Billing Manual for Community Care Network Providers

The health plan may distribute the information to its members.Members may be notified in Community Care’s Member’s Handbook or via membernewsletters that are mailed throughout the year with updated information.Members may request to have this information sent to a different address or locationthen where they are currently residing. They may write a letter to the privacy officerat Community Care or call member services and inform us as to where they wouldlike the information sent (HIPAA 164.522(b)).A Notice of Privacy authorizing uses of member identifiable information is posted onCommunity Care’s website and members are informed of this posting via printedmaterials such as newsletters with a note that Community Care will provide theNotice of Privacy in written form upon request.Whatever the communication mechanism, the following language, or equivalent, is usedto notify subscribers of Community Care’s routine collection and use of memberidentifiable information: “Community Care uses information about you and yourdependents (if applicable) to enable us to verify eligibility for services; authorizetreatment; pay claims; coordinate care; resolve inquiries, complaints, and appeals;improve the care and service rendered by Community Care and its network ofPractitioners and Facilities; and meet regulatory requirements and accreditationstandards. If we use information for reasons other than those described above, we willremove any portions of the information that could allow someone to identify you or yourdependent, or we will contact you or your dependent to ask for written authorization touse the information.”Community Care does not disclose PHI for underwriting purposes.Handling of Member Identifiable InformationAll data and information where the member or subscriber is, or could possibly be,identified are confidential. An individual’s status as the member or subscriber isconsidered confidential member identifiable information.A treatment record is a confidential document that is the record of privilegedcommunication between a consumer and a health care practitioner or facility.Community Care may obtain copies of treatment records for legitimate businesspurposes.Member identifiable information may not be divulged by telephone without firstverifying the identity of the other party.A case number or Social Security Number and date of birth may be used to verifythe identity of an individual claiming to be a member or subscriber.If there is suspicion about the identity of an individual, even when such person cansupply a correct case number or Social Security Number and date of birth, theCommunity Care representative should seek additional verification or requestassistance from a supervisor or manager.The member requesting information about his or her treatment should be referred tothe treating practitioner.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 181