To: All Hospital Providers
This notice is to clarify Alabama Medicaid’s requirement of providers to notify the Agency’s Third Party Division prior to releasing medical records. As indicated in the Alabama Administrative Code, Rule No. 560-X-20-.05(3), it is not the Agency’s intention to deny release of information; however, requests for information pertaining to a recipient's charges are a source of third party information and, as such, must be reviewed by the Third Party Division.
Providers are to ensure that all HIPAA Privacy and Security rules are met regarding an individual’s "right of access to inspect and obtain a copy of protected health information about the individual" (as stated in 45 C.F.R. §164.524).
Medicaid’s rule is also designed to ensure that Medicaid is informed of potential circumstances in which Medicaid may have a subrogation interest pertaining to the medical records being requested.
It does not permit providers to deny individuals access to their records. Providers should not cite Medicaid’s rule as cause for not meeting the HIPAA Privacy rule, nor should they attempt to place the responsibility for notifying the Medicaid Agency on the recipient.
The "Request for Medical Records" form will still be available for use by providers to document that Medicaid has been notified of a medical record request on a Medicaid recipient. The form is available on the Agency’s Web site at http://www.medicaid.alabama.gov/billing/release_info.aspx?tab=6
While Medicaid will continue to send a return response to the form, a provider should not deny the release of medical information to an individual because the provider has not received a response back from Medicaid.
To determine if Medicaid should be notified, the provider should inquire as to the purpose of the medical information and who is in need of the information. If the request meets any of the circumstances in Rule No. 560-X-20-.05(1) [attached], then the provider is not required to send Medicaid notification of the request. Otherwise, the provider should notify Medicaid of the request and provide the information to the requestor (if all other provisions have been met).
In addition, the Alabama Medicaid Agency has contracted with Health Management Systems (HMS) to handle the processing of requests for medical records. "Request for Medical Records" forms should be faxed to HMS at 866-274-5974. Other notifications to Medicaid regarding medical record releases should be provided to HMS by phone at 877-252-8949.
If you should have any questions regarding this notice, please contact Keith Thompson, Director, Third Party Division, at (334) 242-5248.
Rule No. 560-X-20-.05. Release of Information - All Providers
(1) Information pertaining to a patient's treatment (including billing statement, itemized bills, etc.) may be routinely released ONLY UNDER THE FOLLOWING CIRCUMSTANCES AND/OR TO THE FOLLOWING AGENCIES if Medicaid has been billed or is expected to be billed:
(a) The Medicaid Fiscal Agent,
(b) The Social Security Administration,
(c) The Alabama Vocational Rehabilitation Agency,
(d) The Alabama Medicaid Agency,
(e) Requests from insurance companies for information pertaining to a claim filed by the provider in accordance with Medicaid Regulations and for which an assignment of benefits to the provider was furnished the insurance company.
(f) Requests by insurance companies for information to process an application for insurance, to pay life insurance benefits, or to pay on a loan.
(g) Requests from other providers for medical information needed in the treatment of patient.
(2) If information pertaining to a patient's treatment is requested by any other source, or under any other circumstance, the Alabama Medicaid Agency, Third Party Section, must be contacted PRIOR TO RELEASE OF INFORMATION. The only exception is when a subpoena is received during nonworking hours of the Alabama Medicaid Agency and must be responded to immediately. Should this occur, the provider may respond to the subpoena and must include with the released records a notice that the patient was covered by Medicaid. In addition, the provider must notify the Third Party Section of the subpoena as soon as possible.
(3) It is not the intention to deny release of information; however, requests for information pertaining to a recipient's charges are a source of third party information and, as such, must be reviewed by the Third Party Section.
Authority: 42 CFR Sections 432 & 433; Section 1902(a)(25), Social Security Act; Section 22-6-6 of 1975 Code of Alabama.