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Data Management & Reporting 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.

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  1. A credentialing specialist notices two provider records in the database share the same NPI but have different birth dates. What is the best first step?

    Answer: Verify the correct data against NPPES and primary sources before correcting

    Data discrepancies must be resolved by checking authoritative sources before any merge or correction to protect data integrity.

  2. How many digits make up a National Provider Identifier (NPI)?

    Answer: 10

    The NPI is a unique 10-digit numeric identifier issued through NPPES.

  3. Which database feature best supports demonstrating to auditors who changed a provider's license expiration date and when?

    Answer: An audit trail or change log

    An audit trail records user, date, time, and before/after values for each data change.

  4. An expirables report is primarily used to:

    Answer: Identify credentials such as licenses, DEA registrations, and malpractice coverage nearing expiration

    Expirables reports flag time-limited credentials so they can be renewed and re-verified before lapsing.

  5. Which key performance indicator most directly measures credentialing department efficiency?

    Answer: Average turnaround time from complete application to committee decision

    Turnaround time is a core credentialing KPI reflecting processing efficiency.

  6. When submitting a credentialing roster to a health plan, why is roster reconciliation important?

    Answer: It ensures the plan's directory and payment data match the organization's records

    Reconciling rosters prevents directory inaccuracies and claims problems caused by mismatched provider data.

  7. Under HIPAA's minimum necessary standard, a credentialing report sent to a department chair should include:

    Answer: Only the information needed for the chair's specific purpose

    Minimum necessary limits disclosed information to what is needed for the intended purpose.

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