HIPAA
What application do you use to see if there is an authorization to release information on file?
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B. M360 – checking if there is a lock is good enough
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When a Provider calls in what information do we need to verify?
A. Caller’s full name and affiliation/name of provider’s office
B. Caller’s first name, name of provider’s office/affiliation, member id or ssn plus each patient’s full name and dob
C. Caller’s first name plus member id or ssn plus each patient’s full name and dob
If a spouse calls in and gives their first and last name, is it ok for them to only provide their spouse’s first name?
A. No – First and last names need to be verified for every patient
B. No – First and last names plus dob are needed for verification
C. Yes – We can see they have the same last name
If a Plan Member is calling about someone other than themselves and there is no authorization on file, even if the caller is the subscriber, what information is NOT ok to disclose to the caller?
A. Available benefits remaining
B. General benefits of the plan
C. DOS, billed amount, allowed amount, member responsibility, or denial reason for a claim
D. Plan type
E. A, B and D
F. A and C
G. All of the above
If a caller is being transferred to you from another plan (i.e. Nevada plan representative is warm transferring the call) and you are informed that all PHI has been verified, do you need to re-verify the caller’s information?
A. Yes – you are required to re-verify HIPAA with the member - full name and dob
B. No – the other plan representative has already verified HIPAA
C. No – you only need to verify that the caller’s name matches the name advised by the other plan’s representative
If a parent calls in about a minor dependent on their plan, after verifying HIPAA for the dependent, can you disclose PHI information if there is no authorization on file?
A. Yes – you can disclose any information about a dependent to their parent if they are under 18
B. Yes – you can disclose information so long as it is not a service that is listed on the Medical Services Exceptions for Minors list
C. No – an authorization is needed before you can disclose any information. You can Confirm or Deny only.
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