NPDB querying for provider credentialing

Steps

1. Register your organization with the NPDB at https://www.npdb.hrsa.gov; organizations must submit credentialing policies and procedures and be approved before querying.
2. For high-volume credentialing, integrate with the NPDB Querying and Reporting XML Service (QRXS) — an XML-based API that allows automated submission of queries and retrieval of reports from within your credentialing system.
3. Submit a continuous query (ongoing monitoring) or one-time query per provider: supply the provider's name, date of birth, NPI, and professional license number(s) to maximize match accuracy.
4. Parse the NPDB XML report response: review MedicalMalpractice, Licensure, ClinicalPrivilege, and ExclusionAction sections; any adverse report requires credentialing committee review before a privilege decision is made.
5. Document NPDB query results, dates, and committee disposition in the credentialing file — NCQA and The Joint Commission require evidence of NPDB query at initial credentialing and at each recredentialing cycle.
6. For self-queries, direct providers to the NPDB self-query portal (practitioners may query their own record at any time at no cost to review what hospitals and plans see).