What To Know About The National Practitioner Data Bank (NPDB)

The National Practitioner Data Bank (NPDB) reports and exposes high-risk providers, allowing organizations to perform due diligence by screening and monitoring a provider applicant. Verifiable is one of four organizations that have automated NPDB verifications allowing organizations to decrease the time it takes to run these verifications while also lowering credentialing costs by using these verifications as a phase-gate to full credentialing.

What To Know About The National Practitioner Data Bank (NPDB)

To ensure an organization’s credentialing processes align with specific accreditation standards, many organizations leverage the National Practitioner Data Bank or NPDB. Certifying bodies such as NCQA, URAC, HFAP and The Joint Commission each recognize NPDB querying and monitoring as meeting the requirements for: Licensure Sanction, Malpractice/Professional Liability History and Medicare/Medicaid Sanction screening. Some accreditations go so far as to require an NPDB query at point of hire, reappointment and/or the granting of temporary privileges.

What is NPDB?

The NPDB is a repository of reports containing information on healthcare providers, entities and suppliers. It is reported by Malpractice Payers, State Medical and Dental Boards, Hospitals, Professional Societies, DEA, Federal Government Agencies including the Department of Health and Human Services, State Agencies including Medicaid Fraud Control Units, Health Plans and private accredited organizations.

Many organizations screen providers through an NPDB lookup, referred to as a query, as part of NCQA-compliant credentialing or if mandated by federal law. However, the reports are confidential and not available to the public, therefore a query must be run by either the provider (self-query) or a registered organization (with permission from the provider).

When an organization orders a query, there are two types of queries that can be run:

• One-time query - a one-time, point-in-time check
• Continuous query - an ongoing check which lasts for twelve months and notifies an organization if a new report appears

Continuous query allows organizations to be notified if a new or updated report appears, and is the same cost as a one-time query.

How Do I Register With NPDB To Obtain Access and Run a Query?

In order for an organization to run an NPDB query they need to be registered with the NPDB and approved. Organizations must provide evidence of proper credentialing processes by providing a copy of their credentialing policies and procedures approved and signed by their credentialing committee. Ensuring an organization has properly set up their credentialing processes is a crucial step as an organization works to become delegated with payers. Verifiable helps organizations establish policies and procedures, set up their credentialing committee and works closely with organizations on the path to delegation. Click here to learn more about registering with the NPDB.

Once an organization has been registered and approved, they can designate other authorized agents, such as Verifiable, to run these queries on their behalf. Click here to learn how to designate an authorized agent with the NPDB.

How Verifiable Can Help

Verifiable is one of four organizations that have automated NPDB verifications for organizations looking to streamline and speed-up their credentialing, onboarding or pre-screening processes. Automated NPDB queries can be run via the Verifiable Salesforce App, the Verifiable Platform, or an integration with Verifiable’s API. This integration helps organizations ensure they are mitigating risk by screening and monitoring providers against the NPDB, while also staying compliant with accrediting bodies such as NCQA.