Certified Provider Credentialing Specialist (CPCS) Practice Exam 2025 - Free CPCS Practice Questions and Study Guide

Before provisional credentialing can be granted by the National Committee for Quality Assurance (NCQA), it is essential to verify both a current license and a five-year malpractice history. This requirement ensures that the provider not only possesses the necessary active licensure to practice but also has a clean record regarding malpractice claims over the past five years, which reflects their professional conduct and risk profile.

Having a current license confirms that the provider is legally authorized to offer services, which is fundamental to patient safety and quality of care. The five-year malpractice history provides insight into any past incidents that may indicate a pattern of concern or risk. Both elements together help organizations make informed decisions about allowing provisional privileges to a provider while additional comprehensive credentialing processes are completed.

This combination of checks is crucial in maintaining the integrity of healthcare services and safeguarding patients, which is why it is a stipulation prior to provisional credentialing in the NCQA framework.