Compliance with our state and federal partners is essential to providing accurate, timely and comprehensive care for Members. Below is a short list of requirements (not all-inclusive) that Physicians and Providers should meet.
Protected Health Information (PHI)
The Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. For a complete description of Physician/Provider requirements, visit the Department of Health& Human Services' website at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html
The Center for Linguistic and Cultural Competence in Health Care (CLCCHC) managed by the Office of Minority Health was established as a vehicle to address the health needs of populations who speak limited English. Please visit their website to access their guides to implementing language access services in healthcare organizations: http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=34
Our Provider Manual also covers this topic and describes how to access language related resources for our Members.
National Provider Identifier (NPI)
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. An NPI is a unique identification number for covered health care providers.
Optimum HealthCare requires the use of NPIs for all claims transactions. For more information about NPI, visit the website for the Centers for Medicaid and Medicare Services at: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/
For more information on HIPAA requirements, please visit the regulations and guidance page of Centers for Medicare and Medicaid website at: http://www.cms.hhs.gov/home/regsguidance.asp