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

NCQA requires that any gap in work history of 6 months or more within the past 5 years must be explained in the practitioner's signed attestation or accompanying documentation in the file.

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

A medical license must be verified through primary source verification (contacting the state medical board directly or using a recognized equivalent), not just by reviewing a copy provided by the applicant.

Question 3

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

Accepted Answer

Reviewing the application for completeness

Answer

The first step in application processing is reviewing the application for completeness to ensure all required elements are present before beginning verification activities.

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

Disclosed adverse history must be thoroughly investigated through additional documentation requests and referred to the credentials committee for review and decision — automatic denial without investigation is inappropriate.

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

NCQA requires peer references from practitioners who have directly observed the applicant's clinical performance. A physician in the same specialty who has worked alongside the applicant meets this requirement.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

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