Scenario
Which element is not required for CAMPBELL, JANICE L – 3463537?
Hospital privileges are not required because CRNAs are not included in the provider categories requiring hospital privileges.
Per the state and federal credentialing grid, hospital privileges apply to the following provider types:
Review NDB: You receive a credentialing request for the following provider for the state of Florida (FL) under TIN 26‑2909414. Would you submit this request for a Site Visit (SV)?
No, a site visit should not be submitted because the provider is delegated, credentialing is not needed.
What is the correct order to work your files off the inventory report?
Since there have been several technology issues over the last couple of months, what is the catchphrase that Zaimah and Nicole have both reiterated lately?
“See something, say something.”
Explanation: If you notice anything unusual, inconsistent, or not working as expected, you should notify someone to reveiw it.
Which team member has a work anniversary next month?
Tanie
You received a new credentialing request for:
Question:
Would you start the credentialing process?
No, you would not start credentialing at this time.
Explanation
Since there is an active AR currently processing, the correct action is change your CC status to 319 and send an email to PSV_restart.
Review Olivia Johnson, who works under TIN 27‑2039417 in Indiana. Can you explain why a site visit is not required for this provider?
Olivia Johnson practices at a specialty clinic and works under the supervision of a specialist in Thoracic Vascular Surgery. Site visits are not required for specialty practices, as long as the provider is operating within a supervised specialty setting and not practicing in a primary care.
On what screen in NDB do you add or change the credentialing contact’s email address?
The email address is added or updated on the I‑L‑Z screen.
Steps
If a Nurse Practitioner (NP) indicates they are Board Certified on the replica app for a recred CC, do we need to verify the board certification?
No. Board certification verification is not required for Nurse Practitioners during recredentialing.
Which team member has a daughter named Ellia?
Nicole — our fearless leader! 😄
If you called a credentialing contact and they began asking about UnitedHealthcare (UHC) credentialing rules and regulations, where would you direct them to find this information?
On UHCProvider.com, under the “Join the Network” section, the cred contact can access the UnitedHealthcare Credentialing Plan (2025–2027). This document outlines the official credentialing rules, requirements, policies, and regulatory standards used by UnitedHealthcare.
When checking I‑R‑Z, which of the following scores indicate that a new Site Visit is required?
Possible Scores
A new Site Visit is required for the following scores:
Which providers are not required to have Hospital Privileges or Admitting Arrangements?
Per the state & federal grid, the following provider types are not required to have hospital privileges or admitting arrangements:
For a virtual provider requesting credentialing in Pennsylvania (PA), is a collaborating agreement required?
Yes. A collaborating agreement is required.
Even for virtual care in PA, the collaborating agreement requirement remains in effect, while DEA and hospital privileges may be waived.
How many team members work 10‑hour shifts?
Three (3) team members work 10‑hour shifts:
If you received a credentialing request for a new provider requesting Commercial and Medicare products under TIN 39‑3464594, are you able to start credentialing?
No, credentialing cannot be started because there is not an active group contract under the TIN and the FL market is closed for the requested product.
Review CC‑001308623 and explain why a Site Visit (SV) is not required.
A site visit is not required because the provider operates as a virtual provider for the state of New Jersey (NJ).
You have a Florida (FL) credentialing cycle for EI / MR / CS. You have made two outreaches for the Patient Attestation form but have received no response. How do you close out this file?
The Patient Attestation form is a C&S requirement. Therefore, the file may be split, with EI/MR approved and C&S denied due to the missing Patient Attestation.
On the Opera AI enhancement, which agents does NCC use?
For the Opera AI enhancement, NCC is expected to utilize:
How many team members have a birthday in July?
Four (4) team members have birthdays in July:
For an MD provider who is not Board Certified (BC), if you are unable to find residency program information on FREIDA, how would you verify the provider’s education?
You could research the residency program directly on the internet to obtain the contact information.
Why does CC‑001258538 not require a Site Visit (SV)?
A site visit is not required because the credentialing request is only for PA products under EI, MR, and VACCN. Site visit requirements apply only to the CS line of business
Per the state and federal grid, which degree types require a DEA?
The following degree types require a DEA:
What is the one document that should be attached to all credentialing cycles?
The NPDB (National Practitioner Data Bank) report.
Who on our team was the Employee of the Month for the months of February and March?
Alfreda was the Employee of the Month for both February and March.