u of u patient history operating report

What are the medical records requirements for U of U health plans?

Medical records must be provided at no cost to U of U Health Plans, and must be available for inspection by U of U Health Plans, its assigned representatives, and/or Federal and State agency representatives during reasonable business hours.

Does University of Utah Health have access to patient records?

Without an authorization or a court order, University of Utah Health cannot even disclose whether such records exist. See 42 CFR Part 2. If you have questions, please contact the Health Information Department at 801-581-2704.

What is U of U health plans Utilization Program?

The U of U Health Plans Utilization / Care Management Program will ensure that adequate resources and systems are in place to accomplish these goals. U of U Health Plans is committed to providing timely access to high-quality health care services in an effective manner that meets or exceeds patients’ needs and expectations.

What are the U of U utilization review guidelines?

The U of U Health Plans Utilization Management Department shall maintain a set of written utilization review decision guidelines, which are based on InterQual and Hayes criteria, nationally recognized guidelines, to help determine medical necessity.

What information is required to request medical records?

A person requesting medical records must submit a written consent with the following information: Patient name, date of birth, contact information and last four digits of your SSN. Information being requested and dates of service. The name and address of the person the information is being released to.

What do you need to bring to the Health Information Department?

If the patient comes in person, they must bring government-issued, picture identification, such as a driver’s license, passport, military card.

What is a PHI release?

Patient Authorization for Release of Protected Health Information (PHI) - A notarized authorization, signed by the subject of the records, which identifies the specific records we are authorized to release. A valid release and authorization is available below. If the patient appears in person and presents identification, no notary is required. If the request is submitted by mail or FAX, the signature must be notarized to ensure verification of requestor identity.

Can University of Utah Health disclose records?

Without an authorization or a court order, University of Utah Health cannot even disclose whether such records exist. See 42 CFR Part 2. If you have questions, please contact the Health Information Department at 801-581-2704. Many of these forms can be opened, filled in, and printed on-line.

Does the University of Utah sign a form?

A University of Utah Health staff member will sign the form as a witness to verify that the form is complete and the signature belongs to the person making the request. If the patient completes the form and send their request by mail, email or FAX, the form must be notarized to verify that the signature belongs to the patient.

What are the rights of a patient?

A Patient's Information Privacy Rights. You have the right to request actions related to your health information: Request a copy of your medical record or identify third parties with whom you authorize us to share your medical record. Submit a Patient Authorization for Disclosure of Health Information form.

What information can inform decisions regarding treatment?

Information from other health care encounters could inform decisions regarding your treatment. Information about your illnesses, injuries, allergies, medicines, test results, and health history allow health care professionals to make the best possible decisions to care for you.

What are some examples of health disclosures?

Examples include reporting communicable diseases; work-related illnesses; births and deaths; reactions to drugs; and problems with medical devices .#N#• To protect victims of abuse, neglect, or domestic violence or to avert a serious threat to health or safety.#N#• For health oversight activities, such as investigations, audits, and inspections.#N#• When requested by law enforcement or as required by law or court order.#N#• To coroners, medical examiners, and funeral directors.#N#• For organ and tissue donation.#N#• For research approved by our review process under strict federal guidelines.#N#• For specialized government functions such as intelligence and national security.

Is U of U Health a private company?

U of U Health understands that your health information is very personal and private. Every patient we serve is provided a Notice of Privacy Practices the first time they come to us for health services. This document is the centerpiece of our privacy promise to you.

Can a doctor share your health information?

Your doctor may share your health information with other providers who are involved in your care. Some health records, including confidential communications with a mental health professional and substance abuse records, may have additional restrictions for use and disclosure under state and federal law.

Why is patient reporting important?

Traditionally, health care providers have been measured on quality process measures like infection rates. However, none of these measures really helped to define the value a patient received from a medical intervention.

Does University of Utah Health use a questionnaire?

When possible, University of Utah Health uses PROMIS questionnaires, which were developed by the National Institutes of Health. These questionnaires have been validated across a wide variety of patients and conditions and help to standardize answers.

Your Rights & Responsibilities As a Patient

At University of Utah Health our goal is to provide excellent health care to every patient.

It is your responsibility to

Give correct and complete information about your health status and health history.

When does U of U require prior authorization?

University of Utah Health Plans (U of U Health Plans) will require prior authorization for inpatient admissions except healthy maternity and healthy newborns beginning June 1, 2017. Selected services will be reviewed prior to payment for medical necessity.

What is the University of Utah provider manual?

The University of Utah Provider Manual is intended for use by physicians, ancillary providers, and contracted facilities/vendors as well as their practice managers and office staff. The manual can be used as a reference guide for University of Utah Health Plans (UUHP) policies and procedures for commercial and government plans. The information communicated in this manual does not take the place of physician service agreement signed by the contracted or employed provider. This provider manual is considered an attachment to and thereby part of all executed University of Utah Health Plans Provider Services agreements as referenced thereto and incorporated therein. The provider manual will be updated occasionally.

What is UUHP health plan?

UUHP was organized in 1998 with the formation of Healthy U (a Medicaid Managed Care Plan) as a managed care entity to handle the administrative functions of Healthy U. Our initial enrollment was approximately 3,000 members. Since our inception, we have grown our Healthy U membership , and have added several lines of business. In 1999, the University Health Care Plus plan was added. University Health Care Plus (UHCP) is a self-funded health plan for the employees of the University of Utah and their dependents . Effective July 1, 2016, University Health Care Plus is administered by Regence BlueCross BlueShield of Utah in a joint venture between Cambia and the University of Utah. In subsequent years we became the claims administrator for the other University and State projects – UNI HOME, as well the University’s behavioral health benefits. Healthy Premier is a commercial plan that we offer to employer groups and individuals throughout the state of Utah and surrounding intermountain areas. Healthy Preferred is a commercial plan that we offer to employer groups, primarily along the Wasatch Front, for their employees. Grand Valley Preferred is a commercial plan that we offer to employer groups in Grand Junction, Colorado and the surrounding areas. As a member of the University Health Care team, we hold ourselves to the highest standards in the services we provide to our members and to the providers who care for our members. Our goal is not to just operate at industry standards, but to exceed them in every possible way. For us, this is more than insurance, this is personal. We welcome your comments and suggestions on how we can better serve you and your staff.

What is a PPO?

A PPO gives members the freedom to choose any doctor, specialist, or hospital to provide their care. The level of member responsibility is determined by whether or not the provider or facility chosen is contracted with UUHP. Although the member may choose any provider there are advantages to choosing network providers. These include lower copays and reduced out-of-pocket expenses.

What is a 5010 837?

The 5010 837 transaction allows for providers to submit a claim electronically while submitting attachments on paper. Elements in the file will indicate if you are sending an attachment , the type of attachment you are sending, and identification number for the attachment and the mode for sending the attachment (fax, email, etc.)

What is the out-of-pocket maximum for University of Utah?

An out-of-pocket maximum is the amount of covered expenses that must be paid each calendar year by a member toward the cost of health care. The individual out-of-pocket maximum applies separately to each member. The family out-of-pocket maximum applies collectively to all members in the same family. Members may have an in-network out-of-pocket maximum that is separate from the out-of-network out-of-pocket maximum. University of Utah Health Plans will pay 100% of the allowable (except for copayments and the charges excluded, including the PPO discount) for any covered family member during the remainder of the year. Some products and services that do not apply toward the annual out-of-pocket maximum include copayments, deductibles, prescription copayments, mental healthcare services, and non-covered services.

What is UHCP health insurance?

University Health Care Plus (UHCP) is a self-funded health plan for the employees of the University of Utah and their dependents. Effective July 1, 2016, University Health Care Plus is administered by Regence BlueCross BlueShield of Utah in a joint venture between Cambia and the University of Utah.

When does U of U require prior authorization?

University of Utah Health Plans (U of U Health Plans) will require prior authorization for inpatient admissions except healthy maternity and healthy newborns beginning June 1, 2017. Selected services will be reviewed prior to payment for medical necessity.

What is the University of Utah Provider Manual?

The University of Utah Provider Manual is intended for use by physicians, ancillary providers, and contracted facilities/vendors as well as their practice managers and office staff. The manual can be used as a reference guide for University of Utah Health Plans (U of U Health Plans) policies and procedures for commercial and government plans.

What is a PPO?

A PPO gives members the freedom to choose any doctor, specialist, or hospital to provide their care. The level of member responsibility is determined by whether or not the provider or facility chosen is contracted with UUHP. Although the member may choose any provider there are advantages to choosing network providers. These include lower copays and reduced out-of-pocket expenses.

What is a 5010 837?

The 5010 837 transaction allows for providers to submit a claim electronically while submitting attachments on paper. Elements in the file will indicate if you are sending an attachment , the type of attachment you are sending, and identification number for the attachment and the mode for sending the attachment (fax, email, etc.)

What is the out-of-pocket maximum for University of Utah?

An out-of-pocket maximum is the amount of covered expenses that must be paid each calendar year by a member toward the cost of health care. The individual out-of-pocket maximum applies separately to each member. The family out-of-pocket maximum applies collectively to all members in the same family. Members may have an in-network out-of-pocket maximum that is separate from the out-of-network out-of-pocket maximum. University of Utah Health Plans will pay 100% of the allowable (except for copayments and the charges excluded, including the PPO discount) for any covered family member during the remainder of the year. Some products and services that do not apply toward the annual out-of-pocket maximum include copayments, deductibles, prescription copayments, mental healthcare services, and non-covered services.

What is UUHP appeal?

A Clinical appeal means services that were denied in a pre-service review, or services that were billed and require medical review, that were denied.

What is UHCP health insurance?

University Health Care Plus (UHCP) is a self-funded health plan for the employees of the University of Utah and their dependents. Effective July 1, 2016, University Health Care Plus is administered by Regence BlueCross BlueShield of Utah in a joint venture between Cambia and the University of Utah.

Patient Reported Outcomes and Health Care

Patient care is of top priority at University of Utah Health and has consistently been measured and monitored in order to improve the quality of service provided.

Patient Reported Outcomes and Science

University of Utah Health commonly uses PROMIS questionnaires developed by the National Institutes of Health (NIH). These digital questionnaires are always evolving and striving to provide questions that relate to patients and provide data for health care teams. These questionnaires are delivered and collected through our mEVAL system.

Patient Reported Outcomes and Our Research

Over the past seven years, members of our department have worked diligently to transform measuring outcomes of musculoskeletal care. They have done so by exploring and leveraging item response theory (IRT), computerized adaptive testing (CAT), and a new set of validated questions provided by the NIH-supported PROMIS effort.