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Fast Referrals and Authorizations—Online (Article 4) |
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Take just a few minutes to become a registered user of Online Provider Services. Click on the “Sign Up” link on the right-hand side of the Online Provider Services page to get started.
Within just a few minutes, you’ll be ready to set up new referrals and authorizations, check on existing referrals and authorizations, and quickly locate specialists and hospitals that meet your referral needs—all online and with the ease that electronic secure access to vital information offers.
You, your staff and your patients will be glad when you become a registered user of Online Provider Services.
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Keep Your Information Up to Date (Article 5)
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The next time you log on to Online Provider Services as a registered member with your ID and password, a separate screen will pop up that reads “Review Your Provider Locator Information.”
Please take a minute to update your information—especially regarding whether or not you’re accepting new patients. Keeping your data current ensures that you receive information from Humana Military, that you receive your claims payments, and that new patients can find you when they go to the Provider Directory.
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How to Balance Patient Privacy with Treatment (Article 6) |
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Providers have asked what types of protected health information (PHI) they should and shouldn’t share with Humana Military. As a TRICARE regional contractor, Humana Military requires beneficiaries’ PHI for a variety of purposes, including medical necessity review, case management, consult report tracking, payment, claims review, etc. The following are answers to other commonly asked questions about PHI.
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What information is considered to be PHI under HIPAA? |
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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. |
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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? |
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No. According to the Code of Federal Regulations (CFR) 45 CFR [164.506(c)(2)], providers may disclose PHI to another health care provider for treatment purposes. |
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If a patient is a minor or is not competent to make health care decisions, may I release information to the parent or guardian? |
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Depending upon state laws, providers may or may not release a minor’s information to parents or guardians without the 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. |
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May I release patient information to Humana Military, TMA or health care insurance companies for payment purposes? |
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Yes. Under 45 CFR Final Rule [164.506(c)(3)], providers are permitted to disclose PHI as necessary to obtain payment for health care. However, the Privacy Rule requires providers to reasonably limit the amount of information disclosed for such purposes to the minimum necessary.
TRICARE offers guidance and resources regarding HIPAA compliance. Visit the TRICARE Web site or send information requests to Privacymail@tma.osd.mil.
In addition, detailed disclosure and confidentiality information can be found in the TRICARE Operations Manual
6010.51-M, August 1, 2002.
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Contacts (Article 7) |
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Last Reviewed: February 7, 2007
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