Certified Provider Credentialing Specialist (CPCS) study guide | 2025-2026
LATEST UPDATED|226 ACTUAL EXAM COMPLETE QUESTIONS AND
ANSWERS | 100% RATED CORRECT | 100% VERFIED | ALREADY
GRADED A+
Are limitations of the clinical privileges of a psychiatrist for more than 30 days
reportable to the NPDB? - (answer)Yes
According to TJC, who may amend the medical staff bylaws? - (answer)Governing
body/board.
Failure to meet the established qualifications and criteria for appointment should
be reported to whom? - (answer)The applicant
NCQA requires the MCO to obtain a minimum of how may years of work history?
- (answer)Five years
According to the NCQA what policy must an organization have in place to obtain
approval to enter into a delegated agreement? - (answer)Credentialing policies
,How often does the OIG report to the NPDB? - (answer)Monthly
When must hospitals query the NPDB? - (answer)Initial appointment, granting of
privileges, every two years.
NCQA requires verifications must be less than how many days old? - (answer)180
days
What is the verification time limit on malpractice history according to the NCQA?
- (answer)180 days
Time limited credential must be verified by the CVO with how may days prior to
submission to the client? - (answer)120 days
,According the AAAHC, for initial appointments, in addition to licensure and
education, what verification is required? - (answer)Experience and hospital
affiliations.
What accreditation body states "The NPDB is an acceptable source for sanctions or
limitations on licensure, Medicaid/ Medicare sanctions and malpractice history? -
(answer)NCQA
Who is required to query the NPDB? - (answer)Hospitals
Is disciplinary action taken against the license of a dentist reportable to the NPDB?
- (answer)Yes
Under HCQIA a hospital failure to report an adverse privilege action lasting longer
than 30 days may cause the organization to lose HCQIA immunity for how many
years? - (answer)3 years
, According to NCQA, verification of Medicare/Medicaid sanctions can be queried
by any of what sources? - (answer)AMA, FSMB, HIPDB, OIG Sanctions Report,
NPDB, State Agency
According to NCQA, how often must an organization conduct an audit of the
credentialing process delegated to another organization? - (answer)Annually
How far back does TJC require evaluation of malpractice history? - (answer)Back
to medical school
According to TJC, what source may be used to evaluate malpractice history? -
(answer)NPDB
Is an internet verification from a website not contracted by the primary source that
attests to the accuracy and timeliness of the information considered a complete
verification by NCQA? - (answer)No
LATEST UPDATED|226 ACTUAL EXAM COMPLETE QUESTIONS AND
ANSWERS | 100% RATED CORRECT | 100% VERFIED | ALREADY
GRADED A+
Are limitations of the clinical privileges of a psychiatrist for more than 30 days
reportable to the NPDB? - (answer)Yes
According to TJC, who may amend the medical staff bylaws? - (answer)Governing
body/board.
Failure to meet the established qualifications and criteria for appointment should
be reported to whom? - (answer)The applicant
NCQA requires the MCO to obtain a minimum of how may years of work history?
- (answer)Five years
According to the NCQA what policy must an organization have in place to obtain
approval to enter into a delegated agreement? - (answer)Credentialing policies
,How often does the OIG report to the NPDB? - (answer)Monthly
When must hospitals query the NPDB? - (answer)Initial appointment, granting of
privileges, every two years.
NCQA requires verifications must be less than how many days old? - (answer)180
days
What is the verification time limit on malpractice history according to the NCQA?
- (answer)180 days
Time limited credential must be verified by the CVO with how may days prior to
submission to the client? - (answer)120 days
,According the AAAHC, for initial appointments, in addition to licensure and
education, what verification is required? - (answer)Experience and hospital
affiliations.
What accreditation body states "The NPDB is an acceptable source for sanctions or
limitations on licensure, Medicaid/ Medicare sanctions and malpractice history? -
(answer)NCQA
Who is required to query the NPDB? - (answer)Hospitals
Is disciplinary action taken against the license of a dentist reportable to the NPDB?
- (answer)Yes
Under HCQIA a hospital failure to report an adverse privilege action lasting longer
than 30 days may cause the organization to lose HCQIA immunity for how many
years? - (answer)3 years
, According to NCQA, verification of Medicare/Medicaid sanctions can be queried
by any of what sources? - (answer)AMA, FSMB, HIPDB, OIG Sanctions Report,
NPDB, State Agency
According to NCQA, how often must an organization conduct an audit of the
credentialing process delegated to another organization? - (answer)Annually
How far back does TJC require evaluation of malpractice history? - (answer)Back
to medical school
According to TJC, what source may be used to evaluate malpractice history? -
(answer)NPDB
Is an internet verification from a website not contracted by the primary source that
attests to the accuracy and timeliness of the information considered a complete
verification by NCQA? - (answer)No
