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Overview Submitting Reports to the NPDB Reporting Medical Malpractice Payments Reporting Adverse Clinical Privileges Actions Reporting Adverse Professional Society Membership Actions Reporting State Licensure and Certification Actions Reporting Federal Licensure and Certification Actions Reporting Peer Review Organization Negative Actions or Findings Reporting Private Accreditation Organization Negative Actions or Findings Reporting Exclusions from Participation in Federal or State Health Care Programs Reporting Federal or State Health Care-Related Criminal Convictions Reporting Health Care-Related Civil Judgments Reporting Other Adjudicated Actions or Decisions

Q&A: Reporting state Licensure and Certification Actions

  1. A state Medicaid agency terminated the contract for participation of one of its Medicaid MCOs after holding formal hearings and determining that the MCO had not maintained a sufficient network of providers to meet the state's access and quality requirements. Should the state agency report this action to the NPDB?

    Yes. Any adverse action taken against a health care practitioner, entity, provider, or supplier by a licensing or certification authority of the state as a result of a formal proceeding, including revocations or suspensions of a certification agreement or contract for participation in a government health care program, must be reported to the NPDB. This termination of the MCO's contract for participation in the state's Medicaid program should be reported to the NPDB as a government Administrative action on the Adverse Action Report format.

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