Disclosure of Health Insurance Information by Providers

170 - Disclosure of Health Insurance Information by Providers (Rev. 124, Issued: 05-17-19, Effective: 06-18-19, Implementation: 06-18-19 The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes. Records and information, acquired in the administration of the Medicare program, may be disclosed only under prescribed rules and regulations or under the authority of the Administrator of CMS. Information furnished specifically for purposes of a claim under the health insurance program is subject to these rules and regulations. These regulations apply to Governmental or private agencies that participate in program administration. These entities include the following: • Institutions; • Agencies; • Person(s) providing services; and • Providers of services. The type of information includes, but is not limited to, the following: • The individual's Medicare beneficiary identifier; • Facts regarding the individual's entitlement to health insurance benefits; and • Medical and other information obtained from CMS, a MAC (contractor). Information not subject to these rules and regulations includes information in the provider's own records, such as the following: • Name; • Date of Birth; • Sex; • Marital status; and • Address. A provider's own records are, however, subject to requirements listed in the "Conditions of Participation", that "Patient's records be kept confidential (20 CFR Part 405.126). These records may also be subject to State or local laws governing disclosure. Providers are also responsible for following conditions for coverage. A provider or supplier that receives a request for disclosure of information about a Medicare beneficiary, Medicare claim, or related information that it may not disclose, should refer the requestor to the appropriate contractor for further consideration of the request.