medicaid managed care, Pennsylvania, Philadelphia, Medicare Coverage, Find a Medicaid Health Insurance Plan, Find a Medicaid Provider, Doctor, Pharmacy, Pharmacist, What is Medicaid, How much does it cost to sign up for Medicaid, What is Medicaid Managed Care, How does Medicaid Managed Care Work?
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Medicaid Managed Care Health Insurance, What is Medicaid, How do I sign up for Medicaid?
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Medicaid Care, Managed Care or Medicaid, Manager, Manage Management of Care, and how to get health care. hospitals that accept Medicaid Managed Care patients
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Find a Doctor in Pennsylvania, Find a Hospital in Pennsylvania, Who accepts Medicaid Managed Care
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Healthcare Providers Pennsylvania, Medicaid Managed Care
Understanding Medicaid, Pennsylvania, Medicare, Medicare Advantage, Perform Rx, Members, Medicare Part D, Centers for Medicare & Medicaid Services (CMS), Getting help with Medicaid Assistance, Medicaid Managed Care, How to enroll in medicaid, AmeriHealth Mercy, PerformRx, Providers, Healthcare, Medical Assistance, Transition Policy, Prior Authorization Process, Pharmacy Network, Drug Formulary, Medication Therapy Management, Medicaid Enroll, Enrollment Medicaid, Premiums, Coinsurance, Deductable, Coverage Gap, Medicaid Eligibility, Co-insurance, Managed Care, Copay/copayment, Dual eligible, Emergency care, Evidence of Coverage (EOC), Generic drugs, Medically necessary services, Medicare Modernization Act (MMA), Medicare Part A, Medicare Part B, Over the Counter (OTC) Drugs, Practitioner, Where to get Medicaid Managed Care, Primary Care Provider (PCP), Summary of Benefits, Urgent care, Special Needs Plan, SOBRA - Poverty level pregnant women and children, TANF - Temporary Assistance to Needy Families, SSI without Medicare - Individuals who are medically needy, aged, blind and disabled, SSI with Medicare - Individuals receiving Supplemental Security Income and Medicare benefits, Managed Care Welfare, Medical Assistance and Medicaid States, Pennsylvania Medical Assistance, Medicaid, Managed Care Health Plan, Keystone Mercy Health Plan, Philadelphia, PA, A Managed Healthcare Organization, Serving Medical Assistance recipients in Southeastern Pennsylvania, Bucks County, Chester County, Delaware County, Montgomery County, Philadelphia County.
Local Medicaid Managed Health Insurance in Pennsylvania
Allentown Altoona Back Mountain Bethel Park Bethlehem Chester Drexel Hill
Easton Erie Harrisburg Hazleton Johnstown Lancaster Lebanon Levittown McCandless
Township Medicaid McKeesport Mount Lebanon Municipality of Monroeville New
Castle Norristown Penn Hills Philadelphia Pittsburgh Plum Pottstown Radnor
Township Reading Ross Township Scranton Shaler Township Springfield State
College Upper St. Clair West Mifflin Managed Care Wilkes-Barre Williamsport
York
Hospitals in the Philadelphia / Pennsylvania Area
Children's Hospital, Cooper Medical Center, Einstein Hospital, Episcopal Hospital,
Fox Chase Cancer Center, Frankford Torresdale Hospital, Frankford Frankford
Hospital, Managed Care, Friends Hospital, Graduate Hospital, Hahnemann Hospital,
Holy Redeemer Hospital, Jeanes Hospital, Jefferson Hospital, J.F.K. Hospital,
Lankanau Hospital, Vencor Hospital, Lower Bucks Hospital, Methodist, Moss
Rehab Hospital, Nazareth Hospital, Northeastern Hospital, Pennsylvania Hospital,
Presbyterian Hospital, Rolling Hill Hospital, Shriners Hospital, Saint Agnes
Hospital, Saint Christopher's Hospital, Saint Joseph's Hospital, Saint John
Neuman Home, Saint Mary's Hospital, Temple University Hospital, University
of Pennsylvania Hospital, Vencor Hospital, Will's Eye Hospital, Women's Medical
Hospital
Pennsylvania Medicaid, Pennsylvania Health Plan, Pennsylvania Health Insurance, Pennsylvania, Medical Assistance, Pennsylvania Medical Assistance, Pennsylvania Medicaid, Pennsylvania Health Plan, Pennsylvania Health Insurance, Pennsylvania Medical Assistance, Pennsylvania Medical Assistance, Pharmacy Benefit Management Solutions (PBM) Perform Rx, Pharmacy Benefits Management, Prescription Drug Plan for Medicare Perform Rx PDP, Kentucky Medicaid, Medicare Advantage Kentucky, Medicare Advantage South Carolina, New Medicare Drug Plan, Prescription Drug Benefit
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| Providers | | Home > Providers > Provider Communications > HIPAA > HIPAA Requirements & Allowed Activities |
HIPAA Requirements & Allowed ActivitiesWe understand that the Health Insurance Portability and Accountability Act (HIPAA) may create some questions about appropriate access to protected health information. Therefore, we are providing information to clarify the access that Keystone Mercy Health Plan is afforded under the HIPAA Privacy Regulations. These regulations, effective April 14, 2003, permit a health plan (such as Keystone Mercy Health Plan) to request health care information about its members for purposes of treatment, payment and/or health plan operations (TPO) without the member's prior consent/authorization. This includes access to a member's medical records when necessary and appropriate. The HIPAA Privacy Regulations permit such use by health plans in order to promote ready access to treatment for its membership and efficient payment for health care services rendered. Further, the HIPAA Privacy regulations provide that a covered entity (such as you) may disclose PHI to another covered entity (Keystone Mercy Health Plan) for heath care operations activities of the entity that receives the information (Keystone Mercy Health Plan), if each entity has or had a relationship with the individual who is the subject if the PHI being requested (our member/your patient), and that disclosure pertains to heath care operations. "TPO" disclosures include, but are not limited to, the following: Activities that can constitute "Treatment" include but may not be limited to:
Activities that constitute "Payment" include but may not be limited to:
Activities that constitute "Operations" include but may not be limited to:
We hope this information is helpful in clarifying our right to access the protected health information of your patients and our members. If you have any questions, please contact your Provider Network Management Representative. |
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