Billing Manual for Community Care Network Providers

Member identifiable information may not be disclosed to the member’s relatives orfriends except as described in the Disclosure of Information policy and procedure.Data and information derived from treatment records, utilization management records,or other clinical sources shall not be considered confidential if they are de-identified orcombined and aggregated with other data and information in a manner that precludesthe identification of specific members. When considering the adequacy of suchaggregation or de-identification to maintain the members’ confidentiality, the CommunityCare representative disclosing the data or information must consider what other data orinformation may be available to the recipient that could enable the recipient of theinformation to identify specific members.Members have the right to request special limits on access to member identifiableinformation. For example, the member who is also an employee of Community Caremay request that information on his or her treatment be afforded special protection.The following table describes circumstances that Community Care has determinedcreate a right to special protection of member identifiable data and information and themechanism that Community Care has implemented to adhere to the request:Reason for Special Protection ofProtected Health InformationThe subscriber is a staffmember/employee (or a familymember) or volunteer at CommunityCareMechanism to Adhere to RequestNo clinical information is maintained inCommunity Care’s information systemother than routine eligibility dataClinical reviews are conducted by themedical director, designatedprofessional advisor, or Chief ClinicalOfficerClaims adjudication is handledmanually by the department supervisorInforming Members about ConfidentialityCommunity Care prepares information, written at a 4 th grade reading level, for membersthat describes Community Care’s confidentiality policies and procedures. Theinformation covers the following topics:Collecting and using member identifiable information, including provisions for routinenotification of the collection and use of member identifiable data and information.Use of authorizations and ability to give informed authorization.Access to protected health information.Internal protection of protected health information across the organization.Member access to protected health information.Disclosure of Information.Protection of information disclosed to plan sponsors or employers.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 182