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Hipaa Privacy Rules


Guest debbiem

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Guest debbiem

We are a large group health plan with a self-insured component(covered entity - we receive PHI), and a smaller HMO component (we do not receive PHI from the HMOs). We are preparing processes and procedures for the benefits department relative to the HIPAA Privacy Rules. I am curious how other similar group health plans are going to continue to deal with providing its associates, family members, and others who call on behalf of associates, customer service. If your company is similar to ours you provide assistance with regard to everything from enrollment questions, covered services, claims, treatment and appeals assistance and also advocate on behalf of associates regarding claims payment, etc. I am afraid that to just put this in the TPO category will cause our clerks to have to continually make judgement calls as to the minimum necessary when not speaking directly to an individual who is the subject of the PHI; therefore, I am proposing clear guidelines as to when authorization is and is not needed. Thanks for sharing!

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