) Encounter reports

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Carin

1 months ago

I was leaning towards C. Durational ratings, but now I'm second-guessing myself. Decisions, decisions!

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Claribel

4 days ago

C) Durational ratings

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Bea

8 days ago

B) Diagnostic codes

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Serina

24 days ago

A) Encounter reports

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Kiley

2 months 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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Dante

12 days ago

D) Edits

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Della

14 days ago

C) Durational ratings

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Shannon

25 days ago

B) Diagnostic codes

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Bulah

1 months ago

A) Encounter reports

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Dominque

2 months 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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Merilyn

1 months ago

Yes, edits are commonly used in automated claims processing systems to prompt further investigation.

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Berry

1 months ago

I think you're right, edits are definitely used to flag claims for further review.

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Reed

2 months ago

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

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Stefanie

2 months ago

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

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Shay

3 months ago

I think the answer is B) Diagnostic codes.

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