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Glossary
A
- Adverse Action
(1) An action taken against a practitioner's clinical privileges or medical staff membership in a health care organization, (2) a licensure disciplinary action, (3) a Medicare/Medicaid Exclusion action, or (4) any other adjudicated action.
- Adverse Action Codes
The codes used on reports to identify the adverse action that was taken. They are used when submitting reports to the NPDB.
- Adverse Action Report (AAR)
The format used by health care organizations and state agencies to report an adverse action taken against a physician, dentist, or other health care practitioner.
- Adversely affects
Reduces, restricts, suspends, revokes, or denies clinical privileges or membership in a health care organization.
- Authorized Agent
An individual or organization that an eligible health care organization designates to query or report to the NPDB on its behalf. No querying or reporting to the NPDB, by an agent, is done without this designation.
- Authorized Submitter
An individual empowered by an eligible health care organization to submit reports or queries to the NPDB. The authorized submitter certifies the legitimacy of information in a query or report submitted to the NPDB. In most cases, the authorized submitter is an employee of the health care organization (such as an Administrator or Medical Staff Director).
B
C
- Certifying Official
An individual selected and empowered by an organization to certify the legitimacy of registration for participation in the NPDB.
- Clinical Laboratory Improvement Amendments (CLIA)
An identifier assigned to clinical laboratories by the Centers for Medicare & Medicaid Services (CMS).
- Clinical Privileges
Privileges, membership on the medical staff, and other circumstances in which a physician, dentist, or other licensed health care practitioner is permitted to furnish medical care by a health care organization.
- CMS Certification Number (CCN)
A six-digit Medicare certification number assigned to health care entities by the Centers for Medicare & Medicaid Services (CMS).
- CMS Identifiers
Online Survey, Certification and Reporting (OSCAR) Provider Number, Medicare Provider Number (MPN), and Provider Transaction Access Number (PTAN).
- Correction Report
A Correction Report corrects an error or omission in a previously reported action by taking the place of the current report. The organization that submitted the current report must also be the one to submit a correction of that action.
- Customer Service Center
The Customer Service Center provides information and support to NPDB users. Questions may be directed to Information Specialists at the Customer Service Center
D
- Data Bank Control Number (DCN)
The identification number assigned by the NPDB that is used to identify each query and report. Health care organizations use the DCN when submitting a correction, revision, or void to the NPDB.
- Data Bank Identification Number (DBID)
A unique, 15-digit number assigned to an eligible health care organization and authorized agents when they register with the NPDB. Health care organizations and agents need this number to query and report to the NPDB using the IQRS. The DBID must be included on all correspondence to the NPDB.
- Dentist
A doctor of dental surgery, a doctor of dental medicine, or the equivalent who is legally authorized to practice dentistry by a state, or who, without authority, holds him or herself out to be so authorized.
- Department of Health and Human Services (HHS)
The government agency responsible for the administration of the NPDB.
- Dispute
A formal written statement to challenge a report when the accuracy, completeness, timeliness, or relevance of the report is in question. Disputes may be made only by the subject of a report.
- Division of Practitioner Data Bank (DPDB)
The Division of Practitioner Data Bank (DPDB) is responsible for the implementation of the National Practitioner Data Bank (NPDB). The NPDB is an alert or flagging system intended to facilitate a comprehensive review of the professional credentials of health care practitioners, providers, and suppliers.
- Draft
A report that is temporarily stored without being submitted to the NPDB for processing. Reporters may create drafts of any type of report and store them for future retrieval for up to 30 days. Draft reports are not required to have all mandatory data elements completed and are not considered valid submissions to the NPDB.
- Drug Enforcement Administration (DEA)
The government agency that registers practitioners to dispense controlled substances and assigns practitioners Federal DEA numbers.
E
- Electronic Funds Transfer (EFT)
A method of electronic payment for NPDB queries. Health care organizations may authorize their financial institution to directly debit their accounts in order to pay for queries processed by the NPDB. To use the electronic funds transfer payment method, organizations must provide to the NPDB the account number, routing code, and type of account (checking or savings) for the bank account from which fee payment is authorized.
F
- Federal Employee Identification Number (FEIN)
An FEIN is a nine-digit number assigned to your organization by the Internal Revenue Service (IRS). Enter it into the field in the format XXXXXXXXX (do not use hyphens, dashes, or spaces).
- Formal Peer Review Process
The conduct of professional review activities through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing.
- Freedom of Information Act (FOIA)
The law that provides public access to Federal Governmental records.
G
H
- Health Care Quality Improvement Act of 1986, as amended
Title IV of Public Law 99-660; legislation intended to improve the quality of medical care by encouraging hospitals, State Licensing Boards, and other health care organizations, including professional societies, to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent practitioners to move from state to state without disclosure or discovery of the practitioners' previous damaging or incompetent performance.
- Health Care Organization
A general term used by the NPDB to refer to any entity that is required to report or query the NPDB. Examples of health care organizations include: hospitals, organizations that provide health care services and follow a formal review process, Federal and state agencies, health plans, professional societies, accreditation organizations, and medical malpractice insurance agencies.
- Hospital [as described in Section 1861(e)(1) and (7) of the Social Security Act]
An institution primarily engaged in providing, by or under the supervision of physicians, to inpatients (1) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or (2) rehabilitation services for the rehabilitation of injured, disabled, or sick persons; and, if required by state or local law, is licensed or is approved by the agency of the state or locality responsible for licensing hospitals as meeting the standards established for such licensing.
I
- Individual Taxpayer Identification Number (ITIN)
A nine-digit tax processing number assigned by the Internal Revenue Service (IRS) for those not eligible for a Social Security Number (SSN).
- Initial Report
The original record of a medical malpractice payment, adverse action, or judgment or conviction submitted by a reporting organization. An eligible health care organization references an Initial Report (using the DCN) when submitting a correction, void, or revision to action.
- Integrated Querying and Reporting Service (IQRS)
An electronic, Internet-based system for querying and reporting to the NPDB.
- Interface Control Document (ICD)
Provides information about the format, structure, and content of electronic files for submitting queries or reports to the National Practitioner Data Bank (NPDB).
- Interface Control Document Transfer Program (ITP)
An alternative to the Integrated Querying and Reporting Service (IQRS) for queriers and reporters who wish to interface their data processing systems directly with the NPDB to submit reports and receive responses. On July 31, 2014, ITP was replaced with the Querying and Reporting XML Service (QRXS).
J
- Judgment or Conviction Report
The format used to report a health care related criminal conviction or civil judgment against a practitioner, provider, or supplier that is related to the delivery of health care items or services.
K
L
- Locum Tenens
A descriptive term applied to qualified health care practitioners who fill positions on a temporary basis when practitioners are on sabbatical, vacation, or absent for an extended period. A hospital must query on a locum tenens practitioner each time a practitioner applies for temporary privileges.
M
- Medical Malpractice Payer
An organization that makes a medical malpractice payment through an insurance policy or otherwise for the benefit of a practitioner.
- Medical Malpractice Payment
A monetary exchange as a result of a settlement or judgment of a written complaint or claim demanding payment based on a physician's, dentist's, or other licensed health care practitioner's provision of or failure to provide health care services; and may include, but is not limited to, the filing of a cause of action, based on the law of tort, brought in any state or Federal Court or other adjudicative body.
- Medical Malpractice Payment Report (MMPR)
The format used by medical malpractice payers to report a medical malpractice payment made for the benefit of a physician, dentist, or other health care practitioner.
- Medicare/Medicaid Exclusion
The NPDB includes information regarding practitioners who have been declared ineligible from participating in, or have been reinstated to participate in, Medicare or Medicaid. Hospitals, managed care organizations, and other providers are prohibited from billing Medicare and Medicaid for any services that might be rendered by practitioners with this exclusion.
N
- National Provider Identifier (NPI)
A 10-digit unique identifier assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS). NPI replaced the Unique Physician Identification Number (UPIN) in 2007.
- Notice of Action
A notification from the NPDB to a State Board that an NPDB report is available for viewing in the NPDB. NPDB reporters of Medical Malpractice Payment Reports, Clinical Privilege Action Reports, and Professional Society Action Reports are required by Federal law (42 USC§11134) to notify State Boards of these report submissions. These NPDB reporters can elect to send electronic notifications of these actions to the appropriate State Boards through the NPDB system, if the State Board has opted to receive these electronic notifications. State Boards are notified via email when an electronic Notice of Action is ready to view in the NPDB. Once the report is viewed by the State Board, the reporter is notified by email that the report has been viewed and the legal obligation of the reporter to notify the Board is fulfilled.
O
- Occupation/Field of Licensure Codes
A list of occupational activities/licensure categories for health care practitioners, providers, and suppliers, and the codes used to identify them.
- Originating Agency Identification Number (ORI)
A nine-character identifier assigned to an agency by the Federal Bureau of Investigation (FBI).
P
- Personally Identifiable Information (PII)
Information that can be used to distinguish or trace an individual's identity, such as their name, social security number, biometric records, etc. alone, or when combined with other personal or identifying information which is linked or linkable to a specific individual, such as date and place of birth, mother's maiden name, etc. (Defined in OMB M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information)
- Physician
A doctor of medicine or osteopathy who is legally authorized to practice medicine or surgery by a state, or who, without authority, holds himself or herself out to be so authorized.
- Portable Document Format (PDF)
Files with this type of extension are Adobe Acrobat Reader files. This format is used for NPDB query and report responses and other forms accessed via the IQRS.
- Practitioner
A physician, dentist, or other licensed health care practitioner.
- Primary Function Codes
A three-digit code that best describes the primary function your organization performs. The code is used on the Entity Registration form.
- Professional Review Action
An action or recommendation of a health care entity: (1) taken in the course of professional review activity; (2) based on the professional competence or professional conduct of an individual physician, dentist, or other health care practitioner which affects or could affect adversely the health or welfare of a patient or patients; and (3) which adversely affects or may adversely affect the clinical privileges of the physician, dentist, or other health care practitioner.
This term excludes actions which are primarily based on: (1) the physician's, dentist's, or other health care practitioner's association, or lack of association, with a professional society or association; (2) the physician's, dentist's, or other health care practitioner's fees or the physician's, dentist's, or other health care practitioner's advertising or engaging in other competitive acts intended to solicit or retain business; (3) the physician's, dentist's, or other health care practitioner's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis; (4) a physician's, dentist's, or other health care practitioner's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional; or (5) any other matter that does not relate to the professional competence or professional conduct of a physician, dentist, or other health care practitioner.
- Professional Review Activity
An activity of a health care entity with respect to an individual physician, dentist, or other health care practitioner: (1) to determine whether the physician, dentist, or other health care 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.
- Professional Society
An association of physicians or dentists that follows a formal peer review process for the purpose of furthering quality health care.
Q
- Query
A request for information submitted to the NPDB by an eligible health care organization or authorized agent.
- Querying and Reporting XML Service (QRXS)
The QRXS is an alternative to the Integrated Querying and Reporting Service (IQRS) for those users who wish to receive machine-readable responses. The QRXS is an electronic service for reporters and queriers who wish to interface their data processing system directly with the NPDB to submit reports and/or queries and receive responses.
R
- Report
Record of a medical malpractice payment, adverse action, judgment, or conviction submitted to the NPDB by an eligible health care organization.
- Revision-to-Action
An action relating to and modifying an adverse action previously reported to the NPDB. A revision-to-action does not take the place of a previously reported adverse action. An organization that reports an initial adverse action must also report any revision to that action.
S
- Secretary
The Secretary of Health and Human Services.
- State
The 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
- State Licensing Board
A generic term used to refer to state medical and dental boards, as well as those bodies responsible for licensing other health care practitioners.
- Subject Statement
A subject statement is a statement of up to 4,000 characters (including spaces and punctuation) or less, submitted by practitioners regarding their report contained in the NPDB.
T
U
- Unique Physician Identification Number (UPIN)
A Medicare certification number assigned to health care entities by the Centers for Medicare & Medicaid Services (CMS) before 2007. CMS replaced the UPIN with the National Provider Identifier (NPI) after 2007.
V
- Void
A retraction of a report in its entirety. Voided reports are not disclosed in response to queries, including self-queries by practitioners. Reports may be voided only by the reporting organization or the Secretary of HHS through Dispute Resolution.
W
X
Y
Z
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