Credentialing Processes & Standards Flashcards
7 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 7 Credentialing Processes & Standards flashcards as text
Under NCQA standards, how often must a health plan recredential its practitioners?
Answer: At least every 36 months
NCQA requires recredentialing at least every 36 months.
Which source is considered acceptable primary source verification of a physician's current state medical license?
Answer: The state licensing board's official website
The issuing state board, including its official website, is the primary source for licensure.
Under The Joint Commission, what is the maximum period for which clinical privileges may be granted at reappointment?
Answer: 2 years
The Joint Commission requires privileges to be renewed at least every two years.
Which database must be queried to identify individuals excluded from participation in federal healthcare programs?
Answer: OIG List of Excluded Individuals/Entities (LEIE)
The OIG LEIE lists individuals excluded from Medicare, Medicaid and other federal programs.
A practitioner's application shows a 9-month gap in work history. What should the credentialing specialist do?
Answer: Obtain an explanation of the gap from the practitioner
Significant work history gaps must be explained by the practitioner and documented in the file.
Which body is the primary source for verifying graduation of an international medical graduate from a foreign medical school?
Answer: ECFMG
ECFMG certification is accepted as primary source verification of foreign medical education.
What is Ongoing Professional Practice Evaluation (OPPE) designed to do?
Answer: Continuously monitor current practitioners' performance between reappointments
OPPE is a continuous evaluation of privileged practitioners' performance to identify trends that affect quality.
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