ServiceXG Basics

Can I discuss a dependent’s claim with a member?

Based on information privacy HIPAA HIPAA (Health Insurance Portability and Accountability Act of 1996) is the United States legislation that provides data privacy and security provisions for safeguarding medical information. laws, you can't sharean adult dependent's Personal Health Information (PHI Any health information that could identify a person. This can include a person's past or present medical status or condition, payments made for health care, and health care services received.) with a member unless the dependent authorizes it and you can't share a member's PHI with a dependent unless an authorization is on file.

An adult dependent could sign a form which authorizes the fund office to disclose their health information with the member. If you receive a phone or email inquiry from a member about an adult dependent’s claim, you must verify this consent exists before sharing claim information with themember.

1. Search and open the dependent record.
2. In the navigation pane, check Disclose PHI on the Demographics data tile to find out if you can discuss the dependent's PHI with the member.
   • Disclose PHIwill beNoif the dependent is over the Age of Majority When an individual reaches this age, which may be different from state to state, the individual is no longer considered a minor and is legally responsible for his or her decisions and actions. Parents or guardians no longer have the legal right to the person's PHI (Protected Health Information). or is under the Age of Majority, but is emancipated The individual is no longer under the care and responsibility of the parents or guardians..
   • If the dependent has authorization on file and the disclosure status was updated, Disclose PHI will be Yes. In that case, you can disclose the claim information.
   • If the dependent is over the Age of Majority HIPAA defers to state law to determine the age of majority and the rights of parents to act for a child in making health care decisions, and thus, the ability of the parent to act as the personal representative of the child for HIPAA purposes., authorization An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. or a disclosure document is required to allow the member access to the dependent's PHI. If the document is available and the disclose PHI isn't accurate see Dependent's PHI disclosure statusto update the disclosure status.
     
     

Find the disclosure document

The dependent’s signed disclosure document might be saved as an attachment to a correspondence item.

1. On the Correspondence tab, sort and filter the dependent's correspondence items to find the one related to information disclosure (seeCommon features for more information).
2. Double-click the correspondence item to open it in the Correspondence Viewer.
3. In the Correspondence Viewer, click the Images tab to find the attached document.
   
   

4. Double-click the image row to view the document.

   Hint: If you can't find the consent form under the dependent's correspondence, try searching the member's correspondence for the consent form.

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