Billing Manual for Community Care Network Providers

The specific information to be released.The purpose for the release.The individual or entity authorized to receive the information.The expiration date of the authorization.The signature of the member or member’s legally authorized representative.The address of the member or member’s legally authorized representative.The signature of the witness.The date of the authorization.Two representatives of Community Care (such as employees, staff, or practitionerproviders) must witness the entire process of obtaining verbal authorization to releaseinformation.III.C.7 Handling of Practitioner-specific InformationCommunity Care considers practitioner specific data and information, including but notlimited to, that information used for network development, credentialing/assessment,performance evaluation, quality assurance, quality improvement, compliance audits andpeer review, to be confidential to the extent permitted by law.A practitioner’s name, professional degree, status as a member of Community Care’spractitioner network, business address, business telephone number and specialty (ies)or self-identified areas of special interest are not considered confidential when disclosedfor legitimate business purposes.Data and information related to a practitioner’s racial, cultural, or ethnic background;age; religious affiliation; gender; and ability to communicate in languages other thanEnglish is confidential unless the practitioner explicitly authorizes the release of thisinformation. For example, if the practitioner volunteers the information on thecredentialing/assessment form that the practitioner has the ability to communicate inlanguages other than English, this information may be used by Community Care tomeet specific member needs or requests when making referrals.Regarding files of practitioner information maintained at Community Care: Physical files are maintained in a locked room or locked file cabinet when not beingused by credentialing staff or the Credentialing Committee. Practitioner files stored in electronic, magnetic, or optical format are protected with asecure password. Access to practitioner files is limited to credentialing staff, Credentialing Committee,network management staff, and the compliance staff. Upon request, practitioners may review information in their file, except for anyinformation from the National Practitioner Data Bank (NPDB). Review of NPDBinformation is prohibited by federal statute.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 75