COMPLIANCE, HIPAA, AND PRIVACY
Compliance Training Materials
CCHCA is committed to ensuring compliance with health care industry standards and regulations. We provide trainings to our providers in preventing, detecting, reporting, and correcting non-compliant practices. Network providers are required to complete and attest to having reviewed and completed all of the following trainings on an annual basis:
Having completed the above trainings, please complete a Compliance Training Attestation form and return it to our Provider Relations Department.
For Physicians and Clinics:
CCHCA Compliance Training Attestation Physician & Clinic Form
For First Tier, Downstream, & Related Entities:
CCHCA Compliance Training Attestation - General Form
Critical Compliance Policies are available to you for reference below. For any other policies and procedures, contact the Compliance Department at Compliance@cchca.com.
NOTICE REGARDING CCHCA'S UTILIZATION MANAGEMENT DECISION-MAKING
CCHCA ensures that utilization management decision-making is strictly based on the appropriateness of care, service, and patients’ individual medical benefits. CCHCA does not offer incentives for individuals, staff, or practitioners for issuing denials of coverage, services, or care resulting in under-utilization.
If you suspect instances of non-compliance, you may contact our confidential Compliance Hotline at (415) 216-0095 to file a report.
HIPAA & PRIVACY
CCHCA is committed to safeguarding the privacy of personal health information and abide by HIPAA (Health Insurance Portability Accountability Act) law.
Our Notice of Privacy Practices (see below) describes the different ways in which we or our affiliated medical partners may use of disclose protected health information. It is important for all affiliated medical partners must comply with HIPAA law.
If you have any questions about the privacy of your personal health information, please contact our confidential Compliance Hotline at (415) 216-0095.
NOTIFICATION OF PRIVACY PRACTICES
827 Pacific Ave, San Francisco, CA 94133
Tel: (415) 216-0088 Fax (415) 216-0081
www.CCHCA.com
CCHCA
Notice of Privacy Practices
Effective Date: April 18, 2016
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At CCHCA, we respect the confidentiality of your health information and will protect your information in a responsible and professional manner. We are required by law to maintain the privacy of your health information and to provide you this notice. We must follow the terms of this Notice while it is in effect.
This notice explains how we use information about you and when we can share that information with others. It also informs you of your rights with respect to your health information and how you can exercise those rights.
WHAT IS PROTECTED HEALTH INFORMATION?
Protected Health Information (PHI) is information created or received by CCHCA that identifies an individual applying for or enrolled in a health benefits program in which CCHCA is a provider. Protected Health Information includes the person's participation in the program, the person's past, present or future physical or mental health condition, the provision of health care to that person, and payment for the provision of health care to that person. Protected Health Information does not include publicly available information or information that is available or reported in a summarized or aggregate fashion that does not identify any individual person.
The following are ways we may use or share information about you:
We may use the information to help pay your medical bills that have been submitted to us by doctors and hospitals for payment.
We may share your information with your doctors or hospitals to help them provide medical care to you. For example, if you are in the hospital, we may give them access to any medical records sent to us by your doctor.
We may use or share your information with others to help manage your health care. For example, we might talk to your doctor to suggest a disease management or wellness program that could help improve your health.
We may share your information with others who help us conduct our business operations. For example, we may contract with a disease management company to offer services to improve our health status. We will not share your information with these outside companies unless they agree to keep it protected.
We may use or share your information for certain types of public health or disaster relief efforts.
We may use or share your information to send you a reminder if you have an appointment with your doctor.
We may use or share your information to give you information about alternative medical treatments and programs or about health related products and services that you may be interested in. For example, we might send you information about smoking cessation or weight loss programs.
We may use or share your information with an employee benefit plan though which you receive health benefits. We will not share detailed health information with your benefit plan unless they promise to keep it protected.
There are also state and federal laws that may require us to release your health information to others. We may be required to provide information for the following reasons:We may report information to state and federal agencies that regulate us such as the US Department of Health and Human Services and the California Department of Managed Health Care.
We may share information for public health activities. For example, we may report information to the Food and Drug Administration for investigating or tracking of prescription drug and medical device problems.
We may report information to public health agencies if we believe there is a serious health or safety threat.
We may share information with a health oversight agency for certain oversight activities (for example, audits, inspections, licensure and disciplinary actions.)
We may provide information to a court or administrative agency (for example, pursuant to court order, search warrant or subpoena).
We may report information for law enforcement purposes. For example, we may give information to a law enforcement official for purposes of identifying or locating a suspect, fugitive, material witness or missing person.
We may report information to a government authority regarding child abuse, neglect or domestic violence.
We may share information with a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law. We may also share information to a funeral director as necessary to carry out their duties.
We may use or share information for procurement, banking or transplantation of organs, eyes, or tissue.
We may share information relative to specialized government functions, such as military and veteran activities, national security and intelligence activities, and the protective services for the President and others.
We may report information on job-related injuries because of requirements of your state worker compensation laws.
If one of the above reasons does not apply, we must get your written permission to use or disclose your health information. If you give us written permission and change your mind you may revoke your written permission at any time.
EXERCISING YOUR RIGHTS
You have a right to receive a copy of this notice upon request at any time. You can also view a copy of the notice on our web site. Should any of our privacy practices change, we reserve the right to change the terms of this notice and to make the new notice effective for all protected health information we maintain. Once revised, we will provide the new notice to you upon request and post it on our website.
If you have any questions about this notice or about how we use of share information, please contact CCHCA Compliance Officer at (415) 216-0095. That office is open Monday through Friday from 9:00 am to 5:00 pm.
If you believe your privacy rights have been violated, you may file a complaint to CCHCA Compliance Officer c/o CCHCA, 827 Pacific Ave., San Francisco, CA 94133. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Ave., S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at https://www.hhs.gov/ocr/about-us/contact-us/index.html.
All complaints must be submitted in writing. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.
We reserve the right to change our practices and to make the new provisions effective for all individual identifiable health information that we maintain. If we change our privacy practices, we will post a revised notice within 60 days of the revision and provide a copy to you upon your request.