Billing Manual for Community Care Network Providers

III.C.5 Member Access to Utilization RecordsIn accordance with HIPAA Section 164.524, members may request to access theirutilization file. The member may request to view his/her information by contactingCommunity Care. Community Care will coordinate the processing of the request. Theprivacy officer will respond to the request within 10 days. The process for requestinginformation is outlined in Community Care’s Confidentiality Policy.III.C.6 Disclosure of Member identifiable InformationCommunity Care requests authorization from the member or member’s legallyauthorized representative before disclosing member identifiable data or information(except as described in the procedures for “Collecting and Using Member identifiableInformation” (See Section III.C.2) and “Disclosure Without Authorization of Member toMember Representative” (See Section III.C.6a)). The member or the member’s legallyauthorized representative has the right to deny the request to release memberidentifiable information without consequence for the member or the member’s coverage.If member identifiable data and information are to be disclosed for purposes other thandescribed in the procedures for “Collecting and Using Member identifiable Information”(See Section III.C.2) and “Disclosure Without Authorization of Member or MemberRepresentative” (See Section III.C.6a), the authorization of the member or member’slegally authorized representative is required.Times when authorization of the member or member’s legally authorized representativeis required include:Before disclosing member identifiable data and information for research purposes.Before disclosing the member’s behavioral health signs, symptoms, diagnoses, ortreatment to a primary care physician (PCP) or other clinician not providingbehavioral health care to the member.When disclosing the member identifiable data and information that could foreseeablyresult in the member being contacted by another organization for marketingpurposes.Whenever member identifiable information is disclosed, only that information necessaryto accomplish the purpose of the disclosure is released.III.C.6a Disclosure without Authorization of Member or Member RepresentativeMember identifiable information can be disclosed without authorization of the memberor the member’s legally authorized representative in the following circumstances:Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 73