Benefits Determination definition

Benefits Determination as those terms are defined in the most recent version of the Trusted Exchange Framework and Common Agreement as published in the Federal Register. Prior to publication of the Trusted Exchange Framework and Common Agreement in the Federal Register, those terms shall have the meaning set forth in the Draft Trusted Exchange Framework published by the Office of the National Coordinator for Health Information Technology on January 5, 2018.
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Benefits Determination means a determination made by any federal or state agency as to whether an individual qualifies for federal or state benefits for any purpose other than health care (for example, Social Security disability benefits) to the extent permitted or required by Applicable Law. Disclosure of PHI for this purpose may require an Authorization if the conditions of 45 C.F.R. part 154.512(k)(6) are not met.
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Examples of Benefits Determination in a sentence

  • Government Benefits Determination: a determination made by any agency, instrumentality, or other unit of the federal, State, local, or tribal government as to whether an Individual qualifies for government benefits for any purpose other than health care (e.g., Social Security disability benefits) to the extent permitted by Applicable Law.

  • Only a federal, state, local, or tribal agency, instrumentality, or other unit of government may assert Government Benefits Determination for a Query.

  • However, Subscribers and Covered Dependents have the right to file an appeal requesting that the Company formally review the Benefits Determination.

  • Principal: a QHIN, Participant, or Subparticipant that is acting as a Covered Entity, Government Health Care Entity, Non-HIPAA Entity (NHE) Health Care Provider, a Public Health Authority, a government agency that makes a Government Benefits Determination, or an Individual Access Services Provider (as authorized by an Individual) when engaging in TEFCA Exchange.

  • Provider shall provide the client/beneficiary with a Notice of Adverse Benefits Determination (NOABD) as set forth in the County’s governing beneficiary protections policy and procedures.

  • The TEF Draft 1 included Treatment, Payment, Health Care Operations, Public Health, Individual Access (as those terms are defined by the HIPAA Privacy Rule), and Benefits Determination, as required Exchange Purposes.

  • The review of the Adverse Benefits Determination will take into account all new information, whether or not presented or available at the initial determination.

  • If Signatory is a NHE (but not to the extent that it is acting as an entity entitled to make a Government Benefits Determination under Applicable Law, a Public Health Authority, or a Government Health Care Entity), then it shall comply with the provisions of the HIPAA Privacy Rule listed below with respect to all Individually Identifiable information that Signatory reasonably believes is TI as if such information is Protected Health Information and Signatory is a Covered Entity.

  • An appeal of an Adverse Benefits Determination must be made in writing within 180 days upon receipt of the notice that the claim was denied.

  • If an appeal is not made within the above referenced timeframe all rights to appeal the Adverse Benefits Determination and to file suit in court will be forfeited.