HIPAA
If you receive a call from the health plan what pieces of information do you need to verify HIPAA?
Member name, member ID, and DOB
When we receive an intake form and no clinicals are attached after making 1st attempt do we send to review?
No, you must make second attempt then send case to review
How will you ensure you do not miss HIPAA when getting interrupted by the caller during the call?
Any answer is a great answer as long as HIPAA has been verified!!
When we receive an intake form and no clinicals are attached after making 1st attempt do we send to review?
No, you must make second attempt then send case to review
If a provider office/facility can verify 3 pieces of information (name, DOB, and member ID), What can be used to substitute for the TIN/NPI for facility/practice?
Nothing, you need the TIN/NPI to verify HIPAA!
When an intake is completed over the phone and 1st attempt and 2nd attempt have been done but dx code is missing do we send case to review?
No, case is to be placed on hold until dx code is receieved
When can we speak to someone one other than the member?
If member is under 18 or if member gives verbal consent.
Can you send case to review if case is sitting in draft?
No, please reach out to leadership as we may need it to be recreated.
If caller is unable to verify HIPAA, can we provide hints?
No, we are to advise no case on file.
If case is created over the phone & caller does not have all needed information, are we sending case to review or placing on hold?
Neither, we need to advise caller to call us back when they have all info to create case.