Source: https://www.sclhealth.org/scl-health-phi-access/
Timestamp: 2020-06-05 04:09:35
Document Index: 309095940

Matched Legal Cases: ['§160', '§164', '§164', '§164', '§164', '§164', '§164']

SCL Health PHI Access | SCL Health
SCL Health PHI Access
Agreement for Electronic Access to PHI
External User, Entity Name: THIS AGREEMENT FOR ELECTRONIC ACCESS TO PHI (“Agreement”) is made and entered into as of (“Effective Date”) by and between Sisters of Charity of Leavenworth Health System, Inc. dba SCL Health, on behalf of its Affiliate hospitals, and _____ ("External User") with _____ (Entity Name).
External User is not a member of SCL Health’s Workforce. External User is one of the following (please check all that apply):
A Business Associate of SCL Health
An organization legally responsible for collecting quality data from health care institutions
A health care provider or the Business Associate of the health care provider requiring access to PHI of SCL Health for TREATMENT **Also complete Exhibit B
A health care provider or the Business Associate of the health care provider requiring access to PHI of SCL Health for PAYMENT **Also complete Exhibit B
A health care provider, health plan or organization requiring access to PHI of SCL Health in order to conduct a UTILIZATION REVIEW on its own behalf or on behalf of another health care provider or a health plan **Also complete Exhibit B
A health care provider, health plan or organization requiring access to PHI of SCL Health in order to conduct QUALITY ASSURANCE on its own behalf or on behalf of another health care provider or a health plan **Also complete Exhibit B
A health care provider, health plan or organization requiring access to PHI of SCL Health in order to conduct CASE MANAGEMENT on its own behalf or on behalf of another health care provider or a health plan **Also complete Exhibit B
EXTERNAL USER (entity name)
SCL Health Entities to which access is requested:
Individual to be Granted Access
Length of time access needed:
Description of need for access to patient information systems:
SCL Health Sponsor Name*: *SCL Health Sponsor must be
a Workforce Member (manager level or above) of SCL Health or one of the SCL Health Care Sites, or
if for access by a healthcare provider’s staff, a credentialed member of the Medical Staff at an SCL Health Care Site for which access is being requested
Application Access Requested
PHI Applications:
AllScripts Care Manager
eSummit – EH AMB – PB view only access (vendor)
eSummit – EH-HB Staff (Insurance Rep)
eSummit – HB Agency
eSummit – HB Agency Ins
eSummit – HIM Coder
eSummit – Insurance Reviewer
eSummit – Nursing Home
eSummit – HIM Vendor Access
eSummit Other (Specify in Additional Info box)
eSummit – Care Manager
eSummit-Chart View Only Access
eSummit – HB Agency Financial Counselor
eSummit – HB Agency Professional Billing
eSummit – IST eSummit Analyst Contractor/Consultant or EPIC Systems Employee
eSummit – OR Perfusionist/ Neuromonitoring Tech
eSummit – RN/LPN – Inpatient Depts.
eSummit – RN/LPN – Outpatient Depts.
eSummit – Rx-Collier Hospice Pharmacist
eSummit – Security Guard (Info/Reception Desk Coverage)
eSummit – Tech/CNA – Inpatient Depts.
eSummit – Tech/CNA – Outpatient Depts.
eSummit – Transporter
eSummit – Work Queue
Centricity DMS
OptioMedex
Pulsecheck Non-ED Role
Other (Specify in Additional Info box):
Non PHI Application Access:
Ambulatory Locum Provider
Vendor – OR Room/Optime
Required to take e-learning modules
Other (Specify in Additional Info box)
Exhibit B: ACCESS BY ANOTHER COVERED ENTITY’S WORKFORCE
Access to PHI by another Covered Entity’s Workforce into the SCL Health Patient Information Systems MUST meet one of the following permitted disclosures.
NOTE: Access by the workforce of one covered entity into the patient information systems of another covered entity, is a disclosure of protected health information by the covered entity whose patient information systems are accessed. Disclosure means the release, transfer, provision of, access to, or divulging in any other manner of information outside the entity holding the information §160.103 Definitions, Disclosure)
Is the disclosure for Treatment? A covered entity may disclose protected health information for treatment activities of a health care provider. [§164.506(c)(2)] If at least one of the below boxes is checked, the disclosure is for treatment and permitted by HIPAA. (§164.501 Definitions. Treatment)
Provision, coordination, or management of health care and related services
Referral of a patient from one health care provider to another
Is the disclosure for Payment? A covered entity may disclose protected health information to another covered entity or a health care provider for the payment activities of the entity that receives the information. [§164.506(c)(3)] If at least one of the first two boxes below is checked, the disclosure is for payment and permitted by HIPAA. (§164.501 Definitions. Payment)
Payment activities by the health plan to determine or fulfill its responsibility for coverage and provision of benefits under the health plan
(If this box is checked, use the following payment activities as a guide for activities that are included in Payment activities.) Payment activities by a health care provider or health plan to obtain or provide reimbursement for the provision of health care and these activities relate to the individual to whom the health care is provided.
Payment activities may include, but are not limited to:
Determining eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts) and adjudication or subrogation of health benefit claims
Obtaining payment under a contract for reinsurance (including stop-loss insurance and excess of loss insurance), and related health care data processing
Review of health care services with respect to: Medical necessity, Coverage under a health plan, Appropriateness of care, Justification of charges
Utilization review activities, including: Precertification and preauthorization of services, Concurrent and retrospective review of services
Disclosure to consumer reporting agencies of any of the following PHI related to collection of premiums or reimbursement: Name and address, Date of birth, Social security number, Payment history, Account number, Name and address of the health care provider and/or health plan.
Is the disclosure for Health Care Operations? A covered entity may disclose protected health information to another covered entity for health care operations activities of the entity that receives the information, if each entity either has or had a relationship with the individual who is the subject of the protected health information being requested [and] the protected health information pertains to such relationship … [§164.506(c)(4)] The first box is REQUIRED AND if one or more of the other boxes below is checked, the disclosure is for permitted Health Care Operations in accordance with HIPAA. (§164.501Definitions, Health Care Operations)
REQUIRED: Both organizations have or had a relationship with the individual who is the subject of the PHI and the PHI pertains to such relationship AND the disclosure is for:
Conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies resulting from such activities;
Population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting of health care providers and patients with information about treatment activities.
Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, or practi-tioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities.
The purpose of health care fraud and abuse detection or compliance.
6/5/2020 @ 6:00 PM
6/6/2020 @ 9:00 AM