Chapter 5 CPMA Exam: Contract-based

Commercial Insurance Plans Questions

and Answers

Most common commercial insurance plans are - Answer-contract based

That is, benefits arise primarily under a contract between the insurance company and the

subscriber/patient

Where the healthcare provider is in network, - Answer-the provider agrees to abide by

certain rules in a separate contract..

The auditor must review the contract to determine the rules the provider is bound to follow

For commercial...
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