Claim Info.

[Guest MC2]

A multiemployer plan has a large claim (in excess of 100k) and seeks to obtain information as to the identity of the individual making the claim. The plan is a small local union (Local Union A) and the trustees of the plan are concerned that the insurance company made a mistake in assigning the claim to their plan. Another small local union (Local Union B) in the area had a claim that is similar to what has been described to Local Union A and, therefore, Local Union A believes that the insurance company made a clerical error in assigning the claim to Local Union A's plan. How can the info. legally (keeping in mind the HIPAA regs) be obtained from the insurance company to verify that the individual making the claim is member of Local Union A and not B?

Thanks

[Guest SHaddon]

Who does the eligibility verification for the plans? It would seem to me that the TPA should verify the eligibility with them. They can confirm if claimant's expenses are being processed under the correct plan and there will be no issue of HIPAA for the trustees.