Billing Manual for Community Care Network Providers

Community Care’s requirements for provider storage and transmission (by email orfax) of member identifiable information (Section III.C.8).Community Care’s policy on confidentiality describes for Community Care employees,representatives (including providers), and members, our policies and procedures onobtaining authorizations for use of member medical information, allowing membersaccess to their medical records held by providers and protecting access to member“protected health information” as defined by HIPAA.III.C.1 General Confidentiality ProvisionsCommunity Care agents and contractors (including providers) potentially having accessto confidential information are required to sign Community Care’s Statement ofConfidentiality agreeing to be bound by Community Care’s strict confidentiality policiesand procedures, or must conform to equivalent provisions as determined by CommunityCare staff or legal counsel. Breach of the Statement of Confidentiality or equivalent isgrounds for immediate termination with cause (See Section III.B.5).III.C.1a What Constitutes Confidential InformationThe following are highlights of what constitutes confidential information:Member identifiable data and information, including explicitly identifiable data suchas member name, social security number, or other identifier that can be directlylinked to a specific individual and implicitly identifiable data such as memberaddress, telephone number, date of birth, or other information that, alone or incombination with other available information, can lead to identification of a specificindividual, are confidential.Data and information specific to practitioner providers, including but not limited to,that used for network development, credentialing, performance evaluation, qualityassurance, quality improvement, and peer review are Confidential. A practitionerprovider’s name, professional degree, status as a member of Community Care’spractitioner provider network, business address, business telephone number andspecialty/specialties or self-identified areas of special interest are not consideredconfidential when disclosed for legitimate business purposes. Data and informationrelated to a practitioner provider’s racial, cultural, or ethnic background, age,religious affiliation, gender and ability to communicate in languages other thanEnglish, are Confidential unless the practitioner provider explicitly authorizes therelease of this information. For example, completing optional sections of theprovider credentialing/recredentialing or assessment/reassessment applicationregarding a provider’s ability to communicate in languages other than English maybe used to help fulfill members’ requests when making referrals.Information specific to a practitioner practice group or facility, including but notlimited to, that used for network development, organizational assessment andCommunity Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 67