CPCS - Certified Provider Credentialing
Specialist Exam 2026 Questions and
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
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,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
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,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
What accreditation bodies require privileges to be distributed to essential
department personnel? - Correct Answer-TJC, CMS
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, TJC and NCQA do not require criminal background checks. - Correct Answer-True
Is a payment made by an insurance company reportable to the NPDB? - Correct
Answer-Yes
Who is the best person to consult when releasing adverse information in a
verification request from another organization? - Correct Answer-Legal counsel
According to CMS, who in the organization may make decisions regarding
approval of credentialing applications? - Correct Answer-Governing body/board.
According to the NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - Correct Answer-Locums Tenens,
hospital based practitioners
How many peer references does HFAP require at initial appointment? - Correct
Answer-One
Denial of a medical license application by a state medical board is not reportable to
the NPDB. (T/F) - Correct Answer-True
Which two accreditors state a hospital may not rely solely on board certification
when considering a practitioner for medical staff membership? - Correct Answer-
HFAP, CMS
©COPYRIGHT2025, ALL RIGHTS RESERVED 4
Specialist Exam 2026 Questions and
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
©COPYRIGHT2025, ALL RIGHTS RESERVED 1
,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
©COPYRIGHT2025, ALL RIGHTS RESERVED 2
,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
What accreditation bodies require privileges to be distributed to essential
department personnel? - Correct Answer-TJC, CMS
©COPYRIGHT2025, ALL RIGHTS RESERVED 3
, TJC and NCQA do not require criminal background checks. - Correct Answer-True
Is a payment made by an insurance company reportable to the NPDB? - Correct
Answer-Yes
Who is the best person to consult when releasing adverse information in a
verification request from another organization? - Correct Answer-Legal counsel
According to CMS, who in the organization may make decisions regarding
approval of credentialing applications? - Correct Answer-Governing body/board.
According to the NCQA what providers are NOT required to be credentialed when
working in an independent relationship? - Correct Answer-Locums Tenens,
hospital based practitioners
How many peer references does HFAP require at initial appointment? - Correct
Answer-One
Denial of a medical license application by a state medical board is not reportable to
the NPDB. (T/F) - Correct Answer-True
Which two accreditors state a hospital may not rely solely on board certification
when considering a practitioner for medical staff membership? - Correct Answer-
HFAP, CMS
©COPYRIGHT2025, ALL RIGHTS RESERVED 4
