Mission:

To help protect the health, safety and welfare of the dental consumer public by providing accurate, in depth personal and professional background information on licensure applicants to state licensing agencies and professional health care organizations.

1. Statement of Service

PBIS provides a centralized source for procuring, verifying and securely storing a dentist's or dental hygienist's core credentials for the authorized use of state licensing boards and other health care entities (User). Additionally, PBIS compiles background information regarding the applicant from multiple sources. Primary source records are compared to information provided by the applicant. A Dentist or Dental Hygienist Information Profile is then forwarded to the authorized board or entity. At no time will PBIS or its agents give recommendations or opinions on applicants. Only information received and processed according to the most recent established policies and procedures will be reported.

PBIS was created to provide a time and effort saving method of storing primary source verified credentials (static) and background information (dynamic) for easy access by authorized entities.

PBIS shall not be held liable or responsible for, and shall be held harmless by the USER from and against, any and all claims and damages which arise from or are directly or indirectly attributed to the licensing or certification decisions and operations of the USER based upon information provided by PBIS under terms of the USER Agreement. PBIS makes no representations or warranties, either implied or expressed, as to the accuracy of information obtained from any primary source, database, agency, applicant or any other source entity as used according to the Policies and Procedures set forth herein.

1.1 Level I Service

The PBIS application is reviewed and processed according to the policies and procedures herein. Original certified documents are obtained and verified directly from primary sources. PBIS certifies photocopies of the credentials for distribution to the User. The American Association of Dental Examiners Clearinghouse, individual State Boards, the National Practitioners Data Bank and other sources are queried for disciplinary actions, peer reviews and civil judgements. A national data bank system is queried (explained in Level III below) for personal background information, i.e., criminal history, past addresses, etc. Procured information is cross referenced for discrepancies and omissions which are reported to the User. A Clinical Examination Equivalency Assessment is compiled. The completed PBIS user file is sent to the user agency for consideration by the appropriate board or committee.

1.2 Level II Service

Level II Service includes all the components of Level I Service excluding the Clinical Examination Equivalency Assessment.

1.3 Level III Service

Level III Service is a check of the national criminal and civil history, past business and residence locations, and other records from national data banks. Criminal histories will be obtained from the county and federal courthouse for each residence and work address of the Applicant for the last seven years. Additional criminal histories as well as supplemental information may be requested by the User and involve additional surcharges to the Applicant. The information is not guaranteed to be perfect. For example, local or municipal records, older infractions and sealed cases may not be on any computer system. However, the information PBIS receives is taken from the most complete and up to date national records service available.

2. Definitions

Applicant - the dentist or dental hygienist applying for state licensure, hospital staff privileges or employment with a health care entity which has agreed to accept PBIS.

Core credentials - certified credentials which are static. Examples include college transcripts, National Board Exam results, diplomas and degrees, residencies, etc. The exception to a static document would be a college transcript which has additional courses that were completed after the initial query.

Primary source verification - certification by official seal or notarization from the institution of origin that a document, diploma, transcript or other credential is authentic and factual. This type of verification is limited to direct correspondence between PBIS and source entities.

User - state licensing board, hospital, health maintenance organization or other health care entity which agrees to accept PBIS's service.

3. Prerequisites of Service

The following must be received to initialize PBIS.

3.1 Applicant Prerequisites: A signed, notarized applicant release and authorization, and full payment of fees

4. Confidentiality

PBIS maintains complete confidentiality of all information obtained according to these Policies and Procedures on each dentist or dental hygienist. PBIS will discuss information with the Applicant, the User indicated on the Applicant's authorization, and the primary sources of such information. Any variation of this policy will be with specific authorization of the User and Applicant as well as prior notification of the PBIS manager.

5. PBIS Application

5.1 General Application Policies

PBIS has developed its own Instructions, Application and Forms packet which are sent directly to the Applicant upon the request of the Applicant or the User. All such dispatch will be first class mail delivery.

PBIS reserves the right to alter or modify the Instructions, Application and Forms as needed with due notice given to the Users. The PBIS Instructions, Application and Forms may not be reproduced for commercial purposes or modified by anyone other than PBIS.

Different applications will be available from PBIS:

1. Levels I & II Application - a more comprehensive information request including name, date and place of birth, personal information, educational history, examination history, professional history and professional information (as described in 5.3 through 5.6).

2. Level III Application - will request information on name, date and place of birth, and personal information.

PBIS reserves the right to require and request additional information from the Applicant or User if needed to perform the service intended.

The application type to be used by the Applicant will be determined by the User state or entity which is identified at the initial request. A state or entity which has entered into a User agreement with PBIS will determine by such agreement the Level of Services to be utilized. For example, if the User has agreed to utilize Level I Service for licensure by credentials and Level III for licensure by testing, that information would be needed to determine application type. PBIS will maintain a list of Users and their Levels of Service per agreement.

5.2 Receipt and Review of Application

Applications received by PBIS are reviewed for completeness and fulfillment of instructions. If the Applicant fails to submit any information, documents or fees according to the established requirements, the Applicant will be required to resolve the omitted component(s).

5.3 Application Information and Verification

If the application is determined complete and acceptable, PBIS will begin requests and verification procedures. Any deficiencies in the application packet will be addressed in a deficiency letter to the Applicant for rectification.

5.3.1 Verification of Name, Date of Birth and Place of Birth

PBIS requires the Applicant to submit a certified birth certificate. A birth certificate can be obtained directly from the appropriate state Vital Statistics office, which displays an affixed seal and the signature of an authorized representative of that office. This birth certificate will become a permanent part of your PBIS file and will not be returned. For information on obtaining an official birth certificate, please contact the state Vital Statistics office in your birth state. A photocopy of the birth certificate will not be accepted.

*If born in a country other than the United States, please call the PBIS office at 602-861-5867 for other options.

5.3.2 Personal Information Required

PBIS requests the following information from the Applicant: U.S. Social Security Number or other National Identification Number and issuing country, Current Mailing Address, Permanent Address, Dental Office Address(es), Telephone numbers (home, business, fax), Gender.

5.3.3 Educational History

PBIS requires the Applicant to give a complete educational history, listing colleges and universities, including dental and dental hygiene schools and graduate schools.

PBIS will obtain a certified transcript of dental education and/or equivalent document from the dental or dental hygiene school(s) listed by the Applicant. The transcript or equivalent document shall contain dates of attendance, course work, grade or performance information and graduation date if applicable. This document shall have an embossed or raised seal or official stamp and signature of an authorized representative of the institution.

Postgraduate dental education is verified by similar procedures. A Verification of Graduate Dental Education Form is completed by the institution, affiliated university and/or hospital, name and address, dentist's name of record, program type, postgraduate year, department, dates of attendance, completion status, accreditation and unusual circumstances regarding the Applicant. This document shall have an embossed or raised seal or official stamp and signature of the Program Director or authorized representative of the institution or agency.

5.4 Examination History

PBIS will directly request and obtain original examination score cards directly from the Joint Commission on National Dental Examinations. All other regional, state or other dental or dental hygiene examinations taken will be verified through primary sources.

5.5 Professional History

5.5.1 State Licensure

PBIS will verify dental, dental hygiene or any other health profession licensure history by directly requesting certification of licensure to each state in which the Applicant has held or is currently holding a license to practice. All such information shall have a disciplinary history of the Applicant, which shall be cross referenced with the professional information provided by the Applicant.

5.5.2 Employment History

PBIS will attempt to verify employment history from two sources listed in the chronological history by direct telephonic (if phone number provided) or written contact with employers, partners, associates, or through national databank referencing.

Affidavits regarding proof of active clinical practice over the last five years shall be required.

5.5.3 Character References

PBIS will contact and confirm each character reference listed by the Applicant by direct telephonic or written means.

5.6 Professional Information

5.6.1 PBIS requires responses to questions relating to dental or dental hygiene licensure history, disciplinary actions, peer review, state board agreements, pending proceedings and details if applicable. Drug registration numbers, restriction on prescription privileges and information on such history is required.

5.6.2 PBIS inquires as to any drug or alcohol use, or health problems which may affect the Applicant's ability to practice dentistry or dental hygiene. PBIS has no intent to discriminate against challenged individuals. The questions are informational only; and intended to protect the public by revealing unsafe practices.

5.6.3 A history of all malpractice or negligence lawsuits is required, as well as felony and misdemeanor arrests or convictions. The Applicant is requested to provide the malpractice insurance carriers from the previous ten (10) years.

6. Requests and Verification Procedures

6.1 Requests and Receipt of Verification

PBIS initiates all requests for certified documents and verification to the appropriate institution or agency listed in the Application and will not accept documents directly from the Applicant unless:

1. otherwise specified in the USER Agreement,
2. directly expressed by Policies and Procedures, or
3. specifically authorized by the User. Other than as indicated above, PBIS will not accept documentation from institutions or agencies if the request was initiated by the Applicant.

Dental and Dental Hygiene Schools: PBIS will forward all requests and verifications to the names and addresses of such colleges listed in the most recent edition of the Commission on Dental Accreditation, Accredited Program Listing of Dental Schools and Dental Hygiene Schools and the Accredited Program Listing of Advanced Specialty and General Dentistry Education. All foreign dental colleges will be contacted to verify their existence. PBIS will build a file of such foreign schools as verified. If such information proves to be unreliable, PBIS will use alternate means necessary to procure correct information.

6.2 Dilatory Verification Responses

Institutions or agencies that fail to respond within 10 days of the initial request will be contacted to verify the status of the request. If the requests are reported as not received, an additional request will be sent. If the institution or agency does not comply after three requests from PBIS, the institution or agency will be classified as non-responsive. In such cases, requested information will be subject to Secondary Verification, section 6.3.

6.3 Secondary Verification

If required information and documents are not received by institutions or agencies which are then classified as non-responsive, PBIS will request exact quality photocopies of such information and documents from the dentist or dental hygiene Applicant. Information obtained by such means shall be subject to standard verification and quality assurance procedures, but will not be considered verified by the primary source.

Documents and information subject to secondary verification shall be flagged appropriately, and the User notified in the Omission and Discrepancy Report.

6.4 Translations

PBIS requires all documents received from the primary source in a language other than English be translated by a third party professional translation service selected by PBIS. PBIS will first request if such translation is offered by the primary source institution or dental school. If secondary verification documents are submitted by the Applicant in a foreign language, a translation must be included by the Applicant.

All charges of translation, postage and handling must be prepaid by the Applicant.

6.5 Problematic Information

If information received by PBIS from requested sources is illegible, inconsistent, incorrect or incomplete, PBIS will attempt to rectify the problem(s) directly with the institution or agency. Any unresolved problems will be reported to the User on the Omission and Discrepancy Report.

7. Data Bank Information

7.1 Professional Disciplinary Actions

PBIS will use nationally established professional disciplinary data banks to obtain information on the Applicant's professional licensure. The American Association of Dental Examiners' (AADE) Clearinghouse for disciplinary actions and the National Practitioners' Data Bank (NPDB) will be queried. Due to regulations of the NPDB, each User state must designate PBIS as an Authorized Agent of that state or the Applicant must request a self query. (This exception of primary source verification is addressed in Section 6.1). Information from these services is confidential and non-reproducible. PBIS will generate an Adverse Findings Report which will show none if the queries reveal such. If the queries indicate disciplinary or legal action, , PBIS will request information from the board or entity which reported the action. This information will be included in the Adverse Findings Report.

7.2 National Data Bank Queries

PBIS will query a nationally used public records access system. Information which may be accessed include county and federal criminal and civil histories, current and historical addresses, a variety of business information, and other information available.

More extensive searches require an additional fee and take more time to collect the data. These expanded searches may be requested by the User if the appropriate charges are paid.

8. Examination Equivalency Evaluation

PBIS will assess the existing licensure examination of the User and make an in depth comparison with the licensure examination that has been successfully completed and submitted by the Applicant. Equivalency will be assessed regarding the test candidate information package, examiner information package and calibration, scoring criteria and methods, required clinical procedures and written examinations.

9. Fees and Payment

PBIS has established various fees for the different levels of service. PBIS reserves the right to change fees and surcharges with written notice to the Users. Every attempt will be made to keep fees as low as possible for the Applicants, while maintaining a reasonable margin of positive cash flow to continue providing services. Payment of fees is the responsibility of the Applicant, and a prerequisite to begin services. All fees must be paid by credit card, United States money orders, certified check, or cashier's check, payable to Professional Background Information Services (PBIS).

9.1 Level I Service Fee

Level I Service Fee is seven hundred and fifty dollars ($750.00).

9.2 Level II Service Fee

Level II Service Fee is:

Dentists:
By exam (new graduate) - three hundred and fifty dollars ($350.00)
By exam (with license) - five hundred dollars ($500.00)
Limited - three hundred and fifty dollars ($350.00)
Limitied Facilitators - five hundred dollars ($500.00)
Specialist - five hundred dollars ($500.00)
Geographically Restricted - five hundred dollars ($500.00)
Credentialing - five hundred dollars ($500)

Dental Hygienists:
By exam (new graduate) - three hundred and fifty dollars ($350.00)
By exam (with license) - four hundred dollars ($400.00)
Limited - three hundred and fifty dollars ($350.00)
Credentialing - four hundred dollars ($400.00)
Geographically Restricted - four hundred dollars ($400.00)

9.3 Level III Service Fee

Level III Service Fee is three hundred dollars ($300.00).

9.4 Surcharges

Surcharges are necessary when institutions, agencies or other entities require fees for processing information requested by PBIS; and when PBIS incurs additional expenses in processing.

9.4.1 Passport Shipping and Handling

In those cases when a passport is sent by the Applicant for identification verification, a five dollar ($5.00) fee will be required from the Applicant to cover costs of returning the passport (via certified mail).

9.4.2 Translations

When translation services are required, the amount charged by the translation company plus appropriate shipping and handling charges will be required from the Applicant.

9.4.3 Verification, Certification and Data Bank Charges

PBIS will pay for additional charges to total fifty dollars ($50.00) or less. Charges incurred by PBIS greater than fifty dollars ($50.00) are to be paid by the Applicant. These charges will be totaled and invoiced to the Applicant. Payment in full by United States money order, certified check, or cashier's check, payable to Professional Background Information Services (PBIS), must be received by PBIS before the Applicant Profile is forwarded to the User.

9.4.4 Database Extended Searches and Reports

If requested by the User, extended searches into areas of concern may be ordered by PBIS through national records sources. Any additional fees or expenses must be paid by the Applicant or the requesting User.

9.5 Multiple Users and Subsequent Requests by Applicant

A reduced fee will be charged for subsequent requests after a completed profile and core credentials have been established. A Level I or II application which requests multiple states or entities will be invoiced for two hundred dollars ($200.00) per additional User.

9.6 Refunds

The only refund given will be a full refund of fees paid if the Applicant's cancellation by written request via facsimile or mail service is received within forty-eight (48) hours from the time PBIS receives the initial Application.

10. Reports - Applicant Profile

A Dentist Profile or Dental Hygienist Profile will be compiled and sent to the User in accordance with the User Agreement with PBIS. The Profile packets will include a Dentist or Dental Hygienist Information Summary, Omission and Discrepancy Report, Verification of Dental, Postgraduate, or Dental Hygiene Education (from each institution), PBIS certified copy of each primary source certified transcript, PBIS certified copies of examination results, PBIS certified copies of state licensure certification and disciplinary documents, Adverse Information, Examination Equivalency Evaluation, and copies of documents sent by the Applicant with initial application.

10.1 Dentist or Dental Hygienist Information Summary

PBIS will prepare a profile summary of the information in the Personal Information, Educational History, Examination History, Professional Disciplinary History and Adverse Information. This will be included in the Dentist or Dental Hygienist Profile Packet.

10.2 Omission and Discrepancy Report

PBIS will review information obtained from the PBIS Application, primary sources, data bank queries and any other verifiable information procured through PBIS processing. An Omission and Discrepancy Report will be generated showing any omission of relevant material or discrepancies in information provided by different sources. This information is for the consideration of the User. PBIS may provide additional assistance for further inquiry on omissions and discrepancies when requested by the User for an appropriate surcharge.

10.3 Verification of Dental, Postgraduate, and Dental Hygiene Education

PBIS will include PBIS certified copies of the corresponding transcript.

10.4 Examination Results

PBIS will provide PBIS certified copies of state, regional and National Board examinations' results.

10.5 State Licensure Certification and Disciplinary Documentation

PBIS will request and receive state certification of licensure and disciplinary history for all states listed in the application as completed by the Applicant. Also, any state indicated by action, via data bank queries, will be requested to provide license certification and disciplinary history for the Applicant. This documentation will be included as PBIS certified copies.

10.6 Adverse Information

Any information procured by PBIS in the course of service, as stated in these procedures, which would be relevant to consideration for licensure or credentialing by the User will be provided in an Adverse Information Report. PBIS makes no inference by this report on the weight of importance of this information regarding licensure or credentialing. This is merely an instrument to provide the User with a complete information packet.

10.7 Examination Equivalency Evaluation

PBIS will include this report on Level I Service. Refer to section( 8.) for additional information regarding report content.

10.8 Documentation Provided by Applicant

This section of the report includes copies of documents sent to PBIS by the Applicant, i.e. dental school diploma, explanations of responses, etc. These are separate documents from all other information which is procured directly by PBIS via the primary sources.

11. Information and File Management

11.1 Original Source Documents

Original documents procured directly from the sources will be maintained in each Applicant's file. If a User must review an original document for legal purposes, PBIS may loan an original document to the User with consent of the PBIS manager and a written agreement that the original document will be returned to PBIS within twenty (20) working days via certified mail. The User shall agree the document will be under sole custody of the User at all times and will be returned to PBIS without any changes or alterations of any kind.

11.2 Confidentiality

As stated in section four (4.), all materials will be maintained confidentially. Reports obtained by PBIS from certain contracted sources cannot be reproduced nor forwarded from the custody of PBIS. In these cases, relevant information will be provided to the User in report form.

11.3 File Retention

Information relating to each applicant procured by PBIS will be maintained for a period of twenty four (24) months from date of initial receipt of application in locked storage at the PBIS office. Each file will have an assigned number, applicant's full name, date of birth, and social security number for identification.