HIPDB Query and Report
Frequently Asked Questions (FAQ)

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  1. What information is in the Healthcare Integrity and Protection Data Bank (HIPDB)?

    The HIPDB collects the following information:

    1. Licensing and certification actions.
    2. Civil judgments (health care-related).
    3. Criminal convictions (health care-related).
    4. Exclusions from Federal or State health care programs (including Medicare and Medicaid exclusions).
    5. Other adjudicated actions or decisions.

    For more information on the above actions, please review the HIPDB Guidebook found under the Publications category, on the Data Banks home page.

  2. 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 Eligibility Criteria FAQ.)

  3. Why should I query the Healthcare Integrity and Protection Data Bank (HIPDB)?

    The HIPDB contains information that queriers can use to verify background information when they are granting a license, or employing or contracting with health care practitioners such as physicians, nurse practitioners, midwives, counselors, pharmacists, and accountants. The queriers may also request information on organizations such as group practices, hospitals, nursing homes, rehabilitation units, home health agencies, mammography service providers, clinical laboratories, and durable medical equipment suppliers prior to contracting with such organizations. The HIPDB contains health care related criminal convictions and civil judgments, licensure and certification actions, exclusions from State and Federal health care programs, and other adjudicated actions.

  4. What are the two types of Healthcare Integrity and Protection Data Bank (HIPDB) queries?

    The two types of HIPDB queries are: Explicit and Investigative Search. An explicit query is a normal query on a named subject. It is used by entities for licensing, credentialing, and employment activities and is available to all HIPDB users. An investigative search is a full-text or field HIPDB search where the querier does not have to specifically name an individual or organization. Only a law enforcement agency with an Originating Agency Identification number (ORI) may perform an investigative search.

  5. I received a query response on a Licensed Professional Nurse that states the action was taken against the Nurse's Multi-State Privilege. What does this mean?

    Some States are members of a Nurse Licensure Compact Agreement (NLC). The NCL allows a nurse that is licensed in a NCL State (home State) to work in another NLC member State (remote State) without acquiring another license. The NLC Agreement results in a "privilege" to work in the remote State.

    The Multi-State Privilege Adverse Action Classification codes were developed to enable a remote State to report actions it takes against the nurse's privilege to practice in a remote State. The remote State should use only the Multi-State Privilege Adverse Action Classification codes. The home State should use the Licensure Adverse Action Classification codes to report an action taken against the nurse's license. If the home State (the State that issued the license) also takes an action against the nurse's Multi-State Privilege to Practice, it should file a second report of that action using the Multi-State Privilege Adverse Action Classification codes. The Multi-State Privilege Adverse Action Classification codes, along with the Licensure Adverse Action Classification codes and other Adverse Action Classification codes, are available under Reporting Codes under the General Information category on the Data Banks home page. (Also in Querying FAQ.)

  6. Does the Healthcare Integrity and Protection Data Bank (HIPDB) accept reports on actions that occurred prior to August 21, 1996?

    No. The HIPDB governing statute, the Health Insurance Portability and Accountability Act, was enacted on August 21, 1996 and, therefore, only reports of actions taken on August 21, 1996, or later can be submitted to the HIPDB.

  7. What is the deadline for reporting adverse licensure actions, health plan other adjudicated actions and Judgments or Convictions to the Healthcare Integrity and Protection Data Bank (HIPDB)?

    All reportable actions must be reported to the Healthcare Integrity and Protection Data Bank (HIPDB) within 30 calendar days of the date the final adverse licensure action was taken, or the date when the reporting entity became aware of the final action, or by the close of the entity's next monthly reporting cycle, whichever is later. The general guidance is within 30 days of the date of the action. (Also in Reporting FAQ.)

  8. How do I submit a report on a contract termination?

    Reports of contract terminations and any other adjudicated actions taken by a health plan should be submitted to the Healthcare Integrity and Protection Data Bank (HIPDB) using the Health Plan Action Report type. To submit Health Plan Action Reports through the Integrated Querying and Reporting Service (IQRS) located on the Data Banks home page, log in to the system, click Continue, then click Report. Select the appropriate report on the Report Type screen, then click the Health Plan Action button on the Select Action screen. If this action also meets the criteria for reporting an adverse panel membership action, then it must be reported separately to the National Practitioner Data Bank (NPDB) as a Clinical Privileges Action. For more information, please review the NPDB Guidebook and the HIPDB Guidebook, which can be found under the Publications category on the Data Banks home page.

  9. A practitioner was convicted of tax evasion on his personal income taxes and subsequently had his license to practice suspended. Should this adverse action be reported to the Healthcare Integrity and Protection Data Bank (HIPDB)?

    The practitioner's license suspension is reportable to the HIPDB; however, the conviction for tax evasion is not reportable to the HIPDB because it is not health care related.

  10. How do I report an action taken against a nurse who is licensed in another State but is authorized to practice in our State under the Nurse Licensure Compact (NLC)?

    The Multi-State Privilege Adverse Action Classification codes were developed to allow the reporting of actions taken against a nurse's privilege to practice under the NLC. The State that issues the license to practice (the nurse's home State or State of residency) should use the Licensure Adverse Action Classification codes to report an action it takes against the nurse's license. If the remote State (the State that did not issue the license) also takes an action against the nurse's Multi-State Privilege to Practice, it should also file a separate report of that action using the Multi-State Privilege Adverse Action Classification codes. The Multi-State Privilege Adverse Action Classification codes, along with the Licensure Adverse Action Classification codes, and other Adverse Action Classification codes, are available under Reporting Codes under the General Information category on the Data Banks home page. (Also in Reporting FAQ.)

  11. When should a State entity file a Licensure Action report instead of a Government Administrative Action report?

    When reporting to the Healthcare Integrity and Protection Data Bank (HIPDB), State agencies that license health care practitioners, providers, and suppliers should use the State Licensure Action category for adverse actions taken against the subject's license. The agency should not report the action in the Government Administrative category, even if it views its action as administrative in nature.

    Examples of State Licensure Actions include revocation and suspension of license, probation and limitation on the license, as well as reprimand and censure. These types of actions are only available as selections in the Adverse Action Classification Code field for State Licensure Actions. Codes that are appropriate for State licensure actions are not included in the Government Administrative Action category.

  12. Who should report Government Administrative Actions?

    The Government Administrative Action category is designed for government health care programs (including Medicare and Medicaid), government health care facilities, and State survey and certification agencies to use when reporting their actions to the HIPDB.

    Examples of Government Administrative Actions include adjudicated actions and decisions (e.g., personnel actions and contract terminations) and adverse actions taken with regard to a certification agreement or contract for participation in Federal or State health care programs. Note that these actions do not directly affect a practitioner, provider, or supplier's license.

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Last revised June 2008