CHCS Credentialing Processes & Standards 2

Question 1

Under NCQA standards, how often must a health plan recredential its practitioners?

Accepted Answer

At least every 36 months

Answer

NCQA requires recredentialing at least every 36 months.

Question 2

Which source is considered acceptable primary source verification of a physician's current state medical license?

Accepted Answer

The state licensing board's official website

Answer

The issuing state board, including its official website, is the primary source for licensure.

Question 3

Under The Joint Commission, what is the maximum period for which clinical privileges may be granted at reappointment?

Accepted Answer

2 years

Answer

The Joint Commission requires privileges to be renewed at least every two years.

Question 4

Which database must be queried to identify individuals excluded from participation in federal healthcare programs?

Accepted Answer

OIG List of Excluded Individuals/Entities (LEIE)

Answer

The OIG LEIE lists individuals excluded from Medicare, Medicaid and other federal programs.

Question 5

A practitioner's application shows a 9-month gap in work history. What should the credentialing specialist do?

Accepted Answer

Obtain an explanation of the gap from the practitioner

Answer

Significant work history gaps must be explained by the practitioner and documented in the file.

CHCS - Certified Healthcare Credentialing Specialist Practice Test