CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers Flashcards
6 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers flashcards as text
Which of the following is considered an acceptable alternative to primary source verification for medical education when the original institution is no longer in existence?
Answer: Verification through a recognized national repository such as the AMA Physician Master File or ECFMG
When a medical school no longer exists, recognized national repositories such as the AMA Physician Master File or ECFMG (for foreign graduates) that maintain historical education records are acceptable alternative PSV sources.
Under NCQA credentialing standards, what is the maximum acceptable age of primary source verifications at the time the credentials committee reviews the file?
Answer: 180 days
NCQA requires that primary source verifications be no more than 180 days old at the time of the credentialing committee review or the approval decision.
A credentialing specialist is verifying a physician's residency training. The residency program director is no longer with the program. Who else can provide primary source verification of residency completion?
Answer: The current program director or program administrator, as designated representatives of the program
The current program director or program administrator/coordinator, as authorized representatives of the sponsoring institution, can provide primary source verification of residency completion even if the original program director has left.
What is the significance of verifying a practitioner's malpractice insurance through the insurance carrier rather than accepting a certificate of insurance from the practitioner?
Answer: Direct carrier verification confirms current active coverage and may reveal pending cancellations or coverage limits changes
Direct verification with the insurance carrier confirms that coverage is currently active, the policy has not been cancelled or modified, and the stated limits are accurate, information that a practitioner-provided certificate may not reflect.
Which of the following verification sources is considered a 'recognized equivalent' to primary source verification under NCQA standards?
Answer: A verification service that contacts primary sources on behalf of the credentialing organization
Under NCQA standards, a recognized equivalent is an agent or intermediary that obtains information directly from the primary source, such as a credentials verification organization (CVO) that contacts primary sources on behalf of the credentialing organization.
A state medical board's online license verification database is updated in real-time and indicates a physician's license is 'Active.' Does this constitute primary source verification of licensure?
Answer: Yes, a real-time database maintained by the licensing authority constitutes primary source verification
A real-time online database maintained by the licensing authority (such as a state medical board website) constitutes primary source verification because the data comes directly from the issuing source.