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 verifying a provider's medical education, which source is considered an acceptable primary source?
Answer: The American Medical Association (AMA) Physician Masterfile
The AMA Physician Masterfile is recognized as an acceptable primary source equivalent for verifying medical education and training.
A credentialing specialist receives an application from a provider with clinical privileges at another facility. What should the specialist obtain from that facility?
Answer: A current performance evaluation or letter of good standing
Requesting a current performance evaluation or letter confirming good standing from current or previous facilities is standard practice during initial credentialing.
Which organization accredits hospitals and requires compliance with credentialing standards, influencing initial application processes?
Answer: The Joint Commission (TJC)
The Joint Commission sets credentialing standards for accredited hospitals, and compliance with TJC standards shapes initial application requirements.
What is the standard timeframe that a provider has to submit a complete application after being invited to apply for medical staff membership?
Answer: 30 days
Most medical staff bylaws require the provider to submit a complete application within 30 days of receiving the application materials.
When reviewing a new application, the specialist discovers the provider has had a malpractice claim that was settled. What is the CORRECT action?
Answer: Request detailed information about the claim for committee review
Settled malpractice claims must be disclosed and reviewed; the specialist collects details so the credentialing committee can make an informed decision.
A provider applying for hospital privileges holds a license in multiple states. Which license must be verified?
Answer: All current active licenses in all states
Best practice and most accreditation standards require verification of all active state licenses a provider currently holds.
What is the role of the credentialing coordinator when a provider's DEA registration has expired during the application review?
Answer: Notify the provider and request a current, valid DEA certificate before completing verification
An expired DEA registration requires the provider to renew and submit a valid certificate before credentialing verification can be completed.