Maintaining privacy of Protected Health Information (PHI) is an important part of providing quality health care to TRICARE beneficiaries. Understanding the rules that govern the release of PHI is essential in maintaining the security and confidentiality of PHI and will reduce the risk of unauthorized disclosure.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) permits the release of PHI without an authorization for purposes of treatment, payment and health care operations. However, the HIPAA Privacy Rule requires providers to reasonably limit the amount of information disclosed for payment and health care operations to the minimum necessary.

PHI is any individually identifiable health information that relates to a patient’s past, present or future physical or mental health and related health care services. PHI may include demographics, documentation of symptoms, examination and test results, diagnoses and treatments.

Do I need a patient’s written authorization to send a copy of the patient’s medical record to a specialist or other health care provider who will treat the patient?

No. Providers may disclose PHI to another health care provider for treatment purposes. However, treatment information may not be disclosed in cases of substance abuse, mental health treatment or other specifically protected health conditions.

If a patient is a minor or is not competent to make health care decisions, may I release information to the parent or guardian?

Depending upon state laws, providers may or may not release a minor’s information to parents or guardians without a minor’s consent. If the patient is unconscious or incompetent, whether a minor or not, the provider may use their professional discretion; or in the case of minors, the guardian or other person authorized to act on the patient’s behalf may give the consent.

TRICARE offers training in HIPAA compliance. For more information about PHI and other HIPAA issues, visit TRICARE's Privacy Web site.

  
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Humana Military’s Web site now offers a new way to get the word out to your TRICARE beneficiaries.

This new Web feature, the “Provider Direct Entry for Updates and Changes,” was launched in the closing months of 2006. This new tool is currently not available to behavioral health providers.

“We created this option so providers can view and update their locator information,” said Humana Military’s Provider Relations manager. “This is a much faster method for providers to identify old information and provide us with new information if their street address or phone/fax number changes, or if they move offices.”

This new Web-based change service gives you the ability to update your locator information and removes several steps from old processes. And without having to relay information from person to person, there are fewer chances for errors to seep into the process.

The online update tool is currently available for individual provider updates—excluding behavioral health providers. In the future, Humana Military hopes to make it available for hospitals, clinics and group settings including physical therapy, outpatient rehab and ambulatory surgical centers.

Another reason it’s important for you to keep your location and contact information current is TRICARE’s access to care standards. Your TRICARE beneficiaries should not have to travel more than 30 minutes to an appointment with their primary care manager, or more than one hour to a referred specialty care appointment.

Beneficiaries and providers frequently utilize Humana Military’s Web locator so it’s important that they be pointed in the right direction.

  
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Created: March 19, 2007