13 COMPLIANCE AND ETHICS
13.8 Confidentiality Statement
Members have the right to privacy and confidentiality regarding their health care records and information in accordance with the Medicare Advantage program and provisions of HIPAA concerning members’ rights with respect to their protected health information and obligations of covered entities.
Utilization management, case management, disease management, discharge planning, quality management and claims payment activities are designed to ensure patient-specific information, particularly protected health information obtained during review, is kept confidential in accordance with applicable laws, including HIPAA. Information is used for the purposes defined above and shared only with entities who have the authority to receive such information and only with those individuals who need access to such information to conduct utilization management and related processes.
Providers must comply with all state and federal laws concerning privacy, confidentiality, accuracy and timely maintenance of health and other member information. Providers must have policies and procedures regarding use and disclosure of health information and comply with applicable laws.