CERTIFIED PROVIDER CREDENTIALING
SPECIALIST COMPREHENSIVE
CERTIFICATION EXAMINATION 2026 FULL
QUESTIONS AND CORRECT ANSWER
◉ According to TJC, who may amend the medical staff bylaws?
Answer: Governing body/board.
◉ Failure to meet the established qualifications and criteria for
appointment should be reported to whom?
Answer: The applicant
◉ NCQA requires the MCO to obtain a minimum of how may years of
work history?
Answer: Five years
◉ According to the NCQA what policy must an organization have in
place to obtain approval to enter into a delegated agreement?
Answer: Credentialing policies
◉ How often does the OIG report to the NPDB?
,Answer: Monthly
◉ When must hospitals query the NPDB?
Answer: Initial appointment, granting of privileges, every two years.
◉ NCQA requires verifications must be less than how many days
old?
Answer: 180 days
◉ What is the verification time limit on malpractice history
according to the NCQA?
Answer: 180 days
◉ Time limited credential must be verified by the CVO with how
may days prior to submission to the client?
Answer: 120 days
◉ According the AAAHC, for initial appointments, in addition to
licensure and education, what verification is required?
Answer: Experience and hospital affiliations.
,◉ What accreditation body states "The NPDB is an acceptable
source for sanctions or limitations on licensure, Medicaid/ Medicare
sanctions and malpractice history?
Answer: NCQA
◉ Who is required to query the NPDB?
Answer: Hospitals
◉ Is disciplinary action taken against the license of a dentist
reportable to the NPDB?
Answer: Yes
◉ Under HCQIA a hospital failure to report an adverse privilege
action lasting longer than 30 days may cause the organization to lose
HCQIA immunity for how many years?
Answer: 3 years
◉ According to NCQA, verification of Medicare/Medicaid sanctions
can be queried by any of what sources?
Answer: AMA, FSMB, HIPDB, OIG Sanctions Report, NPDB, State
Agency
, ◉ According to NCQA, how often must an organization conduct an
audit of the credentialing process delegated to another
organization?
Answer: Annually
◉ How far back does TJC require evaluation of malpractice history?
Answer: Back to medical school
◉ According to TJC, what source may be used to evaluate
malpractice history?
Answer: NPDB
◉ Is an internet verification from a website not contracted by the
primary source that attests to the accuracy and timeliness of the
information considered a complete verification by NCQA?
Answer: No
◉ What accreditation bodies require privileges to be distributed to
essential department personnel?
Answer: TJC, CMS
◉ TJC and NCQA do not require criminal background checks.
Answer: True
SPECIALIST COMPREHENSIVE
CERTIFICATION EXAMINATION 2026 FULL
QUESTIONS AND CORRECT ANSWER
◉ According to TJC, who may amend the medical staff bylaws?
Answer: Governing body/board.
◉ Failure to meet the established qualifications and criteria for
appointment should be reported to whom?
Answer: The applicant
◉ NCQA requires the MCO to obtain a minimum of how may years of
work history?
Answer: Five years
◉ According to the NCQA what policy must an organization have in
place to obtain approval to enter into a delegated agreement?
Answer: Credentialing policies
◉ How often does the OIG report to the NPDB?
,Answer: Monthly
◉ When must hospitals query the NPDB?
Answer: Initial appointment, granting of privileges, every two years.
◉ NCQA requires verifications must be less than how many days
old?
Answer: 180 days
◉ What is the verification time limit on malpractice history
according to the NCQA?
Answer: 180 days
◉ Time limited credential must be verified by the CVO with how
may days prior to submission to the client?
Answer: 120 days
◉ According the AAAHC, for initial appointments, in addition to
licensure and education, what verification is required?
Answer: Experience and hospital affiliations.
,◉ What accreditation body states "The NPDB is an acceptable
source for sanctions or limitations on licensure, Medicaid/ Medicare
sanctions and malpractice history?
Answer: NCQA
◉ Who is required to query the NPDB?
Answer: Hospitals
◉ Is disciplinary action taken against the license of a dentist
reportable to the NPDB?
Answer: Yes
◉ Under HCQIA a hospital failure to report an adverse privilege
action lasting longer than 30 days may cause the organization to lose
HCQIA immunity for how many years?
Answer: 3 years
◉ According to NCQA, verification of Medicare/Medicaid sanctions
can be queried by any of what sources?
Answer: AMA, FSMB, HIPDB, OIG Sanctions Report, NPDB, State
Agency
, ◉ According to NCQA, how often must an organization conduct an
audit of the credentialing process delegated to another
organization?
Answer: Annually
◉ How far back does TJC require evaluation of malpractice history?
Answer: Back to medical school
◉ According to TJC, what source may be used to evaluate
malpractice history?
Answer: NPDB
◉ Is an internet verification from a website not contracted by the
primary source that attests to the accuracy and timeliness of the
information considered a complete verification by NCQA?
Answer: No
◉ What accreditation bodies require privileges to be distributed to
essential department personnel?
Answer: TJC, CMS
◉ TJC and NCQA do not require criminal background checks.
Answer: True
