Manual do Provedor


All documentation that is created as a result of the Quality Management Program is confidential and is maintained in compliance with applicable legal requirements and HealthChoices Program policies and procedures pertaining to confidentiality. Such documentation includes, but is not limited to, Quality Management / Utilization Management Committee (QM/UMC) minutes, quality management data and reports, records of clinical care and services, and administrative records and reports. All participants in QM/UMC meetings, including both QM/UMC members and guests, sign a statement attesting to the foregoing.

The HealthChoices Program and Carelon recognize the need for the careful handling of all clinical and claims information, particularly as it relates to behavioral health treatment. Consequently, we will follow and clearly communicate strict confidentiality guidelines designed by the Commonwealth as well as federal guidelines where applicable. Carelon will take the lead in implementing confidentiality procedures for the HealthChoices Program. These confidentiality policies will comply with Federal and Pennsylvania confidentiality requirements.

The HealthChoices Program and Carelon recognize that Pennsylvania State regulations governing the confidentiality of HIV Related Information are unique to Pennsylvania. All records kept by the HealthChoices Program and Carelon will be kept in strict compliance with the Confidentiality HIV Related Information Act of 1990 (commonly known as Act 148).