Medical Credentialing

Do you really know your Doctor or Medical Personnel?

e-VERIFILE.COM has developed exciting new products, built specifically for Hospital Systems, Insurance Companies, Third Party Administrators and Network Plans, and Medical Practices to provide the most cost effective solution to the dilemma of credentialing medical providers. e-VERIFILE.COM will customize a plan that will best suit your needs for one low rate. Of course, you will always have access to single products whenever you need them for those out-of-the-ordinary cases.

Physician Profile

Individual Profiles can be generated for all U.S. Doctors of Medicine (MD) and most Doctors of Osteopathic Medicine (DO).

Information Contained in the Physician Profile are derived from:

		Medical Schools
		The American Medical Association (AMA) Medical Student File contains approximately 67,000 records, and it is updated annually through freshman matriculation, graduation and change of status reports. This information is reported to the AMA by each medical school director, unless by exception, a student does not pass from years 1, 2, and 3 on schedule. AMA receives the full name of each student, their school address, year and place of birth, gender, and school and year of graduation directly from each US medical school. Information received from The Liaison Committee on Medical Education (LCME)-accredited Canadian schools is stored electronically and is added to the file if the physician moves to the US. Graduation reports prepared by the osteopathic schools are supplied to the AMA by the American Osteopathic Association. This information is used to initiate a record on the AMA's medical student file. A unique record identifier, the medical education number (ME), is assigned to the record when the student enters medical school and can remain unchanged throughout that individual's career. Students are tracked for as long as it takes them to complete their undergraduate medical education.
		Residency Training Programs
		Each year the AMA conducts a survey of Graduate Medical Education (GME) Programs. Approximately 7,900 The Accreditation Council on Graduate Medical Education (ACGME)-accredited programs receive the electronic survey (on computer disk). Also surveyed are some 239 programs that offer medical specialty board-approved "combined specialty" programs. The survey collects data on over 97,000 individual residents in graduate medical education programs and is used to update physician records in the AMA Physician Masterfile.
		State Licensing Agencies
		The state licensing agencies issue approximately 45,000 licenses per year. Each of the 67 state medical and osteopathic boards provides AMA data on an ongoing basis. Licensure data is obtained at a minimum every 180 days. Most of the state boards provide: the degree (MD/DO); the date the license was initially granted; the expiration date (approximately 95% of all records have expiration dates); licensure status (active, inactive, denied or pending); and the licensure type (unlimited, limited or temporary). The "Last Reported" date is included on each profile to reflect the last time that data pertaining to that record was provided to the AMA from the individual licensing board.
		State Disciplinary Actions/Federal Sanctions
		The AMA processes disciplinary action reports received directly from the state medical boards and osteopathic boards. The AMA receives reports directly from: the Department of Health and Human Services in relation to Medicare and Medicaid regulations. AMA flags the physician's file with a star which appears on the physician's profile. A record is flagged if a license has been revoked, suspended, surrendered or has a stipulation of a disciplinary nature. For historical purposes, flags are never removed from the Masterfile. Over 300 physician records are flagged each month. The Profile refers the user to the state agency that took the action for further information.
		National Board of Medical Examiners Certification Year
		Medical students and physicians who have passed all parts of the National Board Examination are reported to the AMA by the National Board of Medical Examiners (NBME). NBME certification provides a permanent record of qualification for licensure. With the implementation of the United States Medical Licensing Examination (USMLE), the NBME will continue to issue its certificate based upon successful completion of a combination of NBME/USMLE examinations and any other requirements established and announced by the NBME. Such combinations will be accepted for medical licensure if completed prior to the year 2000. Annually, the NBME provides a computer tape with the names of physicians awarded national board certificates, along with their national board identification number, city, state, zip code, certification date, medical school and year of graduation.
		Educational Commission for Foreign Medical Graduates (ECFMG)
		Graduates of international medical schools who are located in the United States generally are incorporated into the Masterfile upon entry into an ACGME-accredited program of graduate medical residency training. Background information is supplied to the AMA by the ACGME-accredited programs and by the ECFMG.
		American Board of Medical Specialties
		Physicians certified by member boards of the American Board of Medical Specialties (ABMS) are reported to the AMA by the ABMS. The ABMS File provided to AMA includes the following information (as used in the following enumeration, the term "certification" shall also include certificates of special and/or added qualifications): the physician's name; the name of the certifying Board or Boards; the certification or sub certification awarded; the certificate type; the date of the original certification; sub certification and any recertification; and the date of expiration or revocation of the certification and any recertification AMA records carry only information on board certifications issued by boards that are recognized by the Liaison Committee for Specialty Boards (LCSB). The LCSB is comprised of members from the AMA Council on Medical Education and ABMS member boards.
		Federal Drug Enforcement Administration (DEA)
		DEA Registration is updated quarterly. The "as of" date reflects the last quarterly update. Many states require their own controlled substances registration/license, e-VERIFILE.COM as well, can obtain verification of these registrations.

National Practitioner Databank (NPDB)

The NPDB is primarily an alert or flagging system intended to facilitate a comprehensive review of health care practitioners' professional credentials. The information contained in the NPDB is intended to direct discrete inquiry into, and scrutiny of, specific areas of a practitioner's licensure, professional society memberships, medical malpractice payment history, and record of clinical privileges. The information contained in the NPDB should be considered together with other relevant data in evaluating a practitioner's credentials; it is intended to augment, not replace, traditional forms of credentials review.

Information is reported on Physicians, Dentists, and other healthcare practitioners who are licensed or authorized by a State to provide health care services.

e-VERIFILE.COM is a registered agent with the Department of Health and Human Services and is therefore authorized to query on behalf of the eligible entities.

Information Contained in the NPDB are derived from:

Information on medical malpractice payments
Adverse licensure actions
Adverse clinical privileges
Adverse professional society membership actions
Medicaid and Medicare exclusions

The information in the NPDB should serve only to alert State licensing authorities and health care entities that there may be a problem with a particular practitioner's professional competence or conduct. NPDB information should be considered together with other relevant data in evaluating a practitioner's credentials (e.g., evidence of current competence through continuous quality improvement studies, peer recommendations, health status, verification of training and experience, and relationships with patients and colleagues).

Healthcare Integrity and Protection Data Bank (HIPDB)

Want to cut health care fraud and abuse? Check out the Healthcare Integrity and Protection Data Bank (HIPDB). The HIPDB now has almost 5,000 Federal and State health care-related judgments or convictions concerning over 4,000 practitioners and administrators dating back to 1996. Individuals in the HIPDB are responsible for more than $75 million in civil judgments, $11 million of which is attributed to reported physicians, pharmacists, and registered nurses. Nearly 1,000 of these reports involve patient abuse.

Practitioners and administrators with questionable backgrounds may seek positions within your organization. Reduce your risk of liability. Thoroughly investigate the background of those providing care to your patients or making decisions on behalf of your institution by querying the HIPDB. The HIPDB is unique in that it contains information on important health care-related criminal convictions and civil judgments, licensure/certification and health plan actions on nurses' aides, business owners, LPN's, accountants, vocational nurses, physicians, dentists, and many other individuals in the health care industry.

Information Contained in the HIPDB are derived from:

Health care-related civil judgments taken in Federal or State court
Health care-related criminal convictions taken in Federal or State court
Injunctions
Federal or State licensing and certification actions, including revocations, reprimands, censures, probations, suspensions, and any other loss of license, or the right to apply for or renew a license, whether by voluntary surrender, non renewability, or otherwise
Exclusions from participation in Federal or State health care programs
Any other adjudicated actions or decisions defined in the HIPDB regulations

The HIPDB information is intended to be used in combination with information from other sources (e.g., evidence of current competence through continuous quality improvement studies, peer recommendations, verification of training and experience, and relationships with organizations) in making determinations on employment, affiliation, certification, or licensure decisions.

Fraud and Abuse Control Information System® (FACIS®)

Information is reported on more than 50 types of healthcare professionals ranging from physicians to midwives to home health agencies and ambulatory services.

Information Contained in the FACIS® include:

The sanction history of individuals and entities in the healthcare field
Reports provide a wide range of disciplinary actions from exclusions to letters of reprimand
Queries individuals or entities with instantaneous results
Database is updated twice per month with reporting directly from the Office of Inspector General (OIG) and General Services Administration (GSA)

In addition to the search results for FACIS®, an automatic search will be performed against information on the Physician Profile Office of Foreign Assets Control (OFAC) and Specially Designated Nationals and Blocked Persons (SDN) List. You can avoid entering into business/financial transactions with individuals/entities that appear on the list of OFAC and SDN.

This List contains the names and aliases of individuals/organizations that have had financial transactions and property blocked by the U.S. Department of Treasury, OFAC. It is part of the anti-terrorist campaign of the Federal government.

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