CMOM Module 5 2025/2026 Exam
Questions and Corresponding Answers
with Surety of 100% Pass Mark
Credentialing - 🧠ANSWER ✔✔verifies that a physician meets standards
through the review of license, experience, certification, education, training,
malpractice and adverse clinical occurrences, clinical judgement and
character via investigation and observation
Privileging - 🧠ANSWER ✔✔Defines a physician's scope of practice and the
clinical services he or she may provide
Council for Affordable Quality HealthCare (CAQH) - 🧠ANSWER ✔✔not-for-
profit collaborative alliance of health plans and networks which offers a
standardized credentialing process
PECOS (Provider Enrollment, Chain and Ownership System) - 🧠ANSWER
✔✔Medicare's Internet Based provider enrollment
NCQ (National Committee for Quality Assurance) - 🧠ANSWER ✔✔used to
limit its accreditation to HMOs, but has recently expanded to accredit
1
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, CVOs, Behavioral Managed Health Care organizations and Physician
Organizations
JCAHO (Joint Commission on Accreditation of Healthcare Organizations -
🧠ANSWER ✔✔started out as a hospital accreditation org, accredits all
types of MCOs through its health care network accreditation program. They
Also have a specific set of standards for PPOs and Managed Behavioral
Health Care Orgs
AAHCC (American Accreditation HealthCare Commission) - 🧠ANSWER
✔✔only accredits orgs that specialize in carry out utilization reviews. They
have recently broadened their focus to accredit MCOs.
MQC (Medical Quality Commission) - 🧠ANSWER ✔✔The smallest
accreditation group, accredits medical groups and Independent Practice
Associations (IPAs)
Exclusive Managed Indemnity - 🧠ANSWER ✔✔In this type of plan, patient
is free to go to any provider, but plan requires some pre-certification by the
payer for inpatient stays and some outpatient procedures
2
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
Questions and Corresponding Answers
with Surety of 100% Pass Mark
Credentialing - 🧠ANSWER ✔✔verifies that a physician meets standards
through the review of license, experience, certification, education, training,
malpractice and adverse clinical occurrences, clinical judgement and
character via investigation and observation
Privileging - 🧠ANSWER ✔✔Defines a physician's scope of practice and the
clinical services he or she may provide
Council for Affordable Quality HealthCare (CAQH) - 🧠ANSWER ✔✔not-for-
profit collaborative alliance of health plans and networks which offers a
standardized credentialing process
PECOS (Provider Enrollment, Chain and Ownership System) - 🧠ANSWER
✔✔Medicare's Internet Based provider enrollment
NCQ (National Committee for Quality Assurance) - 🧠ANSWER ✔✔used to
limit its accreditation to HMOs, but has recently expanded to accredit
1
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, CVOs, Behavioral Managed Health Care organizations and Physician
Organizations
JCAHO (Joint Commission on Accreditation of Healthcare Organizations -
🧠ANSWER ✔✔started out as a hospital accreditation org, accredits all
types of MCOs through its health care network accreditation program. They
Also have a specific set of standards for PPOs and Managed Behavioral
Health Care Orgs
AAHCC (American Accreditation HealthCare Commission) - 🧠ANSWER
✔✔only accredits orgs that specialize in carry out utilization reviews. They
have recently broadened their focus to accredit MCOs.
MQC (Medical Quality Commission) - 🧠ANSWER ✔✔The smallest
accreditation group, accredits medical groups and Independent Practice
Associations (IPAs)
Exclusive Managed Indemnity - 🧠ANSWER ✔✔In this type of plan, patient
is free to go to any provider, but plan requires some pre-certification by the
payer for inpatient stays and some outpatient procedures
2
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
