Practice Test GeeksCPCS - Certified Provider Credentialing Specialist Practice Test
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Credentialing Information Management Flashcards

7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Credentialing Information Management flashcards as text

  1. A provider fails to disclose a prior malpractice settlement on their initial application, which is later discovered during NPDB query. How should this be classified?

    Answer: A material misrepresentation that must be reported to the medical staff committee

    Failure to disclose a malpractice settlement is a material misrepresentation and must be referred to the medical staff committee per standard credentialing policy.

  2. Which element is NOT typically included in a credentialing application for a new physician?

    Answer: Personal financial statements

    Personal financial statements are not a standard component of a physician credentialing application.

  3. Under URAC standards, which of the following is required for a delegated credentialing arrangement?

    Answer: A written delegation agreement and periodic oversight audits of the delegate

    URAC requires a formal written delegation agreement and ongoing oversight audits to ensure the delegate meets the delegating entity's standards.

  4. A credentialing specialist is asked to set up a flagging system for providers approaching license renewal. What is the best practice lead time for sending the first alert?

    Answer: 90 to 120 days before expiration

    Best practice is to alert providers 90 to 120 days before expiration to allow sufficient time for renewal without lapsing privileges.

  5. A physician requests access to their own credentialing file. What is the correct response?

    Answer: Allow access to their own file per organizational policy, excluding peer references if protected

    Providers generally have the right to review their own credentialing file, though peer reference letters may be protected from disclosure per organizational policy.

  6. Which of the following credentialing data elements should be verified through the Office of Inspector General (OIG) exclusion database?

    Answer: Exclusion from federal healthcare programs

    The OIG List of Excluded Individuals/Entities (LEIE) must be checked to confirm the provider has not been excluded from federal healthcare programs.

  7. When a credentialing file is transferred from one facility to another as part of a hospital merger, what must the receiving organization do before relying on the transferred file?

    Answer: Review the file for completeness and re-verify any credentials that have expired or are near expiration

    Receiving organizations must review transferred files for completeness and re-verify any lapsed or soon-to-expire credentials before relying on them.