CPCS - Credentialing and Privileging
UPDATED ACTUAL Exam Questions and
CORRECT Answers
TJC Phone PSV - CORRECT ANSWER - What accreditation can use phone for PSV for
all information including: licensure, education, training, experience, competence, and peer
references
LIP - CORRECT ANSWER - any individual permitted by law and by the hospital to
provide patient care services w/o direction or supervision,
LIP - CORRECT ANSWER - any individual permitted by law and by the hospital to
provide patient care services w/o direction or supervision,
TJC - DNV - HFAP - CORRECT ANSWER - Accreditation bodies for hospitals
TJC - DNV - HFAP - CORRECT ANSWER - Accreditation bodies for hospitals
NCQA - URAC - CORRECT ANSWER - Accreditation bodies for Managed Care
Organizations (MCO)
NCQA who to credential - CORRECT ANSWER - credentialing is required for all
licensed practitioners (physicians and non physicians)
NCQA - URAC - CORRECT ANSWER - Accreditation bodies for Managed Care
Organizations (MCO)
NCQA not credentialed - CORRECT ANSWER - inpatient setting for organizational
member only - pharmacy benefits management - locum tenens unless over 90 days -
, NCQA - CORRECT ANSWER - What accreditation requires credentialing for all licensed
practitioners (physicians and non physicians)
URAC who to credential - CORRECT ANSWER - All participating providers as well as
facilities that provide covered health care services to consumers. All practitioners listed in the
directory must be credentialed
NCQA - CORRECT ANSWER - What accreditation does not require credentialing in
these settings? Inpatient setting for organizational member only - pharmacy benefits management
- locum tenens unless over 90 days -
URAC Directory Criteria - CORRECT ANSWER - Quality of Care, Service, and business
need of organization
URAC - CORRECT ANSWER - What accreditation requires all participating providers as
well as facilities that provide covered health care services to consumers. All practitioners listed
in the directory must be credentialed
URAC Directory Criteria - CORRECT ANSWER - What accreditation required the
following criteria? Quality of Care, Service, and business need of organization
URAC - not credentialed - CORRECT ANSWER - Physicians who are employees of a
facility as hospitalists and who are not listed in the directory.
URAC - CORRECT ANSWER - What accreditation does not require you to credential:
Physicians who are employees of a facility as hospitalists and who are not listed in the directory.
Ambulatory Care Facility (AAAHC) - CORRECT ANSWER - the governing body defines
criteria for initial and reappointment of physicians and dentist. They do not specify which
providers need to be credentialed.
UPDATED ACTUAL Exam Questions and
CORRECT Answers
TJC Phone PSV - CORRECT ANSWER - What accreditation can use phone for PSV for
all information including: licensure, education, training, experience, competence, and peer
references
LIP - CORRECT ANSWER - any individual permitted by law and by the hospital to
provide patient care services w/o direction or supervision,
LIP - CORRECT ANSWER - any individual permitted by law and by the hospital to
provide patient care services w/o direction or supervision,
TJC - DNV - HFAP - CORRECT ANSWER - Accreditation bodies for hospitals
TJC - DNV - HFAP - CORRECT ANSWER - Accreditation bodies for hospitals
NCQA - URAC - CORRECT ANSWER - Accreditation bodies for Managed Care
Organizations (MCO)
NCQA who to credential - CORRECT ANSWER - credentialing is required for all
licensed practitioners (physicians and non physicians)
NCQA - URAC - CORRECT ANSWER - Accreditation bodies for Managed Care
Organizations (MCO)
NCQA not credentialed - CORRECT ANSWER - inpatient setting for organizational
member only - pharmacy benefits management - locum tenens unless over 90 days -
, NCQA - CORRECT ANSWER - What accreditation requires credentialing for all licensed
practitioners (physicians and non physicians)
URAC who to credential - CORRECT ANSWER - All participating providers as well as
facilities that provide covered health care services to consumers. All practitioners listed in the
directory must be credentialed
NCQA - CORRECT ANSWER - What accreditation does not require credentialing in
these settings? Inpatient setting for organizational member only - pharmacy benefits management
- locum tenens unless over 90 days -
URAC Directory Criteria - CORRECT ANSWER - Quality of Care, Service, and business
need of organization
URAC - CORRECT ANSWER - What accreditation requires all participating providers as
well as facilities that provide covered health care services to consumers. All practitioners listed
in the directory must be credentialed
URAC Directory Criteria - CORRECT ANSWER - What accreditation required the
following criteria? Quality of Care, Service, and business need of organization
URAC - not credentialed - CORRECT ANSWER - Physicians who are employees of a
facility as hospitalists and who are not listed in the directory.
URAC - CORRECT ANSWER - What accreditation does not require you to credential:
Physicians who are employees of a facility as hospitalists and who are not listed in the directory.
Ambulatory Care Facility (AAAHC) - CORRECT ANSWER - the governing body defines
criteria for initial and reappointment of physicians and dentist. They do not specify which
providers need to be credentialed.
