Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.
Appears in 2 contracts
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. January 2011
Appears in 2 contracts
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. Addendum H APPROVED SITE(S) Approved Sites are Ambulatory Surgery Facility location(s) specifically approved by BCBSM as either a primary site (Primary Site) or as an additional approved site (Additional Approved Site). Name and Address of Provider’s Approved Primary Site: See Business Name/DBA and BCBSM approved Primary Site address on Signature Document Listed below are all BCBSM Additional Approved Sites that are eligible to submit claims to BCBSM under the facility code/NPI identified on the Signature Document. If there are no Additional Approved Sites that use the same facility code/NPI it is designated by “N/A”. Name and Address of BCBSM Additional Approved Site(s) Date of Approval
Appears in 2 contracts
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members Members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. Addendum H APPROVED SITE(S) Name and address of Provider’s Approved Primary Site: See name and Primary Site address on Signature Document Additional Approved Site(s), (if applicable)
Appears in 2 contracts
Samples: Therapy Facility Participation Agreement, Ambulatory Infusion Center Participation Agreement
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. Addendum H APPROVED SITE(S) Name and address of Provider’s Approved Primary Site: See Business Name or DBA and Primary Site Address on Signature Document Approved Branch Location(s), (if applicable) Listed below are all BCBSM Approved Branch Site locations that are eligible to submit claims to BCBSM under the provider identification number identified on the Signature Document. If there are no BCBSM Approved Branch Sites, it is designated by “N/A”. Name and Address of BCBSM Approved Branch Site Locations(s) N/A Date of Approval
Appears in 1 contract
Samples: Network Affiliation Agreement
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members Members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process. Addendum H APPROVED SITE(S) Name and address of Provider’s Approved Primary Site: See name and Primary Site address on Signature Document Additional Approved Site(s), (if applicable) All BCBSM Additional Approved Site locations that are eligible to submit claims to BCBSM under the same provider identification number as the Primary Site will be listed in a separate approval letter issued by BCBSM.
Appears in 1 contract
Samples: Participation Agreement
Confidentiality Policy. The purpose of BCBSM's ’s Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's ’s Policy sets forth the guidelines conforming to MCLA 550.1101 550. 1101 et seq. seq which requires BCBSM's ’s Board of Directors to “establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. .” In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's ’s specific consent or specific statutory authority. The term “personal data” data refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” information refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure disclosure, and will collect only the personal data necessary to review and pay claims and for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, applications and claim forms and other communications will contain the to Member's ’s consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members Members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act Law 104-191 and the regulations promulgated under the that Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.processes. Addendum D PROFESSIONAL PROVIDER RELATIONS ADVISORY COMMITTEE PROCESS BCBSM will designate one or more committees comprised of professional provider representatives subject to this Agreement as Professional Provider Relations Advisory Committee(s). This Committee or committees will be convened at regular intervals to offer advice and consultation to BCBSM on the following topics, including, but not necessarily limited to:
Appears in 1 contract
Samples: Participation Agreement
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. Addendum H APPROVED SITE(S) Name and address of Provider’s Approved Primary Site: See Business Name or DBA and Primary Site Address on Signature Document Approved Branch Location(s), (if applicable) Listed below are all BCBSM Approved Branch Site locations that are eligible to submit claims to BCBSM under the provider identification number identified on the Signature Document. If there are no BCBSM Approved Branch Sites, it is designated by “N/A”. Name and Address of Provider’s BCBSM Approved Branch Site Locations(s) Date of Approval N/A HOME HEALTH CARE FACILITY IN WITNESS WHEREOF, the parties, wishing to be bound by the terms and conditions of BCBSM’s Home Health Care Facility Participation Agreement, have affixed their signatures on this Signature Document, which is incorporated by reference in the Agreement. HOME HEALTH CARE FACILITY TAX NAME DBA (if applicable - to be used for directory) PRIMARY SITE ADDRESS (for directory) CITY STATE ZIP CODE FEDERAL TAX IDENTIFICATION NUMBER MEDICARE CERTIFICATION NUMBER BCBSM MEDICARE SUPPLEMENTAL EFFECTIVE DATE BCBSM FACILITY CODE/PROVIDER IDENTIFICATION NUMBER NPI EFFECTIVE DATE OF THIS AGREEMENT ****************************************************************************************************************************** FACILITY REPRESENTATIVE BCBSM REPRESENTATIVE AUTHORIZED REPRESENTATIVE AUTHORIZED REPRESENTATIVE Xxxxxx Xxxxxxx Name (Print or Type) Name (Print or Type) Manager, Provider Contracting TITLE TITLE DATE DATE **************************************************************************************************************************** PLEASE RETAIN THE ENCLOSED COPY OF THE HOME HEALTH CARE FACILITY PARTICIPATION AGREEMENT FOR YOUR RECORDS. Please return only the Signature Document to: Provider Contracting Blue Cross Blue Shield of Michigan 000 X. Xxxxxxxxx Xxxx. XX 000X
Appears in 1 contract
Samples: Blue Cross Blue
Confidentiality Policy. The purpose of BCBSM's ’s Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's ’s Policy sets forth the guidelines conforming to MCLA 550.1101 550. 1101 et seq. seq which requires BCBSM's ’s Board of Directors to “establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. .” In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's ’s specific consent or specific statutory authority. The term “personal data” data refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” information refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure disclosure, and will collect only the personal data necessary to review and pay claims and for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, applications and claim forms and other communications will contain the to Member's ’s consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members Members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act Law 104-191 and the regulations promulgated under the that Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.processes. Addendum D PHYSICIAN AND PROFESSIONAL PROVIDER CONTRACT ADVISORY COMMITTEE PROCESS BCBSM will designate one or more committees comprised of representatives of each of the PRACTITIONER classes subject to this Agreement as Physician and Professional Provider Contract Advisory Committee(s). This Committee or committees will be convened at regular intervals to offer advice and consultation to BCBSM on the following topics, including, but not necessarily limited to:
Appears in 1 contract
Samples: Traditional Participation Agreement
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” data refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” information refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.
Appears in 1 contract
Samples: Participating Agreement
Confidentiality Policy. The purpose of BCBSM's Confidentiality Policy is to provide for the protection of the privacy of Members, and the confidentiality of personal data, and personal information. BCBSM's Policy sets forth the guidelines conforming to MCLA 550.1101 et seq. which requires BCBSM's Board of Directors to establish and make public the policy of the Corporation regarding the protection of the privacy of Members and the confidentiality of personal data. In adopting this policy, BCBSM acknowledges the rights of its Members to know that personal data and personal information acquired by BCBSM will be treated with respect and with reasonable care to ensure confidentiality; to know that it will not be shared with others except for legitimate business purposes or in accordance with a Member's specific consent or specific statutory authority. The term “personal data” refers to a document incorporating medical or surgical history, care, treatment or service; or any similar record, including an automated or computer accessible record relative to a Member, which is maintained or stored by a health care corporation. The term “personal information” refers to a document or any similar record relative to a Member, including an automated or computer accessible record, containing information such as an address, age/birth date, Coordination of Benefits data, which is maintained or stored by a health care corporation. BCBSM will collect and maintain necessary Member personal data and take reasonable care to secure these records from unauthorized access and disclosure and collect only the personal data necessary to review and pay claims for health care operations, treatment and research. BCBSM will identify routine uses of Member personal data and notify Members regarding these uses. Enrollment applications, claim forms and other communications will contain the to Member's consent to release data and information that is necessary for review and payment of claims. These forms will also advise the members of their rights under this policy. Upon specific request, a Member will be notified regarding the actual release of personal data. BCBSM will disclose personal data as permitted by the Health Insurance Portability and Accountability Act of 1996, Public Act 104-191 and the regulations promulgated under the Act and in accordance with PA 350 of 1980. Members may authorize the release of their personal information to a specific person. BCBSM will release required data pursuant to any federal, state or local statute or regulation. For civil and criminal investigation, prosecution or litigation, BCBSM will release requested data to the appropriate law enforcement authorities or in response to appropriate legal process.. Addendum H APPROVED SITE(S) Name and address of Provider’s Approved Primary Site: See Business Name or DBA and Primary Site Address on Signature Document Approved Branch Location(s), (if applicable) Listed below are all BCBSM Approved Branch Site locations that are eligible to submit claims to BCBSM under the provider identification number identified on the Signature Document. If there are no BCBSM Approved Branch Sites, it is designated by “N/A”. Name and Address of BCBSM Approved Branch Site Locations(s) N/A Date of Approval
Appears in 1 contract
Samples: Traditional Participation Agreement
