100+ Free MHP Practice Questions

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Which entity sets standards for Utilization Management timeliness for many commercial plans?

URAC and NCQA accreditation standards

SEC

OSHA

FAA

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2026 Statistics

Key Facts: MHP Exam

3 courses

Required for MHP

AHIP designation page

70%

Passing Score Per Exam

AHIP course policy

~$220

Member Fee Per Course

AHIP 2026 pricing

~$280

Non-Member Fee Per Course

AHIP 2026 pricing

180 days

Course Access Window

AHIP enrollment terms

3 attempts

Allowed Per Exam

AHIP course policy

MHP is AHIP's foundational managed-care designation, earned by passing three online course exams (commonly AHM250, AHM510, and AHM540). Each course exam is roughly 100 multiple-choice questions taken online, with a 70% passing score and three attempts allowed. Each course costs about $220 for AHIP members and $280 for non-members, totaling roughly $660-$840 for the full MHP credential. Candidates have 180 days from purchase to complete each course. The curriculum covers HMO/PPO/EPO/POS plan design, PCMH and ACO structures, provider credentialing, narrow and tiered networks, capitation and bundled payments, prior authorization, HEDIS, CAHPS, CMS Star Ratings, CMS-HCC risk adjustment, MLR rules, and Medicare Advantage and Medicaid Managed Care compliance.

Sample MHP Practice Questions

Try these sample questions to test your MHP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which managed care plan type requires members to select a primary care physician (PCP) who acts as a gatekeeper for specialist referrals?

A.HMO (Health Maintenance Organization)

B.PPO (Preferred Provider Organization)

C.EPO (Exclusive Provider Organization)

D.Indemnity plan

Explanation: Traditional HMO products require members to select a PCP who coordinates care and authorizes referrals to specialists. PPOs do not require a PCP and do not gatekeep referrals. EPOs limit coverage to in-network providers but typically do not require PCP referrals. Indemnity plans have no network or gatekeeping.

2A PPO differs from an HMO primarily because a PPO:

A.Capitates all primary care providers

B.Covers out-of-network care at a reduced benefit without requiring a PCP referral

C.Restricts members to a closed panel of physicians

D.Operates only under Medicare Advantage rules

Explanation: PPOs let members self-refer and cover out-of-network care, usually with higher cost-sharing. HMOs use a closed network, PCP gatekeeping, and often capitation. The Medicare Advantage program offers both HMO and PPO plan types, so MA participation is not the defining difference.

3An EPO (Exclusive Provider Organization) plan generally provides:

A.Capitation payment to all specialists

B.Full coverage for any licensed provider

C.No coverage for non-emergency out-of-network care

D.Indemnity-style reimbursement to members

Explanation: EPOs combine PPO-style direct access to specialists with HMO-style network restriction: out-of-network care is generally not covered except in emergencies. They typically pay providers on a discounted fee-for-service basis and reimburse providers, not members.

4A Point-of-Service (POS) plan is best described as:

A.A Medicare supplement plan

B.A pure indemnity plan

C.A PPO without any in-network discount

D.An HMO with an out-of-network benefit at higher cost-sharing

Explanation: POS products combine HMO features (PCP, in-network coordination) with a PPO-like option to seek out-of-network care at higher cost-sharing. They are not indemnity, not a PPO without discounts, and not a Medigap product.

5Which HMO model employs physicians directly as salaried staff in plan-owned facilities?

A.Staff model HMO

B.Group model HMO

C.Network model HMO

D.IPA model HMO

Explanation: In a staff model HMO, physicians are employees of the plan and practice in plan-owned clinics. Group model HMOs contract with one multi-specialty group. Network model HMOs contract with multiple groups. IPA model HMOs contract with an association of independent physicians.

6An Independent Practice Association (IPA) typically:

A.Employs physicians directly as salaried staff

B.Is a legal entity that contracts with independent physicians and negotiates with health plans

C.Owns and operates the health plan's facilities

D.Sets Medicare fee schedules

Explanation: An IPA is an association of independent physicians who maintain their own practices but contract collectively with one or more managed care plans. IPAs neither employ physicians as plan staff nor own facilities, and they do not set Medicare fee schedules.

7A High-Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA) is characterized by:

A.Capitation of all in-network providers

B.First-dollar coverage with no member cost-sharing

C.Statutory minimum deductibles and maximum out-of-pocket limits set annually by the IRS

D.Exclusion from ACA market protections

Explanation: HDHPs must meet annual IRS thresholds for minimum deductibles and maximum out-of-pocket limits to qualify for HSA contributions. They impose meaningful cost-sharing, may use any payment model, and are sold in both group and individual ACA markets.

8A Patient-Centered Medical Home (PCMH) is best described as:

A.A Medicare Advantage marketing channel

B.An inpatient hospice program for terminal patients

C.A long-term care facility for dual-eligible members

D.A primary-care delivery model recognized by NCQA emphasizing team-based, coordinated, and accessible care

Explanation: PCMH is a primary care model formalized by NCQA that emphasizes patient-centered, team-based, coordinated, accessible, and quality-driven care. It is not an inpatient hospice, long-term care setting, or marketing channel.

9Which entity is the most widely recognized accreditor of PCMH practices in the United States?

A.NCQA (National Committee for Quality Assurance)

B.CMS (Centers for Medicare & Medicaid Services)

C.AMA (American Medical Association)

D.AHRQ (Agency for Healthcare Research and Quality)

Explanation: NCQA operates the most widely adopted PCMH Recognition program. CMS administers public programs and demonstration models. The AMA is a professional association. AHRQ funds research but does not accredit medical homes.

10An Accountable Care Organization (ACO) is best defined as:

A.A health plan that owns its own hospitals and clinics

B.A group of providers that voluntarily takes responsibility for the cost and quality of care for an attributed population

C.A federal agency that pays Medicare claims

D.A state agency that licenses health insurers

Explanation: ACOs are provider-led entities that accept accountability for the total cost and quality of care for a defined patient population, sharing in savings (and often losses) versus a benchmark. They are not health plans, federal payers, or state regulators.

About the MHP Exam

The AHIP Managed Healthcare Professional (MHP) designation is awarded after completing three online self-study courses from the Academy for Healthcare Management curriculum (commonly AHM250 Healthcare Management: An Introduction, AHM510 Governance, Legal Issues, Medicare & Medicaid, and AHM540 Medical Management). Each course has its own online exam scored independently. MHP candidates learn managed-care models, provider contracting, network design, utilization and care management, HEDIS and CAHPS quality measurement, NCQA accreditation, CMS Star Ratings, risk adjustment, value-based payment, and health-plan compliance.

Questions

100 scored questions

Time Limit

Self-paced; 180 days per course

Passing Score

70% per course

Exam Fee

~$220 member / ~$280 non-member per course (3 courses) (America's Health Insurance Plans (AHIP) / Academy for Healthcare Management)

MHP Exam Content Outline

15%

Managed Care Models & Operations

HMO, PPO, EPO, POS, and HDHP product structures; IPA, staff, group, and network model HMOs; gatekeeping primary care physicians; PCMH NCQA recognition; and integrated delivery systems

15%

Provider Contracting & Network Design

NCQA credentialing standards, narrow and tiered networks, hold-harmless and most-favored-nation clauses, network adequacy under federal and state rules, and out-of-network surprise-billing protections

15%

Payment Models & Value-Based Care

Fee-for-service, capitation (full, partial, global), DRG and APC hospital payment, RBRVS fee schedules, bundled payments, shared savings, shared risk, pay-for-performance, and HCP-LAN APM categories 1-4

15%

Utilization & Care Management

Prior authorization, concurrent review, retrospective review, discharge planning, case management for high-cost members, disease management for chronic conditions, and chronic care management billing under CMS

15%

Quality Measurement & Accreditation

HEDIS measure domains (Effectiveness of Care, Access, Experience, Utilization), CAHPS patient experience surveys, NCQA health plan accreditation, URAC accreditation, and CMS Medicare Advantage Star Ratings 1-5

10%

Risk Adjustment & Population Health

CMS-HCC risk adjustment for Medicare Advantage, HHS-HCC for ACA marketplace, ESRD model, RAF scores, social determinants of health (SDoH) Z-codes, and population health analytics

10%

Regulation & Compliance

ACA Medical Loss Ratio (80% individual/small group, 85% large group), ERISA preemption, HIPAA Privacy and Security Rules, Medicare Advantage and Medicaid Managed Care regulations, and state Department of Insurance oversight

Health Plan Finance

Underwriting, community vs experience rating, IBNR and IBNP reserves, reinsurance and stop-loss, MLR rebates, risk corridors, and ACO benchmark spending

How to Pass the MHP Exam

What You Need to Know

Passing score: 70% per course
Exam length: 100 questions
Time limit: Self-paced; 180 days per course
Exam fee: ~$220 member / ~$280 non-member per course (3 courses)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

MHP Study Tips from Top Performers

1Memorize the four managed-care plan archetypes (HMO, PPO, EPO, POS) and how each handles networks, referrals, and out-of-network coverage

2Lock in the ACA Medical Loss Ratio thresholds: 80% for individual and small-group, 85% for large-group, with rebates owed when MLR falls below the limit

3Drill HEDIS measure domains and identify which measures feed CMS Medicare Advantage Star Ratings, including the cut-point methodology

4Practice CMS-HCC risk adjustment scenarios so you can compute or compare RAF scores and explain how documentation drives MA payment

5Review the HCP-LAN APM framework (Categories 1-4) and map real examples like fee-for-service, P4P, bundled payments, and full capitation

Frequently Asked Questions

What is the AHIP MHP designation?

The Managed Healthcare Professional (MHP) is an AHIP designation awarded by the Academy for Healthcare Management after a candidate completes three online self-study courses and passes each course exam. It is designed for health-plan staff, provider-network professionals, and managed-care administrators who want documented expertise in managed-care operations, contracting, quality measurement, and value-based care.

How many courses and exams are required for the MHP?

MHP requires three AHM courses, each with its own online exam. The common combination is AHM250 (Healthcare Management: An Introduction), AHM510 (Governance, Legal Issues, Medicare & Medicaid), and AHM540 (Medical Management). Each exam is roughly 100 multiple-choice questions and is taken online inside the AHIP Insurance Education portal.

What is the passing score for AHIP MHP exams?

Each AHM course exam in the MHP track requires a score of 70% or higher to pass. Candidates have up to three attempts per exam. There is no public pass-rate statistic, but AHIP allows reschedules within the 180-day course access window if you do not pass on the first try.

How much does the MHP designation cost in 2026?

Each AHM course is about $220 for AHIP members and $280 for non-members, so the full three-course MHP designation runs roughly $660 for members and $840 for non-members. Some employers or carriers reimburse the fees, and AHIP periodically discounts course bundles. Always confirm current pricing on ahip.org before enrolling.

How long does it take to earn the MHP?

AHIP gives candidates up to 180 days from purchase to complete each course. Most working professionals finish the three-course MHP track in 12 to 24 weeks, studying roughly 15 hours per course. The exam itself is open online and self-administered once you finish the coursework.

Who should pursue the AHIP MHP designation?

MHP is targeted at managed-care professionals: health-plan operations and product staff, provider-network and contracting analysts, utilization and case-management nurses moving into administrative roles, and quality and STARS teams. It is also a common stepping stone toward AHIP's Fellow, Academy for Healthcare Management (FAHM) designation.

How should I study for AHIP MHP exams?

Work through the AHIP course textbook and online modules, then drill practice questions across managed-care models, contracting, HEDIS, CAHPS, Star Ratings, risk adjustment, and value-based payment. Pay extra attention to formulas (MLR, capitation, RAF), accreditation specifics (NCQA, URAC), and current Medicare Advantage and Medicaid Managed Care rules, since those topics generate most exam items.