Ala. Admin. Code r. 560-X-20-.05

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-20-.05 - Release Of Information - All Providers

(1) Requests for copies of recipient's medical bills, histories, and statements provide Medicaid with third party resource leads. Therefore, information that is released by providers and that pertains to the care and treatment of a Medicaid recipient must be documented and reported to Medicaid in the following manner.

(a) Claims submitted by the provider to a health plan or other entity for the purpose of the provider obtaining payment must include an assignment of benefits to the provider.

(b) Billing statements, itemized billings, and medical records released for reasons other than the provider obtaining payment must include the following statement clearly printed on the documents released: Medicaid has a subrogation/assignment interest. Contact Medicaid.

(c) Complete a "Notification of Request for Medical Records from Provider" form to identify the requestor and reason for the request for medical records information. In accordance with paragraph (4), Providers are to ensure that all HIPAA Privacy and Security rules are met regarding an individual's "right of access to inspect and obtain a copy of protected health information about the individual." The Provider's completion of the Notification of Request for Medical Records from Provider form should not be used to impede a recipient's right to their required information. A provider shall not require the recipient to complete this form, nor shall a provider use this form as a mechanism to prevent a recipient from accessing any information for which he or she is entitled to by law. A "Notification of Request for Medical Records from Provider" form can be obtained from the Alabama Medicaid Agency website and submitted to the address, email, or fax number listed on the form.

(2) When a Provider receives a subpoena, they should respond immediately and send a copy of the subpoena to the Third Party Division of the Alabama Medicaid Agency, indicating the records have been released. Sending a copy of the subpoena to the Third Party Division will serve as sufficient notice of a medical record request, therefore, completing a "Notification of Request for Medical Records from Provider" form is not required.

(3) Excluded from this requirement to notify Medicaid's Third Party Division is information released to the following entities:

(a) The Medicaid Fiscal Agent,

(b) The Social Security Administration,

(c) The Alabama Vocational Rehabilitation Agency,

(d) The Alabama Medicaid Agency,

(e) Requests from insurance companies for information pertaining to a claim filed by the provider and for which an assignment of benefits to the provider was furnished to the insurance company.

(f) Requests by insurance companies for information to process an application for insurance, to pay life insurance benefits, or to pay on a loan.

(g) Requests from other providers for medical information needed in the treatment of patients.

(4) This rule is not intended to deny release of information; however, requests for information pertaining to a recipient's charges are a source of third party information and, as such, must be reviewed by the Third Party Section. It does not permit providers to deny individuals access to their records. Providers are to ensure that all HIPAA Privacy and Security rules are met regarding an individual's "right of access to inspect and obtain a copy of protected health information about the individual."

(5) Failure on the part of the provider to meet these requirements may result in recoupment of Medicaid payment.

Ala. Admin. Code r. 560-X-20-.05

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 04, January 30, 2015, eff. 2/13/2015.

Amended by Alabama Administrative Monthly Volume XLII, Issue No. 11, August 30, 2024, eff. 10/14/2024.

Author: Codie Rowland, Director, Third Party Division

Statutory Authority:Code of Ala. 1975, § 22-6-6, 42 CFR §§432, 433 and 164.524; Section 1902(a)(25), Social Security Act.