Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Eligibility Determination Group (EDG) information may be released to individuals who have case authority.

A CHIP or CHIP perinatal household member may give verbal permission to discuss their case with a third party. Staff must authenticate the CHIP or CHIP perinatal household member before discussing the case with a third party.

Limited information may be released to contracted organizations, providers and their contractors, public officials and other state agencies. Reasonable efforts must be made to limit the use, request or disclosure of individually identifiable health information to the minimum necessary to determine eligibility and operate the program. The disclosure of individual medical information from agency records must be limited to the minimum necessary to accomplish the requested disclosure.

It is acceptable to release the following general denial or disenrollment reasons.

• Failure to provide missing Information
• Voluntary withdrawal

It is unacceptable to provide specific EDG details, such as the specific reason for denial (excess assets, excess income).

 

D—2011 Community Based Organizations

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Limited information may be released to contracted or sub-contracted community-based organization (CBO) representatives. The CBO representative must provide the CBO identification number in order to receive EDG information. In addition, the CBO representative must provide the:

• name of the head of household,
• address, and
• child's Social Security number (SSN).

Staff may then release the following CHIP EDG information to the CBO:

• status of the application or EDG (denied, disenrolled, enrolled, missing information),
• missing information on an EDG (types of information needed to complete eligibility determination),
• enrollment coverage dates (start and end dates), and
• enrollment fee amount.

Do not release specific EDG details, such as:

• the reason for denial,
• sources or amounts of income,
• types of assets,
• household size, and
• citizenship/alien status.

 

D—2012 Providers and Health Plans

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Limited information may be released to providers and health plans. Health care providers must give their provider identification number. If a provider participates with more than one CHIP health plan, the provider may have multiple identification numbers. Accept and document any identification number the provider gives.

The provider or health plan must confirm the:

• name of the head of household,
• address, and
• child's Social Security number (SSN).

Staff may then release the following EDG information to the provider or health plan:

• status of the application or EDG (denied, disenrolled, enrolled, missing information);
• missing information on an EDG (types of information needed to complete eligibility determination);
• enrollment coverage dates (start and end dates); and
• other EDG information as requested (enrollment fee, cost share limit, copayments).

 

D—2013 Federal and State Executive and Legislative Officials

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Limited information may be released to federal and state executive and legislative branch members and their staff. Managers and supervisors may release to State of Texas legislators and legislative staff members the following information:

• Case or EDG eligibility status
• Missing information on an application or EDG
• Enrollment coverage dates
• Enrollment status
• Enrollment fee amount

 

D—2014 Teacher Retirement System (TRS)

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Limited information may be released to TRS representatives. In order to obtain any EDG information, the representative must provide the assigned TRS personal identification number and any of the following CHIP EDG information:

• Case or EDG number
• Name of the person with case authority
• Home telephone number
• Child's name
• Child's Social Security number

Staff may then release the following EDG information to the TRS representative:

• status of the application or EDG (denied, disenrolled, enrolled, missing information);
• missing information on a EDG (types of information needed to complete eligibility determination);
• enrollment coverage dates (start and end dates); and
• other EDG information as requested (enrollment fee, cost share limit, copayments).

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Policies and procedures have been established for the secure communication of Protected Health Information (PHI) or confidential information to ensure employees do not use or share any PHI in violation of HIPAA laws and standards. Unauthorized disclosure of PHI is grounds for disciplinary action.

When sharing information is appropriate, HIPAA allows staff to speak to the individual or others with case authority about PHI.

Calls received by the Customer Care Center staff are recorded, which safeguards PHI. These records keep track of who has accessed a recipient's information. Requests from recipients for copies of their records, corrections to mistakes in records and information pertaining to who has accessed the records are forwarded to HHSC.