Random 1
where can you find the HIPAA verification tool?
Operation Resource Center
Give 3 examples of PHI:
-Name
-Date of Birth
-Address
the least amount of health information needed to complete the intended purpose of the request
Minimum Necessary
What does PHI Stand for?
Protected Health Information
How many ways are to verify a contact?
1.Phone
2. In writing
3. In person
What is the name of the job aid that we need to follow to HIPAA verification?
HIPAA Verification Matrix.
Joanna calling on behalf of her wife Mary, asking for their son medical information. What scenario is?
Not active on contract calling on behalf of a minor
If an Entity calls in inquiring for claim's status, what is the HIPAA process?
caller's name and contact number
member's name ID, address and dob
Claim number must be given
What is the Part C of HIPAA Authorization to Release Form for?
Recipient information - Person or organization that will receive the member's information
When do we have to ask for the members id number?
When we are in the wrong account
Not active member is requesting benefits, what is the HIPPA process?
Caller's name and address, Full address, Members ID, Member's name and full address, members DOB and check if there is HIPAA or obtain verbal consent.
If the Member is Partially verified with address, what information do you require if a provider is calling for a dependent?
-Caller name
-Callback # (for provider)
-Are you calling from a facility or an office?
-Name of the provider they are calling from
-NPI
-Full Name (member)
-DOB
HIPAA stands for..?
Health Insurance Portability and Accountability Act
What is the name of the form that identifies the person who has legal authority to act on a subscriber's behalf?
Personal Representative Request Form
Agent did not follow all verification process, and provided information what has he done and consequences?
Violated HIPAA
Department of Heal Dept of insurance...
What info customer service can provide?
- Eligibility specific member info
- Claim status
- Member covered benefits (specific info asked)
Give 3 examples of Legal documents that may to be included with the Authorization to Release Form
-General or Durable Power of Attorney
-Legal Guardianship
-Conservatorship
-Executor of estate or death certificate
Give 3 examples of Legal documents that may to be included with the Authorization to Release Form
-General or Durable Power of Attorney
-Legal Guardianship
-Conservatorship
-Executor of estate or death certificate
What is the address where the member needs to send the HIPAA Request for Confidential Communications of PHI?
1900 Market Street, Philadelphia, PA 19109
another insurance is calling: do we need HIPAA form? yes / no, and why?
No because we DO NOT disclose to much information just member name / ID NUMBER / ADDRESS / AND DOB