Billing Manual for Community Care Network Providers

Protection of information disclosed to plan sponsors or employers.A member’s Right to Amend Protected Health Information.Right to an Accounting of Disclosures of Protected Health Information.If the member feels that his/her protected health information has been released or usedinappropriately, they have the right to file a complaint. They may either file the complaintby calling member services or writing a letter to Community Care’s Complaint andGrievance Department. They may also file a complaint with the Secretary of Health andHuman Services who oversees the HIPPA regulations.As part of the HIPAA regulations, members are notified via a Privacy Notice ofCommunity Care’s privacy policies and how Community Care limits and protectsprotected health information. The Privacy Notice is sent to all members detailing ourprivacy policies and how we will maintain his/her confidentiality. Changes made to thePrivacy Notice or policies dealing with privacy and confidentiality will be sent to themember. Notification will be through the member’s update/alert including a descriptiondetailing the change(s) and when the change will occur. Community Care will give themember a 60-day notice prior to the change becoming effective.Ability to Give Informed AuthorizationCommunity Care obtains special authorization to release member identifiableinformation as described in the Disclosure of Information policy and procedure.Community Care considers the following individuals capable of giving validauthorization for the release of member identifiable health information:The member, who has reached the age of majority as identified by CommunityCare’s eligibility data is capable of giving informed authorization on his or her ownbehalf unless Community Care has received notification that the individual has beenadjudicated incompetent.The legal guardian, natural or adoptive parent of a minor, as identified in CommunityCare’s eligibility data is capable of giving informed authorization on behalf of theminor unless Community Care has been informed that the parent has beenadjudicated incompetent, is not the legal guardian, or the minor has been legallyemancipated.An emancipated minor is capable of giving informed authorization on his or her ownbehalf. If not already on file with Community Care, Community Care will requestproof of the minor’s status from the minor before honoring the authorization.A legally authorized representative is capable of giving informed authorization onbehalf of the individual he or she represents. Community Care requires written proofof the individual’s status as legally authorized representative and that the statuscovers the area for which the authorization is being sought.Community Care extends all reasonable effort to develop and maintain anaccurate and efficient system for member information.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 142