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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.
From the following answer choices, select the response that best identifies Elm and Treble:
A. Elm: direct access HMO
Treble: open access (OA) HMO
B. Elm: direct access HMO
Treble: gatekeeper HMO
C. Elm: open access (OA) HMO
Treble: direct access HMO
D. Elm: open access (OA) HMO
Treble: gatekeeper HMO
Answer: A

NEW QUESTION: 2
Which statement regarding the forwarding policies used in VNS for traffic redirection (also known as service chaining) is FALSE?
A. Traffic between two branch offices or between two devices in the same branch office can be redirected to an appliance located in the data center.
B. Redirection targets cannot be associated with bridge vports (physical appliances).
C. Forwarding policies can be applied to ingress and egress traffic.
D. Redirection targets should be created in advance and associated with vports.
Answer: A