This notice describes how health information about you may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. This notice applies to the privacy practices of Zelis Healthcare , and its affiliated covered entities.
Our Commitment To Your Privacy
Zelis is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in Zelis Healthcare concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy that we have in effect at the time.
- How we may use and disclose your PHI
- Your privacy rights in your PHI
- Our obligations concerning the use and disclosure of your PHI
The terms of this notice apply to all records containing your PHI that are created or retained by Zelis Healthcare. We reserve the right to change our privacy practices or revise or amend this Notice of Privacy. Any revision or amendment to this notice will be effective for all of your records that Zelis Healthcare has created or maintained in the past, and for any of your records that we may create or maintain in the future. Zelis Healthcare will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.
If you have questions about this notice, please contact:
2 Crossroads Dr.
Bedminster, NJ 07921
How We May Use & Disclose Your Individually Identifiable PHI
- Payment. Zelis Healthcare may use and disclose your PHI for our payment-related activities, for example, in order to bill and collect payment for the Zelis Healthcare services rendered or responding to appeals and grievances.
- Healthcare Claims Operations. Zelis Healthcare may use and disclose your PHI to operate our business. For example, we may use and disclose your information to track the progress of your healthcare claim through our system or to ensure that your claim has been received from us by your insurance company.
- Business Associates. Zelis Healthcare may engage third parties to provide various services for us and where those services involve the use or disclosure of your PHI, we will have a written contract with that third party designed to to protect the privacy of your PHI.
- Disclosures Required By Law. Zelis Healthcare will use and disclose your PHI when we are required to do so by federal, state or local law.
Use & Disclosure of Your PHI in Special Circumstances
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
- Lawsuits and Similar Proceedings. We may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
- Law Enforcement. We may release PHI if asked to do so by a law enforcement official, for example, in response to a warrant, summons, court order, subpoena or similar legal process in the public interest from a court or government agency.
- Military. We may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
- National Security. We may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
- Inmates. We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide healthcare services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
- Workers’ Compensation. We may release your PHI for workers’ compensation and similar programs.
Your Rights Regarding Your PHI
You have the following rights regarding the PHI that we maintain about you:
- Confidential Communications. You have the right to request that Zelis Healthcare communicate with you about your health claim and related issues. You must make a written request to Zelis Healthcare specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.
- Requesting Restrictions. You have the right to request we place a restriction in our use or disclosure of your PHI for payment or other healthcare claim operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, or in emergencies. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Zelis Healthcare. Your request must describe in a clear and concise fashion: the information you wish restricted whether you are requesting to limit Zelis’ use, disclosure or both and to whom you want the limits to apply.
- Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you. You must submit your request in writing to Zelis Healthcare in order to inspect and/or obtain a copy of your PHI. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and/or copy in certain limited circumstances; however, we will tell you the basis for our denial and you may request a review of our denial.
- Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for Zelis Healthcare. To request an amendment, your request must be made in writing and submitted to us. You must provide us with a reason that supports your request for amendment. Zelis Healthcare will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion:
- accurate and complete
- not part of the PHI kept by or for us
- not part of the PHI which you would be permitted to inspect and copy
- not created by Zelis Healthcare, unless the individual or entity that created the information is not available to amend the information.
- Accounting of Disclosures. You have the right to request an accounting of disclosures Zelis Healthcare has made of your PHI, such as disclosures required by law. In order to obtain an accounting of disclosures, you must submit your request in writing. All requests for disclosures must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but Zelis Healthcare may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
- Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Zelis Healthcare.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Zelis Healthcare or with the Secretary of the Department of Health and Human Services. To file a complaint with Zelis Healthcare, contact us. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
- Right to Provide an Authorization for Other Uses and Disclosures. Zelis Healthcare will obtain your written authorization for uses and disclosures that are not related to this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.