CPCS CPCS - Certified Provider Credentialing Specialist Credentialing Information Management Questions and Answers 2

Question 1

A credentialing specialist receives a CAQH ProView profile that was last attested 7 months ago. What action should be taken?

Accepted Answer

Contact the practitioner to update and re-attest the profile before using it for credentialing

Answer

Accept the profile as current since it is less than one year old

Answer

Use the profile but note in the file that it is outdated

Answer

Reject the application until the practitioner obtains a new profile

Question 2

Which of the following is the best practice for managing expirables (licenses, DEA certificates, malpractice insurance) in a credentialing database?

Accepted Answer

Set automated alerts at 90 and 30 days before expiration

Answer

Review all files monthly regardless of expiration dates

Answer

Wait for practitioners to self-report renewals

Answer

Only track expirables at the time of recredentialing

Question 3

Under HIPAA, a practitioner's credentialing file is best classified as which type of record?

Accepted Answer

Quasi-administrative record with specific confidentiality protections

Answer

Protected Health Information (PHI) subject to patient rights

Answer

Personnel/employment record not subject to PHI rules

Answer

Public record that must be disclosed upon request

Question 4

What does a 'credentialing file completeness checklist' primarily ensure?

Accepted Answer

That all required verification elements are present before the file is sent to committee

Answer

That all practitioners have completed OPPE requirements

Answer

That the database software is functioning correctly

Answer

That malpractice claims have been settled

Question 5

Which of the following describes the primary advantage of using a centralized credentialing database over paper-based files?

Accepted Answer

Enables real-time expirable tracking, audit trails, and automated reporting

Answer

Eliminates the need for primary source verification

Answer

Reduces the number of credentials that must be verified

Answer

Eliminates the need for committee review

Question 6

A health plan's credentialing policy requires that copies of primary source verifications be retained for a minimum of 10 years. This retention requirement is most likely driven by which factor?

Accepted Answer

State insurance regulations and accreditation standards

Answer

HIPAA patient record retention requirements

Answer

IRS tax record requirements

Answer

Federal antitrust laws