CPCS Basic 2

Question 1

Which organization accredits managed care organizations and sets credentialing standards that many health plans follow?

Accepted Answer

NCQA

Answer

NCQA (National Committee for Quality Assurance) accredits managed care organizations and its credentialing standards are widely adopted by health plans.

Question 2

What is the primary purpose of the National Practitioner Data Bank (NPDB)?

Accepted Answer

To track malpractice payments and adverse actions against practitioners

Answer

The NPDB collects and reports malpractice payments, licensure actions, and other adverse actions to prevent practitioners from moving between states to escape poor performance histories.

Question 3

Under NCQA standards, how often must a credentialed provider be re-credentialed?

Accepted Answer

Every three years

Answer

NCQA requires re-credentialing at least every three years to ensure provider information remains current and accurate.

Question 4

Which document grants a physician the right to perform specific clinical procedures at a hospital?

Accepted Answer

Delineation of privileges

Answer

Delineation of privileges (clinical privileges) specifies exactly which procedures and patient care activities a practitioner is authorized to perform at that facility.

Question 5

What does the term 'primary source verification' mean in credentialing?

Accepted Answer

Contacting the original issuing organization directly to confirm credentials

Answer

Primary source verification requires contacting the organization that originally issued the credential — the medical school, licensing board, or certifying body — not a copy or intermediary.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS Basic 2