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

When a medical school no longer exists, recognized national repositories such as the AMA Physician Master File or ECFMG (for foreign graduates) that maintain historical education records are acceptable alternative PSV sources.

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

NCQA requires that primary source verifications be no more than 180 days old at the time of the credentialing committee review or the approval decision.

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 current program director or program administrator/coordinator, as authorized representatives of the sponsoring institution, can provide primary source verification of residency completion even if the original program director has left.

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

Direct verification with the insurance carrier confirms that coverage is currently active, the policy has not been cancelled or modified, and the stated limits are accurate, information that a practitioner-provided certificate may not reflect.

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

Under NCQA standards, a recognized equivalent is an agent or intermediary that obtains information directly from the primary source, such as a credentials verification organization (CVO) that contacts primary sources on behalf of the credentialing organization.

CPCS - Certified Provider Credentialing Specialist Practice Test

CPCS - Certified Provider Credentialing Specialist Practice Test

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