Billing Manual for Community Care Network Providers

If the privacy officer determines that the request should not be honored, within 30 dayshe/she will send the member a letter including the decision; the reason for the denial; adescription of the appeals process; the process for filing an appeal; and the name/titleand phone number of the contact person for the next step.APPENDIX A.3. Supplemental ConfidentialityPOLICYIt is the policy of Community Care to protect the confidentiality of member information inits administrative functions and among its contracted health care providers. Specificprovider and member information is collected and used by Community Care to theextent necessary and appropriate to requirements relating to accountability functionsand for the delivery of efficient and high quality care and services.This Confidentiality and Disclosure Policy is intended to provide Community Carepersonnel with guidance concerning the disclosure of information relating to members,providers, services furnished to members, or other confidential information, whether theinformation was created by Community Care or acquired in connection with its businessactivities.Responses to requests for information from utilization records must comply withapplicable state and federal laws and regulations and The Health Insurance Portabilityand Accountability Act (HIPAA) regulations including 164.510 governing the release ofsuch information. Responses to requests for information should reflect a customerservice orientation but must also reflect an awareness of the potentially competinginterests of different customers of Community Care, e.g., employer groups and enrolledmembers. This policy also concerns confidentiality regulations related to theassessment, diagnosis, referral, case management, counseling, and treatment of themember, as well as confidentiality related to the complaint and grievance process.It is the policy of Community Care to adhere to all applicable laws, regulations andprotections with respect to assuring the confidentiality of member information and withthe specific requirements set forth at 42 CFR, Part 2 of the Federal Regulations, 255.5of the Pennsylvania Drug and Alcohol Abuse Control Act, the confidentiality of HIV-Related Information Act, the Mental Health Procedures Act and the Mental Health andMental Retardation Act of 1966 and all pertinent regulations. No information will bereleased without the specific authorization of the member except as noted in andconsistent with the attached specific directives and exceptions:CPL 032 Confidentiality Policy.Authorization to Release Confidential Information Form.Patient Record Retention Policy.Policy on Release of HIV-Related Information.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 157