2026/2027
2026/2027 COMSAE Certification
Exam Advanced Study Workbook
Featuring Practice Exams, Review
Questions, and Certification
Preparation Strategies
Question 1
A healthcare organization is recruiting a credentialing professional responsible for
managing practitioner credentialing, primary source verification, and regulatory
compliance activities. Which credential is specifically designed for professionals who
perform these duties?
A. Certified Professional in Healthcare Quality (CPHQ)
B. Certified Provider Credentialing Specialist (CPCS)
C. Registered Health Information Administrator (RHIA)
D. Certified Professional Coder (CPC)
Correct Answer: B. Certified Provider Credentialing Specialist (CPCS)
Rationale: The Certified Provider Credentialing Specialist (CPCS) credential is
specifically designed for professionals involved in provider credentialing, privileging,
and enrollment activities. CPCS-certified professionals are commonly employed by
hospitals, health systems, health plans, ambulatory care organizations, group practices,
and credentialing verification organizations. The CPHQ focuses on healthcare quality
improvement, RHIA focuses on health information management, and CPC focuses on
medical coding rather than credentialing functions.
Question 2
According to standards established by The Joint Commission (TJC), which category
of healthcare practitioners must undergo credentialing and privileging through the
organized medical staff structure before being granted clinical privileges?
A. Only physicians employed by the hospital
B. All licensed independent practitioners
C. Only board-certified physicians
D. Only practitioners with admitting privileges
Correct Answer: B. All licensed independent practitioners
,2026/2027
Rationale: TJC requires that all licensed independent practitioners (LIPs) undergo
credentialing and privileging through the organized medical staff process before
receiving clinical privileges. This requirement ensures practitioners are qualified,
competent, and appropriately trained. Employment status, board certification, or
admitting privileges alone do not determine whether credentialing is required.
Question 3
Under National Committee for Quality Assurance (NCQA) standards, credentialing
policies and procedures must apply to which practitioners?
A. Only physicians employed by the organization
B. Only providers participating in Medicare programs
C. All practitioners who provide care to the organization's members
D. Only practitioners seeking initial appointment
Correct Answer: C. All practitioners who provide care to the organization's
members
Rationale: NCQA requires health plans (HPs) and managed behavioral healthcare
organizations (MBHOs) to maintain documented credentialing policies applicable to
all practitioners providing care to plan members. This broad requirement promotes
quality and patient safety across the network. The requirement is not limited to
physicians, Medicare providers, or practitioners seeking initial appointment.
Question 4
According to the Centers for Medicare & Medicaid Services (CMS), who determines
which categories of practitioners are eligible for appointment to the medical staff?
A. State licensing boards
B. Medical executive committee only
C. Governing body in accordance with state law
D. Department of Health and Human Services
Correct Answer: C. Governing body in accordance with state law
Rationale: CMS requires the governing body of the healthcare organization to
determine practitioner eligibility for medical staff membership in accordance with
state law. At a minimum, the medical staff must include physicians (MDs) and
doctors of osteopathic medicine (DOs). Licensing boards regulate licensure, but they
do not determine medical staff eligibility within organizations.
Question 5
When verifying medical education for an applicant under TJC standards, which
source is considered acceptable?
,2026/2027
A. Applicant's résumé only
B. Letter from a colleague
C. Medical school or accepted primary source verification (PSV) source
D. Self-attestation statement
Correct Answer: C. Medical school or accepted primary source verification
(PSV) source
Rationale: TJC requires verification of medical education directly from the medical
school or from an accepted designated equivalent source. Primary source verification
helps ensure authenticity and accuracy. Self-attestation, resumes, and colleague letters
are not considered adequate substitutes for primary source verification.
Question 6
Which organization is recognized by TJC as an acceptable designated equivalent
source for verification of medical education?
A. National Practitioner Data Bank (NPDB)
B. American Medical Association (AMA)
C. Medicare Administrative Contractor
D. State Medical Board
Correct Answer: B. American Medical Association (AMA)
Rationale: TJC recognizes the AMA, American Osteopathic Association (AOA), and
Educational Commission for Foreign Medical Graduates (ECFMG) as acceptable
equivalent sources for medical education verification. These organizations maintain
authoritative educational records. NPDB and state medical boards do not serve this
specific verification role.
Question 7
According to NCQA, verification of education and training should focus on which
achievement level?
A. All levels obtained by the practitioner
B. Most recent employment experience
C. Highest of the three levels of education and training
D. Undergraduate education only
Correct Answer: C. Highest of the three levels of education and training
Rationale: NCQA permits verification of the highest attained level among
medical/professional school graduation, residency training, or board certification.
This approach reduces duplication while still ensuring adequate verification of
qualifications. Undergraduate education alone would not satisfy NCQA requirements.
, 2026/2027
Question 8
Which of the following represents the three education and training levels recognized
by NCQA for credentialing verification?
A. Undergraduate degree, internship, fellowship
B. Medical school, residency, board certification
C. High school, college, medical school
D. Residency, employment, fellowship
Correct Answer: B. Medical school, residency, board certification
Rationale: NCQA identifies graduation from medical or professional school,
residency training, and board certification as the three primary levels of education and
training. Verification of the highest attained level may satisfy credentialing
requirements. The other answer choices contain educational stages not specified by
NCQA.
Question 9
What does CMS require regarding verification of a practitioner's professional
education?
A. Verification only for physicians
B. Board certification as sole evidence
C. A mechanism to examine evidence of professional education
D. Verification only during reappointment
Correct Answer: C. A mechanism to examine evidence of professional education
Rationale: CMS requires organizations to establish mechanisms for reviewing and
evaluating evidence of professional education. This requirement ensures practitioners
possess appropriate educational qualifications. CMS does not limit verification to
physicians nor permit board certification alone to replace educational review.
Question 10
Under TJC standards, postgraduate training must be verified through:
A. Self-attestation only
B. References from peers
C. Primary source or designated equivalent source
D. Employment verification records
Correct Answer: C. Primary source or designated equivalent source
2026/2027 COMSAE Certification
Exam Advanced Study Workbook
Featuring Practice Exams, Review
Questions, and Certification
Preparation Strategies
Question 1
A healthcare organization is recruiting a credentialing professional responsible for
managing practitioner credentialing, primary source verification, and regulatory
compliance activities. Which credential is specifically designed for professionals who
perform these duties?
A. Certified Professional in Healthcare Quality (CPHQ)
B. Certified Provider Credentialing Specialist (CPCS)
C. Registered Health Information Administrator (RHIA)
D. Certified Professional Coder (CPC)
Correct Answer: B. Certified Provider Credentialing Specialist (CPCS)
Rationale: The Certified Provider Credentialing Specialist (CPCS) credential is
specifically designed for professionals involved in provider credentialing, privileging,
and enrollment activities. CPCS-certified professionals are commonly employed by
hospitals, health systems, health plans, ambulatory care organizations, group practices,
and credentialing verification organizations. The CPHQ focuses on healthcare quality
improvement, RHIA focuses on health information management, and CPC focuses on
medical coding rather than credentialing functions.
Question 2
According to standards established by The Joint Commission (TJC), which category
of healthcare practitioners must undergo credentialing and privileging through the
organized medical staff structure before being granted clinical privileges?
A. Only physicians employed by the hospital
B. All licensed independent practitioners
C. Only board-certified physicians
D. Only practitioners with admitting privileges
Correct Answer: B. All licensed independent practitioners
,2026/2027
Rationale: TJC requires that all licensed independent practitioners (LIPs) undergo
credentialing and privileging through the organized medical staff process before
receiving clinical privileges. This requirement ensures practitioners are qualified,
competent, and appropriately trained. Employment status, board certification, or
admitting privileges alone do not determine whether credentialing is required.
Question 3
Under National Committee for Quality Assurance (NCQA) standards, credentialing
policies and procedures must apply to which practitioners?
A. Only physicians employed by the organization
B. Only providers participating in Medicare programs
C. All practitioners who provide care to the organization's members
D. Only practitioners seeking initial appointment
Correct Answer: C. All practitioners who provide care to the organization's
members
Rationale: NCQA requires health plans (HPs) and managed behavioral healthcare
organizations (MBHOs) to maintain documented credentialing policies applicable to
all practitioners providing care to plan members. This broad requirement promotes
quality and patient safety across the network. The requirement is not limited to
physicians, Medicare providers, or practitioners seeking initial appointment.
Question 4
According to the Centers for Medicare & Medicaid Services (CMS), who determines
which categories of practitioners are eligible for appointment to the medical staff?
A. State licensing boards
B. Medical executive committee only
C. Governing body in accordance with state law
D. Department of Health and Human Services
Correct Answer: C. Governing body in accordance with state law
Rationale: CMS requires the governing body of the healthcare organization to
determine practitioner eligibility for medical staff membership in accordance with
state law. At a minimum, the medical staff must include physicians (MDs) and
doctors of osteopathic medicine (DOs). Licensing boards regulate licensure, but they
do not determine medical staff eligibility within organizations.
Question 5
When verifying medical education for an applicant under TJC standards, which
source is considered acceptable?
,2026/2027
A. Applicant's résumé only
B. Letter from a colleague
C. Medical school or accepted primary source verification (PSV) source
D. Self-attestation statement
Correct Answer: C. Medical school or accepted primary source verification
(PSV) source
Rationale: TJC requires verification of medical education directly from the medical
school or from an accepted designated equivalent source. Primary source verification
helps ensure authenticity and accuracy. Self-attestation, resumes, and colleague letters
are not considered adequate substitutes for primary source verification.
Question 6
Which organization is recognized by TJC as an acceptable designated equivalent
source for verification of medical education?
A. National Practitioner Data Bank (NPDB)
B. American Medical Association (AMA)
C. Medicare Administrative Contractor
D. State Medical Board
Correct Answer: B. American Medical Association (AMA)
Rationale: TJC recognizes the AMA, American Osteopathic Association (AOA), and
Educational Commission for Foreign Medical Graduates (ECFMG) as acceptable
equivalent sources for medical education verification. These organizations maintain
authoritative educational records. NPDB and state medical boards do not serve this
specific verification role.
Question 7
According to NCQA, verification of education and training should focus on which
achievement level?
A. All levels obtained by the practitioner
B. Most recent employment experience
C. Highest of the three levels of education and training
D. Undergraduate education only
Correct Answer: C. Highest of the three levels of education and training
Rationale: NCQA permits verification of the highest attained level among
medical/professional school graduation, residency training, or board certification.
This approach reduces duplication while still ensuring adequate verification of
qualifications. Undergraduate education alone would not satisfy NCQA requirements.
, 2026/2027
Question 8
Which of the following represents the three education and training levels recognized
by NCQA for credentialing verification?
A. Undergraduate degree, internship, fellowship
B. Medical school, residency, board certification
C. High school, college, medical school
D. Residency, employment, fellowship
Correct Answer: B. Medical school, residency, board certification
Rationale: NCQA identifies graduation from medical or professional school,
residency training, and board certification as the three primary levels of education and
training. Verification of the highest attained level may satisfy credentialing
requirements. The other answer choices contain educational stages not specified by
NCQA.
Question 9
What does CMS require regarding verification of a practitioner's professional
education?
A. Verification only for physicians
B. Board certification as sole evidence
C. A mechanism to examine evidence of professional education
D. Verification only during reappointment
Correct Answer: C. A mechanism to examine evidence of professional education
Rationale: CMS requires organizations to establish mechanisms for reviewing and
evaluating evidence of professional education. This requirement ensures practitioners
possess appropriate educational qualifications. CMS does not limit verification to
physicians nor permit board certification alone to replace educational review.
Question 10
Under TJC standards, postgraduate training must be verified through:
A. Self-attestation only
B. References from peers
C. Primary source or designated equivalent source
D. Employment verification records
Correct Answer: C. Primary source or designated equivalent source
