CHCS Delegated Credentialing & CVO Operations 1

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 CVO is an organization contracted to perform credentialing verification activities on behalf of another entity, such as a health plan or hospital system.

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 delegating entity retains ultimate accountability and responsibility for credentialing decisions, even when functions are performed by a CVO.

Question 3

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

Accepted Answer

Delegation agreement

Answer

A delegation agreement is the formal contract that outlines responsibilities, oversight requirements, and performance standards between the delegating entity and the CVO.

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

NCQA requires delegating organizations to audit their CVOs' credentialing activities at least annually to ensure compliance with standards.

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

Oversight audits verify that the CVO is fulfilling its delegated responsibilities according to the agreement terms and accreditation standards.

CHCS - Certified Healthcare Credentialing Specialist Practice Test

CHCS - Certified Healthcare Credentialing Specialist Practice Test

CHCS Delegated Credentialing & CVO Operations 1