Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION (“PHI’) MAY BE USED AND/OR DISCLOSED. PLEASE REVIEW IT CAREFULLY.
Centennial Health is committed to protecting the privacy and confidentiality of our Members’ Protected Health Information (“PHI”) in compliance with applicable federal and state laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”) Act.
How Centennial Health May Use or Disclose Your Health Information
For Treatment. We may use and/or disclose your PHI to a healthcare provider, hospital, or other healthcare facility in order to arrange for or facilitate treatment for you.
For Payment. We may use and/or disclose your PHI for purposes of paying claims from physicians, hospitals, and other healthcare providers for services delivered to you that are covered by your health plan; to determine your eligibility for benefits; to coordinate benefits; to review for
medical necessity; to obtain premiums; to issue explanations of benefits to the individual who subscribes to the health plan in which you participate; and other payment related functions.
For Health Care Operations. We may use and/or disclose PHI about you for health plan operational purposes. Some examples include: risk management, patient safety, quality improvement, internal auditing, utilization review, medical or peer review, certification, regulatory compliance,
internal training, accreditation, licensing, credentialing, investigation of complaints, performance improvement, etc.
Health-Related Business and Services. We may use and disclose your PHI to tell you of health-related products, benefits, or services related to your treatment, care management, or alternate treatments, therapies, providers, or care settings.
Where Permitted or Required by Law. We may use and/or disclose information about you as permitted or required by law. For example, we may disclose information:
To a regulatory agency for activities including, but not limited to, licensure, certification, accreditation, audits, investigations, inspections, and medical device reporting;
To law enforcement upon receipt of a court order, warrant, summons, or other similar process;
In response to a valid court order, subpoena, discovery request, or administrative order related to a lawsuit, dispute or other lawful process;
To public health agencies or legal authorities charged with preventing or controlling disease, injury or disability;
For health oversight activities conducted by agencies such as the Centers for Medicare and Medicaid Services (“CMS”), State Department of Health, Insurance Department, etc.;
For national security purposes, such as protecting the President of the United States or the conducting of intelligence operations;
In order to comply with laws and regulations related to Workers’ Compensation;
For coordination of insurance or Medicare benefits, if applicable;
When necessary to prevent or lessen a serious and imminent threat to a person or the public and such disclosure is made to someone that can prevent or lessen the threat (including the target of the threat); and
In the course of any administrative or judicial proceeding, where required by law.
Business Associates. We may use and/or disclose your PHI to business associates that we contract with to provide services on our behalf. Examples include consultants, accountants, lawyers, auditors, health information organizations, data storage and electronic health record vendors, etc. We will only make these disclosures if we have received satisfactory assurance that the business associate will properly safeguard your PHI.
Personal/Authorized Representative. We may use and/or disclose PHI to your authorized representative.
Family, Friends, Caregivers. We may disclose your PHI to a family member, caregiver, or friend who accompanies you or is involved in your medical care or treatment, or who helps pay for your medical care or treatment. If you are unable or unavailable to agree or object, we will use our best judgment in communicating with your family and others.
Emergencies. We may use and/or disclose your PHI if necessary in an emergency if the use or disclosure is necessary for your emergency treatment.
Military / Veterans. If you are a member or veteran of the armed forces, we may disclose your PHI as required by military command authorities.
Inmates. If you are an inmate of a correctional institute or under the custody of law enforcement officer, we may disclosure your PHI to the correctional institute or law enforcement official.
Appointment Reminders. We may use and/or disclosure your PHI to contact you as a reminder that you have an appointment for treatment or medical care. This may be done through direct mail, email, or telephone call. If you are not home, we may leave a message on an answering
machine or with the person answering the telephone.
Medication and Refill Reminders. We may use and/or disclose your PHI to remind you to refill your prescriptions, to communicate about the generic equivalent of a drug, or to encourage you to take your prescribed medications.
Limited Data Set. If we use your PHI to make a “limited data set,” we may give that information to others for purposes of research, public health action or health care operations. The individuals/entities that receive the limited data set are required to take reasonable steps to protect the privacy of your information.
Health Information Exchange (HIE) We may share your PHI electronically if you have given your permission to share your PHI through one of the health information exchanges we participate in. This may be revoked or changed at any time with written notice from you.
Any Other Uses. We will disclose your PHI for purposes not described in this notice only with your written authorization. Most uses and disclosures of psychotherapy notes (where appropriate), uses and disclosures of PHI for marketing or fundraising purposes, and disclosures that constitute a sale of PHI require your written authorization.
NOTE: The information authorized for release may include records which may indicate the presence of a communicable or non-communicable disease required to be reported pursuant to State law.
Your Health Information Rights
Right to Inspect and Copy
You have the right to inspect and copy your PHI as provided by law. This right does not apply to psychotherapy notes. Your request must be made in writing. We have the right to charge you the amounts allowed by State and Federal law for such copies. We may deny your request to
inspect and copy your records in certain circumstances. If you are denied access, you may appeal to our Privacy Officer.
Right to Confidential Communication
You have the right to receive confidential communication of your PHI by alternate means or at alternative locations. For example, you may request to receive communication from us at an alternate address or telephone number. Your request must be in writing and identify how or where you wish to be contacted. We reserve the right to refuse to honor your request if it is unreasonable or not possible to comply with.
Right to Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your PHI to third parties, except those disclosures made for treatment, payment, or health care or health plan operations and disclosures made to you, authorized by you, or pursuant to this Notice. To receive an
accounting, you must submit your request in writing and provide the specific time period requested. You may request an accounting for up to six (6) years prior to the date of your request (three years if PHI is an electronic health record). If you request more than one (1) accounting in a
12-month period, we may charge you for the costs of providing the list. We will notify you of the cost and you may withdraw your request before any costs are incurred.
Right to Request Restrictions on Uses or Disclosures
You have the right to request restrictions or limitations on certain uses and disclosures of your PHI to third parties unless the disclosure is required or permitted by law. Your request must be made in writing and specify (1) what information you want to limit; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply. We are not required to honor your request. If do we agree, we will make all reasonable efforts to comply with your request unless the information is needed to provide emergency treatment to you or the disclosure has already occurred, or the disclosure is required by law. Any agreement to restrictions must be signed by a person authorized to make such an agreement on our behalf.
Right to Request Amendment of PHI
You have the right to request an amendment of your PHI if you believe the record is incorrect or incomplete. You must submit your request in writing and state the reason(s) for the amendment. We will deny your request if: (1) it is not in writing or does not include a reason to support the request; (2) the information was not created by us or is not part of the medical record that we maintain; (3) the information is not a part of the record that you would be permitted to inspect and copy, or (4) the information in the record is accurate and complete. If we deny your amendment request, you have a right to file a statement of disagreement with our Privacy Officer.
Right to Be Notified of a Breach
You have the right to receive notification of any breaches of your unsecured PHI.
Right to Revoke Authorization
You may revoke an authorization at any time, in writing, but only as to future uses or disclosures and not disclosures that we have made already, acting on reliance on the authorization you have given us or where authorization was not required.
Right to Receive a Copy of this Notice
You have the right to receive a paper copy of this Notice upon request.
Changes to this Notice
Centennial reserves the right to change this notice and make the new provisions effective for all PHI that we maintain.
To Report a Privacy Violation
If you have a question concerning your privacy rights or believe your rights have been violated, you may contact our Privacy Officer at
ATTN: Compliance & Privacy Officer
Centennial Health, 225 Lilac Drive, Suite 200 Edmond, OK 73034
Phone: (405) 330-7003 Toll-free 1-877-625-2652
You may also report a violation to the Region VI U.S. Department of Health and Human Services Office for Civil Rights, 1301 Young ST, Suite 1169, Dallas, TX 75202. You will not be penalized or retaliated against for filing a complaint.
Effective Date: 04/01/2013
Original Notice: 04/01/2003