CPCS 2026 ACTUAL EXAM
QUESTIONS | CREDENTIALING
SPECIALIST PRACTICE TEST | A+
GUIDE
1. Which primary source is used to verify a physician’s medical education?
A. Curriculum vitae
B. State license
C. Medical school diploma
D. Personal interview
C. Medical school diploma
Primary source verification of education comes directly from the issuing institution or its
official documentation.
2. What is the main purpose of credentialing?
A. Increase hospital revenue
B. Ensure provider competence and qualifications
C. Schedule staff shifts
D. Manage billing codes
B. Ensure provider competence and qualifications
Credentialing ensures providers meet standards for safe and effective patient care.
3. Which organization accredits healthcare organizations in the U.S.?
A. CMS
B. NCQA
C. OSHA
D. FDA
B. NCQA
NCQA is a major accrediting body focusing on quality standards in healthcare
organizations.
4. What does PSV stand for?
A. Provider Service Validation
B. Primary Source Verification
C. Professional Skills Verification
D. Patient Safety Validation
B. Primary Source Verification
PSV ensures credentials are verified directly from the original issuing source.
5. How often should recredentialing typically occur?
A. Every year
B. Every 2 years
C. Every 3 years
D. Every 5 years
, C. Every 3 years
Most accrediting bodies require recredentialing every three years.
6. Which document verifies malpractice insurance coverage?
A. Certificate of insurance
B. Resume
C. License
D. DEA certificate
A. Certificate of insurance
This document confirms active malpractice coverage and limits.
7. What is privileging?
A. Hiring a physician
B. Assigning clinical responsibilities
C. Paying provider salaries
D. Reviewing patient complaints
B. Assigning clinical responsibilities
Privileging determines what procedures a provider is authorized to perform.
8. Which entity issues DEA numbers?
A. CMS
B. FDA
C. DEA
D. OSHA
C. DEA
The Drug Enforcement Administration issues DEA registration numbers.
9. What is a key component of a credentialing file?
A. Patient feedback only
B. Verified credentials
C. Billing history
D. Insurance claims
B. Verified credentials
Credentialing files must contain verified documentation of qualifications.
10. Which type of verification involves contacting the original issuer?
A. Secondary verification
B. Tertiary verification
C. Primary source verification
D. Internal verification
C. Primary source verification
This ensures authenticity by confirming directly with the issuing body.
11. What does NPDB stand for?
A. National Provider Database
B. National Practitioner Data Bank
C. National Patient Data Board
D. Nurse Practitioner Data Bank
B. National Practitioner Data Bank
NPDB tracks malpractice payments and adverse actions.
12. What is the purpose of the NPDB?
A. Billing management
, B. Credential verification
C. Reporting malpractice and disciplinary actions
D. Scheduling appointments
C. Reporting malpractice and disciplinary actions
It helps organizations identify potential risks in providers.
13. Which item must always be current in a credentialing file?
A. Resume
B. License
C. Training certificates
D. References
B. License
An active, valid license is essential for practice.
14. What is the CAQH used for?
A. Billing
B. Credentialing data repository
C. Insurance claims
D. Patient records
B. Credentialing data repository
CAQH stores provider information for credentialing purposes.
15. What does CMS stand for?
A. Clinical Management System
B. Centers for Medicare & Medicaid Services
C. Credentialing Management Services
D. Central Medical System
B. Centers for Medicare & Medicaid Services
CMS oversees federal healthcare programs and sets standards.
16. What is the first step in the credentialing process?
A. Committee review
B. Application submission
C. Privileging
D. Contracting
B. Application submission
The provider must first submit a complete application.
17. Which committee reviews credentialing applications?
A. Finance committee
B. Credentialing committee
C. Ethics committee
D. Audit committee
B. Credentialing committee
This group evaluates qualifications and makes recommendations.
18. What is a red flag in credentialing?
A. Active license
B. Clean malpractice record
C. Gaps in employment history
D. Board certification
QUESTIONS | CREDENTIALING
SPECIALIST PRACTICE TEST | A+
GUIDE
1. Which primary source is used to verify a physician’s medical education?
A. Curriculum vitae
B. State license
C. Medical school diploma
D. Personal interview
C. Medical school diploma
Primary source verification of education comes directly from the issuing institution or its
official documentation.
2. What is the main purpose of credentialing?
A. Increase hospital revenue
B. Ensure provider competence and qualifications
C. Schedule staff shifts
D. Manage billing codes
B. Ensure provider competence and qualifications
Credentialing ensures providers meet standards for safe and effective patient care.
3. Which organization accredits healthcare organizations in the U.S.?
A. CMS
B. NCQA
C. OSHA
D. FDA
B. NCQA
NCQA is a major accrediting body focusing on quality standards in healthcare
organizations.
4. What does PSV stand for?
A. Provider Service Validation
B. Primary Source Verification
C. Professional Skills Verification
D. Patient Safety Validation
B. Primary Source Verification
PSV ensures credentials are verified directly from the original issuing source.
5. How often should recredentialing typically occur?
A. Every year
B. Every 2 years
C. Every 3 years
D. Every 5 years
, C. Every 3 years
Most accrediting bodies require recredentialing every three years.
6. Which document verifies malpractice insurance coverage?
A. Certificate of insurance
B. Resume
C. License
D. DEA certificate
A. Certificate of insurance
This document confirms active malpractice coverage and limits.
7. What is privileging?
A. Hiring a physician
B. Assigning clinical responsibilities
C. Paying provider salaries
D. Reviewing patient complaints
B. Assigning clinical responsibilities
Privileging determines what procedures a provider is authorized to perform.
8. Which entity issues DEA numbers?
A. CMS
B. FDA
C. DEA
D. OSHA
C. DEA
The Drug Enforcement Administration issues DEA registration numbers.
9. What is a key component of a credentialing file?
A. Patient feedback only
B. Verified credentials
C. Billing history
D. Insurance claims
B. Verified credentials
Credentialing files must contain verified documentation of qualifications.
10. Which type of verification involves contacting the original issuer?
A. Secondary verification
B. Tertiary verification
C. Primary source verification
D. Internal verification
C. Primary source verification
This ensures authenticity by confirming directly with the issuing body.
11. What does NPDB stand for?
A. National Provider Database
B. National Practitioner Data Bank
C. National Patient Data Board
D. Nurse Practitioner Data Bank
B. National Practitioner Data Bank
NPDB tracks malpractice payments and adverse actions.
12. What is the purpose of the NPDB?
A. Billing management
, B. Credential verification
C. Reporting malpractice and disciplinary actions
D. Scheduling appointments
C. Reporting malpractice and disciplinary actions
It helps organizations identify potential risks in providers.
13. Which item must always be current in a credentialing file?
A. Resume
B. License
C. Training certificates
D. References
B. License
An active, valid license is essential for practice.
14. What is the CAQH used for?
A. Billing
B. Credentialing data repository
C. Insurance claims
D. Patient records
B. Credentialing data repository
CAQH stores provider information for credentialing purposes.
15. What does CMS stand for?
A. Clinical Management System
B. Centers for Medicare & Medicaid Services
C. Credentialing Management Services
D. Central Medical System
B. Centers for Medicare & Medicaid Services
CMS oversees federal healthcare programs and sets standards.
16. What is the first step in the credentialing process?
A. Committee review
B. Application submission
C. Privileging
D. Contracting
B. Application submission
The provider must first submit a complete application.
17. Which committee reviews credentialing applications?
A. Finance committee
B. Credentialing committee
C. Ethics committee
D. Audit committee
B. Credentialing committee
This group evaluates qualifications and makes recommendations.
18. What is a red flag in credentialing?
A. Active license
B. Clean malpractice record
C. Gaps in employment history
D. Board certification
