Disclosure of Confidential Information

Disclosure of Confidential Information A. Records and information acquired in the administration of any part of the Social Security Act are confidential and may be disclosed only under the conditions prescribed in rules and regulations of the Department of Health and Human Services (DHHS) or when authorized by the Secretary of Health and Human Services. B. A provider may disclose records or information acquired under the Medicaid program only when: 1. The record or information is to be used in connection with a claim, or 2. To verify the utilization of Medicaid benefits; and 3. The disclosure is necessary for the proper performance of the duties of any employee of: a) The Division of Medicaid, b) Any public or private agency or organization under an agreement with Division of Medicaid in regard to meeting requirements of the Medicaid program, c) The Attorney General Medicaid Fraud Control Unit, d) A duly authorized legal hearing, or e) Representative of the Secretary of Health and Human Services office. C. If a beneficiary or beneficiary’s attorney requests medical records, billing information, etc., these records should be released in accordance with the Third Party Procedures described in Part 300, Chapter 7. D. Providers that are utilizing collection and/or billing agencies should know that the Division of Medicaid and its fiscal agent cannot release information to these companies without a signed release from the Medicaid beneficiary. Information can only be furnished to: 1. The provider that provided the service to the Medicaid beneficiary, or 2. To a provider’s business agent, billing service, or accounting firm that regularly handles claims filing for the provider, a) If, and only if the company has a written agreement with the provider, and b) Has a confidentiality agreement with the Division of Medicaid that is on file with the fiscal agent. E. State law requires that any medical information concerning a Medicaid beneficiary that is released by a provider must contain the following information: 1. The person is a Medicaid beneficiary, 2. His/her Medicaid identification number, and 3. The bill has been paid by Medicaid or will be submitted to Medicaid.