Health plans are programs or organizations that provide health benefits, whether directly, through insurance, through reimbursement, or otherwise. Health plans include, but are not limited to, the following:
When appropriate, health plans must report to, may query, and may attest to the NPDB.
Health plans must report adverse clinical privileges actions, also known as adverse panel membership or network participation actions, that meet NPDB reporting criteria. Actions include any professional review action that adversely affects the panel membership/network participation of a physician or dentist for a period of more than 30 days, or the acceptance of the surrender of panel membership/network participation, or any restriction on such by a physician or dentist (1) while the physician or dentist is under investigation by a health plan relating to possible incompetence or improper professional conduct or (2) in return for not conducting such an investigation or proceeding. Health plans also may report those same actions when taken against other health care practitioners.
Health plans also must report other actions, such as contract terminations, that they take against health care practitioners, providers, and suppliers, regardless of whether these actions or decisions are subject to a pending. These actions are reported as "other adjudicated actions or decisions." These actions include the following:
Health plans also must report civil judgments related to the delivery of a health care item or service that are entered against health care practitioners, providers, or suppliers, regardless of whether the civil judgment is the subject of a pending appeal.
In addition, health plans and other organizations that make a payment for the benefit of a health care practitioner in settlement of, or in satisfaction in whole or in part of, a written claim or judgment for medical malpractice against that practitioner must report the payment information to the NPDB. A payment made as a result of a lawsuit or claim solely against an entity (for example, against the health plan alone) that does not identify an individual practitioner should not be reported.
Health Plans may query under certain conditions. A query is a search for information that the NPDB collects on medical malpractice payments and certain adverse action reports submitted by entities. To receive the results of a query, health plans must be authorized to query. When a health plan submits a query, the NPDB releases only the information the health plan is lawfully allowed to access, based on its registration.
Attestation is our national education and outreach effort to ensure that all eligible health plans meet their reporting requirements. During attestation, Data Bank administrators attest that their organizations have submitted to the NPDB all reportable actions and medical malpractice payment reports.
As part of the registration renewal process, every 2 years health plans may be asked to attest. Attestation confirms that your entity has submitted all required reports over the 2-year time frame.
Health plans are notified by email when it is time to renew their registration and complete attestation. The NPDB will send a 60-day reminder email to the health plan's Data Bank administrator prior to the entity's registration renewal/attestation due date. If your organization has not received a notification, then your renewal is not currently due. If your organization is asked to attest, detailed instructions for attestation will be available when you sign in to your account to renew.
If your health plan is also registered with the NPDB as a hospital or a medical malpractice payer, you will be asked to attest as a hospital or medical malpractice payer, not as a health plan.
To find out the specific registration renewal date for your organization
All health plans that are required to report to or want to query must register with the NPDB.
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