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MA PAP210

Confidentiality of Member Records


Provider Administrative Policy

Section
Provider Information
Policy Date
April 2007
Status/Date
Reviewed/May 2008

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Confidentiality of Member Records

It is the provider`s responsibility to safeguard all records and confidential information against any alteration or disclosure prohibited by state and federal law.

The provider shall maintain the records and information in an accurate and timely manner.

The provider shall ensure timely access by members to the records and information that pertain to them.

When requesting prior authorization of services, provider shall give necessary information to the provider to whom the service is authorized. This information includes but is not limited to clinical summaries, history and physicals and diagnostic work-ups.

When rendering services as directed by a primary care practitioner (PCP) or other physician, servicing provider shall submit a report of findings or treatments rendered to the referring provider.

The provider shall request and be given information from other screening providers regarding treatments rendered as necessary to provide care.

Upon receiving a signed records transfer form, provider shall facilitate the transfer of a member’s medical records to the new provider. All appropriate medical records must be transferred to a member’s new PCP in a timely manner to ensure continuity of care.


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