National Practitioner Data Bank

Healthcare Integrity and Protection Data Bank

1. Do medical staffing service organizations that employ locum tenens practitioners fulfill the definition of a "healthcare entity" and therefore qualify to register with the National Practitioner Data Bank (NPDB)?

   In order to fulfill the definition of a "healthcare entity", the staffing service organization must directly or indirectly provide healthcare services and engage in professional review activity through a formal peer review process for the purpose of furthering quality health care.

2. How do I determine if my organization is eligible to query the National Practitioner Data Bank (NPDB)?

   The Health Care Quality Improvement Act of 1986 (HCQIA) which defines the types of organizations that are eligible to query the National Practitioner Data Bank (NPDB), specifies that State licensing boards, hospitals, other healthcare organizations and professional societies that provide healthcare services and follow a formal peer review process to further quality care are eligible to query the NPDB. However, each healthcare organization is responsible for determining and certifying its eligibility to participate in the NPDB. The eligibility certification must be submitted in writing.

   You should review the statutory definition to determine whether your organization meets these requirements. The HCQIA is located on the Data Banks home page under the Legislation & Regulations category. Or, see page B-1 of the Eligible Entities chapter of the NPDB Guidebook, which is available under the Publications category on the Data Banks home page. (Also in Registration FAQ and NPDB Query and Report FAQ.)

3. How do I determine if my organization is eligible to query the Healthcare Integrity and Protection Data Bank (HIPDB)?

   Healthcare organizations eligible to participate in the HIPDB are defined in the provisions of Section 1128E of the Social Security Act of the Health Insurance Portability and Accountability Act of 1996, and in the HIPDB Final Rule codified at 45 CFR Part 61. The statute specifies that Federal and State government agencies and health plans are eligible to query the HIPDB. Eligible organizations are responsible for meeting Section 1128E reporting and/or querying requirements, as appropriate, and must certify in writing their eligibility to report to and/or query the HIPDB.

   To determine if your organization is eligible to query the HIPDB, please review Section 1128E of the Social Security Act, which is located on the Data Banks home page under Legislation & Regulations category. Please see page B-1 of the Eligible Entities chapter of the HIPDB Guidebook for more information. The HIPDB Guidebook is available online under the Publications category on the Data Banks home page. (Also in Registration FAQ and HIPDB Query and Report FAQ.)

4. How do I determine if I am eligible to register with the National Practitioner Data Bank (NPDB) as an "other health care entity"?

   Healthcare organizations that qualify as "Other Health Care Entities" must provide healthcare services and follow a formal peer review process to further quality health care.

   "Provide healthcare services" applies to the delivery of healthcare services through any of a broad array of coverage arrangements or other relationships with practitioners, whether they employ the practitioners directly or through contractual or other arrangements. This definition specifically excludes indemnity insurers that have no contractual or other arrangements with physicians, dentists, or other healthcare practitioners. Examples of NPDB eligible healthcare organizations may include Managed Care Organizations (MCOs), Preferred Provider Organizations (PPOs), group practices, nursing homes, rehabilitation centers, hospices, renal dialysis centers, and free-standing ambulatory care and surgical service centers as well as locum tenens and/or permanent staffing organizations who are compliant with the statutory requirements.

   In addition to MCOs and PPOs, other managed care organizations may qualify with the NPDB as healthcare organizations if they provide healthcare services and follow a formal peer review process to satisfy the eligibility requirements of the Health Care Quality Improvement Act of 1986 (HCQIA), as amended, and in the regulations codified at 45 CFR Part 60. The Health Care Quality Improvement Act of 1986 is located on the Data Banks home page under the Legislation & Regulations category. (Also in Registration FAQ.)