ing HIPAA best practices for an organization’s claims handing process increases
consistency and provides staff with clear,
concise directions on HIPAA policies
Here are the 10 most important things
to know when dealing with confidential
claimant health information.
Checklist to protect
confidential health information
1 Validating requests & autho- rizations. Create an established and consistent set of standards to evaluate and validate an authorization. These standards should ensure that the information in the request
corresponds with the authorization (i.e.,
signatures, date of accident, etc.) Make
sure to compare and validate that all signatures in the file, on the request, and on
the authorization match.
2To release or not to release? Proprietary information and non-disclosure agreements are critical to protecting a
company’s own risk. Be sure to screen
any documents or information being
released from the claims file and have
measures, such as non-disclosure statements, in place with third parties. Some
documents that are typically unauthorized for release include: police reports,
attorney-client privileged correspondence and internal communications.
3Quality control processes must be defined and documented. Develop a defined and docu- mented workflow and protocol
for the claims data review process. Protocols should carefully outline the steps
for reviewing protected health information to ensure it meets the requirements
of the authorization. Use trackable delivery methods to ensure accountability
that claims information was received by
the authorized requestor.
4 Who owns the process? Identify the internal parties who will lead the process, develop and docu- ment workflows, protocols, and
oversee these policies. Be sure that all policies are clearly communicated with adjusters and staff and updated as necessary.
5Hybrid records and integra- tion. Integrate and consolidate multiple systems where current claims files are managed and
stored. Leverage technology to transition
hybrid record sets.
6 Training. Conduct initial train- ing, spot training and ongoing training to stay current on new regulations and policies. This
includes understanding HIPAA and HITECH. How will this be applied within
the organization and what are the organization’s standards and philosophy of how
data from claims files is shared? How are
employees sharing and deploying that in-
Clients across the country turn to
Segal McCambridge Singer & Mahoney,
when they need a clear understanding
of a complex insurance coverage plan.
We make a thorough and objective
determination of whether a claim is covered
and, when appropriate, defend claims of
all types. Learn more at www.smsm.com
Don’t miss Larry Mason speak on
“Catastrophic Products Liability Claims
Adjusting” at the PLRB 2015 Claims
Conference on March 31st and April 1st.
AUSTIN BALTIMORE CHICAGO DETROIT
JERSEY CITY NEW YORK PHILADELPHIA ST. LOUIS
A Simple Concept:
We make the complex simple.
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