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Notice of Privacy Practices

MeridianTotal
Notice of Privacy Practices

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.

Effective 03.01.2018

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Covered Entities Duties:

MeridianTotal is a Covered Entity as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  MeridianTotal is required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices related to your PHI, abide by the terms of the Notice that is currently in affect and notify you in the event of a breach of your unsecured PHI.

This Notice describes how we may use and disclose your PHI.  It also describes your rights to access, amend and manage your PHI and how to exercise those rights.  All other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization.

MeridianTotal reserves the right to change this Notice.  We reserve the right to make the revised or changed Notice effective for your PHI we already have as well as any of your PHI we receive in the future.  MeridianTotal will promptly revise and distribute this Notice whenever there is a material change to the following:

  • The Uses or Disclosures
  • Your rights
  • Our legal duties
  • Other privacy practices stated in the notice.

We will make any revised Notices available on our website.

Internal Protections of Oral, Written and Electronic PHI:

MeridianTotal protects your PHI. We have privacy and security processes to help.

These are some of the ways we protect your PHI. 

  • We train our staff to follow our privacy and security processes.
  • We require our business associates to follow privacy and security processes.
  • We keep our offices secure.
  • We talk about your PHI only for a business reason with people who need to know.
  • We keep your PHI secure when we send it or store it electronically.
  • We use technology to keep the wrong people from accessing your PHI.

Permissible Uses and Disclosures of Your PHI:

The following is a list of how we may use or disclose your PHI without your permission or authorization:

  • Treatment - We may use or disclose your PHI to a physician or other health care provider providing treatment to you, to coordinate your treatment among providers, or to assist us in making prior authorization decisions related to your benefits.
  • Payment - We may use and disclose your PHI to make benefit payments for the health care services provided to you. We may disclose your PHI to another health plan, to a health care provider, or other entity subject to the federal Privacy Rules for their payment purposes. Payment activities may include 
    • processing claims
    • determining eligibility or coverage for claims
    • issuing premium billings
    • reviewing services for medical necessity
    • performing utilization review of claims
  • HealthCare Operations - We may use and disclose your PHI to perform our healthcare operations.  These activities may include:
    • providing customer services
    • responding to complaints and appeals
    • providing case management and care coordination
    • conducting medical review of claims and other quality assessment
    • improvement activities

In our healthcare operations, we may disclose PHI to business associates. We will have written agreements to protect the privacy of your PHI with these associates. We may disclose your PHI to another entity that is subject to the federal Privacy Rules. The entity must also have a relationship with you for its healthcare operations. This includes the following:

  • quality assessment and improvement activities
  • reviewing the competence or qualifications of healthcare professionals
  • case managment and care coordination
  • detecting or preventing healthcare fraud and abuse.