Rachel and Patricia,
The payers have consent to use it for TPO
when the patient/member signs up for insurance. In the application the
payer has the member sign has a lot of verbage about the use of information and
data and how it could be used. Hope this
helps. ....
Nancy
Patricia,
You're correct about the original question relating
to payers, not providers...my error. In that case, though, it's my
understanding that payers can use PHI for their own TPO without obtaining
consent....is this incorrect?
Rachel
Rachel:
I agree with what you said about
provider consents (ignoring the new NPRM for the moment), but I'm not sure
of the point you're making. The original question related to
disclosures by health plans, not providers.
Patricia I. Carter, J.D.
Gray, Plant, Mooty, Mooty &
Bennett, P.A.
3400 City
Center
33 South Sixth
Street
Minneapolis, MN
55402
Phone:
612-335-7867
Fax:
612-333-0066
Email:
[EMAIL PROTECTED]
Patricia,
I'm not an attorney, but I believe that consent is
required by all direct treating providers to use and disclose protected
health information for treatment, payment or operations. This consent is a
one-time event and good until/unless revoked by the
individual.
Other than that, I would agree that this consent
would cover the subrogation issue.
Rachel
Rachel Foerster
Rachel Foerster & Associates, Ltd.
Phone:
847-872-8070
Subrogation is part of "payment," and
as TPO would not generally be subject to the authorization requirements,
but rather to the consent requirements (and a health plan need not -- even
before the NPRM-- get consent for TPO uses and disclosures.)
Patricia I. Carter, J.D.
Gray, Plant, Mooty, Mooty & Bennett, P.A.
3400 City Center
33 South Sixth Street
Minneapolis, MN 55402
Phone: 612-335-7867
Fax: 612-333-0066
Email: [EMAIL PROTECTED]
Hi All,
Have any of the payers on the list confronted the problem of
how health plans getting Disclosure Authorization to subrogate claims
with auto/property/casualty/hazard insurance companies... For
example, because the auto insurer is not a CE nor a BA how can the Health
Plan share PHI with the auto insurer when it is looking for them to
subrogate the claim. Getting authorization from the member is going to be
hard because they have no motivation to provide it and may actually have a
disincentive to do so because they do not want their auto insurance rates
to go up. The auto co won't subrogate without the information.
Tips on where to go to get guidance or thoughts on the
matter would be much appreciated....
Jim Moores - HIPAA Team Leader - Privacy
Antares Management
Solutions
23700 Commerce Park Road
Beachwood, Ohio
44122-5832
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