Billing Manual for Community Care Network Providers

collection, use, or disclosure of his/her protected health information. The member maywrite a letter to the privacy officer at Community Care, requesting to restrict thedisclosure of his/her protected health information. The letter must include what specificinformation the member wants restricted, the member’s signature, and it must be dated.The privacy officer will review the member’s request and will respond in 30 days inwriting if this information is on site. If the information that the member is requesting isnot on-site, Community Care will retrieve the information within 60 days.If needed, Community Care may extend the retrieval an additional 30 days provided thatthe member is sent a written letter with an explanation for the delay, and provide a datein which we will have this information. Community Care will only have one suchextension of time for each request. If the restriction of protected health is granted:The privacy officer will send a letter to the member informing him/her howCommunity Care will limit his/her information.The privacy officer will oversee the process to restrict the PHI.This granted request for restriction of PHI will be recorded in the Member Request toLimit Protected Health Information Log, which is maintained by the privacy officer orhis/her designee.The privacy officer will notify the manager of the file room to have the member’s filepulled.The privacy officer or his/her designee will place on the front of the member’sutilization record a sticker.The sticker will have in writing on it “RESTRICTED INFORMATION.”If this file is requested by an employee, the file room clerk must see the privacyofficer, or his/her designee, to receive permission to process the request this file.Once the employee is finished with this file and returns it to the file room, the fileclerk must alert the privacy officer or his/her designee that the file has beenreturned.The privacy officer will notify all necessary department managers of the member’srequest to limit his/her PHI.PsychConsult will contain an alert notifying staff that this particular member’srecords are restricted.If the Member’s request is denied the privacy officer will:Record in the Member Request to Limit Protected Health Information Log that therequest was denied.Send the member a letter within 30 days of the decision including:• The decision.• The reason for the denial.• A description of the appeals process.• The right to, and process for, filing an appeal.• The name, or title, and the telephone number of the contact person for the nextstep.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 179