CPCS Credentialing Processes & Accreditation Standards 3

Question 1

When a health plan delegates credentialing to a medical group, the health plan retains responsibility for which of the following?

Accepted Answer

Oversight and final approval of the delegation arrangement

Answer

Even when credentialing is delegated, the health plan retains ultimate accountability and must maintain oversight of the delegated entity's compliance.

Question 2

A physician applies for privileges in a specialty she has not practiced in two years. Which criterion is MOST relevant to the credentials committee?

Accepted Answer

Recency and volume of relevant clinical activity

Answer

Current clinical competence is demonstrated through recent and sufficient volume of practice in the relevant specialty area.

Question 3

Which element is NOT typically verified through primary source verification during initial credentialing?

Accepted Answer

Provider's personal references

Answer

Personal references are collected but are not obtained directly from a primary (original) source — they are peer references solicited from individuals named by the provider.

Question 4

URAC's credentialing standards most directly apply to which type of organization?

Accepted Answer

Health plans and managed care organizations

Answer

URAC accredits health plans and managed care organizations and sets credentialing standards specifically applicable to those entities.

Question 5

What is the maximum timeframe NCQA allows for completing the initial credentialing process once an application is deemed complete?

Accepted Answer

180 days

Answer

NCQA standards require organizations to complete the credentialing process within 180 days of receiving a complete application.

(CPCS) Certified Professional Credentialing Specialist Practice Test

(CPCS) Certified Professional Credentialing Specialist Practice Test

CPCS Credentialing Processes & Accreditation Standards 3