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, how frequently must CAQH ProView users re-attest that their profile information is current?
Answer: Every 120 days
CAQH requires providers to re-attest their ProView data every 120 days.
Focused Professional Practice Evaluation (FPPE) is required by The Joint Commission in which situation?
Answer: For all practitioners newly requesting privileges
FPPE applies to all initially requested privileges and when concerns arise about a current practitioner.
Which item is verified through the National Practitioner Data Bank (NPDB)?
Answer: Malpractice payment history and adverse licensure actions
The NPDB contains malpractice payments and adverse actions on licensure, privileges and memberships.
In delegated credentialing, what is the delegating organization's ongoing responsibility under NCQA?
Answer: Oversight including at least annual evaluation of the delegate
The delegating organization retains accountability and must annually evaluate the delegate's performance.
Which is an acceptable primary source for verifying board certification of an MD?
Answer: ABMS Certification Matters or the specialty board
ABMS and the certifying member board are recognized primary sources for board certification.
What is the main purpose of the credentialing committee in a health plan?
Answer: To review credentialing files and make network participation decisions
The credentialing committee uses peer review to decide whether practitioners meet network standards.
Under NCQA, ongoing monitoring of Medicare/Medicaid sanctions and license limitations must occur at what minimum frequency?
Answer: Within 30 calendar days of new information release
NCQA requires review of sanction and limitation information within 30 calendar days of its release.
How this page was made: written with AI tools and published by Nathan Beja, founder of Practice Test Geeks, who is responsible for its content. We have not yet matched this exam's facts to an official source, so confirm fees, dates and rules with the exam body. Not reviewed by a subject-matter expert. Editorial policy