Coventry is changing the process for releasing information that contains personal health information (PHI) or personally identifiable information (PII) to brokers. Effective November 15, 2010, brokers are required to submit a signed Member Designated Representative (MDR) form when requesting Explanation of Benefits (EOBs) and ID cards.

The MDR form helps ensure that our members are aware that you are requesting detailed information about them. The MDR form is available in the broker tool kit on our website.

Please read the following background for additional information.

Legislation
There are many new legislative conditions that warrant updated business processes. Since the implementation of HIPAA privacy and security regulation in 2003, Coventry has continued to review privacy practices. Additionally, a portion of the American Reinvestment and Recovery Act (ARRA), called the HITECH Act (Health Information Technology for Economic and Clinical Health Act), encourages streamlining of procedures for releasing protected health information. HITECH also strengthens the HIPAA Enforcement Rule, which increases associated fines and penalties, regarding unauthorized disclosure of protected health information.

Examples of PHI and PII
An Explanation of Benefits (EOB) includes PHI and PII. A member ID card includes PII. While ID cards do not include Social Security numbers, Coventry has always considered the ID number as a key identifier that could potentially lead to health care fraud and abuse.

Serving Your Clients
As one of our valued brokers, you may continue to utilize the same services on behalf of Coventry members. The majority of inquires can be handled with limited PHI/PII, and without the MDR form on file. However, when requesting member id cards or EOB's without an MDR form on file, the request will be mailed directly to the member. If there is an urgent need of care or administrative need on behalf of the group, the broker may at times, receive a copy of the member ID card.
 
Additionally, brokers who have access to Online Account Management may request and print member ID cards from the portal; however, the employer group must first grant you access to Online Account Management. You can also ask a member to appoint you as a Member Designated Representative (MDR) on the member website, My Online Services (MOS).

If you have questions or need further information regarding this change, please contact your Coventry representative.

Coming soon, Coventry Health Care will be introducing the availability of electronic materials for our members. New and renewing members will be able to retrieve their plan documents online. We anticipate that this initiative will be warmly received as it is not only eco-friendly, but fast and convenient for members. The secure site will be activated by using a subscriber ID number and zip code.

Once on the site, members need only click to view their Schedules of Benefits, Evidence of Coverage or Certificate of Insurance, and all attached riders. They may either download them to their computers for permanent access, or visit the site as often as they'd like. Members that do not have the desire or capability to view plan documents online may call Customer Service to opt-out of electronic member kits. A printed kit will be ordered and mailed to the address on record.

Stay tuned in the coming months as we release more information regarding this initiative.

Effective immediately, Coventry Health Care will no longer require binder checks for groups with effective dates on and after March 1, 2011. Instead, we will send new groups an off-cycle invoice for the first month's premium on the first Thursday after the enrollment is complete. This invoice is due within 31 days from the date of issue and will not interfere with the regular process for producing monthly invoices. 

Example: John Broker sells a group on February 10 for a March 1, 2011 effective date. Coventry Health Care completes the enrollment on February 15.  An off-cycle invoice will be generated on February 17 and will be due 31 days from that date. On March 10, the standard invoice will be compiled for the April premium. This invoice is due before the first of the month, as usual.

Please note that this new process is not applicable for groups that we have terminated for non-payment of premium. These groups must pay any outstanding balance from the previous coverage period and submit a binder check for the first month's premium.

If you are not receiving emails notifying you that a new commission statement is available, please check to make sure that the following address is in your "safe senders" list.  You may also use this address to send questions about your commissions. 

coventrycommissions@cvty.com

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