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The nuts and bolts of querying the National Practitioner Data Bank

Credentialing & Verification Update, May 23, 2007

The nature of National Practitioner Data Bank (NPDB) report-triggering events varies depending on the type of reporting organization. According to the NPDB Guidebook, hospitals must report "professional review action, based on reasons related to professional competence or conduct, adversely affecting clinical privileges for a period longer than 30 days; or voluntary surrender or restriction of clinical privileges while under, or to avoid, investigation."

The NPDB Guidebook defines a professional review action as "an activity of a healthcare entity with respect to an individual physician, dentist, or other healthcare practitioner: (1) to determine whether the physician, dentist, or other healthcare practitioner may have clinical privileges with respect to, or membership in, the entity; (2) to determine the scope or conditions of such privileges or membership; or (3) to change or modify such privileges or membership."

Before querying the NPDB, hospitals and other eligible organizations must first register to receive information and authorization. This can be accomplished via the Web site (www.npdb-hipdb.hrsa.gov/register.html). Failure to register does not excuse an organization from the required querying and reporting obligations.

To query the NPDB, entities must use the IQRS, an electronic, Web-based system for querying and reporting. The NPDB does not accept written requests for information from hospitals and other heathcare entities. Currently, the cost of an electronic query and response is $4.75 per name, which must be paid by credit card or electronic funds transfer. Practitioners who wish to self-query may do so online for an $8.00 fee.

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