CPCS CERTIFIED PROVIDER
CREDENTIALING SPECIALIST EXAM
UPDATED QUESTIONS AND CORRECT
ANSWERS.
What elements should a peer recommendation include according to TJC? - ANS Patient Care,
medical clinical knowledge, practice based learning, interpersonal and communication skills,
system-based practice
Peer recommendations according to NCQA - ANS There is no specific requirement for peer
recommendations. The organization must designate a Credentialing Committee that uses a
peer-review process to make recommendations regarding credentialing decisions.
Peer recommendations according to HFAP. - ANS Must obtain at least one peer with the same
professional credential as the applicant that includes a statement regarding the physician's
physical and mental health in relation to privileges requested.
Peer recommendations according to URAC. - ANS There is no specific requirement for peer
recommendations other than that a peer group makes the final credentialing determinations.
Peer recommendations according to AAAHC. - ANS Required for initial and reappointment.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Practitioners Credentialed and Privileged through the Medical Staff - TJC - ANS All individuals
who are permitted by law and the hospital to provide patient care independently in the hospital
are required to be credentialed and privileged under the Medical Staff standards.
Practitioners Credentialed and Privileged through the Medical Staff - NCQA - ANS Standards
address credentialing, not privileging.
Practitioners Credentialed and Privileged through the Medical Staff - HFAP - ANS Standards
regarding medical staff composition are a direct quote of CMS. The governing body must ensure
that any privileges granted to non-physician practitioners are in accordance with State law,
regulations and scope of practice.
Practitioners Credentialed and Privileged through the Medical Staff - URAC - ANS All
practitioners listed in the directory and are providing covered healthcare services to consumers
are credentialed.
Practitioners Credentialed and Privileged through the Medical Staff - AAAHC - ANS At a
minimum, physicians and dentists are credentialed and privileged. Board determines which
other qualified professionals (AHPs) it wishes to allow on staff.
Privileges according to TJC - ANS The hospital must have a clearly documented procedure for
the processing of requests for initial granting, renewal or revision of privileges. This process
must be approved by the medical staff.
Privileges according to NCQA - ANS Verification of clinical privileges is not required.
Privileges according to URAC - ANS Application includes hospital affiliations or privileges, if
applicable.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
CREDENTIALING SPECIALIST EXAM
UPDATED QUESTIONS AND CORRECT
ANSWERS.
What elements should a peer recommendation include according to TJC? - ANS Patient Care,
medical clinical knowledge, practice based learning, interpersonal and communication skills,
system-based practice
Peer recommendations according to NCQA - ANS There is no specific requirement for peer
recommendations. The organization must designate a Credentialing Committee that uses a
peer-review process to make recommendations regarding credentialing decisions.
Peer recommendations according to HFAP. - ANS Must obtain at least one peer with the same
professional credential as the applicant that includes a statement regarding the physician's
physical and mental health in relation to privileges requested.
Peer recommendations according to URAC. - ANS There is no specific requirement for peer
recommendations other than that a peer group makes the final credentialing determinations.
Peer recommendations according to AAAHC. - ANS Required for initial and reappointment.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Practitioners Credentialed and Privileged through the Medical Staff - TJC - ANS All individuals
who are permitted by law and the hospital to provide patient care independently in the hospital
are required to be credentialed and privileged under the Medical Staff standards.
Practitioners Credentialed and Privileged through the Medical Staff - NCQA - ANS Standards
address credentialing, not privileging.
Practitioners Credentialed and Privileged through the Medical Staff - HFAP - ANS Standards
regarding medical staff composition are a direct quote of CMS. The governing body must ensure
that any privileges granted to non-physician practitioners are in accordance with State law,
regulations and scope of practice.
Practitioners Credentialed and Privileged through the Medical Staff - URAC - ANS All
practitioners listed in the directory and are providing covered healthcare services to consumers
are credentialed.
Practitioners Credentialed and Privileged through the Medical Staff - AAAHC - ANS At a
minimum, physicians and dentists are credentialed and privileged. Board determines which
other qualified professionals (AHPs) it wishes to allow on staff.
Privileges according to TJC - ANS The hospital must have a clearly documented procedure for
the processing of requests for initial granting, renewal or revision of privileges. This process
must be approved by the medical staff.
Privileges according to NCQA - ANS Verification of clinical privileges is not required.
Privileges according to URAC - ANS Application includes hospital affiliations or privileges, if
applicable.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
