2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Presbyterian Customer Service Centerhealth information was shared by us and otherswithout written authorization.Right to Receive a Paper Copy of Privacy NoticeMembers have a right to receive a printed copy ofthe Joint Notice of Privacy Practices upon request.Use of Consents and Authorizations to ObtainProtected Health InformationWhen the member signs a plan enrollment form,they are authorizing Presbyterian (including itsauthorized agents, regulatory agencies, andaffiliates) to obtain limited information about themember for underwriting or enrollment purposes.We do not re-disclose this health informationwithout valid authorization from the member (ortheir legally authorized personal representative)unless required by law or as otherwise described inthe plan’s Joint Notice of Privacy Practices.Presbyterian expects that a provider will makemember records available to the plan inaccordance with federal and state regulations andthe contract that exists between Presbyterian andthe provider.There may be situations in which Presbyterianrequests PHI from the provider for Presbyterian’shealth care operations. In these situations, theprovider agrees to provide the requested PHI ormake a good faith attempt, within a reasonable timeperiod, to obtain a valid authorization from themember, and to provide Presbyterian, uponrequest, with written documentation of suchattempts.Privacy regulations also permit health careproviders to obtain consent from individuals to useor disclose their PHI for purposes of treatment,payment, or health care operations. Please notethat the regulations do not require that providersobtain consent to use or disclose PHI for thesepurposes.If a provider opts to obtain consent as describedabove from the member, the provider agrees toprovide a copy of that consent to Presbyterian aspart of a response to a request for PHI fromPresbyterian.A member may access and print an authorizationform from the website athttp://docs.phs.org/idc/groups/public/@phs/@php/documents/phscontent/wcmdev1001068.pdf orcontact the PCSC to request a printed copy.Authorization forms are kept in the member’smedical record or enrollment file.Members Who are Unable to Give Consent orAuthorizationFor children and people who are incapacitated andunable to make health decisions for themselves,health information rights are usually given to aperson with legal authority to make health caredecisions on their behalf (such as a custodialparent, legal guardian, or person holding healthcare power of attorney). In these situations, whenauthorization is needed to use or disclose PHI, theauthorization form is signed by a person with legalauthority to make health care decisions for theindividual.Presbyterian Case Management Staff coordinatecases with appropriate agencies, such as Children,Youth, and Families Department (CYFD) for those19-92014 Practitioner and Provider Manual - Ver. 3