HAR §11-188-2
HAR §11-188-2. "Member" means the insured subscriber and any spouse or dependent covered by the subscriber's policy
Length: 261 wordsOfficial source
Cite as Haw. Code R. § 11-188-2
The member is the subject of the activities of the claim or claim line performed by the health care provider.
"Member eligibility file" means a data file containing demographic information for each individual member eligible for medical, vision, dental, or pharmacy benefits for one or more days of coverage at any time during the reporting period.
"Pacific health informatics and data center" means the data center program of the University of Hawaii telecommunications and social informatics research program of the social science research institute of the college of social sciences of the University of Hawaii at Manoa.
"Personally identifiable information" means information relating to an individual that contains direct or indirect identifiers for which a reasonable basis exists to believe that the information can be used to identify an individual.
"Pharmacy benefit manager" means any person, business, or entity that performs pharmacy benefit management, including but not limited to a person or entity under contract with a pharmacy benefit manager to perform pharmacy benefit management on behalf of a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payer, or health program administered by the State, pursuant to section 431R-1, HRS.
"Pharmacy claims file" means a data file containing service level remittance information from all non-denied adjudicated claims for each prescription, including but not limited to member demographics, provider information, charge and payment information, and national drug codes.
"Protected health information" means individually identifiable health information:
(1) Except as provided in paragraph (2), that is:
(A) Transmitted by electronic media;
(B) Maintained in electronic media; or
188-8
B255