Initial Application Processing 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 Initial Application Processing flashcards as text
When a provider submits an initial credentialing application, what is the PRIMARY purpose of performing a primary source verification (PSV)?
Answer: To confirm credentials directly with the issuing organization
PSV involves contacting the original issuing source to confirm the accuracy and authenticity of credentials reported by the applicant.
Which element is typically NOT required on a standard initial credentialing application for a hospital medical staff?
Answer: Provider's personal investment portfolio
Personal financial or investment information is not a standard credentialing requirement; licensure, DEA, and identification numbers are standard elements.
A provider's application reveals a 6-month gap in work history. What is the credentialing specialist's MOST appropriate next step?
Answer: Request a written explanation from the provider covering the gap period
Unexplained gaps in work history require the provider to submit a written explanation to allow the credentialing committee to evaluate the circumstances.
Under the Health Care Quality Improvement Act (HCQIA), hospitals are required to query which database when making credentialing decisions?
Answer: The National Practitioner Data Bank (NPDB)
HCQIA mandates that hospitals query the NPDB when a practitioner applies for medical staff membership or clinical privileges.
What does 'attestation' mean in the context of a credentialing application?
Answer: The provider's sworn statement affirming the accuracy of submitted information
Attestation is the provider's signed declaration certifying that all information provided on the application is true and complete.
Which of the following would cause a credentialing application to be considered INCOMPLETE?
Answer: Missing signatures on required attestation sections
Missing required signatures on attestation sections means the application lacks mandatory elements and cannot be processed until complete.
How long does an organization typically have to respond once a provider submits a complete initial credentialing application, per most medical staff bylaws?
Answer: 90 days
Most medical staff bylaws specify a 90-day timeframe for the organization to complete the credentialing process after receipt of a complete application.