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I. PURPOSE
The purpose of this policy is to ensure that the confidentiality
of protected health information, as well as all personal information customers
share with
AmeriTrustRx
/ Secured Medical is maintained in a secure database and remains strictly
confidential, and to provide
AmeriTrustRx
members and customers with notice of
AmeriTrustRx
's information management practices.
II. DEFINITIONS
A. Protected Health Information means any information that is created or
received by
AmeriTrustRx
which identifies an individual and relates to the past, present or future
physical or mental health or condition of that individual.
B. Eligibility Information means information, whether written or oral,
which describes a member or a member's eligibility for past or future
AmeriTrustRx
services and the extent to which those services are covered under the member's
plan. Eligibility information does not include Protected Health Information.
III. SCOPE/POLICY
A.
AmeriTrustRx
shall not disclose any Protected Health Information about a member collected or
received in connection with a
AmeriTrustRx
transaction unless the disclosure is required by law, or it is:
1. Requested by you or your legal representative or guardian, and your
request includes a valid Social Security or Member Identification number; or
2.
With the written authorization of the member, or the member's legal
representative or guardian, provided the authorization is:
a. Dated;
b. Signed by the member or the member's legal guardian; and
c. Obtained one (1) year or less prior to the date a disclosure is
sought; or
3. To a group policyholder for the purpose of reporting claims
experience or conducting an audit of
AmeriTrustRx
's operations or services, provided the information disclosed is reasonably
necessary for the group policyholder to conduct the review or audit; or
4.
To a medical care institution or medical professional for the purpose of:
a. Verifying coverage or benefits;
b. Informing an individual of a medical problem of which the individual
may not be aware; or
c. Conducting an operations or services audit to verify the members
treated by the medical professional or at the medical care institution;
provided only such information is disclosed as is reasonably necessary to
accomplish the foregoing purposes; or
5.
To an insurance institution, health care organization, or self-insurer,
provided the information disclosed is limited to that which is reasonably
necessary:
a. To detect or prevent criminal activity, fraud, material
misrepresentation or material nondisclosure in connection with insurance
transactions; or
b. For either the disclosing or receiving entity to perform its function
in connection with an insurance transaction involving the member; or
6. To an insurance or healthcare regulatory authority; or
7.
To a law enforcement or other governmental authority:
a. To protect the interests of
AmeriTrustRx
in preventing or prosecuting the perpetration of fraud upon it; or
b. If
AmeriTrustRx
reasonably believes that illegal activities have been conducted by the
customer; or
8.
Made for the purpose of conducting actuarial or research studies, provided:
a. No member may be identified in any actuarial or research report;
9. To an internal or external professional peer review organization for
the purpose of reviewing the service or conduct of a medical care institution
or provider; or
10. To a governmental authority for the purpose of determining the
member's eligibility for vision or health benefits for which the governmental
authority may be liable; or
11. In response to a facially valid administrative or judicial order,
including a search warrant or subpoena; or
12. To a health maintenance organization, health plan, or insurer, when
AmeriTrustRx
is acting as a subcontractor to that organization, and the member is covered by
AmeriTrustRx
pursuant to his/her enrollment in that organization. In that circumstance, all
Protected Health Information maintained by
AmeriTrustRx
by virtue of the contract with the organization will be made available to the
organization; or
13. Otherwise permitted or required by law.
B.
In addition to those circumstances described in Section III(A), Eligibility
Information will be provided in the following circumstances where permitted or
required by law:
1. To a member doctor, a member, a member's current spouse, a member's
eligible dependent, or the legal guardian of an eligible dependent, upon
presentation to
AmeriTrustRx
of a member's valid Social Security or identification number;
IV. PROCEDURE
1. All
AmeriTrustRx
employees, upon employment, agree to abide by
AmeriTrustRx
's policy and procedure of "Confidentiality of Information" which details the
importance and mandates the confidentiality of medical records, personal
information, insurance claims and other materials. The consequences of
violating this policy includes disciplinary action up to and including
dismissal from employment.
2. Medical Directors, Admin Directors, Clinical Consultants and Clinical
Committee Members must sign a Conflict of Interest and Confidentiality
Statement.
3. Any patient specific information or medical record will be considered
confidential and will be shared only with those parties who have the authority
to receive such information, as provided for in Section II, above.
4. If disclosure is required through a court order or subpoena, the
order or subpoena will first be reviewed by the
AmeriTrustRx
Legal Department to determine the legitimacy of the order, the purpose for the
disclosure, and limitations on the information disclosed.
5. All patient specific medical information will be stored for the
appropriate length of time as required by legal statutes and company policy, in
files that are locked and made accessible only for the purposes stated above.
6. System stored patient specific medical and personal information are
protected through system security measures designed to protect against access
by unauthorized persons. Additionally,
AmeriTrustRx
is monitoring the status of proposed regulations pursuant to the Health
Insurance Portability and Accountability Act, and will implement such security
measures mandated by the final regulations.
AmeriTrustRx
currently employs the industry standard system security measures to protect
electronically stored and transmitted information.
7.
AmeriTrustRx
's Provider Policy states that
AmeriTrustRx
contracted doctor's offices shall maintain the integrity and confidentiality of
Protected Health Information in the record against loss, defacement, tampering
or use by unauthorized persons. The contracted doctor's office shall maintain a
policy of confidentiality regarding patient medical record information.
8. If
AmeriTrustRx
becomes aware of a confidentiality violation by a member doctor, either through
an on-site visit or through a complaint/grievance; the Quality Assurance
Committee and
AmeriTrustRx
staff will determine the proper steps needed to restore confidentiality. Human
Resources will be consulted if the violation was perpetrated through a
AmeriTrustRx
employee.
9. This policy shall be provided to any member, group, or member doctor
upon request.
V. Confidentiality and Security on
AmeriTrustRx
AmeriTrustRx
respects the privacy of its Web site users. Personal information is not
collected by simply visiting the
AmeriTrustRx
web site unless the visitor chooses to enter such information.
AmeriTrustRx
members who enter personal information should know all communication between
your computer and
AmeriTrustRx
's Web Site servers is encrypted using secured server technology (SSL).
AmeriTrustRx's secure server software is the industry
standard and among the best software available today for secure transactions.
Why do you need to enter personal information?
Some features, such as
AmeriTrustRx
's Doctor Group and the Member Eligibility area, are tied directly to your
personal information. For security and legality, we must make sure we're
providing services to the right person. At
AmeriTrustRx
, we understand the privacy concerns surrounding one's medical information.
Rest assured your medical information will only be used to administer and
provide safe and effective prescription fulfillment.
AmeriTrustRx
does not release any information to unauthorized individuals.
VI. The Use of Cookies
Cookies are pieces of information that are stored on a user's PC when the user
accesses a Web site.
AmeriTrustRx
uses temporary cookies to help you access some of the special functions within
the database driven areas of
AmeriTrustRx
's site. Once you leave our Web site, these cookies expire. Cookies do not
collect personal identifying information about the user.
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