CHCS Primary Source Verification & Quality Management Flashcards

What is 'primary source verification' (PSV) in the credentialing process?

Answer: Confirming a practitioner's credentials directly with the originating institution or licensing body

PSV requires confirmation of a practitioner's credentials directly from the source that issued them, such as a medical school or licensing board.

Which organization established the most widely recognized standards for primary source verification in credentialing, particularly for health plans?

Answer: NCQA (National Committee for Quality Assurance)

NCQA's credentialing standards define PSV requirements for health plans and are used as the benchmark for managed care credentialing.

Under NCQA standards, which of the following elements requires primary source verification?

Answer: Current valid license to practice

Current, valid licensure is one of the core elements that must be verified at the primary source (state licensing board) under NCQA credentialing standards.

The National Practitioner Data Bank (NPDB) must be queried during initial credentialing and at minimum how often thereafter?

Answer: Every 2 years

NPDB regulations require hospitals to query the databank at initial appointment and at least every two years at reappointment.

Which type of NPDB report allows a hospital to continuously monitor practitioners between required queries?

Answer: Continuous query (proactive disclosure)

The NPDB's continuous query (proactive disclosure) service automatically notifies enrolled organizations when a new report is filed on a monitored practitioner.

A credentialing application is considered 'complete' for the purpose of starting the PSV process when:

Answer: All required information and supporting documentation have been submitted and are ready for verification

PSV cannot begin until the application is complete with all required elements, as missing information prevents accurate and thorough verification.