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Administrative Manual Section: General Administrative Procedures and Compliance Policy Manual Number: 200.005 Chapter: Confidentiality & Privacy February 1, 2018 Division of TennCare 2 Administration (SSA) or Internal Revenue Services (IRS) must be safeguarded according to the requirements of the agency that furnished the data; and viii. Any information received in connection with the identification of legally liable third party resources. 3. Requests for Information by Outside Parties Regarding Eligibility of Clients and Related Medical Information Federal and state statutes restrict the provision of information about an individual to outside parties. This includes PHI as well as the individual’s eligibility status, and medical, financial and other information used to determine eligibility for TennCare Medicaid. When TennCare employees or TennCare contractors are contacted by outside parties, including family members, family friends and attorneys or their staff, who represent an individual receiving TennCare Medicaid, TennCare employees and contractors must adhere to the following policies and procedures: a. When contacted by an attorney, or someone from the attorney’s office such as a paralegal or member of the clerical staff, about the status of a particular enrollee: i. Inform the person that TennCare requires appropriate authorized representative documentation and that it is TennCare policy to refer attorney inquiries about an individual’s TennCare Medicaid case to the TennCare Office of General Counsel (OGC), Privacy Office when needed. ii. Take the person’s name, number and relevant inquiry details, and tell the person that someone from the Privacy Office will contact him or her. iii. Immediately send the individual’s contact information to Privacy.TennCare@tn.gov iv. Call the Privacy Office at 615-507-6855 or 615-507-6820 to confirm receipt of the information. Do not discuss the individual’s case with the requesting party or provide the person with any information (written or otherwise) about the individual’s case unless otherwise notified by OGC staff. b. Contact by any other third party (including a person who claims to be a relative or friend of the individual): i. Inform the requesting party that federal law prohibits discussion of the individual’s case with a third party unless there is written consent from the individual, or unless the individual is present and provides verbal consent to the discussion. ii. To authorize individuals or organizations to receive healthcare information and make decisions on behalf of an applicant/enrollee, the applicant/enrollee may verbally designate a representative or submit a Tennessee Health Care Finance and Administration Authorization form, or otherwise provide appropriate documentation (e.g. power of attorney, custody/guardianship order) when an authorized representative is not designated on the application.