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 CodesThe codes used on reports to identify the adverse action that was taken. They are used when submitting reports to the Data Bank.
  • 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 affectsReduces, restricts, suspends, revokes, or denies clinical privileges or membership in a health care organization.
  • Any Other Adjucated Action(1) Formal or official final actions taken against a health care practitioner, provider, or supplier by a Federal or State Government agency or a health plan; (2) which include the availability of a due process mechanism; and (3) based on acts or omissions that affect or could affect the payment, provision, or delivery of a health care item or service.
  • Authorized AgentAn individual or organization that an eligible health care organization designates to query or report to the Data Bank on its behalf. No querying or reporting to the Data Bank, by an agent, is done without this designation.
  • Authorized SubmitterAn individual empowered by an eligible health care organization to submit reports or queries to the Data Bank. The authorized submitter certifies the legitimacy of information in a query or report submitted to the Data Bank. In most cases, the authorized submitter is an employee of the health care organization (such as an Administrator or Medical Staff Director).

B

  • Board of Medical ExaminersA board of medical/dental examiners is a body or subdivision of such body that is designated by a State for licensing, monitoring, and disciplining physicians or dentists. This term includes boards of allopathic or osteopathic examiners or its subdivision, a board of Dentistry or its subdivision, a composite board, or an equivalent body as determined by the State.

C

  • Certifying OfficialAn individual selected and empowered by an organization to certify the legitimacy of registration for participation in the Data Bank.
  • Clinical PrivilegesPrivileges, membership on the medical staff, and other circumstances (including panel memberships) in which a physician, dentist, or other licensed health care practitioner is permitted to furnish medical care by a health care organization.
  • Correction ReportA 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.

D

  • Data Bank Control Number (DCN)The identification number assigned by the Data Bank that is used to identify each query and report. Health care organizations use the DCN when submitting a correction, revision, or void to the Data Bank.
  • 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 Data Bank. Health care organizations and agents need this number to query and report to the Data Bank using the IQRS. The DBID must be included on all correspondence to the Data Bank.
  • Data BankThe collective way to refer to the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). NPDB and HIPDB are information clearinghouses created by Congress to improve health care quality, protect the public, and reduce health care fraud and abuse in the U.S. The NPDB receives and discloses information related to the professional competence and conduct of physicians, dentists and, in some cases, other health care practitioners. The HIPDB receives and discloses information related to final adverse actions taken against health care practitioners, providers, and suppliers.
  • Data Bank Customer Service CenterThe Customer Service Center provides information and support to Data Bank users. Questions may be directed to Information Specialists at the Customer Service Center by email at help@npdb-hipdb.hrsa.gov or by phone at 1-800-767-6732 (TDD 1-703-802-9395).
  • DentistA 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 Data Bank.
  • DisputeA 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 Banks (DPDB)The Division of Practitioner Data Banks (DPDB) is responsible for the implementation of the National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB). The NPDB and HIPDB are alert or flagging systems intended to facilitate a comprehensive review of the professional credentials of health care practitioners, providers, and suppliers.
  • DraftA report that is temporarily stored without being submitted to the Data Bank 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 Data Bank.
  • 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 Data Bank queries. Health care organizations may authorize their financial institution to directly debit their accounts in order to pay for queries processed by the Data Bank. To use the electronic funds transfer payment method, organizations must provide to the Data Bank the account number, routing code, and type of account (checking or savings) for the bank account from which fee payment is authorized.
  • Eligible EntityA health care organization may be eligible to query and/or report to the NPDB, the HIPDB, or both.An entity is entitled to query and/or report to the NPDB under the provisions of Title IV of Public Law 99-660, as specified in 45 CFR Part 60. Eligible entities must certify their eligibility to the NPDB in order to query and/or report. Eligible entities include:
    • Hospitals
    • Other health care entities with formal peer review
    • Professional societies with formal peer review
    • Boards of Medical/Dental Examiners and other health care practitioner State Licensing Boards
    • Federal and State Government agencies
    • Health plans

    An entity is entitled to query and/or report to the HIPDP under the provisions of Section 1128E of the Social Security Act and in the HIPDB Final Rule. Eligible entities must certify their eligibility to the HIPDB in order to query and/or report. Eligible entities include:

    • Federal or State Government agencies
    • Health plans

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 ProcessThe 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 Entity(1) A hospital; (2) an entity that provides health care services and follows a formal peer review process for the purpose of furthering quality health care; or (3) a professional society or a committee or agent thereof, including those at the national, State, or local level, of physicians, dentists, or other health care practitioners, that follows a formal peer review process for the purpose of furthering quality health care.
  • Health Care PractitionerAn individual other than a physician or dentist (1) who is licensed or otherwise authorized by a State to provide health care services, or (2) who, without State authority, holds him or herself out to be authorized to provide health care services.
  • Health Care Provider(1) A provider of services as defined in Section 1861(u) of the Social Security Act; (2) any health care organization that provides health care services and follows a formal peer review process for the purpose of furthering quality health care (including a health maintenance organization [HMO], preferred provider organization [PPO], or group medical practice); or any other health care organization that provides health care services directly or through contracts.
  • Health Care Quality Improvement Act of 1986, as amendedTitle 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 OrganizationA general term used by the Data Bank to refer to any entity that is required to report or query either or both Data Banks. 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

  • Initial ReportThe 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 Data Bank.
  • Interface Control Document (ICD)Provides information about the format, structure, and content of electronic files for submitting queries to the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB).
  • 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 Data Bank to submit reports and receive responses. The ITP interface is being phased out and replaced with the next generation interface for high-volume queriers and reporters, the QRXS.

J

  • Judgment or Conviction ReportThe 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

  • Licensure Disciplinary ActionNPDB: revocation, suspension, restriction, or acceptance of surrender of a license; and censure, reprimand, or probation of a licensed physician or dentist based on professional competence or professional conduct.HIPDB: final adverse licensure actions taken against health care practitioners, providers, or suppliers. A reportable final adverse licensure action must be a formal or official action; it need not be specifically related to professional competence or conduct.

    Such actions include, but are not limited to:

    • Formal or official actions, such as the revocation or suspension of a license or certification agreement or contract for participation in Federal or State health care programs (and the length of any such suspension), reprimand, censure, or probation.
    • Any other loss of license, certification agreement, or contract for participation in Federal or State health care programs; or the right to apply for or renew a license or certification agreement or contract of the practitioner, provider, or supplier, whether by operation of law, voluntary surrender, nonrenewal (excluding nonrenewals due to nonpayment of fees, retirement, or change to inactive status), or otherwise.
    • Any other negative action or finding by a Federal or State agency that is publicly available information.
  • Locum TenensA 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 PayerAn organization that makes a medical malpractice payment through an insurance policy or otherwise for the benefit of a practitioner.
  • Medical Malpractice PaymentA 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 ExclusionThe Data Bank 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

O

  • Occupation/Field of Licensure CodesA list of occupational activities/licensure categories for health care practitioners, providers, and suppliers, and the codes used to identify them.

P

  • PhysicianA 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 Data Bank query and report responses and other forms accessed via the IQRS.
  • PractitionerA physician, dentist, or other licensed health care practitioner.
  • Primary Function CodesA two-digit code that best describes the primary function your organization performs. The code is used on the Entity Registration form.
  • Privacy ActThe law that establishes safeguards for the protection of Federal systems of records the Government collects and keeps on individual persons.
  • Professional Review ActionAn 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 ActivityAn 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 SocietyAn association of physicians or dentists that follows a formal peer review process for the purpose of furthering quality health care.

Q

  • QueryA request for information submitted to the Data Bank by an eligible health care organization or authorized agent via the IQRS or ICD format.
  • 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 similar to the Interface Control Document Transfer Program (ITP) for reporters who wish to interface their data processing system directly with the Data Bank to submit reports and receive responses.

R

  • ReportRecord of a medical malpractice payment, adverse action, judgment, or conviction submitted to the Data Bank by an eligible health care organization. Reports may be submitted via the IQRS or by ITP using the appropriate ICD format.
  • Revision-to-ActionAn action relating to and modifying an adverse action previously reported to the Data Bank. 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

  • Secretarial ReviewThe recourse provided a practitioner in the event that he or she disputes a report to the Data Bank and the reporting entity (1) declines to change the report, or (2) does not respond. The Secretary of HHS will review the case and determine whether the report is accurate, complete, timely, or relevant.
  • SecretaryThe Secretary of Health and Human Services.
  • StateThe 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
  • State Licensing BoardA generic term used to refer to State medical and dental boards, as well as those bodies responsible for licensing other health care practitioners.
  • Subject StatementA 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 Data Bank.

T

U

V

  • VoidA 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 Secretarial Review.

W

X

Y

Z

45

  • 45 Code of Federal Regulations Part 60 (45 CFR 60)Federal regulations that govern the NPDB.
  • 45 Code of Federal Regulations Part 61 (45 CFR 61)Federal regulations that govern the HIPDB.