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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 NewnanGroup, 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.
The following statements can correctly be made about the reimbursement for Drugs A and B under the MAC pricing system:
A. All of the above statements are correct.
B. Manor most likely is allowed to bill the subscriber 2 cents per tablet for Drug A.
C. Treble most likely is obligated to reimburse Manor 5 cents per tablet for Drug B.
D. Treble most likely is obligated to reimburse Manor 14 cents per tablet for Drug
Answer: C

NEW QUESTION: 2
Identify three features of Multi-Org. (Choose three.)
A. Users can be assigned to specific organizations.
B. The data can be logically partitioned.
C. Multiple installations of Oracle Applications products are needed.
D. It enables at most two business units to use a single installation of Oracle Applications.
E. It defines organizations and the relationships between them.
Answer: A,B,E

NEW QUESTION: 3
あなたは会社のプロジェクトマネージャーであり、プロジェクトの新しい変更リクエストが承認されました。ただし、この変更要求は、プロジェクトにいくつかの新しいリスクをもたらしました。これらのリスクイベントを伝え、プロジェクトの利害関係者は、これらのリスクがプロジェクトに及ぼす可能性のある影響を理解しています。識別されたリスクイベントの軽減応答を作成することを選択します。緩和応答をどこに記録しますか？
A. リスク管理計画
B. プロジェクト管理計画
C. リスクログ
D. リスク登録
Answer: D