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NPDB 101 Webinar

The NPDB 101 Webinar was held on May 3, 2022.

Watch the recording for the NPDB 101 Webinar exit icon (video - 1:14:26)

Event Materials: Presentation Slides (PDF - 735 KB)

Q&As

  1. What types of reports does the NPDB have on unlicensed practitioners?
    The NPDB requires that reports be submitted on health care practitioners, providers, and suppliers. The practitioner definition includes not only those who are licensed to provide health care services, but those who are otherwise authorized by a state to provide health care services. The definition also includes those who hold themselves out to be so licensed or authorized.
    State licensure and certification actions taken against unlicensed individuals meeting the above criteria that result from a formal proceeding must be reported to the NPDB. When reporting an action against an unlicensed individual, select "No License" on the licensure information screen and select the field of licensure claimed by the individual for the Occupation/Field of Licensure category.
    Another example is a federal hospital employing an "unlicensed" nurse aide. That unlicensed nurse aide might still be certified or otherwise authorized by the state to provide health care services. If the federal hospital fires that nurse aide for stealing medication from a patient, that federal hospital would be required to report a government administrative action to the NPDB.

  2. How do I store practitioner information in the NPDB for future use?
    A subject database allows you to store identifying information about a practitioner or organization and use it later to pre-populate query or report forms. The following steps will allow you to store information about practitioners in the NPDB, i.e. in the subject database:
    1. Sign into the NPDB.
    2. From the Select an Option page, select Maintain Subject Database.
    3. If Maintain Subject Database is not an option, select Query, then select Maintain Subject Database.
      Note: To import subject information from your organization's in-house subject database, select Import File. The Import Subject Information page appears. Follow the online instructions.
    4. To create, update, or edit your subject database, select Maintain Subject Database on the Maintain Subject Database page.
    5. On the Subject Maintenance Type page, update practitioner and organization information. You can add, edit or delete practitioner (or organization subject) information on the Subject Maintenance Type page. The information maintained in your subject database profile pre-populates the subject information section in the report form and allows a querier to select the subject's name from the subject database to submit a query, saving you time.
    6. To have a valid practitioner record, you must store the practitioner's last name, first name, gender, date of birth, valid home or work address, occupation or field of licensure, and either a valid Social Security Number (SSN), valid Individual Taxpayer Identification Number (ITIN), or a valid state license number, state of licensure, and professional school with year of graduation. To have a valid organization subject you must store the organization's name, a valid address, a valid organization type code and either a Federal Employer Identification Number (FEIN), ITIN, or a valid state license number and state of licensure.
    7. Prior to storing the information, select Validate Without Storing. If all required information is complete, select Ok.
    8. Select Store to save the information. If information is still needed, the record is considered incomplete and is not available for querying. Complete the required fields, and select Validate Without Storing again. Once valid and complete, select Store.

  3. I'm querying the same practitioner at multiple sites. How many queries do I need to run and who can I share the results with?
    An NPDB query response must be used solely for the purpose for which it was provided. Information from the NPDB can be shared with those that are part of the investigation, hiring, or credentialing process. They may not be shared for other purposes. A single query can be used for a health care system provided the health care system:
    • Provides for centralized credentialing;
    • Has a centralized peer review process;
    • Has one decision-making body; and
    • Has one unified medical staff.

  4. How can I run multiple queries on the same healthcare practitioner for different entities as a Credentials Verification Organization/Agent?
    CVOs/Agents must query separately on behalf of each entity they represent. The response to an NPDB query submitted for one entity cannot be disclosed to another entity. The NPDB allows these CVOs/Agents to query the same person for multiple sites at the same time. First, they complete the information for the subject, then they can select the appropriate entities that have authorized the agent to query on their behalf. The NPDB will then process a separate query on that particular subject for each of the specified list of entities. Queries/enrollments for each entity are billed separately and are assigned different confirmation numbers.

  5. Who is responsible to report to NPDB?
    Access our Reportable Actions page to find out who is responsible to report to the NPDB.

  6. What are some examples of situations in which accrediting organizations may be required to report practitioners who do not pass the credentialing process?
    Private accreditation organizations do not report health care practitioners to the NPDB. Private accreditation organizations are required to report certain negative actions or findings against health care entities, providers, and suppliers. These negative actions or findings are defined in NPDB regulations as a final determination of denial or termination of an accreditation status that indicates a risk to the safety of a patient, or to quality of health care services. The actions taken must be as a result of formal proceedings. The health care entity, provider, or supplier must be otherwise authorized by the state to provide health care services.

  7. If a provider pays a claim out of pocket, does it still get reported to the NPDB?
    Individuals should not report to the NPDB payments they make for their own benefit. Thus, if a practitioner or other individual makes a medical malpractice payment out of personal funds, the payment should not be reported. However, a professional corporation or other entity composed of a sole practitioner that makes a payment for the benefit of a named practitioner must report that payment to the NPDB.

  8. How do I find out more information about an action a state board took and reported?
    The NPDB report will always include:
    • The action (can be multiple): what action was taken;
    • The basis for action (can be multiple): why the entity took the action;
    • The narrative; and
    • The subject statement.
    If you wish to learn more after viewing the report you should go directly to the state board for clarification.

  9. Which civil judgments and criminal convictions should be reported to the NPDB?
    Federal, state, and local prosecutors must report criminal convictions and civil judgments against health care practitioners, providers, or suppliers related to the delivery of health care items or services, regardless of whether they are the subjects of pending appeals.
    For NPDB purposes, a reportable criminal conviction includes:
    • A judgment or conviction that has been entered against an individual or entity in a federal, state, or local court, regardless of whether an appeal is pending or the conviction or other record relating to criminal conduct has been expunged
    • A finding of guilt against an individual or entity that is made in a federal, state, or local court
    • A plea of guilty or nolo contendere by an individual or entity that has been accepted by a federal, state, or local court
    • When an individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where conviction has been withheld
    NPDB regulations define civil judgment as "a court-ordered action rendered in a federal or state court proceeding, other than a criminal proceeding. This reporting requirement does not include consent judgments that have been agreed upon and entered to provide security for civil settlements in which there was no finding or admission of liability."
    For both judgments and convictions, settlements in which no findings of liability have been made are statutorily excluded from being reported. However, actions that occur in conjunction with settlements in which no findings of liability have been made and that otherwise meet NPDB reporting requirements must be reported.
    Additionally, actions made with respect to medical malpractice claims should not be reported as civil judgments, but any payment made for the benefit of a health care practitioner in settlement of a medical malpractice claim or judgment must be reported to the NPDB by the medical malpractice payer.

  10. When should I submit a medical malpractice payment report?
    Submit a medical malpractice payment report within 30 days of the date the payment was made.
    When a payment is made prior to a settlement or judgment, a report must be submitted within 30 days from the date the payment was made. Since the total amount of the payment is unknown, the medical malpractice payer should state this in the narrative description section of the report. When the settlement or judgment is finalized, the insurer must submit a Correction Report.

  11. How does the NPDB define delegated credentialing?
    Delegated credentialing occurs when a health care entity gives another health care entity the authority to credential its health care practitioners (e.g., a preferred provider organization [PPO] delegates its credentialing to a hospital).
    The health care entity that delegated its credentialing responsibilities (e.g., the PPO) is not considered part of the credentialing process and is not permitted to receive NPDB query results in a delegated credentialing arrangement. In contrast, a health care entity that uses an authorized agent to query on its behalf still retains responsibility for credentialing its practitioners.