Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
Billing Manual for Community Care Network Providers
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A member’s Right to Amend Protected Health In<strong>for</strong>mation.A member’s Right to an Accounting of Disclosures of Protected Health In<strong>for</strong>mation.If the member feels that his/her protected health in<strong>for</strong>mation 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 <strong>Community</strong> <strong>Care</strong>’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 of<strong>Community</strong> <strong>Care</strong>’s privacy policies and how <strong>Community</strong> <strong>Care</strong> 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. <strong>Community</strong> <strong>Care</strong> will give members a 60-day notice prior to thechange (s) becoming effective.Ability to Give In<strong>for</strong>med Authorization<strong>Community</strong> <strong>Care</strong> obtains special authorization to release member identifiablein<strong>for</strong>mation as described in the Disclosure of In<strong>for</strong>mation policy and procedure.<strong>Community</strong> <strong>Care</strong> considers the following individuals capable of giving validauthorization <strong>for</strong> the release of member identifiable health in<strong>for</strong>mation:The member, who has reached the age of majority as identified by <strong>Community</strong><strong>Care</strong>’s eligibility data is capable of giving in<strong>for</strong>med authorization on his or her ownbehalf unless <strong>Community</strong> <strong>Care</strong> has received notification that the individual has beenadjudicated incompetent.The legal guardian, natural or adoptive parent of a minor, as identified in <strong>Community</strong><strong>Care</strong>’s eligibility data is capable of giving in<strong>for</strong>med authorization on behalf of theminor unless <strong>Community</strong> <strong>Care</strong> has been in<strong>for</strong>med that the parent has beenadjudicated incompetent, is not the legal guardian, or the minor has been legallyemancipated.An emancipated minor is capable of giving in<strong>for</strong>med authorization on his or her ownbehalf. If not already on file with <strong>Community</strong> <strong>Care</strong>, <strong>Community</strong> <strong>Care</strong> will requestproof of the minor’s status from the minor be<strong>for</strong>e honoring the authorization.A legally authorized representative is capable of giving in<strong>for</strong>med authorization onbehalf of the individual he or she represents. <strong>Community</strong> <strong>Care</strong> requires written proofof the individual’s status as legally authorized representative and that the statuscovers the area <strong>for</strong> which the authorization is being sought.<strong>Community</strong> <strong>Care</strong> Provider <strong>Manual</strong> | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 183