Billing Manual for Community Care Network Providers

If a member is granted access to review his/her records:The privacy officer will oversee the process to view the protected health information.This granted request to review records will be recorded in the Members’ Request toReview Protected Health Information Log, which will be maintained by the privacyofficer or his/her designee.The privacy officer and or his/her designee will discuss with the member:• The format in which this information will be presented• How and where this information will be viewed (the member may choose toreview his/her records at Community Care or have the information mailed in anenvelope marked confidential to an address that they have specified).• If the member would like a summary of the information, or copies.• That a nominal fee may be charged by Community Care for postage, copying, orpreparation of the information (including the labor of copying the informationrequested).If Community Care is unable to accommodate the member’s request to view thisinformation, the privacy officer will send the member a letter describing:The decision.The reason for the denial.A description of the appeals process.The right to file an appeal along with the process for filing.The name, or title, and the telephone number of the contact person for the next step.Disclosure of InformationExcept as described in the procedures on Collecting and Using Member IdentifiableInformation, Community Care requests authorization from the member or the member’slegally authorized representative prior to disclosing the member’s protected healthinformation to external sources.Community Care will only disclose protected health information in accordance withthe most restrictive consent, authorization or other written legal permission from themember, unless otherwise specified by the member (HIPAA 164.506(e)).The member or the member’s legally authorized representative has the right to denythe request to release member identifiable information without any consequences tothe member or the member’s coverage.If member identifiable data and information are to be disclosed for purposes other thanthose described in the policies cited in paragraph 1 above, the authorization of themember or member’s legally authorized representative is required (HIPAA Section164.504).Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 144