Billing Manual for Community Care Network Providers

must verify that the member has signed an authorization to release such data orinformation to the employer. Community Care will require that the employer agree inwriting to protect all member identifiable data and information from being used in anydecisions affecting the member (HIPAA 164.504(h)(3)(iv)).Many requests from employers for data and information can be fulfilled withdata and information that are not member identifiable: In instances where an employer requests member identifiable information,Community Care will inquire as to the proposed use of the data and information andattempt to meet the need with data and information that are not member identifiable,for example aggregated data or information. In instances where member identifiable data or information is required, CommunityCare will ensure that an authorization for the release of information is signed by themember prior to releasing implicit data to the member’s employer. In all instances, Community Care only discloses the minimal information necessaryto accomplish the purpose of the disclosure.Handling of Practitioner Specific InformationCommunity Care considers practitioner specific data and information, including but notlimited to, that used for network development, credentialing, performance evaluation,quality assurance, quality improvement, compliance auditing and peer reviewconfidential to the extent permitted by law.A practitioner’s name, professional degree, status as the member of CommunityCare’s practitioner network, business address, business telephone number, andspecialty (ies) 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 a practitioner explicitly authorizes to therelease of this information.Community Care’s credentialing and recredentialing applications request that suchinformation be supplied at the discretion of a practitioner.The credentialing and recredentialing applications state that if such information issupplied, Community Care may use and disclose only the minimum amount ofinformation to members or appropriate individuals for purposes of meeting a specificMember needs or requests when making referrals.Practitioner files are maintained in a locked room or locked file cabinet when not inuse by credentialing staff or the Credentialing Committee. Practitioner files stored inelectronic, magnetic, or optical format are protected with a secure password.Access to practitioner files is limited to the network management, compliance, andcredentialing staff and the Credentialing Committee.Practitioners may review the information in his/her file upon request except for anyinformation from the National Practitioner Data Bank (NPDB) and peer (professionaladvisor) review information. Review of NPDB information is prohibited by FederalCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 150