Release of Patient Information
If an inquiry is made by a beneficiary, including an eligible dependent child, regardless of age, the reply should be addressed to the beneficiary, not the beneficiary’s parent or guardian. The only exceptions are:
- When a parent writes on behalf of a minor child (under 18 years old)
- When a guardian writes on behalf of a physically or mentally incompetent beneficiary
In responding to a parent or guardian in the above circumstances, the Privacy Act of 1974 precludes disclosure of sensitive information, which, if released, could have an adverse effect on the beneficiary.
Providers must not furnish information to the parents or guardians of minors or incompetents when services are related to the following diagnostic codes:
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AIDS: ICDM-9-CM 079.53; 042
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Alcoholism: ICDM-9-CM 291.9; 303–303.9; 305
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Abortion: ICDM-9-CM 634–639.9; 779.6
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Drug Abuse: ICDM-9-CM 292–292.2; 304–304.9; 305.2–305.9
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Venereal Disease: ICDM-9-CM 090–099.9; 294.1
TRICARE-eligible beneficiaries must maintain a “signature on file” in the physician’s office to protect the patient’s privacy, for the release of important information, and to prevent fraud. A new signature is required every year for professional claims submitted on a CMS-1500 and every admission for claims submitted on a UB-04. Claims submitted for diagnostic tests, test interpretations, or other similar services do not require the beneficiary’s signature. Providers submitting these claims must indicate “patient not present” on the claim form.
Mentally incompetent or physically disabled TRICARE-eligible beneficiaries 18 years of age and older who are incapable of providing a signature may have a legal guardian appointed or a power of attorney issued on their behalf. This legal documentation must include the guardian’s signature, full name, address, relationship to patient, and reason the patient is unable to sign. For civilian providers, the first claims submission on behalf of the beneficiary should include the legal documentation establishing the guardian’s signature authority. Subsequent claims may be stamped with “Signature on File” in the beneficiary signature box of the CMS-1500 or UB-04 claim form.
If the beneficiary is without legal representation, the provider must submit a written report with the claims describing the patient’s illness or degree of mental competence, and should annotate in Box 12 of the CMS-1500 claim form, “Patient’s or Authorized Representative’s Signature—Unable to Sign.”
If the beneficiary’s illness is temporary, the signature waiver must specify the dates the illness began and ended.
When the beneficiary is mentally competent but physically incapable of a signature, the representative may be issued a general or limited power of attorney by signing an “X” in the presence of a notary public.
Release of Medical Records
All providers are required to request that the TRICARE beneficiary sign a release of medical information at each office visit (unless a signed release is on file), to include ancillary services associated with each visit whereby the PCM and/or the MTF commanders are designated as the recipients of the medical records. For an urgent care visit, the records should be given to the beneficiary at the time of the visit. Providers are required to submit beneficiary records for review upon request.
Under the TPR program (described in the TRICARE Program Options section of this handbook), ADSMs will be instructed to sign annual medical release forms with the provider who manages their care much like a PCM to allow information to be forwarded to civilian and military providers. If an active duty service member is reassigned to a new location, the PCM should provide complete copies of medical records and specialty and ancillary care documentation to the service member within 30 calendar days of the request—prior to moving.
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