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Guidebook Cover Page

Chapter A: Introduction and General Information

Eliminating Duplication Between the NPDB and HIPDB Laws Governing NPDB Operations

Disclosure of NPDB Information Interpretation of NPDB Information Civil Liability Protection Confidentiality and Security of NPDB Information

Fees Official Language Terminology Differences Q&A: General Information

Q&A 1 Q&A 2 Q&A 3

Chapter B: Eligible Entities

Overview What is an Eligible Entity? Defining Eligible Entities

Boards of Medical Examiners Drug Enforcement Administration and HHS Office of Inspector General Federal Agencies Health Care Entities Health Plans Medical Malpractice Payers Peer Review Organizations Private Accreditation Organizations Professional Societies Quality Improvement Organizations State Agencies Administering or Supervising the Administration of State Health Care Programs State Law Enforcement Agencies State Law or Fraud Enforcement Agencies State Licensing and Certification Authorities State Licensing Boards State Medicaid Fraud Control Units

Registering with the NPDB

E-authentication and Identity Proofing Certifying Official Administrator Registration Renewal

Data Bank Identification Numbers (DBIDs)

Deactivating a DBID Lost DBID

Update Entity Information Those Who May Report and Query on Behalf of Eligible Entities

Authorized NPDB Users Authorized Agents

Q&A: Eligible Entities

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7 Q&A 8 Q&A 9 Q&A 10 Q&A 11

Chapter C: Subjects of Reports

Overview Definitions Self-Queries Subject Information

Correcting an Address Correcting Information in the Report

Q&A: Subjects of Reports

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5

Chapter D: Queries

Overview

Hospitals Other Health Care Entities Agencies Administering Government Health Care Programs, Including Private Entities Administering Such Programs Under Contract Federal Law Enforcement Officials and Agencies Federal Licensing and Certification Agencies Health Plans Professional Societies Quality Improvement Organizations State Agencies Administering or Supervising the Administration of a State Health Care Program State Law Enforcement Agencies and State Medicaid Fraud Control Units State Licensing and Certification Agencies State Medical Boards of Examiners or Other State Authorities that License Health Care Practitioners Health Care Practitioners, Entities, Providers, and Suppliers Attorney Access

Authorized Agents Centralized Credentialing Delegated Credentialing Submitting a Query

Querying Through an Authorized Agent Subject Information

Query Processing

Subject Database Query Responses Missing Query Responses Notifying the NPDB of a Missing Report

Retrieving Historical Query Summaries Confidentiality Q&A: Queries

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7 Q&A 8 Q&A 9 Q&A 10 Q&A 11 Q&A 12

Chapter E: Reports

Overview

Reporting Requirements Terminology Differences Time Frame for Reporting Deceased Practitioners Report Retention Civil Liability Protection Official Language

Submitting Reports to the NPDB

Report Formats Types of Reports Notice of Appeal Narrative Descriptions Methods for Submitting a Report Report Processing Submitting a Copy of the Report to the Appropriate State Licensing Board or State Licensing or Certification Authority IQRS Draft Capability Subject Database Retrieving Historical Report and Query Summaries Q&A: Submitting Reports

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7

Reporting Medical Malpractice Payments

Interpretation of Medical Malpractice Payment Information Payments by Individuals Payments for Corporations and Hospitals Identifying Practitioners Written Complaint or Claim Dismissal of a Defendant from a Lawsuit Confidential Terms of a Settlement or Judgment Insurance Policies that Cover More than One Practitioner One Payment for More than One Practitioner Residents and Interns Students Practitioner Fee Refunds Waiver of Debt Loss Adjustment Expenses High-Low Agreements Payments by Multiple Payers Subrogation-Type Payments Structured Settlements Offshore Payers Payments Made Prior to Settlement Reporting of Medical Malpractice Payments by Authorized Agents Submitting a Copy of the Report to the State Licensing Board Sanctions for Failing to Report to the NPDB Q&A: Reporting Medical Malpractice Payments

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7 Q&A 8 Q&A 9 Q&A 10 Q&A 11 Q&A 12 Q&A 13 Q&A 14 Q&A 15

Reporting Adverse Clinical Privileges Actions

Administrative Actions Multiple Adverse Actions Denials or Restrictions Withdrawal of Applications Nonrenewals Investigations Temporary Clinical Privileges Summary Suspensions Proctors Residents and Interns Confidentiality Laws Related to Drug and Alcohol Treatment Submitting a Copy of the Report to a State Licensing Board Sanctions for Failing to Report to the NPDB Q&A: Reporting Clinical Privileges Actions

Reporting Adverse Professional Society Membership Actions

Submitting a Copy of the Report to the State Licensing Board Sanctions for Failing to Report to the NPDB Q&A: Reporting Professional Society Membership Actions

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7

Reporting State Licensure and Certification Actions

Formal Proceeding Certification Administrative Fines and Formal Money Penalties Publicly Available Information Stayed Actions Summary or Emergency Suspensions and Other Nonfinal Actions Denials of Initial and Renewal Applications Withdrawals or Nonrenewals of Applications While Under Investigation Voluntary Surrenders Consent Agreement Confidentiality Laws Related to Drug and Alcohol Treatment Nurse Licensure Compact Sanctions for Failing to Report Q&A: Reporting State Licensure and Certification Actions

Reporting Federal Licensure and Certification Actions

Certification Administrative Fines and Formal Money Penalties Publicly Available Information Stayed Actions Denials of Initial and Renewal Applications Withdrawal of Application While Under Investigation Voluntary Surrender of License Confidentiality Laws Related To Drug and Alcohol Treatment Sanctions for Failing to Report to the NPDB Q&A: Reporting Federal Licensure or Certification Actions

Q&A 1 Q&A 2 Q&A 3 Q&A 4

Reporting Peer Review Organization Negative Actions or Findings

Submitting a Copy of the Report to the State Licensing or Certification Authority Q&A: Reporting Peer Review Organization Negative Actions or Findings

Q&A 1 Q&A 2 Q&A 3 Q&A 4

Reporting Private Accreditation Organizations Negative Actions or Findings

Submitting a Copy of the Report to the State Licensing or Certification Authority Q&A: Reporting Private Accreditation Organizations Negative Actions or Findings

Q&A 1 Q&A 2 Q&A 3

Reporting Exclusions from Participation in Federal and State Health Care Programs

Sanctions for Failing to Report Q&A: Reporting Exclusions from Federal and State Health Care Programs

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5

Reporting Federal or State Health Care-Related Criminal Convictions

Nolo Contendere/No Contest Plea Injunctions First Offender, Deferred Adjudication, or Other Arrangement or Program Where Conviction Has Been Withheld Sanctions for Failing to Report to the NPDB Q&A: Reporting Federal or State Healthcare-Related Criminal Convictions

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7

Reporting Health Care-Related Civil Judgments

Sanctions for Failing to Report to the NPDB Q&A: Reporting Civil Judgments

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5

Reporting Other Adjudicated Actions or Decisions

Other Adjudicated Actions or Decisions Taken in Conjunction with Clinical Privileges Actions Sanctions for Failing to Report to the NPDB Q&A: Reporting Other Adjudicated Actions or Decisions

Q&A 1 Q&A 2 Q&A 3 Q&A 4 Q&A 5 Q&A 6 Q&A 7 Q&A 8 Q&A 9

Chapter F: Subject Statements and the Dispute Process

Chapter H: Information Sources

NPDB Customer Service Center NPDB Addresses

General Information Aggregate Research Data Interpretation of NPDB Statutes and Regulations

Federal Employer Identification Number

Appendix A: Glossary

Appendix B: Acronym Guide

Download the NPDB Guidebook (PDF - 3.0 MB)

Appendix B: Acronym Guide

ACO

Accountable Care Organization

CDS

Controlled Dangerous Substance

CEU

Continuing Education Unit

CFR

Code of Federal Regulations

CLIA

Clinical Laboratory Improvement Amendments

CMS

Centers for Medicare & Medicaid Services

CVO

Credentials Verification Organization

DBID

Data Bank Identification Number

DCN

Data Bank Control Number

DEA

Drug Enforcement Administration

DOD

Department of Defense

DOJ

Department of Justice

DPDB

Division of Practitioner Data Bank

DVA

Department of Veterans Affairs

EFT

Electronic Funds Transfer

EHR

Electronic Health Record

HCQIA

Health Care Quality Improvement Act of 1986

HHS

Department of Health and Human Services

HIPDB

Healthcare Integrity and Protection Data Bank

HMO

Health Maintenance Organization

IQRS

Integrated Querying and Reporting Service

LAE

Loss Adjustment Expense

MCO

Managed Care Organization

MEC

Medical Executive Committee

MMPR

Medical Malpractice Payment Report

NLC

Nurse Licensure Compact

NPDB

National Practitioner Data Bank

OIG

Department of Health and Human Services, Office of Inspector General

PCMH

Patient-Centered Medical Home

PPO

Preferred Provider Organization

QIO

Quality Improvement Organization

QRXS

Querying and Reporting XML Service

Guidebook Cover Page

Chapter A: Introduction and General Information

Chapter B: Eligible Entities

Chapter C: Subjects of Reports

Chapter D: Queries

Chapter E: Reports

Chapter F: Subject Statements and the Dispute Process

Chapter G: Fees

Chapter H: Information Sources

Appendix A: Glossary

Appendix B: Acronym Guide

Appendix B: Acronym Guide

HRSA & HHS

NPDB

NPDB Insights

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