CHCS Delegated Credentialing & CVO Operations 2

Question 1

Which elements must typically be included in a delegation agreement between a health plan and a CVO?

Accepted Answer

Scope of delegated activities, performance standards, and audit requirements

Answer

Provider salary information and billing codes

Answer

Patient health records and clinical outcomes data

Answer

Marketing strategies and enrollment targets

Question 2

What does 'sub-delegation' mean in the context of credentialing?

Accepted Answer

When a CVO further delegates credentialing functions to another organization

Answer

A CVO hiring additional credentialing staff internally

Answer

A health plan performing credentialing for a subsidiary company

Answer

When a provider delegates credentialing authority to a practice manager

Question 3

A health plan reviews a CVO's file audit and finds that 15% of files are missing primary source verifications. What is the most appropriate next step?

Accepted Answer

Issue a corrective action plan requiring the CVO to remediate deficiencies within a specified timeframe

Answer

Immediately revoke all credentialing decisions made by the CVO

Answer

Notify the state medical board about the deficiencies

Answer

Extend the delegation agreement for an additional year to allow more time

Question 4

Which NCQA standard element specifically addresses the requirements for credentialing delegation in health plans?

Accepted Answer

CR (Credentialing and Recredentialing)

Answer

QI (Quality Improvement)

Answer

UM (Utilization Management)

Answer

MBR (Member Rights and Responsibilities)

Question 5

What is URAC's primary role with respect to delegated credentialing?

Accepted Answer

Providing accreditation standards for health plans and CVOs that include credentialing delegation requirements

Answer

Issuing medical licenses to healthcare providers

Answer

Directly verifying provider credentials on behalf of all health plans

Answer

Setting federal regulations governing credentialing delegation

Question 6

In a delegated credentialing arrangement, which party is responsible for notifying providers of credentialing decisions?

Accepted Answer

The party specified in the delegation agreement, though the delegating entity remains ultimately accountable

Answer

Always the CVO, as the entity performing verification

Answer

Always the delegating health plan, as the accountable party

Answer

The state licensing board where the provider is licensed

Question 7

What is the significance of NCQA's CVO certification or 'deemed status' in credentialing delegation?

Accepted Answer

A CVO with NCQA certification may be recognized as meeting certain delegation standards, potentially reducing duplicative auditing requirements

Answer

It exempts a CVO from all oversight audits by delegating entities

Answer

It allows a CVO to credential providers without primary source verification

Answer

It grants the CVO authority to make final adverse credentialing decisions independently