Billing Manual for Community Care Network Providers

Coordination of care.Billing.Adjudication of claims.Performance measurement and improvement (“quality assurance”).Compliance audits.Prevention and disease management activities.Provider credentialing.Investigating and resolving inquiries and complaints.Processing appeals.Complying with regulatory requirements and accreditation standards.Community Care is responsible for notifying members of Community Care’s routinecollection and use of member identifiable data and information for the purposes justdescribed. The use of member identifiable information for purposes other than thoselisted requires written authorization from the member or representative, unless use ofthe information is permitted or required by applicable law or a valid court order.III.C.3 Informing Members about ConfidentialityCommunity Care prepares information for members that describes Community Care’sconfidentiality policies and procedures. This information covers key points of theinformation contained in Community Care’s Confidentiality Policy, such as:Collecting and Using member identifiable Information.Handling of member identifiable Information.Ability to give informed authorization.Member access to utilization records.Disclosure of information.An accounting of disclosure of member protected health information (PHI) tomembers.Amending PHI by the member.Information about confidentiality is disseminated to members in:Member “Rights and Responsibilities.”Member instructions on how to obtain care, appeal a coverage decision, and accesscustomer services support.The member complaint process.Information about confidentiality is sent to members annually via member newslettersand in the Member Handbook. Community Care’s Notice of Privacy is also posted onour website at http://www.ccbh.com/privacy.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 71