NCC Jeopardy

Scenario

100

If a PA has a Board Certification listed but you are unable to verify it, what does the SOP advise you to do?
(This applies only to an INI file.)

 

• In Board Cert, add the following comment <Unable to verify Board Certification>.
• In NDB, go to the I-C-Z screen.
  • In FUNC type C then press Enter.
  • Use F8 to page forward until the comment for the current request is displayed.
  • Under INI Credentialing Comments, add the following:
    “Unable to verify Board Certification. Source website(s): (Primary and/or any other sources used).”

200

You completed the initial outreach to obtain the provider’s hospital admitting privileges and PROMISE ID. The credentialing contact responded and provided a document containing privileged information; however, the document is in an unacceptable status for UHC. What is your next step?

• Complete a second outreach to the credentialing contact to advise that the hospital admitting privileges documentation provided does not meet UHC criteria.
• Inform them of the issue and provide an opportunity to submit acceptable documentation that meets the required standards.

 

300

What is your responsibility when verifying the OIG element if an unknown source is listed?

 

If an unknown source is listed, you are required to complete the verification using an acceptable source and update the Source field with the correct verification information.

400

A file you conducted outreach on yesterday is now showing a 152 code in NDB in addition to your 320 code. What is needed?

• The 152 code indicates that the provider may be showing as a delegated provider and is currently in an active credentialing process under NCC. This requires review to determine whether the file is being processed incorrectly.
• Review the record to confirm whether a delegated entity has been added to the provider on ITC.
• If a delegated entity has been added, follow the Delegated Credentialing SOP for next steps.

500

You are processing a recredentialing file. The provider name on the CC in SFL is Jane Renee Smith, but NDB shows Jane R. Johnson. How is this handled?

Names are not updated during recredentialing. The provider must submit documentation to HPDemo to complete the name change.

State & Federal Grid

100

Which states require site visits?

• Providers requesting Medicaid (C&S) in the following states are required to complete site visits for all practice locations and applicable specialties under the requesting TIN:
  • Florida (FL)
  • Indiana (IN)
  • Maryland (MD)
  • New Jersey (NJ)
  • Pennsylvania (PA)

200

Which website do you use to verify education for Podiatry?

Education for Doctors of Podiatric Medicine (DPMs) is verified using the Council on Podiatric Medical Education (CPME) website.

🔗 Website:
https://www.cpme.org/residencies/ResidenciesList.cfm?navItemNumber=2242#MI

300

True or False: If a provider’s hospital privilege category is restricted, you will 505 the file and deny for No Hospital Privileges or Participating Admitting Arrangements.

False. ✅
Per the Hospital Privilege Category tab, the file should be 334’d for review, not denied.

400

True or False: If you are denying a file because you did not receive a response for the current PLI, the exception reasons should be:

• Exception Reason (General): Liability Insurance
• Exception Reason (Specific): Non‑Responsive to Request for Professional Liability Insurance

False. ✅
Non‑Responsive to Request for Professional Liability Insurance is used only for facilities.
For providers, the file should be denied for No Professional Liability Insurance.

500

If a provider has a sanction for illegal drug use or chemical substance use from 2010, what are your obligations?

• If the provider discloses the sanction without a supporting explanation, you must complete outreach to verify that the question was answered correctly.
• If the provider has answered the question correctly—with or without an explanation—the file must be sent for review.

101's

100

What clues on a CC indicate that you need to select the Order Data button?

You should select the Order Data button if either of the following applies:

• A review of the historic status codes shows a 101 code listed.
• The Elements section is blank or does not display any information.

200

Would a recredentialing file have the Order Data button?

No. ✅
The 101/Order Data button is used only for INI files, not for recredentialing files.

300

Which section of the SOP directs you to select the Order Data button?

The Cred Decision Needed section under Step 8 of the SOP.

400

Which state would never require the Order Data button to be selected?

For providers in Minnesota (MCC), the Order Data button should not be selected. ✅

The following comment will automatically populate in the General Comments section of the CC:

Non‑CAQH app needs to be pulled from the appropriate portal; No MPIN could be found for the Provider, please create the MPIN; System was unable to automate all addresses, please review and take the necessary steps to resolve.

500

🎯 Daily Double (Bonus Question!) 🎯

In Omega, what activity, subcategory, and detail do you select when logging at the end of your shift?

• Activity: Exception Time
• Subcategory: Admin
• Detail: Admin Task

All Team Meeting

100

Which elements are waived for virtual providers?

he following elements are waived for virtual providers:

• DEA ✅
• Hospital Privileges ✅

200

Per the all‑team meeting on 3/31/2026, what is NCC’s job?

To build and maintain a quality network of providers and organizations

300

What is the difference between what the API does and what a CVO delivers for Primary Source Verification (PSV)?

• API:
  The API is a basic automated program that checks designated websites and returns data. Your responsibility is to validate that the information provided by the API is accurate, complete, and usable, and to ensure it is not invalid or incorrect data.

• CVO (Credentialing Verification Organization):
  A CVO performs a similar verification function to NCC, but the work is completed by an actual individual who manually pulls provider information from primary source websites. Your responsibility is to review and confirm that the CVO obtained the correct and appropriate information.

400

If a provider opts out of Medicare, how should the file be handled?

The file should not be denied in its entirety. ✅
Instead, the file should be split to exclude Medicare while allowing processing to continue for the remaining lines of business.

500

Your CC requires a Site Visit. You check SharePoint and see that a site visit is already pending. What is your next step?

On the in‑process Site Visit request, add the following comment:

“Site Visit also needed for CC# / MPIN / TIN / Provider Name / [Your Name]. Once this site visit is completed, please provide the results.”

Getting to Know the Team

100

Which team member has been with UHC the longest?

Brian 

200

Who is the youngest team member?

Diamon

300

Which team member has a rabbit as a pet?

Kishie

400

Which team member(s) live in North Carolina?

Alfreda and Katrina 

500

Whose fun fact from the Guess Who game was:

“This team member lives in the Hoosier State—where basketball is a lifestyle and corn is basically a food group.”

 

Zanetta