HFS & IAMHP Provider Meeting Material
To have your item discussed during an HFS Provider Meeting, please use this template to provide an overview of the billing issue. The overview template should be sent 10 days prior to the meeting and it is highly recommended that you send it directly to HFS and IAMHP to aggregate the issues to ensure all items are discussed in an organized manner.
Personal Health Information should never be listed on this template. Items listed in this template should not be single claims nor should this template be used to raise an issue to an MCO for the first time. The purpose of this template and these meetings is to escalate concerns that have not been addressed through working with your provider representative.
Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and revisions to HIPAA made in 2009's Health Information Technology for Economic and Clinical Health (HITECH) Act, covered entities -- which include healthcare providers, insurers and their business associates -- are Final MCO Claim-Issue Template.xlsx limited in the types of protected health information (PHI) they can share with other organizations.
Protected health information includes all individually identifiable health information, including demographic data, medical histories, test results, insurance information, and other information used to identify a patient or provide healthcare services or healthcare coverage. ‘Protected’ means the information is protected under the HIPAA Privacy Rule.
Send PHI to the designated contact person at the corresponding plan using the template below. IAMHP should not have access to PHI nor should Health Plans have access to other plans' member's PHI.
Providers can find the designated PHI contact for each health plan here:
IAMHP is transitioning to an Excel spreadsheet submission format for certain providers. If your provider group has been advised to use the Excel spreadsheet to submit new issues, please use the Excel template below.