Continuous Query Recognition Letter - URAC

URAC

Division of Practitioner Data Banks (DPDB)
NPDB-HIPDB
Parklawn Building, Room 8-103
5600 Fishers Lane
Rockville, MD 20857

Re: Proactive Disclosure Service

Dear Sir or Madame:

URAC wishes to acknowledge recognition of the National Practitioner Data Bank (NPDB) Proactive Disclosure Service (PDS) as an acceptable alternative to querying the NPDB as well as a way to meet the requirements for the specific URAC standards identified in this letter.

The PDS can be used to verify information on a healthcare provider at initial credentialing [CR 1] and recredentialing [CR 15] as well as conduct ongoing monitoring of compliance with credentialing criteria [CR 14(a)] for the following:

• Malpractice settlements or judgments paid on behalf of a practitioner;
• Sanctions and limitations on licensure;
• Medicare/Medicaid participation and sanctions;
• Hospital or other healthcare entity privileges; and
• Membership in professional societies.

The NPDB receives the information listed above from the issuing source; however, even though the PDS can be used to verify and monitor sanctions and limitations on licensure, it cannot be used to primary source verify licensure [CR 9(a)]. The PDS does not receive notification of licensure expiration unless it is a reportable event; therefore, an organization must primary source verify licensure, including the expiration date, through the state licensing board - no exceptions - even if there is a reportable event involving licensure expiration.

Continuous monitoring can include checking for licensure "inquiries" and "investigations" for adherence to credentialing criteria. In some states this information is disclosed, but then they are not reportable events to the NPDB. As a result, an organization must monitor for inquiries and investigations through the issuing source (i.e., state licensing board).

Best regards,

/s/
John P. DuMoulin, MS, CAE
Vice President
Product Development, Government Relations and Education

/s/
Christine G Leyden, RN, MSN
Senior Vice President and GM Client Services
Chief Accreditation Officer