PHI
A member's Address, SSN, Phone number, Diagnosis and Services rendered are all considered to be
What is PHI?
This provides a framework that safeguards who has access and who can view specific health data.
What is HIPAA
For calls from members this must be obtained for each call
What is first and last name?
This is the Health Insurance Portability and Accountability Act of 1996.
What is HIPAA?
If the caller is not entitled to receive the requested PHI, you should not release the PHI without....
What is Verbal or Written Authorization?
Parents of whom, is entitled to receive PHI.
What is their minor children?
This should be obtained in the instance a callback is necessary.
What is phone number?
Protected Health Information
What is PHI?
This can only be sent to "Others" if we have the members written or verbal authorization.
What is Documents (i.e EOB's, Claims itemizations, ID cards)?
What should be used to explain the claim when the member does not specifically request the procedure or diagnosis information.
What is general terminology?
Do not do this and ask if it is right or wrong
What is offer information?
A consent obtained from an individual that permits a covered entity or business associate to use or disclose that individuals PHI.
What is a HIPAA Authorization?
Requested PHI may be released without a verbal or written authorization when the requestor already has.....
What is knowledge specific to the inquiry.
Use this to explain the claim when the member does not specifically request the procedure or diagnosis information.
What is the same terminology?
The Date of Birth, Enrollee ID Number, Subscriber Telephone Number and Subscribers Mailing address can be used to....
Person who has been appointed by the court or otherwise has the legal authority to make decisions relevant to the person's needs when they are unable to.
What is Legal Guardian?
At what age can you no longer release information related to reproductive services, alcohol or drug treatment, sexual abuse, mental health treatment, STDs and other communicable diseases to a parent or guardian.
What is 14 years old.
The HIPAA requirement that PHI requested, used and disclosed is limited to that which is necessary to accomplish the purpose at hand.
What is minimum essential?
This contact type is used when the caller is a group and is not inquiring about a specific member.
What is Group?
This gives one or more persons the power to act on your behalf as your agent.
What is Power of Attorney?