NCQA & URAC question and answers 2023 verified

NCQA & URAC question and answers 2023 verified NCQA defines credentialing as - correct answer A process by which an organization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members. According to NCQA standards, practitioners who do not need to be credentialed are: - correct answer - Those who practice exclusively within the inpatient setting and who provide care for organization members only as a result of members being directed to the hospital or another inpatient setting - Those who practice exclusively within free-standing facilities and who provide care for organization members only as a result of members being directed to the facility - Pharmacists working for a pharmacy benefits management (PBM) organization to which the organization delegates utilization management (UM) functions - Covering practitioners (locum tenens) unless working for longer than 90 days -Practitioners who do not provide care for members in a treatment setting (example: board-certified consultants) -Rental network practitioners providing out of area care. When NCQA standards require the organization to verify board certification at re-credentialing? - correct answer In all cases According to NCQA standards, which of the following is an approved source for verification of board certification? - correct answer State licensing agency if state agency conducts primary verification of board status