CPCS - Certified Provider Credentialing Specialist Credentialing Information Management Questions and Answers Flashcards
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A credentialing specialist receives a CAQH ProView profile that was last attested 7 months ago. What action should be taken?
Answer: Contact the practitioner to update and re-attest the profile before using it for credentialing
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.
Which of the following is the best practice for managing expirables (licenses, DEA certificates, malpractice insurance) in a credentialing database?
Answer: Set automated alerts at 90 and 30 days before expiration
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.
Under HIPAA, a practitioner's credentialing file is best classified as which type of record?
Answer: Quasi-administrative record with specific confidentiality protections
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.
What does a 'credentialing file completeness checklist' primarily ensure?
Answer: That all required verification elements are present before the file is sent to committee
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.
Which of the following describes the primary advantage of using a centralized credentialing database over paper-based files?
Answer: Enables real-time expirable tracking, audit trails, and automated reporting
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.
A health plan's credentialing policy requires that copies of primary source verifications be retained for a minimum of 10 years. This retention requirement is most likely driven by which factor?
Answer: State insurance regulations and accreditation standards
Credentialing record retention requirements are primarily driven by state insurance regulations and accreditation standards (NCQA, URAC), which specify minimum retention periods for credentialing documentation.