The Record - Reminder: Provider ID verification required to keep members' data safe

Reminder: Provider ID verification required to keep members’ data safe

Protecting the health information of Blue Cross Blue Shield of Michigan members is important to us. We’re also required by the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 to verify the identity and authority of anyone requesting sensitive information about our members.

So we want to remind all health care providers, billers, clearinghouses and service bureaus that when you call us, we must confirm your identity prior to releasing our members’ protected health information, or PHI.

Our identity verification procedures require you to provide the following data elements before we disclose PHI:

Caller’s name

Name of health care provider, facility or office

Reason for call

Member’s contract number

Member’s name

BCBSM will release PHI after all of these elements have been verified.

Provider identification data
Michigan providers will also be asked for the following identity information:

Provider class

Required ID information

Professional

BCBSM provider ID number, taxpayer identification number, national provider identifier or Medicare number

Facility

Facility code, national provider identifier or Medicare number

Dental, vision, hearing

Taxpayer identification number or Medicare number

Pharmacy

National Code for Prescription Drug Plan number

Out-of-state providers will also be asked for the following identity information:

Provider class

Required ID information

Professional

Taxpayer identification number, national provider identifier or Medicare number

Facility

Taxpayer identification number, national provider identifier or Medicare number

Dental, vision, hearing

Taxpayer identification number or Medicare number

Pharmacy

National Code for Prescription Drug Plan number

Reference the Disclosure Use Guide to determine what data can be disclosed.

By following this identity verification process, you will assist BCBSM in protecting the privacy and security of your patients’ protected health information.

For more information, contact your provider consultant.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.