General Manual Home | Table of Contents | Confidentiality Policy | Administrative Functions | Policy Statements | Quality Improvement
Confidentiality Policy
CareFirst and CareFirst BlueChoice have policies and procedures to protect
the confidentiality of member information. The following is a brief summary
of how CareFirst and CareFirst BlueChoice use and protect member information.
General Policy
- All records that have confidential medical and insurance information must
be handled and discarded in a way that ensures the privacy and security of
the records.
- All medical information that identifies a member (person who signs a policy
with CareFirst or CareFirst BlueChoice) are confidential and protected by
law from unauthorized disclosure access.
- The release or re-release of confidential information to unauthorized persons
is strictly prohibited.
- CareFirst and CareFirst BlueChoice limit access to a member's personal information
to persons who "need to know," such as our claims and medical management
staff.
- The disposal of member information must be done in a way that protects the
information from authorized disclosure.
Routine Consent for Release of Information
By enrolling in a CareFirst or CareFirst BlueChoice health plan, the subscriber
provides routine consent for the release of information for administrative purposes.
Note that routine consent applies whether the member enrolls electronically,
by telephone or by completing and signing an enrollment form. Member information
under this routine consent may be used for many purposes under routine consent,
including:
- Payment of doctors and other providers
- Measurement and improvement of care and service
- Preventive health and disease management programs
- Member surveys
- Investigation of complaints and appeals
- Other purposes needed to administer benefits
The routine consent for release of information is in effect for as long as
the member has health coverage with CareFirst or CareFirst BlueChoice. Routine
consent can be extended past the last day of coverage to allow CareFirst or
CareFirst BlueChoice to pay claims or resolve complaints or appeals. The routine
consent from the member applies to the administrative use of information relating
to all covered adults and dependents. Dependents are other members of the family
who are also enrolled.
Consent for Release of Information for Other Purposes
(Special)
The following uses of member information requires a special consent from the
member:
- Data requested for a worker's compensation or auto insurance claim
- Release of information that could result in another company contacting the
member for marketing purposes
- Release of information from behavioral health care practitioners (mental
health and substance abuse providers) to the member's primary care physician
or specialist.
Member Access to Medical Records
Members may access their medical records by contacting the PCP's office or
the provider of care (such as a hospital). The member must follow the provider's
procedures for accessing medical information.
Members covered under contracts issued by CareFirst or CareFirst BlueChoice
under a Virginia Certificate of Authority may access records directly from CareFirst
or CareFirst BlueChoice.
Disclosure of information to employers is limited to the information the employer
needs to administer the health plan. If this includes medical information, the
employer must agree to protect the information from being used for any decisions
affecting the employee. The employer must identify persons or positions that may
have access to the information and must ensure there are measures in place to
prevent unauthorized access.
Treatment Setting
Practitioners and providers are expected to implement confidentiality policies
that address the disclosure of medical information, patient access to medical
information and the storage/protection of medical information. CareFirst and
CareFirst BlueChoice review practitioner confidentiality processes during pre-contractual
site visits for primary care physicians.
Quality Improvement Measurement
Data for quality improvement measures are collected from administrative sources,
such as claims and pharmacy data, and/or from member medical records. CareFirst
and CareFirst BlueChoice protect member information by requiring that medical
records are reviewed in non-public areas, and that reports do not include member-identifiable
information.
Notice of Privacy Practice
CareFirst and CareFirst BlueChoice are committed to keeping the confidential
information of members private. Under the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), we are required to send our Notice of Privacy Practices
to members of fully insured groups only. The notice outlines the uses and disclosures
of protected health information, the individual's rights and CareFirst and CareFirst
BlueChoice's responsibility for protecting the member's health information.
To obtain a copy of our Notice
of Privacy Practices, visit www.carefirst.com or call your Provider Representative.
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