Priority Partners MCO - Notice of Privacy Practices and Release of Protected Health Information

This page details Priority Partners’ Notice of Privacy Practices and Authorizations for Release of Personal Health Information

Priority Partners Managed Care Organization Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

Safeguarding Your Protected Health Information

Priority Partners Managed Care Organization (PPMCO) is committed to protecting your health information. In order to provide treatment or to pay for your healthcare, PPMCO will ask for certain health information and that health information will be put into your record. The record usually contains your symptoms, examination and test results, diagnoses, and treatment. That information, referred to as your health or medical record, and legally regulated as health information may be used for a variety of purposes. PPMCO is required to follow the privacy practices described in this Notice, although PPMCO reserves the right to change our privacy practices and the terms of this Notice at any time. You may request a copy of the new notice from PPMCO Customer Service at 1-800-654-9728.

How PPMCO May Use and Disclose Your Protected Health Information

The PPMCO workforce will only use your health information when doing their jobs. For uses beyond what PPMCO normally does, PPMCO must have your written authorization unless the law permits or requires it. The following are some examples of our possible uses and disclosures of your health information.

Uses and Disclosures Relating to Treatment, Payment or Health Care Operations

For Treatment: PPMCO may use or share your health information to approve, deny treatment and to determine if your medical treatment is appropriate.  For example, PPMCO health care providers may need to review your treatment plan with your healthcare provider for medial necessity or for coordination of care.

To obtain payment: PPMCO may use and share your health information in order to bill and collect payment for your health care services and to determine your eligibility to participate in our services. For example, your health care provider may send claims for payment of medical services provided to you.

For health care operations: PPMCO may use and share your health information to evaluate the quality of services provided, or to our state or federal auditors and regulators.

Other Uses and Disclosures of health information required or allowed by law

Information purposes: Unless you provide us with alternative instructions, PPMCO may send appointment reminders and other materials about the program to your home.
Required by law:  PPMCO may disclose health information when a law requires us to do so.

Public health activities: PPMCO may disclose health information when PPMCO is required to collect or report information about disease or injury, or to report vital statistics to other divisions in the department and other public health authorities.

Health oversight activities: PPMCO may disclose your health information to the Maryland Department of Health and Mental Hygiene and other agencies for oversight activities required by law. Examples of these oversight activities are audits, inspections, investigations, accreditations and licensure.

Coroners, Medical Examiners, Funeral Directors and Organ Donations: PPMCO may disclose health information relating to a death or coroners, medical examiners of funeral directors, and to authorized organizations relating to organ, eye or tissue procurement, donations or transplants.

Research purposes: In certain circumstances, and under supervision of an Institutional Review Board or other designated privacy board, PPMCO may disclose health information to assist medical research.

Avert threat to health or safety: In order to avoid a serious threat to health or safety, PPMCO may disclose health information as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.

Abuse or Neglect: PPMCO will disclose your health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect, domestic violence or some other crime. PPMCO may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health of safety of others.

Specific government functions: PPMCO may disclose health information of military personnel and veterans in certain situations, to correctional facilities in certain situations to government benefit programs relating to eligibility and enrollment, and for national security reasons, such as protection of the President.

Families, friends or others involved in your care: Unless you say no, PPMCO may share your health information with people as it is directly related to their involvement in your care. PPMCO may share your health information if related to payment of your care. Unless you say no, PPMCO may also share your health information with people to notify them about your location, general condition or death.

Worker’s Compensation: PPMCO may disclose health information to worker’s compensations programs that provide benefits for work-related injuries or illnesses without regard to fault.

Lawsuits, Disputes and Claims: If you are involved in a lawsuit, a dispute, or a claim. PPMCO may disclose your health information in response to a court or administrative order, subpoena, discover request, investigations of a claim filed on your behalf, or other lawful process.

Law enforcement: PPMCO may disclose your health information to law enforcement official for purpose that is required by law or in response to a subpoena.

You have the right to:

Request restrictions: You have a right to request a restriction or limitation on the health information PPMCO uses or discloses about you. PPMCO will accommodate your request if possible, but is not legally required to agree to the requested restriction. If PPMCO agrees to restriction, PPMCO will follow it except in emergency situations.

Request Confidential Communications: You have the right to ask that PPMCO send you information at an alternative address or by alternative means. PPMCO must agree to your request as long as it is reasonably easy for us to do so.

Inspect and copy: You have the right to see your health information upon your written request. If you want copies of your health information, you may be charged a fee for copying, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying.

Request amendment: You may request in writing that PPMCO correct of add to your health record. PPMCO may deny the request if PPMCO determines that the health information is: (1) correct and complete; (2) not part of our records; or (3) not permitted to be disclosed.  If you request an amendment to records that we did not create, we will consider you request only if the creator of records in unavailable. If PPMCO approves the request for amendment, PPMCO will amend the health information and inform you, and will tell others that need to know about the amendment in the health information.

Accounting of disclosures: You have a right to request a list of the disclosures made of your health information after April 14, 2003. Exceptions are health information that had been used for treatment, payment, and operations. In addition, PPMCO does not have a list discloses made to you, made in connection with a permitted use or disclosure, based on your written authorization, made to your family, friends others involved in your care, provided for nations security, made to law enforcement officials or correctional facilities, or made as part of “limited date set” (where all by a few identifiers are removed.) There will be no charge for up to one such list each year.

NOTICE: You have the right to receive a paper copy of this Notice and/or an electronic copy by email upon request.

For more information: This document is available in other languages and alternate formats that meet the guidelines for the Americans with Disabilities Act. If you have questions and would like more information, you may contact PPMCO compliance Division at 1-800-654-9728.

To Report a Problem about our Privacy Practices

If you believe your privacy has been violated, you may file a complaint.

• You can file a complaint with PPMCO Complaint Division by calling 1-800-654-9728.
• You can file a complaint with Secretary of the U.S. Department of health and Human Services, Office of Civil Rights. You may call PPMCO for the contact information.

PPMCO will take no retaliatory against you if you make such complaints.

Effective Date: This notice is effective on April 14, 2003.

HIPAA is a federal law that deals with, among other things, the privacy of your health information.  HIPAA stands for the Health Insurance Portability and Accountability Act of 1996.  It protects you against the misuse of your Protected Health Information, often called PHI, when the PHI is in the hands of a covered health care provider (doctor, hospital, laboratory, etc.) or health plan such as Priority Partners. 

What is Protected Health Information (PHI)? PHI is individually identifiable health information about a person’s health, the treatment of his or her health condition, or billing or payment for a person’s health care services.  PHI that is written on paper, contained in email, a fax or a computer, or spoken is protected by HIPAA.

Internal Protection of PHI

Priority Partners has put together internal policies and procedures that address how we protect oral (spoken), written, and electronic use of PHI. For your protection, Priority Partners always verifies the identities of both the member and the requestor before responding to a request for a member's PHI. Examples of such contact are:

1. Questions about your treatment or payment activities

2. Requests to look at, copy, or amend your Priority Partners records

3. Requests to obtain a list of Priority Partners disclosures of your health information

Priority Partners secures and limits access to all hardcopy and electronic files. All electronic data is password protected. Priority Partners limits workforce member access to all hardcopy and electronic files. Internal controls are in place to ensure that only those workforce members with a “need to know” have access to information required to perform their specific job function. All workforce members are required to only utilize and/or access the “minimum necessary” information.

Use of Authorizations
Priority Partners must ask your permission to release your PHI to others, with some exceptions.  Priority Partners is allowed to share your PHI with others without your permission to carry out treatment, payment, or health care operations.  This means that Priority Partners may share your individually identifiable health information with other people to provide you with medical treatment and related services, to bill and collect payment for treatment and services, or to run or evaluate its business practices.  Priority Partners may also share your PHI without your permission when it is required by law to do so (for example, in response to a subpoena) or otherwise when it is allowed by law to do so.  For other purposes, such as sharing your PHI with your attorney, your child’s school, or even your husband or wife, you must first give Priority Partners permission to share the information.  You can give this permission by filling out an authorizations form.  These forms are listed below.

Authorization for Release of Health Information – Standing
This Authorization permits another person to access the plan member’s records and general information on an ongoing basis.

Authorization for Release of Health Information – Unique/One Time Request
This Authorization permits another person to access the plan member’s records for the specific limited purpose noted on the authorization.

Request to Inspect and Obtain Copy of a Designated Record Set
This Authorization permits the plan member to receive copies of his or her own records.

Authorizations can be mailed to:
PPMCO Compliance Department
Johns Hopkins Health Care
6704 Curtis Court
Glen Burnie, MD 21060

Or faxed to: 410-424-4996