I agree that each plan can make a business decision to move away from
the SS#, but I don't see how that helps you avoid any responsibilities
under the privacy rule.  You are just creating another identifier that
could be used to identify an individual and their health information.  
If you put your proprietary number on the ID card which then gets
matched up against clinical information for billing purposes and all
subsequent claims information (EOB's), how is that new identification
number not PHI?  PHI can be many things beyond SS#.  It can be a URL,
ISP, etc.  I'd consult with your counsel to make sure you aren't making
an incorrect assumption that you can avoid certain responsibilities just
by not using a SS#.   
 

>>> "Beth Kranda" <[EMAIL PROTECTED]> 02/05/02 12:40PM >>>
While I agree with David that the use of an SSN simplifies COB, I have
also taken the
position of eliminating the SSN as ID number.
In the definition of Payment and in section 164.514 on
de-identification, the SSN is
referenced as an element that is considered PHI.  Some have interpreted
this to mean it is
then protected, and taken that further to imply that, if the ID card
has the SSN on it, it
is then considered PHI and subject to the same type of protection
requirements as the
clinical record.  Not sure if this is true, but certainly, reporting is
easier if you have
a unique identifier that is not the SSN with which to tie de-identified
information back
to a member.

As for the HEDIS problem, this simply means your company needs a
"person ID" to tie a
person's health history together across systems and across enrollment
records.  While
convenient, it is not necessary to use the SSN to accomplish this. 
This is one of those
decisions that needs to be driven by the legal and business issues.  My
guess is that the
"Privacy Act" this patient cited is state based or some other provacy
legislation, not
HIPAA.  Most of the general public is still not aware of HIPAA's
rules.

All of the Health Plans I have talked to in Indiana are moving away
from the SSN.
--
M. Beth Kranda
Sr. Project Consultant and Privacy Director
OASYS
t- (317) 614-2139
f- (317) 614-2001
e- [EMAIL PROTECTED] 
info- www.oasys.com 

David Blasi wrote:

> Don't see this as a HIPAA Privacy Rule requirement.  In fact, until
> there is an alternative individual identifier, each plan or provider
> assigning a proprietary number to identify an individual creates
even
> more confusion than we currently have.  Especially in COB
situations.
> But, are you in California?  California recently passed SB 168
regarding
> the use of SS#'s.  However, the law does allow use of SS# for
"internal
> verification or administrative purposes."  This is what most plans
or
> providers use the SS# for anyway.  What it will require is for a plan
or
> provider to take a look at notifications sent or ID cards used.  
Have
> your counsel take a look at this bill or similar bills proposed in
other
> states.   Essentially, you can prepare a response that states you
are
> permitted to use SS# in certain limited situations, such as
eligibility
> and claims payment.
>
> >>> "Waterhouse, Melissa" <[EMAIL PROTECTED]> 02/05/02 09:33AM
> >>>
> Recently, we have been experiencing resistance from members when we
> request
> their social security number and the numbers of their dependents.
> Several
> letters from employees quote The Privacy Act. We are considering not
> requiring dependents socials but this could negatively impact HEDIS
> numbers
> since SSN's are the only way to track continuous enrollment.
>
> I am wondering if other health plans are also experiencing this and
if
> they
> decided to not require social security numbers or have moved to
using
> another identifier.
>
> Thank you,
> Melissa Waterhouse
> SummaCare Health Plan
>
>
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