Preface

The NPDB Guidebook serves as a policy manual. It is one of a number of efforts to inform the U.S. health care community and others about the National Practitioner Data Bank (NPDB) and the requirements established by the laws governing the NPDB, primarily:

• Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660 (referred to as "Title IV");
• Section 5 of the Medicare and Medicaid Patient and Program Protection Act of 1987, Public Law 100-93, codified as Section 1921 of the Social Security Act(referred to as "Section 1921"); and
• Section 221(a) of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, codified as Section 1128E of the Social Security Act (referred to as "Section 1128E").

By law, certain entities (referred to as "eligible entities") report to the NPDB, query the NPDB, or both. Eligible entities include medical malpractice payers, hospitals and other health care entities, professional societies, health plans, peer review organizations, private accreditation organizations, quality improvement organizations, and certain federal and state agencies. Health care practitioners, entities, providers, and suppliers are authorized to query on themselves for information reported to the NPDB, since they may be the subjects of NPDB reports.

Final regulations implementing the laws referenced above governing the NPDB are found at 45 CFR Part 60. The U.S. Department of Health and Human Services (HHS) is responsible for administering the NPDB.

The NPDB Guidebook is divided into broad topical sections:

• Chapter A: Introduction and General Information (this chapter) contains general information on the NPDB, including its history and information on the laws and regulations that govern it
• Chapter B: Eligible Entities describes the eligible entities that query and/or report to the NPDB directly, and the processes for registering with the NPDB
• Chapter C: Subjects of Reports details the types of individuals and organizations that may be the subjects of reports submitted to the NPDB
• Chapter D: Queries addresses querying the NPDB
• Chapter E: Reports addresses reporting to the NPDB
• Chapter F: Subject Statements and the Dispute Process outlines the procedures available through the NPDB to subjects of reports who disagree with a report in the NPDB about themselves
• Chapter G: Fees addresses NPDB fees
• Chapter H: Information Sources provides a variety of information sources about the NPDB
• Appendix A: Glossary is a glossary of terms used in this Guidebook
• Appendix B: Acronym Guide is a guide to the acronyms used in this Guidebook
• Appendix C: Change History details revisions made to this Guidebook

This edition of the NPDB Guidebook reflects the entire range of NPDB policies, including those that have changed or expanded since the NPDB opened in September 1990. It briefly describes NPDB operational features and includes links to the NPDB website for more information. This edition replaces all previous versions of the NPDB Guidebook and the HIPDB Guidebook, which governed the Healthcare Integrity and Protection Data Bank, or HIPDB (see below).