CPCS Certified Provider Credentialing
Specialist UPDATED Actual Exam
Questions and CORRECT Answers
Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to
the NPDB? - CORRECT ANSWER✔✔- Yes
According to TJC, who may amend the medical staff bylaws? - CORRECT ANSWER✔✔-
Governing body/board.
Failure to meet the established qualifications and criteria for appointment should be reported
to whom? - CORRECT ANSWER✔✔- The applicant
NCQA requires the MCO to obtain a minimum of how may years of work history? -
CORRECT ANSWER✔✔- Five years
According to the NCQA what policy must an organization have in place to obtain approval to
enter into a delegated agreement? - CORRECT ANSWER✔✔- Credentialing policies
How often does the OIG report to the NPDB? - CORRECT ANSWER✔✔- Monthly
When must hospitals query the NPDB? - CORRECT ANSWER✔✔- Initial appointment,
granting of privileges, every two years.
NCQA requires verifications must be less than how many days old? - CORRECT
ANSWER✔✔- 180 days
What is the verification time limit on malpractice history according to the NCQA? -
CORRECT ANSWER✔✔- 180 days
Time limited credential must be verified by the CVO with how may days prior to submission
to the client? - CORRECT ANSWER✔✔- 120 days
, According the AAAHC, for initial appointments, in addition to licensure and education, what
verification is required? - CORRECT 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? - CORRECT
ANSWER✔✔- NCQA
Who is required to query the NPDB? - CORRECT ANSWER✔✔- Hospitals
Is disciplinary action taken against the license of a dentist reportable to the NPDB? -
CORRECT 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? - CORRECT
ANSWER✔✔- 3 years
According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of
what sources? - CORRECT 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? - CORRECT ANSWER✔✔- Annually
How far back does TJC require evaluation of malpractice history? - CORRECT
ANSWER✔✔- Back to medical school
According to TJC, what source may be used to evaluate malpractice history? - CORRECT
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?
- CORRECT ANSWER✔✔- No
Specialist UPDATED Actual Exam
Questions and CORRECT Answers
Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to
the NPDB? - CORRECT ANSWER✔✔- Yes
According to TJC, who may amend the medical staff bylaws? - CORRECT ANSWER✔✔-
Governing body/board.
Failure to meet the established qualifications and criteria for appointment should be reported
to whom? - CORRECT ANSWER✔✔- The applicant
NCQA requires the MCO to obtain a minimum of how may years of work history? -
CORRECT ANSWER✔✔- Five years
According to the NCQA what policy must an organization have in place to obtain approval to
enter into a delegated agreement? - CORRECT ANSWER✔✔- Credentialing policies
How often does the OIG report to the NPDB? - CORRECT ANSWER✔✔- Monthly
When must hospitals query the NPDB? - CORRECT ANSWER✔✔- Initial appointment,
granting of privileges, every two years.
NCQA requires verifications must be less than how many days old? - CORRECT
ANSWER✔✔- 180 days
What is the verification time limit on malpractice history according to the NCQA? -
CORRECT ANSWER✔✔- 180 days
Time limited credential must be verified by the CVO with how may days prior to submission
to the client? - CORRECT ANSWER✔✔- 120 days
, According the AAAHC, for initial appointments, in addition to licensure and education, what
verification is required? - CORRECT 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? - CORRECT
ANSWER✔✔- NCQA
Who is required to query the NPDB? - CORRECT ANSWER✔✔- Hospitals
Is disciplinary action taken against the license of a dentist reportable to the NPDB? -
CORRECT 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? - CORRECT
ANSWER✔✔- 3 years
According to NCQA, verification of Medicare/Medicaid sanctions can be queried by any of
what sources? - CORRECT 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? - CORRECT ANSWER✔✔- Annually
How far back does TJC require evaluation of malpractice history? - CORRECT
ANSWER✔✔- Back to medical school
According to TJC, what source may be used to evaluate malpractice history? - CORRECT
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?
- CORRECT ANSWER✔✔- No
