CPCS CPCS - Certified Provider Credentialing Specialist Initial Application Processing Questions and Answers 2

Question 1

A practitioner's application reveals a gap in work history of 8 months. Under NCQA standards, what must the credentialing file document regarding this gap?

Accepted Answer

The practitioner's written explanation for the gap must be included in the attestation or file

Answer

The gap must be automatically reported to the NPDB

Answer

The application must be denied due to unexplained history

Answer

The gap can be ignored if the practitioner has been board certified

Question 2

Which of the following application elements requires primary source verification rather than just a copy from the applicant?

Accepted Answer

The practitioner's current medical license

Answer

The practitioner's curriculum vitae (CV)

Answer

A copy of a journal article published by the practitioner

Answer

The practitioner's personal statement

Question 3

When a practitioner application is received, what is the first step in processing?

Accepted Answer

Reviewing the application for completeness

Answer

Conducting the NPDB query

Answer

Verifying the practitioner's medical license

Answer

Scheduling the credentials committee review

Question 4

A practitioner applying for network participation discloses on the application that they have had hospital privileges suspended within the past 5 years. What is the appropriate next step?

Accepted Answer

Request additional documentation about the suspension and refer to the credentials committee for review

Answer

Automatically deny the application

Answer

Ignore the disclosure since it is outside the typical 3-year review period

Answer

Contact the NPDB to file a report about the suspension

Question 5

Under NCQA standards, practitioner references must be obtained from individuals who have directly observed the applicant's clinical work. Which of the following is an acceptable reference for a physician seeking privileges?

Accepted Answer

A physician in the same specialty who has worked alongside the applicant

Answer

The physician's spouse, who is also a physician

Answer

A former patient who can attest to clinical competence

Answer

The physician's personal attorney

Question 6

A practitioner submits a credentials application listing ABMS board certification in cardiology. How should the credentialing specialist verify this credential?

Accepted Answer

Verify directly through the ABMS website (certificationmatters.org)

Answer

Accept the certificate copy submitted by the practitioner

Answer

Request a letter from the training program director

Answer

Query the NPDB for board certification status