Use and Disclosure of Protected Health Information: Difference between revisions

===Individual===

The person who is the subject of the PHI. Personal representatives of the Individual have the same rights as the Individual under HIPAA (i.e., they “step into the shoes” of the Individual). Personal representatives include the legal guardian and anyone else authorized by law to act on behalf of the Individual. (See Nebraska Medicine Consents and Permits policy, MS14.)

===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.