Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
collection and use of member identifiable in<strong>for</strong>mation, some of the followingmechanisms are used:The health plan may distribute the in<strong>for</strong>mation to its members.Members may be notified in <strong>Community</strong> <strong>Care</strong>’s Member Handbook or via membernewsletters that are mailed throughout the year with updated in<strong>for</strong>mation.The member may request to have this in<strong>for</strong>mation sent to a different address orlocation then where they are currently residing. They may write a letter to the privacyofficer at <strong>Community</strong> <strong>Care</strong> or call member services and in<strong>for</strong>m us as to where theywould like the in<strong>for</strong>mation sent (HIPAA 164.522(b)).A Notice of Privacy authorizing uses of member identifiable in<strong>for</strong>mation is posted on<strong>Community</strong> <strong>Care</strong>’s website and members are in<strong>for</strong>med of this posting via printedmaterials such as newsletters with a note that <strong>Community</strong> <strong>Care</strong> will provide theNotice of Privacy in written <strong>for</strong>m upon request.Whatever the communication mechanism, the following language, or equivalent, is usedto notify subscribers of <strong>Community</strong> <strong>Care</strong>’s routine collection and use of memberidentifiable in<strong>for</strong>mation: “<strong>Community</strong> <strong>Care</strong> uses in<strong>for</strong>mation about you and yourdependents (if applicable) to enable us to verify eligibility <strong>for</strong> services; authorizetreatment; pay claims; coordinate care; resolve inquiries, complaints, and appeals;improve the care and service rendered by <strong>Community</strong> <strong>Care</strong> and its network ofpractitioners and facilities; and meet regulatory requirements and accreditationstandards. If we use in<strong>for</strong>mation <strong>for</strong> reasons other than those described above, we willremove any portions of the in<strong>for</strong>mation that could allow someone to identify you or yourdependent, or we will contact you or your dependent to ask <strong>for</strong> written authorization touse the in<strong>for</strong>mation.”<strong>Community</strong> <strong>Care</strong> does not disclose protected health in<strong>for</strong>mation <strong>for</strong> underwritingpurposes.Handling of Member Identifiable In<strong>for</strong>mationAll data and in<strong>for</strong>mation where the member or subscriber is, or could possibly be,identified are confidential. An individual’s status as the member or subscriber isconsidered confidential member identifiable in<strong>for</strong>mation. A treatment record is a confidential document that is the record of privilegedcommunication between a member and a health care practitioner or facility. <strong>Community</strong> <strong>Care</strong> may obtain copies of treatment records <strong>for</strong> legitimate businesspurposes. Member identifiable in<strong>for</strong>mation may not be divulged by telephone without firstverifying the identity of the other party. A case number or social security number and date of birth may be used to verify theidentity of an individual claiming to be a member or subscriber. If there is suspicion about the identity of an individual, even when such person cansupply a correct case number or social security number and date of birth, the<strong>Community</strong> <strong>Care</strong> representative should seek additional verification or requestassistance from a supervisor or manager.<strong>Community</strong> <strong>Care</strong> Provider <strong>Manual</strong> | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 140