HIPAA
POA
Authenticators
Scenarios Part 1
Scenarios Part 2
100
What is the difference between HIPAA and a HIPAA form?
HIPAA is an act to protect the privacy of the individual.
A HIPAA form is a document that allows a person to act on behalf of someone else.
100
What does POA stand for?
Power Of Attorney
100
How many authenticators are there?
5 total
100
Emily Smith, an employee with RWJBH, calls in and the Screen Pop shows all 3 authenticators are green. What information can we provide?
We can provide all information that is needed. We just need to confirm her first and last name.
100
If the ppt is not able to secure the call with any of the 5 authenticators, can we provide general information?
No! There is no such thing as general information.
200
Which clients do not allow us to talk to spouses?
City of Detroit
Lockton Clients
ONE Gas
Veolia
(CLOV)
200
When does a POA expire?
Never. They are permanent unless it is modified. We would just need an updated copy of the POA.
200
What are the authenticators?
SSN (last 4)
Zip Code
DOB
EE ID
Date of Hire (exact, MM-DD-YYYY)
200
A Screen Pop shows the name of John Doe. All the authenticators are green. When asked “Am I speaking to John Doe?” the caller stated no, I am John Doe’s brother. Are we able to provide information to John Doe’s brother?
We cannot provide information to John Doe’s brother. If there is a HIPAA or POA on file (or if ppt is on the line and gives consent), then we can speak with the brother.
200
If an RWJBH spouse calls in asking for our website, can we give it to her?
Not without securing the call.
300
When does the HIPAA form expire?
One year
300
Does the POA need to be in the account before talking to someone else about the ppt’s account?
Yes. A note will be added to any applicable systems. (ie. MBE will have a User Contact).
300
How many authenticators do we need to verify to have the call fully secured?
3 out of the 5
300
Mary Jones, a spouse of Lockton (HMG), calls in and wants to know what medical plan the family is enrolled in. Can we provide this information to Mary Jones?
We can only talk to the ppt for Lockton Clients unless there is a POA or HIPAA form on file or the ppt gives consent to talk with the spouse for that one phone call.
300
An upset ppt calls in and asks to be transferred to a supervisor and refuses to secure the call. Can this unsecured call be transferred to a supervisor?
Yes, but let the manager know that the call is unsecured and which pieces of information are still needed.
400
An employee calls in because their child aged out of benefits at age 26. The employee wants to make a payment for their child’s COBRA account. Can we speak to the employee?
No, we cannot, unless there is a HIPAA form or POA on file, or if the child grants permission to talk to the parent for that ONE phone call.
400
Can we send a POA form to someone in an email?
No. A POA is a court-ordered document. We do not send this to the caller.
400
Which calls need to be secured?
Every call needs to be secured. There is no such thing as general information.
400
Robert Gill, calls in and the screen pop shows that he was unable to secure the call. What pieces of information can we use to secure the call?
He can secure the call with the last four of his SSN, DOB, and zipcode. He can also use his exact date of hire (MM/DD/YYYY), or his EE ID number.
400
A ONE Gas spouse calls in with the ppt on the line, and the ppt wants us to talk to the spouse. Is this allowed?
Yes. We can secure the call with the ppt and get consent to speak to the spouse. Once consent is given, the ppt can disconnect the call and we can talk with the spouse. It will only be good for that one phone call.
500
Can we release information to an HR rep?
If the HR rep is on the HR Contacts tab in the client’s TipSheet then yes.
Also if they are on the Connor Strong list, Mistras list, or Perma HIF list we can.
500
What kinds of powers can a POA have?
Health Benefits, Financial, or both.
500
There is a POA on file, but the person calling is not listed on this. They have secured the call with three authenticators. Can we talk to them?
No. We need to have the name on the POA in order to give the caller any information.
500
Linda Engleke, an HR rep from RWJBH called in wanting to know about the medical benefits for Jaclyn Smith’s account. UserID: 3851525. Are we able to talk to this HR rep?
No, we cannot. Linda is not listed as an HR rep in the TipSheet.
500
A ppt calls in because they want to provide the correct DOB for the account, but do not want to secure the call. Ppt is saying they are not asking for any account information, but just want to provide the DOB. Are we able to help them?
We always need to secure the call, even if we are not providing any account information.