HIPAA
Processes
Forms
Random!
100
What is HIPAA?
Health Insurance Portability and Accountability Act.
A law that sets standards to protect the confidential medical information of patients and ensure the privacy of their medical records.
100
If the Spouse is calling about the policy holder, do we have to ask for the spouse's DOB?
True or False
100
What is the name of the form that identifies a person who has legal authority to act on a member's behalf in making decisions related to the member's health care
Personal Representative Request Form!
100
What is the name mailbox that members should send the HIPAA documents to?
PO BOX 41890 Philadelphia, PA 19101-1890
200
What is the information required to confirm a verbal authorization?
Full name of the caller
DOB
Address
200
Which scenario is the one that requests the following information:
- Full name (dependent).
- DOB (dependent).
- Callback number.
- Dependent 2 information.
- Check if there is HIPAA or obtain it verbally.
Dependent (calling another dependent).
200
Does the personal representative form allow the member to submit documents to another locations?
True or False
200
How many months have 28 days?
đŸ‘‰ All 12 months have at least 28 days.
300
What is not PHI?
- Enrollment status
- Coverage information
- Information released to a member's provider
300
A spouse (active on the contract) is calling about PHI for a minor dependent on the contract.
What is the main information to obtain besides: Caller name, ID number, address, phone number and date of birth?
Relationship to minor
300
What is the confidential communication form stand for and what changes on the members account?
It is a notification when a member is in a possible danger situation that restrict the access of account.
Change the address email and phone number that we submit in any phi notification for the member.
300
Name the legal document that allows a person (Account Holder) to authorize another person to act on their behalf in legal matters.
Power of attorney
400
Is any information that can identify a specific person, related to past, present, or future physical or mental health care of a specific person, or related to the provision health care or the payment for that care?
PHI
400
If a government official is requesting information of the policy of a specific member, what do you need to obtain as a verification?
Callers name or government agency.
Members name address and ID number
DOB
Request that the government official verify via written request on agency letterhead for initial request
400
What are the exemptions that should be submitted directly to Independence Blue Cross with an Out-Of-Network Claim Form (PPO)?
- Dental claims.
- Services on a domestic cruise ship.
- Services rendered in Jamaica, Puero Rico, and the U.S. Virgin Islands.
- Services rendered in the U.S. military medical facility in a foreign country.
JOBAID (exceptions):
"Blue Cross Blue Shield Global Core JobAid".
400
In Dash, which option indicates whether a Dependent is a minor or of legal age?
Check Authorization
500
Does HIPAA allow sharing medical information without the patient’s authorization under absolutely no circumstances?
True or False
It does allow it in cases such as treatment, payment for medical services, or when required by law.
500
What are the steps to handle improper PHI disclosure?
1. Collect the callers information
2. Collect the affected members information. however, do not ask the caller to examinate PHI
3. Privacy office will send the members a self-addressed, stamped envelope to return the information received in error.
4. Complete the privacy incident submission form
500
What are the forms and what is the purpose of each?
1. Authorization form: allows to release specific types of PHI.
2. Personal representative form: identifies a person who has the legal authority to act on a member's behalf...
3. Confidential communication form: allows the CRS to send communication to the member to an alternate address
500
Can we disclose COBRA questions and Direct Pay Conversion information to an insurance agent?
No!
We can only mention eligibility information of the member, Claim status, and the member's covered benefits.