Credentialing Processes & Standards Flashcards

What is the generally accepted maximum age of verifications at the time of an NCQA credentialing committee decision?

Answer: 180 days

NCQA requires most verifications to be no older than 180 calendar days at the decision date.

Which type of organization performs credentials verification on behalf of other organizations and may be NCQA certified?

Answer: Credentials Verification Organization (CVO)

A CVO verifies practitioner credentials for other entities and can earn NCQA CVO certification.

Under the Health Care Quality Improvement Act, when must a hospital report an adverse privileging action lasting more than 30 days to the NPDB?

Answer: Within 30 days of the action

Adverse clinical privileges actions over 30 days must be reported to the NPDB within 30 days.

Which is an example of an acceptable primary source for residency training verification?

Answer: The residency program director or institution

The training program or sponsoring institution is the primary source for residency completion.

A practitioner's license is due to expire before the credentialing committee meeting. What should the specialist do?

Answer: Verify the renewed license before committee review

A current, valid license must be verified before the committee makes its decision.

What does the System for Award Management (SAM) query identify?

Answer: Individuals and entities debarred from federal contracts and programs

SAM lists parties excluded or debarred from receiving federal contracts and assistance.

Under NCQA, which right must practitioners be informed of during credentialing?

Answer: The right to review information submitted in support of their application

NCQA requires notifying practitioners of their right to review information obtained to evaluate their application.