HIPAA and Disclosure

martman99

I have an insurance carrier (dental insurance)who claims they are NOT able to divulge claims paid versus premiums paid due to HIPAA. This request does not, in my estimation, run awry of the regulations pertaining to PHI. Can someone shed some light on this with some specificity, please? I believe they are misreading HIPAA.

We are an employer with just under 50 employees

Thanks

Marty

Betty I_O

Your carrier may not be misinterpreting the HIPAA regulations. They can divulge claims paid vs. premiums paid. What they may be objecting to is that claims reports contain patient names and services provided, etc., which do constitute PHI. The claims data would need to be devoid of any ID that could link it to specific enrollees. There is no reason why they cannot provide total $ info to you.

We routinely receive such information. However, the detail on the runs does not show names of participants or any other information which would reveal the identity of the patient. It lists only
dates of service, the procedure, and insurance amount paid to the provider. Ditto for our medical plan claims; in fact, both our medical and dental carriers started doing this at least three years ago.

Under the Privacy Standards, a plan's use or disclosure of or requests for PHI must consist of only the minimum amount necessary to accomplish the intended purpose of the use, disclosure, or request. You should revisit this with your carrier and indicate that you do not want data identifying the participants--only claim type/$ paid, etc. They certianly should be able to supply that.

martman99

Yep!

Already did that. Just seeing if "I" was intrepreting HIPAA correctly. Just get a lot of uneducated, off the cuff, responses just saying "No" due to HIPAA.

Thanks for confirming this Betty! Have a great day!

Marty

Brad Forrister

They certainly should be able to supply summary information.

Brad Forrister
Director of Publishing
M. Lee Smith Publishers