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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If a member is granted access to review his/her records:The privacy officer will oversee the process to view the PHI.This granted request to review records will be recorded in the Member Request toReview Protected Health In<strong>for</strong>mation Log, which will be maintained by the privacyofficer or his/her designee.The privacy officer and or his/her designee will discuss with the member:• The <strong>for</strong>mat in which this in<strong>for</strong>mation will be presented• How and where this in<strong>for</strong>mation will be viewed (the member may choose toreview his/her records at <strong>Community</strong> <strong>Care</strong> or have the in<strong>for</strong>mation mailed in anenvelope marked confidential to an address that they have specified).• If the member would like a summary of the in<strong>for</strong>mation, or copies.• That a nominal fee may be charged by <strong>Community</strong> <strong>Care</strong> <strong>for</strong> postage, copying, orpreparation of the in<strong>for</strong>mation (including the labor of copying the in<strong>for</strong>mationrequested).If <strong>Community</strong> <strong>Care</strong> is unable to accommodate the member’s request to view thisin<strong>for</strong>mation, the Privacy Officer will send the member a letter describing:The decision.The reason <strong>for</strong> the denial.A description of the appeals process.The right to file an appeal along with the process <strong>for</strong> filing.The name, or title, and the telephone number of the contact person <strong>for</strong> the next step.Disclosure of In<strong>for</strong>mationExcept as described in the procedures in Collecting and Using Member IdentifiableIn<strong>for</strong>mation, <strong>Community</strong> <strong>Care</strong> requests authorization from the member or the member’slegally authorized representative prior to disclosing the member’s PHI to externalsources.<strong>Community</strong> <strong>Care</strong> will only disclose PHI in accordance with the most restrictiveconsent, authorization or other written legal permission from the member, unlessotherwise specified by the member (HIPAA 164.506(e)).The member or the member’s legally authorized representative has the right to denythe request to release member identifiable in<strong>for</strong>mation without any consequences tothe member or the member’s coverage.If member identifiable data and in<strong>for</strong>mation are to be disclosed <strong>for</strong> purposes other thanthose described in the policies cited in paragraph 1, above, the authorization of themember or member’s legally authorized representative is required (HIPAA Section164.504). This includes, but is not limited to in<strong>for</strong>mation:<strong>Community</strong> <strong>Care</strong> Provider <strong>Manual</strong> | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 185