CHCS Delegated Credentialing & CVO Operations

Question 1

What is a Credentials Verification Organization (CVO)?

Accepted Answer

An organization that performs credentialing verification functions on behalf of a health plan or hospital

Answer

A government agency that issues medical licenses

Answer

A professional association for credentialing specialists

Answer

A software platform for storing provider credentials

Question 2

When a health plan delegates credentialing to a CVO, who retains ultimate responsibility for the credentialing decisions?

Accepted Answer

The delegating health plan or organization

Answer

The CVO

Answer

The state medical board

Answer

The Centers for Medicare & Medicaid Services (CMS)

Question 3

What document formally establishes the terms of a credentialing delegation arrangement?

Accepted Answer

Delegation agreement

Answer

Medical staff bylaws

Answer

Credentialing policy manual

Answer

Provider participation agreement

Question 4

According to NCQA standards, how often must a delegating organization conduct an audit of its CVO's credentialing activities?

Accepted Answer

At least annually

Answer

Monthly

Answer

Quarterly

Answer

Every three years

Question 5

What is the primary purpose of an oversight audit in a delegated credentialing arrangement?

Accepted Answer

To ensure the CVO is performing delegated functions in compliance with the delegation agreement and applicable standards

Answer

To verify that the CVO is profitable

Answer

To count the number of providers credentialed each year

Answer

To review provider patient satisfaction scores

Question 6

Which accrediting body's standards most directly address credentialing delegation requirements for managed care health plans?

Accepted Answer

NCQA

Answer

The Joint Commission

Answer

URAC

Answer

The American Medical Association

Question 7

What action must a delegating organization take if a CVO fails an oversight audit?

Accepted Answer

Work with the CVO on a corrective action plan or revoke the delegation if deficiencies persist

Answer

Immediately terminate the delegation agreement

Answer

Report the failure to the state insurance commissioner

Answer

Notify all providers credentialed by the CVO