GENERAL
What does HIPAA stands for?
Health Insurance Portability and Accountability Act
Verbal consent is required from third-party callers before any member account information is provided.
True
What is the primary purpose of HIPAA?
To protect members’ protected health information (PHI)
If a caller claims they are the member's Power of Attorney (POA) or Authorized Representative but no documentation is on file, what should the Advocate do?
Request appropriate documentation or obtain the member's verbal consent before discussing protected information
What information can be verified to authenticate a member during a call?
Member ID, Medicare ID, Full Name, Date of Birth, Full Address.
Ivy is calling on behalf of her husband to make a payment for the monthly premium due on the plan. You notice that she is not listed as an authorized representative on the account, and the member is unavailable to provide verbal authorization. Would you assist Ivy with making the payment without the member's consent?
Yes. You can accept the payment without sharing any member information.
Who may discuss a deceased member's medical information with the plan after proper authentication?
A Legally Designated Person, such as an Executor, Administrator, Guardian, or Trustee
A representative appointed to assist a member with filing a grievance, requesting an organization or coverage determination, or navigating any level of the appeals process after verbal authorization has been obtained.
Authorized Representative
Is Social Security Administration considered a Federal or State Regulator for HIPAA purposes?
False. (Federal or state regulators include; CMS, Department of Insurance (DOI), State Department of Health and Human Services (DHS), State Medicaid Agency (State Regulator), & State Pharmaceutical Assistance Program (SPAP)).
After a member successfully verifies their information through the IVR and their Member ID and Date of Birth appear in Genesys/OmniConnect, what should the Advocate do next?
Thank the member for verifying in the automated system and verify whether they are the member