Manual do Provedor

CONFIDENCIALIDADE

Carelon maintains the confidentiality of all sensitive information in accordance with all applicable Federal and State laws and regulations as referenced in the HIPAA Reference Manual, and in accordance with sound business professional principles. Carelon recognizes the sensitive nature of the information gathered and developed in business operations, such as:

• Informações de saúde protegidas específicas do membro, incluindo confirmação ou reconhecimento de que podem existir registros de tratamento ou gerenciamento de cuidados.
• Informações do provedor relacionadas à quantidade ou qualidade do desempenho de um provedor ou às interações de um provedor na prestação de serviços aos membros.

Carelon provides training to employees on their responsibilities regarding confidential information. All employees sign a confidentiality agreement at the time of employment as well as an annual attestation that they have read, understand, and abide by confidentiality policies.

Carelon recognizes that members have a basic right to privacy of their personal information and records. Access to member information lies solely with the member except in the case of a parent or guardian with legal custody of a minor child, or a person with legal authority to act on behalf of an adult or emancipated minor in making decisions related to health care.

Carelon honors members’ privacy unless waived by the member or in rare instances of strongly countervailing public interest or as required by law. When information is disclosed, it is limited to what is necessary to fulfill the immediate and specific purpose.

All requests for release of information are reviewed by management staff and responded to in accordance to Carelon policy. The engagement center screens all requests for clinical information prior to disclosure.