CPCS - Certified Provider Credentialing Specialist Information Management 1

Question 1

A credentialing coordinator discovers that a practitioner's primary source verification (PSV) for their medical school graduation was completed 4 years ago and the organization is preparing for NCQA re-accreditation.
What is the most appropriate action?

Accepted Answer

No action is needed because medical school graduation is a one-time, permanent credential that does not require re-verification

Answer

Re-verify the medical school graduation since PSV must be repeated every 3 years

Answer

Contact the practitioner to re-attest their graduation date before the re-accreditation survey

Answer

Obtain a new copy of the diploma directly from the practitioner

Question 2

Which data element is considered the 'universal identifier' that credentialing databases should store to ensure accurate practitioner matching across multiple health plans and registries?

Accepted Answer

National Provider Identifier (NPI)

Answer

State medical license number

Answer

DEA registration number

Answer

Social Security Number (SSN)

Question 3

A hospital credentialing department wants to implement a 'tickler system.' What is the primary purpose of this system in information management?

Accepted Answer

To automatically generate advance notifications before credentials or documents expire

Answer

To flag practitioners who have received patient complaints

Answer

To track peer review outcomes and quality indicators

Answer

To log access to confidential credentialing files for audit purposes

Question 4

When a credentialing specialist receives a roster from a hospital to load into the credentialing software, what is the FIRST data integrity step that should be performed before importing?

Accepted Answer

Deduplicate the roster against existing practitioner records to prevent duplicate profiles

Answer

Verify that each practitioner holds an active DEA certificate

Answer

Confirm that all practitioners have a signed attestation on file

Answer

Check each practitioner's malpractice insurance limits

Question 5

A managed care organization is transitioning from paper credentialing files to a fully electronic credentialing management system (CMS). Which document retention policy consideration is MOST critical during this transition?

Accepted Answer

Scanned documents must meet applicable state and federal retention requirements, and the organization should establish a validation process to confirm scan quality before destroying originals

Answer

All paper files should be shredded immediately after scanning to save storage space

Answer

Electronic records are exempt from HIPAA retention rules since they are not considered 'designated record sets'

Answer

Retention periods reset to zero once files are converted to electronic format

Question 6

A credentialing specialist is asked to produce a report showing all practitioners whose board certification will expire within the next 90 days. Which category of credentialing information management does this task represent?

Accepted Answer

Expirables management and proactive monitoring

Answer

Adverse action reporting

Answer

Primary source verification

Answer

Peer review data aggregation