CPCS CPCS - Certified Provider Credentialing Specialist Primary Source Verification Questions and Answers 2

Question 1

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?

Accepted Answer

Verification through a recognized national repository such as the AMA Physician Master File or ECFMG

Answer

A copy of the diploma provided by the practitioner

Answer

A letter from the state medical board confirming the degree

Answer

A notarized affidavit from the practitioner

Question 2

Under NCQA credentialing standards, what is the maximum acceptable age of primary source verifications at the time the credentials committee reviews the file?

Accepted Answer

180 days

Answer

30 days

Answer

90 days

Answer

365 days

Question 3

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?

Accepted Answer

The current program director or program administrator, as designated representatives of the program

Answer

The physician themselves, via a signed statement

Answer

The national residency match program (NRMP)

Answer

Another physician who was a co-resident during the same period

Question 4

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?

Accepted Answer

Direct carrier verification confirms current active coverage and may reveal pending cancellations or coverage limits changes

Answer

Insurance carriers charge less for direct verification

Answer

The certificate of insurance format cannot be accepted by credentialing databases

Answer

Direct carrier verification is only required for new practitioners

Question 5

Which of the following verification sources is considered a 'recognized equivalent' to primary source verification under NCQA standards?

Accepted Answer

A verification service that contacts primary sources on behalf of the credentialing organization

Answer

A practitioner-provided copy of their license

Answer

An insurance company's verification of the practitioner's education

Answer

A colleague's verbal attestation to the practitioner's qualifications

Question 6

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?

Accepted Answer

Yes, a real-time database maintained by the licensing authority constitutes primary source verification

Answer

No, primary source verification always requires a written letter from the medical board

Answer

No, online verification is not acceptable for NCQA purposes

Answer

Yes, but only if printed and signed by a credentialing specialist