CHCS Primary Source Verification & Quality Management Flashcards
6 cards from real CHCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CHCS Primary Source Verification & Quality Management flashcards as text
What is an 'acceptable equivalent' for primary source verification of a practitioner's medical degree?
Answer: Verification through a CVO (Credentials Verification Organization) that meets NCQA PSV standards
A NCQA-certified or compliant CVO can perform PSV on behalf of a health plan or hospital and their verification is accepted as equivalent to direct primary source verification.
When a primary source is unable to verify a credential (e.g., a foreign medical school no longer exists), what is the appropriate step?
Answer: Document the inability to verify and follow organizational policy, which may allow alternative verification methods
When a primary source is unavailable, the credentialing specialist must document the attempt and follow policy for acceptable alternative verification methods.
Which of the following is NOT typically a required element verified during the NCQA credentialing process?
Answer: Practitioner's personal bank account information
Financial information is not a credentialing element; NCQA requires verification of clinical qualifications, licensure, sanctions, and work history.
How does a Credentials Verification Organization (CVO) benefit a health plan's credentialing process?
Answer: It centralizes and performs PSV on behalf of multiple delegating organizations, reducing duplication
A CVO performs PSV and credential collection for multiple health plans or hospitals, eliminating redundant verification of the same practitioner by different organizations.
In managed care credentialing, 'delegation' means that a health plan:
Answer: Allows a delegated entity (e.g., a medical group) to perform credentialing on its behalf, subject to oversight and audit
Delegation in credentialing means the health plan authorizes another entity to perform credentialing functions, but the health plan retains accountability and must audit the delegate.
What is 'recredentialing' and how often is it typically required?
Answer: The periodic renewal of a practitioner's credentials and privileges, typically every 2–3 years
Recredentialing is the systematic re-verification of a practitioner's qualifications and performance data to support continued appointment, typically every two to three years.
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