Billing Manual for Community Care Network Providers

Findings will be reported to senior management.If applicable, Community Care will alert the Secretary of Health and HumanServices, and any other state or federal government agencies, and the physicalhealth plan when necessary, of the breach in confidentiality.At times, Community Care may have interns, residents, or students who may beexposed to the member’s protected health information during his/her rotation. They arerequired to sign Community Care’s “Statement of Confidentiality” in the beginning oftheir rotation and review all confidentiality policies and procedures.Education related to the principles and procedures for maintaining confidentiality isrequired for all Community Care employees, staff, and volunteers at the time of hire andannually thereafter. When an employee, staff, or volunteer has a significant change inhis/her job title or assignments, his/her director/supervisor will review all confidentialitypolicies that pertain to his/her new assignments at the time of the transition.Documentation of confidentiality training will be maintained in the employee’s personnelfile located in Human Resources Department (HIPAA Section 164.530(b)(1)).Community Care considers the following data and information to be confidential: Member identifiable data and information: that is, all data and information where themember is, or could possibly be, identified. Explicitly identifiable data include, but are not limited to, member name, socialsecurity number, medical record number, health plan beneficiary numbers, accountnumbers, certificate/license numbers, or other identifier that can be directly linked toa specific individual. Implicitly identifiable data include, but are not limited to, member address, telephonenumber, fax numbers, electronic email addresses, date of birth or other suchinformation that, alone or in combination with other available information, can lead toidentification of a specific individual. Practitioner specific data and information, including but not limited to, that used fornetwork development, credentialing, performance evaluation, quality assurance,quality improvement, and peer review. A practitioner’s name, professional degree, status as a member of CommunityCare’s practitioner network, business address, business telephone number, andspecialty/specialties or self-identified areas of special interest are not consideredconfidential when disclosed for legitimate business purposes. Data and information related to a practitioner’s racial, cultural or ethnic background,age, religious affiliation, sexual orientation, and ability to communicate in languagesother than English, is confidential unless the practitioner explicitly authorizes therelease of this information. Practice or group specific and facility specific data and information, including thatthat is used for but not limited to, network development, organizational assessmentand contracting, performance evaluation, quality assurance, and qualityimprovement.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 131