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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: General Information

  1. A health plan that credentials health care practitioners for participation in various networks includes NPDB query results in the materials presented to its credentialing committee for peer review approval, denial, or termination from the networks. If a health care practitioner appeals a denial or termination, the appeal goes to a separate review body that was not involved in the original decision. The appeal body is composed of a statewide representation of health care practitioners who are not employees of the health plan and who are paid for their services. The decision of the appeal body is final. Is providing NPDB query results to the appeal body a violation of the NPDB confidentiality rules?

    No. NPDB confidentiality provisions do not prohibit an eligible entity receiving information from the NPDB from disclosing the information to others who are part of the peer review process, as long as the information is used for the purposes for which it was provided.

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