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Accounting of PHI Disclosures: Difference between revisions
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Accounting of PHI Disclosures (view source)
Revision as of 09:33, October 28, 2022
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Policy No.: '''6061'''<br /> | Policy No.: '''6061'''<br /> | ||
Effective Date: '''03/17/03'''<br /> | Effective Date: '''03/17/03'''<br /> | ||
Revised Date: '''draft | Revised Date: '''draft 10/28/22''' <br /> | ||
Revised Date: ''' ''' <br /><br /> | Revised Date: ''' ''' <br /><br /> | ||
<big>'''Accounting of Protected Health Information Disclosures Policy'''</big> | <big>'''Accounting of Protected Health Information Disclosures Policy'''</big> | ||
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#General administrative and business functions; | #General administrative and business functions; | ||
#Insurance activities relating to the renewal of a contract of health insurance; | #Insurance activities relating to the renewal of a contract of health insurance; | ||
#Evaluating | #Evaluating health care provider and plan performance; | ||
#Resolution of internal grievances; and | #Resolution of internal grievances; and | ||
#Fundraising. | #Fundraising (see [https://wiki.unmc.edu/index.php?title=Use_and_Disclosure_of_Protected_Health_Information&action=edit#Use.2FDisclosure_of_PHI_for_Marketing Use/Disclosure of PHI for Marketing]). | ||
===Payment=== | ===Payment=== | ||
Activities undertaken by a health care provider or health plan to obtain premiums, to determine or fulfill its responsibility for coverage and provision of benefits under the health plan or to obtain or provide reimbursement for the provision of health care. Some of these types of activities include determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), billing, collection activities, claims management, medical necessity determinations, utilization review activities including pre-certification and pre-authorization of services, disclosure to consumer reporting agencies related to collection of premiums or reimbursement and health care data processing related to the above-listed activities. | Activities undertaken by a health care provider or health plan to obtain premiums, to determine or fulfill its responsibility for coverage and provision of benefits under the health plan or to obtain or provide reimbursement for the provision of health care. Some of these types of activities include determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), billing, collection activities, claims management, medical necessity determinations, utilization review activities including pre-certification and pre-authorization of services, disclosure to consumer reporting agencies related to collection of premiums or reimbursement and health care data processing related to the above-listed activities. | ||