NCQA
NCQA
NCQA
NCQA
NCQA
100
What is the NCQA requirement regarding verification of work history?
A minimum of five years of relevant work history must be obtained through the practitioner's application or CV but does not require PSV of work history.
100
T/F The appropriate specialty board is an approved primary source for verification of education of dentists, according to NCQA requirements.
True
100
According to NCQA standards, which of the following sources can be used for verification of state licensure?
State licensing board
100
T/F Does NCQA specifically require a Peer Recommendation?
False
100
What is the highest level of education and training that the NCQA will accept as verification of education and training?
Board Certification
200
According to NCQA standards, which is an acceptable source for primary source verification of Medicare and Medicaid sanction activity against physicians?
FSMB
200
Per NCQA standards, who must be credentialed?
All licensed practitioners or groups of practitioners who provide care to the organization's members and practitioners who are certified or registered by the state to practice independently and provide care to the organization's members.
200
According to NCQA standards, which of the following criteria must be met prior to the granting of temporary privileges?
1. PSV of license 2. Completed application and signed attestation 3. Written confirmation of past five years of malpractice settlements, either from carrier or NPDB
200
Which accreditation bodies have standards for medical record documentation and confidentiality?
The Joint Commission and NCQA
200
Per NCQA standards, what is the time limit for provisional credentialing?
60 days
300
According to NCQA standards, a copy of which of the following is acceptable certification of the document.
Medical school diploma
300
According to NCQA standards, which of the following credentials MUST be obtained at the time of credentialing?
Current malpractice insurance certificate
300
T/F Does NCQA specifically permit Designated Equivalent Sources?
True
300
According to NCQA standards, an organization must verify sanctions or limitations on licensure in each state where the practitioner holds, or has ever held, licensure.
False. Only licenses in each state where the practitioner provides care for its members.
300
T/F Managed care organizations are accredited by URAC and NCQA.
True
400
T/F NCQA does not specifically require that Medicare/Medicaid sanctions be reviewed?
False
400
According to NCQA, which policies MUST an organization have in place to obtain approval to enter into a delegated credentialing agreement?
Credentialing policies
400
According to NCQA requirements, delegated credentialing is permitted under a written delegation document that includes?
1. Be mutually agreed upon 2. Describe the delegated activities 3. Describe the responsibilities of the organization and the delegated entity
400
According to NCQA requirements, the verification time limit for work history is:
365 calendar days for Health Plan; 305 calendar days for CVO; MA Deeming Surveys 180 calendar days
400
What gap length must be documented, per NCQA requirements?
Greater than six months
500
How many years' work history is required by NCQA?
Five
500
When verifying licensure sanctions for physicians, NCQA allows verification to be done with NPDB, HIPDB, the appropriate state agencies and what other organization(s)?
FSMB
500
According to NCQA standards, which of the following is an approved source for verification of board certification?
State licensing agency if it conducts primary source verification
500
T/F Per NCQA standards, confirmation from the state licensing agency in lieu of verification of education, residency training and board certification may be accepted from the state licensing agency if the state licensing agency performs primary source verification of these elements and, at least annually, the organization obtains written confirmation from the state licensing agency that it performs this primary source verification.
True
500
Per NCQA standards, there is a requirement to primary source verify which of the following at time of recredentialing?
1. License 2. DEA/CDS 3. Board certification 4. Medicare/Medicaid sanctions 5. Malpractice claims
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