Billing Manual for Community Care Network Providers

concerning the member and the like. This information is typically maintained in what iscalled the “utilization record”.Community Care Proprietary Information- means information about the wayCommunity Care conducts business, including but not limited to trade secrets,confidential financial information, provider contract information, business associateagreements, and utilization management (UM) and quality management (QM)methodology created and utilized by Community Care. Community Care proprietaryinformation also includes usual and customary database information and specificcharge information. Descriptions of Community Care business practices routinelyincluded in responses to Requests for Proposals or otherwise made available to thepublic are not proprietary information. Director level personnel, in consultation withlegal services, are responsible for determining whether other information is proprietary.Patient Identifiable Claim Information – see “CLAIMS INFORMATION”Aggregate Claim Information (ACI) and Community Care Non-Medical ProprietaryInformation – Per State law Community Care is prohibited from releasing any claimsinformation or status to HealthChoices members.Confidentiality: Compliance with State and Federal LawsCommunity Care complies with all state and federal laws and regulations pertaining tothe disclosure of confidential member information and to assure that such confidentialinformation is not released without proper documentation, appropriate authorization,and in accordance with HIPAA regulations to contract holders and their minions.Community Care publishes and distributes a DPW approved Member Handbook to allMedical Assistance members. This handbook describes confidentiality protectionsincluding explanation of access to the member’s clinical records by oversight agenciesand access to records for quality and utilization oversight purposes. The MemberHandbook also advises members about the appropriate release of information formsneeded to send information in their utilization record to other providers of health care.In addition, Notice of Privacy statements are sent to all members in accordance withHIPAA privacy regulations.Notice to Accompany Information Released Pursuant to Written Authorization forDisclosureEach disclosure made to a third party with the member’s written authorization must beaccompanied by the following written statement:This information has been disclosed to you from records whose confidentiality isprotected by federal and Pennsylvania law including the Health Insurance Portabilityand Accountability Act of 1996. These laws and regulations prohibit you from makingany further disclosure of this information unless further disclosure is expressly permittedCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 159