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Updated: Aug 03, 2026

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How much AHM-540 Exam Cost

The price of the AHM-540 exam is 220 USD for AHIP members and 280 USD for non-members.

How to book the AHM-540 Exam

These are following steps for registering the AHM-540 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-540 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

Reference: https://www.ahip.org/courses/medical-management-ahm540

AHIP AHM-540 Exam Overview:

Certification Vendor:AHIP (America's Health Insurance Plans)
Exam Name:Medical Management
Exam Number:AHM-540
Available Languages:English
Exam Price:Not officially published (course/exam pricing varies by AHIP membership status)
Certificate Validity Period:Not officially published
Related Certifications:AHIP Healthcare Management Designation Programs
Passing Score:Not officially published
Exam Format:Online assessment, Objective questions
Real Exam Qty:Not officially published
Exam Duration:Not officially published
Sample Questions:AHIP AHM-540 Sample Questions
Exam Way:Online through AHIP's learning platform as part of the course/assessment program.
Pre Condition:No universal prerequisite officially published; typically intended for professionals pursuing AHIP healthcare management education programs.
Official Syllabus URL:https://www.ahip.org/courses/medical-management-ahm540

AHM Medical Management AHM-540 Exam

AHM Medical Management AHM-540 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-540 Exam validates candidate has knowledge about the medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. This exam also verifies the candidate has the ability to discover focused strategies for utilization management, such as clinical paths and disease management. This exam also evaluates the candidate proficiency in accreditation, quality improvement, benchmarking, performance measurement, and legal aspects of QM, as well as QM strategies for different clinical settings.

AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
The Medical Management Function- Environmental influences on medical management
  • 1. Purchaser, provider, and member expectations
    • 2. Impact of environmental factors on delegation
      • 3. Accreditation organizations and standards
        • 4. Federal and state regulatory requirements
          - Role of medical management
          • 1. Responsibilities of the medical director
            • 2. Medical management committees
              • 3. Delegation and subdelegation of medical management functions
                • 4. Goals and components of medical management programs
                  - Relationship of medical management to other health plan functions
                  • 1. Finance
                    • 2. Claims administration
                      • 3. Information management and technology
                        • 4. Sales and marketing
                          • 5. Risk management
                            • 6. Legal affairs
                              • 7. Network management
                                Preventive and Care Management Programs- Disease management
                                • 1. Population health management
                                  • 2. Chronic disease programs
                                    - Preventive care and self-care programs
                                    • 1. Member education and wellness
                                      • 2. Health promotion initiatives
                                        - Utilization management
                                        • 1. Authorization and utilization review processes
                                          • 2. Medical necessity review
                                            - Case management
                                            • 1. Management of complex cases
                                              • 2. Care coordination
                                                Medical Management Across Care Settings- Medical management for pharmacy services
                                                • 1. Specialty services management
                                                  • 2. Pharmacy benefit management
                                                    - Medical management for government-sponsored programs
                                                    • 1. Medicare
                                                      • 2. Other government-sponsored programs
                                                        • 3. Medicaid
                                                          - Medical management for acute care
                                                          • 1. Post-acute care management
                                                            • 2. Acute care strategies
                                                              Clinical Practice and Quality Management- Quality management
                                                              • 1. Quality improvement methodologies
                                                                • 2. Quality assessment
                                                                  • 3. Performance measurement
                                                                    - Clinical practice management
                                                                    • 1. Evidence-based clinical guidelines
                                                                      • 2. Medical policies and practice parameters

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