CHCS CHCS Primary Source Verification & Quality Management 2

Question 1

What is an 'acceptable equivalent' for primary source verification of a practitioner's medical degree?

Accepted Answer

Verification through a CVO (Credentials Verification Organization) that meets NCQA PSV standards

Answer

A NCQA-certified or compliant CVO can perform PSV on behalf of a health plan or hospital and their verification is accepted as equivalent to direct primary source verification.

Question 2

When a primary source is unable to verify a credential (e.g., a foreign medical school no longer exists), what is the appropriate step?

Accepted Answer

Document the inability to verify and follow organizational policy, which may allow alternative verification methods

Answer

When a primary source is unavailable, the credentialing specialist must document the attempt and follow policy for acceptable alternative verification methods.

Question 3

Which of the following is NOT typically a required element verified during the NCQA credentialing process?

Accepted Answer

Practitioner's personal bank account information

Answer

Financial information is not a credentialing element; NCQA requires verification of clinical qualifications, licensure, sanctions, and work history.

Question 4

How does a Credentials Verification Organization (CVO) benefit a health plan's credentialing process?

Accepted Answer

It centralizes and performs PSV on behalf of multiple delegating organizations, reducing duplication

Answer

A CVO performs PSV and credential collection for multiple health plans or hospitals, eliminating redundant verification of the same practitioner by different organizations.

Question 5

In managed care credentialing, 'delegation' means that a health plan:

Accepted Answer

Allows a delegated entity (e.g., a medical group) to perform credentialing on its behalf, subject to oversight and audit

Answer

Delegation in credentialing means the health plan authorizes another entity to perform credentialing functions, but the health plan retains accountability and must audit the delegate.

CHCS - Certified Healthcare Credentialing Specialist Practice Test

CHCS - Certified Healthcare Credentialing Specialist Practice Test

CHCS CHCS Primary Source Verification & Quality Management 2