Billing Manual for Community Care Network Providers

A member’s Right to Amend Protected Health Information.A member’s Right to an Accounting of Disclosures of Protected Health Information.If the member feels that his/her protected health information has been released or usedinappropriately, they have the right to file a complaint. They may either file the complaintby calling member services or writing a letter to Community Care’s Complaint andGrievance Department. They may also file a complaint with the Secretary of Health andHuman Services who oversees the HIPPA regulations.As part of the HIPAA regulations, members are notified via a Privacy Notice ofCommunity Care’s privacy policies and how Community Care limits and protects PHI.The Privacy Notice is sent to all members detailing our privacy policies and how we willmaintain their confidentiality. Changes made to the Privacy Notice or policies dealingwith privacy and confidentiality will be sent to members. Notification will be through themember updates/alerts including a description detailing the change (s) and when thechange (s) will occur. Community Care will give members a 60-day notice prior to thechange (s) becoming effective.Ability to Give Informed AuthorizationCommunity Care obtains special authorization to release member identifiableinformation as described in the Disclosure of Information policy and procedure.Community Care considers the following individuals capable of giving validauthorization for the release of member identifiable health information:The member, who has reached the age of majority as identified by CommunityCare’s eligibility data is capable of giving informed authorization on his or her ownbehalf unless Community Care has received notification that the individual has beenadjudicated incompetent.The legal guardian, natural or adoptive parent of a minor, as identified in CommunityCare’s eligibility data is capable of giving informed authorization on behalf of theminor unless Community Care has been informed that the parent has beenadjudicated incompetent, is not the legal guardian, or the minor has been legallyemancipated.An emancipated minor is capable of giving informed authorization on his or her ownbehalf. If not already on file with Community Care, Community Care will requestproof of the minor’s status from the minor before honoring the authorization.A legally authorized representative is capable of giving informed authorization onbehalf of the individual he or she represents. Community Care requires written proofof the individual’s status as legally authorized representative and that the statuscovers the area for which the authorization is being sought.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 183