The Data Bank is a federally mandated program that helps promote quality health care, prevent patient harm, and combat fraud and abuse in health insurance and health care delivery. Querying the Data Bank is an important element in the comprehensive, continuous review of practitioners’ professional credentials. Depending on your registration, you can query NPDB, HIPDB, or both.
Querying the Data Bank (National Practitioner Data Bank [NPDB] and the Healthcare Integrity and Protection Data Bank [HIPDB]) for information on practitioners that are licensed or certified to provide health care services can assist you in making employment, credentialing, and licensing decisions. Querying should complement the information received from other sources concerning an organization or a practitioner’s past performance. For most health care organizations, querying is done for the following reasons:
- Appointment and privileging
- Professional review
- Two-year mandatory activity, clinical privileges review
- Granting State licensure
- Credentialing and employment
Are You Eligible?
Your health care organization must first register and determine eligibility under the specific laws governing the Data Bank. Then, you must certify your eligibility in writing and submit to the Data Bank. Once processed, you can begin querying. The following are examples of who may query:
- Health care organizations that provide health care services and that follow a formal peer review process
- Professional societies with formal peer review
- State health care practitioner licensure and certification authorities (including medical and dental boards)
- State health care entity licensure and certification authorities*
- State agencies administering State health care programs*
- Agencies or contractors administering Federal health care programs*
- State Medicaid Fraud Units*
- U. S. Comptroller General*
- U. S. Attorney General/other law enforcement officials*
- Quality Improvement Organizations*
- Health Plans**
- Federal and State Government Agencies**
* Section 1921 Information, Only
** HIPDB (1128E)
If You’re a Hospital, Querying is Mandatory
For hospitals, querying is mandatory and you must do so in the following situations:
- When a physician, dentist, or other health care practitioner applies for a position on your medical staff (courtesy or otherwise) or for clinical privileges at your hospital
- Every 2 years (biennially) on all physicians, dentists, and other health care practitioners who are on your medical staff (courtesy or otherwise) or who hold clinical privileges
- When a practitioner wishes to add to or expand existing privileges and when a practitioner submits an application for temporary privileges
Using the Data Bank to Query
All registered health care organizations can query in one of two ways:
- A one-time query, also known as traditional querying, is where you submit the name of a practitioner or organization and receive a query response that includes all the information that the Data Bank has received on the practitioner or organization.
- A Continuous Query formerly known as Proactive Disclosure Service (PDS), is where you receive an initial query response and automatically receive notification within 24 hours of the Data Bank’s receipt of new information during the 12 month enrollment. Continuous Query enrollment must be renewed every 12 months.