HIPAA
This Blue Source Document contains info on who can receive PHI.
What is HIPAA Privacy - CA Guidance for Disclosure of PHI to a caller?
A person other than the subscriber, such as a spouse or child, who is provided coverage under a subscriber’s plan.
What is a Dependent?
This tab displays Medicare eligibility effective dates.
What is the Medicare Tab?
This Blue Source Document can be used to identify if a service can be coded as Preventative.
What is Preventive Care Job Aid Information?
This is the name of the form that can be submitted from the primary insured to allow someone else to receive policy information.
What is a Standard Authorization Form (SAF)?
A specific dollar amount that must be paid by the member before benefits covered under the insurance plan will be paid.
What is a Deductible?
This is where you can find alternate policies the members may be covered under.
What is the Other Membership drop down menu?
A High Deductible PPO Policy that can include either a Health Savings Account or a Health Care Account to assist in lowering Out of Pocket Costs.
What is a Consumer-Directed Health Plan (CDHP)?
These types of information can be disclosed without authorization when the caller is actively covered on the policy.
What is EOB information excluding Procedure and Diagnosis Codes?
A group of physicians, hospitals, or other health care providers who have contracted with a health care plan to deliver medical services to its members.
What is a Network?
This is where you will find if the policy is AEP or not.
What is the Account Details sub-tab under the Membership tab?
While quoting benefits to a Member with a Health Care Account, you must remember to quote this.
What is the Remaining HCA Balance?
A person or organization that is a health care provider that engages in certain reimbursement transactions electronically, a health plan or a health care clearinghouse, and is directly regulated by the HIPAA Privacy Rule.
What is a Covered Entity?
The period of time set up to allow members to choose from available health insurance plans, usually once a year.
What is an Open Enrollment Period?
This is where you will find information on the member's Continuation of Coverage.
What is the COBRA Information sub-tab under the Membership tab?
This tab in RTB is where you can find the Medicare Type Indicator.
What is the Medicare tab under Benefits/Special Topics?
The Primary Insured's spouse not on policy calls in wanting info on a dependent child's claim. If HIPAA is verified for child, can mother receive information?
Not without an SAF or a One Time Verbal Authorization from Primary Insured.
The maximum amount a health care plan will reimburse a doctor or hospital for a given service.
What is an Allowed Amount?
This is where you can find who the coverage vendor is. (ex. Dental, Vision, RX)
What is the Coverage Vendor Tab under the Membership Effective Dates?
These are the six Blue Distinction Services.
What are:
This type of policy will have a Metallic Level showing in RTB, and the Provisions will show as Long Word Form Service Identifiers instead of coded Provisions.
What is a Future State Policy?