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

CAQH ProView requires provider re-attestation every 120 days. A profile attested 7 months ago (approximately 210 days) is overdue for re-attestation and should be updated before use.

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

Best practice is to set automated alerts at multiple intervals (typically 90 and 30 days) before expiration so that renewals can be tracked and practitioners notified in time to avoid lapses.

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

Credentialing files are administrative records containing sensitive professional information protected by medical staff bylaws confidentiality provisions and state peer review protection laws, not PHI under HIPAA.

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

A completeness checklist ensures that all required elements (primary source verifications, attestation, references, etc.) are present and current before the file is submitted for committee review.

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

Centralized credentialing databases enable automated tracking of expirations, maintain audit trails of all changes, generate compliance reports, and allow multiple users to access current information simultaneously.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

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