Billing Manual for Community Care Network Providers

If the client has given written authorization for such release, certain information may bereleased to insurance companies and health plans to include (28 PA Code §709.28Confidentiality): Whether the person is or is not in treatment. The prognosis. Diagnoses on all five Axes. General peculiarities of the case. The provider may present his/her recommendations regarding the client’scontinuation with the treatment program. The nature of treatment. The structure of the program. The methodology of treatment and the treatment models that are utilized by theprogram. A brief description of progress. The provider may speak in general terms of the member’s progress or lack ofprogress as it relates to recovery. The provider may speak in general terms of the clients understanding of the diseaseconcept and their cooperation, or lack of, regarding the rules. A short statement of whether the person has relapsed into drug or alcohol abuseand the frequency of such relapse. Exception: In an emergency where the member’s life is in immediate jeopardy,patient records may be released without the member’s authorization to propermedical authorities solely for the purpose of providing medical treatment. Disclosure may be made for purposes unrelated to such treatment or benefits onlyupon an order of court of common pleas after application demonstrating good causefor disclosure.Community Care Staff Having Knowledge of, or Having, a Relationship with theMemberCommunity Care will ensure that no conflicts of interest exist between Community Carestaff in/when dealing with member treatment decisionsA Community Care staff member that has any independent knowledge of, or arelationship with, the member for whom he/she is making coverage decisions, shalldisclose that knowledge or relationship to his/her supervisor. The supervisor will decideon the appropriate process for making decisions for that member.Confidentiality and Privacy Training for Community Care StaffTraining on confidentiality and privacy regarding member information and utilizationrecords for Community Care staff will be conducted at hire and annually thereafter, withany change in job title/duties, or when significant changes in laws or policies regardingconfidentiality warrant retraining. This training will be intended to provide CommunityCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 166