NPDB Insights

Is It Reportable?

A physician is being investigated by a hospital for issues related to professional competence and resigns her clinical privileges. At the time of her resignation, she states that she plans to move to a different state. Should the resignation be reported to the NPDB?

Yes. Since the physician resigned while under investigation for issues related to professional competence, the reason for the practitioner’s resignation is irrelevant. The hospital must report this action.

Understanding Query Responses

Whether you are new to the NPDB or a longtime user, it is important to review all sections of your query response. The query response summarizes the information you provided, and indicates if any reports were found on the subject you queried. Below is a description of the query response header and sections A–C:

• Header : At the top of your query response, you will find the Data Bank Control Number (DCN), process date, page number, subject's name, and your organization's name as the authorized user. The NPDB assigns a DCN to identify each query and report.
  
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  Header

  
  Helpful hint: If you need to contact the NPDB about a specific query or report, have the DCN ready.
• Section A : Subject Identification Information displays the information you provided for the subject of the query. You should verify that the subject's information is correct. If the information is incorrect, you will need to submit a new one-time query with the correct information or update the continuous query.
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  Section A: Subject Identification Information

  
• Section B : Continuous Query Enrollment Information or Query Information provides your organization's information and the statutes of law under which your organization can query.
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  Section B: Continuous Query Enrollment Information or Query Information

  
• Section C : Summary of Reports on File with the NPDB (as of the Date of the Report) displays what types of reports, if any, were found, such as clinical privilege actions, medical malpractice payments, etc.
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  Section C: Summary of Reports on File with the NPDB

  

If any reports were found, they will be displayed on the following pages of the query response. The article below, "Understanding NPDB Reports," provides further information.

Additional assistance for querying the NPDB can be found in the Help Center.

Understanding NPDB Reports

If your query response contains reports, it is necessary to thoroughly read and understand the report to accurately interpret the context and severity of the action. An NPDB report contains information regarding a medical malpractice payment or action taken against a health care practitioner, provider, or supplier. Only certain actions are reported to the NPDB.

Below is an overview of the important information included in the header, summary, sections A–F, and the footer of an NPDB report:

• Header : At the top of each report, you will find the Data Bank Control Number (DCN), process date, page number, subject's name, and your organization's name as the authorized user.
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  Header

  
• Summary of Action : The report begins by highlighting the basic information about the subject of the report, type of report, and action details:
  • Subject's name
  • Name of the organization that submitted the report
  • Date of the action
  • Type of action (State Licensure Action, Clinical Privilege Action, Health Plan Action, etc.)
  • Basis for action
  • Related reports (if any)
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  Summary of Action

  
• Section A : Reporting Entity lists the contact information for the organization that submitted the report and identifies the type of report as initial, revision, or correction. Report types will be explained further in an upcoming edition of Insights.
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  Section A: Reporting Entity

  
• Section B : Subject Identification Information provides information on the subject of the report, including date of birth, education, state license number, and other identifiers. The reporting organization provides the Subject Identification Information in the report to the NPDB.
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  Section B: Subject Identification Information

  
• Section C : Information Reported explains the incident that occurred, as well as when and why the action was taken. This section will display differing information depending on the type of action.
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  Section C: Information Reported

  
• Section D : Subject Statement contains additional information provided by the subject of the report.
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  Section D: Subject Statement

  
• Section E : Report Status indicates whether or not the report is being disputed by the subject and provides the status of the dispute when needed.
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  Section E: Report Status

  
• Section F: Supplemental Identification Information on File will show any additional subject identification information in the NPDB like a maiden name, additional license number, or a National Provider Identifier. If there is no supplemental information, this section will not appear in the report.
• Footer : The end of each report displays the law that requires the action be reported: Title IV, Section 1921, or Section 1128E.
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  Footer

  

Additional information on NPDB reports can be found in the NPDB Guidebook or the Help Center.

Changes Coming for QRXS Users in June 2018

Organizations using third-party software to query and report through the NPDB’s Querying and Reporting XML Service (QRXS) should be aware of several changes taking effect in June 2018:

• All transaction types will have an expanded field for the street address, allowing up to 50 characters.
• Users are encouraged to now include license specialties for physicians and dentists and National Provider Identifier (NPI) numbers for all subjects on Medical Malpractice Payment, Clinical Privilege, and Professional Society reports, further ensuring accuracy of responses for those who query.
• Query responses for reports that are in Dispute Resolution will have an additional status of "Reconsideration Requested," which indicates that the subject has requested that the Secretary of the U.S. Department of Health and Human Services reconsider the original decision. There is a new field for the number of claimants in global settlements on Medical Malpractice Payment Reports (MMPRs).

Visit the Software Sign In page to find the updated QRXS documents.

Please implement the updated QRXS schemas on the Downloads and Documentation page. The NPDB notified users on the QRXS mailing list of these updated files on February 21st. To receive future updates subscribe on the Mailing Lists page.

The latest updates and resources are available at https://www.npdb.hrsa.gov.

Previous editions of NPDB Insights are available in our archive.