Certified Provider Credentialing Specialist (CPCS) study guide /
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Terms in this set (40)
The Certified Provider Credentialing Specialist (CPCS) is typically employed
or contracted by a healthcare organization including, but not limited to,
Certified Provider Credentialing hospitals (health systems), health plans, ambulatory care settings, group
Specialist practices, and credentialing verification organizations.
Initial Appointment / Clinical All licensed Independent practitioners must be credentialed and privileged
privileges/ practioners covered through the organized Medical staff structure
according to the TJC
Initial Appointment / Clinical HP's and MBHO's must have documented Credentialing policies and
privileges/ practioners covered procedures that apply to all practitioners who provide care to the
according to the NCQA organizations members
The Governing body determines, in accordance with Staye Law, which
Initial Appointment / Clinical categories of practitioners are eligible for appointment to the medical staff.
privileges/ practioners covered At a minimum the medical staff must be composed of MD 's and DO's.
according to CMS
Verification of Medical education Requires verification from the medical school or accepted PSV
according to the TJC
TJC Accepted PSV for medical The AMA, the AOA, and the ECFMG
education
Verification of Medical education Requires HP/CVO the highest of three levels of education and training.
according to the
NCQA
The three levels of education and Graduation from medical or professional school, residency, board
training as defined by certification.
NCQA
Verification of Medical education The medical staff must have a mechanism to examine evidence of
according to CMS professional education
Verification of postgraduate training Requires verification from the primary source or designated equivalent
according to TJC sources.
TJC accepted PSV for postgraduate AMA and AOA
training
Verification of postgraduate training The highest of the three levels of education and training attained.
according to NCQA If board certified, than board certification suffices.
Verification of postgraduate training The medical staff must have a mechanism to examine evidence of
according to CMS training and documented experiences.
Expert Verified Actual Questions & Answers for Guaranteed
Pass | Newest Update, 2025-2026.
Terms in this set (40)
The Certified Provider Credentialing Specialist (CPCS) is typically employed
or contracted by a healthcare organization including, but not limited to,
Certified Provider Credentialing hospitals (health systems), health plans, ambulatory care settings, group
Specialist practices, and credentialing verification organizations.
Initial Appointment / Clinical All licensed Independent practitioners must be credentialed and privileged
privileges/ practioners covered through the organized Medical staff structure
according to the TJC
Initial Appointment / Clinical HP's and MBHO's must have documented Credentialing policies and
privileges/ practioners covered procedures that apply to all practitioners who provide care to the
according to the NCQA organizations members
The Governing body determines, in accordance with Staye Law, which
Initial Appointment / Clinical categories of practitioners are eligible for appointment to the medical staff.
privileges/ practioners covered At a minimum the medical staff must be composed of MD 's and DO's.
according to CMS
Verification of Medical education Requires verification from the medical school or accepted PSV
according to the TJC
TJC Accepted PSV for medical The AMA, the AOA, and the ECFMG
education
Verification of Medical education Requires HP/CVO the highest of three levels of education and training.
according to the
NCQA
The three levels of education and Graduation from medical or professional school, residency, board
training as defined by certification.
NCQA
Verification of Medical education The medical staff must have a mechanism to examine evidence of
according to CMS professional education
Verification of postgraduate training Requires verification from the primary source or designated equivalent
according to TJC sources.
TJC accepted PSV for postgraduate AMA and AOA
training
Verification of postgraduate training The highest of the three levels of education and training attained.
according to NCQA If board certified, than board certification suffices.
Verification of postgraduate training The medical staff must have a mechanism to examine evidence of
according to CMS training and documented experiences.
