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- Medical management employees working in hospitals, health systems, and, health insurance plans
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Reference: https://www.ahip.org/courses/network-management-ahm530
AHIP AHM-530 Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Provider Contracts and Compensation | 25% | - Reimbursement models: FFS, capitation, bundled payments - Contract terms, obligations, and legal requirements |
| Network Adequacy and Performance Monitoring | 8% | - Access, quality, and capacity metrics - Ongoing network evaluation and maintenance |
| Scope and Organization of Network Management | 20% | - Network strategy alignment with organizational goals - Role and function within health plans |
| Provider Selection and Credentialing | 20% | - Credentialing and recredentialing standards - Selection criteria and processes |
| Specialist and Facility Network Management | 15% | - Specialist network design and contracting - Hospital, ancillary, and facility network management |
| Government Program Network Requirements | 12% | - Medicaid and workers’ compensation network standards - Medicare network adequacy rules |
