Eligibility Criteria
Frequently Asked Questions (FAQ)
See also:
- Do medical staffing service organizations that employ
locum
tenens practitioners fulfill the definition of a "health care
entity" and therefore qualify to register with the National
Practitioner Data Bank (NPDB)?
Only if the staffing service organization directly or indirectly provides health care services and engages in professional review activity through a formal peer review process for the purpose of furthering quality health care.
- How do I determine if my entity is eligible to query
the National Practitioner Data Bank (NPDB)?
Each entity is responsible for determining its eligibility to participate in the NPDB and must certify that eligibility in writing. Eligibility requirements for participating in the NPDB are specified in the Health Care Quality Improvement Act of 1986 (HCQIA) which defines the types of entities that are eligible to query the NPDB. The statute specifies that State licensing boards, hospitals, professional societies, and other health care entities that provide health care services and follow a formal peer review process to further quality care are eligible to query the NPDB.
You should review the statutory definition to determine whether your entity meets these requirements. The Health Care Quality Improvement Act of 1986 is located on the Data Banks home page under the Legislation & Regulations category. Or, see page B-1 of the Eligible Entities chapter of the NPDB Guidebook, which is available under the Publications category on the Data Banks home page. (Also in Registration FAQ and NPDB Query and Report FAQ.)
- How do I determine if my entity is eligible to query
the Healthcare Integrity and Protection Data Bank
(HIPDB)?
Entities eligible to participate in the HIPDB are defined in the provisions of Section 1128E of the Social Security Act of the Health Insurance Portability and Accountability Act of 1996, and in the HIPDB Final Rule codified at 45 CFR Part 61. The statute specifies that Federal and State government agencies and health plans are eligible to query the HIPDB. Eligible entities are responsible for meeting Section 1128E reporting and/or querying requirements, as appropriate, and must certify in writing their eligibility to report to and/or query the HIPDB.
To determine if your entity is eligible to query the HIPDB, please review Section 1128E of the Social Security Act, which is located on the Data Banks home page under Legislation & Regulations category. Please see page B-1 of the Eligible Entities chapter of the HIPDB Guidebook for more information. The HIPDB Guidebook is available online under the Publications category on the Data Banks home page. (Also in Registration FAQ and HIPDB Query and Report FAQ.)
- How do I determine if I am eligible to register with
the National Practitioner Data Bank (NPDB) as an "other health
care entity"?
Entities that qualify as "Other Health Care Entities" must provide health care services and follow a formal peer review process to further quality health care.
"Provide health care services" applies to the delivery of health care services through any of a broad array of coverage arrangements or other relationships with practitioners, whether they employ the practitioners directly or through contractual or other arrangements. This definition specifically excludes indemnity insurers that have no contractual or other arrangements with physicians, dentists, or other health care practitioners. Examples of NPDB eligible entities may include Managed Care Organizations (MCOs), Preferred Provider Organizations (PPOs), group practices, nursing homes, rehabilitation centers, hospices, renal dialysis centers, and free-standing ambulatory care and surgical service centers as well as locum tenens and/or permanent staffing organizations who are compliant with the statutory requirements.
In addition to MCOs and PPOs, other managed care organizations may qualify with the NPDB as health care entities if they provide health care services and follow a formal peer review process to satisfy the eligibility requirements of the Health Care Quality Improvement Act of 1986 (HCQIA), as amended, and in the regulations codified at 45 CFR Part 60. The Health Care Quality Improvement Act of 1986 is located on the Data Banks home page under the Legislation & Regulations category. (Also in Registration FAQ.)
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Last revised January 2008 |